Enhancing Employee Relations

If you ask the average medical student what they anticipate as the five greatest challenges in their upcoming career you would of course get a list that would include national healthcare, malpractice, wrongful diagnosis, demanding lifestyle sacrifices, etc. If you ask the same question to these people after five years in practice, very high on this list will be a new category and that is employees. Aesthetic MD Insider spoke with Dr. Joseph Niamtu, III of Love That Face in Richmond, VA about employee relations and he offered some very sound advice.

Dr. Joseph Niamtu, III

Any seasoned doctor (or business owner) will usually admit that employee relations are one of the biggest challenges of running a business. Of course here, we are talking about the doctor’s office. However, no matter what business you are in, be it a carwash, doughnut shop or surgeon’s office, finding competent, dependable, energized, honest and loyal employees remains a challenge.

A great employee can be an invaluable and cherished asset that can greatly enhance your life, whereas a poor, lackadaisical employee can suck the energy and efficiency away from your practice and life.

Since most doctors generally do not obtain real-life, sophisticated training on staff hiring and firing during medical school, it basically boils down to hit or miss and learning by mistakes; for better or worse. Ask any 20 year veteran of a medical practice about their employee experiences and I guarantee they will tell you “If I would have only known then, what I know now, my life would have been a lot easier”. I certainly don’t feign expertise in employee relations. However, based on the experience of many doctors I have worked with, and my own personal experience running a successful practice, I have developed pearls on hiring and firing.

The first and foremost requirement of having a successful practice with great employees is to have a distinct and clear vision. My vision was to limit my practice to cosmetic facial surgery and market myself as the local expert in cosmetic facial surgery. It also was to have an exemplary and accredited facility with employees committed to teamwork and to have fun at work. My vision included the highest level of patient care and communication. When I hire employees I make my vision clear to them so they understand what is expected. If a practice leader (the doctor) does not have a distinct vision, or if his or her staff is unaware of this vision then chaos results. It would be no different than a football team going to the line without a play. No player would know what to do. This is why teams have plays and practice them. A leader without a distinct vision is a journey without a map.

I feel that there are eight attributes that make a perfect employee and I learned much of this 30 years ago when I worked closely with a consulting firm called Mercer Global Advisors.  For the sake of measurement, we will refer to a perfect employee as a “10”. What we desire is to be able to screen for employees that are a “7” or above. The following attributes will greatly assist this evaluation process.

Eight Attributes Of A Good Employee

  1. Competency and Presentation
  2. Unconditionally Committed
  3. Givers or Takers
  4. Offensive or Defensive
  5. Superstar or Team Player
  6. Joyous
  7. Self Managing
  8. Learner
  1. Competency and Presentation

Competency is the foremost attribute required in the consideration. Again in any service oriented business, customers or patients expect and seek a certain level of care and service. When a person goes to a nice restaurant, they know in advance that it will be expensive. For that expense they expect a high level of service, i.e. prompt seating, polite treatment, accurate ordering, fast service, and attention to detail.   A waiter that cannot meet those expectations is incompetent. This incompetence will, across the board, cause unhappy customers and eventually harm the reputation of the owner regardless of how great the food was. What is frustrating here is that the restaurant owner may really have paid attention to detail. He may have a beautiful facility with ample parking. He may purchase only the finest ingredients and he may have hired the best chef in the area. Despite all the attention to detail, a single incompetent employee may shatter his dream of having a fine restaurant by negating his attention to detail. There is a difference between inexperience and incompetence. If our waiter had a badge “waiter in training” we may expect a lesser level of service. This employee may become an excellent waiter, but should not be turned loose on the public without someone supervising. Presentation is also a very important factor to consider in the medical business. This example applies to cosmetic surgery and general medical offices alike.

The discipline of cosmetic surgery involves cosmetics, aesthetics, and health. One of your most powerful marketing principles is the appearance of the doctor and staff. Slovenly, out of shape staff with yellow teeth or fingers from smoking or excessive body piercings are not the image we are trying to convey. An obese employee that is bubbly and neat may be an asset, but someone with cellulite bulging from dingy polyester white scrubs does not assist your marketing efforts. Sorry to be so graphic and judgmental here, but I have honestly been in doctor’s offices with staff that look like the people I have described above. If we are in the health care industry, should we not be exemplifying health? (Doctor’s also need to present a healthy image too which we will get to later!)

  1. Unconditional Commitment

Unconditionally committed is defined as commitment with the lack of conditions. The closest example I can find is a resident in a training program. As residents, we could not allow anything to take precedence over our work. None of us would have dreamed of telling our respective program chairman that we couldn’t meet a deadline because we ate lunch and didn’t have time. We were in an environment where lunch was not a priority, and our work took precedence. When we are called to the ER in the middle of the night, we can’t say “it’s late, call me in the morning.”

