There is no doubt that one of the hardest part of managing private practice today is staffing. Private practice don't have the same resources that are available for hospitals or clinics such as an MBA or Human Resources professional that handles staffing issues. But despite this lack of resources, one fact remains: Failure to recognize and successfully address this key component will lead to more stress, less income, and ultimately a far less rewarding career.

It is unfortunate that most of our grad schools failed in giving doctors with even a small amount of training in this very important part of private practice. Failure to appropriately handle staffing issues leads to costly mistakes, lost revenue and potential legal issues. Unfortunately, most doctors only learn to take these issues seriously after making very costly mistakes; however, you can learn the skills you need to build a winning and successful team.

Consider office staffing as a system made up of five basic tenets.

1. Identify all positions that need to be staffed or outsourced

Payroll is often the most costly element of practice. Hiring should only take place after you have carefully designed an organizational chart showing which job will be filled internally, and which must be filled externally.

Decide which tasks will require on-site personnel, and which tasks are suitable for outsourcing. In today's practice environment, it is imperative not to hire people for tasks which could be more appropriately outsourced, subcontracted to other professionals, or handled by existing technology. A perfect example here is transcription that can largely be eliminated with a good electronic records system. Some collections and billing duties can also be transferred to more affordable subcontractors.

Make sure that you have a clear image of the staff structure that you would like to eventually achieve before putting an ad for a potential employee. This careful consideration is essential to profitability, and an important part of practice management. Hiring personnel for your office is an evolutionary process that must compliment your practice style and financial.

2. Find and select appropriate candidates

In order to find the right candidate, you must have a clear vision for the position or role. Before you begin hiring, create a detailed job description for the position. You won't be able to hire the right staff if you are unclear with what you are looking for.

Spell out the duties, responsibilities, and career path for this position. Outline the necessary skills, competencies, and experience an applicant must possess in order to be successful in the position. Define what "excellent performance" in this role would look like. Failing to do this is like attempting to build a skyscraper without an engineering plan.

Once you have a well-defined role in hand, searching for the right applicant can start. Begin by building up a large pool of applicants. Local or regional newspapers work great in most areas. Referrals from your current personnel can also be a good source of great applicants. You may also get good results from posting openings in your office, in any newsletters you send out, and on your website.

Direct potential candidates to submit their resume, references and cover letter to your office via email. This achieves several things:

- Screen out applicants who are lacking basic level of computer literacy

- Enables you to check submitted for spelling, grammar, and style

- Enables you to see if applicants are able to follow basic instructions

If you are not able to accept applications via email, ask potential applicants to fax in their resumes. Do not accept phone calls about open positions. Don't allow endless stream of phone calls from applicants to disrupt your team's day.

Interviewing is an art in and of itself. Always plan to conduct interviews with a partner, preferably with a staff person of the opposite sex. Interview an applicant side-by-side with a trusted ally has the additional benefit of allowing you to compare impressions and ask different question. Before making your selection, it is a good idea to conduct skills test and a second interview. Remember to have a second choice to fall back on, in case your first choice does not work out.

3. Establish management policies

The establishment of sound management policies is a critical step. The creation and maintenance of an effective policy and compliance manual is crucial. Do not disregard this very important part of the team building process.

This manual will ultimately become your practice playbook. Have you ever known a top-notch team or organization to function at high levels without a system of policies, directions and basic rules? Your office is no different. The clearer your manual is, the better the results you will obtain from your team.

A lot of doctors need assistance with this task. You can purchase well written templates, components and resources online. It is important, however, to ensure that your manual and policies comply with state and federal employment law.

- Visit your own state's website to ensure that you understand local labor laws, wage guidelines, and anti-discrimination policies.

- Have a good employment attorney in your state review your policies and procedures. Any costs spent here will be paid back in spades. Many employment law firms can design an excellent manual on your behalf.

Once you have your preliminary manual, review it to ensure it meets legal requirements for hiring, nondiscrimination, time off, etc. Assemble your final manual and put it in accessible locations in the office. All employees must have access to the manual. Place one at every workstation.

4. Create clear written duties and checklists

Each position within your office should have not only a written position description, but also a written checklist of responsibilities.

Record every task and responsibility, from how to open the office locks, safe, and phone system, all the way through to end of the day responsibilities. The safest assumption when writing these is to assume nothing. The more detail oriented you are when going through this process, the less chance there will be for future employee misunderstanding and error.

There are lots of excellent templates and resources available online that you can use as a starting point, but the key to success will involve customization, so that your documentation precisely matches your requirements. This information should then be integrated into your office handbook.

5. Create exact mechanisms for dealing with staff negligence, noncompliance or willful disregard

Ensure that you have clearly written policies, procedures and mechanisms for dealing with staff negligence, noncompliance, or willful disregard. These topics must be fully covered within your policy and procedure manual. When developing your practice policy, apply all of the resources and information available to you. Obtain the advice of solid legal counsel, and have them review your end product before distilling the information to your staff. This can save you countless legal headaches in the future.

By adhering to these five basic tenets, you can begin building a winning and successful team.