Mastering Hiring In the Midst of the Great Resignation with Dr. Carolynn Francavilla

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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. Umna. Well, hello. Hello, everybody. Welcome back to another episode of the ontremd podcast. You are in for an absolute treat. I have the amazing Dr. Carolyn Francavilla here, and we are gonna be talking about mastering hiring for private practices in the midst of the great resignation. And this is gonna be a fascinating conversation because we been in the space that we are in as employers and we are entrepreneurs, so. Which means if there's a problem, we solve it. So this is, you know, looking at hiring in a very innovative way. And there's a lot of insight to glean from this. So I want you to lean all in. And as always, even if you're not in private practice, even if you are a coach or you run a different kind of service or whatever, but you need to hire. These are things you need to know is a global problem or global shift, actually. So we all need to lean into this. So, Dr. Francavilla, welcome to the show.

Thanks so much for having me. I'm excited to be back.

Yeah, I know our first episode was so much fun because we were celebrating the launch of your course, which you really rocked, by the way. And we'll link to that in the show notes as well. But take a moment, introduce yourself to the listeners so they know who's coming up with all the gems for hiring.

Yeah. So I'm a family physician and specialize in obesity medicine. In addition to practicing family medicine, I have a small private practice in the Denver area, which now has four of us physicians. I'm the sole owner, and I also have a passion for obesity medicine and advocacy and have created a course to teach other physicians how to incorporate obesity medicine into their medical practice.

And she's a rock star. Both businesses are doing really well, and so she knows exactly what she's talking about. So my first question would be this. We had, in my practice, we had hit a place where we were very stable as far as our team and all of that. And then Covid hit, and for the first time in many, many years, I found us having a revolving door. And I was like, okay. Like, you know, team members were either leaving. And it wasn't like, bad stuff, like, I hate it here. Some of it was just, I need more flexibility or I have to be home with my kids or so it wasn't bad stuff, but it was like this whole turnover thing. And then I started hearing the phrase the great resignation. I was like, oh, this is not a me problem. This is a global thing going on.

Right.

So did you notice the same thing or is your practice immune?

We actually were pretty stable during that. And maybe as we kind of talk about what I have done since staffing wise, it will explain itself why we didn't have that turmoil during that great resignation and during all the turmoil with COVID Excellent.

So let's get into it. Tell us all the things.

Yeah, and this is a great time for us to have this talk because actually, in the last couple weeks, we have had two people put in their resignation. One was expected and the other was unexpected. And so really have been dealing with this very recently. So one of the unique things that we have done from the beginning at my practice is hire sort of, sort of different levels of employees than maybe in a traditional medical practice where you might always think about hiring a medical assistant who has that certificate as your primary employee. So I didn't have a lot of mentorship going into medical school and was really struggling to find opportunities to get experience. Experience and see if that's what I wanted to do and get the experience to apply. And as I opened my practice, I wanted to be able to pay that forward and mentor pre helped students and show them what medicine was like. And so we have hired predominantly Pre Health pre med students into our clinic, which does mean we have a bit of a revolving door. However, I absolutely love having our pre med students because they're really, really motivated, they want to learn this stuff, they want to be. They're really hardworking. They've usually just finished college, so they're used to grinding. They're planning to go to med school or PA school. And so they have a really strong work ethic and they're excited. So they're really fun to be around because they have lots of questions about medicine, they want to be mentored. And so it's sort of a win win where we get these fantastic employees, but they're also really a valuable team member because they're really smart, they just finished college, they know this stuff and they're really motivated and hardworking.

So.

So that's been one fantastic staffing solution for us, is utilizing pre med students.

I love that. And I think when we were working together that may have come up, we talked about it quite a bit and you know, that's a really genius way to do that. We actually introduced that after the pandemic started. Cause we were like, okay, you know, we need to look at things differently, need to be more innovative about it. So my question to you, which is what, you know, I'm sure a lot of people are asking, is how do you manage the turnover? Now this is, is different from someone putting in two weeks notice, you know, right when this is going to end and all of that. So how do you manage that and then onboard the next person without it creating a gap, like a true gap. Yeah.

So I think part of it is anticipating that need. We know usually the timeline, people will be with us. And so we plan for that. We kind of start looking. And because our staff, you know, have a lot of respect for us and the process, they tend to give us a lot of notice. And so we usually have at least a month of lead time. And so that gives us usually enough time to reach out to sort of the next batch of students. And it tends to work out pretty well with sort of the school calendar. One of the schools we draw from has a quarter system. And so people do kind of graduate throughout the year a little bit more frequently than a semester system. So that's also really helpful that we never go that long without some new graduates coming out of that college. But I think it's anticipating and creating a lot of response mutually in the environment. So people do give you a lot of lead time so that you can make that transition and what we have found for our pre health students is because they're so hardworking and motivated and they're so used to having to learn new things that they learn really quickly and that the onboarding really is two weeks or so. And so we usually are able to get that overlap and at this point have a staff of five people. And so if you have one person who's a little slow for a month, you know, we have a few other people who are making up for that.

