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Medical Staffing Agency by kif12001

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									VISMedical.com


     Medical Staffing Guide

            Start Your Own

      Medical Staffing
         Agency

             A Medical Staffing Industry
                Step-By Step Guide

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                  By: Roy Vera, MBA, RT
                                  Contents
Medical Staffing Industry Overview………………………………………..1

Chapter 1

      What is Medical Staffing?
           Aspects of services
           A little more information please
           Who can start a medical staffing agency?
           Medical Staffing Industry Professions
           The Potential Growth
           Why professionals choose medical staffing?
           Why Hospitals prefer working with medical staffing agencies?
           Deciding On Your Service
           The Key Elements
           Medical Staffing Entrepreneurs.
           What To Look For Before You Start
           Hard Work To Overcome
           Are You Sure This Is What You Want To Do?

Chapter 2
     Opening the curtains
          Timing is everything
          Handling New Employees
          Preparing for business
          Finding the candidate to match the client.
          Does every employee get paid the same?
          Does every client get charge the same?
          Behind the looking glass
          Lets look at some forms

Chapter 3
     Formulating Your Plan
          Why I need a business plan?
          Deciding how to name your business
          Do you really need an office?
          How to structure your business?
          Does you company need Insurance?

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Chapter 4

            How to Finance Your Company
            Compare and Contrast
            The scary truth of financing your medical staffing agency?
            Start-Up Expenses

Chapter 5
     Help Wanted, Please!
          Different needs from different medical staffing agencies
          The Challenge
          It can get crazy
          Recruitment 101
          Referrals:
          Advertisement
          You are what people say you are.
          The cost of recruiting a new employee
          Examples of success in “Viral Talk”


Chapter 6
     Finding Clients
           The simple stuff
           Farming your area
           The easiest method to get clients
           Other methods that work.
           Insider secrets for finding clients




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Medical Staffing Industry Overview

The medical staffing industry is on a continual growth, with projected yearly
double-digit growth being commonplace. Hospitals and medical facilities find it
cost effective and convenient to work with a medical staffing agency to fill
weekend shifts, short term vacancies, and the fill the overall demand for medical
staff. Many hospitals and medical centers actually prefer to work with medical
staffing agencies because they get to test drive a medical professional and they
minimize the risk associated with the matching process within the permanent
positions.

Today’s trend to work for medical staffing agencies is on upward surge. The
stigma once associated with working for a medical staffing agency no longer
exists. Today working for a medical staffing agency is preferred over full time
positions within a hospital or medical center. Both experienced and un-
experienced workers benefit working for medical staffing agencies. Medical
staffing service can be ideal for new grads, transitioning between careers,
downsized and needing work, full time parents needing part time work or you
simply need extra money for the holidays.

Retired medical workers can benefit from working for a medical staffing agency as
well. They have the experience but are only interested in part time work. Many
young, college graduates eager to travel and get paid for it can benefit working for
a medical staffing agency that provides travel services.

The barriers to entry are small. You can effectively run a medical staffing agency
with a phone and fax. Staying within a specific geographic area will allow you to
grow and compete with larger companies with larger overheads. You can function
with a smaller staff of medical staffing personnel and clients.

The medical staffing industry allows growth by generally tapping into the different
professions. Each profession with the medical staffing industry can by itself
generate annual income to potentially increase your company’s revenue to millions
of dollars per year. The growth of a medical staffing agency is limitless. You can
also decide to be a one person operation making over $100,000 a year and working
half the time you would normally be working in a hospital.



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Chapter 1

What is Medical Staffing?

The medical staffing industry basically is responsible for staffing hospitals,
medical clinics or medical offices. Using medical professionals as employees for
the medical staffing company clients pay for the service. Qualified candidates get
paid usually higher wages and today many medical staffing agencies are beginning
to offer medical staffing employees such things as medical insurance, income tax
withholdings, benefits and retirement plans.

The client is the facility seeking professionals to staff there facility. Candidates are
your labor pool you use to provide clients qualified experienced staff. The medical
staffing company makes its money by being able to charge higher wages to the
clients, and is able to attract candidates by paying higher wages to the employees.
Some staffing agencies are able to combine both the medical staffing and the
finders fee recruitment to increase revenue sources.

Matching the candidate to the client in the medical staffing industry is easier than
any other staffing industry. In the medical staffing industry you are often qualified
to perform the duties by having a license within your scope of practice. The
candidates are simply required to perform the duties in the client’s facility.

Aspects of services

The medical staffing services has different aspects to it, yet today those different
aspects are becoming more aligned than before.

Are medical staffing services employers?

Medical staffing services are employers, while many candidates may prefer to be
designated as an independent contract or with its own set of rules, the candidates
are your employees. When the medical staffing agency sends a candidate to a
hospital, that candidate has become your employee. You will need to provide
insurance and work-mans compensation.

Many medical staffing agencies are doing both medical staffing and providing
recruitment resources for clients. Often a temp to perm position can be part of the
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medical staffing services you provide. The medical staffing, recruitment and temp
to perm services in the past were all independent of each other. Today they are
aspects of service combined in the medical staffing industry.

Providing temp to perm positions still allows you to mark-up your hourly prices
and benefit from the recruitment finders fee. Many medical staffing services use
these to have a continue stream of income and be able to provide different aspects
of service to the client. Making the medical staffing company an all around service
provider is no longer an option in today’s market.

A little more information please

Medical Staffing Agencies have the option of providing all aspects of staffing
within the industry. But to better serve these aspects lets have a closer look at what
they are.

Temporary Medical Staffing: In the medical staffing industry this makes up the
largest chunk. These are short term shifts, sometimes daily or weekly. These are
shifts that are covered in times of need or to cover vacations or holidays. You bill
hourly for services provided and usually you send invoices bi-monthly and get paid
on a monthly basis.

Long-Term Medical Staffing: Often these are assignments that are longer than 13
weeks. Staffing facilities on a long term basis is required usually because clients
are located in rural facilities unable to simply send a professional for one or two
days. At the same time heavily populated dense facilities may also require long-
tem staffing simply because the shortage of professionals merits it.

Medical Staffing Recruiting: Many Staffing agencies prefer to specialize in
providing professionals within the recruiting arena, often times called
(headhunters). Yet you will find that as a medical staffing agency it is easy to
provide this service while providing medical staffing temporary service.
Recruiting fees can be substantial and provide a viable resource in the starting
phase of any medical staffing agency. Many if not all medical staffing agencies
have provided or can provide this service.

Medical Staffing Temp-To-Perm Service: Combining long-term medical staffing
and medical staffing recruiting is seen more often today in this industry. A client
may view an employee, try them out on a temporary basis and hire them later on if
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the client wishes to do so. For this service the medical staffing agency receives a
hiring fee from the client.

Who can start a medical staffing agency?

Having a health-care background certainly helps in making a success from a
medical staffing agency. Deciding how to begin or what services initially to
provide may be your biggest challenge if you do not have a health-care
background. Many begin a medical staffing agency as independent contractors
providing there particular expertise.

A corporation wishing to expand from accounting staffing to the medical staffing
industry will experience a much higher monetary entry than a single Nurse wanting
to self contract herself. Partners have been known to succeed by splitting the shifts
between themselves. One may work day shifts while the other works a night shift.

Let’s look at some of the professionals who can start a medical staffing agency and
the different areas within the medical staffing industry that can be tapped into.

Medical Staffing Industry Professions

Medical Imaging – Radiology
         • Radiology Technologists
         • Ultrasound Technologists
         • Mammography Technologists
         • Radiation Therapist
         • Nuclear Medicine Technologists
         • Computer Technologist
         • Magnetic Resonance Imaging Technologist
         • Cardiovascular Technologist


Laboratory Technologists
         • Cytotechnologist
         • Histology Technologists
         • Medical Technologists
         • Medical Laboratory Technologists
         • Laboratory Assistant
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Rehabilitation Professionals
         • Physical Therapist
         • Occupational Therapist
         • Speech Pathologist
         • Audiologist

Perioperative Professionals
         • Nurse
         • Surgical Technologist

Pharmacy Professionals
        • Pharmacists
        • Pharmacy Technologists
        • Pharmacy Aid

Respiratory Professionals
         • Respiratory Therapists
         • Respiratory Technicians

Paraprofessionals
         • Medical Assistants
         • Phlebotomists
         • EKG Technicians

The Potential Growth

The fastest projected continual growth in terms of dollars is the medical field.
Entering the medical staffing industry and tapping into the billion dollar industry
assures many entrepreneurs with potential million dollar success. In the nursing
field alone by 2010 a 300,000 nurse shortage is estimated in the U.S. Supply and
demand dictates higher wages for nurses and negotiating power for medical
staffing agencies.

