E883 | What To Do With A Difficult Staff Clinician

What To Do With a Frustrating Employee In Your Clinic

Every clinic owner eventually runs into the same problem.

You hire someone who is great with patients. People like them. Outcomes are solid. But behind the scenes they are late on notes, ignore systems, and create friction for the rest of the team.

They are not “bad enough” to fire. They are not good enough to feel fully trusted. They just live in this frustrating middle.

In this episode, Danny lays out how to handle that situation without tanking your culture or burning yourself out.

1. The High-Output, Low-Systems Clinician

Danny starts with a pattern he has seen in every people-heavy business.

You tend to hire people like you. Friendly. Good with patients. Comfortable in front of people. The downside is they may share some of your weaknesses too, especially if you are not naturally systems focused.

So you end up with a clinician who:

• Connects well with patients

• Gets good outcomes

• Is loose with notes, late to meetings, and lazy with internal tools

They lean into what feels rewarding (patient interaction) and avoid what feels boring (EMR, project management, CRM, Slack, email).

You get the results you want on the front end and a quiet mess on the back end.

2. Before You Blame Them, Look in the Mirror

The first step is not to come down on the employee. It is to be honest about how you trained and supported them.

Danny asks a few simple questions.

• Did you actually train them on your EMR and internal tools or just hand them a login?

• Did you explain why updating the CRM or project board matters for data, meetings, and decisions?

• Did you give them examples of what “done right” looks like?

Most owners are busy. They rush onboarding. They assume smart people will figure it out. Then they get frustrated when those same people never build good habits.

If you never set the standard, you cannot be surprised they are not meeting it.

3. Your Real Options: Tolerate, Terminate, or Coach

Once you have owned your side, you basically have three options.

Option 1: Let it slide
You tell yourself they are “not that bad” and try to live with it.

Short term, this feels easier. Long term, it destroys you. Your A-players see that someone gets to ignore systems and still draw a paycheck. Support staff quietly resent picking up slack. The new unspoken standard becomes “we talk about culture, but we don’t enforce it.”

Option 2: Fire them
You decide they are not a fit and let them go.

There are times when this is absolutely the right choice, especially if you have already done the work of training and supporting them. But firing should not be your first move if you have never given them a clear path to improve.

Option 3: Run a performance improvement plan
You sit down, spell out exactly what needs to change, and agree on a timeline to fix it.

This is where most owners need to live.

4. How a Performance Improvement Plan Actually Works

A performance improvement plan (PIP) is not a corporate buzzword. It is just a structured agreement.

In Danny’s world it usually looks like this:

• You define the specific problems. Not “you’re sloppy,” but “notes are not completed within 24 hours,” “CRM is not updated after visits,” “Slack messages go unanswered for more than 24 hours.”

• You explain why each behavior matters. This is how we track marketing. This is how admin prepares meetings. This is how we monitor outcomes.

• You review your systems and remove anything that is redundant or does not need to be done by the clinician. If it does not truly matter, cut it.

• You set expectations for the next 4–6 weeks. What exactly needs to happen and by when.

• You schedule weekly check ins. You review metrics, coach them on better workflows, and answer questions.

• You make the standard non-negotiable. If they are still not meeting it by the end of the plan, they cannot stay in the role.

It is support plus accountability. You are not guessing. You are not venting. You are giving them a real chance to win with you.

5. The Two Ways This Usually Ends

Once you run a real PIP, people show you who they are.

Half the time, they turn the corner. With structure and coaching, they figure out the systems, get faster, and stop being a source of friction. You keep a clinician who is now strong with both people and process.

The other half, they resist. They drag their feet, make excuses, and do just enough to look busy. By the end of the plan they usually realize this is not a place where they can operate on their own terms and they resign.

Either outcome is better than quietly tolerating mediocrity for years.

You either upgrade a team member or free up the seat for someone who will meet the standard.

6. Your A-Players Are Watching

This is where leadership comes in.

Your best people are always paying attention to how you handle the hardest situations. When they see you dodge conversations, lower the bar, or look the other way, they start asking themselves if this is really where they want to build their career.

When they see you:

• Set clear standards

• Have direct but respectful conversations

• Invest time in coaching

• Follow through on what you say

their respect and buy-in go up. They know the culture is real and not just something printed on a wall.

That is how you keep A-players long term.

7. The Hard Work That Actually Scales a Clinic

Danny makes it clear that this is where many clinic owners either level up or stall out.

Scaling is not just more marketing and more patients. It is learning to lead people. To hold standards. To do the uncomfortable things now so you don’t pay for them later with turnover, resentment, and burnout.

It takes time and energy you feel like you do not have, but it is the work that makes everything else easier later.

