This post on employment issues for pain management centers was originally published in Pain Medicine News in 2011; reprinted with permission.

Dear Boost Medical: 

Our pain management center has grown significantly. With additional employees come increased challenges in management. How should a pain practice address human resource issues proactively?

Thank you,
Growing Practice Seeking Fewer HR Headaches



Your practice isn’t unique. As the specialty of pain management has grown, practices have seen an increase in business, number of employees and related human resource issues.

As your practice grows, compensation, recruitment, staffing, communication, employee relations and employee development should be on your mind. Although solutions must be tailored to meet each practice, the following advice is appropriate for any practice in the pain management specialty.


A smart compensation program should be designed to attract, motivate and retain employees. In general, compensation must be competitive and fair for all employees, yet still cost-effective and compatible with the mission and culture of the pain management center. Compensation programs are important to employers because they affect the hire and retention rate of the organization.

The two ways to design and structure a compensation program are direct and indirect compensation. Direct compensation includes wages such as base pay, bonus and direct cash that organizations offer their employees.

Indirect compensation includes non-wages with indirect monetary value, such as unpaid leave, disability insurance, life insurance, working titles and medical benefits programs. Indirect compensation allows a practice to compensate employees for their experience, knowledge and skills. Often the value is equal to or more than direct wages. Indirect compensation also gives pain management centers additional leverage during recruitment.

When developing a compensation package, there are several factors to consider. First, ensure the package is competitive. An organization can lead its competition by paying higher wages and having a better compensation program to attract more qualified employees. When lagging behind competitors in this arena, employers pay more for recruitment and training. The turnover rate of employees and related expenses will be considerable. Some organizations choose to deliberately pay below the market average because of economic necessity; this will always limit the hiring pool.

Furthermore, centers must make sure that they have a clear salary structure and all employees understand how the program is designed. This structure should be based on labor market conditions, which will greatly influence how organizations design and pay employees for their job, knowledge and skills.

Organizations should be proactive, not reactive, to trends. Unfortunately, the reality for many pain management physicians is that reimbursements have declined significantly. Because of declining reimbursements, most practitioners are forced to see more patients, but receive the same income. This environment of declining reimbursements occurs while regulatory and personnel costs increase, creating a difficult scenario for employee recruitment and retention.

Recruitment and Staffing

Recruitment is the process of identifying potential employees and encouraging them to apply for a position within a practice. The process starts with a job-need analysis, including details on how the position will fit and benefit the practice. A new employee’s success or lack thereof depends on an analysis of the center’s goals. Organizations must make sure that they have the right person for the right job.

Does the employee have the credentials and training required for the position? Or is the employee simply likeable and one the organization wants to keep on staff? Employers must not fall into the personality trap. Job descriptions should be written without specific employees in mind. Employers will save themselves, their clients and their employees countless headaches associated with unprepared and underqualified employees who they thought could simply “figure it out.”

Whether recruiting for a position internally or externally, the job description should drive the selection of the employee. If an internal candidate meets all hiring requirements, the pain practice can capitalize on its investment, by posting the job internally first and selecting and developing the current employee. Another great source for recruitment is former employees who are eligible for rehire. Rehire status should be listed on exit interviews and kept in employee files for ready access and review. Former employees often have advantages over new employees because they are familiar with the company’s mission, business culture and systems. The biggest mistake most practices make is rehiring employees with performance, attitude or attendance issues. It does not make sense to rehire a previous employee who lacks skills required for the job simply because he or she is familiar with the organization. Job skills should outweigh personality and familiarity in decision making.


Open, effective and clear communication is the No. 1 priority for most employees in all organizations, regardless of size. There is a right and a wrong way to communicate with staff to achieve the results that the organization wants. An effective communication style helps employers build trust and respect, and fosters an environment where learning can occur for both employees and patients.

