Stop Doing Fifteen-Dollar Work: A Physician's Guide to the First Real Hire

By Mike Woo-Ming, MD, MPH

Look at what you did yesterday. Not the patients — the rest of it.

Somewhere in there you rebooted a printer. You chased a prior auth. You answered an email that four other people could have answered. You reconciled something in a spreadsheet at nine at night, long after you meant to stop, because that's when there was time.

Here's the thing about that. You have a number, whether you've ever worked it out or not. Take what the practice collects, subtract what it costs to run, divide by the hours you actually work. That's roughly what an hour of your time is worth, and for most physicians it's a great deal more than they'd guess. Then you spent forty minutes on a task the market pays fifteen dollars an hour for, and you did it because it was faster to just do it than to explain it to anyone.

I did this for years. And I'll be honest with you — part of me liked it. It felt productive. It felt like being needed.

It was the most expensive habit I had.

Why physicians are unusually bad at this

We're trained into it. Residency rewards the person who stays and handles it. Nobody gets praised for delegating — you get praised for being the one who never drops anything. Then you open a practice and that reflex comes with you, except now the thing you never drop is the vendor invoices.

There's a second reason, and it's less flattering. Handing something off means someone might do it worse. Probably will, at first. If you're a person who got through medical school partly on the strength of not tolerating sloppy work, watching someone else do a mediocre version of your task is genuinely uncomfortable.

But you're not comparing their work to yours. You're comparing their B-plus to what you could have done with that hour instead. That's the actual trade, right?

Find the work before you hire the person

Most first hires fail because the physician hired a warm body and then couldn't articulate the job. Do the diagnosis first.

For two weeks, keep a running log. Every time you do something that isn't seeing a patient or making a decision only you can make, write it down with a rough time. Don't clean it up. Don't be strategic about it. Just capture it.

At the end of two weeks you'll have a list, and it'll annoy you. Sort it into three piles.

Things only you can do, because they require your license or your judgment. Keep them.

Things that repeat on a schedule and follow the same steps every time — scheduling, reminders, refill requests, the weekly deposit, the inbox triage. These are your first hire's job description. You just wrote it without meaning to.

Things nobody should be doing at all. There will be more of these than you expect. Reports you generate that nobody reads. A meeting that exists because it always has. Delete them before you pay someone to inherit them.

That second pile is the job. Write it out with the hours attached and you've basically got a posting — which beats hiring "an assistant" and figuring it out later.

Hire before you feel ready, but hire small

Physicians tend to wait too long, and then hire in a panic at the worst moment.

You don't have to start with a full-time employee and payroll and benefits. Start with ten hours a week of a virtual assistant handling the inbox. Start with a part-time front-desk person two afternoons. Start with a bookkeeper, which is the single highest-return early hire I know of, because the alternative is you doing books badly at eleven at night and then paying an accountant to fix it in April.

One caution, since it bites people: how you classify that person — employee versus contractor — is a real question with real consequences, and it's not decided by what you call them or how you pay them. Ask your accountant before the first check goes out, not after.

Run the arithmetic before you agonize. If someone costs you two thousand a month and gives back forty hours, and those hours let you see even a handful of additional patients or finally build the thing you keep not building, the math is not close. The mistake isn't hiring too early. It's hiring without knowing what the person will do on Tuesday morning.

Write it down, or you'll be doing it again in a month

Here's where most delegation quietly dies. You hand off the task, the person asks four questions, you answer them by doing it yourself, and within six weeks it's back on your desk.

The fix is unglamorous. The first three times you do a task, document it as you go — screenshots, a checklist, a two-minute screen recording, whatever's fastest. Then hand over the document, not the task. You're not teaching a person, you're building an asset the practice keeps when that person eventually leaves. And they will eventually leave.

Then let go of the outcome for a bit. Set the standard, tell them what "done" looks like, and review the first few. Then stop. Still checking every one in month three? You added a step instead of removing one.

What this is actually for

I started my first business as a resident, working nights on something that had nothing to do with the hospital. Years later I built and sold a software company, and I never got an MBA and never wanted one. Almost everything I learned about running things I learned by doing it wrong first, usually while trying to hold onto tasks I had no business holding onto.

The pattern I'd point out to you is this. The physicians who build something durable aren't smarter than the ones who stay stuck. They just get to the point sooner where they stop measuring their worth by how much they personally touch.

You are the only person in your organization who can do the thing you trained a decade to do. Everything else is negotiable. Start with one pile, one person, ten hours a week.

Then go home at a reasonable hour and notice that nothing burned down.

Dr. Mike Woo-Ming is a Mayo Clinic-trained physician, practice owner, and founder of BootstrapMD. He's the author of The Positioned Physician: Earn More, Work Smart, Love Medicine Again. Learn more at michaelwooming.com.

This is general educational information, not legal, medical, tax, or compliance advice.