Even with a pre-med degree in economics from Princeton University, cosmetic surgeon Dr. Filiberto Rodriguez, of RGV Cosmetic Surgery and Vein Care in Edinburg and Brownsville, TX, says running a medical practice comes with many employment issues that go beyond his medical and advanced business training and require assistance from experts in Human Resources and Employment Law. In this interview with Aesthetic Insider™ News, Dr. Rodriguez explains the importance of establishing practice policies that serve employee needs and also provide necessary protection for his practice. He has utilized the services of CEDR HR Solutions, a leading employee relations firm based in Tucson, AZ, for the past four years. To learn more about Dr. Rodriguez visit www.rgvcosmetic.com. To learn more about CEDR HR Solutions visit www.cedrsolutions.com.
What is the biggest challenge to you when it comes to practice management?
The biggest challenge I have is running two practices in two different locations and making sure that both offices are well-staffed. Both practices are open full-time, five days a week. One of the benefits I have is that my wife is also an MD, and not only helps me manage the practice(s), but is also equally concerned about making sure that each location brings the best level of care to our patients, and the best level of personal enjoyment and productivity to the workplace for all of our staff. Between our two aesthetic practices we manage 19 staff members, each with a different job description. However, both my wife and I come from medical families who have been part of this local community for decades, so we do have history and family acquaintances on our side when it comes to hiring our team.
Why did you choose to study economics at Princeton University before becoming an MD?
My father was an expert cardiac surgeon who had a traditional medical education that concentrated primarily on biology and medicine. He had a great practice, but I could see the difficulties he encountered with both staff and financial management. When I decided I wanted to be a doctor, and knowing that business is not part of a regular medical school curriculum, I knew that I needed to learn more about business and economics, so that after medical school I would be better equipped as a doctor. As doctors, our focus is always on the care of the patient, but having increased knowledge of analytics, costs, inventory control, supply and demand, etc., especially in an aesthetic surgery practice, can mean the difference between success and failure. I chose success.
How has CEDR HR Solutions helped you set practice policies?
I first met Paul Edwards, the founder of CEDR HR Solutions, at a hospital here in McAllen, TX. He was giving a lecture to the doctors entitled “Preventing Embezzlement and Litigation in Your Practice.” The first question he asked was if anybody in the room had an Employee Handbook. I raised my hand. (I think I was the only one to do so.) I had a handbook that had been given to me by mentor and teacher during my cosmetic surgery fellowship, which I thought adequately covered my practice needs. Paul offered to review it, and as we went through the importance of policies and procedures, hiring and firing criteria, and vacation policies, it became obvious that all these little things that we take for granted were really quite critical. The first thing I did with CEDR was to have them help me customize an Employee Handbook specifically for my practice. At that time I had about 10 employees. Now we have 19 and growing, so establishing order is important. As mentioned earlier, I had watched my father struggle with these areas, so it was vitally important to me to run my practice as a business, not a “mom-and-pop store.” The Employee Handbook itself is over 76 pages in length and covers State and Federal Labor Law requirements. This Employee Handbook comprises the core of my practices’ policies and procedures, is over 168 pages in length, and covers every single aspect of my practice. CEDR sends me regular updates to the Employee Handbook to keep it current. I am also a monthly subscriber to the CEDR Solution Center, where my management staff can watch webinars and tutorials on employee management and other employee-related themes. I also have unlimited access via telephone and email to CEDR’s legal team. In terms of how CEDR has helped me set practice policies, I would say the Employee Handbook has been one of the best practice investments I have made.
Why Is An Employee Handbook so important to you?
Well, two reasons really. The first is that it creates structure in the practice, which is necessary to run a smooth operation. The second is that the medical industry is a target of both the Department of Labor and employment law attorneys, who are constantly looking for low-hanging fruit. A properly written and legally compliant Employee Handbook helps both my employees and me understand everything from job descriptions, coffee breaks, paid maternity leave, holiday and vacation time, and even hiring and firing policies. If a practice has a clear and compliant handbook, it is less likely to be a target for an employee lawsuit.
What does your Employee Handbook cover?
It covers almost every single aspect of my practice. Almost too many details to mention, but the most important areas that I feel are necessary to be outlined in an Employee Handbook are job descriptions—for all staff, including front and back office. This leaves no room for error. My handbook also covers tardiness, paid vacation, maternity leave policies, job performance expectations, reviews and consequences, dress and attire, patient risk, use of practice time for personal reasons, and the list goes on.
Why do you feel a properly written job description is necessary?
