February 26, 2025 • 12 mins
💡 Thinking about hiring your first (or next) employee? You might be calculating wages and thinking, I can afford this!—but have you considered the hidden costs?
In this episode of The Provider’s Report, I break down what it really takes to bring on a new team member—beyond just salary. From training time and software costs to office supplies and end-of-year bonuses, we uncover the full financial picture.
I also share my personal experience with hiring my first employee—how I realized I needed to see 10 extra patients per week to afford them and how I made that happen. Plus, I'll walk you through a simple audit to help determine if you're financially and operationally ready to expand your team.
🔹 What You’ll Learn in This Episode:
✅ The hidden costs of hiring (that nobody talks about!)
✅ Why waiting until you're drowning in work is a mistake
✅ How to calculate when you’re truly ready to expand your team
✅ Actionable steps to make hiring a strategic and successful move
📌 If you’re a healthcare provider thinking about growing your team, this episode is a must-listen!
🎧 Tune in now and let’s break down the real cost of hiring together.
Follow us on social media!
- Instagram: @theprovidersreport
- Facebook: @theprovidersreport
- Twitter / X: @providersreport
- LinkedIn: @the-providers-report
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Scarlett Solo USB (00:00):
It's the beginning of the year.
(00:01):
So a really hot topic isfiguring out your hiring
situation, who you're keeping,who you're not, what's working,
what isn't.
And for a lot of us, this meansexpanding our team or possibly
making our team smaller.
And so when I think about thisand a lot of the questions I
get, we typically forget.
What goes into hiring a newemployee, which is why it's
(00:23):
really important to understandyour training process,
understand your onboardingprocess, understand what it
takes to even hire an employeeand how to keep them.
so I'm going to go out on a limbhere.
And a lot of us tend to think,especially when we're doing
projections or brainstorming ordaydreaming.
We think, okay, I'm going tohire this person for 35 hours a
week.
I'm going to pay them 20 anhour.
(00:44):
And then we just think it'sgoing to cost us 700 bucks a
week.
And that's that.
And the reality is that itcouldn't be further from the
truth that there are so manyhidden costs to hiring a new
employee, regardless of whatposition they are.
so we're going to tap into thattoday.
I want to make sure you guys arefully aware of some of these
hidden costs.
You can prepare and make sureyou're hiring at the right time.
So obviously salaries and wageskind of come into the mix.
(01:07):
I strongly encourage you all towait until you can afford
someone at slightly higher thegoing market rate.
That's going to help you attractbetter people in the application
process and it's going to helpyou retain your patients very
well.
Other things to consider.
What are you offering benefitwise?
So there's extra costs likeretirement plans, health
insurance, other standardbenefits.
(01:29):
Some people do gymreimbursements or health care
stipends or travel comping orthe purchasing of equipment,
supplies, a laptop, iPad, thosekinds of things.
Even before you hire thatperson, there are costs
associated with posting the adto literally get someone.
some of us use recruitmentagencies.
Some of us spend X amount oftime doing interviews,
(01:49):
especially if you have anotheremployee doing your first round
of interviews for you.
So even before you hire thisperson, there's already cost
involved.
So it's very important torealize that before you make
this decision, make sure you'reready for it.
I know the biggest surprise forme was the cost of training and
the cost of additional softwarelicenses.
(02:10):
So for example, when you firsthire that employee, there's some
training involved.
Our office, we choose to doremote training, so typically
they'll do like five or sevenhours before they even start,
and that's all laid out withvideo modules and like, either
written or informational typesof training that they can get
done in a very short amount oftime.
We do have a different trainingsalary or wage for that.
(02:31):
It's a lower one.
Of course, they're just sittingat home typically reading things
or watching videos and it's onlyfive or seven hours.
That one was an unexpected costthat I didn't really think
about, but I of course wanted topay them for that time.
Another surprise cost for me wasthe amount of money I had to pay
other employees to train the newemployee.
And so, especially if thatperson isn't necessarily in the
(02:53):
same exact role, you could bepaying 20, 25, sometimes even 30
an hour just for training.
and there's ways to get out ofthat, if you so choose or to
have, you know, one person onyour team designated to training
and know that it might be justan additional compensation at a
different hourly rate.
I didn't do that.
I just kind of like lump summedit all together.
(03:14):
So it.
cost me quite a bit of money.
but for me, it was important tohave that one on one training
time in conjunction with theremote training.
So typically the goal is to dolike five to 10 hours of that,
that first one to two months ofa new position.
the number one surprise cost forme was software fees and
subscriptions.
