Jay Holmes: Welcome to the Medical Management Podcast. A podcast focused on helping you level up your practice. Through interviews with some of the most successful leaders in the industry, we help uncover resources, tools, and ideas to help you level up your practice. Thanks for tuning in, and we hope you enjoy today's program.
Jesse Arnoldson: Hello and welcome to the Medical Management podcast, I'm your host, Jesse Arnoldson. I am rejoined by my good friend Scott Tucker of Women's Health Associates in Boise, Idaho. Welcome back, Scott!
Scott Tucker: Thank you. Glad to be here.
Jesse Arnoldson: We are glad to have you here. Today, we are going to get into one of the most, I think, one of the more common interactions that managers have with staff on the topic of pay raises. And so I set this up for Scott to think about what happens when the nurse or the receptionist comes and says, I think I deserve or I want to ask for a pay raise. I think a lot of us don't have a good plan for that, and no plan is still a plan. It's a plan to flounder and either negotiate poorly or make the employee leave unhappy or give them more money than they should. So tell me a little bit about your approach to when you're asked about pay raises.
Scott Tucker: So I think the biggest thing and a lot of this has been through the school of hard knocks, but it first thing I can say is just make sure you have your facts. So.
Jesse Arnoldson: Right.
Scott Tucker: I know you're, I, I watch the market value, fair market value for all of our positions, at least semi-annually, usually especially over the pandemic, because it seems like they were changing monthly. I was watching ..., I keep those ranges so that I kind of know where everybody's at. And one way to kind of curb off people asking for a raise or feeling like they're being underpaid is I make adjustments throughout the year, so if the market shifts up and some people are not within market range anymore, then we adjust them. I will say during COVID, I didn't do a quarterly because they were going up and down, but it seems like things are a little more stable right now, but I have a feeling it's going to change as we're, we're all experiencing with the generation of resignation.
Jesse Arnoldson: Mmhmm.
Scott Tucker: What that does, and even if everybody isn't getting adjusted because of market changes, let's face it, they all talk and so they know, they hear it. They know we're watching it, they know we're, we're making the market changes, so that's, I think the first kind of proactive step we can do. The next is really just making sure you have your facts available so, not only market range, but also look at it, all of the benefits that you provide that you're providing on the employee's behalf and they can be everything from PTO days to paid holidays to paid breaks, in-office services, health insurance, retirement, all of those things that have a dollar value associated with them, those are big numbers you need to have. And the approach that I then take with people is if we ask, if they're coming and feeling like they deserve a raise, we talk through it, I want to hear them out, let them explain what they're feeling, why they're feeling the way they're feeling, and have them give you a number because a lot of times it's why just think I need a raise? Ok, well, how much? I don't know, you need to figure that out.
Jesse Arnoldson: Yeah, right, right. No, no. Wait a minute.
Scott Tucker: That's not how it works.
Jesse Arnoldson: Yeah.
Scott Tucker: And then the next step of that is asking, where are they getting their numbers from? And it's usually, well, my friend says this and they work here.
Jesse Arnoldson: Yeah.
Scott Tucker: OK, great. So let's go through it and I have this exercise that I take people through. Ok, let's look at your hourly wage, and then let's look at health insurance, so we cover X amount for you, over here what does that look like? Oh, you have to pay one hundred dollars a paycheck? Ok, so there's money right there. You know, in-office services we, we have, part of our employee benefit plan is a certain dollar amount attributed for each each employee to get in-office care. Well, that has a dollar value to it. And so then, what I do is I go through this whole step with them and we set things out side by side, so then they can really compare and look at, and because those have dollar values to them, you can then back them into what it equates to per hour based off the hours they work and.
Jesse Arnoldson: So they have to come back to that language, right, Scott? Like it has to come back to the hourly language because that's what everybody understands and who goes off of.