I love it. And I'm guessing since you've done it this way for a while, you probably have a really good relationship with some of the schools because they know we can get our students in it. We can actually even brag that we can get them into spots, right?

Absolutely. Yeah. It actually happens to be my alma mater, the University of Denver. So that makes it even more special that about half our students come from my college. And so it kind of makes it a special alumni connection for me as well.

Oh, that's beautiful. So beautiful. Okay, so that's the first thing. And you know, so for everyone paying.

Attention, sort of non traditional employees, like pre health students.

Love it. All right, so let's go to number two.

Yes. So people who need a flexible schedule, which you mentioned. Right. That was what was very stressful for I think the majority of us in the pandemic, especially essential workers. Right. We had to keep going to work. We were needed more than ever in healthcare, but we have children, we have spouses, we have lots going on that all of a sudden needed our attention as well in the pandemic. And so we already had pretty flexible schedules in a few ways. And I've usually had sort of one permanent person who's not a pre health student, who's here long term, who is a little bit more part time. And so that has originally it was sort of a retiree she had her own business with, still looking for, you know, work to keep her busy, make some money, you know, get out of the house, but wasn't necessarily looking for full time, but she was willing to go full time when she needed, but you know, really flexible. So that was a wonderful fit, right, to find this person who wanted to work but wasn't really fussy about hours. She could work 25, she could occasionally work 40, and really was, was a motivated, fantastic person for our team. And when she retired officially and decided she was definite done working for her lifetime, we replaced her with another person who was a mom, a new mom and she wanted to work less. She didn't want to work 40 hours, but she didn't want to not work at all. And she's incredibly skilled. She's been a great asset to our team. And I think it was hard for her to find physicians. Everyone wants 40 hours a week, which, you know, as a mom myself who also doesn't want to work 40 hours a week, I completely understand. So it was wonderful to be able to make this position for someone, give her the flexibility. And in return, what we find is those people are really flexible with us. Right. So she normally works three days a week, but occasionally she'll work four or she'll answer the phone for a couple hours on her day off. And we pay her for that time, of course. But you know, because we're so flexible with the schedule that I, that I've made for her, she tends to, you know, repay that with flexibility when we need it as well. So sort of non traditional, you know, moms, maybe active retirees, people who are in school, school who want to work but maybe can't work 40 hours a week can be great. And the one bonus of that, if you're a really small practice or really just starting off, don't need a lot of snack, is if you can get two part time people that makes it so that you're not really ever going without coverage. If someone is sick, maybe they get Covid or someone has a surgery or they want to go on a vacation, then you're not left without a staff member at all for weeks. You have another part time person. So if you're just starting out, you really only need one staff member. Consider having two part time people.

I love it. And we did that actually where we. I don't know that most of our people have that flexibility. They're not necessarily held to five days. And even the ones who are five days is fairly easy for them to get days off. And so what we did is we got more people who have flexible schedules. So we have more people, but it's the same number of slots that are filled, you know, if that makes sense.

So that's exactly. That's what I have found is really, really helpful and kind of gives you that protection if someone does need time off.

Yeah. Because what we found is I think we had been used to like as a community. Right. Like private practice owners, we had been used to people being available 40 days except they were quote unquote bad workers. Right. In the sense that, you know, they couldn't keep up with the commitments. But then what we're finding is you have these People who really want to work hard. But Johnny got Covid, and then Johnny was out of school, and then when he went back, his friend had Covid, and they all had to go, you know, had to be isolated all of a sudden. So it's kind of like it is what it is. And to be able to have people who can fill in, that's just amazing. So these are such great tips. I love it. All right, so I know you have at least one more, right?

One more for me. I think I have two more, maybe.

Yeah, she has two more. Yes. Okay, give it to me.

The thing is utilizing technology, making technology a additional team member. We were already doing that when Covid hit. We were like, okay, we need to make as much virtual as possible. Right. So we can work from home when we need to. We literally had it. So we didn't have to go to the office. No one had to be here for a few weeks if we didn't need to see a patient in person. And that was huge. So there's lots of platforms now where you can have online scheduling. People can get their link for their video appointment. They can get their invoice, they can get the forms they need to fill out all sort of automatically when they schedule their appointment. So now you have a virtual staff member who's. Who's doing all of that, and you don't have someone on the phone scheduling appointments.

