Top 5 Employment Issues for Pain Management Centers

By: Tory McJunkin, MD, Paul Lynch, MD, Omor Okagbare, MBA, & Ryan Tapscott, Ph. D.pmnlogo

Dear Arizona Pain Specialists,

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


A smart compensation program should be designed to attract, motivate and retain employees. In general, compensation must be competitive, equitable, fair and rewarding for your employees yet still cost effective and compatible with the mission and culture of your pain management center. Compensation programs are so 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 benefit programs.  Indirect compensation provides a method for your 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.  Your organization can lead the 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, ensure your center has a clear salary structure and all employees understand how the program is designed. This should be based on the labor market conditions, including supply and demand. This greatly influences how organizations design and pay employees for their job, knowledge and skills.

In order to attract the right candidates, you must pay accordingly. Your organization should be proactive instead of 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 for the same income as previously realized.  This environment of declining reimbursements is occurring while regulatory and personnel costs are constantly increasing which creates a difficult scenario for employee recruitment and retention.

Recruitment & Staffing    

Recruitment is the process of identifying potential employees, and encouraging them to apply for a position within your practice. The process starts with a job-need analysis, including details on how the position will fit and benefit your practice. A new employee’s success or lack thereof depends on this analysis — including your center’s goals and objectives. Organizations must make sure that they have the right person for the right job.  Your center should always recruit based on knowledge, skill and abilities which are decided upon when writing the job description.

It is essential for the development and success of the employee within the organization that the employee-position fit should be based on the requirements of the job and experiences required. It is easy to fall into the cart-before-the-horse syndrome at this step of recruitment. “But we have this employee who would do a great job…”

Does the employee have the credentials and training you require for the position? Or do you simply like that employee and want to keep him/her on staff. Don’t fall into the personality trap. Write your job descriptions without employees in mind. Then, place the right people in the right jobs and you’ll save yourself, and all employees, countless headaches associated with unprepared and under-qualified employees who you thought could simply “figure it out.”

With the job description written and needs analysis completed, review applicants. When the job analysis is done correctly, the employee selected should be able to perform core responsibilities of the job description. If not, the employee isn’t a good fit and you are setting up your practice and the staff member for failure, based on your insufficient hiring practices.

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, your pain practice can capitalize on the investment it has made in recruiting, selecting and developing your current employee by posting the job internally first. Another great source for recruitment is former employees – yet only if they are eligible to be rehired (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/she is familiar with your organization. Job skills should outweigh personality and familiarity in your decision-making.


Open, effective and clear communication is the number one priority for most employees in all organizations, regardless of size. There is a right way and a wrong way to communicate with your staff to achieve the results that your center 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 will help improve communication. When speaking with employees, vendors, customers and patients – listen. It seems so simple, but listening without distraction or interruption is paramount to communication. A great leader is a great communicator and listener at the same time. Face-to-face communication, spoken conversation or dialogs are influenced by voice modulations, pitch, volume and even speed and clarity of speaking. Non-verbal communication sends an even stronger message to your staff. Your organization communicates volumes without saying a word; this communication process leaves interpretation to the employees. Non-verbal communication includes everything from how your executive and healthcare staff dress and use body language to the furniture in your waiting room. Communication style influences how your employees respond to you, too. For example, when speaking with the executive who comes to work in faded scrubs, employees may use an inappropriately casual tone when communicating. When the same executive arrives early, keeps a tidy desk, wears a pressed shirt and tie – employees sit up a bit straighter, watch their language and 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 – no exceptions. Equally important, employees often receive a brief overview of the policies during orientation and are then expected to know them, and the consequences of violations, inherently. Give employees ample time to review policies and procedures and communicate the consequences of violations consistently.

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’s 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 work place, and why they are necessary.

Policies and procedures are fluid and keeping your staff updated can be a challenge. Regularly, management should communicate any changes to policy and how these updates influence workflow. Effective implementation of policies and procedures includes such communication. The sooner you 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 your management team on employee issues, and create an environment where staff feels that they are treated with respect. 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 you don’t have a solution, be honest. Actively listen, recognize the issue and try to act to resolve the issue. If you still don’t have a solution, be honest. You want to create a team-orientated environment where employees understand they have a voice when it comes to change or recommendations. Also – the old adage remains true: don’t make promises you can’t keep. You should deliver on promises made, whether they are implied or written.

Training & Development

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

An employee needs assessment will identify gaps in actual versus desired organizational performance. It is within this gap appropriate trainings are designed. The objective of the training should be to teach employees how to meet your expected organizational performance. Creating an effective training is three-fold: design, implementation and evaluation:

  • Design materials that clearly state and teach your organizational objectives.
  • Implement and deliver the training to employees
  •  Evaluate and assess if the employees understood the training and used the information to improve their job performance

With the right design, implementation and evaluation, your practice should see an improvement in employee performance immediately. To determine an appropriate schedule for trainings, management should consider who they want their workforce to be in a year, five years, ten years, etc. Continuing education and training are essential to 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 your workforce headaches.

www. SHRM. Org


Dr. McJunkin and Dr. Lynch founded Arizona Pain Specialists, a comprehensive pain management practice with three locations, seven pain physicians, ten midlevel 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