Joseph S. Eastern

My January column, a collection of possible New Year's resolutions, generated quite a few requests for elaboration on some of the suggestions. Hopefully, the next few columns will fulfill some of those requests.

The suggestion on organizing samples triggered the most feedback. Everybody, it seems, thinks they have too many samples, but you really don't. What you have is too much packaging.

If you doubt this, take a good look at the next set of samples that comes into your office. Each unit will probably consist of a big box or card, and somewhere within its depths, amid all the wasted space, will be a single tablet or 3-g tube.

All that space-wasting packaging is purposeful, of course. Bigger is better, after all, from a promotional standpoint anyway. Bigger packages are more likely to be noticed, and there's more room for advertising.

The marketing people figure that if they use up all of your available sample space, you won't have room for their competition.

As a result, you probably have sample packages taking up two or three closets' worth of expensive square footage—with the samples themselves occupying perhaps 5% of that space or less.

Not only that, but each time you need a particular sample, somebody has to go hunting for it. Sometimes you find it, sometimes you don't. And when you do, there's a fair chance it's expired. It's a waste of time, space, and energy, and it's not necessary.

Here's what you do: Create a “parts-bin system” for your samples.

Have a carpenter build you shelving in a central area of the office. Stock those shelves with cardboard or plastic parts bins, which are available in a variety of lengths, widths, shapes, and colors from many different sources.

Three online examples are: www.anytimeproducts.com, www.papermart.com, www.lkgoodwin.com

As samples come in, ask the representative who brings them to strip off all the space-wasting packaging, leaving only the tablet bubble-pack cards or the 3-g tubes. You'll be amazed at how much less space they take up. Store them in the bins, and arrange the bins on your shelving by whatever organizational system you fancy. We do it alphabetically.

You'll always know what samples you have, what you're out of, and what's close to its expiration date. You and your staff will waste far less time searching for the samples you want, and you can use all that freed-up sample space for something far more likely to generate revenue for your office.

A parts-bin system could be an even bigger boon to your office if the Food and Drug Administration ever makes good on its recurrent promise to require written paper trails for all samples entering and leaving a facility.

Periodic inventories, as well as logging samples in and out, will be far easier with my system.

While you're organizing your samples, consider organizing your pharmaceutical reps too.

Many offices allow representatives to come and go as they please, and too many physicians, physician assistants, and nurse practitioners are all too willing to stop and chat with them, which disrupts efficient office flow. And if multiple reps show up in a single day, the chaos just multiplies.

Have your reps make appointments, just as your patients do. We allow only one rep appointment per day—during the lunch break, 10 minutes before the start of afternoon hours. That prevents disruption of the schedule, and it prevents me from chatting too long (which I have a tendency to do).

We also encourage reps not to make appointments at all unless they have something of significance to communicate. I'm happy to speak with reps, but not when all they have to offer is small talk.

A well-organized sample closet will save time, space, and energy.

Courtesy Dr. Joseph S. Eastern

My January column, a collection of possible New Year's resolutions, generated quite a few requests for elaboration on some of the suggestions. Hopefully, the next few columns will fulfill some of those requests.

The suggestion on organizing samples triggered the most feedback. Everybody, it seems, thinks they have too many samples, but you really don't. What you have is too much packaging.

If you doubt this, take a good look at the next set of samples that comes into your office. Each unit will probably consist of a big box or card, and somewhere within its depths, amid all the wasted space, will be a single tablet or 3-g tube.

All that space-wasting packaging is purposeful, of course. Bigger is better, after all, from a promotional standpoint anyway. Bigger packages are more likely to be noticed, and there's more room for advertising.

The marketing people figure that if they use up all of your available sample space, you won't have room for their competition.

As a result, you probably have sample packages taking up two or three closets' worth of expensive square footage—with the samples themselves occupying perhaps 5% of that space or less.

Not only that, but each time you need a particular sample, somebody has to go hunting for it. Sometimes you find it, sometimes you don't. And when you do, there's a fair chance it's expired. It's a waste of time, space, and energy, and it's not necessary.

Here's what you do: Create a “parts-bin system” for your samples.

Have a carpenter build you shelving in a central area of the office. Stock those shelves with cardboard or plastic parts bins, which are available in a variety of lengths, widths, shapes, and colors from many different sources.

Three online examples are: www.anytimeproducts.com, www.papermart.com, www.lkgoodwin.com

As samples come in, ask the representative who brings them to strip off all the space-wasting packaging, leaving only the tablet bubble-pack cards or the 3-g tubes. You'll be amazed at how much less space they take up. Store them in the bins, and arrange the bins on your shelving by whatever organizational system you fancy. We do it alphabetically.

You'll always know what samples you have, what you're out of, and what's close to its expiration date. You and your staff will waste far less time searching for the samples you want, and you can use all that freed-up sample space for something far more likely to generate revenue for your office.

A parts-bin system could be an even bigger boon to your office if the Food and Drug Administration ever makes good on its recurrent promise to require written paper trails for all samples entering and leaving a facility.

Periodic inventories, as well as logging samples in and out, will be far easier with my system.

While you're organizing your samples, consider organizing your pharmaceutical reps too.

Many offices allow representatives to come and go as they please, and too many physicians, physician assistants, and nurse practitioners are all too willing to stop and chat with them, which disrupts efficient office flow. And if multiple reps show up in a single day, the chaos just multiplies.

Have your reps make appointments, just as your patients do. We allow only one rep appointment per day—during the lunch break, 10 minutes before the start of afternoon hours. That prevents disruption of the schedule, and it prevents me from chatting too long (which I have a tendency to do).

We also encourage reps not to make appointments at all unless they have something of significance to communicate. I'm happy to speak with reps, but not when all they have to offer is small talk.

A well-organized sample closet will save time, space, and energy.

Courtesy Dr. Joseph S. Eastern

My January column, a collection of possible New Year's resolutions, generated quite a few requests for elaboration on some of the suggestions. Hopefully, the next few columns will fulfill some of those requests.

The suggestion on organizing samples triggered the most feedback. Everybody, it seems, thinks they have too many samples, but you really don't. What you have is too much packaging.

If you doubt this, take a good look at the next set of samples that comes into your office. Each unit will probably consist of a big box or card, and somewhere within its depths, amid all the wasted space, will be a single tablet or 3-g tube.

All that space-wasting packaging is purposeful, of course. Bigger is better, after all, from a promotional standpoint anyway. Bigger packages are more likely to be noticed, and there's more room for advertising.

The marketing people figure that if they use up all of your available sample space, you won't have room for their competition.

As a result, you probably have sample packages taking up two or three closets' worth of expensive square footage—with the samples themselves occupying perhaps 5% of that space or less.

Not only that, but each time you need a particular sample, somebody has to go hunting for it. Sometimes you find it, sometimes you don't. And when you do, there's a fair chance it's expired. It's a waste of time, space, and energy, and it's not necessary.

Here's what you do: Create a “parts-bin system” for your samples.

Have a carpenter build you shelving in a central area of the office. Stock those shelves with cardboard or plastic parts bins, which are available in a variety of lengths, widths, shapes, and colors from many different sources.

Three online examples are: www.anytimeproducts.com, www.papermart.com, www.lkgoodwin.com

As samples come in, ask the representative who brings them to strip off all the space-wasting packaging, leaving only the tablet bubble-pack cards or the 3-g tubes. You'll be amazed at how much less space they take up. Store them in the bins, and arrange the bins on your shelving by whatever organizational system you fancy. We do it alphabetically.

You'll always know what samples you have, what you're out of, and what's close to its expiration date. You and your staff will waste far less time searching for the samples you want, and you can use all that freed-up sample space for something far more likely to generate revenue for your office.

A parts-bin system could be an even bigger boon to your office if the Food and Drug Administration ever makes good on its recurrent promise to require written paper trails for all samples entering and leaving a facility.

Periodic inventories, as well as logging samples in and out, will be far easier with my system.

While you're organizing your samples, consider organizing your pharmaceutical reps too.

Many offices allow representatives to come and go as they please, and too many physicians, physician assistants, and nurse practitioners are all too willing to stop and chat with them, which disrupts efficient office flow. And if multiple reps show up in a single day, the chaos just multiplies.

Have your reps make appointments, just as your patients do. We allow only one rep appointment per day—during the lunch break, 10 minutes before the start of afternoon hours. That prevents disruption of the schedule, and it prevents me from chatting too long (which I have a tendency to do).

We also encourage reps not to make appointments at all unless they have something of significance to communicate. I'm happy to speak with reps, but not when all they have to offer is small talk.

A well-organized sample closet will save time, space, and energy.

Courtesy Dr. Joseph S. Eastern

It goes without saying that physicians need to keep their knowledge and skills current, but too many private practitioners overlook the similar needs of their employees. Continuing education is as important for your staff as it is for you.

Like you, staff members provide better care to patients when they know the latest findings and techniques. They also provide better information: When patients ask questions of your staff, either in the office or over the phone (which happens more often than you probably think), you certainly want their answers to be accurate and up to date.

There are a lot of good reasons to invest in ongoing staff training. The more your employees know, the more productive they will be. Not only will they complete everyday duties more efficiently, they will be stimulated to learn new tasks and accept more responsibility.

Staffers who have learned new skills are more willing to take on new challenges. The better their skills and the greater their confidence, the less supervision they need from you and the more they become involved in their work.

They will also be happier in their jobs. Investing in your employees' competence makes them feel valued and appreciated. This leads to reduced turnover, which, alone, often pays for the training.

You already do the yearly OSHA training because the law requires it, and you have everyone recertified periodically in basic or advanced CPR (or you should). I'm talking about going beyond the basic stuff that satisfies legal requirements but does not motivate your people to loftier goals.

An obvious example is sending your insurance people annually to coding and insurance processing courses so they are always current on the latest third-party changes. Others include keyboarding and computer courses for staff members who work with computers, and Excel and QuickBooks classes for your bookkeeper.

Continuing education does not have to be costly, and in some cases it can be free. Pharmaceutical representatives will be happy to thoroughly brief your staff on a new medication or medical instrument, or to refresh their memories on an established one. Just make sure the presentation is as impartial as possible, given the obvious conflict of interest involved.

Your office manager should join the Association of Dermatology Administrators/Managers (www.ada-m.org

Many other venues are available for employee education, both online and in conventional classrooms.

Courses are offered in a wide variety of relevant subjects, including medical terminology, record keeping and accounting, laboratory skills, diagnostic tests and procedures, pharmacology and medication administration, patient relations, medical law and ethics, and many others.

By far, the most common question I receive on this issue is this: “What if I pay for all that training and the employees leave?”

My answer, invariably, is this: “What if you don't, and they stay?”

Well-trained employees are vastly preferable to untrained ones, even with the small risk of the occasional staffer who accepts training and then moves on. By and large, well-trained employees will stay. Education fosters loyalty.

Employees who know that you care enough about them to advance their skills will sense that they have a stake in the practice and will be less likely to want to leave.

In any case, everyone will benefit from a well-trained staff: you, your employees, your practice, and most importantly, your patients.

It goes without saying that physicians need to keep their knowledge and skills current, but too many private practitioners overlook the similar needs of their employees. Continuing education is as important for your staff as it is for you.

Like you, staff members provide better care to patients when they know the latest findings and techniques. They also provide better information: When patients ask questions of your staff, either in the office or over the phone (which happens more often than you probably think), you certainly want their answers to be accurate and up to date.

There are a lot of good reasons to invest in ongoing staff training. The more your employees know, the more productive they will be. Not only will they complete everyday duties more efficiently, they will be stimulated to learn new tasks and accept more responsibility.

