Many administrators and physicians struggle to find the optimal staffing level.  When patient volume is especially high or an employee has called in sick, it can seem like you’re horribly short-handed.  On the other hand, seeing staff idle can make physicians feel as though they are paying for nothing at all – hardly a comfortable thought when profits are being challenged in multiple fronts.   Evaluating your ongoing staffing needs in a methodical, evidence-based manner can be a challenge, but it’s well worth the time and trouble.

While it’s natural to look to other medical practices to see how you compare, don’t give undue weight to such comparisons.  While staffing levels typically fall between 3-6 FTE staff per clinician, it’s underappreciated that the strongest, most profitable practices often have more staff per provider.  To the extent staff assists the physicians in working efficiently, they increase the revenue potential of the practice.  Every task that a physician does that a staff member could do is a lost opportunity. 

When we visit our medical practice clients, we almost always notice productivity gains that could be made with existing practice staff.  If your practice is like most, you can benefit from looking carefully to see if more tasks can be done by staff generally.  And here’s a great little secret: if you have staff who sometimes feel a little bored or underappreciated, simply asking them how efficiency can be improved can yield immediate results. Even after decades of experience, we’re still surprised by how many excellent ideas can come from even the most junior staff.  But more than that, staff feels more valued, engaged, and committed to the practice when you recognize their knowledge by asking their opinions. Also keep in mind that there may be tasks staff would be motivated to do during brief down periods that are beneficial to your practice. For example, many practices fail to update their websites and social media on a regular basis. This type of work can be a perfect fit for slow times at the front desk if you have a person who has the enthusiasm and skill to take it on. It allows the employee the opportunity to make a special contribution to your success, and also allows you to make more use of the employee’s capacity—to avoid the tendency to regard all downtime as “waste.”

The point here is that your staffing levels should be evaluated based on how you would like your practice to function, not on a knee jerk reaction to seeing the front desk staff temporarily idle during a slow afternoon.

Naturally, your practice must function well during adverse but predictable circumstances, such as staff departures and illnesses.  Ideally, you should have a clear sense of your minimum staff to function a short-term basis.  The simple fact that you must continue to function with absences has one somewhat obvious but underappreciated fact: you must have slack built into your staffing levels because your needs might vary considerably.  If you are in “emergency mode” when you go to hire a new person, you are far more likely to make a mistake in hiring which can lead to very costly consequences in terms of morale, efficiency, and profitability. If you allow your practice to get to a persistent “subsistence level” of staffing, you’ll also find yourself unwilling to deal with personnel problems swiftly, out of fear that you can’t keep your work flowing with even one more open job. When you reach this stage, performance problems that aren’t addressed will only snowball, as employees learn it’s unlikely they’ll face consequences of poor performance. We see this happening in practices all the time.

It’s tempting to take an optimistic approach in considering your future staffing needs, but it’s wiser to “hope for the best and prepare for the worst.”  Consider some of the unexpected operations challenges you’ve faced over the last few years.  How many staff have been sick, fired or quit? How many times has your PMS or other software failed? Have you suffered a loss of your computer network?  Any of these things can well result in a need for the entire staff to work together as a team to address the challenge at hand. Again, during such times you’ll be grateful you showed interest in and appreciation for employees that will step up with extra efforts and ingenuity. And you’ll also be glad to have had the “extra” one or two employees who made it possible to maintain productivity without undue stress to yourself or others on the team.