How to Hire and Use Clerical Staff

John Nelson, MD, FACP

For the first few years of my career I was my own secretary. The hospitalist group I was part of ranged in size from two to nine doctors, and each of us handled all our own telephone correspondence and paperwork without clerical help. If you looked up our “office” phone number in the hospital’s physician directory you would find each individual’s pager number.

As a result, each of us got many pages every day regarding routine administrative issues such as hospital medical records, death certificates, and billing questions. Sometimes I felt as though I were answering nearly as many calls via pager as the hospital operator. And the pages about important clinical issues were mixed with all these routine inquiries.

While doing without clerical support in a hospitalist practice can help keep your overhead really low (ours was always well under 10%), it is not an efficient way to operate. A nonclinical support person is nearly always worthwhile. But, while the group I was part of made the mistake of trying to do without such a person (a problem we eventually fixed), a number of groups make the opposite mistake and hire too much clerical help, making it difficult or impossible to justify the cost.

Think carefully about clerical support positions. Unfortunately, in many practices in which the hospitalists are employees of the hospital, the doctors may not be engaged in deciding the optimal role and staffing (number of fulltime employees, or FTEs) for this position. To the doctors, it feels as though this person doesn’t cost them anything (in many cases the doctors aren’t paying for it directly, the hospital is), so they might not spend a lot of time thinking about whether they’re really getting good value for the money. But the doctors are in a much better position than other hospital administrators to know whether that position optimally supports the practice.

The amount of staffing and precise job descriptions will vary tremendously from one practice to another. I want to offer some general guidelines worth consideration by nearly all practices. This discussion is not about support personnel, such as case managers dedicated to the hospitalist practice, midlevel providers, or other clinical support staff. This discussion is really about the front-office support staff for your practice.

How Many to Hire?

My experience suggests a hospitalist practice should have about one FTE of clerical support for every five to 15 FTE hospitalists. The optimal staffing for a particular practice will vary depending on the person’s precise responsibilities. A practice that operates at more than one site (e.g., one hospitalist group covers two hospitals) will usually need more support than one that operates in one hospital.

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