(03:34):
Understanding that this app thatyou use makes you pay for three
users versus five.
And then, you know, logging intoGoogle Workspace might cost this
number or having to raise thatnumber.
different EMRs have cost peruser or cost per provider.
and so the larger your teamgrows, there are really surprise
costs to that.
And I remember when I firststarted and did all my budgeting
(03:55):
and built out my business plan,I just never thought about
subscription fees.
I never thought about how techsavvy and digital my practice is
and how growing my teamdefinitely was going to increase
my cost there.
so some of the top companies weuse would be monday.
com, loom for video, GoogleWorkspace.
Trust Driven Care for our CRM.
(04:17):
We have an EMR obviously, we useJNAP personally for my private
practice.
And with every single one ofthose, the cost slowly
increases.
Even something like a digitalfax system, that cost goes up
per user as well.
There's so many examples ofthis.
Payroll goes up because you'repaying somebody a salary or a
wage, but there are also payrolltaxes.
(04:38):
There are other costs involved,even something as simple and
small as knowing that at the endof the year you're going to have
to pay additional fees to sendsomeone their W 2 or all of
those small things that we justdon't think about.
And then there are fun thingstoo.
Recognizing there's going to bebirthday gifts, anniversary
gifts, like work anniversarygifts.
sometimes you're going to havecoffees and meals If your
(04:58):
meetings are long and they'reduring lunch, a lot of times
you're going to cater food in.
All of those little expensesreally add up.
And yes, a lot of these thingscan be written off, but at the
end of the day, the money stillhas to be there.
So again, the larger your teamgets, the more expensive things
are.
Then you factor in things likeChristmas parties or celebratory
parties for the practice, youknow, maybe it's the four year
(05:20):
anniversary of the practice andyou have an event.
Well, if you have a team of 20versus a team of three, that
event is going to look a littlebit different.
So these are all surprise coststhat like, I know for a fact, I
never thought about when I grewmy team and we decided to grow
pretty rapidly.
I went from a team of one toseven, pretty much in less than
18 months.
That was not my plan.
(05:40):
I don't even really recommendthat to be honest, but it had to
happen in the moment and Ilearned really quickly all of
these additional expenses andhow to adjust for them.
The biggest reason why this isimportant is because employee
turnover costs us so much money.
I found a source from theSociety for Human Resource
Management, and it actually saysthat a bad hire, quote unquote
(06:02):
bad hire, can cost a company upto 30 percent of that employee's
first year salary.
which is a lot of money.
turnover is not ideal and I knowa lot of small private practices
who just don't care aboutturnover.
They pay extremely low, 12 to 14an hour and expect people to
stay forever without benefits,without appropriate training or
onboarding, without evenrecognizing and valuing that
(06:24):
employee on a regular basis, andthen they wonder why their
turnover is so high.
So it will actually save youmoney to invest in your team and
to pour into them to allow themto stay with you.
So yes, there's additional costsinvolved, but you will spend
more money with this employeeturnover.
Another important thing toconsider would be supplies.
So not only are there increasedoffice supplies, devices like
(06:47):
additional laptops and iPads andall of that, you'll go through
equipment at work a lot quicker.
The larger your team isobviously, even down to
something like toilet paper,everything goes up.
Maybe you purchase scrubs foryour employees, whether they're
nurses or assistants or whathave you, that's an additional
expense as well.
And then if you are hiringsomeone that happens to be a
(07:07):
provider, another thing tofactor in when it comes to
turnover and onboarding is thecredentialing process.
Most of the time insurers cantake 90 to 120 days just to
credential and onboard a newemployee and just to get them
accepted into that payer system.
So what are you doing?
During that 90 to 120 days, doyou have a plan for all of my
employee hires, regardless ofposition?
(07:29):
We have a one month, two month,three month plan where there are
clear objectives on training andwhat needs to be done.
We are actually currently in theprocess in 2025 of merging all
of our training information intovideo modules.
Right now it's mostly, textbased.
It's mostly like in blog postformat.
but what I'm hoping to do istransition it all to probably
Trust Driven Care, which is ourCRM platform.
(07:51):
They have a really great way tocreate some modules and then in
conjunction, creating thosevideos through Loom.
the important factor is a lot ofpeople do learn by video and
even the auditory learners, theycan use those videos to just
listen to during their trainingprocess.
It's just nice to have differentways of learning for all of your
employees.
And I also think it's importantto be really clear with these
people, you know, when you hiresomeone, give them a PDF that
(08:13):
says phase one, phase two, phasethree, with clear objectives of
what they have to master monthby month, set those standards on
day one.
