We recently worked with a smart, energetic practice administrator who was very motivated to improve his practice’s bottom line. He’d already found significant savings by switching billing and phone services (even getting better billing results, to boot). Spurred on by those successes, he’d turned his attention to clinic staffing.

While the physicians in his practice mostly used conventional medical assistants (MA) for support, a few of the doctors and non-physician providers (NPPs) had opted to use “scribe assistants.” These hybrid staff help clinicians by both scribing during the visit and handling typical MA tasks like test orders and scheduling follow-up care. Because of the extra duties, and because they were hired through an agency, their hourly cost was a bit higher than for the MAs – a 15-20% differential that caught the administrator’s attention.

The administrator estimated the hourly cost of hiring a new MA would be about $20, including taxes and benefits. The scribe assistants, meanwhile, cost the practice about $24 per hour. The scribes did some tasks the MAs weren’t trained or expected to do – notably, scribing. But the administrator believed that at least one of the NPPs who was currently using a scribe assistant could do just fine with an MA (she was a recent grad and tech enthusiast).

So the administrator decided to suggest gradually switching some of the contracted scribes with employed MAs – and was surprised that his idea met with resistance. (After all, 18% would be a significant cost savings – yet even some of the partners resisted the idea!) As the administrator repeated his idea at a few monthly meetings in a row, the resistance grew into a testier conflict.

Was the conflict a sign the administrator was wrong to bring up the idea of saving money on clinical staff?

We wouldn’t say “wrong” per se – but we might have not have prioritized this particular cost-saving avenue.

It’s natural for clinicians to be wary of any changes to clinic staffing. Clinical support staff is essential to physicians’ productivity. Anything that disrupts clinic flow can make it harder for physicians to keep up with demand – and can add to their stress.

While cost-saving is a noble goal, it’s not nearly as important as a well-functioning clinic flow – or physician morale.

Physicians and NPPs are, after all, the key to the entire practice business. Minimizing avoidable stress is imperative. It may be even more important than containing costs, since the billable services provided by clinicians enable a viable practice business in the first place.

On the surface, the 18% cost savings sounds impressive. But on an annual basis, a $4/hour savings amounts to about $8,300 saved per full-time employee. That’s not bad – provided everything else stays the same. But what if productivity is impacted – even a little?

Per-visit revenue in the administrator’s practice averaged $100-$140. That means that if the change in support disrupted clinic flow even a little – enough so that a clinician averaged just one or two fewer visits per week – the change would be of no value to the bottom line. It might even cause profit to decrease!

Making changes inside the practice – even positive ones – can be stressful for staff and physicians. “Picking your battles” well is important to earning the long-term confidence of your physicians. Since physician morale is essential to clinic performance, we wouldn’t put a change that could be perceived as a “cutback” to physician support at the top of the to-do list. And we’d be especially wary of a change that might risk decreasing profits – as any change to support staff could.

In our experience, providing more support to clinicians is often a more direct path to profit than cutting staff. Generating and capturing more revenue can immediately boost the bottom line. One way to do it is by making physicians more productive by giving them more and better help. (Of course, this depends on each individual practice situation – but in our experience, understaffing has been more common than overstaffing. And besides making physicians less productive than they might be, understaffing also puts your practice at risk of disruption and strain if any staff member has to be out sick or resigns.)


Interested in more detail and examples related to this topic? It’s a focus of the practice case study in part one of my book, People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice Business.

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