Category Archives: Spine Medicine Today

10 Questions an Employer Should Not Ask

Job postings

According to the BC Human Rights Code (Discrimination in employment advertisements), you must not publish job postings or advertisements that give preference to:

  • What is your religious affiliation?
  • Are you pregnant?
  • What is your political affiliation?
  • What is your race, color or ethnicity?
  • How old are you?
  • Are you disabled?
  • Are you married?
  • Do you have children or plan to?
  • Are you in debt?
  • Do you social drink or smoke?

The interview

The Interview

The Interview

Once you are ready to begin your interviews, there are a few key points to keep in mind when designing questions. You need to ensure your interview process is not intentionally or unintentionally asking questions on prohibited grounds. It is important to describe the job and requirements in a way that gives all applicants a chance to apply. For example, if a position requires regular overtime and has an irregular schedule, do not ask:

“Do you have children?” as you would be assuming a person with children could not work longer hours.
If a job requires heavy lifting, do not ask:
“Do you have a bad back or any medical issues?” as you might be discriminating against a candidate with a disability.

Checking references

It is important to note that you cannot ask questions that are illegal during any stage of the recruitment process including your interview or while conducting reference checks. For example, just as you cannot ask a candidate about a disability in the interview process, you cannot then ask their former employer, “How many sick days did they take last year?” However, you can ask if they were reliable and punctual.
While there are many points to cover in preparation for an interview, no point is more important than knowing which questions are considered illegal and are simply NOT allowed to be asked during your interview.
There are numerous state and federal antidiscrimination laws designed to assure that employers hire based upon skill, rather than stereotypes. Therefore, there are some things an interviewer isn’t allowed to ask. How do you know what’s fair game? Here are some questions that should raise red flags.

1. “What’s your race?”
It is illegal for an employer to ask you questions about race or skin color. Unless appearance is a “bona fide occupational qualification” (BFOQ) – for example, if you’re applying for a modeling job- you cannot be required to submit a photo with an application.

Fair questions: None. An employment application may include a space where you voluntarily indicate your race.

2. “What is your national origin?”
An interviewer cannot ask if you are a U.S. citizen, where you were born, or remark upon your accent. Unless a business case can be provided, a company can’t specify that English be the only language spoken on the job.

Fair questions: “Are you eligible to work in the U.S. Could you, once employed, submit documentation to that effect?” Companies now require all employees to fill out an I-9 form, in order to confirm that you’re a citizen or resident who is eligible to work. If fluency in a language other than English is a job requirement, an employer may ask how you learned that language.

3. “What is your maiden name?”
An interviewer can’t discriminate on the basis of gender or marital status. Recruiters may not ask different questions of female and male applicants or of married and unmarried women. It’s also inappropriate for an employer to ask if you’re planning to have a family or have young children.

Fair questions: An employer can ask for your full name or whether you’ve worked under another name – in order to check your employment history. Interviewers may inquire about childcare and other family issues by asking: “Where do you see yourself in five years? What hours are you available to work? Do you have other responsibilities that may interfere with your ability to meet the requirements of the job- such as overtime or travel?”

4. “How old are you?”
The Age Discrimination in Employment Act (ADEA) protects people over the age of 40, who work in companies with more than 20 employees, from employment discrimination. Employers may specify an age limit for a position only in rare cases where it can be proven that age is a.

In all other cases, an interviewer may not ask when you were born, when you graduated from high school (since most students graduate at age 17 or 18), or any other questions from which your age may easily be determined. Individuals under age 40 aren’t covered by the ADEA, but many states offer them some protection.

5. “Do you have any disabilities?”
Under Title I of the Americans with Disabilities Act (ADA), an employer may not discriminate against a qualified candidate who is disabled, and must make “reasonable accommodations” for physically or mentally impaired employees.

Fair questions: “Can you perform the basic functions of this position with or without accommodation?”

6. “What is your religion?”
There is no reason for an employer to ask you about your religion or about any holidays you observe.

7. “Have you ever been arrested?”
You are innocent until proven guilty; therefore, it is illegal for an interviewer to ask if you’ve ever been arrested.

Fair questions: Employment applications often include questions about felony convictions, along with a disclaimer saying that a conviction won’t necessarily remove you from consideration.

In accordance with U.S. Equal Employment Opportunity Commission (EEOC) policy, employers must weigh a variety of elements when factoring convictions into hiring decisions. These include the nature and severity of the offense, the time that has elapsed, and whether the offense has any relation to the position advertised.

8. “What type of military discharge did you receive?”
An employer may not ask whether you received an honorable or dishonorable discharge.