The list above illustrates potential markets to tap into within the medial staffing
industry. They all are expected to experience double-digit deficiencies within the
medical staffing industry. In fact the U.S. Bureau of Labor Statistics (BLS)
predicts that more jobs will be created in the medical industry, yet the labor pool
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will not be available. Medical staffing agencies will be positioned to attract the
labor pool by increasing the pay rate and charging higher hourly rates to facilities
needing these professionals.

The costs associated with starting a medical staffing agency are low and therefore
allows professionals to begin there medical staffing agency quickly and cheaply.
Often times having a phone and computer is all you need to get started.

Why professionals choose medical staffing?

More and more professionals have learned that they can work less and earn more
by working with a medical staffing agency. The labor shortage allows medical
professionals to ask and expect more pay. Hospitals and medical centers are often
unable to compete with medical staffing agencies and are forced to pay the higher
hourly fees medical staffing agencies charge. More medical professionals then
enter and become employed by the medical staffing agencies. This type of action
then adds to the shortage hospitals and medical centers are experiencing.

Another reason professionals look into medical staffing agencies is because often
hospital policies prohibit increasing pay to the medical professionals and working
for a medical staffing agency allows an individual to avoid internal politics

The shift to work for medical staffing agencies has taken hold of this industry and
knowledge has spread to new graduating student. Students graduating within there
particular medical professions are looking to make top dollar. The former idea that
new grad’s cannot make as much as seasoned professionals no longer holds true.
The need for these medical professionals has shifted the paradigm allowing much
more latitude for new grads. Seasoned professionals understanding this paradigm
then expect higher wages from hospitals. When they cannot earn higher wages
from hospitals they then turn to medical staffing agencies. The cycle then takes
hold forcing hospitals to pay higher wages to the medical staffing agencies, thereby
allowing the medical staffing professional to realize there true financial potential.

Why Hospitals prefer working with medical staffing agencies?

When you calculate the total pay associated with having an employee in a hospital
it is usually 35 to 50 percent of the workers salary. The hidden costs allow
Hospitals to view medical staffing agencies as a viable option.

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Hospitals only pay for services rendered to the medical staffing agencies.
Hospitals will never experience absenteeism due to illness when using a medical
staffing agency because the agency will always have a ready warm body available
to cover the needed shifts.

Many managers prefer to use medical staffing agencies over trying to hire new
employees. Many medical staffing agencies are moving into a total streamline
process taking over the entire operation. Managers view this as a monetary gain
especially when hospitals are being force to run a lean operation.

Hospitals view using a medical staffing agency as a viable option to hiring new
employees mainly based on the cyclical nature of the medical industry. Hospital
census dictates manpower in a facility and using a medical staffing agency allows
hospitals to simply call an agency and cancel the shift. This allows the hospital to
save on expenses for any particular day as apposed to firing an employee because
the hospital is slow.

Deciding On Your Service

Deciding what service to provide may be as simple as determining what your goal
is. If your goal is to simply provide services to hospitals using your particular
skills, then finding your niche is a simple as using your professional license.

If your goal is to start with your profession and move into other areas, then you
simply begin hiring professionals within your scope, build a financial base and
slowly move into those other areas.

If you are a seasoned company wishing to build revenue within the medical
industry, finding a qualified manager/business developer will be your best vehicle
to use.

Deciding on your niche will be affected by the local market place. Your particular
region will dictate the supply and demand for both the client and the labor supply.
For example, if there are 5 Hospitals in your area, but there are 25 medical staffing
agencies fighting for your particular niche, then it may not be a viable vehicle to
use. You may find that further specializing may allow you to make a nice living
even with this competition. You may offer weekend night shift services at a higher
rate guaranteeing services. This will allow you to attract employees and beat the
competition in this area.
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One of the companies I consulted for initially specialized in providing only
radiology technologists in a very tight region. Eventually the company slowly
moved into Ultrasound, Nursing and eventually Respiratory. The success came
from slowly establishing themselves within there particular niche earning the
respect of the hospitals who later were willing to allow entry into these other
niches.

The Key Elements

Some medical professions lend themselves for easier entry and higher return with
less capital investment. Depending on several key elements will determine the cost
associated and earning potential of your medical staffing service.

The key elements

Opportunity:

A medical staffing agency can lower there first contract hourly rate for a particular
area simply to get in the door. Provide excellent service to the facility and
overtime you will find that entry into other staffing niches will be met with less
resistance. This causes what I call “loosing pennies to gain dollars” many starting
out don’t realize this and are unable to secure contracts.

Flexibility

You will be asked to perform and supply professionals outside the scope of your
niche. Be prepared to create an environment that lends itself to supply these
requests. The requests are often the catalysts to breaking entry otherwise shut.

Medical Staffing Entrepreneurs.

Having the drive and the love to become self-employed allows owners to succeed
in this business. No day is the same and owners experience great variety dealing
with both clients and candidates. You must be a people person because daily you
will be talking on phone to people, interviewing people and having meetings with
people. Most starting a medical staffing agency are experience in the field solving
the initial problem of talking with knowledge to clients.

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In 1985 in Chino, California a local Radiology Technologists started his X-Ray
Staffing service, worked the shifts until finding candidates to fill the shifts. The
firm began to grow doubling in size over a short period of time. The company
continues to grow and experiences loyalty from the Hospitals it provides staffing
for.

A local Mammography Technologists began simply providing mammography help
to a local clinic while her kids were in school. The sister facility requested staffing
assistance from her establishing her second contract. The Doctor recommended
her to his friend who was a manager in a large imaging center establishing her third
contract. In a matter of two years she began earning enough money to hire a
secretary and a staff to help her fill the increasing number of shifts from her
contracts.

A Nurse decided to provide medical care for her neighbor’s father who was ill and
needed daytime care while the family was at work. The family recommended her
services to friends who also needed long term care. She called several friends who
were retired nurses looking for additional income. She simply took a small fee for
the referral and began her referral service for long term home care for the elderly.

Mike worked for a staffing agency for over five years before deciding to take the
plunge and begin his own medical staffing agency. With his kids and his wife
providing medical staffing customer service, almost instantly he began securing
contracts.

Heidi started her medical staffing agency by providing Ultrasound services. Since
she was an Ultrasound tech she was a one person medical staffing agency. After a
short while request came in to staff other shifts and other areas in hospitals. Five
years later she is a force to be reckoned with in the medical staffing industry.
From what I understand she has demolished her home and in its place rebuilding a
5 thousand square foot mansion. Not bad Heidi!!

This is the way some owners have started there own business. While having deep
pockets helps, it does mean you cannot start a medical staffing agency slowly and
grow it over time. Your first step is to gather as much information as possible
before you decide to begin your medical staffing agency. Knowing your
competition, knowing what you want to do and how to get there will be the
difference between success and failure.

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What To Look For Before You Start

Regardless of your goal or the niche you are targeting you will need clients and
candidates to make money in you medical staffing agency. Looking at these two
areas before you start will allow you to save thousands of dollars in mistakes.
Determine how many hospitals or medical facilities there are in your area.
Determine the qualified client pool in your area. Coordinating this information
will allow a straight line approach in determining the validity of your medical
staffing agency.

Many that have started a medical staffing agency had some kind of background in
the industry and new first hand what the demand was before they got started.
Often times the amount of work they were performing answered the question if
there was a need in the area. Other ways to determine a needs analysis without
spending tons of money on market research include.

   • Call and interview potential facilities you see yourself doing business with.
     Try to make an appointment with the facilities director ask how well their
     medical staffing needs are currently being met. Ask if they would consider
     using a different medical staffing service.
   • Sign on with a medical staffing agency outside of the area you plan on
     covering. This will allow you to get insight into valuable information on
     how others view the temporary service.
   • Get demographic information on the area you plan on covering using the
     Census Bureau.

Hard Work To Overcome

The medical staffing industry is not without its problems knowing what you are
getting yourself into and how to deal with many of the problems will in some
degree alleviate some of the stressors associated with running a medical staffing
industry.

   • Paying your employees: It is easy to accumulate a huge payroll before your
     clients pay for your services. It is not uncommon to have a client in the
     medical staffing industry pay: Net 45, Net 60, Net 90 and in some cases Net
     120.
   • The competition in the medical staffing industry is fierce and in some cases
     down right dirty. Stealing staff by offering more incentives is a common
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     practice in this industry. Loyalties are not a common term used in this
     industry especially if a client can save a few dollars and a candidate can earn
     a few extra dollars.
   • Because competition is what it is, finding candidates will be a challenge
     when faced with competition. The margins have shrunk in the industry in an
     attempt to attract qualified professionals and secure new accounts.
   • The life span of candidate can range between a couple of days to years.
     Keeping your clients happy and your candidates happier are a continual
     process that never, never ends.

