It's the beginning of the year. So a really hot topic is figuring out your hiring situation, who you're keeping, who you're not, what's working, what isn't. And for a lot of us, this means expanding our team or possibly making our team smaller. And so when I think about this and a lot of the questions I get, we typically forget. What goes into hiring a new employee, which is why it's really important to understand your training process, understand your onboarding process, understand what it takes to even hire an employee and how to keep them. so I'm going to go out on a limb here. And a lot of us tend to think, especially when we're doing projections or brainstorming or daydreaming. We think, okay, I'm going to hire this person for 35 hours a week. I'm going to pay them 20 an hour. And then we just think it's going to cost us 700 bucks a week. And that's that. And the reality is that it couldn't be further from the truth that there are so many hidden costs to hiring a new employee, regardless of what position they are. so we're going to tap into that today. I want to make sure you guys are fully aware of some of these hidden costs. You can prepare and make sure you're hiring at the right time. So obviously salaries and wages kind of come into the mix. I strongly encourage you all to wait until you can afford someone at slightly higher the going market rate. That's going to help you attract better people in the application process and it's going to help you retain your patients very well. Other things to consider. What are you offering benefit wise? So there's extra costs like retirement plans, health insurance, other standard benefits. Some people do gym reimbursements or health care stipends or travel comping or the purchasing of equipment, supplies, a laptop, iPad, those kinds of things. Even before you hire that person, there are costs associated with posting the ad to literally get someone. some of us use recruitment agencies. Some of us spend X amount of time doing interviews, especially if you have another employee doing your first round of interviews for you. So even before you hire this person, there's already cost involved. So it's very important to realize that before you make this decision, make sure you're ready for it. I know the biggest surprise for me was the cost of training and the cost of additional software licenses. So for example, when you first hire that employee, there's some training involved. Our office, we choose to do remote training, so typically they'll do like five or seven hours before they even start, and that's all laid out with video modules and like, either written or informational types of training that they can get done in a very short amount of time. We do have a different training salary or wage for that. It's a lower one. Of course, they're just sitting at home typically reading things or watching videos and it's only five or seven hours. That one was an unexpected cost that I didn't really think about, but I of course wanted to pay them for that time. Another surprise cost for me was the amount of money I had to pay other employees to train the new employee. And so, especially if that person isn't necessarily in the same exact role, you could be paying 20, 25, sometimes even 30 an hour just for training. and there's ways to get out of that, if you so choose or to have, you know, one person on your team designated to training and know that it might be just an additional compensation at a different hourly rate. I didn't do that. I just kind of like lump summed it all together. So it. cost me quite a bit of money. but for me, it was important to have that one on one training time in conjunction with the remote training. So typically the goal is to do like five to 10 hours of that, that first one to two months of a new position. the number one surprise cost for me was software fees and subscriptions. Understanding that this app that you use makes you pay for three users versus five. And then, you know, logging into Google Workspace might cost this number or having to raise that number. different EMRs have cost per user or cost per provider. and so the larger your team grows, there are really surprise costs to that. And I remember when I first started and did all my budgeting and built out my business plan, I just never thought about subscription fees. I never thought about how tech savvy and digital my practice is and how growing my team definitely was going to increase my cost there. so some of the top companies we use would be monday. com, loom for video, Google Workspace. Trust Driven Care for our CRM. We have an EMR obviously, we use JNAP personally for my private practice. And with every single one of those, the cost slowly increases. Even something like a digital fax system, that cost goes up per user as well. There's so many examples of this. Payroll goes up because you're paying somebody a salary or a wage, but there are also payroll taxes. There are other costs involved, even something as simple and small as knowing that at the end of the year you're going to have to pay additional fees to send someone their W 2 or all of those small things that we just don't think about. And then there are fun things too. Recognizing there's going to be birthday gifts, anniversary gifts, like work anniversary gifts. sometimes you're going to have coffees and meals If your meetings are long and they're during lunch, a lot of times you're going to cater food in. All of those little expenses really add up. And yes, a lot of these things can be written off, but at the end of the day, the money still has to be there. So again, the larger your team gets, the more expensive things are. Then you factor in things like Christmas parties or celebratory parties for the practice, you know, maybe it's the four year anniversary of the practice and you have an event. Well, if you have a team of 20 versus a team of three, that event is going to look a little bit different. So these are all surprise costs that like, I know for a fact, I never thought about when I grew my team and we decided to grow pretty rapidly. I went from a team of one to seven, pretty much in less than 18 months. That was not my plan. I don't even really recommend that to be honest, but