How to Create a Stable Team For Your Private Practice in the Midst of the Great Resignation

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So go get your audiobook now. Www.entremd.com 7Figurebook. And let's rewrite the narrative for physicians starting today. Hi, docs. Welcome to the Entre MD podcast, where it's all about helping amazing physicians just like you. Embrace entrepreneurship so you can have the freedom to live life and practice medicine on your terms. I'm your host, Dr. Unna. Well, hello. Hello, everyone. Welcome back to another episode of the entremdy podcast. We're going to have a treat. We're going to have a really good conversation about one of the things that's, you know, super trying in the times we live in the middle of the Great Resignation, as it's called. So we're going to be talking about how to build a stable team and the middle of the great resignation. And so I have a special guest here. She's been on here. We talked about finding your next rock star employee the last time she was on the podcast. And she's back. So welcome back to the show, Fatima Sparks.

Thank you for having me back. And it's a pleasure to be back talking to you about this, especially this particular topic. It's very exciting.

Yeah. See, this is. See, people, this is why I'm like, I have a special guest because this is something that's a nightmare for most people and she says it's exciting. So this is going to be so good. So, Fatima, why don't you introduce yourself to the listener, let them know why I'm so excited you're on the show.

Okay. Well, my name is Fatima Sparks. I've been in the medical field since 2000. I have worked in several specialties. Cardiology, Gastroenterology, ENT, and now Pediatrics with Dr. Una. I really enjoy the medical field and it's been a ride, especially these last three years, especially.

And I will say this because Fatima is the practice administrator of my practice. And the reason why, one of the reasons why I'm excited about what we're going to talk about today is because it's not theory, it's not these cute things. We're talking about real challenges that real people are having and then the things that someone that is hands on has done to navigate that, right? So this is worth its weight in gold. So just lean in. This is one of those, if you're running or you're doing laundry and all of that, you're going to still go back, listen again, notebook and pen and workshop the episode. It's going to be really good. So let's talk about where this all started from, right? Because Fatima, we had built a stable team, right? We're like, we got it. We finally got the right people, the right diversity, the right, like, we're like, yes. And then come November 2019, we're even planning like what 2020 is going to look like. You know, all the innovation we're going to do, we're excited about it. And then this Covid thing started, starting right, at which time nobody knew what it was. But then all of a sudden what started happening, which were like, but not much has changed as far as our culture and all that. But it was like we had this revolving door, like people started moving in and I would like, wait, what's going, what's going on? So take us back to that, you know, maybe for a little bit. Just take us back to that moment where that shift happened and what the, the pain and the frustrations around that was. Because it still is. You know what I mean?

It definitely is. And I'll say the unfolding of that was quite long, maybe year one, where things just continuous, continuously change. So you have a stable staff, providers, group. Everything is, is going well. You're building on that. Everyone's just getting better every day. And then here the pandemic comes. There's the stay at home and no one's able to come out and see you. And Dr. Ina was so good to let me know. She wants to make sure she keeps everybody working, keep them employed, not really cut hours. I don't think anyone else did that. So that was really awesome. And so what we did we utilized that time to call all of our patient base and let them know that we're here for them, we're going to be here for them, they can rely on us because basically we're planning for when this pandemic would be over, that we're still going to be here through it all. And so everyone went to work doing that, those sort of tasks. And then I think it started with our nurse practitioner. Her husband lost his job or he would lose his job unless he moved to Florida. So then she was gone. And then a couple of our staff had issues that were unrelated to the work and then they were gone. And then some just got super great offers to work other places and then we ended up losing them as well. And it was just shock after shock after shock. It was happening really too fast to actually accommodate it. And so we had to really rely on the people that were still there, a lot of heavy workload onto them while looking for staff to take the place of the ones who were leaving. And that's, I would say, where the shock, you know, maybe a secondary shock came, where it was difficult to replace them. No one, no one wanted those jobs. So we're, we're back open, the patients are coming back and we don't quite have enough staff to accommodate them after we told them we're going to be there for you. We're, you know, we're still around and other offices were closing, but we're still here. And, and then to, to not be able to keep those promises or feel like you're not going to be able to, it's very stressful. So trying to find, to fill those spots. No one was applying to these positions. Increasing the compensation didn't help. You know, I increased the compensation in the post. Still no note takers increased it more. No takers even for the mid levels, no one was applying. So it just, again, I've never seen that happen before. And on every level it was new ground, a new thing to accommodate. And I guess it's just like the pandemic itself. We never did this before. And so I never in all these years experienced any level of situation like this where I could not find anyone, not even anyone to interview. So at some point I did find people to interview, but that's when you're kind of lowering your standard. You're not getting really anyone in. So it's like, well, let me, let me just start interviewing people that, you know, they're. Finally, there's some people applying. And I've told, told Dr. Una this I don't know if I should share it here, but a lady came in in a T shirt dress which looked like a long hanged T shirt down to her knees and fuzzy plus flip flops to her interview. These are the type of people that were coming in. I was, I. The quality of people completely changed. People were not showing up to their interviews. I had just had never, never encountered this ever in all these years.