Are You Sure This Is What You Want To Do?

The medical staffing industry has a lot of work to overcome in order to become
successful. Are you sure this is what you want to do? Just kidding! The bright
side is that all business has huge obstacles to overcome and the medical staffing
industry is not without them. Rest assured that starting a Janitorial service is just
as complicated as starting a medical staffing service.

The medical staffing industry has become and is being seen as a professional
choice to both work for and own. Today you are in such a great position to begin a
medical staffing service.

After reading this chapter, you should have a general ideal of what the medical
staffing industry is like. In Chapter 2 I will walk you in the day in the life of a
Medical Staffing Company. Keep reading.




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Chapter 2

Opening the curtains

Let’s take a journey and open the curtains to see what is really going on behind the
scenes of a medical staffing agency.

This entire business is about people and dealing with people on a daily basis. Your
employees both office and outside sales reps are constantly talking to or looking
for people. Understanding this allows for growth in several key aspects of
interpersonal relationships and allows you to hire needed people with the skills
necessary to deal with people on a daily basis.

The majority of medical staffing agencies are 24 hours a day, 7 days a week.
Usually office hours are between 8 am to 6 pm and an answering service often
times is used to capture the after hours calls.

Timing is everything

We will start our journey at 8am and take you through a typical morning at
“WeCanStaff Corporation”

8:00 Am, You walk in your office and immediately the phone begins to ring. An
employee is
         running late and will be late for the assignment to the Hospital.

8:12 Am, New hospital calls and needs two employees by 9am to cover shifts.

8: 20 Am, Employee calls needs directions to Hospital. Give directions and
immediately call
      other hospital that employee will be late.

8:25 Am, Call available employees for 9am coverage.

8:30 Am, Other hospital calls, employee has not arrived, assure them you will find
out why.

8:40 Am, Give a call back to hospital needing two employees, assure them they
will arrive by
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8:50 Am, Call and track employee late for hospital, then call Hospital assuring
them she will be there.

9:00 Am, Prospective employee calls to get more information. Tell employee to
come in and fill out resume.

9:15 Am, Sales rep calls needing price modification to secure contract with
Hospital.

9:30 Am, Call comes in from hospital employee has not arrived.

9:35 Am, Call employee on call and send her to hospital.

9:40 Am, Call hospital tell them new employee is on the way.

10: 00 Am, Employee walks in to pick up check.

10:05 Am, Employee calls to check on available shifts for next day.

10:10 Am, Sales rep calls that new hospital wants to secure a contract.

10:15 Am, Fax comes in with contract, immediately sign it and mail it back.

10:30 Am, Call from perspective employee not sure if temp work is for him.

11:00 Am, Call from hospital, they need an employee for tomorrow.

11:10 Am, Call employee is available.

11:20 Am, Call from hospital, not happy with employee and will not accept same
employee tomorrow, please send new employee.

11:30 Am, Received call from employee affirming shift for tomorrow.

11:35 Am, Call hospital confirming shifts coverage.

11:45 Am, Call other employee try to remedy problem. Secure coverage then call
other employee determine cause of hospital frustration.
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12:00 Noon, Order lunch for delivery

12:10 Pm, Perspective employee walks in interested in filling out application.

12:20 Pm, Employee calls back to explain what happened at hospital.

12:30 Pm, Other perspective employee calls wanting to get more information.

12:50 Pm, Sales rep calls telling you that new hospital wants coverage. Assure
them you will send an employee.

Handling New Employees

You will find that dealing with new employees must be done tactfully. They are
your bread and butter and often times the medical staffing candidates understand
there value and can become a bit cranky.

When a perspective employee enters your office, make sure you do the following.

   • Ask the candidate what kind of licenses they have. Usually they are more
     than willing to tell there vast knowledge and what they are able to do. The
     medical staffing industry is unique in that the type of license an employee
     has will determine what work they are able to perform for you.
   • Make sure you get a resume from the perspective employee, determining if
     they are a new grad versus having over ten years of experience will allow
     you to determine at what starting salary you can pay them.
   • Make sure perspective employee not only has the licenses to perform the
     function of the job they are applying for, but make sure you check with the
     state licensing body verifying accurateness of the license.
   • Make sure you make copies of Drivers license, Social Security and any other
     form of ID allowed for verification of U.S. Citizenship.
   • Have employee fill out an application. Provide a comfortable environment
     in order to allow perspective employee to quickly and comfortably fill out
     application.
   • Ask questions concerning there experience upon completing the application.
     Gauge there understanding of the job to determine there efficiency within
     there scope of practice. Understanding this will allow you to determine what
     facilities will be best suited for this perspective employee.
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   • Ask perspective employee when can they start? What shifts they want to do?
     and How far are they willing to travel?
   • Bottom line is that most if not all perspective employees will be looking for
     one thing and one thing only, how much do you pay? This is common in
     this industry and should not be viewed as wrong. It is a very common
     question to ask at times even before the interview. Many medical-staffing
     professionals will not interview until you tell them a ball park figure of what
     you will pay.

Preparing for business

Once your medical staffing is up and running, once you secure contracts and calls
begin to come in, you will no longer be sitting around waiting and hoping for
business. The morning is usually the busiest, especially on Mondays and Fridays.
Your clients will be calling either complaining or needing shifts to be covered.
Prospective employees will at time flood your phones with request for information
and or pay rates.

Calls that come in from prospective employees need to be met with positive
encouragement to come in. It is a good idea to continually interview and collect
resumes to build up your database even though you do not have placements for the
prospective employees. This form of application collection will allow you to
prepare for busy times and have a pool of candidates to call in the event you get an
emergency call.

Your employees will call daily if not weekly letting you know there availability.
You place these names with availability on a database dedicated for the medical
staffing industry. This type of software is specific for the medial staffing industry.

Do not accept call in time sheets from employees. Make it your company policy
that employees will not be paid if they do not mail in there time sheets. Time
sheets are your invoices allowing billing to take place. It is hard enough dealing
with hospitals that pay Net 60 and above to deal with employees not mailing there
time sheets on time.

Work orders come in daily when running a medical staffing agency. Taking note
to accurately write down what is needed is very important. Many facilities are
requesting specific type of employees needed to cover specific areas. A facility
may simply request a female Ultrasound tech. Sending a male Ultrasound tech
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will frustrate the client and possibly cause you to loose the account. When a call
comes in to fill shifts make sure you tell the client that you will call them back
within an hour to confirm the shift. Make sure to call the client back once you
have secured an employee and make sure you call the client if you need more time.
If you cannot produce an employee make sure you tell the client. Nothing
frustrates a client more than not having a shift covered and not being told that the
shift was not covered.

Often medical staffing agencies will confirm with the client that the shift is
confirmed without actually having an employee. This can be done in many cases
depending on the size of your database and if you are fairly certain the shift can be
covered.

Usually calls come in from existing clients that you have already established
contracts with. At times you get calls from new companies that were referred to
you. If a request to cover a shift is made over the phone, go ahead and provide
coverage. Sending a contract and having it signed is secondary to proving
coverage and securing a new client.

If you find that you cannot provide coverage for a request made by a client you
have several choices you can make.

         • Call the client and suggest they try another staffing company
         • Call the client and ask for more time to confirm the shift.
         • Get an employee from another client to cover the shift.
         • Call another staffing agency to arrange coverage.
         • Call an employee on your database to arrange coverage at a much
           higher rate to secure the account.
         • You may consider covering the shift yourself.

Clients and employees are always calling in to report problems and or report
dissatisfaction. You will have clients call you to report no-shows, clients asking
about billing errors, employees requesting to be taken off certain client facilities
and clients calling in to request to place certain employees on a DNC list (Do Not
Call) that means the employee is no longer allowed to work at this particular
client’s location.

Make sure you have a good database to prepare for what I call the Monday sick
bug. Most of the time your employees will call on Mondays sick. Have a back-up
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plan to be able to call employees in case this happens. Some medical staffing
agencies have employees that work a regular job at night and are paid a stand-by
hourly fee by the medical staffing agency on Monday’s. This is an insurance
policy used in cases described above.

When you decide to hire a front office in house employee to answer phones, make
sure they understand the dynamic nature of your business. Some of the
responsibilities tied to this position are.

