Staffing efficiency can be an elusive goal for practices

A column about keeping your practice in good health

By Mike Norbutcovered practice management issues during 2002-06. Posted Oct. 25, 2004.

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There are three common scenarios that can define a physician office environment.

The first is a frantic, stressed workplace where tasks are piling up and staff members are sinking in work.

The second is the opposite: a monotonous, slow-moving office with not enough work to keep everyone busy. One staff member might not be able to handle his or her tasks, while another staff worker kills time by surfing the Internet.

The third scenario is the ever-elusive nirvana most physicians seek, where staff members keep up with their work, allowing the doctors to be productive and the revenue to flow.

But "rightsizing" your office staff, as consultants call it, is far more difficult than simply adding or subtracting people.

"Physicians are well in tune with the clinical side, but it's difficult to put a face to the administrative side," said Ginny Martin of Jasin Martin & Associates, a health care consulting firm in Perrysburg, Ohio.

"The best indicator [of a problem] is no money. When doctors say they're working their fannies off and there's no money, there's a problem."

There are other symptoms as well.

An understaffed practice, for example, could have high stress levels and low patient satisfaction. Maybe a phone rings longer than it should on a regular basis, or perhaps your accounts receivables are piling up.

"Things that aren't fires at that moment don't get done," said Merikay Tillman, director of client services and professional development for HealthCare Consulting, an NCRIC Group company based in Greensboro, N.C.

Setting a hiring ratio

It's difficult to know how many staff members to hire, especially if your practice is brand new or is growing rapidly.

For example, Betti Reese, MD, a family physician in Greensboro, N.C., recently purchased a practice with another family physician, Tanya Martin, MD. They planned to start with three employees when they opened in October, including a certified medical assistant, receptionist and swing person who will handle both billing and receptionist duties.

"We're cross-training them," Dr. Reese said. "We want one person to be able to do more than one job. The goal is to grow to five people: two full-time receptionists, two nurses, and a full-time billing person."

Consultants encourage physicians just opening their practice to start slowly and use certain benchmarks to determine when to add staff.

Bill Bristow, a partner with DoctorsManagement in Knoxville, Tenn., said for primary care practices, his firm usually suggests a ratio of 1.1 employees for every $100,000 in revenue per physician. Two physicians who generate different amounts of revenue don't need the same number of staff members either, he said.

The easy solution in what appears to be understaffed situations is to add more staff, but that might not always be the answer, consultants said.

Sometimes tasks are not assigned correctly, which can affect efficiency, Tillman said. Matching positions to staff members' talents, and looking in-house for replacements when jobs within the office become available, can help improve employee morale, she said.

Good salaries, of course, can help keep an office running smoothly, and they can help save money in the long run, as productive employees might negate the need for more help and another salary. The key, Bristow said, is to have a staffing level that slightly exceeds physician capacity and productivity, so the doctor doesn't have to waste time waiting on office employees during the day.

Too many employees, though, can add unnecessary overhead expenses to a practice, especially if it continues for an extended period of time.

New practices, however, might be quick to think they have too many employees, only to see their workloads increase rapidly.

Monica Nania, MD, a pediatrician in Spring Hill, Tenn., recently opened a fifth office for Tennessee Pediatrics, a group based in nearby Brentwood. The group hired several people to staff the new practice, but when a couple of people didn't work out and the patient flow still was slow, the group didn't move to fill the positions right away, Dr. Nania said.

"It was frustrating at first, because people wanted to be busy," Dr. Nania said. "When we cut back, we started getting busy. With a new practice, it's hard to know what to expect."

With an established practice, the symptoms of an overstaffed office are easier to spot: low income, idle time for some employees and uneven work divisions.

Rather than pulling out the ax, however, physicians should concentrate on the other side of the equation, consultants said.

"We would get them to drive revenues up rather than cut staff," Bristow said. "As a rule, we recommend practices pay above-average wages and expect above-average performance. If you have good people, you'll see that bump in revenue."

Mike Norbut covered practice management issues during 2002-06.

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