How to run the human resources aspect of your practice with tips on interviewing, hiring, classifying employees, and wages and hours issues

No other profession’s premises are as uniquely organized as those of a small chiropractic office. For example: When a new graduate opens a practice, he hires (with or without pay) his spouse and gives her the title of office manager. And if not a spouse, then he hires his mother, sister, or friend. Whom do office managers manage? How do they know how to train? Do they even know how to interview or hire? There are laws and rules on interviewing, hiring, firing, and working. There are issues to consider on policies and procedures. How can they handle human resources (HR) problems when they don’t even know what HR are?

In most large companies, there is usually an HR department. In a small office, the role is usually performed by the office manager. In a chiropractic office, HR are usually the doctor, the doctor’s spouse, or the CA who has been there the longest.

This is the person who takes responsibility for managing and organizing the office and its staff. In many offices, this position is not the person’s only responsibility. Sometimes HR matters are another duty that the office manager is responsible for, along with insurance clerk, accounts receivable/accounts payable (AR/AP) clerk, floater, and chief cook and bottle washer. And in some offices, the HR specialist is the only person in the office other than the doctor; the doctor handles the clinical side, and the office manager handles everything else.

Unfortunately, little training, or sometimes none at all, is put into becoming an office manager. It is a position thrust on one whose sense of responsibility is ingrained. Office managers are the unsung heroes in the office who make sure the job gets done, the patients get treated, the paychecks get written, and the lights get turned on for another day. They are usually the ones with the most stress, the longest hours, and unheard-of personal/family life.

Interviewing, applications, and hiring practices. It is illegal for employers to discriminate against employees based on race, color, sex, religion, national origin (Title VII of the Civil Rights Act of 1964), disabilities (Rehabilitation Act of 1973 and Americans With Disabilities Act of 1990), or age (Age Discrimination in Employment Act of 1967). The Equal Employment Opportunity Commission (EEOC) regulates all employee discrimination issues, including some little-known application or interview questions most small employers have never heard of, much less realized they were flouting.

For example, it is illegal to ask applicants if they own a car; however, employers may ask if the applicant has reliable transportation to get to work. Employers cannot ask if the applicant is a US citizen; they can ask only if the applicant is eligible to work if hired. Employers may not ask about ancestry, birthplace, or native language; however, they can ask if applicants speak another language (but not how they learned to speak another language). An application, nor interviewer, cannot ask applicants to give a list of names and addresses of relatives (this question tends to directly impact concerns related to national origin) or list the date of birth or year the applicant graduated from high school (age discrimination). Questions regarding marital status, child care arrangements, and if applicants have ever filed for bankruptcy or had a workers’ comp claim (sex, national origin, and disability discrimination questions) cannot be asked.

Title VII of the Civil Rights Act and amendments cover everything about the employment relationship—from prehiring ads to working conditions, from performance reviews to postemployment references. To ensure that your office is legally screening, interviewing, and hiring according to federal mandates, visit the EEOC Web site: www.eeoc.gov/regs/.

Classifying employees. Federal and state laws generally do not define the terms of full-time, part-time, or temporary employees; it is the responsibility of the employer to correctly classify full- and part-time employees based on average number of hours required each week. The Fair Labor Standards Act (FLSA) does set the maximum workweek for overtime and the 40-hour workweek. However, it is up to the employer to determine when a workweek begins (day of the week) and what constitutes a normal workweek.

Average chiropractic office employees do not usually work a 40-hour work-week. For patient hours, the average clinic has about 30 hours available, with the employees working an extra 5 to 7 hours based on the position. Although many CAs may be at the office more than 40 hours, it could be stated that the normal workweek is between 35 and 37 hours a week, making full time in a chiropractic office less than a normal 40-hour workweek.

Part-time employees would be a classification of anyone working less than the required full-time position (whatever that number of hours turns out to be for your office). Employers tend to use the classification of part time to define which employees are eligible for benefits such as insurance, vacations, and bonuses. While this differentiation is legal in most cases, employers must be aware that some states, such as Texas, have laws that classify an employee who works 30 hours—although technically classified as part time—as eligible for all benefits that are offered to full-time employees.

