Practice Economics
Think Before You Hire Relatives
In most practices, nepotism sows the seeds of staff discord.

BY MARK E. KROPIEWNICKI, J.D., LL.M.

If your ophthalmology practice doesn't have a firm policy against nepotism in the workplace, you should strongly consider establishing one.

Although hiring family members occasionally works, particularly in solo and smaller practices, having spouses or significant others in the practice usually does more harm than good. As I'll explain in this article, taking a stand against nepotism as part of practice policy is advantageous in most instances.

I'll concede that in many solo practices, the physician's spouse is the practice's first -- and occasionally only -- nonphysician employee. A spouse may work without pay, often for years, when a practice first starts up.

If the practice remains small, the physician's spouse may well nurture a family feeling among a small staff. Many physician spouses are clinical staff members -- ophthalmic technicians, nurses, and the like -- or they keep the practice's books and do the billing. Some are simply excellent employees.

PROBLEMS CAN ABOUND

Nevertheless, in all but the closest practices, just having a physician's spouse, adult offspring, fiancée, or even cousin on the staff can lead to major staff morale problems. Most commonly, the nepotistic employee doesn't work gratis, but rather earns more money than other employees doing the same work.

Further, even if she isn't guilty of running to the doctor with every minor complaint, report of a discouraging word, or tale of dissatisfaction with another employee's work, work ethic or work habits, just the simple perception that there's a "spy" in the office can disrupt a practice staff or even demoralize it.

Also, it isn't unheard of for nepotistic employees to play control games with the rest of the staff, brag about higher wages, better benefits and more perks, and generally lord it over the others.

RELATIVES WILL TAKE LIBERTIES

Occasionally, a nepotistic employee takes the liberty of setting her own work schedule based on whim, frequently generating a personnel hole for hours at a time. Can the other employees really turn to the ophthalmologist for help in rectifying the situation? Probably not.

Consider the case of the ophthalmologist's spouse at vacation time. The spouse, who may be working as a nurse, is entitled to 2 weeks of vacation. The ophthalmologist is entitled to 6 weeks of vacation. Naturally, the spouse will be with the ophthalmologist on vacation, and thus require an extra 4 weeks of vacation time. Even if this is unpaid vacation time (in some cases it is; in others it isn't) it's unfair to the other staff members. They also want the ability to take an extra 4 weeks off, with or without pay.

To implement an anti-nepotism policy, it may be necessary to fire all relatives, including spouses, even though the practice may lose a great worker. This separation may be difficult to achieve without having an outsider make the recommendation. Make the best business decision for the entire practice. If the nepotistic employee is truly a good employee in her own right, finding another job with a different practice should be relatively easy.

Make sure your anti-nepotism policy addresses not only persons related to, married to, or affianced to physicians, but to other staff members as well. Don't restrict the policy to spouses. Brothers, sisters, children, cousins and other significant associated people can also cause the practice problems.

AVOID THE DISRUPTIONS

A relative on staff often disrupts the typical ophthalmology practice, causes friction and resentment, and may lead to higher employee turnover. Usually, the nepotistic employee does less work for more pay than a nonrelative in a similar position, thus generating two problems at the same time. Take a stand against nepotism. You'll be glad you did.

Mark E. Kropiewnicki, J.D., LL.M., is a principal consultant with The Health Care Group, Inc., and a principal and president of Health Care Law Associates, P.C., in Plymouth Meeting, Pa. He regularly advises physicians and practices on their contracting matters and business law obligations. He can be reached at (800) 473-0032.