         • You want to make sure that employees are arriving on time to your
           client’s location. Initially you may want to make check-up calls in the
           morning to make sure employees have arrived. Depending on your
           relationship with the client may not lend itself to these types of calls.
           Some clients will take it upon themselves to call you if your employee
           is 1 minute late. Depending on the client and how long you have been
           working with them will help determine the need to make those phone
           calls.
         • New clients should be called after completion of new shifts to
           determine how the employee did. This is good PR and shows your
           interest in making sure the client’s needs are served. You may
           discover the client was dissatisfied and wishes a new employee.
         • Calling clients on a regular basis on Friday should be a routine. Out
           of site out of mind cannot be truer than in the medical staffing
           industry.
         • Call your new employees the night before the shift is to be covered to
           confirm the schedule, address and time they are to arrive. This helps
           prevent any miscommunication between you and the employee.
         • Call clients that have not requested service for a while. Let them
           know you are still around and have employees ready and willing to
           work in there location.
         • Make sure to send a thank you package to the client when staffing a
           facility continuously. This helps build your relationship with the
           client. Make sure you remind your sales staff to visit new and
           existing facilities to stay on there minds.
         • You will be responsible for handing out applications to new
           employees as well as doing background checks and preparing the
           packages to give to new employees.
         • Orders will come in daily and matching those orders with employees
           will have to be the responsibility of this position initially. Once you
                                                                                   20
             begin to grow the separation between the front office person and the
             scheduler will occur.


Finding the candidate to match the client.

The best way to describe this type of finding the candidate to match the client job
is like playing chess with 100 players who each have made there own rules and
believe they are all special requiring special attention. Working with people and
learning what each client needs is part of the medical staffing industry.
Establishing a small medical staffing agency will allow you to grow with your
employees and learn what each one needs as well as what each client needs.

Using medical staffing software will tremendously alleviate the need to learn what
each client needs and what each candidate requires. A good software allow you to
input the information of each clients and employee into a database that spits out
who is available, when they are available, why they are available, and for how
long. You cannot function and run a medical staffing agency without investing in
some affordable software.

If you are a one-person operation you may be able to use a pencil and notepad to
write down your schedule or use excell to create your monthly schedule. The
investment option to purchase software may not need to be made until you begin to
have employees and more than once client.

Some of the major key aspects of using medical staffing industry specific software
are the types of data that can be inputted and accessed, they include.

   •   Allows you to see instantly who is available on your preferred list.
   •   Only those qualified with certain skills requested by a client will pop-up
   •   Employees interested in long term assignments will be accessed.
   •   Employees placed on DNS lists will be deleted from popping up when
       request are made from facilities who have requested employees to be placed
       on DNS lists.
   •   Distance and location criteria will be accessed.
   •   Licensing criteria and gender specific in some cases will be accessed.
   •   Experience will be accessed.
   •   Hourly par rates will be accessed to get the most bang for your buck.

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   • Much much more.

This kind of software requires a constant feeding in information in order to take
full advantage of the benefits of using the software. With time you will have a
viable database to use as your first line of defense. Understand that the software
does not take away the need to continually make phone calls to prospective
employees and clients.

Eventually you will discover employees that deliver the best service and they will
be constantly requested. You will also discover employees that need a lot of
management. The same is true for clients. Some clients lend themselves for easy
handling and don’t complain much, while some clients want you to part the Red
Sea yet they only use your services one a year.

Does every employee get paid the same?

Does every employee get paid the same? I will answer this question with an
outstanding, viable and insider secret resounding NO! You cannot and should not
pay every employee the same rate. Your negotiating skills as well as
understanding that people’s needs are different at any given time will work in your
favor. The reason you should not pay every employee the same is based on an
insider medical staffing secret. You use your higher paid employees to cover
difficult shifts and you use you lower paying employees to cover easier shifts. A
higher paid employee will less likely say no to a shift requiring him/her to drive 1
hour and work a 12 hour shift, then be asked to drive 2 hours in the opposite
direction to cover an 8 hour shift.

To determine how much to pay an employee you first need to determine a
benchmark. More specifically how much do you regularly charge a client?
Determine what you are charging a client and deduct 75% of that fee, this will be
your high end pay rate. The client fee may differ, but you can at least have a gauge
not to over pay employees.

In the end it all balances itself, how? Lets take a look at John who makes $30 an
hour and works 40 hours a week. His pay will be $1,200 and your ROI is $400.
More specifically your bill the Hospital $1600 for the 40 hours and are left $400
after you pay John $1,200. Understanding that John is being paid at the highest
rate you are willing to pay an employee, or 75% of your gross billing revenue.

                                                                                     22
Mike on the other hand is a new grad and you are able to pay Mike $20 at 40 hours
a week. His pay will be $800 and your ROI is $800. You bill the Hospital $1,600
for the 40 hours are left $800 after you pay Mike $800. Mike has been paid much
less than John. The difference between John and Mike allows you to calculate a
$25 an hour pay rate, thereby your ROI for both employees is $1,200 for the week
or you are paying at a rate of 65% of your billing. At the end of the day using this
method allows you to use your employees in different capacities to your best
interest.

Does every client get charge the same?

The same is true with the above example; you cannot charge every client the same.
The billing rate is subject to change and is subject to negotiation. Your
competition will do it and they will always be on the prowl to find out what you
are billing so they can simply lower there rates and steal your account. It is a very
common proactive in the medical staffing industry to steal accounts by learning
what you are billing called (shopping).

A Hospital that has high volume will more likely be able to negotiate a lower rate
than a facility that may use you once or twice a year. Medical Staffing Agencies I
have consulted for in the past have lowered their prices for customers that have
been using their services for a long time.

Make sure only one person in your organization has the authority to decide the pay
rate you will negotiate with facilities. Gauge each site based on needs and future
and present coverage. Always have a benchmarked pricing structure available to
use as a standard bill rate. It may be that facilities will not negotiate and accept
your terms. In those cases suggested a lower rate in not necessary. Providing the
same rate to other future clients will allow you to have a cushion to negotiate with.
If you plan on offering a lower rate right from the start, you may not have much of
a cushion in the event the facility wishes to negotiate a lower rate.

Make sure you determine ahead of time what the payment schedule is for accounts
receivables. Cashflow is a big problem in the medical staffing industry and
determining how each facility pays is important for your payroll. You may have to
secure funding using a factoring company to help alleviate payroll in certain
months when dealing with facilities that pay beyond Net 60,


                                                                                   23
Your billing rate will be different and higher when covering swing shifts and night
shifts. Make sure this is a standard part of your contract because everybody in the
industry charges more to cover swing and night shifts than day shifts. Weekend
shifts are much higher than weekend day shifts as well.

Behind the looking glass

Dealing with paperwork and invoices in a start-up may be easy at the beginning. If
you are a one person operation with only one contract you probably do not need
fancy software. If you plan on growing or if you are a larger company moving into
the medical staffing industry then purchasing industry specific software is a must.

The amount of work involved in a medical staffing agency requires a dedicated
employee working full time handling paperwork. This assumes you are covering
multiple facilities handling a nice size database.

Paperwork is combined in two categories each with its own needs and assessments.
Clients and Candidates. The clients need to be billed while the candidate needs to
be paid. Balancing each one requires software capable of delivering accounts
payable, accounts receivable, benefits information and payroll distribution.

You cannot escape paperwork and you cannot function without learning how to
handle and organize paperwork. I consulted with a company who was struggling
to meet payroll each and every month. After spending some time with the
company I discovered the problem was not the lack of potential billing, the
problem was that the organizational skills of the staff often times resulted in the
loss of invoices. This prevented them from actually billing facilities for work
already performed. Onc facility was never billed for over $15,000 . After I
showed them to organize and simply keep track, they were able to meet payroll and
turn a profit simply by organizing and keeping track of existing clients.

Lets look at some forms

We have opened the curtains and allowed to see what is required and what is
expected of a medical staffing company. With that in mind, here are some sample
forms you can use in your medical staffing business to get started.



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25
26
Chapter 3

Formulating Your Plan

You are well under way in creating your medical staffing agency, but we must
make sure you have the right path and in order to create a path you must have a
road map. Setting the ground work first will help prevent you from making
mistakes common in start-ups.

What I need a business plan?

Creating a solid business plan is like having a map with key target locations letting
you know if you are heading towards the right location. Imagine an airline pilot
not knowing exactly where she is flying to. Would you want to get on that airplane
and hope to get to your destination? Probably not!.

A business plan should be viewed as the most basic of things you need to run your
company. It should be viewed as no different than naming your business or buying
business cards. Fundamentally it is how you will run your business and succeed in
times of feast or famine.

Your Medical Staffing Agency Business Plan should include not only the basic
business structure, but it should include a marketing plan as well as a financial
plan. A start up medical staffing agency may find it difficult to determine what
should be included and what should be excluded from a business plan. Having
over 10 years experience in the medical staffing industry I have consulted with
both experienced and start up companies and both agree that changes in your
company are dynamic in nature and making a roadmap is essential, yet it will
change with time and experience. It is best to have a goal, but be willing to adjust
that goal as time moves on.