Fair questions: The interviewer is allowed to inquire about your rank when discharged and discuss the skills you gained while in the military.

9. “Have you ever filed for bankruptcy?”
Questions about your financial status, whether you own a home, or have previously had wages garnished are off-limits.

Fair questions: If good credit is a requirement of the job, a company is within its rights to perform a credit check.

10. “Do you belong to any organizations?”
It’s inappropriate for an interviewer to ask whether you are affiliated with or are a member of any political, social, or religious groups- including unions.

Fair questions: An interviewer may ask you if you’re a member of a professional organization, like the American Bar Association.

How to React to Unfair Questions

Try and determine what type of information an employer is looking to receive with her questions. For example, if an interviewer asks if you have children, you may deduce that she wants to know if you’d be missing work often to care for them. You might simply answer that you have no problem meeting the positions attendance requirements.

7 Steps for a Successful Hire

By: Nicola Hawkinson DNP, RNFA, RN

7stepsblog375238_largeFor employers, filling a job vacancy is a daunting and time consuming task. Initially, the employer should be asking themselves: why is there a need? Is there a (n) new hire, expansion, increased volume, new practitioner, replacement? No matter what your reason is you should treat the hiring process as a key business practice.

  • Identifying the Need

A well written job description serves a multitude of purposes and the better they are written, the more useful they will be. There is a lot of power in defining roles. Think about athletes and how each member of the team functions both independently and dependently at the same time. As much as each athlete can function well on their own, they still need their teammates to bring the team to victory. This is because each member has a clearly defined role and knows what their job function is and how that function influences other teammates. The same idea can be attributed to the workplace.

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8 Habits Health Care Practices Should Learn from the Navy SEALS

Healthcare practices can adopt certain behaviors from the military to help not only boost the morale of the office, but also create a more engaged working environment. Follow these eight habits for your practice to operate at the optimal level:
1. Be loyal.
Loyalty to the team starts at the top. Loyalty is about leading by example, providing your team unconditional support, and never throwing a team member under the bus. Member of your team will be loyal to your practice if they feel like they are being appreciated.
2. Put others before yourself.
Go to work every day with the intention to make your team better and offer help to those who need it. People who become overworked and overtired are not productive members of your team. The success of the practice should be a priority for all employees.
3. Be reflective.
Understanding what works for you and what doesn’t is often underappreciated in the workplace. You’re expected to do things according to the way of the practice and that’s fine, but you should reflect on how your behavior and adaptability affect your overall performance.

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Scaling up a Surgical Practice

Adding more doctors to your practice might be a smart move for smaller practices. Yes, the added cost can be expensive but for most doctors it is well worth it. Smaller practices have struggled more and more recently. It is harder to keep doctors in smaller practices when the payoffs are not as big but the responsibilities are greater. You might be stuck deciding what path to take to grow your practice; here are four ways to scale up:
1) Satellite Offices
Scaling up the practices can occur a few different ways. One way would be opening satellite offices as a means to create more revenue and patient. Making the practice more accessible to patients will help you engage new patients you wouldn’t have seen otherwise as well as utilizing more doctors. Life at a larger practiced is more varied. In a big practice, physicians might spend time pursuing special interests or research. Options for part-time work are more available at a larger practice where responsibilities aren’t piled on between one or two physicians. The larger practice setting can also provide economic benefits for the physician.
2) Updating Technology
Utilizing EMR systems and updating software regularly will help with patient flow and wait times. The more organized the practice is, especially a larger office, the more patients can be seen. Implementing new technology can be stressful but if you are dedicated to growing the practice you and your staff must be able to adapt. Practices that are most successful are the most adaptable to change.
3) Adding Ancillary Services
Are you commonly outsourcing an ancillary service that fits with your current and potential patient population? Integrating services needed by your inbound and outbound referrals provides you with a patient-centered continuum of care with the goal of improving continuity of care, compliance and outcomes.
4) Broaden the Types of Specialists in the Practice
Thinking outside the box will help the practice achieve success. Giving patients the option of alternative treatment plans is becoming more popular as patients have greater access to knowledge about treatment options from online resources.
Whatever route you choose to scale up your practice, remember it is important to know that these changes take time. Whether you plan to add more physician, satellite offices or ancillary services each step to grow the practice will ultimately make your practice stronger and more profitable for the future.

