When Robert DiSogra, AuD, was recruiting a few years ago for a front-office position in his Freehold, NJ, practice, he felt sure a particular applicant would not fit the bill.
“She had very little experience, and her résumé didn't even fill three-quarters of a page,” he said. “But the last line said that she had served three years in the U.S. Army. So I brought her in, and I really was just going to thank her for her service.”
It turned out that the applicant was an Iraq War veteran. She and Dr. DiSogra talked for a while, and it quickly became evident to him that she was a problem solver and a quick learner.
“I said, ‘You're hired.’ She asked for $9 an hour, and I said, ‘I can't do that. I'll pay you $15 an hour. Can you start Monday?’ She stayed for three years, until she moved away to get married, and she was one of the best employees I've ever had. She offered constructive suggestions, took criticism very professionally, and presented herself even better than people with 10 years of experience.”
The process of recruiting, training, and retaining hearing healthcare staff members—whether they are audiologists, audiology assistants, or other office team members—seems to be equal parts science and art. It's also one of the most important elements of running an audiology practice, especially in an age where private practices must compete with big-box stores and online hearing aid sales.
“Hiring the right people is essential,” said Kathy Landau Goodman, AuD, who has owned Main Line Audiology Consultants in Philadelphia for about 30 years. “It's been my biggest challenge in running a practice. When you find someone great, do whatever you need to do to keep them.”
For example, two of the audiologists in Dr. Landau Goodman's group have been with her for 26 and 12 years, respectively.
“These audiologists are successful because they always put the patient first,” she said.
In addition, Dr. Landau Goodman's office manager was with the practice for 16 years before she left because of a death in the family. Dr. Landau Goodman then went through half a dozen mismatches, each of whom had taken part in an extensive behavioral interview process, before she finally found the right person.
“Some people are really great at interviewing but then don't have the skill set or expertise to deliver,” she said. “Others may be excellent at some aspects of the job but can't manage processes and people, which is essential for a management position.”
ASK THE RIGHT QUESTIONS
When reviewing résumés for an audiologist position in his practice, which treats infant to elderly patients, Dr. DiSogra looks carefully at candidates’ previous work environments and attitudes toward patient care.
“I'm concerned about their diagnostic skills, and I'm also concerned about attitude toward rehabilitation,” he said. “If their first response when someone has hearing loss is to move straight to hearing aids, they're not going to be working for me.
“You can come out of a hearing aid program and be strong in hearing aids, which is all well and good, but let's give you a multiply handicapped four-year-old who's blind and see what you can do. We function as a diagnostic center as well as a rehabilitation center, so diagnostic and rehabilitation experience is essential.”
The résumé is just the first part of the hiring process, and it often doesn't tell the whole story. Far too many people forego truly checking references when hiring staff, said David Citron III, PhD, director of South Shore Hearing Center in South Weymouth, MA.
“You can find gaps by calling former employers to find out what people's responsibilities really were. How many ABRs [auditory brainstem responses] did they do? How many balance evaluations? How many hearing aids did they fit? That's easy information to find.”
What questions should prospective employees be asked in order to determine if they're the right fit for a practice—the type of audiologist or office staff member who will not just do the job but will help retain patients and attract new ones? Dr. Citron has one question that he said reveals a candidate's character more than any other.
“I ask, ‘Who pays your salary?’ If they say, ‘The patient,’ that's the winner. That's the right thought process,” he said.
Dr. Citron also poses hypothetical situations during interviews.
“I'll say, ‘A physician calls at 4:45 p.m. and has a patient with a sudden hearing loss. The physician wants us to see that patient late. Do you have a problem with that?’ I'm looking for commitment, for a passion for what they do. I want people who see this not just as a job but as a profession.”
These kinds of probing questions aren't reserved strictly for audiologists, Dr. Citron said.
“We'll ask a lot of similar questions for administrative personnel, knowing that they're the voice of the practice.”
TEACH EMPLOYEES WELL
Hiring the right people is only the first step in the staffing process.
“Training has been the weakness in this profession,” said Kenneth E. Smith, PhD, a member of The Hearing Journal Editorial Advisory Board, and vice president and director of operations for the Hearing Center of Castro Valley in California.
“Office staff, for example, need training not only in answering the phone but also in prequalifying patients when they call, being resourceful enough to get information to the audiologist so that the audiologist can do the complete workup.”