And I'm just here like giggling and, and I think I'm giggling because I mean it kind of is what it is. Right. And the picture you painted is such, is such a quote unquote beautiful picture. Right. Because that's the reality of what happened. That's the reality many people are still experiencing. You know, but I really amazed and proud of our practice for what we did to kind of navigate that. Right. Because it's one thing to experience it which was almost universal. Right. Some practices were not effective, but they're in the minority of minorities. Right. But you know, to be able to navigate that and innovate around that and still figure out how to serve your people and keep your word and, and all of those things, it's, it's just so inspiring. So that's what, you know, what we're going to talk about. So thank you for sharing that. I forgot all about the fuzzy flip flops. That was something. Okay, so, so let's talk about it because we never did shut our doors. We never did say patients, we can't see you. The practice grew in spite of it and they're even in the midst of all of this. We were even able to do a lot of developmental changes like so fundamentally the practice is so much stronger and so let's talk about some of the things we did to create a stable team. So I'll let you lead this conversation. We'll go back and forth.

I'm going to start with the baseline. The baseline is it's kind of like having a product that nobody wants or you're the customers you used to have don't want that product anymore. That's how I see trying to hire people. They just don't want that now. I don't know why, but so now I need to find people who want that, who wants this opportunity. Where are they? Who's would be motivated, motivated by having an opportunity like this, who's been looking for it and just hasn't been able to, to obtain it. Those are the people I need to find. So yes, they may not have the exact skill level. There's so many things that Maybe we have to compensate for. But they want the role and they'd be happy to have it. So I think that led us down the road, the road of finding a team and pulling together a team and a great team who wanted to do the job and who, who did it very well or is doing it very well now. So I think, Dr. Una, you're the one who brought up about bringing in virtual staff. I had not. That was very foreign to me and I thought it would be expensive. Number one, they wouldn't have healthcare background. They're talking to our patients and handling very key components of the practice. And they're virtual, so how am I going to manage them? So there's just, there were so many question marks about that. And that also goes to show you that lack of knowledge can hold you back too. And so you happen to know about how to implement and where to get virtual assistants that were skilled in the medical field. And that took, that was the biggest relief from the beginning because we couldn't find physical people to come into the office. So we needed certain things to never break down. And so it was so wonderful to be able to onboard our first virtual assistant.

Love it. And that, that brought, like you said, like, there's some things that are non negotiables, like things can be, this can't fall apart and critical things like, you know, like if you don't have somebody who can confir your appointments, then you have all these really big gaps in your schedule which leads to a lot of lost revenue, which leads to you may not be able to stay open, you know, you know what I mean? And making sure that your insurances are, you know, checked so we know that they're actually eligible. So it means that you're going to get paid on the other end and all of those things. So I think it was really genius of us to really take those critical things that, you know, cannot fall through the cracks and then offload that to the way you describe it, the team that is looking for this opportunity and is excited about it, right?

