Optometrists often have to talk to patients about difficult topics. Most of us have had to inform a patient about a visual condition that may result in blindness, change or loss of career, or financial hardship. These conversations are never easy, but as doctors we are confident in what we are telling our patients.

However, as business owners, we have less confidence in breaking bad news and making difficult decisions. Its in our naturewere healers, not hatchet men. Many optometrists are hopeless optimists and assume that, despite a difficult start, things will get better, but often they do not, state the authors of Business Aspects of Optometry.1

Staff problems are typically the most difficult issues that small business owners must address. Even the most seasoned professional will agonize over how to fire a problem staff member. But, sweeping problems under the rug can only lead to resentment, fear and secrecy in your office. Instead, this action can be an opportunity to improve your office and build a better culture and trust. All your employees are watching how you manage a problem employee, and your actions will become the norm for your office.

In this second installment of Review of Optometrys Role Playing series, well explain why its important to act decisively by following these five simple steps.


How NOT to Fire an Employee

Firing is a last resort. To avoid it, follow these steps to keep employees on the right track.

Give praise and suggestions for improvement daily. Recognition for a job well done and constructive criticism must be timely. It does no good to say to an employee, For the last six months you havent been doing your job! Football coaches dont wait until the season is over to provide ideas that may improve performance. Instead, they make immediate recommendations.
Timeliness of praise is just as important. Give praise often and whenever it is deserved.

Enforce all office regulations or eliminate them. If you have an office policy, you must enforce it for all employees. If you always allow one employee to come to work 10 minutes late, this will appear as favoritism to the other employees. If you dont mind that your employees arrive 10 minutes later, then eliminate that office policy. This prevents the seeds of resentment from growing.

Be understanding of personal problems. Be human. Do consider and understand the problems that your employees face at home. All employees feelings must be considered, but dont take on a parental role. Patience and understanding will improve employee commitment.

Focus on long-term employees, too! Dont forget about your long-term employees. Its easy to assume that they need little or no management after a few years have gone by, but this is a mistake. Be sure to check in with those employees on a regular basis.

Make sure that theyre still doing their jobs and that theyre still happy. Replacing skilled, long-term employees is very difficult, so make sure to give them the attention they deserve.

Communicate, communicate, communicate. Optometrists are excellent at communicating with patients. Showing empathy and taking time to explain difficult diagnoses are skills that we use often with patients. Use these same skills in your role as manager. The best leaders spend lots of time communicating with their employees. Strive to effectively communicate with your staff.

Document, document, document. Praise or criticism must be thoroughly documented. If an employee receives a thank you note from an appreciative patient, place that in the employees file and compliment the employee. If a problem arises with the employees performance, take a few minutes at the end of the day to discuss it and document the conversation in the employees file. A few minutes per day spent on staff management and documentation will help improve your overall management skills.

1. No Discussion

When youve reached the point at which termination of an employee is necessary, theres no need for further discussion or debate. Once you decide that termination is the only option, the goal of the final meeting is simply to inform the employee.

Avoid discussion or argument at this point. Termination is a notification of a decision, not an opportunity to discuss previous problems. Its too late for corrective actions, explanations and excuses.

Simply state the decision that youve made and ask the employee to leave. Certainly, dont make up a story to soften the blow to the employee. This can only come back to hurt you in the end (and possibly result in Fair Labor Standard Act violations). If you feel the need to apologize about this dismissal, then perhaps you should reconsider whether termination is necessary. If youre firing the employee for a valid reason, then no apologies are necessary.

But, youre not Donald Trump, so dont actually say Youre fired. But, do keep the message short: Ive come to the conclusion that you can no longer work at the practice. Ive prepared your last check and will give it to you now. You will need to pick up your personal belongings, and please leave immediately.

Clearly, this language seems harsh, but its necessary. Tough decisions require clear directives and execution. Optometrists are often uncomfortable with this type of commanding language, but this clear directive limits dramatic, emotional responses. An emotional, tear-filled scene or a screaming match only prolongs the event. Remember, the discussion stage is over.


2. No Surprises

Make sure that this termination isnt a surprise. By the time youve reached the point of firing an employee, you must have documented a series of problems, notified the employee of these problem areas, and attempted a series of corrective actions, discussions and solution-driven meetings. (See How NOT to Fire an Employee, below.) Rarely, an egregious action might require immediate termination. But, usually, its the last resort.

