Practice Management Q&As

When you can't afford pay raisesQ. Over the past two years, falling insurance reimbursements have stolen about 30 percent of my income. How can I hold on to my hard-working employees-whom I've always given generous pay and benefits-if I don't have the revenues to fund raises this year?

A. You're right to be concerned about holding on to staffers. Cut your own pay to fund cost-of-living raises, if necessary.

Give staff access to their files?Q. Our receptionist gave notice because her husband is being transferred out of state. She asked us for a letter of recommendation to help with her job search, and we gladly provided it. But she also wants copies of the references we received from her two previous employers when she applied for her current job. Should we give her those?

Finding an expert management consultantQ. How can I find a qualified consultant to help me improve cost controls, cash flow, and employee efficiency?

A. Ask your colleagues for recommendations. Stick to practices the same size as yours. Call physicians you know in other cities too, in case your colleagues (who are, after all, your competitors) aren't candid. You can also ask your specialty society and state and county associations for recommendations. Or you can contact the AMAConsultingLink Network ( http://www.amaconsultinglink.com), the Society of Medical-Dental Management Consultants ( http://www.smdmc.org), or the National Association of Healthcare Consultants ( http://www.healthcon.org).

When you interview candidates, ask for references-lots of them. There's no substitute for experience, and a topnotch consultant can provide a long list of clients for you to talk with. Ask them if the consultant solved the problem-or just created more-and whether they would hire her again. And before you make a final decision, get a formal proposal with a list of what your candidate promises to deliver and for what price.

Putting your teen to work

Q. I'd like to hire my 13-year-old son to do office work after school. I'd put his wages in a college fund. Does he need a work permit? Must I pay him minimum wage? What else do I need to know?

A. Laws on employing minors vary by state, so contact your state's department of labor. Most states don't permit children to work until they're 14, and require work permits (usually available through the local schools)-even if they're employed in a parent's business. When you do hire him, you'll need to put him on the payroll, pay him at least minimum wage, and withhold taxes on his salary even if all of it goes into a college fund.

Although you want to encourage your son to save, bear in mind that the money will be legally his, to spend as he pleases, when he reaches age 18. Also, assuming he works for you three hours a day for 48 weeks a year, at the end of six years he probably won't amass enough to cover expenses for even one year of college. And, if he qualifies for need-based financial aid, having assets in his own name could reduce the amount of aid he's eligible for.

Do you have a practice management question that may be stumping other doctors, too? Write PMQA Editor, Medical Economics, 5 Paragon Drive, Montvale, NJ 07645-1742, or send an e-mail to mepractice@advanstar.com (please include your regular postal address). Sorry, but we're not able to answer readers individually.