Blogs written by and for ACA Members.

Find our member blogs by member name here!

Apr 07, 2015

Warning: Your Employees are Quitting! Are you Ready?

If you’re like many entrepreneurs, when you start your practice you’re doing just about every job:  You’re the counselor, manager, bookkeeper, interior decorator and janitor. In short, you do anything and everything your business requires.

However, as you find success and your caseload grows, multitasking is pushed to its limits. If you’re in session, you can’t answer your phone. If you’re providing customer support, you’re not following up on billing claims.

Soon, you realize that you can’t do it all.

You post a job ad and hire “Carrie.” Carrie’s sharp, and you work well with her. Over the next few months, you rely on Carrie to do a combination of important tasks.

“Carrie is great,” you say. “She manages my schedule, handles all the medical billing and even updates the website!”

You and Carrie have big plans; you’re going to send out monthly press releases, build an online counseling program, place bids for city contracts and exhibit at community fairs and events. It’s going to be a growth year!

Then, something happens that you didn’t expect. Something unthinkable! Something you never saw coming:

Carrie quits.

The days afterward you’re in shock. Tasks you used to be able to juggle have only become more impossible to manage on your own. Moreover, you’re fuzzy on the new CPT codes, and you can’t update the website because you never learned that darn new operating system.

Carrie swore she’d be available to help out until you found a replacement, but now you can’t get her on the phone. How quickly things change.

As press releases don’t go out, events go unregistered for and deadlines for city bids are missed, you realize that it’s not going to be a growth year after all, but a year of stress, chaos and catch-up. You barely have time to eat, let alone time to recruit a “new Carrie” (who you wouldn’t trust again, anyway).

You keep asking yourself, “Where did I go wrong?”

Anticipate Turnover

While we’ve all heard about the office manager who works with one doctor for 30 years. Finding such an employee is like winning the lottery.

Turnover is a normal part of running a business. For some administrative positions, 100 percent turnover per year is typical. Don’t expect people to last 10 years, or even three. Or even two.

At my company, we try to prevent turnover by paying well, offering advancement opportunities and creating a respectful (and even fun) work environment.

But we know, often for factors outside our control, that most of our workers will eventually leave. That’s why we never consider a position filled until we have redundancy.

Copies of Copies of Copies
Do you know how the candy “Mike and Ike” got its name? Neither do I. The person who named the candy died, and no one ever thought to ask him until it was too late.

The moment some knowledge exists only in the mind of one employee should be an employer’s moment of terror. You invest in your employees’ knowledge, so if a designer learns a great technique for making infographics, you want this information to stay with the company.

You don’t want to lose abilities when an employee leaves. In addition, you want to make sure there’s someone ready to pick up the ball and run with it. There are a few ways to do this.

1. Cross Train

Cross training is widely used, and it’s generally thought of as an affordable, effective redundancy solution. But it has some pitfalls.

First, while it seems very low cost, it’s actually a significant investment. A person being cross-trained needs to be up-to-date on multiple jobs, which takes ongoing training.

Second, all the time someone spends cross training is time they’re not doing the work for which they were hired. AND Third, employees tend to differentiate their main job as their “real” job, and cross-trained tasks as some corporate exercise.

Lastly, results may vary! The person you hire to do medical billing might make a terrible blogger, and visa versa.

2. Call for Backup

The most straightforward option in creating redundancy is to hire two people for every job. The problem, of course, is that you might not need two managers at your practice.

There are workarounds, however. First, some companies will hire an “assistant level” employee that could grow to fill the lead position. When this works, it creates a pipeline. If a senior departs, the junior has already been trained to fill the shoes of his or her lead. The assistant gets a promotion, and a new assistant is hired.

A second option is to use a combination of in-house and outsourced service providers. For example, you hire a marketing specialist (employee) and also a local marketing firm to work with your company on a small ongoing basis. If the employee leaves, the marketing firm could fill the gap until a replacement is found (NOTE: calling a firm after your employee tenders her resignation is much too late. You want redundancy with a company that knows what you do, what you need, and that you can trust).

Similarly, even if you exclusively outsource a task, like bookkeeping, you should have a backup in the instance that your bookkeeper stops producing monthly P&Ls. This is especially true if you’re contracting with a one-person firm.

On the surface, it seems affordable to run a business on a skeleton crew. But having redundant employees will save you during holidays, vacations, sick days, maternity days and jury duty. Lastly, having multiple employees in the same role will increase accountability. Employees can “b.s.” their boss, but their work won’t pass the smell test of a co-worker doing the same job. When there’s redundancy, those who aren’t performing are ferreted out fast.

3. Build an Intranet

An intranet is an “Internet” for your company. It’s a place to put instructions on how to do all the tasks your company performs. At my company, we use video, audio and a lot of text and pictures.

If a new employee wants to know how to run the copier, he or she can check the intranet. Need a password? Check the intranet.

It takes time and energy to keep an intranet robust and relevant. For example, how to modify your website could change each time there’s a software update. With that said, having a well-managed intranet could save you if an employee leaves on short notice: “Where did Dan get those great stock photos?” Check the intranet!

Maintaining an intranet is a company-wide commitment. Some employees won’t want to contribute: It can feel tedious documenting processes, and some workers might worry that if all their knowledge is shared, they themselves are at risk of being replaced. Therefore, managers need to set the precedent and expectations early.

It Gets Easier (Slightly)

You’d think the problem of turnover gets easier as a practice gets bigger — what’s losing an employee when you have 100 others? But the truth is, the bigger your company, the more often there’s a departure. Eventually, you may need someone full time just to recruit new team members.

Last January, my company lost a lead scheduler, a marketer, a staff writer and a credentialing specialist, all within a month! I mention this for two reasons. First, because we’re hiring (tell your friends); and second, because unlike years before, we didn’t panic — we had redundancy.

Anthony Centore, Ph.D., is private practice consultant for the ACA, founder of Thriveworks Counseling (with locations in 9 states), and author of the book, How to Thrive in Counseling Private Practice. Anthony is a licensed counselor in Massachusetts and Virginia. Find him on Twitter at @anthonycentore or @Thriveworks.


Contact Name

Contact Title

Contact Email

Contact Phone

Related Info


  1. RadEditor - HTML WYSIWYG Editor. MS Word-like content editing experience thanks to a rich set of formatting tools, dropdowns, dialogs, system modules and built-in spell-check.
    RadEditor's components - toolbar, content area, modes and modules
    Toolbar's wrapper 
    Content area wrapper
    RadEditor's bottom area: Design, Html and Preview modes, Statistics module and resize handle.
    It contains RadEditor's Modes/views (HTML, Design and Preview), Statistics and Resizer
    Editor Mode buttonsStatistics moduleEditor resizer
    RadEditor's Modules - special tools used to provide extra information such as Tag Inspector, Real Time HTML Viewer, Tag Properties and other.

Join/Renew NOW!