The Fair Labor Standards Act and Internal Revenue Service (IRS) regulations become the cornerstone for all employers when it comes to proper handling of salary or independent contractor classifications. The FLSA states that an employer cannot classify an employee as salaried to avoid paying overtime (time and a half for more than 40 hours); and the IRS says that an employer cannot classify an employee as an independent contractor to avoid paying payroll taxes. (This is a tricky issue in many chiropractic offices when it comes to hiring a massage therapist.)

While there is a long list of criteria concerning independent contractors, the short list would include ongoing relationship, using employer’s equipment, employer setting regular hours of employment, not working for more than one employer, and employer having control. These points usually constitute an employee/employer relationship, not an independent contractor arrangement. For more information on FLSA or the IRS regulations, visit http://www.dol.gov/esa/whd/flsa/ or http://www.irs.gov/businesses/small/article/.

Wage and hours issues. The Department of Labor implements the FLSA regulations from a federal standpoint. Wage and Hourly Boards in individual states may also regulate certain aspects of payment. For example, some states have a Payday Law that specifically dictates how and when an employer must pay employees and any specific regulations pertaining to legal and illegal payroll deductions (wage garnishments). A specific state law can, for example, dictate that an employer must pay employees at least twice a month or give a paycheck to a dismissed employee within 6 days of firing, or that it is illegal to withhold pay for nonreturn of the employer’s property (keys, uniforms, etc). Generally, it is illegal in most states for an employer to withhold a paycheck as part of a disciplinary action against an employee.

The issue of overtime is of particular sensitivity to most employers. When (and why) do they have to pay overtime? The short answer is that the FLSA states that all nonexempt employees who work more than a 40-hour workweek must be paid time and a half for those hours. Furthermore, the law states that a salaried classification of an employee does not in and of itself exempt an employee from overtime. Professionals with a master’s degree or higher working in their profession are exempt.

However, most CAs are exempt, whether they are classified as salaried or not. What about paying these employees for nonworkdays to attend a seminar? If the seminar is required, time spent there must be considered as being on the clock. If that weekend seminar puts the employee over 40 hours, it is paid as time and a half. However, state-mandated training or continuing education (such as for radiology technicians) may not be considered as overtime if the training is required for the employee’s status and is not based on the employer’s needs.

Unfortunately, for most employers, comp time is not an alternative to not paying overtime. The practice of banking overtime hours to be used at a later date is illegal under FLSA, with limited exceptions—and even then, the time is computed at time and a half.

Employers are required to keep certain documentation on all employees. It is imperative that HR specialists/office managers have files on all employees (even volunteer family members).

Personnel files should include a copy of the employee’s application or resume, an I-9 form (verification of work-status eligibility with supporting documentation), and a W-4 form (deduction from payroll for dependents). There also should be copies of the new employee’s acknowledgment forms for receiving/reading the office policy and procedures manual, employee handbook, dress code requirements, and all HIPAA regulations and training material.

It is important to ensure that employees understand that their signature does not constitute a contract of employment (this must be written on the form as a disclaimer). If employees refuse to sign an acknowledgment form indicating that they have received and read the above information, it may be because the employees disagree with specific parts of the office’s policies. Refusal to sign these forms should be of great concern to the office manager and employer. Some employers include language on their forms stating that it is the employee’s obligation to know the policies and abide by them. If the employee refuses to sign the acknowledgment, the case may be considered as insubordination and discipline, or termination, would apply. CP

Ces Soyring, CA, is cofounder of the National Academy of Chiropractic Assistants (www.naca-online.com) and a chiropractic consultant. She can be reached via email: naca_csoyring@yahoo.com.

This article is intended to give sound business sense to office managers without its being heavily weighted with legal jargon. While the research is rooted within the framework of the law, this article is not intended as legal advice. Check employment laws governing your state.