by Joe Sansone

While O&P business owners and their practitioners disagree on many things, everyone agrees that bad hiring decisions are bad for both employees and employers. Yet employee turnover is astronomical in O&P. Annual state association meetings become a “Where are you working now?” convention, and it seems the interchange of practitioners amongst O&P facilities is rivaled only by the free agency system of major league baseball.

This sad truth was illustrated once when I was interviewing an orthotist. The applicant stated matter-of-factly, “Quite frankly, you are the only company in town I haven’t worked for. If I don’t work for you, I’ll have to leave town.” Many practitioners hop from one O&P facility to another, until they either decide to make the best of their current position or are forced to leave town because they’ve exhausted all of their options.

Why should it be that way? Here are two main causes of O&P “hiring from the hip.”

Limited job market
All too often, freshly terminated employees leap to take the first job offer they stumble upon. They quickly become frustrated by the limited number of players in the market and still fewer job openings, and consider themselves lucky to find even one position available. So they jump to take the first job offer they receive and then sit back and hope for the best.

Panicking employers
Practice owners contribute to the problem, too. On many occasions, an O&P business owner is blindsided by the resignation of a key practitioner. As a result of the vacancy, patients start stacking up in the waiting room. Fearing the loss of his referral base, and finding a surprisingly limited number of applicants, the employer hires the first life form who walks through the door. Even though his gut tells him the candidate doesn’t look like a perfect fit, he holds out hope that maybe, just maybe, this one will work out.

Consequences of hasty decisions
But the results of such impulse hiring are bad. There is always a honeymoon phase. Wanting to make a good impression, the newly hired practitioner may work a little harder, be more accommodating and go out of his or her way to please the employer. In turn, the employer or supervisor makes a special effort to ensure the rookie employee is fitting in and happy. But then routines set in and the patients keep coming. And the problems begin for two reasons:

The unscrupulous employer
Slowly, the promised nine-to-five work day is forgotten. Appointments at 8:00 a.m. and hospital calls to be completed after 5:00 p.m. become commonplace.

Or, the promised bonus suddenly becomes an issue. Originally vague and ambiguous, when the bonus structure is looked at closely, the loopholes appear. The employer’s excuses—“The reports aren’t ready,” “The bonus system is flawed,” “We’ll have to look at this a little later”—vary, but the net results are the same. The employer just isn’t going to part with his hard-earned money. And all too often, practitioners realize that, in their zeal to accept the first job offer they saw, they didn’t think to get the bonus program in writing.

The embellishing practitioner
Employers, too, often realize they’ve been deceived as the new hire slowly reverts back to his bad habits. The applicant who promised she had no problem working 60 hours per week darts out the door at 4:59 p.m. every day. Or the practitioner who had “tons of pediatric experience” confesses that he actually only fit one or two pediatric patients per month for the last year.

Now one or both parties are unhappy. The situation is exacerbated when an applicant has been recruited from out of state. Stories abound of practitioners responding to an ad for a position thousands of miles away. The offer’s made, and the practitioner puts his house on the market, uproots his family and they move all their belongings across the country.

All too often, a few months later the lazy employee is fired, or the practitioner finds himself longing for the nice calm business owner who interviewed him over dinner, instead of the Mr. Hyde version he now deals with daily.

Avoiding hiring mistakes
After years of similar horror stories and once losing four of my five practitioners in two months, I was forced to swallow my pride and admit that I must be doing something wrong. I had 100 employees, 95 of whom were a joy to manage. I did not have an employee turnover problem in any of the other divisions. But my five practitioners—managing them sucked the life out of me.

As I evaluated the situation, I realized that hiring practices I used for other employees were never used on my practitioners. Since I was always so desperate to fill a position, I resorted to hiring the first applicant I could find. The results were predictable—and disastrous.

We all make mistakes and bad hires do occur, but if both parties do their homework and are open and honest with each other, these mistakes should diminish. Here are the steps I use when hiring:

Look at length of employment
 It’s very difficult to differentiate fact from fiction when interviewing an applicant. Job seekers bombard us with their positive attributes, but how do we separate the truth from exaggeration?

