Many times I have been asked, "How many staff should I have?" Now, that question depends on a lot of things. The answer to that depends on what kind of practice you have.  Do you do a lot of ancillary services which requires additional staff.  Services like laser treatments, in-office surgery, plus dispensing and fitting of orthotics and diabetic shoes?

The traditional answer of how many staff you need is 2.5 per doctor. One front desk person, one MA, and one floater that can do both. In this situation, it is ideal for you to have everyone cross-trained for optimum production.

Now, are you in a state where a medical assistant can debride nails? Then you can have all your routine care be seen by that person. 

Now the way I like to look at how many staff you need is to map out the flow of the office. Start with the phone ringing. I want all my phones answered by the third ring. So, I have every staff member trained on having the ability to answer the phones, make appointments, and answer the patient’s most commonly asked questions. 

I do not want my front desk person to put a new patient on hold, so if she is on the phone making an appointment, then who is taking care of the patient in front of you. If you have a very basic office with one doctor who sees less than 20 patients a day, then one front desk person will be enough. However, the worse number in business is the number one. One of anything will cost your business a lot of money.  Imagine being in the operating room and only having one surgical saw. What would happen if the saw was broken? In this case, what happens when, not if, your front desk person goes on vacation or quits? That will put you behind the 8 ball. 

Continuing with the flow map, let’s look at what happens when a patient enters the office. Can your front staff handle the patient that arrived, the patient that is checking out, and even a patient that calls in? In a small office, maybe your phones don’t ring frequently, and your one front desk person can handle all of this.

Therefore in a small practice, you need your MA to learn the duties of the front desk and that is why you have another person who can float between the two areas at any given time of the day. 

Now, in your practice, is there someone to always greet a patient when they come in? How do you handle this if this person is on the phone or with the other patient checking out? First impressions mean a lot and if you can be the practice that goes above and beyond and provide the best customer service in the area, then you will be the busiest one too.

This all means is that you need to pay attention to see how busy your phones are. A very busy practice will need two or maybe three people at the front desk, but if you only have one doctor, you will probably do not need a third person. Real busy offices might want to consider a call center. 

Another factor to consider is the number of treatment rooms you have. If you are a solo practitioner with a busy office, you might want a scribe to follow you and at least two medical assistants. One MA is gathering information on a patient in one room while the other MA is helping you in another room. The scribe can also be trained on being a MA as well. 

The goal here is for the doctor to be very productive and not do the things a medical assistant can do. Your staff is an extension of you. Your value as a doctor is to listen to your patients and educate them and perform procedures that only you can do.  It is the only way to increase your profitability. 

Most offices won’t be able to reach a new level of growth because they lack an adequate number of staff.  So, the question is:

Which comes first? Being busy then hire extra staff or having staff to help you get busy?

The answer is simply in the metrics. You never have to guess if you need an additional staff member. Look at the graph of total visits. You see there is a steady increase of visits over the last 4-6 weeks. Then you start to see a decline in the visits over the next week or longer and then your graph line starts to climb up again. This ebb and flow of your total patient visits is simply due to lack of staff.

Let me explain. When you have enough time to spend with the patient, your staff will not be rushed, and they will feel relaxed. They joke around with the patient; they get to know them and the patient has a wonderful experience. You, the doctor, also feel relaxed and spend the time to educate the patient on their care. The patient is happy, writes a great review and recommends their family and friends to you.

What happens next is an increase in patient volume. Now, the visits keep on increasing, but your systems have stayed the same. The number of staff is also the same and your office can’t simply handle this volume. You now run behind and everyone starts feeling stressed out. Your normal routine steps like checking benefits prior to seeing the patient, handing out educational material, making sure the patient understands the care plan, and explaining why the patient needs to return for his appointment has now been eliminated. This will lead to cancellations, no-shows, and a decrease in referrals. 

Therefore, it is important to look at your numbers weekly which will allow you to start hiring another staff member before a major problem arises. Last year I increased my practice by 25% and someone asked me how I did it. The first step was simple. I just decided that it had to be done.  Second, I sat down and figured out a plan on how to increase my per-visit revenue without adding additional hours of work. That was the key phrase, without working any harder or longer. I have studied many other offices who have done it and the answer was very simple. I need to spend more time with my patients but less time doing paper/electronic work.  What I needed to do was go to room to room and take care of my patients. So, I hired a scribe and an additional MA. I was able to see more new patients and more quality patients during the same working hours. 

The bottom line, you can’t grow without good staff that doesn’t feel stressed out.  The number of staff you need depends on how fast you want to grow. 

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