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By John Hanks, DC

Many years ago, my wife and I went to see the classic horror movie "The Exorcist" and returned to our apartment so scared we were afraid to take the babysitter home. We were afraid she might turn into a She-Devil and start doing "360s" with her head. Yes, I was frightened then, but that experience was nothing compared to the greatest fear I periodically must face: hiring a new chiropractic assistant.

I would rather take a beating with a bamboo cane than go through the process of selecting a new staff member. That is because at this point in my professional life, I have worked with enough assistants to form a new TV reality show titled, "Survival: How I Made It This Far." There are no illusions in my mind about how my practice has persevered. Let's just call it luck. I have had the good fortune to have worked with a few stellar assistants who made me feel the "good life" of administrative and clinical efficiency would go on forever. Of course, this has never happened. At some point, change occurs and people leave. Then one day you are standing at your reception desk, answering your phone while you have a patient expectantly waiting in a treatment room.

In my early practice years, I operated a satellite office without a receptionist. It wasn't easy. No wonder that I would marvel over the offices with large staffs. Advertisments from one popular practice-building firm pictured chiropractors and their staffs who had been honored for how many seminars they had attended. I remember looking at one picture of a smiling DC, surrounded by about nine attractive women, all dressed in the same-colored outfit. "Which one is he having the affair with?" I wondered at the time.

I have since learned that a staff can grow even if growth is not the goal. Add up the part-time, back-office assistants, the associate doctor, the spouse, bookkeeper, the high-school kid who files in the afternoon, and the massage therapists who come and go, and it can make one big staff family on the Christmas card. That is what happened to me. After years in practice, I found my staff had grown, and I was adding hours to the schedule just to keep them all busy. Soon, I felt compelled to add health insurance, more vacation time and other "perks" to keep everyone happy.

I was facing the dilemma that occurs with most doctors in private practice: How much is enough? How much money, time off, perks, etc., are sufficient to keep the staff content enough to stay? After all, we ask people to work with us during odd hours, stay late until 6 p.m. and put up with the chaos during busy hours. No wonder doctors are often willing to "overdo it" with salary and benefits to prevent the painful effects of staff change. I know of at least one practice where the office manager/receptionist/billing person makes more money per year than her "boss," the chiropractor. I suspect there are more examples like this out there.

At times, I have been desperate to hire someone, and thus made mistakes. One young woman, on her first day in the office, brought in about 40 pictures of her family, kids, dogs, and her pet ferret, and strung them all over her desk, until the desk's working area was reduced to the size of a postage stamp. And she was one of the least annoying ones. I wish I could ask potential employees the questions I really want to ask them, such as "Are you crazy?" or "What personality trait do you have that will drive me crazy?" Most of the problems I have had with chiropractic assistants have been their hidden traits or personal issues, not their clinical or clerical skills.

At least two people who have worked for me turned out to be thieves. And believe it or not, I know of one office that seemed to forgive this penchant in its office manager. She was caught red-handed in an audit, and evidence showed that she had been embezzling for years. But the doctor group did not fire her. "She's a known entity now," one of the docs told me. "We know that she will steal, so we audit her, and don't have to worry that she might steal!" Further conversation with him revealed other reasons they kept her, and I identified with the decision completely. She was very good at her job, and the patients felt at home with her at the front desk. The doctors simply were not ready for the miserable process of hiring a new office manager.

One female assistant I also hired too quickly had a second job at night. She worked as an exotic dancer, which may not have been a problem, except that a couple of young male patients, who apparently frequented her establishment, recognized her. It seemed bizarre for her to be doing ultrasound on a man who, only the night before, had been slipping dollar bills into her thong. Once, a new assistant did not even bother to show up, which seemed to me to be the height of poor manners. We never heard from her again. To this day, I prefer to think she was kidnapped.

It has been said that "no man is an island," but I know of successful practices where the chiropractor does it all alone. It can be done. I no longer need a large staff, but I am resigned to the fact that there will be many more changes before I retire. Change may be inevitable, but that doesn't mean I have to like it!

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