Fully Staffed?


Now is the time to examine how you recruit, onboard, and retain your staff.

By Ingrid Sparrow, PT

Enjoying that rare moment when you have plenty of patients and your clinic is fully staffed? Take a few deep breaths, smile, and then dive headfirst into your process for staff recruitment, onboarding, and retention.

Why now, when things are finally running smoothly? Consider the marketing adage: If you wait until you are slow to market, you are too late. No matter how much you market, you cannot backfill those empty patient spots nor can you recapture that lost revenue. Developing staffing strategies is similar; if you wait until you need to hire new staff, you will not be prepared to simultaneously advertise, network, interview, mentor, and motivate your new and existing staff.

Your strategy depends on many factors, the most significant being the number of clinics and the levels of your staffing. The single physical therapy practice with no employees will not need to do this until it is time to grow, while the physical therapy owner of multisite clinics with several levels of both office and clinical managers may need to hire a clinical administrator or human resources (HR) specialist to develop and manage these processes. Identify who will do what and then get to work, as there is a lot to be done!

Keep in mind that you won’t recognize your next star employee until you have taken time to determine what type of star you and your clinic need.

RECRUITMENT is not just a long word for “hire.” It begins with identifying your clinic’s culture and style of practice, followed by communicating this to your patients, other practitioners, and even your vendors. It is this networking that builds your clinic reputation and brand, and this happens when it comes time to hire.

Have outreach strategies in place such as a Career section on your web page, and be familiar with the popular job posting sites in your area (e.g., Indeed, Glassdoor, LinkedIn, Craigslist, etc.). You will then have these needed resources in place when it comes time to hire.

Be prepared to screen and then interview only your top candidates. This can be an amazing time sink, or it can be done efficiently and effectively if you have done the following unglamorous prep:

  • Have a job description and job ad ready for each of the positions in your clinic, not just the one you are currently looking to fill. Identify and write down the personality and skill set needed to flourish in this position and interview for this person, not the one you would most enjoy having lunch with.
  • Have a full description of your benefits package from pay to parking, and then compare this to your community standard. Know how and where your offer stacks up compared to nearby clinics. While you will not discuss the details of the benefit package until you actually make a job offer, knowing that your offer is reasonable will give you confidence.
  • Reply to all applicants in a timely manner, even if the reply is a polite rejection letter. Each applicant deserves to be acknowledged, and it only improves your reputation in your community.
  • If you will not be bringing someone in for an-person interview, politely let them know this and let them know why. You can create a template for this task.
  • Schedule interviews in a timely and professional fashion. It sets the tone going forward.
  • Use the phone interview to screen an applicant in or out. Know your nonnegotiables and ask those early on. The person may be amazing, but if they are not available to work when you need them they will only be an amazing headache.
  • Have a framework and timeline for your in-person interviews. Help put the interviewee at ease by initially telling them a bit about yourself and the clinic, but beware of doing more talking than listening. Be prepared to ask both closed and open-ended questions. And listen for how and what the person answers in response to your questions as this will tell you as much about them as the answers themselves. And I highly recommend reading the article “15 Questions to Ask During Your Physical Therapy Job Interview.”1 The interview will go well if you are ready with these questions.
  • Stay in touch during the interview process, which can span several weeks. Honestly communicating with your top candidates where you are in the decision and hiring process keeps them engaged and enthusiastic instead of wondering what is happening. If your initial hire falls through, you may still have the option to hire your next best choice.
  • Be ready to negotiate, but keep in mind you need to keep yourself and the rest of the staff happy with any deal that you make. Keep in mind that salary data self-reporting sites such as Glassdoor show salaries that are 10 to 15 percent higher than actual earnings. While you can’t match all of what Google offers—no official work hours, loads of time off at short notice, midday surfing or snow days when the powder and skiing are amazing—you can match Google when it comes to work-life balance, support of volunteer interests, a focus on wellness, and continuing education. By preparing your full benefit package, you will know where and how much you can negotiate.

ONBOARDING is often used to reference the process of hiring and training, but more specifically it is actually “organizational socialization.” It is the mechanism through which new employees acquire the necessary knowledge, skills, and behaviors to become effective organizational members and insiders.2

A well-thought-out onboarding process spans one to two years and can be looked at as your chance to deliver on promises made during the interview. It encompasses sharing the Big Picture along with the Details, including a warm introduction to all of the staff and to the clinic’s resources, processes, and organization. It begins and is supported by building communication and relationships with the owner, manager, and coworkers. The organization and details of onboarding will vary from clinic to clinic, with each owner having a plan in place to meet with the new employee on a scheduled basis, establish mentoring individualized to each new employee, and support their growth in the company.

