You’ve talked to your attorney. You’ve talked to whoever handles HR. You’ve talked it through with your Clinical Director, who has been watching the same substandard performance you’ve been watching for months. They all told you the same thing. It’s time to let this person go.
The decision was made weeks ago, and the person is still with you.
Most owners feel like holding on and holding out hope is being kind. I told myself the same thing and I was wrong about it. Waiting doesn’t protect the person. All it does is make it hard later on. The kind part of this is how you do it, which means telling them honestly, treating them with respect, and not dragging it out.
Whether you can let somebody go and how to do it without creating a legal problem are questions for your attorney and your HR advisor. That’s their work and it’s worth paying for. I’m talking about what happens after you’ve made the decision, because in my experience that’s where owners can get stuck.
Before you let someone go, you should make sure you’ve told them what good looks like in their job. Have you trained them, given them honest feedback, and given them a fair chance to fix what wasn’t working? If you haven’t, that’s the work you should probably do first. I’m going to assume you’ve done it and the person still needs to go.
You’re not deciding anymore, you’re avoiding it
When an owner tells me they’re still thinking it over, I’ll ask what they’re waiting to find out. Sometimes there’s an answer, and if there is, they should go get it. Often there’s a long pause, because there isn’t anything. They have the documentation. They have the pattern. The people advising them have all landed in the same place. They aren’t gathering more information. They made the decision and are avoiding the conversation.
So they go get another opinion. They ask a peer. They run it past their spouse again. And their Clinic Director. If you’ve still got a question, ask the person who can answer it. If you don’t, one more opinion isn’t going to make you feel any better about what you have to do.
I understand why they’re putting it off. I’ve put it off. More than once. Early on I had people working for me who weren’t doing the job well, and I left them in the role long after I knew the work wasn’t getting done properly. Usually because I liked them. Sometimes I was giving them yet another chance. And too often because I didn’t want the conversation. I told myself I was being kind. Looking back, I was just putting it off because it was painful and I didn’t want to do it. Eventually things got toxic enough that we had to part ways anyway, and by then it cost more emotionally and culture-wise than it would have cost at the start.
Something else was going on too, and it took me a while to admit it. I kept running the conversation forward in my head and I didn’t like any of the endings. I thought they’d get mad. I thought they’d do even worse work once they knew where they stood. I thought they’d quit and leave me worse off than I already was. None of that got any better while I waited.
If your attorney, HR advisor, and clinical leadership have cleared the termination and you still haven’t done it, you need to stop overthinking this and just do it. The decision is made. Nothing is going to make the conversation any easier.
What if you can’t replace them
This is the objection I hear most often, and it’s a fair one. Plenty of owners aren’t stalling because they’re afraid of the conversation. They’re stalling because of what happens the next morning. I work with owners in small towns where the nearest place to find a therapist is a ninety-minute drive, and owners competing with a hospital system and two travel companies for the same handful of new graduates. For some of them a hire takes six months, sometimes longer. Letting somebody go in a market like that means covering the work yourself for a while, and you already don’t have the hours.
So let’s do the math, because it’s the only thing I know of that settles this. On the one hand you’ve got the stretch where you’re short-handed while you find somebody and get them trained. You know your own market, so put your own number on that. The owners I’ve worked this through with usually land on a couple of months, and some of them longer. On the other hand you’ve got however much more time you keep things exactly as they are, and everything that comes with it: the documentation that doesn’t get done, the patients who don’t rebook, and the people around this person absorbing the difference every day.
In the conversations I’ve had, the math almost always came out on the side of replacing the person. What kept owners from doing it was how the whole thing felt.
There’s one more piece of it, and owners tend to leave it out of the calculation. You’re not choosing between this person and an open position. You’re choosing between this person and the people you already have. You’re risking losing your A-players to hold on to a C-player, and in a market this tight, your A-players are the ones who have more options. If you’ve got a C-player, you either need to coach them up or you need to let them go.
I’ve watched owners hold on to somebody because some help is better than no help. That works for a while. What comes after it is being persistently disappointed in the results, and eventually feeling like maybe this whole thing isn’t for you.
The conversation you might be designing instead
I see this one a lot, and it took me a while to understand what was happening. The owner doesn’t schedule a termination. They schedule a different meeting. They’re going to sit down with the person and ask whether they’re happy here. They’ve seemed frustrated lately. Is this still the right fit? Maybe there’s somewhere they’d be happier.
It sounds like a reasonable conversation. The meeting is supposed to get the person to say they aren’t happy and maybe resign, so hopefully the owner won’t have to say, “Today is your last day with us.”
Ask an owner what they’ll do if the person says they want to stay, and most of the time they’re not sure. They don’t want to think about it.
If you’re going to have that kind of meeting, decide in advance what you will do if they say they want to stay. They say they want to stay and ask what they can do better. Now you have to do the thing you designed the meeting to avoid, except it’s harder than it was before, because the person has been warned and is watching you, and because you just implied the outcome was theirs to choose.
Some owners respond by giving the person another sixty days. That’s the right call if you can name something specific you’re going to do differently in those sixty days, like training they didn’t get, or a standard you haven’t explained well. If you and the person are both going to keep doing exactly what you’ve been doing, you haven’t given them a better chance at anything. You’ve pushed the decision to another day and asked the rest of your team to live with it until then.
There’s another version of this, and it’s the one that looks most reasonable from the inside. Instead of dealing with the problem, the owner negotiates it down. The person goes to three days a week, or gets a schedule the rest of the team doesn’t get, or stops doing the part of the job they handle badly. The trouble is that the person doesn’t change just because the role got smaller. Whatever they were doing on five days, they do on the three, and those three days often turn into the days the people on the schedule dread. Meanwhile the rest of your team is watching somebody get an arrangement, and they start wondering what they could ask for that they’re not getting.