Staffers who have learned new skills are more willing to take on new challenges. The better their skills and the greater their confidence, the less supervision they need from you and the more they become involved in their work.

They will also be happier in their jobs. Investing in your employees' competence makes them feel valued and appreciated. This leads to reduced turnover, which, alone, often pays for the training.

You already do the yearly OSHA training because the law requires it, and you have everyone recertified periodically in basic or advanced CPR (or you should). I'm talking about going beyond the basic stuff that satisfies legal requirements but does not motivate your people to loftier goals.

An obvious example is sending your insurance people annually to coding and insurance processing courses so they are always current on the latest third-party changes. Others include keyboarding and computer courses for staff members who work with computers, and Excel and QuickBooks classes for your bookkeeper.

Continuing education does not have to be costly, and in some cases it can be free. Pharmaceutical representatives will be happy to thoroughly brief your staff on a new medication or medical instrument, or to refresh their memories on an established one. Just make sure the presentation is as impartial as possible, given the obvious conflict of interest involved.

Your office manager should join the Association of Dermatology Administrators/Managers (www.ada-m.org

Many other venues are available for employee education, both online and in conventional classrooms.

Courses are offered in a wide variety of relevant subjects, including medical terminology, record keeping and accounting, laboratory skills, diagnostic tests and procedures, pharmacology and medication administration, patient relations, medical law and ethics, and many others.

By far, the most common question I receive on this issue is this: “What if I pay for all that training and the employees leave?”

My answer, invariably, is this: “What if you don't, and they stay?”

Well-trained employees are vastly preferable to untrained ones, even with the small risk of the occasional staffer who accepts training and then moves on. By and large, well-trained employees will stay. Education fosters loyalty.

Employees who know that you care enough about them to advance their skills will sense that they have a stake in the practice and will be less likely to want to leave.

In any case, everyone will benefit from a well-trained staff: you, your employees, your practice, and most importantly, your patients.

It goes without saying that physicians need to keep their knowledge and skills current, but too many private practitioners overlook the similar needs of their employees. Continuing education is as important for your staff as it is for you.

Like you, staff members provide better care to patients when they know the latest findings and techniques. They also provide better information: When patients ask questions of your staff, either in the office or over the phone (which happens more often than you probably think), you certainly want their answers to be accurate and up to date.

There are a lot of good reasons to invest in ongoing staff training. The more your employees know, the more productive they will be. Not only will they complete everyday duties more efficiently, they will be stimulated to learn new tasks and accept more responsibility.

Staffers who have learned new skills are more willing to take on new challenges. The better their skills and the greater their confidence, the less supervision they need from you and the more they become involved in their work.

They will also be happier in their jobs. Investing in your employees' competence makes them feel valued and appreciated. This leads to reduced turnover, which, alone, often pays for the training.

You already do the yearly OSHA training because the law requires it, and you have everyone recertified periodically in basic or advanced CPR (or you should). I'm talking about going beyond the basic stuff that satisfies legal requirements but does not motivate your people to loftier goals.

An obvious example is sending your insurance people annually to coding and insurance processing courses so they are always current on the latest third-party changes. Others include keyboarding and computer courses for staff members who work with computers, and Excel and QuickBooks classes for your bookkeeper.

Continuing education does not have to be costly, and in some cases it can be free. Pharmaceutical representatives will be happy to thoroughly brief your staff on a new medication or medical instrument, or to refresh their memories on an established one. Just make sure the presentation is as impartial as possible, given the obvious conflict of interest involved.

Your office manager should join the Association of Dermatology Administrators/Managers (www.ada-m.org

Many other venues are available for employee education, both online and in conventional classrooms.

Courses are offered in a wide variety of relevant subjects, including medical terminology, record keeping and accounting, laboratory skills, diagnostic tests and procedures, pharmacology and medication administration, patient relations, medical law and ethics, and many others.

By far, the most common question I receive on this issue is this: “What if I pay for all that training and the employees leave?”

My answer, invariably, is this: “What if you don't, and they stay?”

Well-trained employees are vastly preferable to untrained ones, even with the small risk of the occasional staffer who accepts training and then moves on. By and large, well-trained employees will stay. Education fosters loyalty.

Employees who know that you care enough about them to advance their skills will sense that they have a stake in the practice and will be less likely to want to leave.

In any case, everyone will benefit from a well-trained staff: you, your employees, your practice, and most importantly, your patients.

Ah, the start of a new year—the traditional time for resolutions, for turning over new leaves, for promising (yet again) to break all those annoying bad habits once and for all.

As long as you're pledging to break bad habits at home, why not set your mind to breaking some bad habits at the office as well?

I can't presume to know what your professional bad habits are, but I do know the ones I get asked about most often, so I can offer a top 10 list that might provide inspiration for your personal list of resolutions:

Start on Time

Many physicians complain about running behind. Guess what? Your patients complain about it, too. Waiting is the most common patient complaint, and you can't hope to run on time if you don't start on time. No single change will improve office efficiency more than this.

Spend Less Time on the Web

Okay, I confess that this one is on my own list this year. Fear not, RxDerm-L and DermChat members. I'll still be there, but you will notice from now on that my posts will be time stamped early in the morning or late at night and not during office hours. It is just too easy to start clicking that mouse and to continue until you're half an hour behind. We all have plenty of other short tasks that we could be completing during those brief office lulls.

Permit Fewer Interruptions

Phone calls and pharmaceutical representatives seem to be the big interrupters in most offices. Make some rules, and stick to them. I'll stop to take an emergency call or one from an immediate family member; all others get routed to the nurses or are returned at lunch or after hours. Reps are instructed to make appointments, like everybody else, and I generally limit rep appointments to one a day, scheduled a few minutes before I start my afternoon hours.

Organize Samples

We strip all of the space-wasting packaging off of our samples and store them, alphabetically, in cardboard parts bins that can be purchased from many industrial catalogs. Besides always knowing what you have on hand, you'll always know what you're out of and your staff will waste far less time searching for the samples that you want. Also, a bin system makes logging samples in and out much easier, should that become a requirement (as the Food and Drug Administration keeps promising).

Clear Your Horizontal File Cabinet

That would be the mess on your desk—all the paperwork you never seem to get to. (Probably because you're answering e-mail.) Set aside an hour or two and get it all done. You'll find some interesting stuff in there. Then, for every piece of paper that arrives on your desk from now on, follow the DDD Rule: Do it, Delegate it, or Destroy it. Don't start a new mess. There's an entire column on this subject in the Archive Collection.

Keep a Closer Eye on the Office's Financial Situation

Most physicians delegate the bookkeeping, and that's fine, but ignoring the financial side completely creates an atmosphere that can facilitate embezzlement. Set aside a couple of hours each month to review the books personally. And make sure that your employees know you're doing it.

Make Sure Your Long-Range Financial Planning Is on Track

This is another aspect physicians tend to set and forget, but economic conditions change all the time. Once a year, you should sit down with your accountant and lawyer and make sure your investments are well diversified and that all other aspects of your finances—budgets, credit ratings, insurance coverage, tax situations, college savings, estate plans, retirement accounts—are in the best shape possible.

Pay Down Your Debt

Debt can destroy the best-laid retirement plans. If you carry significant debt, make sure that you set up a plan to pay it off as soon as you can.

Take More Vacations

Remember Eastern's First Law: Your last words will not be, “I wish I had spent more time in the office.” If you have been working too much, this is the year to start spending more time enjoying your life, your friends and family, and the world. As John Lennon said, “Life is what happens to you while you're busy making other plans.”

Look at Yourself

A private practice lives or dies on the personalities of its physicians, and your staff copies your personality and style. That being the case, it behooves you to take a hard, honest look at yourself. Identify your negative personality traits and work to eliminate them. If you have any difficulty finding the things that need changing, ask your spouse. I'm sure he or she will be happy to outline them for you … in great detail.

Ah, the start of a new year—the traditional time for resolutions, for turning over new leaves, for promising (yet again) to break all those annoying bad habits once and for all.

As long as you're pledging to break bad habits at home, why not set your mind to breaking some bad habits at the office as well?

I can't presume to know what your professional bad habits are, but I do know the ones I get asked about most often, so I can offer a top 10 list that might provide inspiration for your personal list of resolutions:

Start on Time

Many physicians complain about running behind. Guess what? Your patients complain about it, too. Waiting is the most common patient complaint, and you can't hope to run on time if you don't start on time. No single change will improve office efficiency more than this.

Spend Less Time on the Web

Okay, I confess that this one is on my own list this year. Fear not, RxDerm-L and DermChat members. I'll still be there, but you will notice from now on that my posts will be time stamped early in the morning or late at night and not during office hours. It is just too easy to start clicking that mouse and to continue until you're half an hour behind. We all have plenty of other short tasks that we could be completing during those brief office lulls.

Permit Fewer Interruptions

Phone calls and pharmaceutical representatives seem to be the big interrupters in most offices. Make some rules, and stick to them. I'll stop to take an emergency call or one from an immediate family member; all others get routed to the nurses or are returned at lunch or after hours. Reps are instructed to make appointments, like everybody else, and I generally limit rep appointments to one a day, scheduled a few minutes before I start my afternoon hours.

Organize Samples

We strip all of the space-wasting packaging off of our samples and store them, alphabetically, in cardboard parts bins that can be purchased from many industrial catalogs. Besides always knowing what you have on hand, you'll always know what you're out of and your staff will waste far less time searching for the samples that you want. Also, a bin system makes logging samples in and out much easier, should that become a requirement (as the Food and Drug Administration keeps promising).

Clear Your Horizontal File Cabinet

That would be the mess on your desk—all the paperwork you never seem to get to. (Probably because you're answering e-mail.) Set aside an hour or two and get it all done. You'll find some interesting stuff in there. Then, for every piece of paper that arrives on your desk from now on, follow the DDD Rule: Do it, Delegate it, or Destroy it. Don't start a new mess. There's an entire column on this subject in the Archive Collection.

Keep a Closer Eye on the Office's Financial Situation

Most physicians delegate the bookkeeping, and that's fine, but ignoring the financial side completely creates an atmosphere that can facilitate embezzlement. Set aside a couple of hours each month to review the books personally. And make sure that your employees know you're doing it.

Make Sure Your Long-Range Financial Planning Is on Track

This is another aspect physicians tend to set and forget, but economic conditions change all the time. Once a year, you should sit down with your accountant and lawyer and make sure your investments are well diversified and that all other aspects of your finances—budgets, credit ratings, insurance coverage, tax situations, college savings, estate plans, retirement accounts—are in the best shape possible.

Pay Down Your Debt

Debt can destroy the best-laid retirement plans. If you carry significant debt, make sure that you set up a plan to pay it off as soon as you can.

Take More Vacations

Remember Eastern's First Law: Your last words will not be, “I wish I had spent more time in the office.” If you have been working too much, this is the year to start spending more time enjoying your life, your friends and family, and the world. As John Lennon said, “Life is what happens to you while you're busy making other plans.”

Look at Yourself

A private practice lives or dies on the personalities of its physicians, and your staff copies your personality and style. That being the case, it behooves you to take a hard, honest look at yourself. Identify your negative personality traits and work to eliminate them. If you have any difficulty finding the things that need changing, ask your spouse. I'm sure he or she will be happy to outline them for you … in great detail.

Ah, the start of a new year—the traditional time for resolutions, for turning over new leaves, for promising (yet again) to break all those annoying bad habits once and for all.

As long as you're pledging to break bad habits at home, why not set your mind to breaking some bad habits at the office as well?

I can't presume to know what your professional bad habits are, but I do know the ones I get asked about most often, so I can offer a top 10 list that might provide inspiration for your personal list of resolutions:

Start on Time

Many physicians complain about running behind. Guess what? Your patients complain about it, too. Waiting is the most common patient complaint, and you can't hope to run on time if you don't start on time. No single change will improve office efficiency more than this.