Understanding what your goal is and where you see your company in the next five
or ten years is difficult to do. Much of the time it is difficult to see beyond
tomorrow, but a business plan is asking you to do some homework and research
that which you have decided to enter. Why is having a business plan so important/.

            • If you want to get a loan from a bank they require it.
            • Helps determine your goals and how to get there.
            • Helps determine the competition and how to overcome it.
                                                                                   27
           • Helps you stay focus in times of confusion.

Maintaining your focus while running your medical staffing agency is the function
of a business plan. Many of my clients willing to enter into revenue producing
segments within the medical staffing industry, but where forced to suspend such
action until certain milestone were reached. The reason being is that milestones
help determine the success of your company and determine viable financial
fortitude.

Writing a business plan takes time and dedication as well as persistence in your
part. Nothing is easy about writing a business plan, but is the most important thing
you will need to create.

Deciding how to name your business

It may seem that this process may be the easiest to overcome when dealing with
such tasks as writing your business plan, dealing with financing or licensing issues.
I have found within my consulting experience that often this process is so
overlooked it may cost you thousands of dollars if not dealt with right away.

Many starting a medical staffing agency often fail to realize or see a bigger picture.
Growth may come with or without your help. If you plan on expanding your
company or staying within a certain niche the growth of you company may become
a hindrance if your companies name does not reflect this change.

Let me provide an example: Say you are a nurse planning on starting a nursing
agency or more specifically you are a one person operation insterested in only
staffing yourself thereby becoming an independent contractor for hospitals. You
succeed in securing contracts for yourself, now after a while you are seen as a
viable source for staffing help and are asked if you can cover multiple shifts. You
take on the challenge by asking a friend or two to help cover the shifts. Two years
later you are grossing over 1 Million dollars and are asked to help cover respiratory
therapy, radiology and nuclear medicine. The problem is you called your company
“IndependentNurseForYou”. You are becoming successful, yet your name will
become a problem growing into other segments within the medical field.

It is a common problem I have seen in many circumstances. Another problem I
have seen is having too long of a name or it is difficult to pronounce. You must

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make sure your medical staffing name is essentially short, to the point and easy to
pronounce.

A major staffing company currently making over 8 Million in gross revenue a year
made such a fatal mistake when naming your business that the cost to recover at
this point is huge. The company never secured or bothered to check if the name
was available online. At the time they wanted to create a website they discovered
that there name was not available. Atleast the .com was not available and had to
settle for an unpopular Dot ending.

You can avoid this by simply searching the domain names before you decide to
buy your business license, business cards etc. The cost of simply buying a domain
name is less than $15 a year. If you decide to use the name or not, you are only out
$15 dollars and not thousands in the future.

Do you really need an office?

I will answer this question by saying it depends!, It depends on what you are
planning on doing initially and what your finances are currently. These two points
are very important in determining if you need an office or not.

I have seen and read about horror stories dealing with premature office growth. A
client of mine came to me only after he had purchased office equipment and leased
a very expensive office. The problem was that after six months he had no clients
and was unable to spend money on marketing because the majority of his money
was spent on securing a lease, office equipment and software. He has beautiful
business cards and leather furniture, yet he had no clients.

This part of the chapter will help you avoid making those mistakes my client made
and hopefully prevent you from having what I call a “paper medical staffing
agency” Having a medical staffing agency on paper only and not having any
client’s is frustrating and defeating.

With technology today you are able to have a virtual office with all the trimmings
of a real corporate setting without the expense. I always recommend this to new
companies I consult for. I believe that the majority of your money should be spent
on marketing and securing contracts. Once you begin to secure more clients and
candidates and begin to bill, you then can start to grow and spend a little money on
your office.
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Budgeted medical staffing agencies can have virtual addresses and virtual phone
numbers with local area codes. This allow you to appearing larger than you are
while directing your investment towards sales and marketing.

If on the other hand you have deep pockets, or are a corporate staffing company
interested in entering the medical staffing arena, then you can afford an office with
the following criteria’s.

Make sure you settle in an office that provides access to freeways and is centrally
located within a geographical area you plan on marketing too. Many Hospitals
may shy away from dealing with your company if they feel you are to far away
from them. Many office buildings today offer secretarial answering service as part
of there leasing service. This works great for start-ups.

Finding office space that allows for growth will help in future expansion. A
successful medical staffing agency can quickly outgrow its office space in less than
4 years. A perfect example taken from a client of mine forced to move to a new
city solely due to non-available larger lease spaces in her location. She grew
tremendously moving into new areas within the medical staffing industry and
could not continue to function in her two room office.

Be careful not being to eager to sign a lease that offers low rent, but are forced to
sign a lease for five years. Many things can happen in five years and you don’t
want to be tied to a space in the event you begin to grow.

How to structure your business?

Starting a medical staffing business does not shield you from being sued at one
point or another. Choosing the right structure for your medical staffing agency
requires careful planning and understanding what each structure represents and
how each structure can protect you in the event you are sued.

Sole Proprietorship

Not many medical staffing agencies use this form within the medical staffing
industry. You are personally responsible for all debt and liability incurred in your
company. Your personal assets are tied to the company, and if a client or
employee ever sues you they can go after your personal assets.
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Corporation

This is the best way to protect your personal assets. Many medical staffing
agencies chose to be an S-Corporation, an S-Corporation will allow you to avoid
paying the double taxation associated with Corporation.

Many medical staffing agencies also decide to file within other states the S-
Corporation. Some states are less expensive, offer better tax incentives and still
allow you to offer your medical staffing agency within your state. Delaware for
example taxes are lower as compared to say California. If you plan on being a
travel medical staffing agency filing in a state other than yours may not matter as
much if say you are only interested in being a regional staffing agency.

Does you company need Insurance?

Getting proper insurance for your medical staffing agency is as important as
choosing the right business structure for your business. You are setting yourself up
for failure without proper insurance, besides many hospitals will not allow you to
provide staffing service without having the basic insurance protecting them from
theft or injury to your employee on there premises.

Protecting your company as well as your employees is a rudimentary fact in this
industry. You cannot provide any kind of service without first insuring yourself
and your employees.

Usually the medical staffing industry requires General Liability Insurance with a
minimum of 1 million dollars. The cost rise with the amount of employees you
have to include both in and out employees.

Another costly insurance as a medical staffing company you will have to deal with
is workers compensation insurance. If an employee is injured while under your
employment you are liable for that employee. Many hospitals want to make sure
you have workers compensation before they will accept one of your employees.
Your state will determine the cost associated with workers compensation.

At this point if you are getting a bit overwhelmed with the ideal of writing your
business plan and all the different aspects associated with research, development
and the marketing plan as well as the financial plan and making sure you have all
                                                                                      31
the right licenses and insurance I can understand your frustration. I have partnered
with a business plan producing company that offers an excellent business plan
template. It is perfect to use and alleviates much of the research associated with
developing a business plan. You can find the staffing business plan on my website
at http://www.vismedical.com/products.




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Chapter 4

How to Finance Your Company

If you have made it this far then I can say for certain that you are probably serious
about starting your medical staffing business. You either have money or you do
not have money to start your medical staffing business. I believe in “OPM” when
starting a business or “Other Peoples Money”. Before I begin discussing “OPM”
lets first see how much money you will actually need to get started.

Starting a medical staffing agency requires more money than other types of
businesses. Mainly because you have to pay your employees many months before
you actually get paid. The speed of your projected growth will help you determine
how much money you think you will need.
After you discover how much money you will need to start your medical staffing
agency you will then double that figure.

How big will your medical staffing agency be? Will you hire office employees
part time or full time? Will you have part time employees working in the
facilities? Will you pay for there workers compensation or require them to have
there own insurance? This is important because if they carry there own insurance,
they may be classified as 1099 and not W2. The difference is significant in terms
of what you pay and what you don’t pay. Each state has different rules when it
comes to this designation and you should contact your state to get more
information concerning the designation between a 1099 and W2 Employee.

What services are you planning on offering? Depending on the service you are
planning on offering will determine the costs. A Physician based medical staffing
agency will require more start-up money than say a respiratory therapist staffing
agency. You start-up capital will be much higher if you are not specialized in the
initial niche you are targeting as apposed to being able to cover the initial shifts
within your niche.

Depending on the competition and the costs within your region will determine how
much money is required in sales and marketing. Employee pay will vary
depending on your location or state. Tax rates are different in each state as well as
expectations of employees and clients.

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Compare and Contrast

Let me provide two examples of start-up costs of two successful medical staffing
agencies that are both today experiencing gross revenue above 1 million dollars.