Dr. Smith and Beth Ehrlich, AuD, his business partner and wife, developed two-week training protocols for both audiology and administrative staff members.
“Our administrative training, for example, goes through a definition of terms and an introduction to what we do, and then goes through the operating system, front-office practices, back-office practices, and insurance protocols,” Dr. Smith said.
“That's just the first week. We have a whole second week on reviewing charts, battery sales and battery types, and so on.”
Hearing aid manufacturers provide a direct training vehicle for office staff and audiologists, Dr. Smith said.
“In the field, there's generally no organized system for an appropriate level of device training for office staff, but they're the ones prequalifying the patients.
“Our office staff members are trained and licensed to handle basic repairs at the front desk. They can troubleshoot a clogged receiver or a bad receiver, and change it. This gives patients a whole different feeling about the customer service they receive.”
To ensure that this training is achieving its goals, Drs. Smith and Ehrlich have begun using third-party cold callers through Educated Patients.
“They send us a summary of what happens on the phone,” he said. “In one instance, we learned that a certain staff member at the time was not asking people for their name and identifying information, and many patients were not being prequalified and brought into the office. That sounds like a little thing, but it's major.”
Dr. DiSogra employs a residency-style approach in training new audiologists.
“The new hires shadow me,” he said. “I'll introduce them to the patients and let the patients know that this is a new hire who will be observing while I do the testing.
“Then I'll sit down with the new hire and ask, ‘What did you like about what I did? What didn't you like? What would you do differently?’ I put them in situations where they have to employ critical thinking.”
If a new syndrome or new technique appears in the literature, Dr. DiSogra may give the junior audiologist a homework assignment.
“How about on Friday we get together for lunch, and you let me know what you learned?” he will suggest. Next, the new hire might be asked to come back and present his or her findings to the entire staff, almost like grand rounds.
All of the professionals who spoke with The Hearing Journal also said that they regularly pay for their staff members, including audiologists and administrators, to attend continuing education meetings.
Dr. Citron's audiologists go to at least one major conference a year, as well as regional meetings.
Dr. DiSogra closes his office for a day or two and sends his administrative staff to coding and billing workshops, such as the boot camps run by Kim Cavitt, AuD.
“The practice has no income for two days, but we earn it back in the long run with claims that are processed more expeditiously and accurately,” he said.
THE RETENTION EQUATION
Once staff members have been hired and trained, what strategies will help keep them on board?
Salary and benefits are certainly part of the equation.
“We're very generous in many ways to our staff,” Dr. Citron said. “We pay for their full health insurance, and we contribute to a 401(k) plan as well as Aflac, where they can choose whether they want disability/accident coverage.”
He also offers flexible hours to honor his staff's family commitments.
“If we know the school bus arrives at “x” time, we flex their hours accordingly so that they can juggle those balls effectively.”
Dr. DiSogra also noted the importance of flexibility.
“If we're running early on a particular day, I won't make everybody stay until 5,” he said. “I treat my staff the way I like to be treated, and I think that comes back in the type of work they put in.”
Every audiologist interviewed stressed the importance of holding regular staff meetings, encouraging communication, and fostering a sense of empowerment. The specific schedule of meetings, they said, is less important than the fact that the meetings happen and that all in the office feel that they can speak up.
“All of our staff members are empowered to make patient-service decisions without having to come to me,” Dr. Citron said. “If you're walking around here, very seldom would you hear, ‘Well, I have to check with Dr. Citron.’”
“For example, we had a patient who had an above-average amount of repairs needed for hearing aids. That patient had to travel a ways to come here, so all the repairs were an inconvenience to them.
“The audiologist worked with the manufacturer to have the hearing aid repaired again and had the warranty extended by an additional year. He also gave the patient an American Express gift card on behalf of the practice as an apology for the inconvenience.
“He did that on his own without asking. That's the real ‘plus one’ you're looking for from employees, and what you should be encouraging.”
The investment in a good staff pays off many times over, Dr. Landau Goodman said.
“I recently heard from a patient of mine who is himself a physician, with a big practice in Philadelphia. He told me, ‘I wish I could bring my office staff in to train with yours. They're friendly; they're efficient; they get you in right away; they call to confirm—whatever you need, they work it out somehow.’
“We get a lot of compliments like that because, from the top down, our philosophy is not only to make you hear better, but to make it a wonderful experience.”