There is one ironclad chunk of reality that cannot be exaggerated or explained away. And it is staring the interviewer in the face: the applicant’s time at each job. If an applicant’s resume is three pages long and full of one-, two-, or even three-year jobs, then he or she will not fit with your long-term plans. Your company will just be another entry on the resume in a year or two.

It’s possible his last five employers all suffered layoffs or the bosses were all jerks, but it is extremely unlikely. Even with the benefit of the doubt, if a practitioner continued to make such poor decisions in choosing his employers, a potential employer still has the right to question his judgment and decision-making ability.

Test your applicants
Have you ever hired a practitioner who seemed educated, intelligent and well-versed in O&P, only to find out that he or she had the writing skills of a third-grader and consequently couldn’t handle the documentation requirements? You can uncover this shortcoming very easily with any of the numerous skills tests available. We have developed our own written tests which allow us to determine an applicant’s aptitude.

Keep quiet
The golden rule of interviewing is: Let the applicant do the talking. The interviewer’s job is to learn about the applicant, not pontificate about himself or his company. Allow the applicant to do about 80 percent of the talking, and limit your speaking role to answering questions at the end of the interview. If you’ve decided that you like the applicant, this is the time to sell your company.

Check your references
Checking references—a waste of time? Absolutely not! Check references of past employers, and also ask what other practitioners the applicant has worked with. Often times these people will give you the candid answers you’re looking for.

On more than one occasion, I’ve received glowing recommendations from the references listed on a resume, but when I check with the applicant’s peers, I hear, “Run from him! He’s a laughingstock in this town.”

Surprisingly, when I am ready to make an offer, about 20 percent of the time I decide against it based on references.

Spend time together
I like to take applicants out to dinner (or at least lunch) to learn if our personalities match. Once, an applicant completely froze when the waiter asked for his order. I was left to ponder if this was his first foray into a restaurant with a menu. On another occasion, I had taken an applicant to a very important business dinner. The impeccably clad waiter had just waxed eloquent about the frou-frou specials. My wannabe practitioner belted out, in his best Forrest Gump imitation, “How can I git the most fried shrimp?” I decided I simply could not have that individual seeing my patients.

Plus, when your applicants are dining, they inevitably let their guard down. Pay close attention to how they carry themselves. Do they speak well about their past employers? Do they show integrity? A savvy interviewer can gauge how the applicant would interact with patients.

Work together
Before we hire a practitioner, especially one from out of state, we require that the potential employee spend at least one full day, usually two, working with us. While it may be possible to determine the personality traits and tendencies of an applicant during an interview, we can determine with a much higher degree of certainty exactly what a practitioner truly has to offer after watching him or her in action for a few days.

The additional benefit is that I am able to solicit feedback from other employees. I am looking for a member of a team, not a lone wolf. If a candidate cannot mesh with the people he or she would be working with, then he or she will not work out for my company.

During the “day in the field,” I ask the applicant to see patients with my practitioners. I ask them to perform assessments, make recommendations, instruct the patients and answer any questions that the patients may have. My practitioners intervene only when necessary.

Test hand skills
Have you ever known a really nice practitioner who had the hand skills of a hoofed animal? You’d better find out now, before you make a commitment. Our industry is full of really nice guys who just don’t know what they are doing.

I like applicants to be involved in the casting or tracing of patients as well, and I bring applicants into the fabrication shop and observe their modification skills. I must feel certain that they have the hand skills of a practitioner.

It’s a rigorous interview process. But the applicant benefits as well as the employer, because the best interview process is a two-way street.

During all of this, the practitioner is able to peer into the inner workings of his prospective employer. After a day or two of questioning various staff members, the truth always comes out. Does the business owner truly care about his employees, or are they just a mechanism for his Mercedes payment? Does the company allow practitioners to exercise discretion, or is the bottom line all that matters? Does it take three weeks to make a limb, or can we do a rush job in three days?

The result of this long and arduous process is evident. My company enjoys one of the lowest turnover rates in the industry. Since both parties lose when a bad hiring decision is made, a little work up front makes for a much happier practitioner and a more profitable business.

Joe Sansone is CEO of TMC Orthopedic and the Amputee & Prosthetic Center in Houston.