Recruiting a Chiropractic Assistant, Part I

Editor's note: Part II will appear in the 7-17-95 issue.

Every high-volume chiropractic practice requires a competent staff. Although this column will restrict itself to the chiropractic assistant (CA), the material it contains can also be applied to interviewing all other staff personnel: chiropractic technicians, receptionists, massage therapists, billing clerks, or another chiropractic physicians.

Hiring the wrong person can be both an unpleasant and very costly experience. Kenneth Murkowski, DC, reports a recent survey indicating the average cost of hiring and training an in-office CA is $4,200, with an average time of training of 3.6 months. It is essential that you carefully screen all potential applicants.

Following some preliminary remarks about interviewing, some interview questions will be offered for your consideration. However, in addition to simply listing the questions, each will be accompanied by a brief commentary designed to highlight its potential relevance. Also, be advised that you may assign your own personal interpretation to the answer each question elicits.

To illustrate the importance of questions, here is an amusing anecdote: An elderly woman was hospitalized with a heart condition. As she lay in an oxygen tent, her closest friend, Becky, sat by her bed maintaining a constant vigil. In a feeble voice, the patient repeatedly mumbled, "What is the answer, what is the answer?" After 15 minutes of listening to her sick friend's lament, Becky replied, "What is the question?"

The word "interview," from the French entrevue (entre=between, and voir=see) simply meant that a meeting had occurred. Only later did it come to mean a fact-gathering encounter.

Interviewing has also been mistakenly likened to the matching of wits, a dueling contest. While an interview might graduate into an adversarial exchange, it should be avoided whenever possible. In as much as there seems to be an inverse relationship between excessive emotionality and clear thinking, it behooves both the interviewee and interviewer to stay calm and collected. One writer chose to label the participants of an interview as "corporate actors" programmed to mouth certain words according to some organizational script drafted by a giant computer." Robert Goyer defines an interview as, "A form of communication involving two parties, at least one of whom has a preconceived and serious purpose, and both of whom speak and listen from time to time." This means the two persons are aware of one another and that the actions of each affect the other. Although there are such things as "group" or "panel" interviews (involving more than two people), here we shall focus, exclusively, on the one-on-one setting; that is, the doctor and the chiropractic assistant.

It is especially important to note that each of the aforementioned interview descriptions conspicuously neglects to mention the various nonverbal and paralinguistic ingredients so dramatically evident in any face-to-face encounter. One is reminded of the admonition by psychologist Albert Mehrabian that 55 percent of the impact of any verbal interaction derives from how people look when they say things and 38 percent from how they say things.

Aside from the admonition that no interviewer should ever enter an interviewing session cold (unprepared), and regardless of who is being interviewed, the bottom line will always depend upon the type of questions asked. The adequate preparation of questions is the sine qua non of any interview.

Applicants usually come into an interview with certain preconceived attitudes, values, and beliefs. Hence, your paramount objective should be to formulate specific questions capable of evoking relevant personal and job-related responses. If during the process you get the impression that the applicant did not understand one of your questions, do not say, "Did you understand that?" Instead ask, "Did I make myself clear?" As long as you do not sound condescending, the applicant will feel more comfortable and speak more freely. Given the right rapport, you may well discover certain unacceptable characteristics before you have invested considerable time and money in training.

Common knowledge among recruiters is that some people perform impressively during an interview, but fail to measure up after they have been on the job for a reasonable period of time. This phenomenon can usually be attributed to the fact that during the conventional interview the experience is one-on-one. However, once the CA is hired, she is expected to communicate effectively with several other people, e.g., patients, staff members, and outside professional and business contacts instrumental to a well-run office. This may well account for the disappointment following a very strong interview performance.

Let us now go to the actual interview situation. There are four basic types of questions you could ask an applicant: First, there is the "open-ended" question. Example: "What is your conception of health or wellness?" Such a question permits the greatest amount of freedom by allowing the interviewee to answer in a wide variety of ways. Second, is the "closed-ended" question. Example: "Have you ever operated a sine-wave machine?" Or, "Have you ever worked in a high volume practice before?" Such questions usually limit the interviewee's response to a brief yes, no, or a specific number. Third, is the "forced-choice" question. Example: "Do you prefer working late on Monday or Thursday evenings?" As an either/or question, it forces the interviewee to make a choice. And, finally, the probing or follow-up question. This type of question is used to draw out additional information on something the interviewee has said. Example: "Could you give me an example of exactly what you mean by prophylactic care?" Or, "Tell me a little more about your hospital training."