Spend Less Time on the Web

Okay, I confess that this one is on my own list this year. Fear not, RxDerm-L and DermChat members. I'll still be there, but you will notice from now on that my posts will be time stamped early in the morning or late at night and not during office hours. It is just too easy to start clicking that mouse and to continue until you're half an hour behind. We all have plenty of other short tasks that we could be completing during those brief office lulls.

Permit Fewer Interruptions

Phone calls and pharmaceutical representatives seem to be the big interrupters in most offices. Make some rules, and stick to them. I'll stop to take an emergency call or one from an immediate family member; all others get routed to the nurses or are returned at lunch or after hours. Reps are instructed to make appointments, like everybody else, and I generally limit rep appointments to one a day, scheduled a few minutes before I start my afternoon hours.

Organize Samples

We strip all of the space-wasting packaging off of our samples and store them, alphabetically, in cardboard parts bins that can be purchased from many industrial catalogs. Besides always knowing what you have on hand, you'll always know what you're out of and your staff will waste far less time searching for the samples that you want. Also, a bin system makes logging samples in and out much easier, should that become a requirement (as the Food and Drug Administration keeps promising).

Clear Your Horizontal File Cabinet

That would be the mess on your desk—all the paperwork you never seem to get to. (Probably because you're answering e-mail.) Set aside an hour or two and get it all done. You'll find some interesting stuff in there. Then, for every piece of paper that arrives on your desk from now on, follow the DDD Rule: Do it, Delegate it, or Destroy it. Don't start a new mess. There's an entire column on this subject in the Archive Collection.

Keep a Closer Eye on the Office's Financial Situation

Most physicians delegate the bookkeeping, and that's fine, but ignoring the financial side completely creates an atmosphere that can facilitate embezzlement. Set aside a couple of hours each month to review the books personally. And make sure that your employees know you're doing it.

Make Sure Your Long-Range Financial Planning Is on Track

This is another aspect physicians tend to set and forget, but economic conditions change all the time. Once a year, you should sit down with your accountant and lawyer and make sure your investments are well diversified and that all other aspects of your finances—budgets, credit ratings, insurance coverage, tax situations, college savings, estate plans, retirement accounts—are in the best shape possible.

Pay Down Your Debt

Debt can destroy the best-laid retirement plans. If you carry significant debt, make sure that you set up a plan to pay it off as soon as you can.

Take More Vacations

Remember Eastern's First Law: Your last words will not be, “I wish I had spent more time in the office.” If you have been working too much, this is the year to start spending more time enjoying your life, your friends and family, and the world. As John Lennon said, “Life is what happens to you while you're busy making other plans.”

Look at Yourself

A private practice lives or dies on the personalities of its physicians, and your staff copies your personality and style. That being the case, it behooves you to take a hard, honest look at yourself. Identify your negative personality traits and work to eliminate them. If you have any difficulty finding the things that need changing, ask your spouse. I'm sure he or she will be happy to outline them for you … in great detail.

One day last month, I noticed that the plastic carpet protector under my desk chair was disintegrating. When I pulled it up to replace it with a new one I got quite a surprise: The patch of carpet it had been protecting was considerably brighter and cleaner than the rest of the carpeting in my office.

Sometimes it takes a jolt like that to remind us to take a good look at our office furnishings. I discovered that a lot more than a carpet protector needed replacing. We tend not to notice gradual deterioration. Carpets fade and dull with constant traffic and cleaning. Wallpaper and paint accumulate dirt, stains, and damage. Furniture gets dirty and dented.

In particular, you might be surprised by the condition of your waiting room if you haven't been out there for awhile. I certainly was. The wallpaper was smudged behind chairs, where patients had rested their heads. There were stains and pen marks on the chairs' upholstery, and the frames were scratched and worn. The well-trafficked carpet was stained, faded, and pulled.

Even if you don't find anything obvious, it is wise to check periodically for subtle evidence of age. Find some patches of carpeting and flooring under desks and compare them with the exposed areas.

You also might want to look at the décor itself. Is it dated and just plain old looking? Any interior designer can determine when a space was last decorated, simply by the color and style of the materials used. If your office is stuck in the 1980s, it's probably time for a change.

Your next vacation would be a great time to make those changes. You'll come back to a new, fresh environment.

Start by reviewing your color scheme, and consider changing it if you're tired of it, or if, as mentioned, it's hopelessly out of date. Wallpaper and carpeting should be long-wearing industrial quality. The paint should have a high-quality “eggshell” finish to facilitate cleaning, and it should be professionally applied.

If you've grown tired of your wall decorations, now would be a good time to replace at least some of them. This need not be an expensive proposition. If you or a family member is an artist or photographer, consider framing some of the best work. Or invite local artists to display some of their work on your walls.

Furniture is another important consideration. You may be able to resurface and reupholster what you have now, but if not, shop carefully. Beware of products that are promoted specifically to physicians, as they tend to be overpriced.

Get recommendations from colleagues and others, and never shop solely on price. If you shop online, factor in shipping costs, which can be considerable for furniture. Don't be afraid to ask for discounts. You won't get them if you don't ask.

Plants, in my opinion, are important in any indoor environment. They help you, your employees, and your patients feel less cut off from the outside world. If you are hesitant to take on the extra work of plant upkeep, a corporate plant service will rent you the plants, keep them healthy, and replace any that begin to wither.

As I've mentioned in previous columns, consider joining a state or community business/industry association. They maintain lists of merchants willing to give discounts, and they enable you to find other members looking for similar furniture, which could land all of you a big quantity discount.

This is also a good time to clear out old textbooks, magazines, and files you haven't opened in years. And get your building's maintenance crew in to fix any nagging plumbing, electrical, or heating/air conditioning problems that may have developed.

Finally, spruce-up time is an excellent opportunity to take a look at your medical equipment. We've all seen vintage offices containing gadgets that were new when the office opened decades ago, with no modernization in the interim. Would you want to be treated by those physicians? Neither would your patients, for the most part. Patients want cutting-edge technology. Consider replacing your obsolete equipment, even if it “still works okay.”

One day last month, I noticed that the plastic carpet protector under my desk chair was disintegrating. When I pulled it up to replace it with a new one I got quite a surprise: The patch of carpet it had been protecting was considerably brighter and cleaner than the rest of the carpeting in my office.

Sometimes it takes a jolt like that to remind us to take a good look at our office furnishings. I discovered that a lot more than a carpet protector needed replacing. We tend not to notice gradual deterioration. Carpets fade and dull with constant traffic and cleaning. Wallpaper and paint accumulate dirt, stains, and damage. Furniture gets dirty and dented.

In particular, you might be surprised by the condition of your waiting room if you haven't been out there for awhile. I certainly was. The wallpaper was smudged behind chairs, where patients had rested their heads. There were stains and pen marks on the chairs' upholstery, and the frames were scratched and worn. The well-trafficked carpet was stained, faded, and pulled.

Even if you don't find anything obvious, it is wise to check periodically for subtle evidence of age. Find some patches of carpeting and flooring under desks and compare them with the exposed areas.

You also might want to look at the décor itself. Is it dated and just plain old looking? Any interior designer can determine when a space was last decorated, simply by the color and style of the materials used. If your office is stuck in the 1980s, it's probably time for a change.

Your next vacation would be a great time to make those changes. You'll come back to a new, fresh environment.

Start by reviewing your color scheme, and consider changing it if you're tired of it, or if, as mentioned, it's hopelessly out of date. Wallpaper and carpeting should be long-wearing industrial quality. The paint should have a high-quality “eggshell” finish to facilitate cleaning, and it should be professionally applied.

If you've grown tired of your wall decorations, now would be a good time to replace at least some of them. This need not be an expensive proposition. If you or a family member is an artist or photographer, consider framing some of the best work. Or invite local artists to display some of their work on your walls.

Furniture is another important consideration. You may be able to resurface and reupholster what you have now, but if not, shop carefully. Beware of products that are promoted specifically to physicians, as they tend to be overpriced.

Get recommendations from colleagues and others, and never shop solely on price. If you shop online, factor in shipping costs, which can be considerable for furniture. Don't be afraid to ask for discounts. You won't get them if you don't ask.

Plants, in my opinion, are important in any indoor environment. They help you, your employees, and your patients feel less cut off from the outside world. If you are hesitant to take on the extra work of plant upkeep, a corporate plant service will rent you the plants, keep them healthy, and replace any that begin to wither.

As I've mentioned in previous columns, consider joining a state or community business/industry association. They maintain lists of merchants willing to give discounts, and they enable you to find other members looking for similar furniture, which could land all of you a big quantity discount.

This is also a good time to clear out old textbooks, magazines, and files you haven't opened in years. And get your building's maintenance crew in to fix any nagging plumbing, electrical, or heating/air conditioning problems that may have developed.

Finally, spruce-up time is an excellent opportunity to take a look at your medical equipment. We've all seen vintage offices containing gadgets that were new when the office opened decades ago, with no modernization in the interim. Would you want to be treated by those physicians? Neither would your patients, for the most part. Patients want cutting-edge technology. Consider replacing your obsolete equipment, even if it “still works okay.”

One day last month, I noticed that the plastic carpet protector under my desk chair was disintegrating. When I pulled it up to replace it with a new one I got quite a surprise: The patch of carpet it had been protecting was considerably brighter and cleaner than the rest of the carpeting in my office.

Sometimes it takes a jolt like that to remind us to take a good look at our office furnishings. I discovered that a lot more than a carpet protector needed replacing. We tend not to notice gradual deterioration. Carpets fade and dull with constant traffic and cleaning. Wallpaper and paint accumulate dirt, stains, and damage. Furniture gets dirty and dented.

In particular, you might be surprised by the condition of your waiting room if you haven't been out there for awhile. I certainly was. The wallpaper was smudged behind chairs, where patients had rested their heads. There were stains and pen marks on the chairs' upholstery, and the frames were scratched and worn. The well-trafficked carpet was stained, faded, and pulled.

Even if you don't find anything obvious, it is wise to check periodically for subtle evidence of age. Find some patches of carpeting and flooring under desks and compare them with the exposed areas.

You also might want to look at the décor itself. Is it dated and just plain old looking? Any interior designer can determine when a space was last decorated, simply by the color and style of the materials used. If your office is stuck in the 1980s, it's probably time for a change.

Your next vacation would be a great time to make those changes. You'll come back to a new, fresh environment.

Start by reviewing your color scheme, and consider changing it if you're tired of it, or if, as mentioned, it's hopelessly out of date. Wallpaper and carpeting should be long-wearing industrial quality. The paint should have a high-quality “eggshell” finish to facilitate cleaning, and it should be professionally applied.

If you've grown tired of your wall decorations, now would be a good time to replace at least some of them. This need not be an expensive proposition. If you or a family member is an artist or photographer, consider framing some of the best work. Or invite local artists to display some of their work on your walls.

Furniture is another important consideration. You may be able to resurface and reupholster what you have now, but if not, shop carefully. Beware of products that are promoted specifically to physicians, as they tend to be overpriced.

Get recommendations from colleagues and others, and never shop solely on price. If you shop online, factor in shipping costs, which can be considerable for furniture. Don't be afraid to ask for discounts. You won't get them if you don't ask.

Plants, in my opinion, are important in any indoor environment. They help you, your employees, and your patients feel less cut off from the outside world. If you are hesitant to take on the extra work of plant upkeep, a corporate plant service will rent you the plants, keep them healthy, and replace any that begin to wither.