Active listening helps improve communication. This advice may seem simple, but listening without distraction or interruption is paramount to effective communication. Face-to-face communication, spoken conversation or dialogues are influenced by voice modulations, pitch, volume and even speed and clarity. Nonverbal communication sends an even stronger message to staff members. Nonverbal communication includes everything from how executive and health care staff members dress and use body language to the furniture in the waiting room.

Communication style influences how employees respond to employers, too. For example, when speaking with the executive who comes to work in faded scrubs, employees may use an inappropriately casual tone. When the same executive arrives early, keeps a tidy desk, and wears a pressed shirt and tie, employees will sit up a bit straighter. They can recognize a leader who demands their attention and respect.

Written communication with employees and patients is also key. Most practices struggle with unclear, undefined policies and procedures. This makes human resources far more complicated when special employees are able to bend the generally understood rules to their liking. Instead, clearly written and distributed policies and procedures set the rules for all staff. Employees often receive a brief overview of the policies during orientation and then are expected to know them and the consequences of violating them. Employees should be given ample time to review policies and procedures, and the consequences of violations should be clearly communicated to them.

If every practice had the perfect staff, there would be no employment headaches. How can pain management centers decrease employee-related issues and meet the needs of their staff? Practice management must understand employees are not perfect. It is the responsibility of the practice to help and train employees to understand the importance of policies (especially as they evolve), how they can apply in the workplace and why they are necessary.

Policies and procedures are fluid. Regularly, management should communicate any changes to policy and how these updates influence workflow. The sooner the organization can communicate change and allow for question-and-answer time with staff, the better.

Employee Relations

For pain management centers to be successful, they must meet the needs of their patients by offering great customer service and patient care. The goal for all pain management centers should be to treat employees fairly, train and educate the management team on employee issues and create an environment where the staff feels respected. Listening to the needs and concerns of staff—and taking action to address these issues—will keep a practice’s workforce happier and maintain a higher retention rate. What makes a good employee relation program? Simply put: feedback—employees want to be heard.

If there is no solution, be honest. Actively listen, recognize the issue and try to act to resolve the issue. If there still is no solution, be honest. The organization must create a team-oriented environment where employees understand they have a voice when it comes to change or recommendations. The old adage, “don’t make promises you can’t keep,” remains sound advice to follow.

Training and Development

Different types of training programs exist to address performance deficiencies and developmental needs at all levels of employment. Creating or providing a training program first requires a precise and accurate job description, and knowing the abilities of all employees. The right training should provide knowledge, skills and abilities to fill a deficiency in skill.

An assessment of employees’ needs will help identify gaps in actual versus desired organizational performance. In this gap, appropriate training is designed. The objective of the training should be to teach employees how to meet expected organizational performance. Creating effective training requires design, implementation and evaluation. Materials should clearly state and teach organizational objectives. Next, it’s important to implement the training to employees and then evaluate whether the employees understand the training and have used the information to improve their job performance.

With the right design, implementation and evaluation, practices should see improvements in employee performance immediately. To determine an appropriate schedule for training, management should consider who they want their workforce to consist of and where they want their workforce to be in a year, in five years or even ten years.

Continuing education and training are essential to achieve a smart, well-trained workforce. Having the right skills and knowledge help employees perform better; investing in employees’ education makes them feel more valued and should positively influence the business as a whole.

There is no simple formula to create a happy, healthy workforce. However, these suggestions come with experience. All practices will have human resource issues; the advice provided should help minimize workforce headaches.

—Tory McJunkin, MD, Paul Lynch, MD, Omor Okagbare, MBA, and Ryan Tapscott, PhD

Drs. McJunkin and Lynch founded Arizona Pain Specialists, a comprehensive pain management practice with three locations, seven pain physicians, 10 mid-level providers, three chiropractors, on-site research and behavioral therapy. They teach nationally and are consultants for St. Jude Medical and Stryker Interventional Spine. Through their partner company, Boost Medical, they provide practice management and consulting services to other pain doctors throughout the country. For more information, visit and