Finding the Right Staffing Mix for Your Practice

When medical practices evaluate their staffing, it's important not to look at the number of employees, but rather how you are using those professionals on a daily basis.

That was the message by David N. Gans, senior fellow for industry affairs with the Medical Group Management Association (MGMA), who spoke at the organization's 2014 conference on Wednesday, Oct. 29. Gans' session, "Building the Right Team for Your Practice," noted that in tough financial times, practices tend to cut staff first. But that thinking can further erode the bottom line versus correcting it.

"It's not just about money," Gans said, "The most important thing about staffing is to support provider productivity. … If you are going to optimize practice efficiency and profitability, you need the right staff, with the right training, doing the right things."

Ironically, he said, practices can share the same problems - including poor morale and lower productivity, as well as problematic service - by having either too few or too many staff. So the key, he emphasized, is rightsizing, but also providing the necessary support on a daily basis.

"It's about providing [physicians] with the assistance they need," said Gans. "Doctors are a $150 an hour producer. Medical assistants, for example, are a $16 an hour producer. We don't want to constrain that $150 an hour physician because we don't have enough $16 an hour support staff."

One area he advised practices to look at is static staffing in the face of varying patient loads. Perhaps your practice has more patients on a Monday than on a Thursday when one of your physicians is off, at the hospital, or otherwise out of the office. In this case, flexible scheduling might work.

"It's likely you'll have staff willing to work four 10-hour days," he said. "Think in terms of the concept of getting the right staff in place. It's not just the ratio, but who is there each day to support the physician."

Gans also stressed cross-training employees as, "there's nothing better than staff flexible in their abilities." So if the front desk needs help on one day, a biller can step in. "It's about asking the question in evaluating staff: What do we have our staff doing?"

Practices should ask first, if their quality and patient satisfaction are good, and second, the same regarding their revenue and productivity. If the answer is yes, great. If the answer is no, however, Gans advised asking: Do you have the right mix and the right number of staff with the right training and incentives needed to enable your physicians and nonphysician providers to maximize their patient service time?

The next question should be in evaluating employee costs in terms of inputs (employee cost per full-time equivalent physician), revenue (employee cost as a percentage of total medical revenue), and outputs (employee cost per total RVU).

If the assessment comes out negative, it's time to benchmark your staffing levels against similar organizations to determine if you have the right mix and the right number of staff for your practice.

"If the benchmarking is not OK, you are now diagnosing the reason and isolating where your staff should be," Gans said.