If you feel like you need to duplicate yourself, it might be time to take your PA or NP practice to the next level by expanding your team. Whether that means hiring a virtual assistant, cleaning help at home or adding another provider to your practice, growing your team requires thoughtful planning to ensure your first hires succeed without creating more problems than you solve.
Expanding your practice team doesn’t always make your job easier. In the beginning, adding more staff will likely make it harder, says Kathryn Werner, PA-C, owner of White Pine Mental Health and Wellness. “Once you’re well supported and full, it’s a good time to start looking at onboarding somebody.”
As part of CPAC, a group of healthcare business consultants, Werner supports new and existing practice owners with a practice roadmap, coaching, resources and support as their practices grow.
When it comes to growing your team, Werner offers six steps to implement first.
Identify the Right Role Before You Hire
It’s tempting to jump straight into hiring when you’re overwhelmed. That’s why it’s best to start before you’re too busy to support hiring and onboarding a new provider thoughtfully.
When you start to feel almost too busy, identify what’s consuming your time and limiting your ability to focus on important tasks, including practice growth. For example,
- Are you turning away patients because your schedule is full?
- Are you spending hours answering phones, handling billing or managing administrative tasks?
- Are you struggling to juggle your responsibilities at home on top of your practice?
Each challenge has a different solution. “Finding your need is first. You shouldn’t hire a billing person if it’s really answering the phones that’s driving you crazy,” says Werner.
You may need another clinician, a virtual assistant, a billing company, another full-time employee or simply cleaning help at home.
Key takeaway: Start with the need. Then determine the role.
Fix Your Systems Before You Add Staff
Before bringing another person into your practice, consider how you operate now. “Identify any problems and solve them before you hire another provider, because you don’t want to multiply the problem when you add somebody else,” says Werner.
If billing is inconsistent, administrative tasks regularly fall through the cracks or processes live primarily in your head, adding someone else may multiply those problems rather than solve them.
Instead, growth is a reason to strengthen weak areas in your practice. For example,
- Document recurring processes
- Address persistent operational problems
- Determine how you store and share administrative information
- Ensure the systems a new team member will rely on are working
Key takeaway: Your practice should have enough structure that another person can join without creating unnecessary confusion for you, your team or your patients.
Plan for the Financial Reality of Adding a Provider
A full schedule can signal it’s time to grow, but don’t wait until you’re so overwhelmed that you need someone immediately.
Adding a provider takes time, obviously, but investing time in someone you hastily hire and onboard takes even more.
Werner recommends planning for roughly three to six months before a new provider is fully up and running based on her experience building a telepsychiatry practice. “Recognize it’s going to take you time before things really get into the groove, so preparing for that is important.”
Think through the financial side, too. How long can the practice support the additional expense while the new hire ramps up? What patient demand will support the role? What does the practice need financially for the hire to make sense?
“We look at expenses as a bad thing, but if that expense is making you money, throw money at it all day. It’s OK to spend money on your team members if that’s going to bring you more money or even more ease or flexibility,” says Werner.
Key takeaway: Before expanding your team, be sure investing your time and revenue creates enough value to support your practice goals.
Build an Onboarding Process Before Day One
If your team is still small or if you’re a solo provider, you likely haven’t set up systems and processes for the new role. Don’t wait until someone’s first day to figure out what they need.
Start well before by creating an onboarding checklist covering the documents, systems, training and expectations relevant to the role.
“The first time you do it, it’s not going to be systemized. You’re not going to know what you’re doing, and that’s OK,” says Werner.
Of course, if you’re adding another clinician, you also need to identify the licensing, credentialing, professional liability insurance and other requirements that may apply. Healthcare practice owners are particularly vulnerable to negligent hiring claims, a civil lawsuit that occurs when an employee harms others on the job. The typical allegation is that an employer failed to investigate an applicant’s background before hiring them.
Requirements for NPs and PAs can vary by state, practice structure and scope of practice, so verify the rules that apply to your specific situation and speak to an expert if you’re unsure.
You’ll also need to notify your insurance carrier when you add a team member. While CM&F Group business entity policies that covers employees who come and go in a specific coverage year, many insurance carriers require you to notify them every time an employee starts or leaves.
Key takeaway: The work you put into onboarding your first hire can become the foundation for a more repeatable process when you hire the next one.
How to Interview and Onboard Your First Hire
Use interviews to understand how candidates approach patient care, communication and decision-making. Check references and, when appropriate, give yourself more than one conversation to determine whether someone’s working style fits the practice you’re building.
Once they’re hired, don’t confuse a strong candidate with someone who doesn’t need direction. Werner recommends the following:
- Set clear expectations
- Provide training
- Observe how the person handles responsibilities before stepping back
- Establish regular check-ins to address questions or issues early
Key takeaway: Don’t micromanage, but do create enough structure that everyone understands what success looks like.
Why Hiring Staff Means Your Job Changes Too
Managing an employee means your job changes, too. As a solo practice owner, you’re clinician, administrator, marketer, scheduler and decision-maker all at once. As you bring on someone to do some of those tasks, ask yourself what work only you can do and what you can outsource.
The answer may eventually mean spending fewer hours seeing patients. Deciding to expand your team means you should be prepared to give up some of what you enjoy.
Key takeaway: Having a team makes your job more dynamic. Keep asking yourself what the practice needs from you now.
Finally, recognize that expanding a team is another stage of becoming a practice owner. With the right foundation, adding support can give you more than additional capacity and help you build a more sustainable practice.
As your practice grows, your risks and insurance needs may change, too. Whether you’re hiring your first employee or your fifty-first, CM&F Group can advise you on maximizing your ability to hire the best clinicians for your business. Click here to contact us.
