CHAPTER 16
Urgent Care Duties, Staffing Mix, and Ratios
John Shufeldt
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HOW YOU STAFF YOUR urgent care center is an integral component of the smooth and efficient day-to-day operation. Finding the right balance between the number of staff members necessary for an optimal patient experience and prudent financial stewardship is one of the key metrics in successful urgent care management.
The kind of staff members you employ is as important as the number of staff you employ and may weigh into your staffing metrics. For example, is a registered nurse (RN) in the back office as efficient as 1.5 medical assistants (MAs)? Is a physician 1.2 times as efficient as a physician extender (PE)? Do your managed-care plan contracts require a physician, or does the managed-care organization pay at 85% of the physician rate if a PE is used? Does your front-office manager fill in for lunches and breaks for your front-office staff? Do you open the doors on day 1 with a full complement of staff members, or do you scale up the number and capabilities of your staff members as the patient volume grows? Does your staffing formula follow the ebbs and flows of a typical day, and does it account for the historical busy days of the weeks and times of the year?
Although staffing an urgent care facility seems on the surface to be straightforward, it is a complex undertaking, particularly if you are trying to be as fiscally conservative as possible in your pro forma financial plan. It is easy to throw more staff members at prolonged patient waiting times; however, most operators do not have the luxury of staffing up every time patient volume transiently increases. Historically, most hospital-run operations have staffed their urgent care centers richly. In comparison, provider-owned centers, because of their economic model, are forced to staff with a minimal team that grows and fluctuates with patient volume.
How an owner or manager elects to staff the urgent care center has a material effect on patient flow and cost. This cost is magnified when overtime wages are added to the mix. Arguably, the more efficient the staff, the less overtime a center pays. Also, a more efficient staff generally costs more per hour than a less highly trained or educated staff. Balancing these tendencies is the key to finding the most appropriate ratio of staff to providers and staffing mix to patients.
Most centers divide the work into some variation of the following functions:
Front office
• Reception
• Billing
• Triage
Back office
• Medical assistance
• Radiology
• Patient scheduling, follow-up, referral
• Pharmacy (i.e., dispensing medications or transmitting prescriptions)
• Laboratory work
Clinic management
Medical provider (physician, physician assistant [PA], nurse practitioner [NP])
The number of people performing those functions can vary. In smaller operations or in centers with a lower patient volume, most of these functions are shared among the core staff members. The core staff members in every center are
The front-office person
The back-office person
The medical provider