Company A

The company “A’s” owner began working as an independent contractor for her
local hospital as an Ultrasound Tech. She was working at this facility per-diem
and decided to try to do it on her own. The hospital liked her work and decided to
give her a contract. She had a cell phone, a P.O Box and a free email account as
well as a business license and she insured herself. Her initial cost was under
$1,000. She never had an office and worked essentially from home. If a client
wanted to schedule her they simply called her cell phone and requested the shifts.
Soon she was contacted by another hospital that heard she was providing
Ultrasound services and heard good things about her services. She began
providing Ultrasound services for two facilities. The first hospital then asked her if
she could help them with a difficienty in the radiology department. They needed
an xray tech Monday through Friday indefinitely. She simply contacted several
xray techs until she managed to get an xray tech. willing to cover the shifts. She
had enough money saved to pay the tech ($5,000) the first month while she billed
for services. One X\xray tech then turned into two employees eventually she had
to hire an ultrasound tech to cover her shifts while she maintained billing and
recruitment. At the end she only spent $6,000 of her own money to start her
medical staffing agency. Today she is billing over 1 Million dollars a year from a
$6,000 start-up.

Company B

Company B began by establishing a corporation with an expensive office and
hiring employees to handle potential calls. They had a scheduler; they also had a
staff CPA and a secretary. The owners invested $250,000 and it took them 6
months before they began to secure contracts from the moment they first began.
They were able to hire staff to cover shifts and were able to hire a sales person to
help them get clients. Today they are billing over 1 Million dollars in revenue
from a start- up of $250,000 dollars.

Both of these companies are successful and illustrate the huge differences between
two companies in term of start-up expenses. Suggested capital is dependent on
                                                                                       34
many factors, but the biggest expense will always come from paying your
employees. Growth should always be a balancing act between how much money
you have and how many clients will need your services. At the end if you are
unable to pay your employees you will not have employees to staff the clients.

Company A is a success story, but many medical staffing agencies have closed
doors due to inadequate funding. It is always a good ideal to start any business not
just the medical staffing business, with enough capital to survive six to twelve
months of operation.

Keeping your payroll down will help you survive the initial year of your business.
It is often a shock to many starting a medical staffing agency having to pay
employees so much money before they get paid.

The scary truth of financing your medical staffing agency?

Establishing credit I believe to be your first order of priority before you begin to
send out employees. Credit will allow you to borrow money in times of need and
desperation. Remember I was talking about “OPM” Let’s examine this for a while.

If you are able to convince a bank to lend you money without signing off your
entire life to them then you are a genious and good luck. Banks in the past were
the only resource to finding money to start a business. Today we have many more
resources that are used specifically for the staffing industry.

It is a process called Factoring. Companies provide financing options based on
your invoices charging a nominal fee. It is a sure-fire bet allowing you to pay
employees using other peoples money while you get paid from your clients. You
will have to pay the Factoring Company for there services but it alleviates the need
to close your business.

Factoring companies will buy your invoices; this is a great resource for start-up
companies. A client of mine has start-up capital of $40,000. Soon they realized it
was not enough, mainly because they decided to hire a secretary, secure an office
and purchase software that was not needed until much later. I instructed them on
the industry accepted Factoring practices and encouraged them to use this service.



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Using Factoring to pay your employees allows you to use “OPM” to its maximum
potential until you can afford to pay your employees directly from account
receivable.

Many of my clients still want to have a projected costs analysis based on actual
possible expenses in starting a medical staffing agency. I don’t particularly like to
write down figures because every situation is different, but for the sake of those of
you interested in seeing a possible start-up expense sheet I have created the
following.

Start-Up Expenses

                •   Rent/Lease                $500 –     $2,000
                •   Equipment                 $1000 -    $10,000
                •   Software                  $500 -     $5,000
                •   Payroll                   $5,000 -   $40,000
                •   Insurance                 $500 -     $1,500
                •   Phone/Utilities           $100 -     $500
                •   Owner Salary              $3,000 -   $5,000
                •   Marketing                 $1,000 -   $4,000
                •   Licensing                 $200 -     $500
                •   Professional Fees         $150 -     $400
                •   Misc.                     $300 -     $550

                    Total                     $11,350 - $69,450



Most of the companies I have consulted for and have spoken to have started with
less than $20,000 unless they were a corporation moving into a new direction.
Many medical staffing agencies started as a one person operation and grew from
there. They usually had enough funding to pay an equivalent of a full time
employee for three months until accounts receivables came in. It was not
uncommon to have 3 to 5 temporary employees covering shifts equal to one full
time employee. This is a common practice and used by many start-up companies.




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Once you secure your funding and decide to hire employees, you will need to start
recruiting and finding clients. Lets move on to the next chapter and see how this
is done.




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Chapter 5

What came first the chicken or the egg? In the medical staffing industry this
question is often a never ending task and needs to be addressed and understood in
order to make the grade. This Chapter deals with finding candidates while the next
chapter will deal with finding clients. It is very important to realize that although I
have decided to segment candidates and clients, they are both equal parts of the
same action. You cannot perform too much of one thing without being able to
deliver the other. It is a never ending balancing act.

Help Wanted Please!

Your bread and butter comes from employees, so you want to make sure you hire
quality employees that will make your medical staffing company look good. Many
Medical staffing companies choose quantity over quality and end up ruining there
reputation before they even get started.

If you are starting small, many of the tasks associated with recruitment will be
handled by you. A medium to large sized company may be able to afford hiring
in-house employees to perform the recruiting tasks, but as a smaller company you
may not be able to hire a recruiter.

A recruiter is responsible for finding employees. They search in online job banks,
call employees at home, schedule interviews, place want ads online and offline,
perform direct marketing mailers and basically do whatever it takes to find
qualified employees.

Your main priority in recruiting is making sure the employees have the right
credentials and what there availability is. It is a common practice in the medical
staffing industry to interview more candidates than clients. The medical staffing
field experiences huge turn-over rates and the best way to deal with it is by having
a constant pool of candidates.

A client of mine established there business with two brothers and there mom. The
brothers each were able to handle the shifts needed within there niche and the mom
took messages as well as provide scheduling for employees.

Knowing your niche and the industry is important when starting to hire employees.
When I began my first medical staffing company I knew what kind of license my
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technologists needed, I new what kind of questions to ask them and I knew if they
were pulling my leg. If I wanted to schedule an employee to cover a shift that
needed experience, I knew who to call and who not to call.

Different needs from different medical staffing agencies

Simply having the credentials use to be sufficient enough to send an employee to
cover a shift. It is no longer as easy as that anymore.

Positive personal qualities are essential when looking for qualified individuals.
Often times you will either receive more business or loose your client based on the
direct actions of your employees. Your employees are in the front lines
representing your company and if you don’t do your homework initially in
reference to hiring the best employees, you will eventually ruin your reputation.

When I was in the medical staffing industry working as a sales person and
eventually becoming a director of marketing for a large medical staffing agency,
some of the traits I looked for in hiring an employee were.

   • If they had experience working with other staffing agencies I would always
     ask them if they had ever been placed on a “DNS” list, and if so what
     facilities. I always wanted to hear their side of the explanation. Knowing
     this was important because if you are providing service to a facility that
     placed that employee on a “DNS” you then will be unable to send that
     employee there making that employee less valuable.
   • I would ask questions in reference to there skill level and if they could
     handle the field within medical staffing. I would do this more so to gauge
     there body language and eye contact to determine if they were getting
     offended or agitated. The medical staffing industry has a reputation for
     dumping much of the work on Temp help. Knowing how your employee
     will deal with this will determine the turn-over rate of that employee.
   • Do they seem friendly during the interview? This from my experience will
     tell me if they will be friendly when sent out to assignments. Be careful,
     many will be at there best behavior during your interview.
   • Ask the employee why they want to work for a temp service. Knowing this
     upfront has always helped both the employee and employer. The boundaries
     and expectations are set and can be met much smoothly.


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The process of hiring employees is time consuming and knowing who to hire and
who not to hire will eventually come with experience. This is one of the most
frustrating aspects of running a staffing company. Judging what you’re getting in a
prospective employee, and if they have the skills and qualities is at times
frustrating.

Here are some other strategies I have used in the past when screening employees.

   • More experienced employees will be more willing to travel and work odd
     shifts if they are paid higher salaries.
   • New grads seem to be willing to travel in any direction initially independent
     of pay.
   • Being upfront with an employee as to your expectations will later prove
     beneficial.
   • If you are the 5th registry a perspective employee has worked for in the last
     six months, chances are you will not be the last.
   • New grads will work hard for you initially, but there ultimate goal usually is
     to find a permanent placement position. (You can use this to make money by
     placing the employee as well)
   • Older or retired employees don’t particular like traveling long distances.