And then just training that person, they were just so happy to have this opportunity. And I had a choice, you know, that you presented between a pharmacist and an rn. You know, who would have thought I would have those kind of choices? It just wasn't in my, in my mind at all that I would be choosing between these, these two capable people. So that was just really great. And they're just so, you know, and the first one is still with us after all this time. And so she's just gained more and more knowledge. And you know, we've since onboarded a second one and she has assisted in training that virtual assistant along, along with myself. So we've come such a long way with that. And I think the next thing, because I was thinking of physical people more so was, you know, I start thinking who wants to work in the, in the office? So I start thinking of seniors. I start thinking of people who always wanted to be in the medical field. Maybe they're in another field, but they always wanted to be in the medical field. And then I guess the final thought was students, students who want to be providers, nurse practitioners, PAs, doctors. And so I start looking into that. So I think we ended up posting for intern positions and that could have, they didn't have to be a student, but students were the ones who really gravitated to that and they, I had a student, I had so many people gravitate to that post that I had to recommend other places for them to find jobs because I just had too many, which again, another shocker from a drought to having too many people. And they're very excited, very excited to learn, so happy to be given the opportunity. And these are students like from Georgia Tech or some of them. When I ask them different questions, they start telling me about their research projects and biomes and things like that. So I'm like, wow, I've got some really smart people on my hands. So there's no way that they're not capable to learn this position and do it well. And in bringing them in, the whole atmosphere changed. You just could hear they were just so excited to interact with each other and with the staff and with the patients. You could just tell what's that feeling of I am so grateful and happy to be here. You've got your staff so grateful to be there and looking to do better every day, looking for your feedback. And then you've got your virtual team doing the same thing. It just was actually better than I think it ever has been. There's still the newness of it, of having to coach them and share information with them, but they're just so receptive and hungry to know. And so that has really turned things around. Those two choices, the virtual assistant and the intern, our students, those were the most major, major things that we, that we've done.

Now somebody may be wondering, right, like, okay, so if they're students, are they always in the office? How do you navigate that? Are they able to give you full time hours? So can you answer that person because that's going on in somebody's mind right now.

True. So in order to kind of unpack that, the other thing is we're looking to attract people to the position. But once you have them, how do you keep the position attractive? So once you have it, you know, these are students. They're here to learn. How are you going to keep that learning going for them and keep them engaged? So not only that, but what does a student need? A flexible schedule. So we probably have maybe six students and probably three or four waiting to be onboarded or to. For us to have an opening. And so with the flexible schedule, some just work two half days. Some work just only on Fridays. Some work Tuesdays and Thursdays when they need time off. Like, let's say they have a test, they'll let me know. They, of course, will work if I need them to. But I always do my best to let them have that time off because I want to retain them. They can still work somewhere else. It would be a challenge working one day a week or two half days a week. But there is a place that would be glad to have them, especially now that we've gotten them all trained up. So I want to make sure I'm able to accommodate them as much as possible with that flexible schedule. And again, the retraining. And then we've also had an appreciation luncheon, and we have smoothies sometimes, so we just want to kind of keep that going, that momentum and that. That. That good feeling. And they're so happy to meet each other because they're all going through the same thing. So there's some camaraderie or, you know, they feel like they have a colleague and they exchange that information with each other to find out, you know, which classes. You know, one is taken over the other. They give each other tips. So there's a. There's a nice socialization there between the students as well. And they learn. I think I'm going off track with what you asked, but let me just say, they learn so fast because they are used to just taking in so much massive amounts of information and technical information at that, that what you give them, that helps to train them, they absorb it right away. They can almost repeat everything back to you. So I learned to give them more as much as possible up front. Where I wouldn't normally do that. I normally would give people, you know, a bite at a time and. And then kind of not overwhelm them. But I don't do that with the students. So definitely the flexible schedule is one of the main things that they need, and they really appreciate it.

So if I can track back. We've talked about leveraging a virtual team. We've talked about leveraging students. We've talked about a flexible schedule, which it was really important to the students. But as much as possible, we tried to accommodate that for everyone. Right. Just think a little bit about us and how we're going to get coverage. But if you need the day, we'll make it work. You can have the day. You know, we did that. And even for the doctors and the physician assistant as well. And so that, I think, was really powerful. And of course, it wasn't two days a week for everybody, but there's just that flexibility and understanding. Not so rigid. Okay, this is good. What else do you have?

