Staffing and provider productivity.

What to track.

• Collections per provider — monthly and trended over time.
• RVU production and RVU-to-comp ratio for compensation-tied providers.
• FTE per provider — staffing depth around each clinician.
• Payroll as a percent of collections — the cleanest single ratio.
• Provider schedule utilization — booked slots, no-shows, late starts.

When to hire vs. when to restructure.

Hiring solves capacity problems. It does not solve compensation, scheduling, or productivity problems. Before adding an FTE, check whether existing providers and staff are operating at expected productivity. If they’re not, hiring multiplies the problem.

Productivity worth measuring.

Productivity is not how busy the schedule is. It is what the schedule produces. Useful measures:

• Visits per provider per day — against the practice’s own benchmark, not a national average.
• wRVU per provider — for compensation models tied to work effort.
• Collections per provider — closes the loop between work and cash.
• Panel size and panel growth — underused but important for primary care.
• Schedule utilization — booked slots vs available slots, by day and by provider.
• No-show and cancellation rates — lost revenue that rarely shows in any report.

Staffing ratios that matter.

The right support-staff-to-provider ratio is contested ground and varies by specialty. What matters more than the ratio is whether each support role pays for itself in throughput, patient experience, or revenue cycle performance. A few useful questions:

• Is the medical assistant ratio sufficient to keep the provider in the room with the patient?
• Is the front desk ratio sufficient to verify eligibility and collect at point of service?
• Is the billing function staffed to the volume of claims, or to a historical headcount?
• Is one person on each team accountable for the workflow, or is responsibility distributed and therefore unclear?

Compensation models worth understanding.

Most practices use one of three provider compensation models: salary with bonus, productivity-based (wRVU or collections), or some hybrid. None is universally correct. What matters is alignment: the model should reward the behavior the practice wants. If the practice wants growth, comp should reward growth. If the practice wants quality, comp should incorporate quality measures. Comp models that don’t match strategy create friction every year at renewal time.

Questions practice owners ask.

Should new providers be on salary or production? Most groups start new providers on guaranteed salary for 12–24 months, then transition to production. The guarantee is a recruiting tool; the production model is the long-term alignment.

How do we handle a partner who is underproductive? Direct conversation, supported by data. The data usually tells the story before the conversation does. Avoiding the conversation is the costlier choice.

What’s a fair admin time allocation? Specialty- and role-dependent. The principle: protect clinical capacity and pay separately for admin work that builds practice value (leadership, quality, training).