Structuring Your Staff Model: Questions for the Employing Physician
Wednesday, April 21, 2021
By Dylan Chadwick
When physician employers recruit their practice staff, they’re crafting an extension of themselves. Like a swiss watch or say, a Star Fleet command, each staff member contributes an invaluable service to the greater effectiveness of the practice, from answering phones, to coding procedures and to treating patients. Besides cultivating an efficient practice landscape, one which streamlines the divide between the administrative and clinical sides of the equation, these staff members also account for a significant portion of a practice’s overhead.
Decisions of which staff to hire, how many members and how to compensate them, can be a daunting task for any physician. The ultimate goal for most physicians when it comes to employing, according to Medscape's first ever Clinical Office Staff Salary Report, is to find those who can raise their own bottom line by reducing costs and delivering billable services.
The strongest staffing model for one physician won’t necessarily be the best for another. Says Kim Gooden, a practice administrator at Dermatology Consultants, a practice with three locations in the Atlanta metropolitan area, “Physicians are happier when they’re able to utilize their staff in a way that’s more efficient for them. She currently manages seven physicians, five physician assistants and 79 supporting staff (How to Conduct a Staffing Analysis).
With a changing medical landscape, one in which technology permeates deeper into the fabric of private-practice medicine, many physicians have found themselves re-thinking the personnel that they’re hiring. To illustrate, imagine a practice that implements an EHR. This practice may need to hire more medical assistants to act as scribes or data-input specialists, trained in the system's program. Besides medical technology, healthcare reform and fluctuating reimbursement rates play big into how an employing physician chooses to structure their staff.
For an employing physician looking to restructure their practice, a staffing analysis can help physicians get an accurate count of their practice and its individual strengths and weaknesses.
The General Overview
The first real question that any staffing analysis should answer is whether or not a practice has the “right” amount of staff. Besides workflow concerns, it’s also a critical component in determining reimbursements. A practice with too few staff may struggle with productivity and wait times, whereas a practice that has too many staff may become too expensive and create insurmountable overhead challenges.
Physicians can consult various benchmark reports within the industry, reports that survey staffing numbers of practices with similar specialties and sizes. However, these are just benchmarks and if a particular practice differs significantly from any national averages, it shouldn’t send any physicians into a panic. Every medical practice functions differently, and is a product of several other nuanced, non-clinical factors like geography, demographic and income bracket. As a medical practice is highly individual and unique, so to should a staff structure be.
Who’s Doing What?
Another purpose of a staffing analysis is to accurately determine whether each staff member has been tasked with the most correct and efficient responsibilities. Westgate’s article suggests using a measuring stick like to determine these tasks. As an example, analyzers can choose a certain task (like “answering phones”) and write it on a paper, tape it to the wall in a staffing area and ask staff involved to write down each role and the responsibility associated with it. These kinds of exercises may lead to a re-configuring of staffer responsibilities, especially if it reveals that staff members are spending too much time on tasks which take them away from their “core” responsibilities and prevent them from their best productivity. Good questions to ask in this regard may be, "how can my practice reduce the number of steps involved in the workflow?" or "how can I utilize technology to improve the process?"
At this point, there’s not really much debate as to whether or not technology can improve workflow, it's just a question of integration. That’s also what makes it a relevant component to consider when conducting a staffing analysis. Things to take into account are the fact that when a practice acquires new technology, it likely forecasts some time in order to restructure responsibilities to adequately accommodate it.
In the analysis, the "Staff performance" category can be difficult to empirically assess. Experts in the field suggest shooting for 75-85% of a practice’s staff members to be somewhere in a "top performers" category, with a solid mentoring or coaching system put in place for any who struggle.
Analysts may also find that calculating a measurement of various staff member workload ranges can assist in the assessment. Industry benchmarks can help, but a solid rule of thumb is to determine how long it takes various staff members to complete their tasks and how much work can be completed by a single staff member in a workday. However, this is nitty-gritty evaluation components that get deep into "nuts and bolts" territory that can be rather time-intensive. Some practices may have phone systems that record call statistics and can give figures such as the average call length. For those who don't, informed estimates are just as effective.
Once the staffing analysis is complete, the ideal number of staff has been determined and they're tasked with the correct responsibilities, employing physicians can consider payment models for their staff.
Medscape’s official report Physician Compensation Report surveys United States doctors from a wide range of specialties regarding their own salaries and the compensation packages they offer their various staff members.
According to the study and report, non-clinician employees earn less than their clinical staff peers across the board. Roughly ⅔ (64 per cent) of surveyed physicians report paying their front desk staff less than $30,000 annually. However, there are those who acknowledge the reality that front desk personnel have a tremendous impact in patient satisfaction by setting the tone of the patient's office visit and by facilitate practice efficiency by scheduling appointments, fielding phone calls and other billing and coding duties, and they'll pay them accordingly. 35 percent pay their front desk personnel between $30-60,000 annually and a smaller portion (1 percent) pay even more than this.
Medical records clerks earn less, and 31 percent of surveyed practices employ them. 72 percent of these participating physicians report paying record clerks less than $30,000. Medical billers statistically (60 percent) earn more, somewhere between $30,000-60,000.
Rewarding Revenue Creators
In consulting national statistics, employing physicians reward their staff who can generate more revenue for the practice. These sorts of staff work in roles like nurse practitioners and physicians assistants because they allow a practice to accommodate more patients at one time. Healthcare reform is forcing many states to expand the scope of services that Nurse Practitioners and Physician’s Assistants hold. They can economically benefit a practice because they alleviate many of a physician’s duties so that they can more specially focus on areas that have the highest reimbursements. They also provide services which are billable under Medicare and enable primary care physicians to compete with retail clinics that are developing around the country. According to the report, 55 percent report paying their nurse practitioners more than $80,000 annually, and 16 percent pay more than $100,000. Physicians assistants see a similar payment curve with 57 percent of them earning upwards of $80,000 and 19 percent earning more than $100,000.
Monetary compensation isn't all an employing physician must consider, as benefits packages are equally important to staff morale and job competition. According to the survey, most private practice physicians offer staff paid vacation and sick time (80 percent) and paid for health insurance (68 percent). Roughly half (46 percent) offered a retirement plan with a match and a smaller portion (22 percent) offer one without a match.
By and large, the huge benefits packages offered by corporate America aren’t as common in healthcare practices. Only about ⅓ (36 percent) provide dental plans for staff members and even fewer offer healthcare savings accounts (26 percent), vision insurance (23 percent), short term disability (22 percent), life insurance (19 percent) or long-term disability (16 percent) policies.
The Bottom Line
Overall, physician pay scales reflect the state of the market, changing landscape conditions (like healthcare reform) and the value an individualized practice puts on an individual service. While each practice has different needs, strengths and deficits, a thorough staffing analysis and an informed consultation of industry benchmarks and reports can help employing physicians make the most efficient and economical decisions for their staffing model.
Pekham, Carol. "Clinical and Office Staff Salary Report." Medscape.com.
Medscape, 21 Nov.
2013. Web. 08 Dec. 2013.
Reese, Shelly. "How Much Are You Paying Your Staff?" Medscape.com.
Nov. 2013. Web. 08 Dec. 2013.
Westgate, Aubrey. "How to Conduct a Staffing Analysis." PhysiciansPractice.com.
1 Nov. 2013. Web. 08 Dec. 2013.