Dealing with sub-standard employees

This may seem like something rude to say about people who work for you, but at times, one is faced with the bitter fact that the person who is working for you and with you is not altogether competent/energetic/honest/hard-working/diligent or whatever. Now, I run a consulting practice and I have just one employee who sits outside my cabin and - takes calls, gives appointments, takes out print-outs of my prescriptions, coordinates the incoming/outgoing patients, collects my fees and so on. He/she is, effectively, more than one person rolled into one: receptionist, telephone operator, water server, etc. etc. etc.

I should be more accomodating since I am taking the work of four or five people from one person. Right? So why is it that I am saying so many negative things about this soul? Mind you, this is a general rant, and does not refer to any specific person or persons who have, at any time, worked with me or under me.

Well, the sorry fact is that some of the people who have worked with me have really, really been horrid. Either they are plain stupid (in which case, I should be called the bigger fool for having employed them!), but some of the others are wily, lazy, pre-occupied with their own things or simply, so truant that I am paralysed without their presence. On the other hand, even when they are around, they are so incompetent or adverse to improving that they end up giving me grief and stress.

How does one deal with this kind of mess? I cannot well throw them out for I need them too, to carry on with the mechanical work that forms a lot of the work that they do. I also consider the fact that I am not paying them top rupee, since most of them are students who come to work for me in their spare time, and a few are really needy people with families who it would be heartless to throw out of job. Thus, I continue to tolerate them till I can, or till they themselves realise their fault and ask to be released from the job.