Staff Management

Hitting the Staffing Sweet Spot How to Compute Optimal Staff Size

At Berryessa Optometryin San Jose, Calif., six full-time and three part-time staff members support two full-time ODs.

By Judith Lee

What is the magic number of staff you need to best serve patients–without draining profits? Regularly running a staff-size reality check can keep your practice budget and revenues on target.

MBA Staff-Level

Even practices in the highest percentile of staff productivity should be vigilant and not allow the staff to doctor ratio to fall below 3.0, according to the MBA.

Symptoms of

• Low staff morale

• Administrative tasks frequently unattended

• Frequent patient waits of 5 minutes or more during office visits

• Doctor assumes some of staff’s testing or administrative duties to keep process flowing.

The MBA recommends thatyou look at both gross revenue per staff hour and gross revenue per exam.

If these figures are average, first consider enhancing your lens and frame offerings and training current staff to present them effectively. If you are already doing this, then you may need to add staff so they have the time to sell more of the premium products.

For more MBA data: Key Metrics: Assessing Optometric Practice Performance

How Much Staff per How Much Revenue?
There are several yardsticks for determining optimal staff size. One of the best is found in Key Metrics: Assessing Optometric Practice Performance, a publication of the Management & Business Academy (MBA) sponsored by CIBA VISION and Essilor. According tothe MBA database, derived from financial surveys fromover 1,600independent optometric practices, typical independent practicesmaintain the followingnon-OD staff size per gross revenue.

Gross Revenue Staff Size (non-OD)
$500,000 3.5



Another key measurement is percent of gross revenues. On average, non-OD staff costs a practice between 18.8 and 21.4 percent of gross revenues, according to the MBA. The median is 19.7 percent of gross revenues.Calculate your cost by adding every expense you pay for your existing non-OD staff: wages, bonuses, benefits, uniforms, taxes, etc. Then divide that number by your gross revenue.

Test What is Optimal for Your Practice
“A lot of doctors think it’s staff cost as a percentage of gross revenue (25 percent); others believe in one staff per $150,000 of gross revenue,” says Gary Gerber, OD, of optimal staff size. Dr. Gerber is founder ofThe Power Practice,which consults to optometric practices.”But there is no percentage or number that’s right for everyone. It takes time and careful analysis to determine the number that’s right for your business model.”

Some practices need to experiment to test out what is optimal. At Berryessa Optometry, in San Jose, Calif., a staff of six full-time and three part-time supports two optometrists. Theideal staffing ratio, the practice discovered, is about 3.5 staff per doctor.At one time the staff was smaller, then it was larger, and about 18 months ago settled at the current level.

Top Retailers,PrimeStaffing Model
In computing optimal staff size, Dr. Gerber applies a simple standard that’s used by top retailers: Is the patient tended to immediately upon arrival?

“There never should be a line. If the office isn’t running on time, you either fell behind, or you don’t have enough staff. Think about a great retailer like Nordstroms,” Dr. Gerber says. “There are sales people ready to greet you as soon as you walk into their department. That’s because Nordstroms knows that as long as the customer is wandering aimlessly, she isn’t in ‘buy’ mode.”

One of Dr. Gerber’s clients, Steven Chander, OD, of Primary Eye Care Associations in Chicago, has taken this retail standard to heart. Dr. Chander employs a staff of 20 to support two full-time ODs and a part-time ophthalmologist. Dr. Chander calculates a ratio of staff hours to OD hours to comprehensive exams. Rather than causinga drop in profitability, the larger staff enables the practice to earn more money due to better patient/customer care service, more staff available to spend time reviewing important factors of treatment, and in optical for sales on second/third pairs and lens coating options. Their ideal staffing ratio, Dr. Chander points out, is 2.2 staff per doctor. “We know that increasing staff increases patient education, facilitates more delegation and results in more refractions per hour,” Dr. Chander says.

HowIsStaffingLevel Affecting Patients?
Berryessa Optometry measures its “staffing sweet spot” via patient satisfaction. An online survey goes out 24 hours after a patient receives an exam. The key question: Would you recommend Berryessa Optometry to a friend?

Teresa Carter, president of International Eyecare Centers, in Quincy, IL., says the multi-location practice has concluded that a staff/doctor ratio offive to oneis just right for them. At one point, IEC maintained a 3.3 ratio. “At 3.3, our capture rate and sales suffered, we missed billing, and multiple touches on the patient account were needed to rectify poor attention to detail.Our patients deserved more than our staff had time to give, andit was reflected in our patient return and every aspect of our business,” Carter notes. Current staffing levels at Berryessa are running at 26 percent of practicerevenues, down from last year, when it was 28 percent.

Somepractice owners and managers say they know they’ve hit their “sweet spot” by feel–along withproven measurements of what works best.Anthony Diecedue, MS, OD, of Eye Associates of Monroe County, in Stroudsburg, Penn., says hisideal staffing level is “25 percent of my gross payroll.” The practice relies on those numbers to steer staffing decisions, rather than emotion.“On busy days the staff may feel we are understaffed,” says Dr. Diecedue, “but we have to be able to ride out the busy days along with the slower days, and resist the temptation to over-hire.”

Talk the Talk

You canget the most out of each staff member by cross-training.Here are sample conversations with staff.

Ruth Archuleta, Berryessa Optometry: Cross-training is key.
“We want every staff person to be able to pitch in and help every other staff person. In this way, you can help a patient when they need it, and help keep the practice running as it should.

(We have two staff meetings a month in which we review operational issues and cross-training. Every other month, we have a mini-workshop for opticians to teach them front desk tasks.When our opticiansdo frame adjustments, they often pull a front desk person in to observe.)

Teresa Carter, International Eyecare Centers:
Staff is an extension of the doctor.

“You are an extension of the doctor, doing everything possible to ensure thatwhen the doctor enters the room with the patient, everything needed to spend quality time with the patient is accomplished accurately and concisely. This provides the patient with the comfort and education of a one-hour visit in a much shorter time.

“When it is time for the patient to be empowered with the opportunity to make the best choices for their future eye care and eyewear, you and other staff members must be present and available. In our practice, a ‘hand-off’ means ‘hands-on’ by our staff members. This makes for happy patients and a strong future.”

Related ROB Articles

Decisive Hiring: Put Time on Your Side for Effective Staffing

Hiring Top Talent: Assess Will-Do vs. Can-Do

Judith Lee is a health-care writer and founder of Communication Works Now, an online communications firm. To contact

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