When to add another provider

Q: I think I am busy enough to support an associate. Are there quantifiable measures I can apply to determine whether I should recruit someone?

A: First, objectively clarify the need. Generally, if a practice has a two-week wait for routine visits at least 75 percent of the time, it can support an additional provider. The need might be satisfied by an additional midlevel provider-or two-instead of a physician, unless other circumstances require a doctor, such as hospital call. Will the local health maintenance organizations allow the person into the plans you accept? (Get it in writing!)

Second, validate the economics of adding another provider. What is the anticipated impact on income? Clearly define the compensation and incentives. Are there additional costs required, such as extra space or staff? Will you have to pay a recruiter 30 percent of the new associate's first-year salary, or can you find someone on your own? Will your hospital subsidize the cost of recruitment? How long will it take to amortize the cost out of anticipated extra profits, if any? Midlevel providers are often easier to find than physicians, and are likely to be much more profitable for you.