As I've mentioned in previous columns, consider joining a state or community business/industry association. They maintain lists of merchants willing to give discounts, and they enable you to find other members looking for similar furniture, which could land all of you a big quantity discount.

This is also a good time to clear out old textbooks, magazines, and files you haven't opened in years. And get your building's maintenance crew in to fix any nagging plumbing, electrical, or heating/air conditioning problems that may have developed.

Finally, spruce-up time is an excellent opportunity to take a look at your medical equipment. We've all seen vintage offices containing gadgets that were new when the office opened decades ago, with no modernization in the interim. Would you want to be treated by those physicians? Neither would your patients, for the most part. Patients want cutting-edge technology. Consider replacing your obsolete equipment, even if it “still works okay.”

[email protected]

Accepting credit cards in your office—both for capturing charges immediately at the time of service and for billing residual balances—has huge advantages. But how do you arrange for credit card processing at your office at the best possible price?

Several processing services are available. Which one you choose will depend not only on cost, but on what specific services you need.

It will also depend on what cards you wish to take. MasterCard and Visa require you to establish a merchant account through an intermediary, but American Express and Discover give you the option of applying directly to them.

Your current bank is probably the easiest intermediary to turn to, but many offer credit card services as part of a package that will include other merchant services you may or may not need.

Another option is an independent sales organization (ISO), which is essentially a broker who represents one or more card processors. An ISO will set up and serve your office but, like a bank, will not do the actual processing itself: It outsources that job to a third-party credit card processor.

If your state or city has a small business and trade association, ask if it offers credit card processing at discount prices.

Consider only processors that provide excellent customer service. Call colleagues and ask which banks or processing companies they use, and ask each candidate company for a list of the medical offices they already serve. Call some of those offices and ask questions: How difficult is it to reach customer support? Are problems handled quickly? How does the provider deal with “chargebacks” (charges later disputed by the cardholder)?

Question the processors about their level of support: Are their phones staffed 24 hours a day? Do they charge for support, either monthly or per call?

Compare prices carefully. Some providers charge application fees of up to $200, and these may be nonrefundable even if you change your mind. You may also be asked to pay setup or account activation fees, Internet processing fees, customer support fees, etc. As always, be sure you have a complete understanding of all the charges you will incur before making your decision and signing a contract.

The principal equipment cost will be for the terminal, which is the machine used to swipe cards. Basic terminals typically cost between $150 and $300; terminals with printers are $200 to $600; and wireless terminals can run from $600 to $1,000. Leases start at $35 a month and rise from there, depending on the sophistication of the terminal and the length of the lease.

The primary ongoing fee is the “discount rate” or “swipe rate,” a percentage the provider takes off the top of each transaction. Ask about reduced rates for high volume, or for total receipts higher than a specified amount per month.

Watch out for extra charges, such as “per transaction” fees and monthly transaction summary preparation fees. Such fees may be negotiable or even waivable, although the company may not volunteer that information.

Beware of long-term leases with early-termination fees. If you are unhappy with your service, you don't want to have to pay a hefty charge for the privilege of changing companies. Also watch out for a trick borrowed from the consumer credit card industry: low introductory rates that increase significantly after a few months or a year.

Find out how long it takes for receipts to be deposited to your account, as this can vary widely. A marginally lower swipe rate won't be worth it if you don't have the use of your money for months.

Finally, if you're not using a bank or financial company you know well, make sure the company is legitimate. Contact the Better Business Bureau to check its status. And if the company is based primarily on the Internet, make sure that you get a physical address and phone number, plus recommendations from existing clients.

[email protected]

Accepting credit cards in your office—both for capturing charges immediately at the time of service and for billing residual balances—has huge advantages. But how do you arrange for credit card processing at your office at the best possible price?

Several processing services are available. Which one you choose will depend not only on cost, but on what specific services you need.

It will also depend on what cards you wish to take. MasterCard and Visa require you to establish a merchant account through an intermediary, but American Express and Discover give you the option of applying directly to them.

Your current bank is probably the easiest intermediary to turn to, but many offer credit card services as part of a package that will include other merchant services you may or may not need.

Another option is an independent sales organization (ISO), which is essentially a broker who represents one or more card processors. An ISO will set up and serve your office but, like a bank, will not do the actual processing itself: It outsources that job to a third-party credit card processor.

If your state or city has a small business and trade association, ask if it offers credit card processing at discount prices.

Consider only processors that provide excellent customer service. Call colleagues and ask which banks or processing companies they use, and ask each candidate company for a list of the medical offices they already serve. Call some of those offices and ask questions: How difficult is it to reach customer support? Are problems handled quickly? How does the provider deal with “chargebacks” (charges later disputed by the cardholder)?

Question the processors about their level of support: Are their phones staffed 24 hours a day? Do they charge for support, either monthly or per call?

Compare prices carefully. Some providers charge application fees of up to $200, and these may be nonrefundable even if you change your mind. You may also be asked to pay setup or account activation fees, Internet processing fees, customer support fees, etc. As always, be sure you have a complete understanding of all the charges you will incur before making your decision and signing a contract.

The principal equipment cost will be for the terminal, which is the machine used to swipe cards. Basic terminals typically cost between $150 and $300; terminals with printers are $200 to $600; and wireless terminals can run from $600 to $1,000. Leases start at $35 a month and rise from there, depending on the sophistication of the terminal and the length of the lease.

The primary ongoing fee is the “discount rate” or “swipe rate,” a percentage the provider takes off the top of each transaction. Ask about reduced rates for high volume, or for total receipts higher than a specified amount per month.

Watch out for extra charges, such as “per transaction” fees and monthly transaction summary preparation fees. Such fees may be negotiable or even waivable, although the company may not volunteer that information.

Beware of long-term leases with early-termination fees. If you are unhappy with your service, you don't want to have to pay a hefty charge for the privilege of changing companies. Also watch out for a trick borrowed from the consumer credit card industry: low introductory rates that increase significantly after a few months or a year.

Find out how long it takes for receipts to be deposited to your account, as this can vary widely. A marginally lower swipe rate won't be worth it if you don't have the use of your money for months.

Finally, if you're not using a bank or financial company you know well, make sure the company is legitimate. Contact the Better Business Bureau to check its status. And if the company is based primarily on the Internet, make sure that you get a physical address and phone number, plus recommendations from existing clients.

[email protected]

Accepting credit cards in your office—both for capturing charges immediately at the time of service and for billing residual balances—has huge advantages. But how do you arrange for credit card processing at your office at the best possible price?

Several processing services are available. Which one you choose will depend not only on cost, but on what specific services you need.

It will also depend on what cards you wish to take. MasterCard and Visa require you to establish a merchant account through an intermediary, but American Express and Discover give you the option of applying directly to them.

Your current bank is probably the easiest intermediary to turn to, but many offer credit card services as part of a package that will include other merchant services you may or may not need.

Another option is an independent sales organization (ISO), which is essentially a broker who represents one or more card processors. An ISO will set up and serve your office but, like a bank, will not do the actual processing itself: It outsources that job to a third-party credit card processor.

If your state or city has a small business and trade association, ask if it offers credit card processing at discount prices.

Consider only processors that provide excellent customer service. Call colleagues and ask which banks or processing companies they use, and ask each candidate company for a list of the medical offices they already serve. Call some of those offices and ask questions: How difficult is it to reach customer support? Are problems handled quickly? How does the provider deal with “chargebacks” (charges later disputed by the cardholder)?

Question the processors about their level of support: Are their phones staffed 24 hours a day? Do they charge for support, either monthly or per call?

Compare prices carefully. Some providers charge application fees of up to $200, and these may be nonrefundable even if you change your mind. You may also be asked to pay setup or account activation fees, Internet processing fees, customer support fees, etc. As always, be sure you have a complete understanding of all the charges you will incur before making your decision and signing a contract.

The principal equipment cost will be for the terminal, which is the machine used to swipe cards. Basic terminals typically cost between $150 and $300; terminals with printers are $200 to $600; and wireless terminals can run from $600 to $1,000. Leases start at $35 a month and rise from there, depending on the sophistication of the terminal and the length of the lease.

The primary ongoing fee is the “discount rate” or “swipe rate,” a percentage the provider takes off the top of each transaction. Ask about reduced rates for high volume, or for total receipts higher than a specified amount per month.

Watch out for extra charges, such as “per transaction” fees and monthly transaction summary preparation fees. Such fees may be negotiable or even waivable, although the company may not volunteer that information.

Beware of long-term leases with early-termination fees. If you are unhappy with your service, you don't want to have to pay a hefty charge for the privilege of changing companies. Also watch out for a trick borrowed from the consumer credit card industry: low introductory rates that increase significantly after a few months or a year.

Find out how long it takes for receipts to be deposited to your account, as this can vary widely. A marginally lower swipe rate won't be worth it if you don't have the use of your money for months.

Finally, if you're not using a bank or financial company you know well, make sure the company is legitimate. Contact the Better Business Bureau to check its status. And if the company is based primarily on the Internet, make sure that you get a physical address and phone number, plus recommendations from existing clients.

Last month, I outlined the advantages of accepting credit cards in your office, both for capturing charges immediately at the time of service and for billing residual balances which come in later. (If you missed that column, you can find it at www.skinandallergynews.com

This month, I'll discuss the nuts and bolts of acquiring credit card processing for your office at the best possible price.

Several sources of processing services are available. Which you choose will depend not only on cost, but on which specific services you need.

It will also depend on which cards you wish to take. MasterCard and Visa require you to establish a merchant account through an intermediary, but American Express and Discover give you the option of applying directly to them.

Your current bank is probably the easiest intermediary to turn to, but many offer credit card services as part of a package that will include other merchant services you may or may not need.

Another option is an independent sales organization (ISO), which is essentially a broker who represents one or more card processors. An ISO will set up and service your office but, like a bank, will not do the actual processing itself: It outsources that job to a third-party credit card processor.

If your state or city has a small business and trade association, ask if it offers credit card processing at discount prices. This is a particularly good option in many areas.

Consider only processors that provide excellent customer service. Call colleagues and ask which banks or processing companies they use, and ask each candidate company for a list of the medical offices they already service. Call some of those offices and ask hard questions: How difficult is it to reach customer support? Are problems handled quickly? How does the provider deal with “chargebacks” (charges later disputed by the cardholder)?

Also question the processors closely about their level of support: Do they have phones staffed 24 hours a day? Do they charge for support, either monthly or per call?

Compare prices carefully. Some providers charge application fees of up to $200, and they may be nonrefundable, even if you change your mind. You may also be asked to pay setup or account activation fees, Internet processing fees, customer support fees, etc. As always, be sure you have a complete understanding of all the charges you will incur before making your decision and signing a contract.

The principal equipment cost will be for the terminal, the machine used to swipe cards. Basic terminals typically cost between $150 and $300, terminals with printers are $200 to $600, and wireless terminals can run from $600 to $1,000. Leases start at $35 a month and rise depending on the sophistication of the terminal and the length of the lease.

The primary ongoing fee is the “discount rate” or “swipe rate,” a percentage the provider takes off the top of each transaction. Some processors charge different rates for in-person transactions and for mail/telephone/Internet transactions. If you plan to sell products via mail order on your Web site, you'll want to ask about that. Ask about reduced rates for high volume or for total receipts higher than a specified amount per month.

Watch out for extra charges, such as “per transaction” fees and monthly transaction summary preparation fees. Such fees may be negotiable or even waivable, although the company may not volunteer that information.

Beware of long-term leases with early termination fees. If you are unhappy with your service, you don't want to have to pay a hefty charge for the privilege of changing companies. Also watch out for a trick borrowed from the consumer credit card industry: low introductory rates that increase significantly after a few months or a year.

