Staffing For Greater Profitability

By: Alannah k. Levian, RN, ND, DC, DCC

Chiropractors like to think of hiring staff as a long-term investment, like high-interest yielding, long-maturing corporate bonds. Fully aware that integrating a new team member requires an initial period of high investment in terms of training combined with low productivity, most of us are content to realize our profits from new staff over a long period of time, once they become proficient in our office systems and begin recruiting patients into the practice. Ideally, it takes a year or less to fully train our assistants; but three to five years to make our training investment back through realizing profits on the growth spawned by each new employee. No problem for those of us skilled in long-term investment strategies. There is one glitch, however; most CAs last only two years in any given practice! Not long enough to allow profitability, much less growth, to evolve from their meteoric presence on staff.

To find out why CA’s have such a short tenure, and how to lengthen it into a much longer and far more rewarding length of service, we confidentially interviewed 25 CAs and their doctors. The results were quite revealing. Overall, there seems to be agreement between Chiropractors and their assistants on certain employment objectives, but a major divergence in one key objective: pay and benefits.

Is it true, as the old joke asks, that the objective of every employer is to pay just enough so the employees won’t quit? It is likewise true that the objective of the employee is to work just hard enough so as not to be fired? Our survey of Chiropractors and their assistants reveals the answer to both of the above questions to be a resounding “no.”

Chiropractors we interviewed were more than willing to pay employees well, and even willing to pay for and provide extensive training as needed to bring the new CA up to speed in the more fully-equipped offices. Naturally there is a period of time when integrating a new employee in the labor force that employer investment is high and productivity is low. If the employee manages to succeed in mastering the elements of their training, growth potential rises steadily, along with productivity and profitability for the entire office. Unfortunately, with a two-year turnover average, few employers feel it is worthwhile to invest heavily in staff during training. But consider the options!

Either the Chiropractors are left doing much of the work themselves (which naturally limits growth potential), or they are unable to afford to modernize the functional aspects of the office (which restricts potential earnings), or they are on a hiring-training-parting-hiring-training-parting treadmill that saps critical resources, leaving the business without capital for growth.

The fact of the matter is that Chiropractors must break through the two-year barrier before they can realize the growth potential of their business with a long-term, well-trained staff at the helm.

There must be a good reason why the average Chiropractic assistant’s term of service is only two years in any given office! And, more importantly, there must be a way to extend this time parameter to prove more profitable for both the CA and the doctor. After all, it costs plenty of time, energy, and money to replace staff, and it costs the staff plenty of anxiety, effort, time and energy (not to mention money) to have to find new jobs every other year!

What could induce a promising CA to stay on beyond the two-year threshold? Our survey again proved most revealing. We listened to representatives from both the Chiropractor’s and the CA’s perspective, and this is what we learned. It comes down to the basics:

  • Communication
  • Respect
  • Consistency
  • Compassion
  • Common Sense

Communication must be open, easy, and clear between people for there to be a good working relationship. Both employee and employer agreed that the best work relationships are based upon mutual respect, an ingredient essential from the onset, along with good communication skills. Respect your employer enough to show up on time, ready to work when scheduled. Respect your employees enough to pay them on time, in full, ready to give bonuses when the employee provides referrals or other money-making or money-saving innovations.

CA and Chiropractor alike desired to work in as stress-free an environment as possible, specifically referring to having modern operating systems in place that were organized, effective and consistent. One of the most often-repeated complaints from CAs was that their doctors seemed to have more exceptions than rules, making it necessary for the CA to develop “psychic powers” which were not readily forthcoming!

Keeping a timely schedule, while quoted as being important to CA and Chiropractor alike, seems to be an issue requiring greater attention from both sides. Doctors often cannot imagine the frustration their CAs experience when the doctor falls behind schedule, and CAs tend to underrate their own importance when arriving late or returning from errands or breaks tardy. Many practices suffer once they earn a reputation of not valuing patient’s time enough to be prompt in keeping scheduled appointments.

Patient education, while being a task shared by all staff members, is most effective when delivered by the in-house authority figure: the Doctor. A well-educated patient is a dream come true for the CA, who no longer has to hard-sell each follow-up appointment nor track down too many missed appointments. Educated patients are motivated patients; and motivated patients are compliant. Compliant patients get better results, thus becoming better sources for referrals, and so it grows. Doctors must set the tone and carry the bulk of responsibility for educating each and every patient so the CAs can fill the appointment books.

Mood swings are a natural part of life, therefore unavoidable in the close quarters CAs and Chiropractors often work in. However, it is important to be grown up enough to realize that the workplace is not a marathon encounter/counseling session, and to seek professional help on your own time to resolve issues that generate untenable work environments. Employees cannot be expected to maintain high levels of respect for a Chiropractor who unloads domestic discontent on them every morning, professional piques all day long, and payroll/financial worries every Friday. Can you blame a CA for seeking more stable employment when all they hear are gripes about financial concerns from their employers, or worse, have to field calls from bill collectors all day long?

Compassion comes from putting yourself in another’s position. Does this sound like an ad you would consider answering? “A bright, efficient, cheerful, and very friendly CA willing to work 10–12 hour days for less than minimum wage in conditions resembling uncontrolled chaos, under the hostile scrutiny of a very uptight, upwardly mobile boss whose ration of compassion is reserved for paying patrons only. No opportunity for advancement, no benefits package, no time off (with or without pay) permitted unless deceased.”

Or if we look at it from the CAs perspective, is this an ad you could honestly place as an employer: “A mature Chiropractor with a waiting-list practice who is well-organized, consistent, fair minded, and staff-friendly, willing to invest in the CA’s learning curve with humor & tolerance, offering career advancement and a satisfying professional level of compensation plus full benefits, and opportunity to showcase employee’s unique intelligence and skills.”

Common sense would tell us that employees and employers are people. People all want essentially the same things from life: acceptance, respect, a decent lifestyle, safety, growth, and most importantly, opportunity to fully express the unique skills, talents, and abilities each of us is endowed with. Begin today to look at yourself and those who work with you with the goal of providing an environment for full human potential to blossom within, and perhaps you, too, will begin to enjoy a solid return on your long-term investment in staffing your successful practice.