These are just a few of the things to look for and to pay attention to when hiring
employees and which employees may prove to be loyal and which will not.

The Challenge

Finding employees for the medical staffing agency will depend on what your niche
is or what you are trying to staff. Knowing how many employees to have is a
critical balancing act. It must be based on how many clients you have and if you
are able to keep your employees working. If you are unable to keep your
employees working they will seek employment elsewhere. If you are unable to
staff your clients with employees they will seek medical staffing assistance
elsewhere. This is the balancing act that will make you a successful medical
staffing agency or not.

Certain segments of the medical staffing allow employees to seek work daily or
once a month. Many of your employees will have full time work and are simply
interested in making extra money. Another small percentage of your employees
will want full time work and are interested in a full paycheck.
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Your company will need to have a pool of both types of employees. The full time
employees willing to work daily and the floaters who are simply interested in
working part time or less. The type of skills involved in juggling these employees
is critical. You don’t want employees leaving to other medical staffing agencies
when times are slow. The skills and trade secrets involved are beyond the scope of
this book and would take up the majority of the book to explain. My experience
has shown me that not understanding this will be a catalyst that leads to business
failure. To learn more about this and other topics relating to finding candidates
visit my website at http://www.vismedical.com/staffingfacts.

It can get crazy

A client of mine had in the beginning just herself and one employee. After one
year she had 3 full time permanent staff and 50 temporary employees. Another
had 5 full time employees with only 2 temporary employees. Ten years later they
have 30 full time in-house employees and over 800 employees in there database.

The fact is as your medical staffing agency grows so will the need to hire internal
full time staff to handle the day to day operations. There is a point when a small
two person operation will eventually break if they don’t hire internal staff. The
point break will depend on such factors as how far spread your clients are, how
many clients you have, how many temporary employees you have and how well
are you at organization.

Recruitment 101

The above examples have dealt with the process of interviewing and securing good
quality employees once you have them. But the true challenge comes with finding
those employees. How to find potential candidates on a continual basis ? The
following high level suggestions are industry tested recruiting techniques used by
many small and large medical staffing agencies. Many of these techniques I have
refined and taught in my courses I teach periodically.

Remember the challenges you will face in recruitment whether you are a small
company or a large national based medical staffing agency is no different. These
strategies work mainly because the medical staffing workforce is more educated
and understands the importance of there skills and how much they need to get paid.
A larger medical staffing agency may have deeper pockets enabling them to
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provide a wider net in marketing. A smaller medical staffing agency may not have
the deep marketing budget, but is able to pay higher wages because of there small
overhead.

Understanding this will give each player a competative advantage in recruiting
candidates. A competitive advantage within the medical staffing industry is so
tight and almost non-existent. When comparing two medical staffing companies
you often will find that what separates then is often as simple as $1 raise.
Friendly staff, comfortable environment and basically being nice to your staff will
help keep your employees once you have them.

The top three methods for finding perspective employees are referrals and
advertisements.

Referrals:

Having an effective referral based system in place will result in an effective and
least expensive recruiting method. A client of mine never advertised his services
and strictly relied on referrals to capture needed quality employees. He would pay
a referral fee to those that referred candidates to him. His only criteria was that
employees referred to him must be top candidates and known for quality work by
those referring employees.

A constant referral based is needed especially within the medical staffing industry.
Having all new employees provide listings of potential candidates at the time of
signing onboard will prove invaluable.

Always ask candidates as well as clients if they know someone interested in
working for you. Provide a means to get in contact with you if the need arises.
Clients may be your biggest source of referrals mainly because many employees
are always seeking part time work often called “moonlighting”.

When you send out employees to work in facilities, remind them to keep an eye
out on potential employees interested in working for your company. Your
employees will be your eyes and ears and using them as a branding tool is an
accepted norm in the industry.

Set up a routine yearly visit to schools that graduate within your particular niche.
These students will be valuable resource as candidates as well as add to your
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referral base. Providing students a hiring bonus with certain expectations will
increase your base. The reason the base will increase is because students often are
hungry for money and are poor. Receiving a lump check at the beginning may be
the difference between starving or not. This tactic has worked wonderfully in
recruiting new grads and securing employment. .

Advertisement

Trade publication: This method used wisely can create exposure if done correctly.
Marketing on a trade publication that is national base, while you are a new start-up
company regional base, will be marketing dollars thrown to the trash. Consider
smaller adds on regional publications such as smaller newspaper, weekly local
publications, and if your budget allows for larger publications.

Online you will find many sources for industry specific advertisement. Simply go
to any search engine online and type the keyword “Medical staffing jobs” and
thousands of websites will appear eager to take your advertising dollars to place
ads on there site. Online publications can be tricky especially when dealing with
such tight niches. Make sure your online advertisement focuses on regional
viewers and not international advertisement. It is essential that each dollar spent
on advertisement is used effectively and accurately. You will be on a budget and
can be out of business if spending money on advertisement does not pay for itself
eventually.

You should have an arsenal of business cards ready to give away at any moment.
Order thousands and hand them out like candy. Give them to everybody you meet.
Give them to perspective employees, to clients, to the mailman because everybody
knows somebody that works in the medical field. Don’t be afraid to give out your
business cards. Give ten at a time, give twenty at a time. You never know when
the person sitting next to you might be a good prospect.

I have never really seen effective advertisement work in the yellow pages, I always
discourage my clients from spending a dime on the yellow pages only because
most professionals looking for trade specific work are not looking in the yellow
pages to find work. They go to such giants as Monster.com or any of the larger job
banks. You can probably though receive a better response by advertising in trade
specific job bank capturing your specific area of interest. If you are looking for
RN’s, advertising in RNJobs.com may prove to be more effective than a more
general but larger job bank site like Monster.com.
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Send out Newsletters on a regular monthly basis. I have found that this form of
soft marketing can be as effective than in your face marketing prompting people to
action. I started a client of mine on an email monthly newsletter marketing
campaign focusing primarily on educating the managers and directors on the area
of management. This free email later was used as a springboard for referrals
directly from the facilities they were emailing to. The managers were happy to
receive the information and valued the monthly publication. On the end of the
newsletter a short description and webaddress was provided describing who the
company was and what services they offered besided the free e-newsletter. This
form of advertising proved to be very effective.

You are what people say you are.

Part of the challenge in recruiting medical personals is what I call “viral talk” A
virus can spread quickly if not contained. If the virus is spreading and no means
are in place to stop it, then the virus will eventually win the battle. Such is true
concerning “Viral Talk” Your employees in the medical staffing industry will
communicate with each other and with other people and nothing you can do will
stop it. The communication between employees grows quicker than you can ever
imaging or have anticipated. Although you cannot contain it, you can control it.
The best resource you can do to control “viral talk” is by having positive viral
conversation. If you treat your employees good, they will communicate this to
others within there same field. If you pay your employees well they will
communicate this to others faster and more effectively than any form of
advertisement you can possibly imagine. The medical staffing industry is a tight
community and everyone knows everyone.

A larger medical staffing company began successfully recruiting employees via
viral marketing. Many of the employees the company recruited were themselves
managers of hospital and medical centers. The company treated the employees
well and subsequently more and more clients began to call the facility for staffing
assistance. As this began to occur the company began to receive more and more
referrals from personal eager to work with this company who seemed like they
cared for the employees. Eventually the company began to loose sight of how they
arrived at there success and began treating long term employees as well as new
employees, like dirt. In less than a year they lost 50% of contracts and the same
was true about its staff. They currently are unable to keep internal staff and have a

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90% turn-over rate. Viral Talk was the biggest downfall this company experienced
and currently has been unable to recover at the time of this publication.

The cost of recruiting a new employee

Finding and recruiting employees for a medical staffing agency has never been a
cheap prospect. I encourage staffing agencies to do a little bit of work on the front
end to experience huge return on the back-end. I am always amazed how many
medical staffing agencies don’t understand this concept and are still using
traditional shoot-gun approaches to finding candidates. It isn’t how many
applicants you interview or talk to, but the quality of those applicants.

In the medical staffing industry using traditional recruiting methods to find
qualified employees can cost between $3,000 to $5,000 or higher in certain
circumstances. Now, calculate this number by 100 and you can quickly begin to
see the value of positive “viral talk” and how this can ruin a company instantly.

Examples of success in “Viral Talk”

I remember trying to explain this to a client of mine and they initially did not
understanding this concept. I instructed them on the value of initiating a “viral
talk” medium by periodically providing incentive to employees, bonuses, raises,
insurance benefits and real stuff that mattered to employees.