For me, as far as what we've done to create a good team, I would say really leveraging the senior people to kind of cultivate the learning and understanding of the newer people so that they had some sort of level of mentorship, so they didn't feel like they're kind of out there on. On their own. Because little things here and there, you think you've trained a person up until certain situations come up, and then you realize that there's a little gap there. So having experienced people around is still super important. And then even, you know, with myself going, being with them is important. Instead of them feeling that they're thrown out there, that the door is open, or I'm going to be working right with you, let me know if. Or they may find me taking a patient back. They didn't get a chance to ask because they were so busy. And so they definitely need to fill that a level of support. And I think this has also challenged us to be more organized with how we train and the materials that we. That we provide. Because when you have a group of people who are new, you have to be really structured in how you share information and know who needs what information where. Where we are with the training. And especially like Dr. Una and I were discussing this morning, if you have someone working one day a week, they're not really experienced, even though you've been seeing them for three months. So they, you know, so they're still. They're still fairly new. And I get shocked, you know, by this. I just actually realized it a couple weeks ago because they are so. They do so well that it feels like they've been with us for, you know, every day for six months, but they really have not. And so that's very impressive in our and their level of professionalism because, you know, they are trying to be PAs and doctors. So they have worked on their communication skills. And so the way they deliver information to the patients, the patients really can tell a big difference.

Yeah, I think this goes back to like Winston Churchill quotes like, never waste a good crisis, you know, and so, you know, bringing the students on board has really kind of made us create our own little academy for, you know, the whole process. And to get them up to speed, I want to pivot to something that every time we talk about hiring our team and all of that stuff, it always comes up some kind of way for you. And which is this concept of do you even need the role at all? Right. Like, do you, like, do you even need that? Like, when you start, like, I can't find anyone to hire. Okay, but let's start before we go there. And the answer may be yes, but before we go there, there, let's talk about do we need this? So. So speak a little bit to that because somebody may be thinking they need to fill five roles and maybe they need to fill three. I don't know. But, you know, talk a little bit about that.

That's so true. I would say before the pandemic, I always went there first. Do I need to replace this person? Can this job be absorbed by several people? Or do I. Can I promote someone from within? So it was always my go to. And I'll say it's still my go to, but being in this state of constantly looking and that that need being so high, I've almost put that to the wayside as far as do I need that. That role? Because I've. We've been in such a state of need. But 100% that is always what you do first is challenge yourself. That with the idea of do payroll labor costs are. Is such a high expense in compared to everything else, there's no way that you should not think about it first. And even though we have students, we are bringing them in at a price, and that's good for us as well. So there's room to give incentives, there's room to give increases to them, and there's room to give increases to our staff who held us down. So everything, you know, there's a financial perspective to all of these decisions.

Love it. She's like, I almost threw it away, but it's still there. But I almost threw it away. Okay, now while we talk about this, there is the piece of the hiring had to change. Right? Like, the hiring process is not. It's not like it was before because you would have so many people who would schedule interviews. Now we're a little bit more savvy. You can tell who's going to come and who's not going to like, you know, and all these things. So let's talk about a little bit about those nuances because I think that's part of building the stable team. We can't bring people on the way we used to bring them on before. So what are some of the changes that you've needed to make? Right. Like someone may be listening to your old episode. Everything there is still valid, but what are the things you had to add or tweak or be on the lookout for in this time? In the middle of the great resignation.

