Working With Your Spouse or Child: Dangerous Problems

Shelly Reese

Disclosures

October 08, 2019

Some physicians don't know whether their family members are a problem in the office. According to replies in the Medscape survey, a nurse described being caught between bickering spouses, a physician assistant complained of not knowing who is in charge, and a patient reported she found a new doctor after her physician's "dingbat wife" failed to communicate her question to the physician despite repeated faxes, emails, and calls.

Hiring Family Means They Won't Steal From You (Hopefully)

There are many benefits to hiring family members. They can help you save money by working for a reduced rate, and there may be tax and retirement planning advantages. Family members are also likely to understand your preferences and your communication and organizational styles.

However, the primary reason physicians hire family members often comes down to trust, particularly when they're hiring someone to manage their office and/or billing operations.

"It gives them a sense of comfort related to internal controls," says Elizabeth Woodcock, an Atlanta-based physician practice management consultant. "There's a reassurance that 'nobody is going to steal from me.'"

Doctors are justified in their concern—healthcare is one of the top industries for embezzlement, accounting for more than 5% of all embezzlement cases in 2016 and a median annual loss of $437,016, according to one study. Hiring a family member to oversee a practice's finances comes with its own set of financial pitfalls and issues related to the office culture.

Assigning a family member "control of the checkbook" can cause major financial problems, according to Randy Bauman, president of Delta Health Care consulting.

Bauman frequently evaluates independent practices that are being considered as acquisitions for large practices and health systems. Many of those solo physicians employ their spouses as office managers.

"I see practices where the income is from 30% to 50% below what it should be because there are issues that haven't been addressed," Bauman says. "They're not collecting the money or the billing is incorrect, and the physician doesn't know what to do, so they try to sell the practice."

With Family on Staff, Practice Culture Can Suffer

However, it's not just the intricacies of billing and collections that pose a problem, says Woodcock. Office managers have to contend with personnel issues, such as setting schedules, determining compensation, and conducting performance reviews. Consequently, they can have a profound impact on the culture or the organization.

Working in a practice where a family member is in that office manager or gatekeeper role can be very stifling for the rest of the practice.

"Working in a practice where a family member is in that office manager or gatekeeper role can be very stifling for the rest of the practice," says Ken Hertz, a healthcare practice consultant based in Dallas, Texas. "There's a lack of candor."

As a result, a practice may struggle with high turnover, recruiting challenges, and poor morale. Sadly, the physician may not know the reason for the problem.

Hertz describes an engagement with a midsized gastroenterology practice in which the wife of the president, who was also a physician, took over management of the office following the death of the practice administrator. Hertz found it challenging to give honest advice and assessment.

"What if I tell you that one of the problems is your practice administrator?" he asked the president. "Well, that's not going to happen because she's doing a wonderful job and everyone agrees," he responded.

Confidential conversations with the staff and other physicians in the practice indicated otherwise. The staff described instances when they felt like they were treated unfairly or had issues with the head of the practice. Physicians cited operational problems.

Regardless of their concerns, no one felt they could voice them. When the board opted to adopt Hertz's recommendation that the practice hire a new administrator, "it didn't go over well with the president," who ultimately left the practice with his wife.

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