Your Front Desk Staff Are Your Flight Navigators

Can your front desk be a profit center for your practice? Yes, but there are instances where physicians may not know what is happening out in the waiting room while they are taking care of patients. Any practice will have some bumps in the road with employees, but physicians must be conscious about checking in with every member of their team. When there is a lack of communication between the physician and staff, patients will feel the negative impact. How well the front desk operates could make or break your practice. The front desk is the first in line to a patient’s access to care making it one of many important elements in patient satisfaction. The front desk staff are the navigators of your practice and staying in tune with them to see how the practice is operating on a day to day basis not only keeps patients happy but helps retain them as well.

First impressions count–When a patient walks into the waiting room they are either walking into a warm and inviting environment or a stark and cold one. How you present your practice to the patients starts way before you see them in the exam room. For the receptionist a patient’s visit starts with the same, and sometimes monotonous, procedures like asking for insurance information, paperwork and answering questions. Receptionists may also be responsible for answering the phones as well, adding extra stress to an already busy schedule. Even though there might be high call volume and patients in the waiting room, this is not an excuse for the front desk to act exasperated by patients. If the practice is large, this might be a good time to suggest hiring candidates specifically for phone triage. If the practice is small, create a way to delegate responsibilities at the front desk. Instead of having all receptionists answer the phones make it only one or two people’s job. If the office runs smoothly patients are much more likely to feel comfortable about the capabilities of the physician. Some physicians may not feel like their staff is a direct reflection of them and this is a common mistake. You might value patient satisfaction as a physician, but if the front desk is doing a mediocre job patients will think that you must not care as well. Patients are much more likely to return to an office where receptionists, medical assistants, nurses and physicians work well with one another. If a patient is frustrated after dealing with disgruntled employees this will take away from important time spent with the physician. What can be done to remedy this?

For starters, physicians need to be aware of what’s going on in every aspect of their practice. Having weekly staff meetings where you discuss proper protocols for face-to-face and telephone communications with patients are a must. You’d be surprised by how many practices do not take the time to do this and it shows. Schedule one day a week where staff is able to come in 15-20mins before the days begins and use that time to have a meeting. This should be something that is understood by both current and prospective employees. You need people who want to be a part of a team and who respect that you are staying on top of what goes on in the office. Another way to ensure the practice is functioning well is by having a formal orientation for new employees making sure there is a set time for training at the start of employment. Training could take two weeks or possibly more depending on the job responsibilities. During this time period new employees should have ample time to learn what is expected of them from them professionally and how to carry out job responsibilities in an effective and timely manner.

Following-up with patients means much more than the physician calling after the original appointment. It means staying on top of follow-up appointments and referrals. It also means keeping in touch with patients. Receptionists should be responsible for collecting both phone numbers and emails to reach patients. Technology is much more advanced than it was even a decade ago and using it to your advantage will be beneficial. Sending out e-newsletters introducing new physicians to your patients or services your office has to offer is one way of keeping patients in the loop. Healthcare is a service industry so take the time to make sure your staff is cultivating long-term patient relationships.

If your practice is being managed properly then learning and professional development will be valued. All employees, whether they are receptionists, medical assistants, nurses or physicians, should undergo training for how to respond and engage with patients. The waiting room might just be the start of a patient’s visit, but it says a lot about how the office runs on a daily basis. If there are major issues in the waiting room physicians are unaware of that makes the patient think that there is very little communication between the physicians and the receptionists. When all employees are on the same page regarding how to care for patients then you will see the organization flow from check-in, treatment and follow-up.

Creating the Correct Environment for Medical Staff Retention

Healthcare workers are in high demand and this means healthcare organizations must create environments that encourage them to stay once they’re hired; easier said than done. Lack of advancement opportunities is one of the main reasons people working in healthcare leave jobs; recruiting and retaining healthcare workers depends on developing a nurturing environment where these professionals can thrive.

Most healthcare professionals are more likely to leave jobs when they are unhappy with the office culture or they feel like they can get more experience somewhere else. You have to create reasons for them to stay. Some options include, but are not limited to: In-house skills training, technology training, performance-based incentives and sign-on bonus. Healthcare workers value these programs because they encourage professional development and upward career mobility for all medical staff. The experience they get from your practice should be invaluable to them over the course of their career. You will attract more highly qualified candidates if you are offering employees more than just a paycheck.

Office environments are underrated by most professionals. Medical practices tend to assume that if people are leaving jobs it has more to do with that person than with the structure of the practice. Some people might leave because the job just isn�t what they expected, but other people will leave because of what you aren�t offering them. Medical assistants, nurse practitioners, physicians and receptionists won’t stay if you are unable to offer the kind of atmosphere that ensures a safe, healthy and productive work environment.

