American College of Physicians: Internal Medicine — Doctors for Adults ®

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Tips for finding and keeping a good receptionist

A competitive wage—and an occasional 'please'—can help retain good front-line employees

From the January 1998 ACP Observer, copyright 1998 by the American College of Physicians.

By Bryan Walpert

It had reached the point where Sharon Handy was ready to quit.

A receptionist for a two-person medical practice in West Long Branch, N.J., Ms. Handy had no sick time, no vacations, no paid holidays. The office was tense and disorganized, and expectations were unclear.

Then the practice hired Vicki DeLeonardo as office manager. Ms. DeLeonardo quickly got the receptionist a raise, a week of paid vacation and paid holidays. Just as important, the new office manager defined exactly what Ms. Handy was expected to do—and made sure that the doctors treated their receptionist with respect.

"She's a staff member I don't want to lose," Ms. DeLeonardo explained. "I would have a hard time replacing her."

For good reason. Receptionists are the front-line and first impression at hectic internal medicine practices. Depending on the size of the office, a receptionist's job runs the gamut: check patients in and out, schedule appointments, collect money, enter information into the computer, file, photocopy, answer an unending stream of phone calls and, of course, help calm impatient or irate patients.

With the growth of managed care, receptionists' jobs have become even more complex and harried. They deal with more forms, more calls for authorizations and, because managed care plans use primary care physicians as a first contact, more patients seeking referrals.

The role of receptionists has also become more important. "If internists are the gatekeepers to specialists, then receptionists are the gatekeepers to the internal medical practice," explained Lynn Statz Lazzaro, a health care consultant with Walpert Smullian & Blumenthal, a CPA and management consulting firm in Baltimore. "The front line for the front line is the receptionist."

Yet, according to office managers and consultants, many practices don't realize the critical role their receptionists play. It should come as no surprise, then, that receptionists have the highest burnout rate in medical practices.

Nearly 40% of medical practices reported high turnover among their receptionists last year, according to The Health Care Group, a consulting firm in Plymouth Meeting, Pa. By contrast, less than 10% reported high turnover for medical assistants, only 6% reported high turnover for clerical workers and less than 5% reported high turnover for nurses and medical secretaries.

Turnover is no small problem. For one, losing an employee is costly. As a general rule of thumb, you can expect to spend 1.5 times an employee's salary to refill a position—$30,000 to replace a $20,000 employee, for example—after you pay for training time, errors, advertising and other recruiting costs.

Front-office turnover can also cause turmoil in a busy practice. New employees learning the job can hurt relations with patients, who prefer consistency. "In internal medical practices especially, people like to see a familiar face and hear a familiar voice," Ms. Lazzaro said. "It's nice when you can have some longevity in those positions."

So how do you keep a good receptionist? Here are some tips:

  • Screen carefully. "Hiring the right people is the first thing you can do to retain them," said Ms. Lazzaro, the consultant from Baltimore. While that advice may sound obvious, she said that medical practices routinely go for the wrong candidate.

"People think the receptionist needs to be a bubbly, people person," Ms. Lazzaro said. "The truth is that in a busy office, the receptionist has to be 'reactively' friendly. A bubbly kind of person often wants to talk too long and can't move efficiently from call to call."

Consider carefully how much experience you think a receptionist will need to handle your patient flow. Mount Vernon Primary Care in Alexandria, Va., has seen nearly 10 receptionists come and go over the past few years. Medical director David W. Gehring, ACP Member, attributes some of that turnover to a merger, but he also puts much of the blame on the growing demands of managed care. Many of the receptionists who left, he said, simply couldn't handle the stress.

As a result, Dr. Gehring said, the practice, which has three offices staffed by five internists and two nurse practitioners, has developed more rigorous experience requirements. "Before, experience wasn't felt to be as important," Dr. Gehring said. "But now we're very, very rigid about it."

To assess a candidate's level of experience, ask questions to get a feel for how the person would react to certain situations, suggested Loretta Swan, who last year worked as an administrator of a group of internal medicine, family practice and pediatric physicians in Orange County, Calif.

"For a receptionist, you might describe a situation where you had an irate patient who came in and was disrupting the office," said Ms. Swan, who is now project manager for a group of hospital-owned clinics in Tyler, Texas. "How would you handle that? Let them fill in the blanks."

While you're naturally in a hurry to fill front-office vacancies, don't skimp on references. C. David Carpenter, principle with PCSi HealthCare Consultants in Southern Pines, N.C., said that instead of talking to friends, relatives and other personal references, stick with former employers. While lawsuit-wary organizations may resist giving anything more than dates of employment, Mr. Carpenter said he frequently has luck with one important question: Would you hire this person again?

"If you wait long enough, you can often squeeze a yes or no out of them," he said. "Oftentimes, if you get no answer, it implies they would not hire that person again."

Mr. Carpenter even recommended getting a credit report. "If you've got somebody that is behind on a mortgage and owes everybody all over town," he said, "maybe that person shouldn't be handling money."

