Physiatry Practice Management Resources

Trout also gives job applicants a test that assesses math, spelling, grammar, alphabetization skills, and familiarity with common medical office terms (deductible, copayment, participating provider, PPO, etc.). The test also contains several front-desk scenarios for the applicant to respond to, such as how he or she would handle a patient who is frustrated by a delay. "If someone is applying for, say, a medical records job, I can determine if I can cross-train her to work in the billing department, or if she has the temperament to pitch in at the reception desk."

Applicants who Helena Dahan interviews learn up front that they'll be cross-trained. Someone who's seeking a medical assistant job, for instance, is told she'll learn to triage phone calls, and work in the lab and at the checkout desk. "If they have a resume, I look at it to see if they've multitasked," she says.

Chris Kelleher is impressed when a job applicant says that she likes to be busy and wants to grow professionally. "We hire attitudes," he says, "someone who is patient-friendly and a team player." Kelleher has hired many former waitresses. "Waitresses can usually think on their feet and pay attention to detail, and can easily be cross-trained because multitasking is second nature to them."

The logistics of cross-training Like any management task, cross-training should be tailored to your practice's size and needs. At Weston Pediatric Physicians in Weston, MA, clerical employees switch tasks periodically so that there's some respite from high-stress duties. "It's not fair to have one person getting pounded on the phone constantly while another person spends all her time pulling and filing records," says practice administrator Alec Ziss. "We've set up a rotation that allows for four-hour shifts in three job slots: directing patient traffic at the main desk, handling records, and making future appointments."

To be sure, while you can train your clinical employees to do clerical jobs, the process doesn't necessarily work in reverse. "We cross-train every position except those that are either regulated or license-restricted," says Chris Kelleher. "We can't train a medical records person to be an RN, but we can teach her to do medical assistant tasks such as blood-pressure checks and calling in prescriptions."

You can blur the clinical/clerical divide even more if clerical employees obtain the requisite licenses. Rhonda L. Sutton, practice administrator of Corona Family Care in Corona, CA, agreed to let front-office personnel cross-train in back-office procedures once they got their phlebotomy license—on their own time and at their own expense. "We couldn't afford to pay for off-site courses or let employees take classes on our time," she says. "But we agreed to teach clinical skills to clerical workers once they got some of the basics down on their own."

Most of the administrators we spoke with cross-train employees themselves or assign these tasks to the appropriate staffer. Alec Ziss, for example, relies on the practice's billing supervisor to select candidates for occasional billing work. "She judges their potential by the work they've done elsewhere in the practice."

At Karla Trout's practice, cross-training takes place during a slow time—when, for instance, one or two physicians are on vacation. Trout first has the trainee shadow the trainer for a few days, observing how the job is done and taking notes. Then the process is reversed, and the trainer trails the trainee. "Ultimately, we let the trainee do the job on her own. But we always have someone nearby to answer questions," Trout says.

To ensure that staffers maintain their newly learned skills, Trout has a rotation system so that no one goes too long without doing the other job. She also does annual retraining, and tests employees to make certain that they can perform procedures and operate machines as needed.

Dahan assigns cross-trained workers based on whom she considers the best person for that slot. "Staffers who know they're going to be absent are instructed to call me at home before the workday starts so that I can deploy people based on their knowledge and skills," she says.

Generating buy-in from employees In general, employees are amenable to cross-training. Those who aren't usually see the light after they're told how the process benefits them: In addition to gaining a stronger background and a more interesting workday, they won't have to slog through a mound of work that's piled up when they're out of the office. Those who are reluctant to pinch hit in a certain slot because it's too stressful, boring, or difficult can usually be persuaded when you point out that they'll be helping the practice—and it's only temporary.

"For cross-training to work effectively, everyone has to buy into it—physicians, administrators, and rank-and-file employees—and commit long term to the process," says Hertz. "All policies, procedures, and protocols should be put in writing and kept up to date, either by the office manager or department head."

Policies and procedures that are physician-specific should be put in writing, too. "We do a lot of in-office minor surgery," says Kelleher. "Nurses have written down what type of instruments and other materials each physician prefers, so that a medical assistant can step in if the nurse is absent."

Should you reward employees who have been successfully cross-trained? Kelleher says No. "We consider cross-training to be part of the job, and as such it's already factored into employee compensation," he points out.

Karla Trout agrees, but says she'll make an exception if someone assumes a responsibility that wasn't discussed beforehand. "Recently, we trained a file clerk to do digital transcription, which is new to our office," she explains. "Because we didn't hire the clerk with that in mind, we increased her salary."

If you can't afford a financial reward, show your gratitude in other ways. "It could be a celebratory lunch or dinner," says the MGMA's Ken Hertz, "or a handwritten note from you indicating that you appreciate the staffer's additional contribution to the practice."