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 By Neil B. Gailmard, OD, MBA, FAAO, Editor December 3, 2008 - Tip #357 
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Staff: Too Many or Too Few


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Sometimes it seems like every day is an exercise in balancing the number of employees on hand. One day we will have two people call in sick on top of two others who had scheduled vacation days and the office will be hectic and stressful. On another day, a doctor will be off and the staff on duty will be standing around with nothing to do. Here are some tips for adjusting your staff on any given day so you are close to the proper number.

What is the proper number?

This article will concentrate on ways to adjust the number of employees on hand based on unusual circumstances, assuming your level of staffing is correct in general. In other words, we can have an acute staff problem if several people call off work unexpectedly, or we could have a chronic staff problem if you have too few employees for the size of your practice. The correct staffing level is best determined by observing the practice in action over time and we should also consider other aspects like the overall marketing strategy and pricing philosophy of the practice. There is always an ebb and flow of activity in an eye care office, so owners and managers must accept that there will be times when a patient has to wait a short period and there will be times when employees are standing around chatting. Over time, there should not be too much of either situation.

There are some benchmarks that can be useful, but I consider these as rules of thumb that must be refined through practice observation.

  • I think total payroll costs (not counting doctors or in-office optical lab employees) should be around 20%. A few points higher is OK in larger high service practices.
  • One full time equivalent employee per $150,000 gross revenue is typical. This is a very rough estimate, but if your collected gross is $800,000, you should have about 5.3 staff members.

Too many staff

Here are some ideas if you are faced with a day where you have too many employees on duty. If some of your staff is paid on an hourly basis, you could ask for volunteers who would like to go home.

  • Some employers may simply tell an employee they must go home, but I prefer to ask. Cutting an employee's income by cutting their hours can have a profound effect on his or her personal life and can result in morale problems. Asking for volunteers is more respectful and I can't recall a time where we didn't have people who wanted to comply.
  • I would limit the request for voluntary time off without pay to the department that needs it. In other words, I may ask for one employee who wants to leave early in the business office department, but not offer it to the patient care staff, optical staff or lab staff.
  • If you have more people volunteer than you can release, you should have a fair system to decide who gets to go. It could be a random drawing or simply keep track of who goes home today and move that person to the bottom of the list next time.
  • If you know a doctor is taking time off in advance, try to alter the staff schedule in advance. Always consider this from the employee's point of view and realize it may be an inconvenience, but talking to employees may reveal some situations where it works well for all concerned.

Another way to approach the extra staff issue is to have plenty of projects and tasks to assign. There are probably many things that could help your practice that are not part of anyone's daily duties.

  • Work on that employee procedure manual. Employees may not be able to decide on office policy by themselves, but they can write down what they do and how they do it. After editing and compiling, you'll have a book that will instruct future employees and others who are not familiar with a department how things get done. Some employees are protective of their knowledge because it gives them power, but don't allow that. Knowledge should be shared and it belongs to the practice.
  • Move old files into storage.
  • Deep clean some areas of the office that have been neglected.
  • Research inactive patient files for a special recall effort or to call patients and inquire about their eye care status.
  • Review accounts receivable.
  • Check inventory of supplies.
  • Review frame inventory for accuracy.
  • Review pricing information and product costs.
  • Review patient education brochures and search for new material.
  • Design a practice brochure or newsletter.

Too few staff

If patient services will suffer when staff members call off work, you can call other employees who are not scheduled to see if they wish to work. Obviously, such special requests should not occur too often or they will become annoyances for the employees and will adversely affect morale. But staff members who pitch in and help the practice when possible are generally highly regarded when it comes time for salary reviews. It doesn't hurt to ask, but we can't demand an employee work extra hours. Keep in mind that if an hourly employee exceeds a 40 hour work week, you should pay time and one half wages. Don't succumb to employees who want the extra hours and tell you they don't need time and a half. State law typically requires it and it's better to pay it than face a labor review later.

Here are a few other ideas:

  • If there are some openings in the patient schedule, you could block them off so you can provide optimum service.
  • Reassign employees to the areas that are in most critical need. A lab technician may be able to dispense eyeglasses. An insurance coordinator could cover the front desk.
  • Doctors may have to see some patients without the usual pretesting - or could do some of it themselves.
  • Administrative tasks take a back seat to patient care. The office manager should pitch in and help wherever needed.

Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week


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Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
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