Adding a doctor? Ask these questions

March 18, 2005

With money tight and overhead up, it's a tough call. But experts say groups can't afford not to grow.

Here's the scenario: You're in a small or medium-sized group, and you and your partners are working faster and longer to accommodate growing patient volume. Perhaps some of you have already closed your practices to new patients. Meanwhile, overhead is growing, and you want to spread it over more doctors. Clearly, it's time to look at adding a new physician.

But is it feasible for your practice? If you're facing this question or think you might be in the near future, read on to find out what several management consultants and a leading physician recruiter have to say. And to learn what a nine-doctor internal medicine practice did in a similar situation,

Is there enough space for a new physician? Before you bring in a new doctor, make sure there's enough room for him or her. An internist or family physician needs at least three exam rooms. If those rooms are already being used to capacity, you can't add another physician without adding extra rooms, says David C. Scroggins, a practice management consultant with Clayton L. Scroggins Associates in Cincinnati. "That would hurt everybody, particularly the new doctor, and the new person's practice would never develop."

There is one way to bring in a new doctor when you don't have enough space: Offer extended hours on evenings and Saturdays. "You can do a lot by staying open an extra hour a day and having some swing schedules. All of a sudden, exam rooms become more available."

How much staff do you need? You're also going to need more space for support staff. While a new primary care doctor might not need much extra support while building his practice, he'll eventually require 3.5 to 4 full-time staffers, says Scroggins. That ratio is independent of the size of the practice, he notes, but a small group will have to add support staff faster than a larger one will.

Other consultants, however, point out that adding more staff might not be necessary. "When a group expands, you can often add a doctor or two with the existing staff by making sure they're working as efficiently as possible," says Michael D. Brown of Health Care Economics in Indianapolis.

But if your practice is well run and staff members are working up to their capacity, adding a new physician means hiring some additional staff. That might not include a billing person at first, because the new doctor won't be billing for too many visits. But the new doctor will need a nurse right away. Some practices will be able to fill the need by getting part-time nurses to work full time, says Scroggins. He also advocates having doctors share nurses, because they may have downtime if each one is assigned to a single physician.

Eventually, you'll have to hire even more employees as the extra work the doctor generates strains the capacity of receptionists, triage nurses, record clerks, and other staffers.

One exception is when the new doctor is hired to work at a satellite office. These offices can have a very low staff to doctor ratio, observes Steve Messinger, a consultant in Arlington, VA. With the main office providing additional support, he says, a practice can put two new doctors in a satellite with two staffers who double as receptionists and nurses.

Should you hire an experienced doctor? Timing your staffing decision will depend to a degree on what kind of physician you bring in. Experienced doctors cost 30 to 40 percent more but build their practices much faster than young ones just out of residency, Brown points out. So an older physician might be your best bet if you're concerned about bringing in extra income right away to offset higher overhead.