The art and science of cross-border management

Invisible lines raise real barriers to practices

In an era of mergers, more and more physician practices find themselves struggling with how to manage staff remotely. For some, the problems of remote management are compounded by having offices in more than one state.

But the problems that arise are manageable, says Robyn Smith, director of human resources for Physicians Specialty Corp., a practice management company with practices in four states. "There are different state laws, different benefits, but with some education of your staff, you can get through this," she says.

Patty Brewster, regional director of the Hughston Clinic in Atlanta, agrees. She also manages staff in more than one state. But she sees combining cultures as harder than making sure you meet legal requirements. "The laws are the science," she says. "The cultural issues are the art."

Both Smith and Brewster say there are steps you can take to face down the problems of cross-border management:

1. Learn the legal differences.

Rules on issues as mundane as whether and when employees get breaks or as important as who is paid by what company can differ from one state to another. For instance, says Smith, in Georgia, physicians, physician assistants, and nurse practitioners must be paid by the practice, while others can get their income from a management company. In New York, LPNs, RNs, audiologists, and physicians are paid by the practice. At-will employment laws also vary from state to state.

Many of the differences are explained in pamphlets and handouts that are easy to obtain. State chambers of commerce usually have some information on employment legislation available for sale.

Smith relies heavily on a series of books on medical employees and workers' compensation rules published by Summers Press, in Fort Worth, TX. Thompson Publishing Group in Washington, DC, publishes the book, The Employers Guide to Fair Labor Standards. (For contact information, see Editor's note, p. 76.) Smith also relies on the attorneys and consultants she has worked with in the past to guide her.

Once she knows she's getting a practice in another state, Smith immediately orders the books for that state and starts reading. Brewster relies more heavily on the management in the new location. "We make a point of using the local managers," Brewster says. "They know the law, and it helps to bring them into our organization."

Don't forget federal laws

Some federal laws may not apply to a part of the practice, and Smith says you have to deal with such issues carefully. For example, the Family and Medical Leave Act requires that you provide the leave if you have a certain number of employees within a 75-mile radius. "But even if we don't meet that requirement, we still offer it. It is a real boost to morale."

You also have to make sure you have staff fill out I-9 employment eligibility forms again. "And make sure that they fill out that year's forms. If they don't, it's a $100 per line fine," warns Smith.

2. Consolidate benefits.

Perhaps the most labor-intensive aspect of a cross-border merger is figuring out what benefits the new practice has and how they compare to benefits of the existing practice. Smith has created a 12-page questionnaire (for a list of topics covered by the questionnaire, see the related story, p. 75) for managers in other locations to complete. "We have to find out what they have, compared to us," says Smith. "There has to be comparability of sick time, holidays, and vacation time. And while some practices may have a really good leave policy, they may not have a 401k plan."

Smith usually has a 90-day phase-out period for any benefit changes. "It gives them time to deal with any outstanding issues," she says, "particularly if we are changing medical plans, and one of them is expecting a baby or [anticipating other medical procedures]."

Some benefits, like seniority, are best carried over. "Your hire date is the date you were hired at the old practice, not the date you started with us," says Smith.

Regardless of changes, Smith says you have to be honest with the staff. "If you don't have a benefit, such as a retirement plan, and you aren't going to have it, tell them."

3. Establish relationships. Brewster says the easy part is learning the new laws.

The real struggle comes in getting staff in another location to feel they are part of your team. "I fly or drive to every location once a month," she says. "I bring managers to use for team-building sessions, and I make great use of the telephone and technology."

Smith agrees that going out and meeting the new staff is imperative. "But that first meeting can be hostile," she says. "Be ready to work through every issue they bring up, one at a time. Mostly, it's just fear of the unknown."

Brewster makes sure that all staff are brought to the main location for the annual holiday party, and that new locations participate in employee appreciation week. Next year, she hopes to start a teleconferencing program that will further assist remote management.

"Remember the science is the laws," says Brewster. "The art is the culture, and you have to bring the art and science together to be successful."

[Editor's note: For more information on various state labor laws, contact: Summers Press, Fort Worth, TX. Telephone: (800) 743-6491; or Thompson Publishing Group, Washington, DC. Telephone: (800) 677-3789.]