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TRANSCRIPT
2013 Pacific Dermatologic Association Managing Office Politics: Just Fire Them All August 18, 2013
Speakers: Amelia Kaymen, MD San Francisco, CA John Geisse, MD Vallejo, CA Neal Bhatia, MD Long Beach, CA
Agenda: Review cases and Discuss
Amelia Kaymen, MD: None John Geisse, MD: None Neal Bhatia, MD: None
Discussion Cases
Two employees managing the front desk are clockwatchers, always the first to leave at 11:59 am for lunch and 4:59 pm for the end of the day no matter what is happening leaving the other employees stuck with their work.
1) How is this cycle broken: Who approaches the offending employees? Who repairs the morale and how?
2) What is the breaking point for termination, even for a good employee?
The employees turn to the junior associate dermatologist for help, as the senior managing partner is unresponsive. The office manager is also “buddies” with the offenders
3) What is the role of the non-‐partner physician?
4) Any other strategies to prevent this pattern from recurring? Or for anyone retaliating?
The office hires a new male associate who is responsible for supervising the established female PA. She has been “independent” for many years and uses her nurse allies to hide charts and do surgeries that he is not aware of. The senior partner looks the other way and takes extensive time off because he is making money but the new associate is responsible for the bad outcomes.
1) What are the new physician’s options?
2) What should be done to break the routine between the MAs and PA?
3) The PA’s husband is an attorney and begins making some noise in the office about her rights now that she is being supervised. How should this be handled?
The new associate has a restrictive covenenant but the PA does not.
4) Is the new associate’s only option to leave?
5) If so, does he have enough of a case to fight his non-‐compete clause?
The new MA in the office is amazing and does the work of three, is efficient and energetic, and the patients love her…but she calls in sick every other Friday. Everyone in the office knows she is not sick but feels trapped.
1) How should this be addressed with the MA?
2) What can be done to break the pattern?
3) How should morale be restored since many of the staff are upset with her?
4) What adjustments, if any, should be made to the policy on days off for illness?
The office staff has counted on lunch from drug companies for years, but thanks to the Sunshine Act one of the senior physicians said no more because they do not want to be reported online. Needless to say the staff is unhappy, although they treated the reps like caterers and would never thank them. Two have the physicians have also stopped writing brand name drugs and are only writing generics due to this change.
1) Is cutting off the lunches extreme?
2) How is the policy enforced when the reps get involved and ask the staff to reinstate lunch?
3) Is it fair for the other physicians to have lunch outside with the reps instead, since they write the prescriptions?
Eventually the policy becomes modified so that only the prescribers can have lunch with pharmaceutical reps, which makes the staff furious but that is the decision.
4) Is this situation being handled well?
5) Is there too much scrutiny by patients that creates a concern?
One of the new physicians and MAs starts an affair and it is not a secret. They meet after work and are often seen in public, and use the office as a rendezvous point. There is clearly favoritism in the office but the senior partner and office manager are not aware of the issue.
1) What, if anything, should be done?
2) What happens if the affair ends? Ends badly?
3) What is the liability to the practice?
Employees regularly “curb-‐side” physicians or mid-‐levels in the hallway to ask a question about a lesion on their face, arm, a picture of their child, etc. They have been told that they need to schedule an appointment to discuss medical issues. However, in the era of high copays and deductibles they want an easy way to get care.
1) What can be done to break the pattern without affecting morale?
2) One of the employees shares the curbside advice with the physician treating her and after a disagreement at the office threatens litigation against the clinic…is there a case?
A marginal employee spends a good part of her day on social media. After hours she has been posting information about her day at work including information about her employer, the practice, and specifically other employees that she has had disagreements or issues with. Eventually the posts start occurring during the work day and the other employees are hearing about it from outside sources. The reputation of the practice and the employees is now being compromised as she airs her "dirty laundry" out.
1) What is the course of action here to protect the employees and the practice?
2) What are the consequences of her actions? What if she calls this "freedom of speech?“
3) How can this be prevented? Do office internet policies solve these issues?
The office then decides to incorporate a daily post on Facebook with updates and medical advice in an attempt to increase public relationships. However, one patient acts on what is considered medical advice and suffers an adverse outcome.
4) What is the liability to the practice? Or any of the physicians?
5) Who should be monitoring the content of these posts?
One of the drug reps who has worked her way into the favor of many of the nurses with lunches and other gifts is now in a contest, and is recruiting the staff to help her out by having them hide the samples and rebate cards of the competition's drugs. The other reps hear about this and start a bidding war of lunches and gifts to win favor to a point where it is out of control.
1) How is this cycle broken?
2) Is this a bad problem to have?
3) Who should be held responsible and how can it be remedied without extreme solutions?