When to add staff members -- and when to hold off

Medical practices are expected to add jobs in the immediate future, according to government surveys. But how do you know if the time is right to hire more staff members? And what are the signs that you should hold off?

"People are not being so quick to jump to hire additional staff, because times have been so tough," said Randy Keasling, human resources director of The Medical Center P.A, a multispecialty clinic in Hutchinson, Kan. "But it's important to ask if staff can handle the workload, or are they maxed out? Is customer service slipping? Should you look at maybe adding additional staff?"

There are several signs that it is time for a practice to add full-time staffers, such as when patients complain about how long they are placed on hold when they call in. When they call, can they get through on the first try? Are physicians complaining that patients are not in an exam room when they are supposed to be because staffers are weighed down with other duties? Have physicians been added to a practice, and do they have the support to do their jobs? Have new service lines increased patient volume?

"When myself and my office manager are a little more overwhelmed and our staff gets more stressed and cannot handle the amount of work, that's when we start looking at our budget and if we can hire," said Angelo Cuzalina, MD, DDS, owner of Tulsa Surgical Arts in Oklahoma, whose practice added three staff positions in the past year. Dr. Cuzalina is president-elect of the American Academy of Cosmetic Surgery. (See correction)

Staffers' opinions should be considered. Many workplaces are accomplishing more with less, but this does have limits. Some employees may be doing as much as they can and may not be able to take on more responsibilities.

"These people are human beings -- adults," said Eric Brodsky, director of billing and operations at the Midwest Center for Women's Healthcare, which has several offices in Chicago's northern suburbs. "They know what they are capable of and what is expected of them. They will let us know that they are overloaded and not able to get things done."

Looking at benchmarking data from organizations such as the Medical Group Management Assn. may offer insight into appropriate staffing levels. Practices with more than one office also can create their own benchmarking data by comparing the workflow of each office.

After deciding that another person needs to be added, experts say the next step is to consider what type of employee will address the practice's needs. Small practices are more likely to need staffers with skills that allow them to work in the front and back offices and perform other duties as needed. Larger practices are more likely to have specialized staffers. With regard to clinical staff needing licensure and bound by scope-of-practice regulations, would a registered nurse be the right person? Or would a certified nurse assistant or medical assistant suffice?

Experts point out that adding employees may not always solve a practice's problems. An employee who is not performing well may slow down other staffers, for example. An office's physical layout also might be the cause of workflow issues.

For example, Yvonne Mart Fox, a practice management consultant in Middleton, Wis., once worked with a primary care practice that was considering adding employees. Patients had problems getting through on the phone and waited a long time in the reception area. Employees seemed to have a hard time getting their work done. Paying attention to how the staff carried out their work revealed that they were spending a significant amount of time running to the back of the office to use the photocopier.

"The staff was walking back and forth and back and forth," Fox said. "Sometimes problems can be a function of the tools and the layout more than the number of people."

The copier was moved. No new staff members were brought in, and the office started running more smoothly.