Since healthcare changes and evolves your education and training for members of the staff cannot be static. EMR systems will be subject to change especially as the technology advances as well as processes for billing and coding. These changes will affect the entire staff and how you recruit for new candidates. Concurrently, urgent care facilities are becoming more prominent and hospital employment is looking more favorable for physicians; because of this, private practices are having trouble with retention. Instead of scrambling to replace people, look into what you are currently doing and how to make it better. Happy employees don�t go searching for new jobs.

Reviewing an Orthopedic Practice’s Ancillaries

An Orthopedic Practice should like about reviewing ancillary services by looking at which procedures and tests your practice is referring out. Building practice profitability require sufficient time and effort. Having a marketing plan in place and considering the amount of time, staffing and space needed will help create a new form of revenue for the practice.

For some physicians, the decision to add ancillary services is a matter of survival rather than a choice. Before this becomes the case, carefully assess where the market potential is. Does you practice contract out to physical therapists and ambulatory surgery centers? Design a marketing plan for adding ancillary services and market to your patients accordingly. Marketing to the public might take more time but convenience and patient health will help add revenue. Understand the location of your practice and what medical procedures might be underserved in that area in order to better serve patients.

Best Practices when Conducting Pre-Employment Screening of Medical Staff

After interviews have been completed with potential future employee(s), there comes pre-employment screening. Pre-employment screenings are a necessity. Pre-employment screening is the type of checks that employers conduct during the hiring process when an offer has been made to the candidate(s). The types of screenings companies include are criminal background check, credit checks, employment history verification, education verification, and driving record checks. This step in the hiring process is critical to making a final decision and, if all goes well, then the next stop is to think about how best to manage the candidate’s transition into the organization.

Employment history and education verification as well as reference checks can reveal information that causes you to eliminate a candidate. For example, you may find that the candidate exaggerated information about employment history or education on his or her resume.

Contacting references provided by the candidate is an easy way to determine whether or not he or she is suited for the company.
5 Tips to Remember When Checking References:
1) Ask candidate to sign a waiver: the waiver will grant you permission to contact references.
2) Ask candidate for at least 5 professional references. You will need to contact all 5 and most likely only 3-4 will contact you back. You want to be able to get as much information as possible to see if the candidate has the right attitude and personality for your organization. Professional references should be at least a manager/supervisor from a past job, or a co-worker.
3) Ask candidate for references within the last five years. A reference check should cover the most recent five years of employment. Most people will be hard pressed to remember the specifics of an individual’s past job performance outside of five years.
4) Verify all degrees and licenses. It is unfortunate that people misrepresent themselves on their resume. You should always call the state licensing board and school registrar’s office for confirmation and verification.
5) Ask open ended questions during the reference: the goal of references is to learn as much about the person as much as possible. Refrain from asking questions about age, race, sex, religion, marital status, or national origin. These are the categories protected by law, and have no bearing on the person’s ability to do the job.

Criminal background checks are mainly performed for security purpose. In other words, they target to protect companies from potentially risky candidates. Some companies like to perform the background checks themselves or some may have third party agencies complete the background checks. There are several things you should know about the candidate when conducting a proper criminal background check.

1) Full name (preferably what appears on the candidate’s driver’s license or another government-issued document) including any nickname and maiden name.
2) Date of birth from an official source (e.g., driver’s license, passport, birth certificate, etc.)
3) Current Address where the candidate is resides.
4) A social security number.

In regards to healthcare sanctions background check, it searches a U.S. Federal Government list to detect individuals and organizations that have been excluded from participating in Medicare, Medicaid, or any federally funded healthcare programs due to fraud and/or abuse. In conclusions, it is important to promote quality, safety, and value to your organization and conducting pre-employment screenings on medical staff can secure the future for your establishment.

Utilization of Medical Scribes

Hospitals and private practices are utilizing medical scribes in order to fill the gap left by EMR systems. With EMR systems becoming more prevalent, there is now a way for physicians to effectively treat patients and document their visit in real time. Emergency physicians are finding that scribes are becoming an asset in healthcare rather than a cost. However, the use of scribes has not caught on with private practice physicians, and since EMR systems are still on shaky ground with physicians and there has become an increasing need for medical scribes in hospitals as well as private practices.

Physicians are still unsure about how to properly use EMR systems. In some cases the interest level may not be particularly high, but in other cases, there may be lack of trust with a system and inclusive amount of training time needed. Doctors run on busy schedules and are often rushing from patient to patient. They frequently get stuck doing after hours dictation, and this increases the doctor’s stress level, exhaustion and could lead to burnout. Scribes are able to take on the clerical aspects of patient care. The average pay for a scribe could be anywhere from $9-$25/hour, but a lot of the benefits of having scribes on staff are non-monetary; Medical scribes are able to cut a lot of the stress felt by physicians and increase patient satisfaction.