That is so good. Treat technology like a staff member. Leverage it to create a whole new staff member.

Yes. And that's literally what I told my patients when we launched that system. I'm like. Or our staff was. You know, I know that they're a little nervous about using this system for so much, but you just have to think of it like another team member. It's going to make some mistakes. It's going to have some quirks, just like the people you work with. But trust it. It'll do its job, and we just have to keep an eye on it sometimes.

Oh, this is so good. Because that's a little shift, you know? And I think it's important to say that everything we're talking about here is about shifting. Right. And I think the recipe for frustration is going like, I want things to go back to the way they used to be. I'm waiting for the great resignation to be over. I'm waiting for the pendulum to swing back. And I' here to tell you that it is not swinging. It's not swinging back in that sense. Like, we're almost. It seems we're always going to have to deal with this in some shape or form. Covid just changed things. Right. And so the things you're talking about are so critical. The non, non traditional staff, the flexible schedules, you know, leveraging technology, they're not so crazy that it can be done. So many people have done it. You've done it. You show other people to, you know, that they should be doing this. So it's something that I would invite everybody to embrace. Don't feel like, yeah, whatever, this will make a significant difference in your practice. So this is so good. So good. Okay, you told me you have one more.

I'm loving it. Yeah. I think the final thing is the culture you create and how you treat people. And so that's become really evident in the past few weeks. Number one, the two people who left gave us lots and lots of notice. So that is huge. And again, you know, not unanticipated, given that our. Our staff gets into school. And that's very exciting. But what was really exciting is that we had three people in that same time period reach out to us asking for jobs and one person asking for a volunteer position. So our practice has now created this reputation of being a great place to get mentorship, to get experience, experience to have a nice boss. And people are asking us for jobs in the Great resignation. So that, to me, was one of the best compliments I've ever received that, like, people are reaching out to us for employment based on the way we've interacted with our community. And so that looks like realizing that people are not always just looking for a paycheck. There are those people, and that may not be your ideal employee. So people want other things out of the job, and figuring out what that is can really set you up for success. So some people want mentorship. Some people want a place where they fulfilled and satisfied. Some people want to just have fun and enjoy the people that they work with. And if they're just happy at work, which is actually kind of rare for a lot of people nowadays, then that's enough. Some people want that flexibility, the ability to work from home some days. So figuring out what your employees need, we need to stop thinking so much what we need and saying, okay, I need someone 40 hours a week, these hours. If we can work with employees to figure out what is going to benefit them, what's going to make the job fulfilling or satisfying to them, then that really creates a totally different atmosphere.

Okay, so I'm just going to sit over here and go like, this woman has three people saying, please Employ me in the middle of the great resignation, right? And you have the people who are leaving giving you lots of notice, where I'm sure you've read tons of comments on Facebook of people who are like, they left for lunch, they didn't come back, right? Like, and stuff like that. So the reason why I point that out is because I am a big fan of learning from practitioners who are getting the results right. So when I hear that kind of result, I'm like, okay, let's look at what made that happen. And, you know, you're so gracious. You spilled all the beans as to how you created that. So thank you for sharing that. But this is. This is. This is phenomenal. Now someone is listening, going like, okay, I thought my employees just wanted a better paycheck. And people are finding that you offer them more, and they're still not coming. We've discovered that the motivators have changed. And what you said is exactly what it is. Like, what do they want? How can you have a vision that is large enough in your practice that their vision fits underneath it, right where you create a win win situation where they're going home happy, you're going home happy. Like, that's kind of what we need to do. So someone has 10 employees. They're like, okay, how do I figure out what is important to each one? Because they're different. We don't. We can't. You know, it's not cookie cutter anymore.

And that's part of the interview process when I interview someone is what are your goals? Like, what do you ultimately want to do? Are you trying to get into a certain type of school? Are you just looking for something where, you know, you have a very steady job that's safe and secure and flexible and going to let you take time off when you need it, really? Just asking, what are they looking for? And seeing if you can make that happen for them and then create that win win. For example, working from home, when you utilize technology, a lot of what we do can be done from home. And so for some people, that's huge, right? Maybe they kind of don't live that close to your office. And so they're okay coming one or two days a week, but they are cool clicking things on their own schedule and assigning faxes and doing some of the more menial stuff at home. So asking and then being that entrepreneur, being that creative person, being that problem solver and figuring out, okay, can I make that puzzle piece work to get this great team member on our team?