What To Do Next as a Clinic Owner

If this episode hit close to home, here are a few simple next steps.

1. Audit your onboarding.
Write down everything you expect a clinician to do in your clinic. Then ask if you have actually trained them on each one and explained why it matters.

2. Pick one person and build a simple PIP.
Get specific about what needs to change, give them a clear runway, and meet weekly to support them.

3. Decide what you will no longer tolerate.
Make a short list of non-negotiables in your clinic. Be honest with yourself about where you have been letting things slide.

4. Buy back time from documentation.
If you are drowning in notes, you do not have the bandwidth for real leadership. Let Claire handle your documentation so you can be present with patients and have the mental space to lead your team.

👉 Talk through your people and growth strategy with a PT Biz advisor:
https://vip.physicaltherapybiz.com/discovery-call 

👉 Get your documentation time back with a free 7-day trial of Claire:
https://meetclaire.ai 

👉 Still working part time and trying to go full time with your own practice?
Join the free PT Biz Part Time to Full Time 5-Day Challenge here:
https://physicaltherapybiz.com/challenge

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Ready to elevate your practice? Book a call at the link below with one of our expert consultants today and start your journey to delivering unparalleled physical therapy.

Podcast Transcript

Danny: 

[00:00:00] Hey, what's going on, doc Danny here with the PT Entrepreneur podcast, and today we're talking about, about [00:00:05] what do you do with a frustrating employee? [00:00:10] This happens in any business, any business I've ever been involved in. It [00:00:15] doesn't really matter. The same sort of it, it pattern tends to occur. So [00:00:20] when we hire people.

Uh, we, we oftentimes, you know, [00:00:25] hire people that are similar to us, um, whether we know that or not. Like we hire people that [00:00:30] we, that we typically like, we think it'd be a good culture fit and that can be great, you know, but sometimes if you're [00:00:35] like me, uh, you're maybe more. Uh, you, you're, you're not the best [00:00:40] follower of systems.

You're not the best follower of rules. Uh, and that can be the case in pretty much [00:00:45] any business that you're gonna hire people that are very talented with people, uh, forward facing, but maybe they aren't doing the [00:00:50] best job when it comes to the, the systems in the business that need to be followed in order to be run.

This is [00:00:55] a very common scenario where we see. Clinicians, for instance, that are [00:01:00] great with their patients, they're great with interactions. They get great outcomes, [00:01:05] but they're not doing their notes, they're not, uh, putting in the right [00:01:10] information needed that the business is tracking. Maybe they're a little late to meetings, maybe they're, [00:01:15] uh, you know, they show up a little late here and there.

Um, maybe they're slow to respond to, [00:01:20] you know, communication, uh, email or slack message or whatever it might be. Uh, so. [00:01:25] They're fantastic with forward facing people, you know, interaction skills, [00:01:30] outcomes potentially as as a clinician, but they're not necessarily following. [00:01:35] The system that the business needs to be followed.

So what do you do here? Because you have this person who, [00:01:40] by all accounts, let's say they're, um, they're not a liability to the business, right? They're [00:01:45] not, they're not necessarily crippling your business. 'cause they're, they're, they're doing everything wrong and [00:01:50] they're, they're, um, they're not getting good outcomes.

They're not showing up on time. They're, they're completely not following any, [00:01:55] any, uh, systems. But they're not necessarily doing the things you're supposed to. So you have, you have three [00:02:00] options, and I see this a lot. So here's the options. Number one, you can just let [00:02:05] it go. This is just the way this person is.

And you just, you can, you can essentially just say, [00:02:10] um, that you accept the fact that they are this way. They're just this way. [00:02:15] I, they're, they're not terrible. They're okay at these things. They're not okay at these things. [00:02:20] So I'm busy. I'm just gonna let it go. That's option number one. Number [00:02:25] two, you can fire them.

You can let them go. You're not following these processes and procedures. [00:02:30] Uh, it's creating problems for other people in the business. We we're gonna have to let you go. Okay? That's number two. Number [00:02:35] three is you can create a performance improvement plan where you actually sit down with them and you detail out [00:02:40] what it is that, uh, they need to improve, and then you track that.

Um, so I'll, I'll talk [00:02:45] about these and pros and cons of these, but for most people, here's what [00:02:50] happens. You have to look at your business. And [00:02:55] honestly be, be serious, serious, and very truthful with yourself about whether you have trained this person [00:03:00] effectively and supported this person effectively.

Because if you're busy in [00:03:05] particular and you're bringing somebody on the onboard process, it's easy to just not, not [00:03:10] do a thorough, onboard process with your team. You know, you're like, okay, cool, you got this right? Yeah. I, [00:03:15] I got this. And they don't really know if they're doing the right or wrong things.