Each employee at my practice serves a different purpose, and in order to avoid overlap or confusion we make clear job descriptions that the staff read and sign off on. This way none of my staff have to make assumptions about their responsibilities, and there is less room for error. The job descriptions are an important aspect of protecting my practice against frivolous attempts for unemployment benefits after termination. Detailed job descriptions combined with written corrective action forms support a practice’s decision to terminate an employee and avoid costly unemployment benefits.
How long did it take for CEDR to customize your Employee Handbook?
The main thing to understand is that an Employee Handbook is only as good as the amount of time that has gone into establishing the content. What I mean is that it is up to the practitioner to actually help CEDR customize the handbook based on their individual practice, and quite frankly it can be a lot of work; especially for a large practice. CEDR HR Solutions sent me a draft of my employee manual that was about 80 pages in length. At first I thought, this is great, it’s exactly what I need—but CEDR encouraged me to read through it more than once and to make notes as to areas that did not apply to me, and areas where policies were lacking. We customized it together based on their guidelines. Things I had to take into consideration were practice description, practice philosophy, what holidays we observe, vacation time, maternity leave, breaks, patient protocols, dress and behaviour, supplies and inventory, lock up of meds, medical supplies and inventory, etc. They were very helpful with State and Federal legal compliance policies, and they ensured that we had those in place. The whole process took a couple of months, and even now they continue to update my Employee Handbook the moment something changes with the Department of Labor.
Did you ever have an incident that was not covered in the Employee Handbook?
Yes. I have a Registered Nurse Injector who is paid on commission. We had drafted a separate agreement and job description for her that included the terms of how she was paid on commission, expectations, etc. What we did not have in the agreement was who was responsible for refunding a patient who wasn’t happy with the service they received from the RN. Well, even though we rarely give refunds, because nothing is guaranteed in medicine, I did have an instance where we had to issue a refund to a patient. When this happened, I couldn’t by law have the nurse refund me her commission for this service, because refunds were not specifically addressed in her agreement, and we did not have a written policy in that regard. This is a case of something that you may not be able to foresee or know about until it happens. Fortunately, it only happened once, and since then CEDR has adjusted our Employee Handbook to include RN agreements, plus a lot more of such precautions.
Do you use the CEDR Solution Center Advisor service?
Yes, of course. I think anyone who creates an Employee Handbook and who doesn’t sign up for the monthly service is really missing out. It has been so helpful to me and to my practice managers. Any time I have an employee issue or concern, I know I can pick up the phone and call CEDR and get an immediate answer to my question. There have been times when I have been asked a question by an employee that I cannot answer, but one of CEDR’s HR Advisors or attorneys are able to. If I was to call a regular attorney with that same question, it would start at around $300 to $400 per hour, and that is much higher than the monthly subscription to the CEDR Solution Center. If I had to call my attorney every time I had an employee issue or question, it could end up costing a small fortune.
Does it make financial sense for you to be a customer of CEDR?
Absolutely. I am most valuable when I am in the OR, or consulting with patients, and my staff and managers are most valuable when they are happy at work and serving our patients. Having CEDR as part of my team allows us to be the best, and the cost is pennies on the dollar. My manager is on a first name basis with the top attorneys at CEDR HR Solutions, who are able to immediately help her with any issue that might arise.
Have you ever had to fire an employee? If so, how did you handle it?
I have terminated several employees, but the most difficult termination I ever had to do was a physician employee, for breach of contract. It was very complicated, and the last thing you want as an employer is a wrongful termination claim. I can’t stress enough the importance of a legally compliant and all-inclusive Employee Handbook. Set policies and sign agreements that protect you.
What recommendations would you make to a young doctor starting a medical practice?
Call CEDR and get an Employee Handbook. It’s easier to start one when you have a small practice and a single employee. As the practice grows and becomes more complex, CEDR can work with you to adjust the handbook, write up job descriptions, add new policies and laws, etc. The more established a practice becomes, the harder these things get, and the less time you have to pay attention to small details that can quickly become big problems.
What’s next for RGV cosmetic surgery?
We are actually in the process of building a 16,000 square foot office, and ambulatory surgery center complex to replace our current offices in Edinburg. This will give me more time to see patients as I perform surgery. We will keep the second office located in Brownsville, TX, but the next big thing for me is the building of this surgery center. It’s a great time for RGV Cosmetic Surgery, and the whole team is excited about our future growth.
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TO LEARN MORE ABOUT HOW CEDR HR SOLUTIONS CAN HELP YOUR PRACTICE, READ THESE ARTICLES!