NO FTE FOR YOU!

The success of your program is dependent on your ability to staff to your program’s needs. When you ask the C- suite for more FTEs, the situation may be similar to Jerry’s and Elaine’s attempts to score that delicious bowl of soup from the soup Nazi.  There is a protocol to follow.  Mis-step, and you go hungry. As the group leader, you know what is best for your patients and your doctors.  Convincing the C’s is the burden you must carry, and this requires a thoughtful approach.

Many physician staffing models are derived from the traditional outpatient practice paradigm. However, staffing a 24/7- hospitalist program requires complex data analysis and modeling not germane to outpatient practice. Several inputs can drive a hospitalist staffing model: historical encounter volume, revenue targets, payer mix, admission sources, etc… But at the crux of hospitalist staffing is the provision of 24 hour coverage, some of which is non-revenue generating. Using productivity targets, collections per encounter, or other financial metrics can be helpful, but these are not sufficient to model an effective program.
John Nelson, MD, MHM espouses a metric that can help you staff to appropriate levels based on the Physician:Patient ratio and the frequency to which a program exceeds its maximum (threshold) number of patients per hospitalist per day. I employ this concept and find it very useful. However I have also found that it is difficult to explain this concept to those who control the purse strings; partly because it is a sophisticated concept and partly because it is value-centric versus revenue-centric.

When I’m asked, “How do you determine how many FTEs a program needs?”

I usually respond, “How many hours do you want me to cover?”

Please refer  to Dr. Alstrom’s post from a few weeks back  for more insight into Malthusian economic theory and the law of diminishing marginal productivity of labor. The needed FTE calculation is simple:it equals the number of hours scheduled per year divided by number of hours worked per FTE.
EG:If a group uses the following daily staffing model:
4 daytime shifts=48 hrs
1 swing shift=12 hrs
1 night shift=12 hrs
72 hours per day     x   365 days per year = 26,280 hours

26,280/2000 hrs per FTE = 13.1 FTE to staff model.

The real question is “how does one determine the model?”

I will discuss this in the next installment….

3 Comments

  1. […] NO FTE FOR YOU! 12:44 am […]

  2. Troy Ahlstrom on January 10, 2011 at 10:56 am

    Mike,

    I like the formula, but hey, I like just about all formulae excepting the kind babies ingest.

    I can’t help but point out that this construct leaves out those who work at varying numbers of encounters or types of work (ICU vs. floors). We had to switch to variable FTEs to fix that so I could see 12 patients while someone else sees 20. We have different staffing on different days based on the number of encounters that need to be done and the present levels that each doc will perform.

    In a small program, where we have 2-4 people per day, everyone does about the same work. But the tricky part is in a bigger program, where folks work differently and are paid based on the amount of work done. The idea of a fixed number of FTEs breaks down because it limits flexibility to actually meet the programs staffing needs. When the C-suite tries to count warm bodies at the table, they miss the point. How many people do the work matters little as long as all of the goals are met or exceeded. But helping them understand the complexities of the problem is indeed the crux of the issue.

    I look forward to seeing the rest of the blog!

    • Mike Radzienda on January 10, 2011 at 4:22 pm

      You Bet.
      It is the model you speak of that is key.

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