The pros and cons of hiring family members as practice employees

This article appears in the 5/25/2018 edition of Medical Economics

Many physicians hire family members as employees in both clinical and non-clinical roles at their practice. After all, why hire a stranger rather than a family member who presumably is more personally committed and likely to go the extra mile?

Some also want to help their family members by giving them a job. Perhaps a high school student needs summer work, or a newly licensed dietician is ready to step into his first employment setting.

This is especially the case in rural areas, says Robert Wergin, MD, a primary care physician in Milford, Neb.

“Sometimes, if you’re surrounded by cornfields rather than cities or suburbs, it can be hard to find people with the skillsets you need,” he says.

So, “if you’re looking for a dependable person for a particular position, it’s not uncommon for rural practices to have family members work as receptionists or office managers, for a father to take his son into the practice, or for a doctor to hire a spouse as a nutritionist or nurse,” says Wergin.

But there are also some serious downsides.


Potential conflict with other employees

Nitin Damle, MD, immediate past president of the American College of Physicians, says it generally is not a good idea to hire family members at a practice. 

“It creates a fair amount of potential for conflict with other employees, who may be on the lookout for potential nepotism in hiring or promotions,” says Damle, senior/managing partner at South County Internal Medicine, Inc., an eight-physician practice in Wakefield, R.I.

Other employees might also feel that poor performance in the family member will be brushed aside because of the family relationship. “You can get into issues if the employed family member isn’t performing adequately but the physician employer overlooks it,” he says.

To address these concerns, Wergin advises physicians to be vigilant about favoritism and treat all practice employees the same professionally. A practice operates as a team, he says, with each person playing a key part in operations.

“If they feel that you are professional, clear, and transparent about roles, and that you accord all team players equal respect, they are less likely to feel resentful and more likely to feel genuinely valued,” says Wergin.

Family issues in the workplace

Family members do not always get along, and family squabbles can potentially find their way into the workplace.

“It can be tricky when family members feel they are being overworked, and this can lead to resentment,” Damle says.

“Part of being professional is leaving relationship issues and emotions outside the front door,” Wergin stresses.

But if that is too difficult, and if the personal dynamic is causing problems with other employees or with patients, “you might have to sit down with your employee and have an honest, straightforward talk to say that this scenario isn’t working out,” he says.

Clinical vs. non-clinical positions

Damle advises physicians “separate out clinical positions from non-clinical positions, such as office management, front desk work, or other positions that do not involve direct patient care.

His internal medicine practice has a policy not to employ family members for non-clinical positions.“However, if a partner’s son or daughter is a physician or nurse practitioner, for example, and we had a position available, we would be open to it, but we would want to make sure we base our decision on the candidate’s merits,” he says.

The decision to hire a family member is complex and carries both benefits and drawbacks.

“All team members, whether family or non-family, need to be on the same page in making the work environment as inviting and patient-friendly as possible,” Wergin says.