Working With Your Spouse or Child: Dangerous Problems

Shelly Reese

Disclosures

October 08, 2019

A physician, bewildered as to why his busy practice was struggling financially, decided to sell it. He was completely unaware that billing and collection errors made by his spouse, working as the office manager, were the root cause of his problem.

In another medical practice, a physician hired his son to be the scribe for one summer. The son had good intentions, but his sloppy work created potential legal, coding, billing, and compliance issues for the practice.

In the most extreme cases, family members can cause patient harm. In July 2019, the Kentucky medical board placed a physician on probation for 5 years for allowing his wife to improperly handle flu vaccines, leading to an infection outbreak in three states.

Doctors have many reasons for employing family members in their practices. They feel that family members have a better understanding of their preferences, as well as a more vested stake in their successes.

How do you reap the myriad of benefits of working with family while avoiding the pitfalls? Carefully. Very carefully.

When Family Joins the Practice

For generations, family members were an entrenched part of private medical practice. Physicians frequently employed their spouses as nurses or office managers and encouraged their children to study medicine with the goal of one day bringing them into the practice. Although most physicians now work for larger healthcare organizations, employing family members is still a common practice among self-employed doctors.

Currently, of the 435 physicians responding to a Medscape poll, more than half (56%) say they currently employ a relative, and 1 in 5 (20%) say they have done so in the past. Spouses are by far the most common familial hires (38%), but respondents also reported employing their adult children (19%), siblings (5%), parents (4%), nieces or nephews (3%), cousins (3%), and other relatives (5%).

Family members are most often hired to manage the office (25%) or oversee billing (13%). Consequently, they can have a big impact on the culture and financial success of the business. Some physicians hire medically trained family members to work in a clinical capacity (16%) as doctors, nurses or, most commonly medical assistants, and an equal percentage have family members working at the front desk.

Most of the time, doctors say that hiring someone in their family works out fine. About half (54%) of the physician respondents say employing a family member has never created tension in their practice; in written remarks to provide explanations for their answers, some say the arrangement is integral to their practice's success.

"Employing family members helps a lot when there is an unexpected crisis and extra load of work," noted one physician respondent. "You can be more flexible, and it is easy to share the burden of extra work." Some staff members commenting in online medical forums also praise the arrangement, saying it promotes a sense of family in the office.

Hidden Downsides to Working With Loved Ones

However, employing family members has its downsides, which doctors may not even realize. Fifteen percent of respondents in the Medscape poll say employing a family member sometimes creates tension or causes issues among other members of their practice.

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