Find out how long it takes for receipts to be deposited to your account, since this can vary widely. A marginally lower swipe rate won't be worth it if you don't have the use of your money for months after the transaction.

If your office will be selling merchandise over the Internet, you will need either a secure server that can encrypt credit card information or a processing company that provides secure ordering, or (preferably) both.

Finally, if you are not using a bank or financial company you know well, make sure it is legitimate. Contact the Better Business Bureau to check the company's status. And if the company is based primarily on the Internet, as happens more and more frequently, make sure you get a physical address and phone number, plus recommendations from existing clients.

Last month, I outlined the advantages of accepting credit cards in your office, both for capturing charges immediately at the time of service and for billing residual balances which come in later. (If you missed that column, you can find it at www.skinandallergynews.com

This month, I'll discuss the nuts and bolts of acquiring credit card processing for your office at the best possible price.

Several sources of processing services are available. Which you choose will depend not only on cost, but on which specific services you need.

It will also depend on which cards you wish to take. MasterCard and Visa require you to establish a merchant account through an intermediary, but American Express and Discover give you the option of applying directly to them.

Your current bank is probably the easiest intermediary to turn to, but many offer credit card services as part of a package that will include other merchant services you may or may not need.

Another option is an independent sales organization (ISO), which is essentially a broker who represents one or more card processors. An ISO will set up and service your office but, like a bank, will not do the actual processing itself: It outsources that job to a third-party credit card processor.

If your state or city has a small business and trade association, ask if it offers credit card processing at discount prices. This is a particularly good option in many areas.

Consider only processors that provide excellent customer service. Call colleagues and ask which banks or processing companies they use, and ask each candidate company for a list of the medical offices they already service. Call some of those offices and ask hard questions: How difficult is it to reach customer support? Are problems handled quickly? How does the provider deal with “chargebacks” (charges later disputed by the cardholder)?

Also question the processors closely about their level of support: Do they have phones staffed 24 hours a day? Do they charge for support, either monthly or per call?

Compare prices carefully. Some providers charge application fees of up to $200, and they may be nonrefundable, even if you change your mind. You may also be asked to pay setup or account activation fees, Internet processing fees, customer support fees, etc. As always, be sure you have a complete understanding of all the charges you will incur before making your decision and signing a contract.

The principal equipment cost will be for the terminal, the machine used to swipe cards. Basic terminals typically cost between $150 and $300, terminals with printers are $200 to $600, and wireless terminals can run from $600 to $1,000. Leases start at $35 a month and rise depending on the sophistication of the terminal and the length of the lease.

The primary ongoing fee is the “discount rate” or “swipe rate,” a percentage the provider takes off the top of each transaction. Some processors charge different rates for in-person transactions and for mail/telephone/Internet transactions. If you plan to sell products via mail order on your Web site, you'll want to ask about that. Ask about reduced rates for high volume or for total receipts higher than a specified amount per month.

Watch out for extra charges, such as “per transaction” fees and monthly transaction summary preparation fees. Such fees may be negotiable or even waivable, although the company may not volunteer that information.

Beware of long-term leases with early termination fees. If you are unhappy with your service, you don't want to have to pay a hefty charge for the privilege of changing companies. Also watch out for a trick borrowed from the consumer credit card industry: low introductory rates that increase significantly after a few months or a year.

Find out how long it takes for receipts to be deposited to your account, since this can vary widely. A marginally lower swipe rate won't be worth it if you don't have the use of your money for months after the transaction.

If your office will be selling merchandise over the Internet, you will need either a secure server that can encrypt credit card information or a processing company that provides secure ordering, or (preferably) both.

Finally, if you are not using a bank or financial company you know well, make sure it is legitimate. Contact the Better Business Bureau to check the company's status. And if the company is based primarily on the Internet, as happens more and more frequently, make sure you get a physical address and phone number, plus recommendations from existing clients.

Last month, I outlined the advantages of accepting credit cards in your office, both for capturing charges immediately at the time of service and for billing residual balances which come in later. (If you missed that column, you can find it at www.skinandallergynews.com

This month, I'll discuss the nuts and bolts of acquiring credit card processing for your office at the best possible price.

Several sources of processing services are available. Which you choose will depend not only on cost, but on which specific services you need.

It will also depend on which cards you wish to take. MasterCard and Visa require you to establish a merchant account through an intermediary, but American Express and Discover give you the option of applying directly to them.

Your current bank is probably the easiest intermediary to turn to, but many offer credit card services as part of a package that will include other merchant services you may or may not need.

Another option is an independent sales organization (ISO), which is essentially a broker who represents one or more card processors. An ISO will set up and service your office but, like a bank, will not do the actual processing itself: It outsources that job to a third-party credit card processor.

If your state or city has a small business and trade association, ask if it offers credit card processing at discount prices. This is a particularly good option in many areas.

Consider only processors that provide excellent customer service. Call colleagues and ask which banks or processing companies they use, and ask each candidate company for a list of the medical offices they already service. Call some of those offices and ask hard questions: How difficult is it to reach customer support? Are problems handled quickly? How does the provider deal with “chargebacks” (charges later disputed by the cardholder)?

Also question the processors closely about their level of support: Do they have phones staffed 24 hours a day? Do they charge for support, either monthly or per call?

Compare prices carefully. Some providers charge application fees of up to $200, and they may be nonrefundable, even if you change your mind. You may also be asked to pay setup or account activation fees, Internet processing fees, customer support fees, etc. As always, be sure you have a complete understanding of all the charges you will incur before making your decision and signing a contract.

The principal equipment cost will be for the terminal, the machine used to swipe cards. Basic terminals typically cost between $150 and $300, terminals with printers are $200 to $600, and wireless terminals can run from $600 to $1,000. Leases start at $35 a month and rise depending on the sophistication of the terminal and the length of the lease.

The primary ongoing fee is the “discount rate” or “swipe rate,” a percentage the provider takes off the top of each transaction. Some processors charge different rates for in-person transactions and for mail/telephone/Internet transactions. If you plan to sell products via mail order on your Web site, you'll want to ask about that. Ask about reduced rates for high volume or for total receipts higher than a specified amount per month.

Watch out for extra charges, such as “per transaction” fees and monthly transaction summary preparation fees. Such fees may be negotiable or even waivable, although the company may not volunteer that information.

Beware of long-term leases with early termination fees. If you are unhappy with your service, you don't want to have to pay a hefty charge for the privilege of changing companies. Also watch out for a trick borrowed from the consumer credit card industry: low introductory rates that increase significantly after a few months or a year.

Find out how long it takes for receipts to be deposited to your account, since this can vary widely. A marginally lower swipe rate won't be worth it if you don't have the use of your money for months after the transaction.

If your office will be selling merchandise over the Internet, you will need either a secure server that can encrypt credit card information or a processing company that provides secure ordering, or (preferably) both.

Finally, if you are not using a bank or financial company you know well, make sure it is legitimate. Contact the Better Business Bureau to check the company's status. And if the company is based primarily on the Internet, as happens more and more frequently, make sure you get a physical address and phone number, plus recommendations from existing clients.

I continue to receive questions on the benefits of conventional mail billing versus keeping patient credit card numbers on file, an idea first proposed in this column almost 2 years ago.

(If you missed the original December 2005 column on the subject of credit card billing, or its sequel 3 months later, you can find them at www.skinandallergynews.com

Many physicians, especially those of a traditional bent, continue to resist the idea of accepting credit cards—or even asking patients for payment at the time of service—because it smacks of “store keeping.”

I often hear from physicians who feel more comfortable billing patients but complain that their bills are ignored.

It is much more efficient to collect payment at the time of service, while you still have the patient at hand. With each passing day after office treatment, the likelihood decreases that a patient will pay the bill.

Besides, billing is expensive. When you total the costs of materials, postage, and staff labor, preparing and mailing a bill can cost from $2 to $10. And every minute your office staff spends producing and mailing bills is a minute that could have been spent on more productive work.

Billing services are an alternative, but they are also expensive and those bills get ignored, too.

Credit and debit cards eliminate many of the problems associated with billing. They allow you to collect more fees at the time of service, while patients still think they are important.

An immediate credit or debit card charge reduces the chances of a balance falling through the cracks, getting lost in the mail, or getting embezzled. And they won't bounce like checks. If the patient is delinquent in paying the credit card bill, it's the credit card company's problem, not yours.

Card payments also improve cash flow, which is always welcome.

Credit cards offer more payment flexibility for patients. In the case of a large balance, you can offer the option of putting all the charges onto a credit card, which can then be paid in monthly installments affordable to the patient. Your practice gets reimbursed in full, even as the patient is paying it off at a pace that makes sense for his or her finances.

As described in detail in my December 2005 column, “How to Slash Accounts Receivable,” you can also keep patients' credit card numbers and signatures on file, and use them to bill insurance balances that come in later.

This practice also comes in handy for patients who claim to have come to the office without cash, a checkbook, credit cards, or any other method of payment. In such situations my office manager loves to say, “No problem, we have your credit card information on file!”

Many consultants feel that physicians will have to become increasingly flexible in how they accept payments as the population continues to age.

That flexibility will take on more importance as increasing numbers of patients rely on health savings accounts (HSAs). Many experts predict that the number of HSAs will increase tenfold by the end of this decade. That's a trend you will want to accommodate in any way you can.

Some financial institutions have even begun creating medical credit and debit cards designed specifically to be kept on file at doctors' and dentists' offices.

Like it or not, your practice is a business, and your patients, like all customers, need to be offered every convenience your competitors offer—including credit card services.

How do you go about acquiring credit card services for your office? That's the subject of next month's column.

I continue to receive questions on the benefits of conventional mail billing versus keeping patient credit card numbers on file, an idea first proposed in this column almost 2 years ago.

(If you missed the original December 2005 column on the subject of credit card billing, or its sequel 3 months later, you can find them at www.skinandallergynews.com

Many physicians, especially those of a traditional bent, continue to resist the idea of accepting credit cards—or even asking patients for payment at the time of service—because it smacks of “store keeping.”

I often hear from physicians who feel more comfortable billing patients but complain that their bills are ignored.

It is much more efficient to collect payment at the time of service, while you still have the patient at hand. With each passing day after office treatment, the likelihood decreases that a patient will pay the bill.

Besides, billing is expensive. When you total the costs of materials, postage, and staff labor, preparing and mailing a bill can cost from $2 to $10. And every minute your office staff spends producing and mailing bills is a minute that could have been spent on more productive work.

Billing services are an alternative, but they are also expensive and those bills get ignored, too.

Credit and debit cards eliminate many of the problems associated with billing. They allow you to collect more fees at the time of service, while patients still think they are important.

An immediate credit or debit card charge reduces the chances of a balance falling through the cracks, getting lost in the mail, or getting embezzled. And they won't bounce like checks. If the patient is delinquent in paying the credit card bill, it's the credit card company's problem, not yours.

Card payments also improve cash flow, which is always welcome.

Credit cards offer more payment flexibility for patients. In the case of a large balance, you can offer the option of putting all the charges onto a credit card, which can then be paid in monthly installments affordable to the patient. Your practice gets reimbursed in full, even as the patient is paying it off at a pace that makes sense for his or her finances.

As described in detail in my December 2005 column, “How to Slash Accounts Receivable,” you can also keep patients' credit card numbers and signatures on file, and use them to bill insurance balances that come in later.

This practice also comes in handy for patients who claim to have come to the office without cash, a checkbook, credit cards, or any other method of payment. In such situations my office manager loves to say, “No problem, we have your credit card information on file!”

Many consultants feel that physicians will have to become increasingly flexible in how they accept payments as the population continues to age.

