Creating the Perfect Urgent Care Staffing Model


By: Pam Reynolds

I can read our CFO like a well illustrated children’s book when it comes to our monthly financial meetings. If we’ve had a less than perfect month, the tension is in the room before the meeting starts. If we’ve had a great month, the happy energy is in the room when I walk in. Either mood is largely due to how I helped calculate staffing for a particular month.

Staffing is expensive. You would be hard pressed to find an owner of any company who wouldn’t agree that staffing is his or her biggest expense. In urgent

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{ 11 comments… read them below or add one }

John Dollman May 17, 2011 at 3:20 pm

Hi Pam,

Your article was an excellent read! I specialize in working with many multi-site urgent care facilities across the country to alleviate staffing challenges. My company is really focusing on providing customized staffing solutions. You mentioned PRN’s in your model. Where do you see locum physicians fitting into a successful staffing model? Thank you very much for your time!

John Dollman
Business Development Executive
(800) 955-1919
john_dollman@dystaffing.com

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UCMM Staff July 7, 2011 at 7:50 am

We hire locums as needed – but seldom. For us it is more important to train people who we know are going to fit into our culture. It takes time for them to learn our culture. The problem with locums is they are temporary and changing. We have used them before, but we don’t rely on them. Dr. Reynolds just recorded a good video to be posted later this month on Physician Staffing Model Formulas and using midlevels.

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robert February 22, 2012 at 12:13 pm

We have experienced 30% growth in our practice. We currently staff two providers and two nurses. Is there an industry standard for what the staffing ratio should be and what is the threshold of patient visits to warrant additionmal nursing staff??

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Cathie, FNP February 29, 2012 at 1:28 pm

We are planning a new urgent care clinic. Our organization has gone to a model where they staf with MAs rather than RNs or LP(V)Ns as a mechanism to save $. I would like to advocate using nurses rather than MAs at the urgent care clinic. Any personal experience or awareness of studies or other data that would support staffing with nurses vs MAs?

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Steve PA-C March 1, 2012 at 6:27 pm

Hi Pam-
How does one actually compute adequate staffing when taking in to account PTO, military leaves….We have an extremley busy urgent care and with pretrty significant acuity and all run by mid-levels. We are being tasked to work with I feel to be a pretty bare bones skeleton crew and our fears are being spread too thin not to mention the burn out factor. One can really notice a difference of having 3 providers on on Mondays and we’d like to advocate for just that. How does one justify that need? We find pts and staff alike are more pleased from a job satisfaction standpoint as well as the patient experience.
I look forward to hearing back from you.

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Steve PA-C March 1, 2012 at 6:28 pm

Above meaning is how to justify ( acuity, volumes, etc) having 3 providers/day everyday?

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Pam Reynolds March 5, 2012 at 9:53 am

We trend our patient volumes by hour and by day. Then we have a formula we use to figure out how much we’re spending on providers and on nursing staff each day.

We have trended over the past several years (and continue to do so) the average cost per patient. We use that average cost and multiply it by the number of patients seen each day. Then we divide that by the salaries spent on nursing staff and then salaries spent on providers and get a percentage. We track the percentage of net revenue spent on providers and nursing staff. If that number increases over our average trend, then we know we’re overstaffed at the moment. If that number goes substantially down, we know we are understaffed. That’s how we justify our staffing numbers.

Additionally, we also trend our patient counts by hour to figure out when we need the most people in the clinics on which days. We have some employees who work split shifts because our numbers have indicated that’s when we need people in the clinic.

Hope this helps.

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Andy Nelson May 18, 2012 at 1:58 pm

Hi Pam,

So the real question is what is the nursing/MA staff ratio to provider for a UCC? This seems to be a most unheard of ratio but everyone seems to want to know. Thank you.

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Kari June 26, 2012 at 2:38 pm

Pam,
I’m with Andy and am really intrigued to hear your answer. We currently staff no MA’s due to limited scope of practice and always have a minimum of 1 RN on per shift. We staff 3 providers (minimum of 1 MD) and 3 nurses per shift. I’m also interested in hearing of what your patient wait times average? I’m finding it hard to decrease the wait times when we an not find a precipitating factor for patients numbers on a nightly basis (besides flu season influx). Thanks for your insight Pam!

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UCMM Staff June 26, 2012 at 3:06 pm

Kari & Andy,

The answer I gave in March is still the answer we use to find out what our clinics need staff wise. I don’t think there is a one-size fits all answer. The salary expense trend is easy to trend by department, and if the % you’re spending on salaries in any department goes way up, you have too many people. If it starts to go way down, it’s time to add additional staff.

At our busiest clinic (we see about 120 patients per day right now) we currently staff with the following:
3 mid-levels (staggered shifts, i.e. 8-4, 8-8, 10-10)
1 MD
1 X-Ray Tech
1 LVN
3 PCTs (patient care techs)
3 Front Desk Staff
Our out-the-door time (from check-in to check-out) is 45 minutes per patient.
At times, we send home PCTs/Front Desk early because the bulk of our patient rush comes in the morning and during the summer months, we just don’t need as many people there.

At our smaller clinics (average 40 patients per day), we staff with the following:
1 mid-level
1 X-Ray Tech
1 LVN
1 PCT
1 Front Desk Staff
Our out-the-door time (from check-in to check-out) is around 25 minutes per patient.

There are certain days when that mix changes (i.e. when we do Occupational Medicine Follow-Up days). On those days, we have 1 mid-level and 1 PCT just to handle those additional patients.

That’s why it’s hard to give a one-size fits all answer. I highly encourage you to implement the patient per hour or the staff salary % of revenue trend model to help you find the solution that works the best for your urgent care center.

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Mary Teague August 10, 2012 at 6:29 pm

We have an urgent care center that see’s a higher level of care than just minute type of patients with sore throats and ear aches. We see patients with dehydration, abdominal pain, minor MVC’s. We are hospital connected and many patients see us as part of the hospital and many times have patients presenting with emergent types of complaints such as chest pain, shortness of breath and anaphylactic reactions. Do you have these types of patients that present to your clinic and how do you handle them?

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