That employee wants how much?

You’ve got a great office and it’s been growing nicely. You need to hire more team members, specifically, another clinical assistant. So, you place an ad and go through tons of phone interviews until you actually find someone very capable and sane. She is amazing at her working interview and has great patient and hand skill Then the trouble begins. You ask about salary requirements and she says: “My last boss paid me $28/hr, so I’d like to be around there.” You eyes almost fall out of your head as you contemplate the employee costs, but you haven’t seen a decent applicant out of the 40 who’ve applied and the summer “rush” is coming. What do you do?
This scenario is played out in practices every day and we are all faced with the dilemma of whether or not to hire someone at the salary they ask (but we can’t afford) or offer them a lower (realistic) salary and lose them to an office that is willing to pay. Some would say that a great assistant is worth the money, so just bite the bullet and absorb the costs while others would say that you have a responsibility to the overhead of your office above all else. So, what are you supposed to do?
You should start by verifying their previous pay and make sure that they are telling the truth. If someone doesn’t want me to call their previous employer, that’s a huge red flag. But, for the sake of this post, let’s assume that the previous employer did, in fact, pay the very high amount mentioned. At the end of the day, as I’ve said before, there are only 100 pennies in every dollar and every penny more that you pay an employee, means one less penny somewhere else (including your pocket). Obviously, the market for assistants will play a role in your decision. If you’ve been looking for months and can’t find anyone, you’re more likely to want to pay versus your first 24 hrs looking for a new assistant. Perhaps this assistant can make you more productive and the increased productivity can translate into a financial value beyond the average employee. I’ve found that this can be true in smaller practices where every employee plays a fractionally larger role in the collective output of work.
But what about administrative team members?
I’ve seen many discussions related to a treatment coordinator applicant who claims that she can turn a smaller practice into a bigger one through some enchantress-like skills of converting cases. I return, she asks for a very high salary. There are definite pros and cons to each side of the debate, but I’ve definitely seen some very small minded thinking. There are many clinicians who are scared of spending an extra $5000 or $10,000/year on a treatment coordinator who could change their office and help them bring home 50 times that. For instance, if case acceptance is 50% and you’re presenting care to 400 patients/year, and your average case  fee is $5000, what would a 5 or 10% increase in case acceptance mean to you? If you could potentially see an increase of $100,000 because of a $10,000 investment in an employee, wouldn’t it be worth it?
Bigger question: Can a great TC make a real difference, or is it just a bad TC who reduces our case acceptance? Even moreso, have you developed systems where the TC plays a smaller role in case acceptance?
I would strongly suggest checking references and historical claims with previous employers and even then I would create achievement based incentives to easily reward the employee if the claims of incredible success are proven true.
My point is that too many clinicians draw a “line in the sand” and say that they aren’t going to pay above a certain amount, yet have an applicant in front of them who could potentially change their practice forever. While you have a responsibility for the financial well being of your office, you also need to consider the value of investing in the quality of your team.
I remember a saying I learned over 20 years ago at a management course: “Hire for personality and train for skill.” I’ve always believed that the right employee in a sea of bad hires IS worth a higher salary, but one must be responsible with their overhead.
And if you’re desperate for an employee, please don’t just gratuitously throw out a huge number to them because when you invariably let them go, it’s going to make it tough for the next person with whom they interview.
I would LOVE your feedback, and insight, so please feel free to share it.
All the best,
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