So, you’ve decided to open your own practice. That’s great! You’ve probably realized that running your own practice involves much more than just practicing medicine. You’ll no longer be a doctor—you’ll be a doctor and a business owner. You’ll be in charge of everything from marketing to reception to billing and more. And you’ll have to manage many priorities competing for your time.
There are multiple roles and responsibilities that have to be managed. Someone has to check-in the patients. Someone has to take their blood samples. Someone has to checkout the patients. Someone has to do the billing. Someone has to monitor the overhead. And more. How are you planning to manage all of these roles? Do you plan on doing everything yourself? Or are you going to hire staff to help you? Part of the challenge of running a business successfully is to know what kind of help you need and when to bring it on.
There are varying schools of thought on the ideal ratio of physician to support staff but when you’re starting out, you should be able to function optimally with minimal staff and add to your head count as your practice grows. In order to keep your costs low, it might make sense to handle most responsibilities yourself to start and then add to your team when you’re unable to handle all the competing tasks that demand your attention.
Your first hire will likely be a receptionist. You’ll need someone to be your greeter and gatekeeper. Your second hire will likely be a medical assistant. Ideally, you’d hire someone who was willing do double duty as receptionist and medical assistant—they might cost a little more, but you’d be filling two roles with one person, which could very well be worth it. As your patient volumes increase, you might want to add a licensed or registered nurse to help fill out your roster. And as you continue to grow, an office manager will help alleviate your administrative burden. In the early days, the administrative side of your practice should be relatively easy to manage. It’ll also be good experience to understand the nuts and bolts of how your practice functions and stay on top of what needs attention. But as you get busier, hiring some administrative help will free you to get back to what you trained for—practicing medicine!
You’ll need someone to welcome patients, take their information, and process their insurance when they arrive. The receptionist will also help check them out, help with referrals, and schedule any tests and follow-up appointments at the end of their visit, as well as managing the paperwork of the office.
You’ll need a medical assistant (MA) to help you with your patients. They can handle a variety of tasks ranging from administrative to clinical, and you can tailor your assistant’s duties to fit your needs, whether it be managing front-office operations, patient flow, changing dressings, or whatever else is required. MAs are not only versatile, they’re cheaper than nurses with their typical salary averaging just over $31,000 compared to a registered nurse’s average salary of just over $70,000.
The legal requirements governing the scope of activities that MAs can perform vary from state to state, so be sure to research which activities are covered in your area. Generally, MAs will be working under your license and are not allowed to give independent medical assessments or advice. However, they can provide clinical information on your behalf, as well as follow clinical protocols when they’re speaking to patients. It’ll be up to you to determine what duties they can perform, which is something that you’ll have to gauge by evaluating their work experience and observing them in action.
Medical assistants are an invaluable part of most medical practices. They help keep things moving by doing prep work, taking vital signs, and reading charts. One rule of thumb says that if you see 25 or fewer patients a day, you can get by with one MA to assist you. If you’re seeing more than 25 patients a day or are doing procedures in your office, a registered nurse, a licensed nurse or a physician assistant might be necessary.
Registered nurses (RNs) are more expensive than medical assistants, but they have greater scope in the activities they can perform, freeing you up to see more patients. If you’re performing procedures in your office, you’re going to need an RN. Given their more extensive training, they’re able to provide more advanced patient care like starting intravenous lines, administering chemotherapy treatments, and other treatments.
RNs can also speak to patients on the phone. They have more in-depth knowledge and are legally able to do things like discuss test results, whereas an MA would have to consult with you before they can respond to patient questions and concerns.
The rule of thumb with RNs is that if you’re seeing more than 45 patients a day, an RN may be more suitable to help you manage your patient load.
Like the name implies, licensed practical nurse (LPNs) operate under their own license (as do RNs), not yours. However, a licensed nurse works directly under the supervision of registered nurses and as such, may not fit the bill for what you need if you’re looking to gain the maximum leverage out of your team when you’re starting out. While cheaper than a registered nurse—the average salary for a licensed nurse is $45,000—a registered nurse has a greater ability to deal with patients directly, freeing you up to see more patients. That being said, as your practice grows, adding a licensed nurse to your team could make sense at some point.
A physician assistant (PA) works in coordination with a physician and performs many of the same duties diagnosing and treating patients. Given their duties, they need more education and training than RNs and LPNs. PAs need a master’s degree from an accredited institution and then must pass the Physician Assistant National Certifying Examination (PANCE) to be licensed. Due to the higher education requirements, they usually earn higher incomes than nurses, with the average salary being just over $107,000. You might consider hiring a PA when your practice expands to the point where you have limited availability to see more patients yourself.
Unless you’re expecting a massive backlog of patients right out of the gate, you won’t need an office manager to start. As your practice grows, hiring an office manager to take on the administrative activities and freeing you up to focus on patient care could make sense. Depending on your goals for your practice, an office manager may, or may not, be in your future.
The number of staff in your office will depend on your specialty and patient volume. As your practice grows, you may find yourself adding clinical lab, radiology and imaging capabilities, and more. Keep in mind that the larger your staff is, the more time you’ll spend managing them and the less time you’ll have to spend with patients. But to start, you could probably get by with a receptionist and a medical assistant.
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