Becoming a medical scribe can be a great move for students who are interested in attending medical school. Working as a scribe looks great on a resume, and scribes learn important terminology and training that will ultimately help them in medical school. Scribes also build up a professional network of doctors and nurses that could lead to great letters of recommendation; the extra experience prior to residency can be invaluable to any med student or anyone who is looking for a long term career in healthcare. However, scribes usually have a high turnover rate because students that are in medical school cannot commit to being a scribe for more than a year or two; but usually scribes are highly motivated and willing to go through the training process so there is little to no problem finding a replacement. Scribes are able to have a first-hand account of what it’s like working in a fast paced setting with a preview for how physicians think. Medical scribes are nonclinical or clinical employees that work under a doctor’s supervision. Some medical students choose to work as a scribe in order to gain a better understanding of the healthcare field; other non-clinical medical scribes generally have an interest in medicine but are not licensed to provide healthcare. Since the scribe in the room with the doctor and patient, the doctor does not have to do after hour’s dictation.

Scribes are able to boost the EMR productivity since offices and hospitals are in a period of transition where the learning curve is high. The daily responsibilities of a scribe include: taking patient histories, transcribing details of the physical exam and patient orders, documenting procedures performed by the physician, recording physician-dictated diagnoses, prescriptions and instructions. Some patients fear that scribes are not adept enough to pick up on drug interaction warnings. However, this can be avoided with proper training and routine performance evaluation. In order to make EMR’s more successful in hospitals and private practices there needs to be proper training for physicians, nurses and nonclinical staff and utilizing medical scribes is one way to help reinforce and stay on top of quality patient care.

How to Manage Physician Staff Performance

Effectively managing clinical staff, for a medical practice, takes a lot of work and can be stressful at times. However, taking the proper steps to manage physicians and medical staff will boost revenue and decrease your turn-over rate. There are six steps that every practice should employ in order to create a productive and stress free work environment:

1) Shared GoalsPhysicians and staff should all share the same goal which is providing quality care for all patients. This is an overall goal for your practice as well as an individual goal for each physician and member of the nonclinical staff. In order to create shared goals amongst doctors and staff, there has to be guidelines and mission statement for staff. Creating a specific office culture that encourages growth and hard work will ultimately benefit how your practice operates. Connect with members of the staff during meetings in order to form cohesive goals that will have measurable outcomes.

2) Clearly Defined Roles
For any practice to function, and function well, roles need be to be clearly defined prior to an employees’ start date. A lot of the issues that arise between healthcare professionals have to do with confusion about job responsibilities. However, cross-training staff to learn your current EMR system may be a good idea; if someone is out sick then you won’t have to worry about jobs not getting done. It’s easy to say that doctors treat the patients and the staff controls the filing and scheduling, that’s true, but there is a lot more to the daily operations than just patient flow. When hiring an employee there needs to be a clear set of job skills and responsibilities that need to be met not just so they can understand their role, but the employer can organize daily operations of the practice better.

3) Effective CommunicationCommunicating effectively may seem like the easiest part about managing clinical staff, this is not the case; you’d be surprised to hear that many practices flounder because of poor communication. Communication needs to start with the practice manager and trickle down from there. If the practice manager does not communicate well with staff, then other aspects of the practice will suffer; revenue might decrease and the turnover rate will be high. Employees do not want to work in a setting where they are not given proper direction; the environment becomes chaotic and no practice can afford that.

4) Physician Productivity
How the physician is able to conduct his/her work on a daily basis greatly affects the entire staff. Dividing tasks into two categories: clinical and non-clinical, so the physician isn’t doing tasks that take away from seeing patients. Reducing unnecessary inbound calls and interruptions by nurses will help give the physician more structure throughout the day and maximize the amount of face-to-face time with patients.

5) Evaluation
Evaluating medical staff regularly and consistently can help you stay on top of staff performance. From the start of employment, a physician should know about your evaluation system and that they will be evaluated on regular basis. This will help doctors and nonclinical staff know that you will be evaluating them in order to better their job performance and better the practice overall. If you notice an employee is underperforming, there should be a set time limit for improvements. Documenting problems with a staff member will help you in the long term in case termination is necessary.

6) Mutual Respect
Holding weekly staff meeting will help develop respect between clinical and nonclinical staff. Meetings are a good way to keep in touch and stay on top of things. This does not mean your staff should feel like they are being micromanaged. Giving your staff enough room to excel at their jobs while staying on track of their performance will have a positive effect on your office culture.