That flexibility will take on more importance as increasing numbers of patients rely on health savings accounts (HSAs). Many experts predict that the number of HSAs will increase tenfold by the end of this decade. That's a trend you will want to accommodate in any way you can.

Some financial institutions have even begun creating medical credit and debit cards designed specifically to be kept on file at doctors' and dentists' offices.

Like it or not, your practice is a business, and your patients, like all customers, need to be offered every convenience your competitors offer—including credit card services.

How do you go about acquiring credit card services for your office? That's the subject of next month's column.

I continue to receive questions on the benefits of conventional mail billing versus keeping patient credit card numbers on file, an idea first proposed in this column almost 2 years ago.

(If you missed the original December 2005 column on the subject of credit card billing, or its sequel 3 months later, you can find them at www.skinandallergynews.com

Many physicians, especially those of a traditional bent, continue to resist the idea of accepting credit cards—or even asking patients for payment at the time of service—because it smacks of “store keeping.”

I often hear from physicians who feel more comfortable billing patients but complain that their bills are ignored.

It is much more efficient to collect payment at the time of service, while you still have the patient at hand. With each passing day after office treatment, the likelihood decreases that a patient will pay the bill.

Besides, billing is expensive. When you total the costs of materials, postage, and staff labor, preparing and mailing a bill can cost from $2 to $10. And every minute your office staff spends producing and mailing bills is a minute that could have been spent on more productive work.

Billing services are an alternative, but they are also expensive and those bills get ignored, too.

Credit and debit cards eliminate many of the problems associated with billing. They allow you to collect more fees at the time of service, while patients still think they are important.

An immediate credit or debit card charge reduces the chances of a balance falling through the cracks, getting lost in the mail, or getting embezzled. And they won't bounce like checks. If the patient is delinquent in paying the credit card bill, it's the credit card company's problem, not yours.

Card payments also improve cash flow, which is always welcome.

Credit cards offer more payment flexibility for patients. In the case of a large balance, you can offer the option of putting all the charges onto a credit card, which can then be paid in monthly installments affordable to the patient. Your practice gets reimbursed in full, even as the patient is paying it off at a pace that makes sense for his or her finances.

As described in detail in my December 2005 column, “How to Slash Accounts Receivable,” you can also keep patients' credit card numbers and signatures on file, and use them to bill insurance balances that come in later.

This practice also comes in handy for patients who claim to have come to the office without cash, a checkbook, credit cards, or any other method of payment. In such situations my office manager loves to say, “No problem, we have your credit card information on file!”

Many consultants feel that physicians will have to become increasingly flexible in how they accept payments as the population continues to age.

That flexibility will take on more importance as increasing numbers of patients rely on health savings accounts (HSAs). Many experts predict that the number of HSAs will increase tenfold by the end of this decade. That's a trend you will want to accommodate in any way you can.

Some financial institutions have even begun creating medical credit and debit cards designed specifically to be kept on file at doctors' and dentists' offices.

Like it or not, your practice is a business, and your patients, like all customers, need to be offered every convenience your competitors offer—including credit card services.

How do you go about acquiring credit card services for your office? That's the subject of next month's column.

A survey by the Council of Communications Management confirms what any good human resources manager knows: Recognition of a job performed well, not money, is the best motivator of employee performance.

Unfortunately, most physicians do not seem to understand or apply this basic business concept. This is despite the fact that doctors themselves said, in a separate survey, that they much prefer to practice in offices and clinics where their hard work is recognized and rewarded.

In “1001 Ways to Reward Employees” (New York: Workman Publishing, 1994), Bob Nelson said, “While money is important to employees, what tends to motivate them to perform—and to perform at higher levels—is the thoughtful, personal kind of recognition that signifies true appreciation for a job well done.”

Too often, a physician or a boss's idea of a reward is a yearly cash bonus, usually given during the holiday season. But giving the same reward to everyone at the same time every year—often called “jelly bean motivation” by consultants—not only does not inspire employees to work harder and better, but on the contrary, can actually serve as a disincentive to excellent employees who see no appreciation or acknowledgement of their beyond-the-call performance. Even the most mediocre employees don't see it as a reward. Rather, the bonus becomes an entitlement—just an expected, meaningless component of their normal compensation.

Nelson lists three simple guidelines for effectively rewarding employees:

▸ Match the reward to the individual. Reward each person in ways that each individual employee finds rewarding.

▸ Match the reward to the achievement. An employee who successfully completes a 2-year-long medical records reorganization deserves a more substantial reward than does one who simply runs an errand for you.

▸ Be timely and specific. To be effective, rewards must be given as soon as possible after a specific laudable behavior or achievement, and the employee should always be told why he or she is receiving it. Additionally, it's important to keep in mind that rewards that come weeks or months after the fact, and those that seem to be given for no particular reason, do little or nothing to accomplish their desired effect.

So how do you know which rewards your employees will find rewarding? That's easy: Ask them!

I periodically solicit suggestions for nonmonetary rewards from my staff. “I can't give you money,” I tell them, “but I'll consider just about anything else.”

Some of their ideas have been surprisingly creative—and surprisingly cheap. For example, my employees are required to park their cars each day on the other side of the hospital campus from my office building. One of them suggested that a closer parking space would be a good reward. I was able to obtain an extra access card for the doctors' lot right next to my building, and each month one “Employee of the Month” gets to park there. This reward, which costs me nothing, has become the most sought-after in our office.

In fact, there are many effective rewards that cost little or nothing. As Nelson puts it, “A sincere word of thanks from the right person at the right time can mean more to an employee than a raise, a formal award, or a whole wall of certificates or plaques.”

One of the strongest motivators imaginable is the knowledge that you, as the boss, will take a moment to notice a job well done and praise it publicly, in a timely manner.

Time off is another powerful motivator, which surveys show is almost universally popular among employees of all types.

According to Michael LeBoeuf, author of “The Greatest Management Principle in the World” (New York: Putnam, 1985), there are three ways you can use time off as a reward:

▸ If the job permits it, assign a deadline and minimum quality standard to a task. If the task is finished ahead of the deadline, the extra time is the employee's reward.

▸ If allowing employees to leave early is impractical, specify an amount of work you want done by a certain time. If the work is completed on time and satisfactorily, give a predetermined amount of time off as the reward. You can also set up a scoring system in which employees earn an hour off for a specified period of productive work. When they have earned 4 hours they can have a half day off, and 8 hours earns a day off, and so on.

▸ Award time off for improvements in quality, safety, teamwork, or any other behavior you feel is important.

By the way, LeBoeuf's “greatest management principle” is that “the things that get rewarded get done.”

Whatever rewards you choose, monetary or otherwise, always be sure to choose them and award them with sincerity. Cheap wall plaques, lapel pins, and other tchotchkes usually fail to motivate employees in the intended way because they come across as being empty gestures given out in a thoughtless manner. On the other hand, a few very simple and honest words of thanks go much further.

A survey by the Council of Communications Management confirms what any good human resources manager knows: Recognition of a job performed well, not money, is the best motivator of employee performance.

Unfortunately, most physicians do not seem to understand or apply this basic business concept. This is despite the fact that doctors themselves said, in a separate survey, that they much prefer to practice in offices and clinics where their hard work is recognized and rewarded.

In “1001 Ways to Reward Employees” (New York: Workman Publishing, 1994), Bob Nelson said, “While money is important to employees, what tends to motivate them to perform—and to perform at higher levels—is the thoughtful, personal kind of recognition that signifies true appreciation for a job well done.”

Too often, a physician or a boss's idea of a reward is a yearly cash bonus, usually given during the holiday season. But giving the same reward to everyone at the same time every year—often called “jelly bean motivation” by consultants—not only does not inspire employees to work harder and better, but on the contrary, can actually serve as a disincentive to excellent employees who see no appreciation or acknowledgement of their beyond-the-call performance. Even the most mediocre employees don't see it as a reward. Rather, the bonus becomes an entitlement—just an expected, meaningless component of their normal compensation.

Nelson lists three simple guidelines for effectively rewarding employees:

▸ Match the reward to the individual. Reward each person in ways that each individual employee finds rewarding.

▸ Match the reward to the achievement. An employee who successfully completes a 2-year-long medical records reorganization deserves a more substantial reward than does one who simply runs an errand for you.

▸ Be timely and specific. To be effective, rewards must be given as soon as possible after a specific laudable behavior or achievement, and the employee should always be told why he or she is receiving it. Additionally, it's important to keep in mind that rewards that come weeks or months after the fact, and those that seem to be given for no particular reason, do little or nothing to accomplish their desired effect.

So how do you know which rewards your employees will find rewarding? That's easy: Ask them!

I periodically solicit suggestions for nonmonetary rewards from my staff. “I can't give you money,” I tell them, “but I'll consider just about anything else.”

Some of their ideas have been surprisingly creative—and surprisingly cheap. For example, my employees are required to park their cars each day on the other side of the hospital campus from my office building. One of them suggested that a closer parking space would be a good reward. I was able to obtain an extra access card for the doctors' lot right next to my building, and each month one “Employee of the Month” gets to park there. This reward, which costs me nothing, has become the most sought-after in our office.

In fact, there are many effective rewards that cost little or nothing. As Nelson puts it, “A sincere word of thanks from the right person at the right time can mean more to an employee than a raise, a formal award, or a whole wall of certificates or plaques.”

One of the strongest motivators imaginable is the knowledge that you, as the boss, will take a moment to notice a job well done and praise it publicly, in a timely manner.

Time off is another powerful motivator, which surveys show is almost universally popular among employees of all types.

According to Michael LeBoeuf, author of “The Greatest Management Principle in the World” (New York: Putnam, 1985), there are three ways you can use time off as a reward:

▸ If the job permits it, assign a deadline and minimum quality standard to a task. If the task is finished ahead of the deadline, the extra time is the employee's reward.

▸ If allowing employees to leave early is impractical, specify an amount of work you want done by a certain time. If the work is completed on time and satisfactorily, give a predetermined amount of time off as the reward. You can also set up a scoring system in which employees earn an hour off for a specified period of productive work. When they have earned 4 hours they can have a half day off, and 8 hours earns a day off, and so on.

▸ Award time off for improvements in quality, safety, teamwork, or any other behavior you feel is important.

By the way, LeBoeuf's “greatest management principle” is that “the things that get rewarded get done.”

Whatever rewards you choose, monetary or otherwise, always be sure to choose them and award them with sincerity. Cheap wall plaques, lapel pins, and other tchotchkes usually fail to motivate employees in the intended way because they come across as being empty gestures given out in a thoughtless manner. On the other hand, a few very simple and honest words of thanks go much further.

A survey by the Council of Communications Management confirms what any good human resources manager knows: Recognition of a job performed well, not money, is the best motivator of employee performance.

Unfortunately, most physicians do not seem to understand or apply this basic business concept. This is despite the fact that doctors themselves said, in a separate survey, that they much prefer to practice in offices and clinics where their hard work is recognized and rewarded.

In “1001 Ways to Reward Employees” (New York: Workman Publishing, 1994), Bob Nelson said, “While money is important to employees, what tends to motivate them to perform—and to perform at higher levels—is the thoughtful, personal kind of recognition that signifies true appreciation for a job well done.”

Too often, a physician or a boss's idea of a reward is a yearly cash bonus, usually given during the holiday season. But giving the same reward to everyone at the same time every year—often called “jelly bean motivation” by consultants—not only does not inspire employees to work harder and better, but on the contrary, can actually serve as a disincentive to excellent employees who see no appreciation or acknowledgement of their beyond-the-call performance. Even the most mediocre employees don't see it as a reward. Rather, the bonus becomes an entitlement—just an expected, meaningless component of their normal compensation.