So not only will they know ifthey're doing a good job on
paper, but then you can comeback to that at your 90 day
review and say, Hey, Mary, Thesewere the clear objectives I had
for you after 90 days and you'remissing half of them.
Decide if you're going to findanother solution to that problem
(08:34):
or if it's time to move on andtry to hire someone else.
So being clear from thebeginning and setting a goal.
clear expectations really goes along way.
Now, before you pull the plugand you decide you want to hire
someone, I really recommend youdo a full practice and financial
audit.
Take a look at your bankaccounts and your systems,
figure out what it's going totake for you to be able to hire
someone.
If you do not have a lot ofexcess income right now, don't
(08:56):
even think about hiring.
Figure out why that's the casefirst off.
And then I know for mepersonally, when I made my first
hire, I was not ready.
I thought I was going to bethree years staffless.
I wanted to have a small privatepractice and it just didn't work
out that way.
And that's okay.
But when I realized I had tohire someone, I was Kind of
already swimming underwater andI realized in that moment I took
(09:17):
a look at my financials did apractice audit and realized I
only had to see a certain numberof patients per week In order to
hire that person and that gaveme all of the courage that I
needed All I did was change someof my visit types, changed some
of my approaches to what I wasdoing week by week, and it was
fairly easy for me to see anadditional five or 10 people a
week in order to pay thatperson's wage.
(09:38):
That made all the difference inthe world because it eliminated
that fear of hiring somebody newbefore I was ready.
So take a look at your practice,take a look at your numbers,
make a decision that way.
And then to close, I want totouch a little bit more on the
right timing for all of this.
There's a really great quote byEric Fang, and it specifically
says, the best time to beforeyou need one.
And I was always taught inschool the best time is when
(10:00):
you're at about 80 ish percentcapacity before you're drowning,
but you're definitely busyenough to feel that pressure
build because then when you hirethat person, you're going to be
able to pour into them at thesame time.
They're gonna be able to see howbusy you are, but at the same
time, you'll be able to be apart of their training and be
involved with their onboarding.
So that is truly the best time.
I hope this information washelpful and helped you realize.
(10:22):
before you make a deep mistakeor maybe realize that you are
ready to hire an employee.
And I hope you don't make thesame mistake I did and thinking
that it was just going to be ablanket, you know, X number of
dollars per week.
There are so many additionalexpenses.
I really hope it encourages youto think about what your dream
team looks like, evenfuturistically.
I know personally, I don'treally want a team larger than
(10:44):
10 for my private practice.
My other companies, differentstory, but this one.
I just think that 10 is aperfect sweet spot.
I have heard that things get alittle bit wild after the number
10.
So I want to make sure thatwhatever number I have, 5, 8, 10
people under me, I want to makesure that I am pouring into them
and giving them the bestemployee experience possible.
(11:05):
Thanks for listening.
It's the beginning of the year.
(00:01):
So a really hot topic isfiguring out your hiring
situation, who you're keeping,who you're not, what's working,
what isn't.
And for a lot of us, this meansexpanding our team or possibly
making our team smaller.
And so when I think about thisand a lot of the questions I
get, we typically forget.
What goes into hiring a newemployee, which is why it's
(00:23):
really important to understandyour training process,
understand your onboardingprocess, understand what it
takes to even hire an employeeand how to keep them.
so I'm going to go out on a limbhere.
And a lot of us tend to think,especially when we're doing
projections or brainstorming ordaydreaming.
We think, okay, I'm going tohire this person for 35 hours a
week.
I'm going to pay them 20 anhour.
(00:44):
And then we just think it'sgoing to cost us 700 bucks a
week.
And that's that.
And the reality is that itcouldn't be further from the
truth that there are so manyhidden costs to hiring a new
employee, regardless of whatposition they are.
so we're going to tap into thattoday.
I want to make sure you guys arefully aware of some of these
hidden costs.
You can prepare and make sureyou're hiring at the right time.
So obviously salaries and wageskind of come into the mix.
(01:07):
I strongly encourage you all towait until you can afford
someone at slightly higher thegoing market rate.
That's going to help you attractbetter people in the application
process and it's going to helpyou retain your patients very
well.
Other things to consider.
What are you offering benefitwise?
So there's extra costs likeretirement plans, health
insurance, other standardbenefits.
(01:29):
Some people do gymreimbursements or health care
stipends or travel comping orthe purchasing of equipment,
supplies, a laptop, iPad, thosekinds of things.
