Evaluating Staff Levels

February 1, 2009

I am an administrator for a primary care practice with 1.80 full-time equivalent family practice providers. Together they see an average of 30 patients per day. We have four support staff. There are two unit clerks and two medical assistants who draw blood. We have decided to get an LPN to help the providers with shots, medication and supply ordering, and supervision of the medical assistants. We have hired the LPN and are getting ready to terminate one of the medical assistants. The problem is approximately 20 percent of our patient population speaks only Spanish. The LPN does not draw blood or speak Spanish. Do you think that we should have hired the LPN?

Question: I am an administrator for a primary care practice with 1.80 full-time equivalent family practice providers. Together they see an average of 30 patients per day. We have four support staff. There are two unit clerks and two medical assistants who draw blood.

We have decided to get an LPN to help the providers with shots, medication and supply ordering, and supervision of the medical assistants. We have hired the LPN and are getting ready to terminate one of the medical assistants. The problem is approximately 20 percent of our patient population speaks only Spanish. The LPN does not draw blood or speak Spanish. Do you think that we should have hired the LPN?

Answer: The devil is in the details, but let me try to respond anyway.

Your current physician to staff ratio, 1 to 2, is actually a little low, relative to the MGMA benchmark for family practice of 1 to 3.6.

That said, if you add another staff person, you should run some numbers to make sure, in advance, that the value is there.

So, for example, I assume that you wanted to add the LPN because you thought having her handle shots, ordering, and supervision would free up the physicians to handle more patients. Their productivity seems a little low at 30 patients a day for nearly two physicians. True? If so, how many more patients and at what revenue per patient would you expect over the coming year? Would that cover some or all the LPN’s salary?

What if you also account for what would presumably be more efficient MAs?

Are there services you can add with an LPN that you otherwise could not do? Can she handle revisits under her license?

Keep in mind what return you actually get for blood draws and shots, for that matter. Many practices lose money on these services, sadly.

Some of this is guesswork, clearly, but you should have some expectations in place.

Some other angles to consider:

Can’t the LPN be trained to draw blood or is this outside the state license?

If 20 percent of patients speak only Spanish, the Spanish-speaking MA can handle those.

It’s certainly probably worthwhile, regardless, for the whole team to learn at least some practical Spanish, related to what you typically need to communicate.

Are the MAs also rooming patients? Is it possible for an MA to work part-time around peak times for lab work?

In short, you need to look a little more closely at what everyone would be doing.