How Much Staff Do You Need?
Practice Management
Written by Dr. Eric Kaplan, D.C., F.I.A.M.A.   
Saturday, 28 February 2004 00:00 Read : 813 times

As a Consultant, I have had the opportunity to visit clinics throughout the United States.  This is one area of my consulting that is unique.  As the owner operator of 5 clinics that saw in excess of 1200 patient visits per week, it is interesting to see how many clinic’s staff their practices.  Some clinics are overstaffed and some understaffed.  The key is to know which you are.

Clinics of the 2000’s can learn a lesson or two from clinics of the 1970’s.  Most clinics today are overstaffed.  A clinics staff overhead should equal 12% or up to 18% of entire overhead with billing and collections.  The office should run at 50% and never more then 60%.  This is not what I see out there today.  Many doctors hire employees with no set formula in mind.  Doctors like saying, “I have eight employees.”  It is not how many employees you have but how they are utilized and how profitable you are.  Staffing should be equated by number of patient visits as well as collections.  This is also the reason so many clinics have financial troubles.  The first thing I teach my doctors is to understand overhead, how to mange a clinic and how to make it profitable. (See chart)


Use the following guidelines:

  •  
    •  
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        •  
          • 0-100 Patient visits per week = 1 full time CA, possibly one part-time after 50 visits.


Front Desk CA

Doctor handles treatment, exams, X-rays, and therapy

 

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    •  
      •  
        •  
          • 110-175 Patient visits per week = 2 CA’s, maybe an additional part-time may be added at 150, to assist with patients or billing.


Front Desk CA

Therapy CA (also traffic control)

Doctor handles treatment, exams, and X-rays

  •  
    •  
      •  
        •  
          • At the 150 level an associate doctor may be considered.  He or she will then take on the responsibility of doing the following:
  1.  
    1.  
      1.  
        1.  
          1.  
            1. Exams
            2. Taking X-rays
            3. Marking X-rays
            4. Preparing report booklet
            5. Managing therapy or rehabilitation
            6. Diagnostics
            7. Outside marketing

 

It is only after mastering the above that he or she will be allowed to treat patients. Having an associate can often give you more time to treat and bond with your patients, thus increasing your volume.

 

  •  
    •  
      •  
        •  
          • 175-250 Patient visits per week = 3 CA’s

Front Desk CA

Therapy CA (backs up front desk)

Billing Control CA (backs up both above CA’s)

Associate doctor handles treatment, exams, X-rays

 

 

  •  
    •  
      •  
        •  
          • 275-350 Patient visits per week = 4 CA’s

2 Front Desk CA’s

Therapy CA

Billing Control/Office Manager CA (backs up all above CA’s)

One of the front desk CA’s at this level assists with billing and collection.

 


When you get to this level, often one front desk CA answers the phone and does intake.  The second usually sets up patient visits does insurance verification and collects money.  This employee sees the patient as they exit and handles any insurance problems.

 

  •  
    •  
      •  
        •  
          • 350 + Patient visits per week = 5 CA’s

2 Front Desk CA’s

2 Billing CA’s

1 Therapy CA

 

 

You can use this knowledge as a motivator for yourself and your staff.  Just knowing that a small increase in patient visits per week will put you at a level that warrants an additional staff member should inspire you to make the push necessary to exceed and maintain that level.  You must maintain this level, though, for four weeks before hiring the additional person.  Let your staff know that increased business can lead to increased staffing.  Many doctors add employees because the staff says they are overwhelmed; that they need help.  The real question is, do they really?  An empirical formula on staff control will lead your staff to more production.  They will know what they must maintain, and what the office must produce to bring on help.

Once the new staff member has been added, you now have a vacuum to fill once more!  Successful people never rest.

Successful doctors throughout the United States have used the recommendations above effectively for years.  Today it is usually insurance that puts a strain on the office.  Many offices utilize billing companies.  Remember, a billing company is nothing more than an outsourced employee.  You must manage them as you would any employee and judge them by their effectiveness.  Before hiring a billing company, ask for doctor recommendations, then call them.  Make sure they do electronic billing and assist in follow up.  A good billing company should provide you with weekly reports.

Some clinics may offer services, which require additional staffing, such as diagnostic testing, rehab services, or massage therapy.  A massage therapist does not equate into the calculations, as they can produce revenue.  It is also their responsibility to assist with therapy and diagnostics when not massaging.  Often they are paid hourly (never by percentage) and are treated as Independent Contractors.


Staff Management

When professionals initially start their professions, they focus on being chiropractors, optometrists, dentists, etc.  But, as their practices grow, they find they must also become managers.  Some feel involvement in management makes them less of a health-care provider.

All careers eventually lead to management and management means managing people.  Skill, hard work, dedication, and technical competence alone won’t get you to the top.  Over-reliance on technical skills and neglect of the people skills leads to the leveling-off effect.  Continued advancement requires people skills.

There are no tricks to being a manager just an awareness to respond to the human needs of your staff.  Basically, you cannot change people.  You cannot put in people what they do not already possess.

Management of people is like placing a string on your desk.  Try pushing the string, notice how it binds up.  Now pull the string and see how it takes your lead and follows you.  Pulling people is tiring, but pushing people is exhausting and fruitless.


Rules to Remember

The following are rules to remember when you work with people:

  1. All people are motivated.
  2. People do things for their own reasons, not yours.
  3. You cannot motivate people.  You can inspire them, thus, they will motivate themselves.  Don’t FIRE employees, FIRE THEM UP.
  4. You can create factors that will be motivational in their environment.
  5. People won’t change for you, but they may change with you.

Good office procedure and clinical competence will help you sustain a certain level of success, but it’s your ability to manage people that will get you into the major leagues. TAC


Dr. Eric Kaplan is the CEO of MBA, Inc., one of the nation's largest multi-specialty consulting companies.  Dr. Kaplan ran and operated five  of his own clinics, seeing over 1000 patient visits per week.  He is the best-selling author of Dr. Kaplan’s Lifestyles of the Fit and Famous, endorsed by Donald Trump, Norman Vincent Peale and Mark Victor Hansen.  He was a recent commencement speaker at New York Chiropractic College and regularly speaks throughout the country.  For more information about Dr. Kaplan or MBA, call 561-626-3004.


 
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