They're just doing the [00:03:20] things. They're probably leaning more into the things that, that they feel comfortable with that are getting them the direct [00:03:25] outcomes that they're, uh, that they're trying to get, that they're either a incentivized to do or that [00:03:30] the job, you know, primarily dictates. So as a clinician, that would be, are people getting better?

[00:03:35] Right. Are are patients seeing. The benefit of working with you? Are they feeling better? Are they getting back to the activities they [00:03:40] like? That's huge, right? So that's obviously number one. But maybe you didn't [00:03:45] teach them how to use the EMR very well. Maybe you didn't teach them how to use your project [00:03:50] management software very well.

Maybe they don't understand how to use your communication tools. You know, maybe they do a bad job of, [00:03:55] uh, triaging email and they don't have a very good system for that. So these are all things that you [00:04:00] assume that they. Have figured out on their own probably. Or maybe they watch some screen share videos that you [00:04:05] put together, but you didn't really train them on it.

Right. That's usually what we see happens. So in these [00:04:10] options, here's what you have, you can let them go, which is probably not the best option. It's hard to, [00:04:15] to hire somebody and train somebody, and, um. And if you have done these things with them, [00:04:20] you've trained them on this, you repeatedly have sat down and gone through things and they know, and, and you've [00:04:25] actually like, you know, created some structure around them improving these things and tracked it, and they're still not doing [00:04:30] it, you probably need to let 'em go.

Um, because here's what happens if you don't, the, [00:04:35] the, the second option is that you let them stay. And you just accept the flaws that they have. You [00:04:40] accept that they're going to just do what they wanna do in the business and not necessarily [00:04:45] follow your processes. So what's that gonna do? Well, that is going to set a bad [00:04:50] standard for everybody else.

So if you have people that are a players that are getting great outcomes, they're following all the [00:04:55] systems, um, they're gonna look at this as. Uh, okay, well this, now [00:05:00] the standard is mediocrity, so I can just be mediocre. The other thing is you may have support staff, [00:05:05] administrative staff that now has to do more in order to support this person than they should.

[00:05:10] So they have to do more work because somebody else is unwilling to do it themself. This is a terrible [00:05:15] standard. It's a bad precedence for people to follow, and it makes you look like a, uh, [00:05:20] a, a very weak leader. Someone who just accepts what these people are, are going to do, and maybe [00:05:25] you're checked out.

Right. And they, they view that as, uh, maybe this isn't the place that they wanna be long [00:05:30] term. And the challenge of that is that a players will not accept that, and then a players [00:05:35] will look to move on to something else because they need, uh, good leadership. They need [00:05:40] consistency. Uh, a players man are, you know, they are great for your [00:05:45] business, but they also require more leadership and they require a higher standard from you as well.

[00:05:50] So keep in mind that the things that you let go other people see that. [00:05:55] And they're, you know, they'll have their own opinions on, on that, and you as a business owner and a leader, and whether they [00:06:00] feel like it's the right place for them to be and where they can grow in their own role. Um, the [00:06:05] last phase or last option would be a performance improvement plan.

And this [00:06:10] is the go-to for most people that we, you know, work with on this. And this is the go-to in the [00:06:15] businesses that, that I, um, own and, and am a part of as well, where what we [00:06:20] want to do is establish okay. Here's the problem. We [00:06:25] have not done a good enough job of, you know, educating you, uh, on [00:06:30] how to do these things that you're not doing, and maybe also why they're really important.

So [00:06:35] why is it important for you to, you know, um. Whatever, [00:06:40] update this project management tool or this, this, um, you know, [00:06:45] CRM or something like that after a visit. Well, it's important because we track this data. [00:06:50] This data helps our administrative staff pull everything together for a. [00:06:55] Our meetings. This allows us to better track our advertising.

This allows us to better [00:07:00] track our outcomes so we know what we need to improve or not improve. Where people are coming [00:07:05] from all this stuff that maybe is a part of what they're doing and they're just not, because they don't see the value in it, they don't know why. They [00:07:10] just think it's extra time. Or maybe the question should be, should this [00:07:15] person even be doing it?

You have to take a hard look at your systems. Is this redundant? Is this something necessary [00:07:20] for the provider to do? And the answer is no. Well. All. All right, cool. [00:07:25] We realize that this isn't even something you should do, then we're going to remove that. That's one less thing. Uh, [00:07:30] but we need to do X, Y, and Z and here's why.

We're gonna work with you. We're gonna meet with you [00:07:35] once a week over the next six weeks to make sure that we're effectively tracking these things. That [00:07:40] we're training you on these, that you have any questions, we're gonna go ahead and make sure we answer those. And over this next six [00:07:45] weeks, we expect to see this progress.

