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 By Neil B. Gailmard, OD, MBA, FAAO, Editor August 3, 2011 - Tip #493 
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How many staff members?

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Last week's tip article prompted a strongly positive reaction from readers, so I'm going to use this article to dive into the most common question I received: How many technicians does a practice need to manage 24 patients per day per doctor?  If you missed the last article you can click on the past tips button at the end of this message.

Practice variables
Since no two practices are alike in how they operate and in the duties that are assigned to staff members, it's impossible to give a blanket answer to the question of how many employees are needed.  As you seek to compress your existing patients into fewer days with more delegation, it is likely that you'll need another technician.  Don't worry about that increased cost, however, because typically more income is generated with the additional employee.  It does not take much more gross revenue to make up for the additional payroll expense.

As we compare the staffing needs of one practice to another, we must try to compare apples to apples.  We must analyze how the practices operate.  One of the biggest variables to consider is if the practice uses scribes and if the scribes are cross-trained to perform pretesting and optical dispensing.  The more traditional approach is to have separate pretesters and opticians and for the doctor to not use scribes. 

My practice uses the scribe approach and we try to schedule three scribes per working doctor.  On a three doctor day, we would have nine of these scribing technicians.  Scribes in our practice are not assigned to a specific doctor, but they go wherever they are needed most.  Three scribes per doctor sounds like a lot at first, but remember that these staff members are also called to optical to do adjustments, repairs, deliveries and walk-in frame selections.

If you do not use scribes, I would estimate you would need two full time technicians per working doctor to manage the fast paced flow of 24 patients per day.

Additional staff
Staff requirements will also vary based on other duties.  We have a separate business office staff of six people plus an office manager.  I like to have some specialized training for staff who greet patients, handle money, file insurance claims and book appointments. 

We have two full time opticians who do not perform pretest or scribing duties, but always stay on the floor in optical.  We find we need these experts in optical to give us the high quality service we need and they are very good at sales.  Typically, the scribe stays with the patient they cared for in the clinic and just continues if frame selection is needed, but if the clinic is extremely busy and we need their technician skills, a hand-off is made to one of the opticians.

We also have two full time and one part time lab technicians.  These individuals make glasses with our own surfacing and finishing equipment and place orders to outside labs.  On rare occasion, a lab tech will be called out to work with a patient in optical.

Hiring can jump-start your practice
Most ECPs tend to avoid hiring an additional staff member, but I've always found that doing so actually stimulates practice growth and profitability.  Four good things happen when you hire a new employee:

  • Customer service improves because you have more staff to take care of people.
  • You will delegate more because you have someone to delegate to.
  • Staff performance improves because staff members are less stressed and the presence of a new employee often increases the effort of existing staff.
  • Productivity increases because everyone has more time to educate patients and sell premium products.

Useful metrics
The best way to determine if you have enough staff is to observe practice operations over a period of weeks.  There should be a good balance of general activity; some non-busy time for socialization in the office is OK, but not too much.  Beyond that, here are two rules of thumb to consider:

  • The AOA and the Management and Business Academy say that the median staff payroll cost in optometric practice is about 19%.  That is actually too low for my model of a highly delegated practice with excellent customer service.  I would try to hold at 22% to 24%.  This expense category does not include any ODs or lab technicians.  It includes all costs of employment including payroll taxes, uniforms, etc.
  • The collected gross revenue per full time staff member should be about $135,000.  If your practice grosses $600,000 per year, you should have about 4.5 employees.  If you gross a larger number per staff person, it either means that you are very good at sales or you are understaffed.

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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