Scott Tucker: Right, absolutely. And so we can attribute that to, yeah, you're you're making x dollars an hour, and while you might make the latest one that came and talked to me, she was going to make seventy five cents more an hour. So I said, OK, let's, let's look at that. What it really came down to when we went through and compared truly apples to apples and the benefit structure and everything, she still makes three dollars and fifty cents more an hour here than what she was going to make at this other clinic, but it was enticing because I'm going to make seventy five cents more an hour.
Jesse Arnoldson: Right, right. But at the end of the day, man, the paycheck doesn't go as far.
Scott Tucker: Yeah. And then.
Jesse Arnoldson: For some reason.
Scott Tucker: So that next step of, well, I'll have more money in my bank. Well, let's break that down because for health insurance, you've got to pay this. We with a 401(k) plan and with pre-tax allotments that we do for part of our benefit plan, I also back out and show them that we reduce their taxable income, which actually gives them more money than just getting seventy five cents an hour and going through those steps with people, and, and you just find that most of them just never put two and two together, they just hear the hourly thing and then that's all they're focused on. Will I make x dollars an hour and over here I can make 50 cents more a dollar more, even two dollars more, but not really comparing everything that goes into it. And the other piece that I find when going through this exercise, I have yet to be where we're under, we've been close, fortunately so it tells me we're still doing good, but it also opens up their eyes to how much it costs an employer to have an employee. They just think, well, no, you just pay me my wage, you know? And so we'll also go through the exercise as well is showing, well, here's how much the employer taxes are, here's how much worker's comp is, and while this doesn't go into your compensation, these are the expenses that the employer has, so when you're talking about 50 cents an hour, this is the downstream of what it really turns into for an employer and.
Jesse Arnoldson: Right.
Scott Tucker: Just trying to open up their eyes to how employment works. And it's not just about paying X number dollars an hour. So you're really trying to.
Jesse Arnoldson: Not many people understand that. So it's good to bring them into the, into the know. Do you have, Scott, do you have a philosophy of what it does take to get a raise. Like, let's say, let's say somebody comes in and says, look, I, you guys pay fair market value, I feel like I am better, I am at a higher level than what you've put me at.
Scott Tucker: Yeah.
Jesse Arnoldson: Or I deserve a raise because I've been working really hard.
Scott Tucker: Absolutely. So the way we approach it is we have just pay bands, so entry level to the upper echelon and a lot of flexibility within those pay bands. And we give credit to a medical assistant that also manages all our supplies and inventory, that's above and beyond work. The other thing that, that we've done is we've tried to break down, even though the medical assistant role is a medical assistant role, we've kind of even broken those into categories based on general roles and responsibilities, if they focus mainly on patient intake and rooming versus patient intake, rooming, and calling with lab results and whatnot, or they take on extra roles like supplies or QI stuff or for those kind of things, take those into account and then give some compensation there. As well as we feel there's a lot of value in people's previous experience and putting.
Jesse Arnoldson: Right.
Scott Tucker: Maybe a little heavier weight than some places would consider. And that's just to attract experienced qualified staff. And we want to recognize that if they worked, you know, out of state and a specifically like W.J. and a women's health office, there's, there's value to that that they should they get compensated for.
Jesse Arnoldson: Absolutely. Can I share with you? You know, this is just an example, but I'll show the example I put in a couple of different clinics of, well, what does it take to get a raise? I think I have three reasons. One, would be your normal annual because I think there should be a ..., because it just gets more expensive to live every year. Two, would be if your job changed drastically, you know, like if we were going to add the above and beyond stuff that you talked about, or let's say we moved somebody from reception to care coordinator or from nurse to lead nurse, we're going to add money to that. The third one would be the market value. You know, our pay scales, fair market value, and if we put you fairly in the right spot in those scales. And I try and have those ready like they're just simple rules, simple ways of doing it because you've got to have an answer, because if you, if you fumble and then end up not getting it, the impression is, well, we thought about it and you're not worth it.
Scott Tucker: Absolutely.