it had to happen in the moment and I learned really quickly all of these additional expenses and how to adjust for them. The biggest reason why this is important is because employee turnover costs us so much money. I found a source from the Society for Human Resource Management, and it actually says that a bad hire, quote unquote bad hire, can cost a company up to 30 percent of that employee's first year salary. which is a lot of money. turnover is not ideal and I know a lot of small private practices who just don't care about turnover. They pay extremely low, 12 to 14 an hour and expect people to stay forever without benefits, without appropriate training or onboarding, without even recognizing and valuing that employee on a regular basis, and then they wonder why their turnover is so high. So it will actually save you money to invest in your team and to pour into them to allow them to stay with you. So yes, there's additional costs involved, but you will spend more money with this employee turnover. Another important thing to consider would be supplies. So not only are there increased office supplies, devices like additional laptops and iPads and all of that, you'll go through equipment at work a lot quicker. The larger your team is obviously, even down to something like toilet paper, everything goes up. Maybe you purchase scrubs for your employees, whether they're nurses or assistants or what have you, that's an additional expense as well. And then if you are hiring someone that happens to be a provider, another thing to factor in when it comes to turnover and onboarding is the credentialing process. Most of the time insurers can take 90 to 120 days just to credential and onboard a new employee and just to get them accepted into that payer system. So what are you doing? During that 90 to 120 days, do you have a plan for all of my employee hires, regardless of position? We have a one month, two month, three month plan where there are clear objectives on training and what needs to be done. We are actually currently in the process in 2025 of merging all of our training information into video modules. Right now it's mostly, text based. It's mostly like in blog post format. but what I'm hoping to do is transition it all to probably Trust Driven Care, which is our CRM platform. They have a really great way to create some modules and then in conjunction, creating those videos through Loom. the important factor is a lot of people do learn by video and even the auditory learners, they can use those videos to just listen to during their training process. It's just nice to have different ways of learning for all of your employees. And I also think it's important to be really clear with these people, you know, when you hire someone, give them a PDF that says phase one, phase two, phase three, with clear objectives of what they have to master month by month, set those standards on day one. So not only will they know if they're doing a good job on paper, but then you can come back to that at your 90 day review and say, Hey, Mary, These were the clear objectives I had for you after 90 days and you're missing half of them. Decide if you're going to find another solution to that problem or if it's time to move on and try to hire someone else. So being clear from the beginning and setting a goal. clear expectations really goes a long way. Now, before you pull the plug and you decide you want to hire someone, I really recommend you do a full practice and financial audit. Take a look at your bank accounts and your systems, figure out what it's going to take for you to be able to hire someone. If you do not have a lot of excess income right now, don't even think about hiring. Figure out why that's the case first off. And then I know for me personally, when I made my first hire, I was not ready. I thought I was going to be three years staffless. I wanted to have a small private practice and it just didn't work out that way. And that's okay. But when I realized I had to hire someone, I was Kind of already swimming underwater and I realized in that moment I took a look at my financials did a practice audit and realized I only had to see a certain number of patients per week In order to hire that person and that gave me all of the courage that I needed All I did was change some of my visit types, changed some of my approaches to what I was doing week by week, and it was fairly easy for me to see an additional five or 10 people a week in order to pay that person's wage. That made all the difference in the world because it eliminated that fear of hiring somebody new before I was ready. So take a look at your practice, take a look at your numbers, make a decision that way. And then to close, I want to touch a little bit more on the right timing for all of this. There's a really great quote by Eric Fang, and it specifically says, the best time to before you need one. And I was always taught in school the best time is when you're at about 80 ish percent capacity before you're drowning, but you're definitely busy enough to feel that pressure build because then when you hire that person, you're going to be able to pour into them at the same time. They're gonna be able to see how busy you are, but at the same time, you'll be able to be a part of their training and be involved with their onboarding. So that is truly the best time. I hope this information was helpful and helped you realize. before you make a deep mistake or maybe realize that you are ready to hire an employee. And I hope you don't make the same mistake I did and thinking that it was just going to be a blanket, you know, X number of dollars per week. There are so many additional expenses. I really hope it encourages you to think about what your dream team looks like, even futuristically. I know personally, I don't really want a team larger than 10 for my private practice. My other companies, different story, but this one. I just think that 10 is a perfect sweet spot. I have heard that things get a little bit wild after the number 10. So I want to make sure that whatever number I have, 5, 8, 10 people under me, I want to make sure that I am pouring into them and giving them the best employee experience possible. Thanks for listening.