Medical Practice Staffing: It's Quality Not Quantity That Pays Off

May 17, 2012

One of the top ways that a family practice clinic, in particular, hemorrhages money is staffing, or more specifically, too large of an entourage.

One of the number one complaints I hear from physician offices - and typically family practices - is that they are not earning enough money. But that is every person’s complaint right? When it comes to a physician's office, there are often a few simple tweaks that can really change your bottom line, and therefore your paycheck.

One of the top ways that a family practice clinic hemorrhages money is staffing, or more specifically, too large of an entourage.

How many people does it take to run an office? Assuming the team is properly trained and motivated and the right systems are in place …surprisingly few. For a single physician clinic seeing an average of 30 patients per day (without any ancillary services), you should have three team members other than yourself, in the entire clinic. Often times I see family practice clinics of this size with upwards of seven staff members (check in receptionist, check out receptionist, billing specialist, lab tech, two medical assistants, and an office manager). It is time to cut your staffing nearly in half. Here's how to trim down:

1. Office Manager: In a practice that sees 30 patients per day or less, your office manager should be spending the majority of his or her time working on billing. Your office manager should also back up the receptionist on the phones and check in/checkout. She/he should also be competent enough to fill in for the medical assistant when help is needed on the clinical side. The office manager should be the liaison between the physician and the staff for routine issues, i.e. vacation/sick days, tardiness, payroll, accounting, posting payments, etc. Remember if you give your office manager the responsibilities, you must also give her the authority to handle issues when they arise without interrupting you several times per day.

2. Receptionist: Your receptionist should be responsible for answering the phone by the second ring (you may elect to have an automated system to answer your phones. I believe a live person is best, but automated will work in a pinch), transferring those phone calls, checking patients in and out, and initiating the billing process at the end of the day. The receptionist, believe it or not, should at a minimum be able to help room patients and understand the flow of the clinical side as well.

3. Medical Assistant: Your medical assistant(s) should be able to do their primary jobs quickly and accurately, and utilize communication to move the patients through the clinic quickly and anticipate the needs of the patient and physician. MAs should take vitals, height and weight, get a brief description of the reason for the visit, and walk the patients to and from the front desk/waiting room. The physician should never be standing around waiting on the next patient. In addition, your MA should be the backup for the receptionist and have an understanding of the billing side so they can fill in there as well.

You are probably beginning to notice a pattern: Everyone should be cross-trained and eager enough to work together as a team to jump in wherever is needed. A few general rules that help a clinic run smoothly on this number of staff members:

1. If there is no set lunch break, where the office is closed for an hour during the lunch period, then the office manager and receptionist should alternate lunches, and the MA should take a lunch simultaneously with the physician.

2. Schedule staff to arrive 15 minutes to 30 minutes prior to the first patient. Set the schedule so that the last scheduled patient before lunch is set for 11:30 a.m., and the next half of clinic begins at 1 p.m., with the last patient of the day at 4:15 p.m. or 4:30 p.m.; this gives the office manager and receptionist time to push claims to insurance at the end of each day.

3. Interruptions should be minimal during clinic hours. MA phone messages such as refills and medical questions should be answered right before or after lunch break or at the end of the day, and make sure the MA’s voicemail message reflects that policy.

4. Make sure you promote TEAMWORK. You don’t want to hire employees. You want to hire a team that shares your goal of a successful practice and making a difference in patients’ lives.

When you begin to add more patients, and grow your practice, you should be able to add one additional medical assistant at around 40 patients per day. Usually at 40 patients per day you can look into starting to add mid-levels (nurse practitioners/physician assistants) to your practice. If you elect to pay them a salary, you may also have them manage the MA team and report to the office manager.

One of the better routes is to put them on a plan where they earn a percentage (the majority percentage) of the billing for the patients that they see. This is an excellent way to encourage them to bring patients into the office and actively market for clients as well as keep your overhead low during this growing stage of the practice. You may also have the mid-level in a dual function role initially, so that they earn a majority percentage of their patients seen as well as a stipend for managing the MA team.

With this knowledge how will you trim your team to revamp your paycheck?

Find out more about Audrey "Christie" McLaughlin and our other Practice Notes bloggers.