I think one thing that comes to mind is that we had, you know, with our. We had a middle group before, you know, when our established people started to leave or find other opportunities or have to transfer to other states and that sort of thing. We had that middle group, you know, that were experienced but not doing a good job. So we brought them in and we kind of, you know, I'll speak for myself. I put up with more than my norm because it was difficult to find them. And so. And now when I interview, there's really a zero tolerance in my mind. So we're going to be on time, we're going to do a great job, maybe even an exceptional job every day. So the standard is way higher now and it's refreshing and they can't wait to live up to it. And so as far as finding people or bringing them in, I really, I used to do zoom or a lot of phone conversations. So I might do a phone call, but then you have to physically come. I need you to have some skin in the game. So you may need to come at 5 o' clock during traffic. I just need to know that you actually want this. So I need to vet. I feel the more need to vet them up front that they really, really want the opportunity. And so I think that's definitely one thing that has changed. And then I let them know the challenges of the job. I really focus in on the complexities and what could happen. Especially, you know, if you're interviewing students, you know that parents are depending on you. I just make sure they feel the weight of it and, you know, how they respond matters. So, you know, if they're like, oh, I can't wait, like, it sounds delicious, you know, I want to. I want this job. Sounds delicious, I want this. That's a key to Me that that's a person to bring on. You know, I can't wait to learn how to do vaccines or, oh, I get to get a certificate. I'm required to be certified for by vfc. Oh, where's the website? You know, they can't wait for these things. So that's the type of attitude that I'm looking for. To where they would be really, really, really upset if they couldn't get to do these things. So anyone that's like, take it or leave it, that's not. No, that's just not acceptable anymore. Oh, I have other opportunities. You know, if they say, well, oh, I'm choosing between you and several other. I probably don't want them. I understand. But at the same time, I need them to really want this opportunity.

Yeah. So what you're talking about is two things here, right? Like, the first is the whole you hire for attitude, and then you train for skill. I mean, that was a cute saying pre pandemic, but now it's not a cute saying. Like, you.

You.

You need that, right? Like, you need that because the times are more challenging. Being on the customer delivery side of things is more challenging. I think Covid made the whole world angry. So it's kind of like more difficult, you know, and you have to be more flexible. Things are changing. Things are in flux. And so if you don't have the attitude for it, it's such a problem. And the other thing is wanting the. Not just wanting an opportunity, but wanting this opportunity. Right? Because the fact that someone says, I'm going to work with you doesn't mean one week later they won't say, I found something else. Right. And so you're looking for someone who wants not just that job, like a role. They want the job in your company. And it's really important to listen for that in conversation. It will come out, you know, like, you want to. You want to listen to that. You want to hear that.

You.

You want to see what skin they have in the game. I think we. We did a lot more work interviews and things like, just like, to. To demonstrate that you do want to be here. You're not just doing this so that you can continue to collect unemployment checks or whatever it is, you know, so that's really powerful. I would say, you know, again, I think I've already said it, but I would say that I'm grateful and I'm really proud of our team, Right. Like, for how we've been able to navigate this. But someone is listening now, and they're overwhelmed Right. Like, so maybe it's a doctor doing their own vitals, giving their own vaccines because they couldn't find a team or a doctor who has had a key person, like maybe their lead ma or their office manager, just leave. And I want you to, as someone who feels the pain too, right. I just want you to talk to that person. Right. They came to you, they met you at the elevator. You're like, how are you doing? They burst out crying. They're like, oh, my goodness. This, you know, as if it was not overwhelming enough, this key person is leaving. What do you tell them?

Well, I believe in tough love, so I would ask them to look at themselves because sometimes when things are bad, you have to look at your thought processes and it does start with you. There's a pandemic. There are things that are situational, but I know that sometimes people are slow to adapt and some of us are waiting for things to be back, come back to normal, and it's causing a lot of pain, pressure and stressors for our staff. You know, it's overwhelming because they have to keep pulling so much weight while you decide to wait for things to go back to normal. And so I would, I would definitely say make sure you're open to change and open to innovation and the ingenuity that it takes to do this pivot. And so because we, we dig in and we work harder and we ask our staff to work harder, but sometimes that's not exactly the right answer. It's always good to work hard, but sometimes that's not the bottom line solution. So, you know, after that, I would say rally, you know, rally your troops, like, like we always say, to kind of bring them in, to help them to have hope that you're, that things are going to change and that they're part of the change and that you know, their input is important and that your team, you want to embrace them into the decisions that you're going to make and make sure that they feel hopeful about the change that's coming and that we're going to need, we're going to need them to help with the change and to implement things. And then I think sometimes when you change your mindset, you will see opportunities in front of you once you decide that there are, that they're near, they're nearby and don't be closed off from it. But I would say the same thing. The virtual assistants, students taking that person, maybe who's. That's been there a while, doing the same role, adding a little extra responsibility, bringing in maybe A newer person to do some of the, the, the basic tasks that they were doing, just that kind of thing. I still would interview, you know, look for, look for those special people, but at this point, the, I guess it's called the cost of labor. It's expensive now, so you need to make sure that you can afford that, that special person that you're looking for. And so that's still going to take a certain amount of change to your organization if you want to replace someone of that caliber these days.

