Selma Vaughn manages two primary-care practices made up of three physicians, two nurse practitioners, and 20 staff members. Over the nine years Vaughn has worked at the practices, she has seen her fair share of staff turnover, changes, and challenges. One thing she's learned: Teamwork is crucial to forming a positive and productive staff. "You have to have it 100 percent," says Vaughn, whose practices are located in Richmond and Glen Allen, Va., and are part of the Bon Secours Health System. "You need your team to work well — you need them to work well together, and you need them to work well with the physicians."

To that end, Vaughn works hard to ensure staff members are working together — and working to the best of their abilities. She checks in with them frequently, runs reports to monitor performance daily, and asks staff to huddle each morning to discuss potential problems that may arise during the day. "You're trying to get ahead of anything you think might be an issue or cause any type of backup in the schedule," says Vaughn. "I have conversations with them and I try to do different things to motivate them."

Like Vaughn, physicians and administrators across the country are working hard to boost staff performance and productivity. But it's not easy. Staff members are already stretched thin as practices operate with smaller staffs due to declining reimbursement and increasing overhead. Plus, at many practices, staff members face mounting pressure to increase visit volume. That's leading to high rates of clinical and administrative staff turnover at many practices. In 2012, for instance, the turnover rate among physician assistants and nurse practitioners at medical organizations was about 12 percent, nearly double the rate of physician turnover, according to the 2012 Physician Retention Survey from healthcare professional recruiting firm Cejka Search and the American Medical Group Association.

Luckily, experts say there are many ways practices can better retain staff members while boosting their performance and productivity. We asked administrators and consultants to weigh in on this subject. Here's what they say your practice should do to make the most of its staff.

Finding the magic number

Right-sizing your staff is critical as reimbursement declines and overhead increases. One staff member too many could push your practice into the red, one too few could lead to backlogs and high turnover. Industry benchmarks, such as those included in the Medical Group Management Association's cost survey reports, provide average physician-to-staff ratios by specialty. Consulting such benchmarks can help you determine if your practice's staffing numbers align with other similar practices.

Still, don't adhere to benchmarks too strictly. The ideal staffing number for a practice varies depending on several factors, including reimbursement model, technology acquisitions, and even the physicians within the practice. Some physicians, for instance, are more productive if they are working with two or three medical assistants (MAs), while others are "gangbusters" with just one, says medical practice consultant Charlene Mooney of the Halley Consulting Group in Columbus, Ohio. Similarly, a practice that has acquired the newest technologies may have different staffing needs than one that has not, says Karen Zupko, president of Chicago-based practice management consulting and training firm Karen Zupko & Associates.

When determining if your staff is the right size, in addition to benchmarks and your practice's unique characteristics, consider your goals and priorities, says practice management consultant Owen Dahl. For instance, if increasing visit volume is a big initiative, an additional receptionist may be appropriate, and if you are adding ancillary services, you may want to add staff as well. "It really depends upon the driver of the type of practice you have, and then the type of services and volume of patients that you would have in the practice," says Dahl.