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Staffing evolution: Responding to a new environment

Insight Article - February 23, 2018

Staffing Models

Practice Efficiency

In the mid-19th century, Charles Darwin published On the Origin of Species by Means of Natural Selection, describing how species respond to their environment by adopting the traits that best enable survival. His theory of evolutionary change described how modern organisms are different from those that lived in the past and why separated populations adopt different forms and behaviors.

In many ways, medical groups exhibit a similar pattern of evolutionary change as practices respond to their local and national environments.

Among an administrator’s most complex tasks is staffing the right mix of skills and number of employees while keeping practice overhead as low as possible. Between meeting demands to increase patient volume and improve clinical support for providers, and complying with ever more complex regulations and demands from payers, staffing is one of the areas that no matter what a practice executive does, someone will not be pleased.

The need to balance demands and costs encourages practices to continuously examine staffing levels — one of the most frequently benchmarked metrics. Since staffing levels are a key performance indicator, it is important to know that they do not remain the same and that different types of practices have very different staffing levels and skill mix. Additionally, staff needs change over time as new demands are made on practices.

It is difficult for a practice to evaluate how staffing has changed over time, but MGMA’s national surveys offer insight into how practices staffed in the past and how they staff today.

Figure 1 compares clinical support staff per full-time-equivalent (FTE) physician as reported by participants in the MGMA Cost Survey in 2006 and again in the 2017 MGMA DataDive Cost and Revenue. During this 10-year period, many changes in clinical practice and in administration are reflected in staffing. Among the changes have been the widespread adoption of EHRs, a multitude of new clinical procedures, the implementation of digital technologies in the practice, and new data collection and reporting requirements associated with the shift from fee-for-service to forms of value-based payment.

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About the Author

David N. Gans
David N. Gans MSHA, FACMPE
Retired senior fellow, industry affairs MGMA

David N. Gans can be reached at


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