In August, the Medical Group Management Association released the results of its annual survey of its members on issues that challenge them the most in their professional lives. In this edition of Practice Makes Perfect, we address No. 19 on the list: determining optimal staffing ratios.
The staff complains that they need more people to get the job done. The physicians often remark to the administrator, “We must have too many people.” And with the ever-increasing downward pressure on revenue and upward pressure on costs, our boards of directors are looking to staff reductions as viable cost-cutting measures. As with most situations, the solution is neither black nor white: The situation requires a careful analysis to ensure arriving at the correct solution. In the end, this is a matter of science and art.
The medical practice administrator is charged with ensuring the smooth, efficient and effective operation of the practice, and to meet this challenge within budget while maintaining accuracy and a positive work environment. And they said getting to the moon would be difficult!
In order to arrive at the appropriate staffing level for your office, begin with the situation, not the desired solution. This may sound trite, however, I see many administrators setting the full-time-equivalent staffing ratio based from a national norm, and working backwards to rationalize the number for their practice. While survey data are a vital benchmark for this process, they cannot be the only tool employed.
According to Rightsizing: Appropriate Staffing for your Medical Practice by Deborah L. Walker Keegan and David N. Gans, your ultimate goal is to have the right number of staff members doing the right jobs in the office, thereby ensuring the best physician productivity, office efficiency and financial performance.
Here are a few of the key steps required to ensure that your office staff is rightsized.
Take a good look at your practice.
How many FTE physicians and other providers are there? How many office locations do you have? What extra procedures are performed in your office? What is the work style of your providers?
How many FTE staff do you have for each category of job function? Are they properly trained, and even cross-trained? What amount of overtime does your practice incur? What are the causes of the overtime?
How does work flow? Can there be improvements in the work flow? Where are there unnecessary redundancies and unnecessary steps?
Are you leveraging technology? Are there opportunities in this area?
Evaluate capacity vs. utilization for provider scheduling, procedures and testing, laboratory work, etc.
Benchmark your practice. MGMA surveys provide an excellent source for benchmarking your practice to similar other practices. Be sure to compare “apples to apples” as much as possible. Compare private practice with private practice, single specialty with single specialty, etc. In every case, use the benchmark as a guide, not an absolute. Just because the median FTE support staff per provider in a specific category may be 3.0 does not automatically mandate that the number of FTE support staff per provider in your practice should equal 3.0 as well. You may have mitigating circumstances in your practice supporting a different staffing level.
Develop a staffing design for your office. You've done your homework. You understand your practice, and you've benchmarked your practice to other similar practices. This is where the art comes in. This is where think time is critical.
At this stage, the practice administrator should take the specific practice operation, compare and contrast it with normative data, and develop the staffing plan. Ask how many people do we need, doing what jobs? Match that against the current situation. Assess and understand the differences. From the gap analysis you complete you can develop the proper plan to move your practice forward.
Kenneth HertzPrincipalMGMA Health Care Consulting GroupEnglewood, Colo.
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