Make sure that all problems have been properly documented in the employees file. Specifically, take these steps if the problems persist:

Provide a verbal warning and document it in the employees file. Corrective warnings must be specific to the action and behavior that occurred: The way that you spoke to Ms. Lee on the telephone is inappropriate. We always address our patients with respect. Its up to you to know when to escalate verbal warnings to the next level, but when these warnings are ineffective, the next step is necessary.

Provide a written warning and have the employee to sign it. Multiple written warnings can be provided if that is your office policy. Remember, never make an office policy that youre not willing to enforce. If your policy states that an employee can be dismissed after two written warnings, stand by it.

Dismiss the employee and take notes on what happened. If youve made the decision to terminate an employee, continue to clearly document the manner in which the dismissal was made and any statements made by the fired employee.


3. Pick the Right Time

Dismiss the employee at the end of the day and at the end of a pay period, if possible. Ideally, no patients should be in the office at the time. Youll want the terminated employee to leave your office as quickly as possible after the meeting, so timing is important.

End of day. Call the employee into your office at the end of the workday. By firing an employee at the end of the day, the rest of your staff wont have to deal with the stress of the firing while trying to conduct normal business. Everyone in an office is affected by the firing of an employee, so this gives everyone the evening to deal with your decision.

End of pay.
You may choose to terminate an employee at the end of a pay period to simplify the calculation of the final paycheck. Make sure to have the employees final paycheck already prepared. This eliminates the need for the employee to return to the office and potentially cause a disruption. (If you outsource your payroll, be sure to request this final paycheck in advance.) Make sure to pay the employee for any unused vacation time and any bonuses that are owed. Err on the side of generosity to minimize the amount of future contact with the employee. Its worth an extra few dollars to avoid an argument in the future over a minimal amount of money.

On their way. Seat the employee in front of your desk, while you remain standing to inform them of your decision. This body language demonstrates to the employee that you are not going to engage in further discussion. Remember: Your decision to fire this employee has been well thought out and should come as no surprise.


Employees and Unemployment Benefits

Dismissed employees may be eligible for unemployment benefits. Each state has its own set of specific guidelines for unemployment compensation, but proper documentation is the best defense that an optometrist can have for appealing unemployment claims.

If the termination is not clear-cut, state unemployment offices are likely to provide unemployment benefits to the employee. Clearly, its challenging to document warnings and corrective actions for probationary employees, and its even more difficult to follow through on documentation for long-term employees. More than this, providing continuous feedback compels you to give the employee the chance to get on the right track.

If unemployment benefits are granted to a fired employee, its not a drastic problem. Your unemployment tax may increase temporarily. Consider unemployment tax as a cost of doing business, like insurance. If you need to use this insurance to rid your office of a bad employee, it is money well spent.
4. Escort to the Door

Do not leave the employee alone once youve made the dismissal. Prevent the employee from having any access to your computer system, patient records or cash register after the termination. Ask for any office keys to be returned to you at this time. Politely escort the employee from your office to gather his or her personal belongings and then to the front door.

Even though youve asked for the keys, have the door locks changed whenever an employee is terminated. Likewise, change any alarm codes, safe combinations or computer passwords that the terminated employee had access to.

5. Dont Stress Out

Dont make yourself sick with worry and stress. Sure, thats easier said than done. Its human nature to want to avoid confrontation, but sometimes its necessary.

When youve made the decision in your mind to terminate a problem employee, do it quickly and get it over with. Anecdotal experience suggests that there are very few regrets when terminating a problem employee. A bad employee impacts every aspect of your practice. Tossing out a bad apple improves many things, especially employee morale and your happiness.

The loss of an employee will create a temporary sense of anxiety in the office no matter the circumstances. The remaining employees will look to the owner to guide them through this transition period. They may also evaluate their own performance and begin to work harder to compensate for the lost employee.


Firing an employee is never an easy thing to do, but in the end, its usually the best thing to do for your practice. If youve tried everything else, then termination may be the best decision. Do it decisively.

Dr. Bacigalupi was in private practice in Texas for 12 years before joining the faculty of Nova Southeastern University College of Optometry as assistant professor. He has a masters degree in business management and teaches in the practice management track.

Dr. Crandall practiced for 20 years in a large O.D./M.D. practice in Kansas City prior to joining the faculty at Nova Southeastern, where she is an associate professor.

1.Thal LS, Rounds RS, Kamen RD, Classe JG. Business Aspects of Optometry. 2nd ed. Philadelphia: Butterworth-Heinemann; 2004:241-2.

Vol. No: 145:03Issue: 3/14/2008