Okay, so that's a whole podcast episode on its own. But I think going back to the first part of your answer really is the starting point, because the challenges of pain, but the bigger pain is your resistance to the challenge. Like, I just, I, I just don't want to deal with this. I want things to go back to the way they were. And you and I know that, that, that's never happening. Like, the way things were is like, so far away that we almost don't remember how they were, you know, and, and so that is, that is really pop because what you spoke to are things that are, yeah, high impact, but they're painful, right? So you talked about getting out of resistance, right? You talked about changing your mindset around that. Like, okay, this is, this is going to, going to work. You talked about rallying the troops, right? Which is really for most, that's upleveling, your leader, your level of leadership. You know what I mean? So these are all playing around with roles with your team, which, again, is change. And nobody likes change. They're going to get kickback and again, up, leveling leadership. So they're all the, the more challenging things, but the things that will give you the biggest bang for your buck. You know what I mean? And so that's, that's, that's really good. I love all of it. If you're, I mean, like, if you're in that position, I'll just add on to that and say we can pull this off, right? It, I mean, yes, it hurts. Yes is different. Yes, it's not the way it used to be, but we can pull it off. But rolling over and playing dead is not, Is not the way. I know there's a lot of complaining, A lot of people feel stuck and all of that, but I mean, like, if we do want to complain, then we can shut it down and then complain. But if we are going to keep it open, right, then the question is, what can, can we do? And one of the best things I've, as far as mindset Games I've learned to play is, you know, switching a problem to a question. Right? There are no people anywhere. This sucks. I can't find anyone. So the question is, how can I build an A team? Right? Where the complaining is very disempowering.

Right?

It's like, there are no options. There's nothing that can be done. The question immediately unlocks creativity because, like, huh, how could I? Right? How could I? And so changing problems to questions, that's just fantastic, you know, but we're getting through this. We are going to get through this. And I just hope that this was, like, super encouraging and gave a lot of strategy for someone who's really been having a hard time with their. With, with their practice. So any last words you have before I let you go? This is so good.

Yes. I think reaching out to your colleagues, just reaching out to people who are going through the same thing and seeing what they're doing. If you reach out to 10 people, you'll probably find 10 little tidbits that you can implement within your practice, because we're all trying to figure it out.

Love it. Lean on your community. Make new friends if you don't have them. And since I'm an introvert, I will say, you can still do it as an introvert. Right. Networking is not a personality type. It's a skill. Right? And so. And so we can do that. That is so powerful. Okay, so guys, you. You got this. This is one of these episodes where I'll say, yeah, you definitely want to. You definitely want to take this and you want to share it on social media. Hashtag on trendy. Share your biggest nugget from it and tag the doctors you love and the ones you don't, but tag them and say, hey, you got to listen to this. Okay, this is. This is good. Let's have some more dialog around this. Right? That would be an amazing thing to do. If you have any questions, you can always reach me on social media. Fatima Sparks is on LinkedIn as Fatima Sparks, and so you can meet her too. We do do some consulting for private practices. We don't promote it because we do it on a case by case basis. And so you can always email us doctor unowntremd.com and we can see if, you know, you're a fit for what we do. Okay. So, Fatima, thank you so much for coming on. This was so good.

Thank you so much.

All right, people, well, go share the episode. We gave you all our stuff, and we'll see you on the next episode of the EntreMD podcast Hey, if you love listening to the EntreMD podcast, I want to invite you to join Entre MD on demand. It is my signature subscription program that gives you access to a library of business courses designed to help you do one thing as a physician entrepreneur, and that is to thrive. Just head out to entremd.com ondemand and I love to have you join us you on the inside.