Before any scheduled interview, you should draw up a list of your personal and professional needs; know exactly what qualities you would like a CA to possess. Job-related needs might include such qualities as: honesty, professional appearance, punctuality, cleanliness, courtesy, reliability, ethics, ability to learn, technical skills, knowledge of chiropractic, intelligence, sensitivity, common sense, stress management, adaptability and, most importantly, being a good communicator.

Now some specific questions: In a variety of different ways, each question should provide you with greater insight into a given applicant. While some questions might not seem directly related to chiropractic, they will facilitate a better understanding of the applicant's psychological disposition and character: a dimension often concealed by the social mask most people wear during the conventional interview.

Question 1: What grade would you give the human race?

The general nature of this question should not be taken as a strictly reliable yardstick to measure an individual's outlook on life. It can provide the interviewer with some additional insight to an applicant's personality and character.

While assigning the grade of "C" or "D" could suggest a somewhat pessimistic view, a grade of "B" (or better) might suggest a more optimistic perspective. Whatever answer the applicant offers to this question, probe a little deeper. Attempt finding out, in more detail, why a particular grade was given. See if the grade rendered is consistent with other attitudinal cues.

Question 2: What kind of person upsets you most?

How a CA responds to this question could also be a helpful predictor of future performance. Assume the answer you are given is, "Someone who is highly opinionated." Such a response could be construed to mean that contact with strong minded patients might result in a communication breakdown.

Another response might be, "Someone who is disorganized." Here, you should be forewarned that the applicant might experience some interpersonal difficulty with anyone on your staff who happens to be a little disorganized. Naturally, how one defines the word "organized" must also be taken into consideration. Nevertheless, it would behoove the interviewer to probe a little deeper into what exactly the CA considers being disorganized.

Question 3: What do you think motivates most employees?

Millions of dollars are spent each year on motivational research. Other than financial gain, inquire what other incentives the applicant considers important; i.e., work satisfaction, promotion, or recognition by patients or co-workers. Knowing what motivates someone before a hiring decision is made should be included in every recruiting strategy.

Question 4: What do you do for relaxation?

Why is a question like this relevant? Because, in an already stress-prone society, health caregivers who are excessively stressed-out themselves tend to detract from the healing process. Because illness, itself is a stressful experience, CAs who have not learned the secret of relaxation incline to transmit that uneasiness to others. Those who know how to relax communicate an invaluable calmness to patients.

Question 5: What role do you think body language plays in health and disease?

The answer you get to this question will denote an applicant's power of observation; that is, their ability to observe how people look and act -- in addition to what they say. The experienced clinician has learned that a patient's nonverbal behavior can often reveal more than their verbal behavior. Not infrequently, a patient's verbal description of how they feel will be at odds with their nonverbal appearance. Therefore, it is essential that an efficient CA be sensitive to body language.

Question 6: How would you describe your sense of humor?

Be wary of any applicant who lacks a sense of humor. A discrete expression of humor in an office setting can have definite healing qualities. In fact, the therapeutic value of humor was dramatically revealed in Anatomy of an Illness, an excellent book by Norman Cousins. Suffering from amyothrophic lateral sclerosis (Lou Gerig's disease), in addition to taking high doses of Vitamin C, Mr. Cousins watched a series of funny films (Marx Bros., etc.). He held the firm conviction that laughter improved the immune system and significantly augmented the healing process. Having said that, he seemed convinced that humor was no laughing matter. Henceforth, be sure to ask applicants what they find humorous, e.g., a joke, a film, a book, or an amusing event.

Question 7: How good a communicator are you?

Since effective communication is the backbone of any successful practice, the answer to this question deserves the highest priority. Carefully analyze the explanation you are given why the person thinks she is a good communicator. Listen attentively for whether the person is other-centered or self-centered. A self-centered person will stress the fact that the messages they send out are clear and concise and should definitely be understood. The other-centered person, conversely, will manifest a greater interest in whether or not she is being understood, i.e., she will make a concerted effort to insure that a meeting of minds has occurred.

You might also ask for a definition of the word, "communication." Take notice of whether the definition extends beyond just words. Does it include nonverbal and vocal cues, listening skill, and a clear comprehension of what is being communicated?

Abne Eisenberg, DC, PhD
Croton-on-Hudson, New York

Editor's Note: As a professor of communications, Dr. Eisenberg is frequently asked to speak at conventions and regional meetings. For further information regarding speaking engagements, you may call (914) 271-4441, or write to Two Wells Avenue, Croton-on-Hudson, NY 10520.