Jesse Arnoldson: That's so bad. That's why most people, most people's experiences, I ask for a raise, I get told no, I'm going to go elsewhere. And that is the risk that I think people, these managers, they need to have a plan because it's not just a one off conversation, can I get through this awkward conversation and get to the other side of it, and I'll be OK? No. This is a very high risk moment where the person could turn over, if you do it wrong.
Scott Tucker: It's actually, right now in the current environment of leaving and whatnot. I think the other piece, as we were talking about earlier, when you start the conversation with explain to me, you know, kind of what you're thinking and where you're feeling you're being under compensated. And what's that number that puts that? It sounds bad, but it puts it back on them and then they're engaged in that conversation and it gives you time to react. It gives you time to get a sense of where everything is at. If they come and say, well, I feel like I, I'm the one you hear the most well, I'm good and I'm loyal, Ok.
Jesse Arnoldson: Right.
Scott Tucker: You've been here for a year, so, and that's not with five dollars an hour or more.
Jesse Arnoldson: Right. Oh my goodness, I love that. I need the one that I had that probably bugged me the most because somebody came in and they were very genuine, they were very sincere in what they're saying. So, you know, I've, I've worked my butt, I've worked really hard, and if I had and I don't say this in my head, I go, well, if you had it, I didn't realize that I could have come back to you and said, hey, we're going to pay you less. Oh, and that's just the jerk side of me, and I keep that very much suppressed inside. But I think my explanation to that person was, you know, working hard is the prerequisite to just staying here, like that is, that's what it takes to keep your, stay employed here. And we're going to make this an awesome place to work so that you want to be here, you want this to be your place of work and not on the assembly line of doing frozen chicken meals, you know, we want you to enjoy it here. But just because did your job well, that's not, that doesn't fit into the rules, like this philosophy, here's the philosophy, let's, let's figure out where to sit. I didn't come out on top of that conversation. The person ended up leaving, so I probably did say something offensive, well.
Scott Tucker: I think to add on to that, that's that's where your, you can lead them there without having to tell them. And that is what additional things have you provided outside of your normal, normal everyday function?
Jesse Arnoldson: Are there other things that you want to do?
Scott Tucker: Yeah.
Jesse Arnoldson: You want to take on more responsibility because I'm all about it.
Scott Tucker: Yeah, absolutely. And I think that's the key and especially with the generations we're seeing now is, you know, not, not in a negative way, but they just don't know, they don't get it. This is a foreign concept to kind of a deep understanding of what goes in to make the wheels turn. But more importantly, is and you know, we saw it in our previous podcast talking about the No Surprise that they're very much into this. They want to have more details than what, maybe, historically other generations did. So we have to adjust to that.
Jesse Arnoldson: It's an informational, only that we were in the industrial age, now we're in the information age and people want, they want to know.
Scott Tucker: Yeah, absolutely.
Jesse Arnoldson: And I want to, you know, to the point they made earlier, Scott, that people talk. I think that it always been good general practice to pretend that if everybody's pay was posted on the break room fridge, would you look the people in the eye and justify why they make what they make? And I've been in some clinics where I couldn't do that, you know, maybe it had been set a certain way that I didn't have much control over and, or maybe in my younger years, maybe I gave more money to people I like, I can admit that. But now I sure as heck have documented, OK, I gave Scott, you know, an extra 50 cents because he speaks Spanish, that I gave him two dollars for his degree and I gave him five dollars for his experience.
Scott Tucker: Right.
Jesse Arnoldson: Perfect.
Scott Tucker: Right.
Jesse Arnoldson: That's how it goes, and you can, to another appointment you made, you can bring in applicable experience. I've given money for experience outside of health care, customer service.
Scott Tucker: Absolutely.
Jesse Arnoldson: Call center work, any, anything like that that can be added on to kind of help, not to give away the farm, but to make, make somebody know their value and to show that.
