practice management

Hiring New Employees in a Tight Pediatric Market

Since the COVID-19 pandemic, pediatric practices have been hit hard with staffing shortages. The pandemic’s upheaval has led many to reexamine priorities, leading even long-time employees to seek more stable or better-paying pastures as retention plummets. Practices looking to hire during this difficult period are left with few applicants, and those who apply are inexperienced or desire benefits or pay small businesses can rarely afford. What’s a pediatric practice to do? 

Practice owners seeking out and managing a staff that includes new employees have a lot on their plate. In some ways, hiring and managing staff is much the same as before the pandemic, while other aspects require creative thinking, negotiation skills, and even a recommitment to what brought a practice to life in the first place. Whether you’re preparing to hire new staff for a new office or looking to replace experienced workers, let’s break down the management of new personnel one step at a time.

Culture Above All

Before ever hitting the word “Submit” on a job posting website or in an email to your local newspaper, pediatric management expert Susanne Madden, founder and CEO of The Verden Group, notes that practice owners should have a solid understanding of practice culture and values before hiring a new candidate. “What is it that you're trying to build?” she said in a webinar co-hosted by PCC’s Chip Hart. “What are you trying to create?”

In previous posts, experts like Madden, Hart, and PedsOne billing CEO Tim Rushford have explained to PCC the need to hire for culture above all. Does this truly mean that practices should hire a culture fit beyond everything else? Even experience? Even skills or degrees?

For the most part, yes. While clinical staff need the appropriate licensure and credentialing to practice legally, their interests, values, and experience can vary. Non-clinical staff like front desk personnel and office managers need not have 100% of the experience or skills that would be ideal for their position. Everyone will need to learn a little on the job, but values and interests can’t be taught or often changed.

This is why knowing exactly what your values are can help land you the right candidate for the job: one who, like your practice, wants to work with infants, children with disabilities, Spanish-speaking populations, immigrant families, or their own small-town neighbors. This may not be a new employee, but someone looking for growth or a new skill set, like an MA seeking to help out at the front desk. Hart adds that this “broad” way of hiring within your practice can be a win/win for employees and practice owners, as more hours and a more skilled employee works out for both parties.

Everyone will need to learn a little on the job, but values and interests can’t be taught or often changed. Says Susanne Madden: “Ask the candidate how their experience and their personality and their education fits with what it is that you're trying to do… your vision, your mission.”

“You Want How Much Money?”

It can be tempting to celebrate after finding a great candidate, especially if applications are few and far between. Still, practice owners and managing pediatricians should hold back on the fireworks just a little longer, because part of the hiring process is getting the candidate to accept your offer – which means their pay (and benefits – more on this later).

Whether you’re crunching numbers for new employees or existing staff who want a pay raise, negotiating salaries is often a difficult task – there is only so much that practices can afford and still make a profit, after all. Negotiation skills aside, when sitting down with an employee to talk money, it’s important to recognize a few hard facts going in:

  1. Your practice has financial limits. You can’t pay someone from an empty till, nor should you try to pay them more just to get them to stay. Salaried employees like nurse practitioners should make enough profit to cover their expenses (i.e., their salary/benefit packages).
  2. Other employers nearby probably have broader financial limits. Hospitals, large clinics, and other employers can and will be able to supply bigger paychecks.
  3. If your employee values their paycheck over other benefits, and refuses your offer, it could be a blessing in disguise – or an opportunity to reexamine your benefits package.


In a study of PCC practices conducted by Chip Hart in 2014, he found that partners in pediatric practices had a range of values in their compensation package: not just salary, but work-life balance, including flexibility, fairness, time off, and after-hours duties. 

Whether they are a practice partner or the new kid at the front desk, the pandemic has forced many to reevaluate their work/life balance priorities, which gives pediatric practices big leverage points in flexibility, values, and fairness over hospitals and hospital-owned clinics.

For more information on getting the most of your compensation package (for partners and employees), check out this full article to get to the math with data hero Chip Hart for The Verden Viewpoint.

Stay to Play with Benefits Packages

Practices can’t often afford “pay to play” negotiation tactics – if an employee or candidate is asking more than the practice can afford and won’t take no for an answer, it’s probably a good idea to let them go. “Enough” pay rarely stays “enough” pay, long term. Instead, practices can offer “stay to play” packages – benefits that support employees’ non-financial, intangible values like family, children, travel, or community.

What practice managers should offer employees before they leave the negotiation table is a good look at the practice’s fantastic, incomparable, “I-love-my-job-because” benefits package. To the right candidate, the benefits package is what should send stars into their eyes. Not sure your practice has such a sparkling package? 

The benefits package should fit right into practice culture and often doesn’t need to be in black-and-white. According to Dr. Hiral Lavania of One Family Pediatrics in GA, her practice’s benefits package often blends with practice culture in ways that make her employees feel seen, valued, and supported. Her employees are hired for a culture that values family, and they are reassured that should they need to leave early to care for an elderly parent or sick child, they’ll be told, “Go right ahead.”

Does your practice value community involvement and giving back? Your package could include built-in days for volunteering or community events. If your culture values mental health and wellness, flexible time off instead of pay raises could encourage retention. It’s also a great idea to add fun perks that other practices just don’t offer: free tickets to a practice-sponsored event like sports or theater, membership to a local gym via the health insurance carrier, or two “wellness” days a year in which staff members build team bonds and learn a new activity, like yoga or pottery.

For independent pediatric practices, the biggest sell for attracting and retaining staff are these intangible but often priceless benefit packages. When a disgruntled employee says she wants more pay because she and her partner can’t afford housing, you can counter-offer with more time off, a more stable schedule, or if she won’t budge, less time off in exchange for her raise.

Involving employees in the benefits discussion can help attract new candidates and maintain your current staff. For example, the employee who needs housing may come back to her manager in a few years and ask for more time off, even at the cost of less pay, and she knows she can negotiate rather than shop around for a new position.

For the same reason, it’s a good idea to keep in contact with great candidates who decline to work with you because they received a higher salary elsewhere. After a year or two, they may return and say, “It’s just not worth it. I want more time to travel and a predictable schedule and management that listens to what I say.” When that time comes, larger companies may say “no,” but your practice can say, “We’re glad to see you again. We have just what you’re looking for.”

Allie Squires

Allie Squires is PCC's Marketing Content Writer and editor of The Independent Pediatrician. She holds a master's in Professional Writing from NYU.