ISSUE 2: A New Direction for Maintenance of Cerftification


Solving the Staffing Equation

Determining employee needs is more involved than one might think.


At A Glance

  • Figuring out a practice’s staffing needs takes a combination of subjectiveand objective analysis.
  • Checking in with key players in the office on how things are runningprovides valuable information.
  • The benchmarking process can be telling, but it’s not always straightforward. The goal is to stimulate discussion and to set goals to improve business efficiency and enable practice leaders to make better business decisions.

How many staff members does a practice with four MDs need? How many technicians does an established retina surgeon need? How many billing staff members do I need for my practice that generates $10 million in revenue?

As a practice management consultant working with many retina practices, these types of questions are among the most common that I receive from clients. This is not surprising, considering that staff salaries and benefits are the largest expense category that a practice incurs, often representing close to 30% of practice revenue.

Further, having the optimal number of staff members enables physicians to see a high volume of patients, which is important in maintaining profitability in a busy retina practice. Whether for front desk duties, technician work, prior authorization, or billing, finding the right balance of staff to provide great patient care while also maximizing financial efficiency is one of the greatest challenges leaders face in managing their health care practices.

The reality is that there is no simple, one-size-fits-all answer when it comes to solving the staffing equation. Every retina practice is unique, and multiple factors must be addressed, including the number of physicians, number of locations, and overall business model. Finding the right solution for your practice includes a mix of subjective and objective analysis.

The Subjective View

Subjective assessment requires input from the various stakeholders that play roles in your practice’s operations. Getting answers to the complex questions below should be your starting point in this assessment.

Physicians: Do the practice’s physicians feel they have the right number of technicians to manage a busy patient schedule?

Front Desk/Phone Staff: How long does new patient registration take? Can the staff keep up with the number of phone calls coming into the practice?

Technicians: Do technicians feel they are running around all day just to keep up? Are there bottlenecks that force the clinic to run behind schedule?

Billers: Does the billing staff feel it can keep up with the volume by posting and processing claims in a timely manner?

Practice Administrator: What is the overall morale of practice staff and physicians?

Patients: What do your patients say regarding wait times and overall experience?

The Objective View

Benchmarking is the process of measuring one’s historic results against internal trends or industry benchmarks. It is a directional tool that will not necessarily give you an exact answer but rather will indicate potential areas of opportunity to improve overall business efficiency. A number of metrics, described in the sidebar “Key Staffing Metrics,” are used to measure staffing volume and efficiency. The results should be tracked for the practice overall as a starting point and subsequently at the individual department level. The retina practice benchmark ranges used in this article represent the 25th to 75th percentile of the BSM Consulting database, which was developed from a combination of several sources, including the American Academy of Ophthalmic Executives and American Society of Ophthalmic Administrators benchmark surveys, as well as our own client experience.

Don’t Be Led Astray

One of the biggest mistakes practices make in using staffing benchmarks is looking at any result in isolation. The key to getting the most out of this exercise is to look at the results of the three metrics together to identify potential trends. For example, let’s assume the payroll ratio for a practice was 28% for a given period (Table). The natural reaction would be to assume that the practice is overstaffed. Before making that conclusion, however, what do the other two metrics indicate? In this case, the number of full-time equivalent (FTE) staff per FTE MD was 6.0, right in the middle of the benchmark range. The result for the net collections per FTE staff was $165,000, which, although within the benchmark range, is on the lower end.

Based on these three metrics, then, there are two indications that the practice could be overstaffed: payroll ratio and net collections per FTE. However, it is not totally clear. In this type of situation, additional analysis might be necessary. Because the payroll ratio and net collections per FTE both include net collections in their formulas, it is possible that, for this practice, the issue is not staffing volume but rather physician productivity. In addition, the high payroll ratio could be related to the geographic area of the practice. Regardless, performing this level of analysis leads to a problem-solving process based on objective analysis rather than gut feelings.

Take A Balanced Approach

By marrying together the subjective and objective parts of the process described above, solving the staffing equation in your practice can become a more manageable exercise. The benchmarking process can be very telling, but, as illustrated in the example above, the answer is not always straightforward. Ultimately, the goal of using benchmarks is to stimulate discussion and set goals in order to improve business efficiency and enable practice leaders to make better business decisions.