I wanted to decrease the turn-over rate and increased the positive viral talk. The
client believed that this would ruin him because according to his calculations was
cost prohibited. I explained to him that it is cost prohibited not to do it and
capturing positive “viral talk” will ensure a profitable future.

Eventually the client agreed and we began the process of capturing positive “viral
talk” as well as providing benefits to employees. Several things occurred with this
plan in place. Employees began to stay longer, he began to receive more calls
from clients that were happy with his employees, he bagan to hire more employees
as well as new grads.

 He was able to pay the new grads a lower wage, but yet provide other key benefits
that made the new grads stay. Two years latter the company stopped advertising
and solely relied on viral talk.

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We have focused some general attention on finding candidates and the many
avenues you can take in order to find the best qualified candidates. Eventually you
will have to set up a system in place that continually interviews and hires
employees once your company begins to grow. Now that you have more
information on finding employees for your medical staffing agency, it’s time to
learn how to find clients to staff your employees.




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Chapter 6

Finding Clients

The ability to find and keep clients is the stuff that will make or break your
medical staffing agency. You can have qualified employees ready and willing to
be placed, yet without clients to place those employees you will be “dead in the
water”.

The simple stuff

Let’s start by addressing the need for exposure and how the exposure can best be
used effectively with the quickest response time. I have found that many hospital’s
and medical facilities will often ignore advertising geard towards providing
medical staffing in times of feast, yet will scramble in desperation grabing the first
medical staffing agency that presents itself. Why does this occur? Mainly because
if they don’t need you, they don’t have time for you. This may sound cruel and
unpleasant to hear but truth be said, “out of site, out of mind”. How then does a
medical staffing company overcome “out of site, out of mind” syndrome found in
medical facilities.

First, Begin by writing an effective ad campaign geard towards your area of target
and within your specified niche. The ad need not be expensive, keep your costs
down by writing the add yourself.

Make the ad simple and to the point. Tell them who you are, what services you
can offer and provide a nice picture. Include your telephone number on the front
cover along with your business name and fax number as well as a website or email.

You want to keep your direct add campaign as simple as possible. Most
supervisors or directors are aware what a medical staffing agency is and at this
point you simply want to begin your marketing campaign with simple ad
campaigns. A simple nudge or what I call the soft side of marketing is all you
need in this first step. This particular add can be sent in a 5x7 card on a monthly
basis. You will eventually get to know your potential clients by name and can
begin addressing the cards specifically to the supervisors or directors.



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Farming your area

Using the above method will ensure the “out of site out of mind” scenario does not
happen to you.

So the first part of your campaign has begun, but you are only beginning.
Remember you are sending the post cards to as many facilities you can find or buy
that you plan on targeting within your geographical area.

Remember, that the majority of medical facilities are mainly interested in two
things. Can you supply me a body? And , how much does it costs? I will say that
50% of your potential clients are thinking along these lines. Another 40% have
loyalties and are happy with there current medical staffing company they use, but
remember things are dynamic in this field and can change. Don’t take them off
your mailing list.

Then you have 5% that hate to be bothered and will only see you by appointment
and will never use registries. You can never change who they are and the best
thing to do with these facilities is to simply send the postcards.

Then you have another 5% that will never use your staffing services because the
current medical staffing company is a friend or relative or perhaps are involved in
illegal activities receiving Laker tickets or something like that. This is another fact
and is something that you will just have to deal with. Your main focus should be
on the 95%. Besides, we will show you how to spend 20% of your time to get
80% of the business in this chapter.

The easiest method to get clients

The easiest and least expensive method that I have learned in my experience to
secure clients is to simply walk in and ask to talk to the director or supervisor. It
amazes me how many start-up medical staffing agencies spend so much money on
marketing and fail to farm the territory they are targeting. The term farming comes
from a real estate term meaning to drive by and visit the facilities you plan on
doing business in.

The area you plan on marketing and providing medical staffing services for is your
farming territory. I have closed more accounts as a salesperson simply by walking
in cold to a facility and asking to speak to the director.
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Always look sharp and professional when visiting a new facility. When asked who
is asking for Mr. Director, say you are Mr. (your last name). Many people assume
you are important and simply direct you to the office. Once in the office they are
so surprised that you managed to get in they actually will take the time to listen.

I closed more deals using this method saving thousands of dollars in marketing
expense to the company I represented at the time. I got so good at it that I stopped
cold calling facilities and simply relied on visits to get new contracts.

Other methods that work.

If you have deeper pockets and money is no object for you, then the following
methods can resolve further the problem of “out of site out of mind” problem I
have found to be true in the medical staffing industry.

Remember, nothing replaces actually physical contact with a customer in the
beginning.

   • Marketing Brochure: If you are a start-up medical staffing company this
     may be too expensive at this point. If you are a more experienced company
     wishing to capture a larger stake in the field, creating marketing brochure
     will generally produce a more professional bonding image.
   • Website: Creating a website today is relatively inexpensive. Anyone
     starting a business should have a web-presence. Make sure you have in your
     website a way for candidates to sign in and for clients to reach you.
   • Newspaper: I place this here only to acknowledge this method should
     mainly be used as a means to capture candidates. From my experience it
     rarely is effective in finding new clients.
   • Specific publication. The medical staffing industry has many industry
     specific publications both offline and online. Your industry specific
     advertising must assure a supervisor or director readership to maximize your
     advertising dollars.
   • Telephone: You need to use the telephone to call existing clients, but for
     new clients I have found that you will be lucky if you get 30% of call backs.
     You have to be persistent without annoying your perspective clients. I used
     the 5:1 rule, if after five attempts to contact a potential client fails, I make a
     walk in visit.

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   • Viral Marketing: You can begin to have facilities talking about you in the
     hopes that they will call you. Remember we spoke about sending a 3x5 card
     on a monthly basis to facilities. Using this method along with a quarterly
     newsletter will place you in the minds of the movers and shakers.

Insider secrets for finding clients

What I am about to reveal to you is worth its weight in gold. This trade secret is
closely guarded by many medical staffing agencies and I am about to reveal it to
you. This method alone will save you time and money for finding clients.

This is what you do!

         • Go online and look at all the job banks related to your niche
         • Look at newspapers and publications related to your area of target.
         • Once you have all these materials begin sourcing for job openings
           related to the area of staffing you are targeting.
         • Begin calling or visiting the facilities looking for medical staffing
           within your staffing niche.
               o Why? Because, these are qualified, viable, tested potential
                  clients in need of candidates and have been unable to fill the
                  position. You must be quick and to the point. They need
                  staffing and you can provide staffing.

Remember earlier in this book I spoke about how I will show you to use 20% of
your effort to capture 80% of your clients. The essence is captured within this
chapter with an emphasis on the insider secrets for finding clients. Finding job
wanted ads posted both online and offline will be your biggest targeted free listings
you have access to. Companies are paying big money to advertise jobs that need to
be filled. Contacting these facilities providing temporary help is an option that
many facilities will undertake.

You can take it a step further and visit the facilities posting job wanted ads. Make
sure you call the Human Resources department and inquire if the job is still
available. This information is available freely to anyone who calls.

Visiting the facility certainly is preferable and visiting a facility after leaving a
message is much more preferable. Try to get an appointment by phone if possible,
if this fails then use the method above describing how to simply walk in to a
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facility and asking to speak to the director or supervisor in charge. Make sure to
gauge the responsiveness of your target market. As described earlier the
percentages of distribution are in your favor in reference of who will or will not
talk to you.

Make a concerted effort to ritually read and view the help wanted ads because they
can change weekly and often daily. Place these facilities in your mailing database
and begin a marketing campaign targeting these facilities.

My success in securing new clients came once I learned to use the above secret and
use the facilities as my farming agent. The facilities became my resource and
visiting these facilities increased my success rate.

The blueprint of success using the above method can be realized in a short period
of time. Using 20% of your effort to produce 80% of your results in the medical
staffing industry can quickly place you in direct competition with the larger
medical staffing agencies.

Strong indications have proven that most sales and marketing efforts are still using
80% of effort to capture 20% of results. Experts agree that the success of any
person or company is enhanced when they harness and focus the actions that are
actually producing results. Learning what is “Value Added” and performing
actions that are tied together, results in 80% results using 20% of effort.

Take each step described in this chapter to expand your business and knowledge.
Develop a positive reputation among your existing and new clients. Use a viable
knowledge base center to continually educate yourself and keep updated on
changes to the medical staffing industry. Use 20% of your effort to produce 80%
of your results and in no time you will have success.

Take each step written in this chapter and use the many years experience from
experts in the field to start your medical staffing agency. The Medical staffing
industry has many exciting and rewarding opportunities that make owning and
starting one fulfilling.




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