If you're still not sure, consider giving your new receptionist a trial run. Ms. Swan from Texas has paid candidates to try the job for a day or two; she recalls one applicant who decided after a day and a half that she couldn't handle all the interruptions of a busy office. "They get a feel for the office. You get a feel for them," Ms. Swan said. "It works out really well."

Once you've found the right candidate, be honest about the job requirements—duties, hours, working conditions—even if you're desperate. A receptionist who finds the job isn't what was promised will quickly grow frustrated, resentful and increasingly interested in the classified ads.

  • Write a clear job description. Outline the job in writing from the start, and be specific. There's nothing more frustrating than not knowing what your responsibilities are from day to day-and not knowing how to prioritize.

A good job description will be three pages long, outline specific responsibilities and tasks and describe the skills and level of education required, said Bette Waddington, a practice consultant with the Medical Group Management Association in Englewood, Colo.

"Set realistic performance expectations so employees understand what the expectations are and what the goals are," Ms. Waddington recommended. "You set them up for failure by asking them to do more than humanly possible."

Ms. Waddington suggested working with your receptionist to create those goals. After all, she said, the receptionist knows the job, its obstacles and time requirements better than anyone.

Besides, she added "if receptionists participate in setting goals, they will work harder at achieving those goals. If you just dictate to them you don't set up a very positive relationship."

Make goals as specific as possible, and be sure to include some that you can check objectively. Look over records to see how quickly patients are checked in, for example, or send out patient satisfaction surveys to see how long patients spend holding on the phone and whether the receptionist is courteous.

Finally, don't let job descriptions gather dust. A lot can change in a year: Growing numbers of managed care patients, for example will likely boost office visits and require front office personnel to do more preauthorization work.

  • Give feedback. Once you have clear job descriptions and goals, you're in a good position to do regular, formal reviews. "The most important thing with evaluations is to make sure the employer and the employee agree on what that person's strengths and weaknesses are," said Mr. Carpenter, the consultant from The Health Care Group.

Not only do reviews put everyone on the same page, they indicate where the receptionist may need additional training, such as how to ask patients for money or how to move from one call to another more smoothly.

Continuing training can not only improve the quality of work, it can also boost morale. "Sending employees to seminars is an overt admission that their job is important," Mr. Carpenter said, "that it's important enough for them to be out of the office."

Informal feedback is also critical. "Make sure you find some reason to compliment them on something once in a while," Mr. Carpenter said. "Don't go up front and keep your head buried in the sand all the time. Realize that at the end of a busy day, when you've seen 10% to 15% more patients than normal, the person up front saw all those people twice."

  • Pay your receptionists well. Don't skimp on compensation. Though experienced receptionists can make $20 or more per hour, some practices pay as little as $6 an hour, according to The Health Care Group.

"Too many doctors trying to cut costs don't care about staff. They just want a warm body standing there," said Vicki Seibert, administrator for a solo internal medicine and gastroenterology practice in Clearwater, Fla. "It's important to keep any staff long-term, no matter what it takes in terms of salaries and benefits."

Start by knowing the going rate in your market. Good receptionists get noticed—and recruited by other practices. Ms. Handy, for example, received job offers from physicians who came to the practice as patients. A poor wage makes such offers that much more tempting.

To keep up-to-date with the local going rate for office staff, Ms. DeLeonardo, Ms. Handy's office manager, relies on a salary survey by the local chapter of the Professional Association of Health Care Office Managers, which is based in Pensacola, Fla. If you don't have a local chapter or it doesn't do surveys, Ms. DeLeonardo suggested calling other practices and asking what they pay.

  • Treat them even better. Remember that money is only the beginning, and that how you treat your employees is probably even more important. Think of your receptionists as people, and they are more likely to stick with you.

" 'Please' can go so far," said Ms. DeLeonardo. "A lot of doctors would never tell their nurse 'Go in room two and do an EKG.' They say 'When you can, could you do an EKG?' Why should the receptionist be talked to any differently?"

Flexibility is also important. "Many of our people are raising families and have urgent needs," said W. James Stackhouse, FACP, an internist in a three-physician office in Goldsboro, N.C. and an ACP Regent designee. "A son bumps his head on the school playground and they need to leave. We're flexible enough to handle that in most cases. Our office understands."

Edwina Bernier, his receptionist, agreed that such flexibility is key. "To me, it is very important," she said. "My job is important, but my children come first."

A little gratitude never hurts. Roger Wang, MD, a solo family practitioner in Santa Ana, Calif., celebrates employee birthdays in the office. He also invites his staff, which includes a receptionist/office manager, nurse and X-ray technician, and their families out to lunch every couple of months. When he receives candy, wine, fruit and other gifts from patients, he shares it with the entire office so they know they are part of the team.

"You need to treat them with respect," Dr. Wang said. "It's not just a matter of a good salary. It's also a matter of treating personnel like a part of the family."

Such treatment can make a difference. Just ask his receptionist, Ingrid Lira. She's been with Dr. Wang since 1992, even though the practice could not give employees their usual bonus last year and another practice offered her another job with more money and better benefits.

"I told them I was happy," Ms. Lira said. "I told them 'Thanks for the offer, but I'm pretty comfortable here.' "

Bryan Walpert is a freelance writer in Baltimore, Md.

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