Owners of a business have much more impetus to be unconditionally committed, because they reap more of the benefits or failures than the employees do. For this reason, it is rare to find this level of commitment in an employee. When you have a good leader, clear-cut goals and the correct employees, the ensuing is a beautiful machine. Doctors that have exceptional and profitable practices probably are good leaders and have exceptional employees with a well-defined common goal.

An unconditionally committed employee will perform within reason to accomplish the task at hand. An applicant that won’t work overtime or on Saturdays or follow your rules of the game is only conditionally committed, and does not meet the criteria.

  1. Givers vs. Takers

Someone is either a giver or a taker. A giver is a loving compassionate person who truly enjoys giving of themselves. Givers understand the “win/win” concept and fully realize that the more they give, the more they will receive in return.

A taker on the other hand operates in the win/lose environment in that in order for them to win, someone else must look bad or lose. Any person that speaks negatively about anything in order to enhance their own identity is a taker. A giver would complement the other person on their efforts then focus on those of their own. Although it is impossible to screen for this attribute in an interview, this behavior must be identified and these people removed from your staff. One bad apple can spoil the whole bunch! Takers are the type of employees that gossip, and gossip can cripple a practice. If, as an employer, you ever come across the “what’s in it for me?” attitude, you must take action. If an employee must have someone lose for them to win, guess who will be losing? YOU, the other staff, and the patients.

  1. Offensive and Defensive Employees

By this categorization we are referring to one’s ability to accept change. Positive change is energy. If you examine successful people and successful practices you will see that they thrive on change. Change should breed excitement, but for many people it breeds fear and insecurity. If a doctor is truly interested in approaching excellence, then they must continually change all aspects of their practice to increase efficiency and service. I challenge and reward my staff for changing. We look at our forms, our policies, our furnishings and so on and brainstorm, as a group, on how to improve every aspect of the practice.

Some employees are intimated by change and take the “if it ain’t broke, don’t fix it” attitude. This is poison in a motivated practice. Employees that accept and encourage change are termed offensive, while those employees that fear and resist change are termed defensive. We all like change because it counters boredom. If we all wore the same clothes every day and ate the same food at every meal, life would not be as interesting. The same holds true in the workplace. A valid leader understands that all change may not be effective and must concede to their staff that a given plan was not working. It is alright to make mistakes and not to dwell on them, but rather to attempt to understand what went wrong, do all you can to not let it repeat itself and move forward and enhance the service to your patients. Successful practices have offensive players.

  1. Superstars vs. Team Players

The term superstar is not a positive adjective in this sense. A superstar is that type of employee that can do it all. The superstar manipulates situations so all the attention swirls around them. It is not about winning the game, it is about how many points they scored. The superstar feels that for their previous experience or superior intellect that they can “do better”. They feel a superiority and are often over protective of the doctor and the practice. Their attitude is that they must “save” the practice from the incompetent hands of the other employees. Superstars place themselves in situations that “no one else can do”. For instance, they are the only ones that can back up the computer, or the only ones that do the payroll, etc. They thrive on being needed for important functions. They frequently do this to become indispensable.   Guess what, you can’t fire these employees because no one else can perform the vital functions like back up or payroll. The key to neutralizing superstar status is cross training. Give several staff responsibility for critical functions. This is good business sense and lessens the chance of fraud and embezzlement. Cross training prevents superstardom.

The above examples do not mean that one person should not have responsibility. The difference is in the person. While the superstar wanted other staff kept in the dark, the team player would have communicated the important responsibilities to the other staff so the office would function in his or her absence. Look for, hire and reward team players, they will make your life and practice less stressful.

Although cosmetic surgery is not physically challenging, many doctors go home at night exhausted and stressed. They are not exhausted from doing surgery; they are exhausted from making constant attempts to steer a team to success while keeping peace. Superstars embezzle from the practice. They don’t steal money, they steal energy. They are like sponges and they steal the energy and excitement from the other staff or even patients. To counter this type of behavior in these “indispensable” staff, the doctor must constantly make attempts to skillfully influence situations. This is what becomes stressful and exhausting. Surround yourself with team players and you will be energized. Remember, we are most successful when we are doing what we love to do. My love is surgery. When I have more time to do surgery, I am happier and more energized for my family, my friends and for myself.

  1. Enthusiasm, Joy and Energy

Knowing that we spend a significant part of our time with our staff, it makes sense to seek enthusiastic, joyous and energetic people. Happiness and enthusiasm are contagious and are self-perpetuating. Friendly people with high energy levels are a welcome addition to any group of people anywhere. If you truly believe that there are no dress rehearsals in life then you should make the most out of every waking second. For a practice to approach excellence, there is no room for pessimism. Surround yourself with enthusiastic, joyous, energetic employees with the other previously mentioned attributes and your practice will prosper.

