by Karen Zupko*
Hiring qualified staff is critical for a medical practice. As many physicians have discovered, taking applicants’ resumes on faith can be a mistake. Background company searches show that one in three applicants provide false, inaccurate, misleading, or incomplete information. Fake degrees, false licenses and certifications, and criminal histories are a few of the problems that a proper background check can reveal. This article describes further why background checks are essential, how to incorporate a background check into your hiring process, and some of the legalities involved in the process.
Everyone would agree that medical practices have an obligation to patients to hire qualified clinicians with appropriate training and credentials to perform their job functions. This same obligation also extends to business staff members who are entitled to work with colleagues who have the education that they say they do and who are competent, honest, and not likely to cause them personal or professional harm. While agreement is unanimous, few practices seem to deliver by verifying that information provided by candidates on their resumes and applications is truthful and accurate.
A few examples:
- A 15-physician orthopaedic practice checked on its administrator’s credentials only after he’d been there for 4 months and things were going badly. The physicians discovered he had neither the undergraduate nor graduate degree listed on his resume.
- Physicians of a Chicago-area internal medicine practice were shocked when they opened the newspaper and read, in the headlines on page 3, about their office manager’s conviction for stealing from her previous surgeon employers. The hundreds of thousands of dollars gone had an economic impact on staff in both practices.
- A plastic surgeon in West Palm Beach reported at a meeting that the angelic young woman he’d interviewed for his reception position had three felony charges against her—but no convictions yet!
- The managing partner of a radiology group was in shock when he learned that the applicant for the group’s administrator position, who was with a large group, had credit card debt that was close to $100,000.
- Shocked was the reaction when a group of surgeons discovered that its manager was using the payroll records to steal the identities of employees for her shopping binges. More than shocked was their reaction when they learned she had a criminal background.
Whether it is forged degrees, implying qualifications that the person doesn’t have, or a personal history that includes theft or other criminal tendencies, these are all issues that imply the practice will likely have problems as time goes by. While personal reform is certainly possible, in many small practices taking the risk that 25% of its work force is “recovering” may be more than it bargained for. Often a larger environment offers more supervision and structure and the support needed for someone to “make good.”
CAN YOU AFFORD TO HAVE THESE PROBLEMS?
Given that the payroll and benefits in most practices is the single largest expense item and that competency is a must, you can’t afford to hire nonproducing personnel assets. Lack of proper audit controls already makes the practice vulnerable to a sticky-fingered employee when it comes to cash collected.
Plus with many offices having ambulatory surgical facilities, there are drugs that can be stolen or abused by employees. With more offices offering so-called medi-spa services, practices have Botox, Restylane, and other injectables that could be used by an entrepreneurial clinical assistant who has his or her own weekend practice. Lastly, patient healthcare identify theft is a growing problem. Incidents of physician employees dealing in patient identities are in the news. Because physicians and managers often panic-hire, recruit “friends,” and skip steps that no business would opt out of, they are more likely to experience trouble. The combination of physicians’ inherent distaste for managing people and lack of a meaningful personnel management function means that it often takes a while for wrongdoers to be found out. Embarrassed, few practices prosecute, although in the author’s experience this is beginning to change.
JCAHO MANDATED STANDARD
On January 1, 2006, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) required that hospitals and covered healthcare entities, which include many practices and their surgical facilities, conduct verifications on all licensed, registered, or certified staff. The process of tracking license renewals is covered as well. This requirement calls for verification from the primary source—calling the board and the certifying educational institution—not just accepting a photocopy of a document. Forgery happens.
Verifying the background of anyone delivering patient care is mandatory and, from a liability standpoint, in the practice’s best interest—even without a JCAHO mandate.
Clearly with the nursing shortage and the difficulty many practices have in recruiting qualified clinical staff from certified registered nurse anesthetists to medical assistants, there is an opportunity for candidates to present false credentials and for practices to turn a blind eye. Verifying the background of anyone delivering patient care is mandatory and, from a liability standpoint, in the practice’s best interest—even without a JCAHO mandate.
HOW DO YOU INCORPORATE BACKGROUND CHECKS INTO YOUR HIRING PROCESS?
The first step is to enroll with an accredited company that provides background checks (see box for a listing of several companies). You can’t just pick up the phone and call about a candidate when he or she is in your office. The information service company must verify that a practice is a bona fide entity and will in some cases have someone verify that there is a medical practice in the building address you provide. So enroll now.
Ask about fees. The more there is to check, the higher the fee. In the author’s experience, verifying addresses, credit, criminal background in one state, and education typically runs from $65 to $85 dollars. Some practices have the company call all previous employers except the most recent, whom the practice phones personally. If you request criminal checks in multiple states or drug tests, the cost can mount. So inquire about fees, but keep in mind that this small investment can help you avoid big trouble. Avoid the cheap online Internet search firms; they are of dubious value, and in fact, some news articles feature them as scam artists.
As a practical matter, some recruiters include a statement in their newspaper and online ads that a background check will be done. This is effective in dissuading marginal prospects from applying. The verification company you select will provide an approved form to have candidates complete. Many practices limit background checks to their top three candidates. So after job candidates fill out an Equal Employment Opportunity Commission-approved job application form, they will complete a separate form authorizing the background check that you will fax to the company. At this point, an applicant may want to amend his or her application or share a problem with you.
You then submit the form to the company that performs the background check. Within a matter of minutes, you will likely receive the credit check. The criminal check typically takes two to five days—depending on the number of states. The time required for education and employment verification varies. So, if you make an offer, it should be contingent upon a successful background check.
Next, understand that you must be consistent in running background checks. Practices that pick and choose when to perform a check can run afoul of the law. Develop a written policy that states what aspects of background will be checked for all applicants and for those with special responsibility. For example, if an employee will drive to satellite offices, you would be justified in checking motor vehicle records. Because of the type of information in your office and its sensitivity to your patients, you would be smart to run a criminal background check on all employees.
REGULATIONS APPLY
In a nutshell, here’s what you need to know. The Fair Credit Reporting Act applies to background checks. The company you enroll with should provide you with the particulars. Further, some 20 states have regulations that affect pre-employment checks. California, New York, New Jersey, and Massachusetts are among them. The point is that if you choose a reliable company to work with, it will help you stay abreast of and comply with the applicable laws.
Remember, your goal is minimize your “mis-hires” because they usually result in “mis-fires.” Developing a qualified work group and providing a safe environment for staff and patients are your goals, and relying solely on your intuition or a resume is unlikely to help you accomplish that.
Additional articles from The Journal of Medical Practice Management:
Reprinted with permission from The Journal of Medical Practice Management, Copyright Greenbranch Publishing, (800) 933-3711, www.mpmnetwork.com.
*President, KarenZupko & Associates, Inc., 625 North Michigan Avenue, Suite 702, Chicago, IL 60611; phone: 312 642-5616; fax 312 642-5571; e-mail: kzupko@karenzupko.com. Copyright © 2007 by Greenbranch Publishing LLC.