Decide the outcome before you walk in. If the answer is that this position isn’t going to work out, then that’s the meeting you’re having, and they deserve to hear that plainly instead of being led through a conversation where they have to figure out what you’ve already decided.
What the rest of your team is learning while you wait
Waiting doesn’t cost you much on any given day, which is what makes it easy to keep waiting. Still, your indecision is taking a toll.
Your good clinicians know. They’ve probably known longer than you have, because they’re closer to it. They’re dealing with the documentation that doesn’t get done or done well. They’re taking the patient who asks not to be scheduled with that person again, and absorbing the schedule changes. Most of them aren’t going to come tell you about it, because they assume you can see what they see and they’ve decided you’re choosing not to act. Payroll is part of the cost, but it isn’t the largest part. The larger cost is your A-players deciding this is a place where a C-player can coast.
What they learn from that is what your standards are and what you’re willing to tolerate. You can write whatever you want on the wall and put it in the handbook. The version your team believes is the one they watch you enforce.
I’ve had clients put off a difficult conversation with a Front Desk Coordinator for months, and the business was worse for it in ways the owner couldn’t see from where they sat. Calls were handled poorly, patients stopped rebooking without saying why, and clinicians stopped bringing problems forward because nothing happened when they did. When they finally had the hard conversation and let the person go, everything got better. When everything gets better right after somebody leaves, you know you’ve done the right thing for your clinic.
Keep the conversation about the job
Owners tell me the conversation feels difficult because it feels like a judgment about the person, not just their work. That’s what makes it stick in your throat. You like them, or you used to, or you know what’s going on at home, or they were here when the clinic was three people and a tiny room.
So say what the job needs instead. The clinic has to get notes finished and rooms turned over, this position exists to do that, and it isn’t happening.
That puts the conversation on the work instead of on the person. The standard didn’t come from your opinion of them. It came from what the clinic has to do to serve the people you’re meant to serve. Notes have to be finished because the next clinician needs them and because you can’t bill for care you can’t document. Rooms have to be turned over because the next patient is waiting in the lobby. Those requirements applied before this person was hired and will apply after they leave.
It keeps the conversation on the work, even when the person brings up tenure, a bad day, or problems at home. Holding the job for a long time doesn’t change what the position requires. A bad day doesn’t. A health problem or something hard at home might deserve a serious conversation, but it doesn’t change what this position requires. It might change whether this is the right position for them, which is a different conversation and one worth having if it’s true.
If there’s a health problem in the picture, or the person is out on leave, or they’ve asked you for a change because of a disability, talk to your HR advisor or your attorney before you do anything else. Those situations have rules around them, and I recommend you get expert advice rather than trying to figure things out on your own.
Once you’ve said what the clinic needs, what the job requires, and where the work is falling short, the only thing left to discuss is whether the work met the standard. You can do that without judging the person.
Write the sentence down before the meeting
Before the conversation, write down the first sentence you’re going to say. You don’t need a whole script. You need one sentence that tells them what you’ve decided.
Owners who don’t do this tend to open with context, then more context, then a question, and twenty minutes later the person leaves without knowing what happened. I’ve seen someone come back from a meeting like that believing they’d been given another chance. Then the letting-go conversation has to happen again, and the second one is worse for both of you.
It doesn’t have to be perfect. It has to be clear and it has to sound like you. Something along the lines of, “We’ve talked a few times about what this job needs, and it hasn’t changed. I’ve made the decision that today is your last day with us.” If you’re not sure, run the exact words past your attorney or your HR advisor before you use them.
Say the outcome early and keep it short. Have everything your attorney and HR advisor tell you to prepare ready before you sit down. The person will probably have immediate questions about money, insurance, and what they’re going to tell their family.
Then pick the day. Put it on your calendar and tell one person you trust that it’s happening on that day. Everything above is still something to think about until there’s a date on it, and an owner can agree with every word here and be sitting in exactly the same place next month.
And then let it be over. Don’t keep arguing it in your head for a week afterward. You made the decision a while ago, and what’s happened since then is that it’s weighing on you. Let it go.
There’s one thing about afterward that surprises people, so it’s worth knowing it’s coming. What most owners describe feeling is relief. They usually feel bad for the person too, and both of those sit there together, but relief is the louder one. It tells you something about the timing. Relief that strong usually means you were carrying this a lot longer than you needed to.
Before you schedule that meeting, check these
- Have you told this person what good looks like, trained them, given them honest feedback, and given them a fair chance to fix it?
- Is this an ongoing pattern rather than one mistake or one bad week?
- Is there a health problem, a leave, or a request for an accommodation in the picture? If so, call your HR advisor or your attorney before you do anything else.
- Do you know what you’re still waiting to find out, and is there someone who can answer it?
- If you’re worried you can’t replace them, have you run both sides of it, the stretch you’d be short-handed against how long you’d be keeping things the way they are?
- If you’re planning to ask whether they’re happy here, what will you do if they say they want to stay?
- Have you written down the first sentence, the one that tells them what you’ve decided?
- Can you say why the business requires this, in terms of what the clinic has to do for patients, without referring to how you feel about the person?
- Do you have everything prepared, so the meeting can be short and the person can leave with their dignity?
- Is there a date on your calendar, and does one person know about it?
- If the schedule and the mood improve right after this is done, what does that tell you about how long you waited?
I’m a business coach for PT, OT, and SLP clinic owners. I work one-to-one with owners doing \M to \M in revenue and run monthly mastermind groups of four owners using a hot-seat format. If you want help setting the standards your clinic runs on, get in touch.