I love all of that. All right, so it starts with the interview process. So no more random interviews, right? We're doing, we're paying attention. We're having strategic interviews. Okay.

Very strategic.

Yeah. So you can figure out or just.

Get a warm body.

Yeah, I love it. Now, someone may be wondering, you know, well, if I have someone work remotely, are they working? You know, this is a big conversation, right? Like how do I monitor them? How do I know they're actually doing the work they say they're doing? How do I know they're managing my stuff in a HIPAA compliant way? What are your thoughts about that?

So everyone that I have does work in the office part time and then they do some work from home. So, you know, we have the ability to observe them here, make sure that they are, you know, following the rules. And of course we do HIPAA compliance training and all of that. And then I think, you know, it is trusting people. And I actually think that goes a long way. And that may not be possible in every setting, but if I can't trust you to do your job at home, how can I trust you to do it in the office either? I think that really, really goes a long way. Trusting people, to be honest.

There you go. Trust the people, observe the people. And if they're performing in the office, chances are they're performing at home. The way you do one thing is the way you do everything.

Yes, 100%.

Yeah. Okay. This was so good. I would ask, is there anything else you would tell somebody who's really, let's say Doc is listening. They've had a revolving door, They've been really burnt. They're tired at this point. They're probably like, I should just sell this thing and walk away. Right. And it's mostly staffing. Like everything else is good. Like if the staffing was good, it will be good. And you know, they're thoroughly discouraged. What would you say to that person?

I would say one of two things. Think about it differently. And so that could mean hiring from a different pool of people than what you've done before. Right. Don't post indeed for an MA slot that is not working in your community. Can you network and find that pre helped students? Can you find that person who wants that part time job? Can you find someone who's just a good fit regardless of what's on their resume? Because most of what we do is pretty teachable and ultimately they're under our license anyways. If something happens, right? So it needs to be someone you trust. And then the other thought, which I've had many a times is, do I need staff at all? And if you're small enough, like, you actually just make things a little bit smaller potentially and add a little bit of virtual and technology and, you know, are you in the sort of practice where you maybe really don't need staff or could actually have less staff, see less patients, but now you're not having to generate income to pay staff? And I think sometimes we have seen practices a certain way, a certain size, a certain amount of staff, and when we look at what our needs are as the clinician, maybe it's not that model we saw in residency or when we were employed, maybe we can actually make it smaller and use less staff.

Okay, I'm just going to say this. I love this. I love all of it. This is such innovative, out of the box strategic thinking. Right. Do I even need staff at all? And sometimes people are like, no, because I need to see this number of patients, all of that. But why though, right? Because it could be you need to do that to meet all this overhead. But if you did it in this other way, you don't have the overhead. So your top number, your revenue number may look so smaller, but your profit may be exactly the same.

Yeah.

Or bigger. You know what I'm saying?

Right?

Yeah.

So.

So the thing, what you're talking about is going back to the drawing board. Brian Tracy will call it a quink analysis. Like, knowing what I now know. Right? Knowing what I now know, how would I do this? How would I approach this? It's like you tear down the building, not the actual building, like, but in your mind. You can play on paper, tear it all down. Knowing what you now know, how would you build this? How would you make it better? And you come up with the most amazing thing. I just love this conversation. Okay, that was so good. I'm glad I asked that last question. So someone is going, like, she's so fascinating. Where can I find her? And did she say obesity? Yes, I've been looking for someone like her. Where did they find you?

So my obesity resources are at www.helpyourpatientsloseweight.com and you know Dr. Francavilla, there's not many Francavillas. You can find me on social media. Carolyn Francavilla. I'm pretty easy to find.

Yep. And all the links will be in the show notes as well. Dr. Francavilla, thank you for coming and for sharing this. This is so insightful. People are going to get a lot out of it. Thank you for spilling all the beans, because you did.

Thank you so much for having me. And I really hope that people will pick something from this and that it'll be help them enjoy hiring a little bit more.

Yeah, I think they will. This is. This is a really good way of looking at it. Okay, so for everyone listening, this is what I would really love for you to do. Doctors are having a lot a hard time. A lot of doctors in private practice are having a lot a hard time. And this episode right here has the potential to help them step into a version of their practice that has less burnout, less worry, more coverage, more peace and quiet, better team, better culture, all of those kind of things. You have within your power the ability to change the life of a private practice owner. So share the episode, share it on social. Share it with the doctors in your life. They will thank you forever. Okay, so, Dr. Francavilla, thank you for coming on. Everybody go share it, and I'll see you on the next episode of the MD Podcast.