Even before you hire thatperson, there are costs
associated with posting the adto literally get someone.
some of us use recruitmentagencies.
Some of us spend X amount oftime doing interviews,
(01:49):
especially if you have anotheremployee doing your first round
of interviews for you.
So even before you hire thisperson, there's already cost
involved.
So it's very important torealize that before you make
this decision, make sure you'reready for it.
I know the biggest surprise forme was the cost of training and
the cost of additional softwarelicenses.
(02:10):
So for example, when you firsthire that employee, there's some
training involved.
Our office, we choose to doremote training, so typically
they'll do like five or sevenhours before they even start,
and that's all laid out withvideo modules and like, either
written or informational typesof training that they can get
done in a very short amount oftime.
We do have a different trainingsalary or wage for that.
(02:31):
It's a lower one.
Of course, they're just sittingat home typically reading things
or watching videos and it's onlyfive or seven hours.
That one was an unexpected costthat I didn't really think
about, but I of course wanted topay them for that time.
Another surprise cost for me wasthe amount of money I had to pay
other employees to train the newemployee.
And so, especially if thatperson isn't necessarily in the
(02:53):
same exact role, you could bepaying 20, 25, sometimes even 30
an hour just for training.
and there's ways to get out ofthat, if you so choose or to
have, you know, one person onyour team designated to training
and know that it might be justan additional compensation at a
different hourly rate.
I didn't do that.
I just kind of like lump summedit all together.
(03:14):
So it.
cost me quite a bit of money.
but for me, it was important tohave that one on one training
time in conjunction with theremote training.
So typically the goal is to dolike five to 10 hours of that,
that first one to two months ofa new position.
the number one surprise cost forme was software fees and
subscriptions.
(03:34):
Understanding that this app thatyou use makes you pay for three
users versus five.
And then, you know, logging intoGoogle Workspace might cost this
number or having to raise thatnumber.
different EMRs have cost peruser or cost per provider.
and so the larger your teamgrows, there are really surprise
costs to that.
And I remember when I firststarted and did all my budgeting
(03:55):
and built out my business plan,I just never thought about
subscription fees.
I never thought about how techsavvy and digital my practice is
and how growing my teamdefinitely was going to increase
my cost there.
so some of the top companies weuse would be monday.
com, loom for video, GoogleWorkspace.
Trust Driven Care for our CRM.
(04:17):
We have an EMR obviously, we useJNAP personally for my private
practice.
And with every single one ofthose, the cost slowly
increases.
Even something like a digitalfax system, that cost goes up
per user as well.
There's so many examples ofthis.
Payroll goes up because you'repaying somebody a salary or a
wage, but there are also payrolltaxes.
(04:38):
There are other costs involved,even something as simple and
small as knowing that at the endof the year you're going to have
to pay additional fees to sendsomeone their W 2 or all of
those small things that we justdon't think about.
And then there are fun thingstoo.
Recognizing there's going to bebirthday gifts, anniversary
gifts, like work anniversarygifts.
sometimes you're going to havecoffees and meals If your
(04:58):
meetings are long and they'reduring lunch, a lot of times
you're going to cater food in.
All of those little expensesreally add up.
And yes, a lot of these thingscan be written off, but at the
end of the day, the money stillhas to be there.
So again, the larger your teamgets, the more expensive things
are.
Then you factor in things likeChristmas parties or celebratory
parties for the practice, youknow, maybe it's the four year
(05:20):
anniversary of the practice andyou have an event.
Well, if you have a team of 20versus a team of three, that
event is going to look a littlebit different.
So these are all surprise coststhat like, I know for a fact, I
never thought about when I grewmy team and we decided to grow
pretty rapidly.
I went from a team of one toseven, pretty much in less than
18 months.
That was not my plan.
(05:40):
I don't even really recommendthat to be honest, but it had to
happen in the moment and Ilearned really quickly all of
these additional expenses andhow to adjust for them.
The biggest reason why this isimportant is because employee
turnover costs us so much money.
I found a source from theSociety for Human Resource
Management, and it actually saysthat a bad hire, quote unquote
(06:02):
bad hire, can cost a company upto 30 percent of that employee's
first year salary.
which is a lot of money.
turnover is not ideal and I knowa lot of small private practices
who just don't care aboutturnover.
They pay extremely low, 12 to 14an hour and expect people to
stay forever without benefits,without appropriate training or
onboarding, without evenrecognizing and valuing that
(06:24):
employee on a regular basis, andthen they wonder why their
turnover is so high.
So it will actually save youmoney to invest in your team and
to pour into them to allow themto stay with you.