  1. Self Managing

Once you have found staff with the positive attributes, you need to make sure that they are self-managing. There are employees that know just what to do, but will not perform unless directly supervised. This is a drain because you need two people to do the job of one. There is nothing wrong with the concept of a manager, but if you must literally stand over someone to ensure progress, you have an employee that is not self-managing. Self-managing employees are a pleasure to work with and take all the effort out of management.

  1. Learners vs. Non-learners

It is always preferable to hire experienced employees, but often not possible. It is a joy to hire an employee that catches on quickly. It is stressful and regressive to have employees that need to be continually told how to do a task. Unfortunately, some employees never seem to catch on. Our practice has a three month training period where employees are given some slack on learning their job. If they require continual instruction on learning repetitive tasks, then they probably won’t remain on staff.

Hire competent, unconditionally committed, offensive, givers that are self-managing, joyous learners and you will love your job.


If there is a single entity that holds back progress and perpetuates turmoil it would be the hesitancy of doctors to terminate an employee. One must make a decision to run a practice or an employee repair service. There is no doubt that terminating an employee is a decision that is wrought with emotional and legal ramifications. Firing someone or being fired can provoke so many emotions in both parties, that many doctors procrastinate or endure years of unnecessary stress because they cannot bring themselves to “pull the trigger”. It is very traumatic for an employee to be terminated as it signifies failure and humiliation. It is even worse when the employee feels that they were unfairly terminated. If an employee is terminated for being tardy and has the retort that “Mary Ann is always late”, your credibility is lost and you may open yourself to a wrongful termination suit. The best way to avoid termination is to use correct hiring principles. This sounds so trite, but in most offices hiring is such a haphazard event that it becomes a roll of the dice. I am continually amazed by the lack of attention to basic human resource policy in medical practices. Time after time well established offices do not have written job descriptions, policy manuals, employee documentation files, and other basic information. Every office should have written policy on exactly what it takes to be an excellent employee and what it takes to be terminated. For all the above reasons, every practice needs a map and a compass. The map is the policy manual and the compass is the leader of the practice, the doctor. When the performance of an employee begins to falter, the leader must conscientiously ask their self if it is an employee or employer problem. If the employer feels that the employee is not catching on or is unsalvageable, then it is better to approach the inevitable as soon as possible. It is also important to document employee shortcomings and proof of counseling the employee. This is critical in terms of defending a wrongful discharge suit or an unemployment claim. Check with your local and state Labor Board for correct protocol.

If the proper pre-termination steps have been carried out, the actual task of termination need not be complicated. The single most important point is to have the entire script well thought out and clear in your mind. This is no time to ad lib or fumble around, absolute clarity is essential. It is also important to realize that if you are unhappy with the performance of a staff member, they are probably aware of this and they are also probably unhappy and sometimes the termination of employment is actually a relief to both parties. We always terminates an employment relationship on a Friday afternoon, unless a significant infraction such as theft or substance abuse has transpired. It is important to have a private environment away from other employees and it is mandatory to have an employee, preferably of the opposite sex, present to document and witness. I simply tell the employee that the employment relationship is not working. I also tell the employee that I feel that they are a fine person, but that they are just not a good fit for the practice. I tell the employee that I have a certain vision and direction for the practice and that the employee is not moving towards the goals of the practice, and again it is not a good fit. I do not delve into specifics as it opens the door for argumentation or comparison to other employees. It is imperative not to insult the employee and important to leave them with self-esteem. If the situation is applicable, then we offer the employee the ability to resign with severance benefits or be terminated with no benefits. It is acceptable to have a manager do the actual termination, as long as the proper channels are followed. In fact it may be wise for the doctor to distance his or her self from these proceedings and stick to doctoring.

It is an absolute necessity to obtain any keys, credit cards or any other practice possessions immediately. There are many cases of documented sabotage involving the violation of this procedure.

An even greater temptation for sabotage is to terminate an employee with two weeks’ notice. This a perfect invitation for this person to be unproductive or diabolic within your office. A prudent employer will already have a replacement lined up to step right in the position.

To have an all-star team, you have to be ready to play an all-star game.

Dr. Joseph Niamtu, III is a Cosmetic Surgeon who practice in Richmond, VA. A member of the American Academy of Cosmetic Surgery Dr. Niamtu is involved in all aspects of aesthetics. He was recently awarded BEST Cosmetic Surgery Center by Virginia Living Magazine, and ranks among the top three injectors of Botox Cosmetic in the USA. Visit to learn more.

To listen to a Radio Interview with Dr. Niamtu, CLICK HERE:

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