Nelson lists three simple guidelines for effectively rewarding employees:

▸ Match the reward to the individual. Reward each person in ways that each individual employee finds rewarding.

▸ Match the reward to the achievement. An employee who successfully completes a 2-year-long medical records reorganization deserves a more substantial reward than does one who simply runs an errand for you.

▸ Be timely and specific. To be effective, rewards must be given as soon as possible after a specific laudable behavior or achievement, and the employee should always be told why he or she is receiving it. Additionally, it's important to keep in mind that rewards that come weeks or months after the fact, and those that seem to be given for no particular reason, do little or nothing to accomplish their desired effect.

So how do you know which rewards your employees will find rewarding? That's easy: Ask them!

I periodically solicit suggestions for nonmonetary rewards from my staff. “I can't give you money,” I tell them, “but I'll consider just about anything else.”

Some of their ideas have been surprisingly creative—and surprisingly cheap. For example, my employees are required to park their cars each day on the other side of the hospital campus from my office building. One of them suggested that a closer parking space would be a good reward. I was able to obtain an extra access card for the doctors' lot right next to my building, and each month one “Employee of the Month” gets to park there. This reward, which costs me nothing, has become the most sought-after in our office.

In fact, there are many effective rewards that cost little or nothing. As Nelson puts it, “A sincere word of thanks from the right person at the right time can mean more to an employee than a raise, a formal award, or a whole wall of certificates or plaques.”

One of the strongest motivators imaginable is the knowledge that you, as the boss, will take a moment to notice a job well done and praise it publicly, in a timely manner.

Time off is another powerful motivator, which surveys show is almost universally popular among employees of all types.

According to Michael LeBoeuf, author of “The Greatest Management Principle in the World” (New York: Putnam, 1985), there are three ways you can use time off as a reward:

▸ If the job permits it, assign a deadline and minimum quality standard to a task. If the task is finished ahead of the deadline, the extra time is the employee's reward.

▸ If allowing employees to leave early is impractical, specify an amount of work you want done by a certain time. If the work is completed on time and satisfactorily, give a predetermined amount of time off as the reward. You can also set up a scoring system in which employees earn an hour off for a specified period of productive work. When they have earned 4 hours they can have a half day off, and 8 hours earns a day off, and so on.

▸ Award time off for improvements in quality, safety, teamwork, or any other behavior you feel is important.

By the way, LeBoeuf's “greatest management principle” is that “the things that get rewarded get done.”

Whatever rewards you choose, monetary or otherwise, always be sure to choose them and award them with sincerity. Cheap wall plaques, lapel pins, and other tchotchkes usually fail to motivate employees in the intended way because they come across as being empty gestures given out in a thoughtless manner. On the other hand, a few very simple and honest words of thanks go much further.

The questions don't stop when it comes to the mechanics of hiring new associates. Several readers have written to ask when to add new employees and how much to pay them.

Generally, it shouldn't be too difficult to determine if you need a new associate. Just look at your appointment book. How many slots are open? How long does a new patient have to wait for an appointment? Practice experts differ on rules of thumb, but in my opinion, if it takes 3 weeks or longer for a new patient to get an appointment, you are almost certainly losing patients and referrals to your competitors.

Another red flag may come from your referrers. If you are beginning to hear complaints that you are not as available as you once were, or that your reports are not prepared in as timely a manner, it is important to address these concerns before your referrers begin sending their patients elsewhere.

Young associates also ensure that your practice will continue to thrive. Your long-time referrers will eventually retire, and the young newcomers who replace them will naturally tend to refer to specialists closer to their age, leaving your practice to stagnate if younger physicians are not a part of it.

Additionally, expanding your practice may enable you to negotiate better terms in your managed care contracts by offering more hours and services.

If you are referring out substantial quantities of subspecialty services, such as laser or cosmetic work or Mohs surgery, you might want to recruit an associate who is specially trained in those services to keep those patients in-house.

Before you begin recruiting, however, make sure that all of the current physicians are in agreement that another physician is necessary.

It is worth considering the possibility that your practice needs something other than a new physician. If physicians are doing administrative tasks when they could be practicing medicine, consider hiring a practice administrator to manage your business and finances.

You may want to consider bringing in a nurse practitioner or physician assistant to do acne follow-ups and other routine duties, freeing physician time for more specialized procedures. (If you missed the column I wrote last year addressing this subject in detail, go to www.skinandallergynews.com

If indeed it is a new physician that you believe your practice needs, consider all of the costs related to hiring and supporting him or her for at least the first year. (Once again, check out the online archives for a previous column addressing this subject in more detail.)

You must also remember to include the costs of additional support personnel; additional examination or procedure rooms; a larger reception area; and the associated mortgage or leasehold improvement costs, overhead expenses, payroll taxes, and lawyer fees.

If the new physician provides services that are new to your practice, you will most likely need new equipment. This means that you must factor quotes from suppliers into your calculations.

Then, there is always the question of just how these additional costs will be met. No matter how large their current backlog, many dermatologists worry that their practices won't have enough additional patients to support a new doctor.

You can remove much of the guesswork by estimating how many additional patients your practice will need to break even. Do that by dividing your previous year's total revenues by the total number of patient visits to determine average revenue per visit. Then divide the total estimated cost of hiring a new physician by your revenue per visit. This is the approximate number of additional visits that must be generated for the new associate's costs to be covered.

The calculations will, of course, become more complex if the new physician will be doing only Mohs or cosmetic procedures, but you get the idea.

How much you pay a new associate will depend heavily on your location and individual circumstances. Find out what nearby practices are paying their recruits, and ask applicants themselves how much they expect to be paid.

The ultimate determination may require the services of an experienced practice consultant who is familiar with your practice area.

Many candidates will also expect incentive compensation for exceeding their revenue-generation goals.

You should also consider rewarding other performance achievements, including relationship building, teamwork, practice promotion, and attraction of new referrers.

Remember to factor in the fringe benefits that your practice provides. Most compensation packages include such standard benefits as paid time off, health insurance, society dues, hospital staff fees, CME costs, subscriptions, retirement plan contributions (when eligible), and malpractice insurance.

Lastly, you may also want to consider covering the physician's moving expenses, especially if it would help close the deal.

The questions don't stop when it comes to the mechanics of hiring new associates. Several readers have written to ask when to add new employees and how much to pay them.

Generally, it shouldn't be too difficult to determine if you need a new associate. Just look at your appointment book. How many slots are open? How long does a new patient have to wait for an appointment? Practice experts differ on rules of thumb, but in my opinion, if it takes 3 weeks or longer for a new patient to get an appointment, you are almost certainly losing patients and referrals to your competitors.

Another red flag may come from your referrers. If you are beginning to hear complaints that you are not as available as you once were, or that your reports are not prepared in as timely a manner, it is important to address these concerns before your referrers begin sending their patients elsewhere.

Young associates also ensure that your practice will continue to thrive. Your long-time referrers will eventually retire, and the young newcomers who replace them will naturally tend to refer to specialists closer to their age, leaving your practice to stagnate if younger physicians are not a part of it.

Additionally, expanding your practice may enable you to negotiate better terms in your managed care contracts by offering more hours and services.

If you are referring out substantial quantities of subspecialty services, such as laser or cosmetic work or Mohs surgery, you might want to recruit an associate who is specially trained in those services to keep those patients in-house.

Before you begin recruiting, however, make sure that all of the current physicians are in agreement that another physician is necessary.

It is worth considering the possibility that your practice needs something other than a new physician. If physicians are doing administrative tasks when they could be practicing medicine, consider hiring a practice administrator to manage your business and finances.

You may want to consider bringing in a nurse practitioner or physician assistant to do acne follow-ups and other routine duties, freeing physician time for more specialized procedures. (If you missed the column I wrote last year addressing this subject in detail, go to www.skinandallergynews.com

If indeed it is a new physician that you believe your practice needs, consider all of the costs related to hiring and supporting him or her for at least the first year. (Once again, check out the online archives for a previous column addressing this subject in more detail.)

You must also remember to include the costs of additional support personnel; additional examination or procedure rooms; a larger reception area; and the associated mortgage or leasehold improvement costs, overhead expenses, payroll taxes, and lawyer fees.

If the new physician provides services that are new to your practice, you will most likely need new equipment. This means that you must factor quotes from suppliers into your calculations.

Then, there is always the question of just how these additional costs will be met. No matter how large their current backlog, many dermatologists worry that their practices won't have enough additional patients to support a new doctor.

You can remove much of the guesswork by estimating how many additional patients your practice will need to break even. Do that by dividing your previous year's total revenues by the total number of patient visits to determine average revenue per visit. Then divide the total estimated cost of hiring a new physician by your revenue per visit. This is the approximate number of additional visits that must be generated for the new associate's costs to be covered.

The calculations will, of course, become more complex if the new physician will be doing only Mohs or cosmetic procedures, but you get the idea.

How much you pay a new associate will depend heavily on your location and individual circumstances. Find out what nearby practices are paying their recruits, and ask applicants themselves how much they expect to be paid.

The ultimate determination may require the services of an experienced practice consultant who is familiar with your practice area.

Many candidates will also expect incentive compensation for exceeding their revenue-generation goals.

You should also consider rewarding other performance achievements, including relationship building, teamwork, practice promotion, and attraction of new referrers.

Remember to factor in the fringe benefits that your practice provides. Most compensation packages include such standard benefits as paid time off, health insurance, society dues, hospital staff fees, CME costs, subscriptions, retirement plan contributions (when eligible), and malpractice insurance.

Lastly, you may also want to consider covering the physician's moving expenses, especially if it would help close the deal.

The questions don't stop when it comes to the mechanics of hiring new associates. Several readers have written to ask when to add new employees and how much to pay them.

Generally, it shouldn't be too difficult to determine if you need a new associate. Just look at your appointment book. How many slots are open? How long does a new patient have to wait for an appointment? Practice experts differ on rules of thumb, but in my opinion, if it takes 3 weeks or longer for a new patient to get an appointment, you are almost certainly losing patients and referrals to your competitors.

Another red flag may come from your referrers. If you are beginning to hear complaints that you are not as available as you once were, or that your reports are not prepared in as timely a manner, it is important to address these concerns before your referrers begin sending their patients elsewhere.

Young associates also ensure that your practice will continue to thrive. Your long-time referrers will eventually retire, and the young newcomers who replace them will naturally tend to refer to specialists closer to their age, leaving your practice to stagnate if younger physicians are not a part of it.

Additionally, expanding your practice may enable you to negotiate better terms in your managed care contracts by offering more hours and services.

If you are referring out substantial quantities of subspecialty services, such as laser or cosmetic work or Mohs surgery, you might want to recruit an associate who is specially trained in those services to keep those patients in-house.

Before you begin recruiting, however, make sure that all of the current physicians are in agreement that another physician is necessary.

It is worth considering the possibility that your practice needs something other than a new physician. If physicians are doing administrative tasks when they could be practicing medicine, consider hiring a practice administrator to manage your business and finances.

You may want to consider bringing in a nurse practitioner or physician assistant to do acne follow-ups and other routine duties, freeing physician time for more specialized procedures. (If you missed the column I wrote last year addressing this subject in detail, go to www.skinandallergynews.com

If indeed it is a new physician that you believe your practice needs, consider all of the costs related to hiring and supporting him or her for at least the first year. (Once again, check out the online archives for a previous column addressing this subject in more detail.)

You must also remember to include the costs of additional support personnel; additional examination or procedure rooms; a larger reception area; and the associated mortgage or leasehold improvement costs, overhead expenses, payroll taxes, and lawyer fees.

If the new physician provides services that are new to your practice, you will most likely need new equipment. This means that you must factor quotes from suppliers into your calculations.

