Determining Your Urgent Care’s Physician Staffing Model

Written by on October 1, 2014 in Features - No comments

DoctorCollageWEBTrying to determine the perfect physician staffing model is an ongoing saga for any urgent care center. For the first 10 years of my career I was responsible for staffing a busy emergency room, and for the last eight years I have been staffing busy urgent care clinics with physicians. Creating the perfect physician schedule is a constantly moving target. The target is finding the balance between adequately staffing to allow time to provide great patient care and not overstaffing and killing the budget.

Why You Should Analyze Your Staffing

When swine flu hit in the fall of 2009, our urgent care clinics were the busiest they had ever been. Both our physician and our physician extender staffing was maxed out. In fact, we couldn’t find enough people to work all the shifts it took to adequately take care of the influx of flu patients. By the fall of 2010, the swine flu numbers had tapered off, and we were back to our normal patient flow volumes.

In August of 2010 I noticed our profit margins had really decreased. We had not switched our staffing number to reflect our normal patient volumes. Someone had fallen asleep at the wheel, and that someone was me. After fixing the problem, our profit margins went back up. In a service based industry, staffing is your number one expense. You have to be diligent at not over spending on staff, especially in the highly compensated roles filled by physicians and physician extenders. Decreasing staffing costs by as little as 10 percent can increase your profits by 50 percent.

Physician Staffing Formulas

I wish I could tell you there was a simple formula for you to use to determine the exact number of physicians and physician extenders you need at your urgent care clinic. There is not. However, there are a few numbers and tips you can use to create your own staffing formula.

Tip 1: Number of Patients by Hour

The average provider at an urgent care clinic should be able to see between 2.5 and 4 patients per hour. Physicians who are responsible for overseeing physician extenders may see less patients per hour. Additionally, depending on the acuity of what you see at your urgent care center, your numbers may be higher or lower.

When you first open, you only need one provider at your clinic until you begin to see more than three patients per hour. After your patient volume increases, consider adding an additional provider during peak hours.

Tip 2: Physicians and Physician Extenders

The decision to utilize physician extenders at your urgent care center really comes down to two things:
1. The laws in your state; and
2. Your philosophy on patient care.

At HealthCARE Express, we use physician extenders to compliment our physician staff. I think they work great and patients love them. The key is physicians must be able to provide adequate supervision in compliance with your state laws. Your supervision policies should be clearly written in your policies and procedures manual.

Tip 3: The Right Mixture

Finding the right mixture of physicians and/or physician extenders depends on two equally important parts. First, it is your responsibility to make sure your clinic culture is what it should be and that your clinical standards are high. Therefore, you must be able to determine the clinical abilities of your medical providers.

Second, you must insist your providers become part of your company culture. Creating the right culture, and allowing people to become part of it, is more important in the long run than finding the “right” people. Providing a challenging, positive, and great work environment will help ensure your providers are always performing at their best, even when you are super busy. Remember, physician staffing numbers change as the patient volume at your urgent care clinic changes. What works this month may not work next month. If you keep an eye on your volumes and are quick to adjust your coverage accordingly, your profits should stay positive. If you hire quality people and allow them to become part of your culture, staffing will be a pleasurable experience, too.

Tips on Physician Employment Contracts

Once you have your staffing metrics in place, you may find you need additional physicians.  Once you have found a physician for your team, the “fun” of negotiation an employment contract begins. In the urgent care business, physicians you hire are your customers. Unfortunately, many of them have been taken advantage of by previous groups or employers, so they may come to you very wary, especially when you start discussing their contract. The best way to approach a physician contract is with a mutual understanding of what is expected of the physician and what they can expect from you.

Because it is a contract, legalese will be used. But at the end of the day, the contract is about a cooperative effort to make you and the physician happy. Don’t let all the legal stuff get in the way of the primary goal you both share: Finding a way to employ the physician with your urgent care. Compensation, benefits, and the like should be worked out long before the physician is given the contract to sign. Additionally, any other “sticky points” should be discussed face-to-face before the contract is given out. The contract is not a place to hide things.

It is important to include certain things in the contract like:

1. Essential job functions
2. Length of the agreement and performance benchmarks
3. Compensation

When you discuss compensation, make sure to include:

a. Benefits
►Will the benefits be the same as all your employees?
►Will the company pay for all of the health and/or life insurance or will the physician pay a portion?
►Will vacation accrue from day one? Will it be scheduled according to staffing needs?

b. How Pay Is Structured
►Base salary only
►Hourly rate
►Base salary plus commission (i.e. % of net profits)
►What if the physician leaves prior to the end of the month? Will you prorate?

c. Required Hours
►40 hour work week
►40 hour work week including weekends and/or rotation thru facilities

d. Sign on-bonus
►What if the physician leaves after he has received the bonus?

e. Will you allot funds for licenses?

f. Will you pay for the professional liability insurance coverage?
Who will pay for the “tail” policy covering the physician after termination of employment?

Non-Compete Clause

I do not believe in making doctors sign a non-compete that says they will not go to work for one of my competitors. However, I do have them sign a non-compete saying they will not take my ideas and then open a business that competes directly with mine.

Example language: On the termination of the physician’s employment with the company for any reason, the physician will not solicit any patient of the company that was a patient of the company during the course of the physician’s employment with the company, whether or not knowledge of the patient is considered confidential information, or in any way aid and assist any other person to solicit any such patient for a period of three (3) years from the date of termination of the physician’s employment in urgent care within a 30 mile radius of any company location where physician has provided services.

It’s important for you to note that different states have different laws on non-compete language in an employment agreement.

In Summary, the best way to overcome fear of physician contracts is to be straight forward and work together to problem solve rather than “negotiate”. Instead of putting both sides on the defensive, work together towards a win-win solution.

By Tim Reynolds M.D.

About the Author:
Tim Reynolds M.D. is the Urgent Care Industry’s leading expert on Leadership, business strategies, and work-life balance.  He is committed to helping doctors, owners and practice managers put the FUN back in their business. 

He has written nearly 100 articles for industry publications and online resources, regularly presents at industry conferences, and is a sought after consultant for some of the top urgent care clinics across the nation. He is the managing partner for a rapidly growing network of urgent care, occupational, and wellness centers known for providing the WOWZA! Customer Experience. He is the co-creator of the industry’s leading online resource for growing and improving your business, UrgentCareSuccess.com, and his annual Urgent Care Success Summit, is often described by attendees as “the best conference in the industry.”

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