In the short term, this includes the hiring paperwork—your first opportunity to impress your new employee. Make this paperwork easy to access and allow plenty of time for the new person to complete this paperwork and ask questions. Ways to make your new employee feel valued and welcomed may include a prepared work space complete with a welcome packet, ID cards/passwords/etc. set up and ready to use, and a clinic logo shirt so they feel part of the team. It is helpful to identify a staff member whose job it is to make the new employee feel welcome and included during their first several weeks.

How you organize and implement the longer term portion of onboarding will depend on the factors of your time and interest, staff size and variety of staff positions, and so on. Be honest as to the best use of your time and energy, and if you are not the best person for this job select the employee or contractor who will make you shine. There are companies that can provide continuing education resources on staff development that can assist with this. Or it may be that you choose to outsource portions of the onboarding process by contracting with a human resources service in your area. Whichever path works for you, it is important to refer back to why you hired this particular person and the goals you set at the time of hire, and then pursue these goals.

RETENTION, or how you keep them. We all know that some changes are inevitable—people move, marry, return to school, change careers, grow families, or become ill—so enjoy your employees while you have them and support them through these transitions.

But as staff turnover is financially expensive, with the average cost of replacing a salaried employee being between six to nine months of salary and that of a midrange position being 20 percent of annual salary, it literally pays to retain top tier staff.4 So when you find a good employee, plan and work to hold onto them. You will be rewarded with the time, energy, and emotion you saved by not having to return to the recruiting and hiring merry-go-round.

The keys to employee retention are harder to define than those of a good hiring process, in part because what employees want and need changes over time. Keeping this in mind, common threads that have been identified with a stable and satisfied workforce are:

  • Clear job expectations, frequent feedback on job performance, and the ability to use skills and grow. The employee feels recognized and rewarded.
  • Safe, ethical, and fair workplace that supports a purpose-driven mission statement.
  • A safe and well-maintained workplace with current tools and technology and the time and training to use them.
  • Honest and open communication that encourages open and inclusive collaboration.
  • Flexibility, respect, and autonomy with setting goals, work-life balance, and recognition of input and decisions.
  • Ability to practice so that work has purpose and is sustainable. Each day employees should be reminded why they were attracted to the field of physical therapy and be made to feel that they are making a difference in their patients’ lives.
  • Fair pay that provides a livable wage. Top dollar is not often the driving force, but the ability to support oneself as well as the option to earn more through productivity systems or choice of scheduling can be key, as can the perception as to how profits are being defined and spent.
  • Recognition that as employees, some weeks we spend more time with our coworkers than we do with friends and family, so we need time to laugh and share stories, be both our best and just our blah selves, celebrate birthdays and cry over hard times, support stellar and below average days while encouraging each other.

In a way, you can approach staffing using your well-honed patient care mind. Recruitment is the initial evaluation when you use your deductive reasoning to determine a diagnosis. Onboarding is patient engagement in the process of care and the building of relationships. And retention can be seen as the development and implementation of care, requiring frequent reassessment and progression/modification of the plan of care. While not a perfect analogy, this is the approach to problem solving in the métier in which we are trained and experienced.


1. www.ptprogress.com/physical-therapy-job-interview-questions. Accessed January 2018.

2. Bauer TN, Erdogan B. Organizational socialization: the effective onboarding of new employees. In S. Zedeck (Ed.), APA Handbook of Industrial and Organizational Psychology, Vol. 3: Maintaining, Expanding and Contracting the Organization. APA Handbooks in Psychology. Washington, DC: American Psychological Assocation; 2011:51-64.

3. www.naylornetwork.com/ahh-nwl/articles/index-v2.asp?aid=134767&issueID=22500. Accessed 2018.

4. www.zanebenefits.com/blog/bid/312123/employee-retention-the-real-cost-of-losing-an-employee. Accessed January 2018.

Ingrid Sparrow, PT, is the owner of Sound Physical Therapy in Seattle, Washington. She can be reached at Ingridsparrow@soundpt.com.

Copyright © 2017, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

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