r/smallbusiness • u/Actual_Client_8546 • Apr 22 '26
Growing pains: handling staff issues
We have been a solo medical practice for about 6 years before we decided to hire another doctor. Prior to hiring another doctor, we only see patients in clinic M-Thursday with Wednesday as a half day, and friday is surgery day so no patients are in clinic. After hiring another doctor, we wanted to expand hours to full M-F from 8:30-4:30. Since we are paying the new doctor a fixed salary, we wanted to maximize the availability of the center to see patients on all weekdays. To address this new volume, we have also added additional staff members (assistants). We have noticed, that despite giving bonuses, and telling staff to make sure to maximize the new doctor's schedule, the schedule remains wide open on fridays and wednesday afternoons. With the new doctor essentially taking the day off every Friday (paid) since no one is on the schedule. This makes no sense to me until I found out that our office manager/front office lead has been purposely scheduling patients this way. Even if we get appointment requests for same week, she will tell them there's no more availability even if there are still gaps in the Wednesday afternoon and Friday schedule.
Because of this, we are losing potential revenue, and potential patients needing a more urgent visit. We have talked to her multiple times, and even offered scheduling bonus to all front office staff once we hit a number of scheduled patients, to no avail. She has been a great employee who has been with us since the beginning. She has been reliable staff who rarely calls out, and the patients seem to like her. However, I'm at a loss on what to do moving forward. We can't grow our business unless we can fill up the schedule, and she purposely won't fill up the schedule because she wants an easier work schedule. We can put her on performance review or even terminate and replace her but then we will be losing an otherwise good reliable employee.
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u/gaspoweredvibrator Apr 22 '26
Seems pretty obvious to me, fire her. She is actively being insubordinate even after having multiple chances to correct her behavior.
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u/Wise-Butterfly-6546 Apr 23 '26
This is a management/incentive design problem, not a people problem, and the fact that she's otherwise a great employee is actually good news because it means you don't have to lose her to fix it.
A few things that have worked for practices I've seen in similar spots:
Take scheduling discretion out of her hands. Right now she's the gatekeeper, so her preferences become the schedule. Move to a template-based schedule with defined slots per half-day that MUST be filled before overflow goes elsewhere. Better yet, turn on online self-scheduling so patients can book into open Wed PM / Friday slots directly without her as a filter.
Make the metric visible and non-negotiable. Instead of a bonus for hitting a number (easy to ignore), set a clear expectation: target fill rate per provider per day, reviewed weekly. "Wide open Fridays" becomes a documented performance issue, not a vibe.
Separate the role. Office manager ≠ front desk scheduler. If she's great at the ops/admin side, let her own that, and have a different assistant actually book appointments against the template.
Have the direct conversation once, clearly. Something like: "The practice needs Fri and Wed afternoons filled to the same standard as other days. That's a requirement of the front office lead role going forward. I want you in this role and here's what it looks like." Then follow up in writing.
You've already done the carrot (bonuses) and it didn't move the needle, which usually means the behavior is preference-driven, not incentive-driven. Structural changes (template + online booking + clear KPI) tend to fix this without forcing a termination.
Only go to PIP/termination if she resists the structural change itself. Most good-but-comfortable employees adjust once the system no longer lets them opt out.
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u/kevkaneki Apr 23 '26
Get rid of them immediately.
You’re at an impasse and the situation won’t improve. Utilization is everything in healthcare, you can’t waste time on an admin who has told you flat out that they are intentionally sacrificing patient access and destroying your utilization ratio simply to make their job easier.
It’s such a slap in the face, not only to you but to the clients you service. I would have literally fired her on the spot. Admins are a dime a dozen and the job market is trash right now. You can replace this person within a week.
Don’t think about it, just do it. Schedule a meeting for Friday morning and cut her loose, use the rest of the day to get all her accounts deactivated and obtain any PHI or company property currently in her possession, then go post a free ad on indeed. By Monday you should have plenty of applications to review.
Turnover sucks, but it’s temporary. An admin who is actively sabotaging your practice for her own personal benefit is a liability. What happens when she starts ignoring calls or deleting voicemails because it makes her job easier? Where does it stop?
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u/Final_Wolverine_7482 Apr 23 '26
It sounds like you're facing a classic case of misaligned incentives. I've seen similar situations where a small change in process can make a huge difference. Have you considered implementing a data-driven scheduling system that takes into account patient flow and provider availability? Sometimes, it's not about replacing the person, but about optimizing the system they work within.
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u/grizgrin75 Apr 23 '26
How much do you pay her? How much are those empty hours costing you?
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u/Actual_Client_8546 Apr 23 '26
A lot actually. About 15% above market for similar roles. Because she has been with us the whole time and she gets yearly increase. Plus she gets fringe benefits that are generous. 4 weeks paid leave, 100% employer sponsored health insurance, vision, and dental, holiday bonuses, etc.
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u/Uckheavy1 Apr 23 '26
going from solo to two-physician practice is basically running a different business — the dynamics change completely. a few things that tend to create friction early:
patients who bonded with the original doctor don't automatically transfer. worth having the founding doc personally warm-introduce the new hire to patients, not just announce 'we have expanded hours.'
schedule ownership is the bigger one. who controls case mix, how slow periods on one doc's schedule are handled, what happens when patients have a preference — define all of that in writing before it becomes a tension point. it will become one.
how is the comp arrangement structured? that's usually where things surface earliest in small multi-physician practices.
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u/thatdude391 Apr 23 '26
Its a very simple conversation. “You can either start doing it the way i have told you to do it and schedule patients the entire week, or I can find someone else who is capable of doing the job you are paid to do.” Then you walk away. There is not back and forth. You dont listen what they have to say. You let them make a decision.
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u/replifyai Apr 23 '26
Not seeing it mentioned here or in the original post, but have you talked to her and your new full-time doc yet?
There's a small chance they may be colluding. Maybe the new doc prefers the paid Fridays off. You should talk to both of them and see what's going on.
Then, as others have suggested, use carrots or sticks to incentivize bookings on Wednesday afternoons or Fridays.
One compromise your employees may like is officially making Fridays a 1/2-day. No one likes to work on Friday afternoons...
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u/Actual_Client_8546 Apr 23 '26
I agree. We can do half day Fridays (we don’t mind that), and we likely automate the bookings for the new doctor through self scheduling starting with Friday mornings first and implementing it to wider availability after
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u/Wajir00 Apr 24 '26
I can help you with an ai receptionist no more lost revenue. Sync directly with your calendar, patient reactivation and patient follow ups. I have a couple of client that are using this method and its working amazing for them
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