Scott Tucker: Oh yeah, I think that goes into more talking a little bit earlier and just historically with pay scales, you know, there was this shift for a while and I get it, it really helped with kind of the times we were in, but it was like, OK, you're in this position with this degree and this is your experience, this is what you make. So very black and white. Just pull you size on a chart and go in there. And while that has some benefits to it, especially when you know to your point about, well, if everybody's pay was posted, how would you feel, happy to defend that? That's easy. Here's the pay, here's where you sit. The downside of that is the people side of it, which is it doesn't account for things, it doesn't account for oh, you speak Spanish, or you know, you've got 10 years in a call center, that plays a lot of role into what you're doing in our phone center and.
Jesse Arnoldson: Right.
Scott Tucker: Just kind of thinking, and then.
Jesse Arnoldson: Could you make it match, though? Because that's I mean, you and I, we built our pay scales off the same foundational stuff, right? Like ours are very similar to each other of how it's put together. But I put language, I put, I got, what, did I put? Language, education, general experience and then directly applicable experience, I think those are the four categories that I gave more money for. So if you worked at a call center, you got a certain amount of money, if you worked at the pediatric clinic down the road on the same EMR, holy moly, you know, you hit the jackpot.
Scott Tucker: Yeah, no, absolutely. But I think that's where it, having some subjectivity to it is exceptionally helpful. And that also helps you, for the staff member it helps build a little more of that personal touch as opposed to just being another cog in a wheel that, this is where you are, you know, especially with the generation we have, you know, 50 cents an hour is the, you know, I'll leave a job over 50 cents an hour without knowing anything else into it. So we've got to remember that, we've got to somewhat play into that and understand where the mindset is and how we can best educate and explain and provide that information for them to make an informed decision. And if they end up leaving because of it, you know, at the end of the day, then we also know that we did everything we could and it just wasn't a good fit.
Jesse Arnoldson: Exactly. No, I love it. Scott, thank you for your insight and for your your ideas and advice. I know it'll be of help to a lot of people. And you're welcome back any time. And for all of our listeners, thank you for tuning in, please make sure that you take this subject seriously because it's a high risk situation where you quite easily could be the last straw that kind of pushes that employee, good employee to turn over, and that is not what we need in this time of, Scott, what did you call it? The generation of resignation.
Scott Tucker: The generation of resignation.
Jesse Arnoldson: Definitely don't need any more reason to have to be, in recruiting more than you need to. So guys, for anything that MedMan does, the show notes to this episode and any other, please visit us at MedMan.com and we'll see you next time.
Jay Holmes: Thanks for tuning in to the Medical Management Podcast. We hope you enjoyed today's featured guests. For the show notes, transcripts, resources, and everything else, MedMan does to help you level up, be sure to visit us at MedMan.com.
This time, Scott joins us to chat about a topic that most employers may not be keen to talk about: asking for a raise. Having the market values in mind is always important, even though during the pandemic they have been changing constantly. Scott always rechecks them every few months to see that every employee is having a good number on their paychecks. As a manager, always be open to listening to your employee’s reasons to get a raise; their explanations can show you things you might be missing out on. Employees need to understand how much it costs an employer to have them in the company, and that includes health insurance, retirement, in-office services, and more.
Tune in to this episode and understand the other side of the coin when it comes to raises in a company!
About our guest – Scott Tucker
Scott Tucker is a practice administrator in MedMan, working in Women’s Health Associates in Boise, Idaho. With a diverse background, he began working in public safety at the age of 14 when he joined the local fire department. He got his EMT at the age of 18 and has experience in the revenue cycle and practice management.
Scott developed a big passion for emergency medicine and nowadays still works as a paramedic.
Always check the market prices.
Have your facts available when you are considering raising or lowering rates for your employees.
The benefits that you provide also weigh into your employee’s salary.
Employees usually only have a one-sided view of this topic.
Having pay bands is the most simple way to demonstrate to an employee how their salary is being defined.
Taking into account someone’s past experience may attract more experienced qualified staff.
The generation that is entering the workforce needs to know the details.