So yes, there's additional costsinvolved, but you will spend
more money with this employeeturnover.
Another important thing toconsider would be supplies.
So not only are there increasedoffice supplies, devices like
(06:47):
additional laptops and iPads andall of that, you'll go through
equipment at work a lot quicker.
The larger your team isobviously, even down to
something like toilet paper,everything goes up.
Maybe you purchase scrubs foryour employees, whether they're
nurses or assistants or whathave you, that's an additional
expense as well.
And then if you are hiringsomeone that happens to be a
(07:07):
provider, another thing tofactor in when it comes to
turnover and onboarding is thecredentialing process.
Most of the time insurers cantake 90 to 120 days just to
credential and onboard a newemployee and just to get them
accepted into that payer system.
So what are you doing?
During that 90 to 120 days, doyou have a plan for all of my
employee hires, regardless ofposition?
(07:29):
We have a one month, two month,three month plan where there are
clear objectives on training andwhat needs to be done.
We are actually currently in theprocess in 2025 of merging all
of our training information intovideo modules.
Right now it's mostly, textbased.
It's mostly like in blog postformat.
but what I'm hoping to do istransition it all to probably
Trust Driven Care, which is ourCRM platform.
(07:51):
They have a really great way tocreate some modules and then in
conjunction, creating thosevideos through Loom.
the important factor is a lot ofpeople do learn by video and
even the auditory learners, theycan use those videos to just
listen to during their trainingprocess.
It's just nice to have differentways of learning for all of your
employees.
And I also think it's importantto be really clear with these
people, you know, when you hiresomeone, give them a PDF that
(08:13):
says phase one, phase two, phasethree, with clear objectives of
what they have to master monthby month, set those standards on
day one.
So not only will they know ifthey're doing a good job on
paper, but then you can comeback to that at your 90 day
review and say, Hey, Mary, Thesewere the clear objectives I had
for you after 90 days and you'remissing half of them.
Decide if you're going to findanother solution to that problem
(08:34):
or if it's time to move on andtry to hire someone else.
So being clear from thebeginning and setting a goal.
clear expectations really goes along way.
Now, before you pull the plugand you decide you want to hire
someone, I really recommend youdo a full practice and financial
audit.
Take a look at your bankaccounts and your systems,
figure out what it's going totake for you to be able to hire
someone.
If you do not have a lot ofexcess income right now, don't
(08:56):
even think about hiring.
Figure out why that's the casefirst off.
And then I know for mepersonally, when I made my first
hire, I was not ready.
I thought I was going to bethree years staffless.
I wanted to have a small privatepractice and it just didn't work
out that way.
And that's okay.
But when I realized I had tohire someone, I was Kind of
already swimming underwater andI realized in that moment I took
(09:17):
a look at my financials did apractice audit and realized I
only had to see a certain numberof patients per week In order to
hire that person and that gaveme all of the courage that I
needed All I did was change someof my visit types, changed some
of my approaches to what I wasdoing week by week, and it was
fairly easy for me to see anadditional five or 10 people a
week in order to pay thatperson's wage.
(09:38):
That made all the difference inthe world because it eliminated
that fear of hiring somebody newbefore I was ready.
So take a look at your practice,take a look at your numbers,
make a decision that way.
And then to close, I want totouch a little bit more on the
right timing for all of this.
There's a really great quote byEric Fang, and it specifically
says, the best time to beforeyou need one.
And I was always taught inschool the best time is when
(10:00):
you're at about 80 ish percentcapacity before you're drowning,
but you're definitely busyenough to feel that pressure
build because then when you hirethat person, you're going to be
able to pour into them at thesame time.
They're gonna be able to see howbusy you are, but at the same
time, you'll be able to be apart of their training and be
involved with their onboarding.
So that is truly the best time.
I hope this information washelpful and helped you realize.
(10:22):
before you make a deep mistakeor maybe realize that you are
ready to hire an employee.
And I hope you don't make thesame mistake I did and thinking
that it was just going to be ablanket, you know, X number of
dollars per week.
There are so many additionalexpenses.
I really hope it encourages youto think about what your dream
team looks like, evenfuturistically.
I know personally, I don'treally want a team larger than
(10:44):
10 for my private practice.
My other companies, differentstory, but this one.
I just think that 10 is aperfect sweet spot.
I have heard that things get alittle bit wild after the number
10.
So I want to make sure thatwhatever number I have, 5, 8, 10
people under me, I want to makesure that I am pouring into them
and giving them the bestemployee experience possible.
(11:05):
Thanks for listening.
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