Then, there is always the question of just how these additional costs will be met. No matter how large their current backlog, many dermatologists worry that their practices won't have enough additional patients to support a new doctor.

You can remove much of the guesswork by estimating how many additional patients your practice will need to break even. Do that by dividing your previous year's total revenues by the total number of patient visits to determine average revenue per visit. Then divide the total estimated cost of hiring a new physician by your revenue per visit. This is the approximate number of additional visits that must be generated for the new associate's costs to be covered.

The calculations will, of course, become more complex if the new physician will be doing only Mohs or cosmetic procedures, but you get the idea.

How much you pay a new associate will depend heavily on your location and individual circumstances. Find out what nearby practices are paying their recruits, and ask applicants themselves how much they expect to be paid.

The ultimate determination may require the services of an experienced practice consultant who is familiar with your practice area.

Many candidates will also expect incentive compensation for exceeding their revenue-generation goals.

You should also consider rewarding other performance achievements, including relationship building, teamwork, practice promotion, and attraction of new referrers.

Remember to factor in the fringe benefits that your practice provides. Most compensation packages include such standard benefits as paid time off, health insurance, society dues, hospital staff fees, CME costs, subscriptions, retirement plan contributions (when eligible), and malpractice insurance.

Lastly, you may also want to consider covering the physician's moving expenses, especially if it would help close the deal.

Questions keep coming in on the broad and complex subject of hiring employees. (If you missed any of the several columns I've written about hiring and firing, go to www.skinandallergynews.com

Several readers have asked about candidate interviews. As I've written before, the importance of thorough interviewing cannot be overemphasized.

The tendency of many physicians is to conduct superficial interviews—or even skip them entirely—and then hire the candidate they have the “best feeling” about. This probably leads to more bad hires than any other hiring mistake. And hiring the wrong person can be one of the most expensive mistakes you can make.

As every physician knows, hunches are no substitute for hard data. You need to be well prepared before conducting interviews. Know the job description and hiring criteria, carefully review resumes (highlighting items you would like to ask about), check references, and conduct thorough but efficient interviews.

Be alert for resume red flags: significant time gaps between jobs; positions at companies that are no longer in business or that are otherwise impossible to verify; job titles that don't make sense, given the applicant's history and qualifications. The interview can resolve such quandaries, or confirm them.

Conduct your interviews in a comfortable location and allocate a reasonable amount of time. I need about 30 minutes: 5 for getting acquainted, 15 to ask the questions I have prepared, and 5–10 for the candidate to ask me questions.

I always have an identical list of questions to ask all candidates, which gives me a level basis of comparison of candidates' answers; however, I also tailor questions for each individual, based on what I have discovered in resumes and other reference materials.

There are, of course, certain questions which by law cannot be asked, such as those related to gender, race, creed, religion, or national origin, but there are acceptable alternatives to many forbidden questions.

For example, you cannot ask an applicant's age or date of birth, but you can ask if he or she is over 18 years old. You cannot ask about specific disabilities, but it is legal to ask if the applicant is physically capable of performing the job's essential duties.

You cannot inquire about marital status, maiden name, or how many children an applicant has or who cares for them, but it is permissible to ask if the applicant has ever gone by another name (for employment history and background check). And while you can't ask if he or she is a U.S. citizen, you can ask if the applicant is legally authorized to work in the United States.

Rather than ask about past drug or alcohol addictions, you can ask about current addictions, but only to illegal drugs. Questions about arrest records are forbidden, but you may ask if the applicant has ever been convicted if the question is accompanied by a statement that an affirmative answer will not necessarily disqualify him or her from employment.

Other than those sorts of obligatory, specific questions, I try to be as nonspecific and open-ended in my questioning as possible. In the first edition of “Human Resources Kit for Dummies” (John Wiley & Sons, 1999), Max Messmer suggests some excellent general questions:

▸ What do you know about our practice and why do you want to work here?

▸ What interests you about this job and what skills and strengths can you bring to it?

▸ What would you describe as your greatest strengths as an employee? What are your greatest weaknesses?

▸ Who was your best boss ever and why? Who was your worst boss, and looking back, what could you have done to make the relationship better?

▸ How do you think that best boss would describe you? What about the worst boss?

▸ What do you think was your single greatest achievement on the job? What was your worst failure?

▸ Where do you see yourself and your career in 3 years?

▸ Can you tell me about an important decision you made and how you arrived at it?

▸ How do you handle conflict? Can you give me an example of how you handled workplace conflict in the past?

The idea is to avoid leading questions, which tend to elicit exactly the answers you want to hear, which lead, in turn, to snap judgments.

Conversely, the questions a candidate asks can be very helpful in making your decision. Candidates who go beyond the basic salary/benefits questions, who show evidence they have done their research about your practice, can offer important insights into their values, goals, and aspirations as well as their analytical abilities and true desire to work for you.

Questions keep coming in on the broad and complex subject of hiring employees. (If you missed any of the several columns I've written about hiring and firing, go to www.skinandallergynews.com

Several readers have asked about candidate interviews. As I've written before, the importance of thorough interviewing cannot be overemphasized.

The tendency of many physicians is to conduct superficial interviews—or even skip them entirely—and then hire the candidate they have the “best feeling” about. This probably leads to more bad hires than any other hiring mistake. And hiring the wrong person can be one of the most expensive mistakes you can make.

As every physician knows, hunches are no substitute for hard data. You need to be well prepared before conducting interviews. Know the job description and hiring criteria, carefully review resumes (highlighting items you would like to ask about), check references, and conduct thorough but efficient interviews.

Be alert for resume red flags: significant time gaps between jobs; positions at companies that are no longer in business or that are otherwise impossible to verify; job titles that don't make sense, given the applicant's history and qualifications. The interview can resolve such quandaries, or confirm them.

Conduct your interviews in a comfortable location and allocate a reasonable amount of time. I need about 30 minutes: 5 for getting acquainted, 15 to ask the questions I have prepared, and 5–10 for the candidate to ask me questions.

I always have an identical list of questions to ask all candidates, which gives me a level basis of comparison of candidates' answers; however, I also tailor questions for each individual, based on what I have discovered in resumes and other reference materials.

There are, of course, certain questions which by law cannot be asked, such as those related to gender, race, creed, religion, or national origin, but there are acceptable alternatives to many forbidden questions.

For example, you cannot ask an applicant's age or date of birth, but you can ask if he or she is over 18 years old. You cannot ask about specific disabilities, but it is legal to ask if the applicant is physically capable of performing the job's essential duties.

You cannot inquire about marital status, maiden name, or how many children an applicant has or who cares for them, but it is permissible to ask if the applicant has ever gone by another name (for employment history and background check). And while you can't ask if he or she is a U.S. citizen, you can ask if the applicant is legally authorized to work in the United States.

Rather than ask about past drug or alcohol addictions, you can ask about current addictions, but only to illegal drugs. Questions about arrest records are forbidden, but you may ask if the applicant has ever been convicted if the question is accompanied by a statement that an affirmative answer will not necessarily disqualify him or her from employment.

Other than those sorts of obligatory, specific questions, I try to be as nonspecific and open-ended in my questioning as possible. In the first edition of “Human Resources Kit for Dummies” (John Wiley & Sons, 1999), Max Messmer suggests some excellent general questions:

▸ What do you know about our practice and why do you want to work here?

▸ What interests you about this job and what skills and strengths can you bring to it?

▸ What would you describe as your greatest strengths as an employee? What are your greatest weaknesses?

▸ Who was your best boss ever and why? Who was your worst boss, and looking back, what could you have done to make the relationship better?

▸ How do you think that best boss would describe you? What about the worst boss?

▸ What do you think was your single greatest achievement on the job? What was your worst failure?

▸ Where do you see yourself and your career in 3 years?

▸ Can you tell me about an important decision you made and how you arrived at it?

▸ How do you handle conflict? Can you give me an example of how you handled workplace conflict in the past?

The idea is to avoid leading questions, which tend to elicit exactly the answers you want to hear, which lead, in turn, to snap judgments.

Conversely, the questions a candidate asks can be very helpful in making your decision. Candidates who go beyond the basic salary/benefits questions, who show evidence they have done their research about your practice, can offer important insights into their values, goals, and aspirations as well as their analytical abilities and true desire to work for you.

Questions keep coming in on the broad and complex subject of hiring employees. (If you missed any of the several columns I've written about hiring and firing, go to www.skinandallergynews.com

Several readers have asked about candidate interviews. As I've written before, the importance of thorough interviewing cannot be overemphasized.

The tendency of many physicians is to conduct superficial interviews—or even skip them entirely—and then hire the candidate they have the “best feeling” about. This probably leads to more bad hires than any other hiring mistake. And hiring the wrong person can be one of the most expensive mistakes you can make.

As every physician knows, hunches are no substitute for hard data. You need to be well prepared before conducting interviews. Know the job description and hiring criteria, carefully review resumes (highlighting items you would like to ask about), check references, and conduct thorough but efficient interviews.

Be alert for resume red flags: significant time gaps between jobs; positions at companies that are no longer in business or that are otherwise impossible to verify; job titles that don't make sense, given the applicant's history and qualifications. The interview can resolve such quandaries, or confirm them.

Conduct your interviews in a comfortable location and allocate a reasonable amount of time. I need about 30 minutes: 5 for getting acquainted, 15 to ask the questions I have prepared, and 5–10 for the candidate to ask me questions.

I always have an identical list of questions to ask all candidates, which gives me a level basis of comparison of candidates' answers; however, I also tailor questions for each individual, based on what I have discovered in resumes and other reference materials.

There are, of course, certain questions which by law cannot be asked, such as those related to gender, race, creed, religion, or national origin, but there are acceptable alternatives to many forbidden questions.

For example, you cannot ask an applicant's age or date of birth, but you can ask if he or she is over 18 years old. You cannot ask about specific disabilities, but it is legal to ask if the applicant is physically capable of performing the job's essential duties.

You cannot inquire about marital status, maiden name, or how many children an applicant has or who cares for them, but it is permissible to ask if the applicant has ever gone by another name (for employment history and background check). And while you can't ask if he or she is a U.S. citizen, you can ask if the applicant is legally authorized to work in the United States.

Rather than ask about past drug or alcohol addictions, you can ask about current addictions, but only to illegal drugs. Questions about arrest records are forbidden, but you may ask if the applicant has ever been convicted if the question is accompanied by a statement that an affirmative answer will not necessarily disqualify him or her from employment.

Other than those sorts of obligatory, specific questions, I try to be as nonspecific and open-ended in my questioning as possible. In the first edition of “Human Resources Kit for Dummies” (John Wiley & Sons, 1999), Max Messmer suggests some excellent general questions:

▸ What do you know about our practice and why do you want to work here?

▸ What interests you about this job and what skills and strengths can you bring to it?

▸ What would you describe as your greatest strengths as an employee? What are your greatest weaknesses?

▸ Who was your best boss ever and why? Who was your worst boss, and looking back, what could you have done to make the relationship better?

▸ How do you think that best boss would describe you? What about the worst boss?

▸ What do you think was your single greatest achievement on the job? What was your worst failure?

▸ Where do you see yourself and your career in 3 years?

▸ Can you tell me about an important decision you made and how you arrived at it?

▸ How do you handle conflict? Can you give me an example of how you handled workplace conflict in the past?

The idea is to avoid leading questions, which tend to elicit exactly the answers you want to hear, which lead, in turn, to snap judgments.

Conversely, the questions a candidate asks can be very helpful in making your decision. Candidates who go beyond the basic salary/benefits questions, who show evidence they have done their research about your practice, can offer important insights into their values, goals, and aspirations as well as their analytical abilities and true desire to work for you.