And this is a non-negotiable if you are not writing, [00:07:50] completing your notes at this point in time, if you're not doing these things, then we're gonna have to [00:07:55] part ways because this is something that has to be done in our business. This is a standard that we [00:08:00] have, and you must do it if you wanna work here.

It's that simple. Then we go through the [00:08:05] performance improvement plan. Now here's what you're gonna see. One of two things. Usually. Number [00:08:10] one, that person is going to now have the support that they need. They're gonna [00:08:15] understand why they're going to improve what they're doing with consistency. You're [00:08:20] checking in with them.

They're getting the training they need. They're getting the questions answered that they need. They're understanding it. They're starting to [00:08:25] build better workflows. You're helping them become more efficient with the things they need to do. It's great, [00:08:30] and they, they do fantastic and you never have a problem with that Again, that's option one.

I would [00:08:35] say 50% of the time that happens. The other 50% of the time you're checking in with them. [00:08:40] They are not interested in changing anything. They're not changing it. They're making [00:08:45] excuses. They're like, they're unwilling to change. [00:08:50] Usually by the end of that six weeks they've decided to resign. They, they've just [00:08:55] quit, uh, because they've realized this is not a place where they can [00:09:00] just get away with whatever they want.

And somehow we missed this in the hiring process. I've had this [00:09:05] happen, the same exact situation where people have either turned the corner or people have [00:09:10] just decided this isn't the right spot for them in multiple businesses, and it's a 50 50 in my [00:09:15] experience. Maybe it's not gonna be the case for you, but what you see, you see what somebody [00:09:20] really is like when you start to create a performance improvement plan.

Some people call this [00:09:25] coaching people out. Which is a, a pretty, I don't know, uh, [00:09:30] it's a pretty direct way of looking at it. Like, but that's kinda what's happening. We're either gonna coach you to what needs to happen [00:09:35] or you're gonna get frustrated and you're gonna leave. Uh, which for the business has a lot of pros actually.

So like, if they leave, it's [00:09:40] better for you than you firing them in many states. Um, so, you know, like you holding a standard [00:09:45] though, you're gonna have people that are gonna commit to that. They're gonna, they're gonna follow the actual process that you [00:09:50] have, and then you're gonna be better off for it.

You're gonna also show your team that you have a standard. And everybody [00:09:55] else is doing it. That is a standard. You're trying to bring everybody up to it. They're gonna have a lot more respect for you when it comes to that. [00:10:00] And you're either gonna have somebody who's gonna turn around and be a great, a great staff member from there on out, or [00:10:05] you're gonna have somebody that's gonna realize this isn't the place for you.

This isn't the place where you can just do whatever you want. [00:10:10] And they're gonna, they're gonna end believing. So this is a very common scenario. Leadership is a tough [00:10:15] thing. You know, this is one thing that I think is the [00:10:20] biggest. Determining factor of whether somebody's really gonna scale their business or not, [00:10:25] especially in clinics because it's so people heavy.

So you [00:10:30] being able to, uh, be an effective leader, being able to. [00:10:35] Work with people in this capacity. Being able to hold a standard, being able to, to, to communicate at a high [00:10:40] level with people that have different communication styles and growing this group of people that [00:10:45] maybe all have different views on what they want, uh, how they want to be [00:10:50] led, how they like to work, and being able to pull those people together to follow a common [00:10:55] system and develop a tight culture.

That is a very hard thing to do. And a lot of it has to do with how you [00:11:00] work with these folks because one of the things that, uh, you know, we. We [00:11:05] neglect is we let a lot of this stuff just go, go. Like, we're just like, oh, okay. I'm busy. They're [00:11:10] not doing that bad of a job. And that's a kiss to death to your business.

It really is. [00:11:15] You cannot look at it that way. You have to be the person that is driving it. I. [00:11:20] It's holding a standard and then once you get to a certain size, maybe this is where you hand that off to [00:11:25] a clinic director or a COO or something like that, and you can, you can work on some of the other strategic things you need to, [00:11:30] to really grow past where you're at.

But for a lot of people, this is where they're gonna make or break their clinic. Having these tough [00:11:35] conversations, following through on some of these difficult things, taking the extra time, even though I know you're time [00:11:40] poor, to make sure your staff understands what there's, what they need to be doing.

And then actually. Like [00:11:45] training them up, you know, educating them, making sure that they know. 'cause they may not, they may not know why it's important or how to do it [00:11:50] correctly, and they may just not care. You're gonna find out whenever you actually take [00:11:55] them through a structured plan of who they really are and who you hired.

Better to know that than let 'em just hang [00:12:00] around and ruin your [00:12:05] culture.