How many support staff per doctor would you say is necessary?
Depends on a number of things. How well trained/knowledgeable/independent they are, the number of doctors working, whether you have breaks built in to the day, how busy your practice is, and how fast the doctors move. Essentially as many as you need so that the doctor is never waiting for support staff and is able to spend all their time doing doctor things. That’s going to be different for each clinic.
There needs to be enough receptionists that they don’t need help answering phones all day from other staff, and that there is not a bottleneck in flow for check in/cash out of clients.
There needs to be enough techs/assistants to have adequate history taken, have all vaccines and dewormers drawn up, have ear cytologies taken (and bonus if they can read), pet vitals taken to the extent they need to be all before I go in; enough support staff to do treatments and diagnostics after my PE, full meds, and for someone to go over care instructions for puppies/kittens/sick pets. And to keep that flow going with tech appts running in and out. If I want to see the maximum number of patients, I need techs working with my last patient/clients, AND I need the next one being loaded and prepared, while I’m in with the current patient.
To actually maximize things like that, a few things have to also happen:
*there needs to be someone other than myself that can reasonably answer and assure clients about their pets, whether it be triage over the phone, or continued update about a case. This person has to be pretty experienced because they need to have enough medical experience and common sense to know what things they can address, and what they really need me to address. I need to be on the same page with them, and I need to be able to trust that even if they take care of the issue, they let me in on what is going on. “Fluffy the Urinary cat from two days ago is still straining a little and having hematuria so the owner was concerned. He is passing a good amount of urine and otherwise is himself, and they still have bupe, prazosin and onsior. I told them to continue to make sure he is passing urine and if there is any question on that front to call back ASAP or take to ER. I reiterated again for you that without xrays we can’t rule out stones. Owner elected to wait on that, so I told her if it doesn’t resolve within another couple of days they really should.” This amazing type of tech is worth their weight in gold, and acts as my extra arm. If I just have 5 lay kids off the street, even if they know how to hit a vein and take xrays, there isn’t enough thinks I can have them do to keep going because I have to stop and take care of so many things they can’t. If I don’t have anyone to talk to a client properly about a cat who is pissing out of the box and troubleshooting that, I’m stuck on the phone for 30 min instead.
*there needs to be a couple of amazing people communicators who can be there for client emotional support, be it for tough situations or for client complaints. Without these guys and those in above bullet, I am drowing in messages from clients. I hate clinics where staff simply take messages and leaves them for the doctors and have no ability to deal with it. Though I Would rather take care of those myself if the staff can’t be trusted to handle it properly or not keep me in the loop about it. It’s my license on the line after all.
*at least a couple of technically advanced techs that I can trust to induce anesthesia, get a patient monitored and prepped as I’m finishing the last case. So I can just come out from finishing up whatever I was doing and start whatever procedure needs to be done. Like those who I trust to troubleshoot and start cpr while someone runs and gets me from a room 50 feet away. Those that can reliable take good radiographs and quality check those.
*entire team that can communicate well and keep track of the flow so clients/patients aren’t forgotten and keep moving
*staff that can take concise but complete history (and consistently get it in the record) and also can extract from the client what the goal of that appt is, AND figure out ahead of time what preventatives, vaccines, etc... they are interested in so those can be prepared ahead of time so we aren’t waiting for it at the end. Staff also need to be good about understanding wellness protocols so they can figure it out and all I have to do is a very quick check (or even be better, be solid enough I don’t have to check, but it takes a lot of experience to get there).
*staff need to be able to go over estimates with the owner and be in good communication with me about what the priorities are. The fewer “the owner want to talk to you about it first” the better.
*a good amount of tasks staff need to complete on their own time so that they can keep busy during short down times. We can’t afford to have staff sitting around.
With a full schedule and never ending supply of patients that want to be seen, I can easily use 6 support staff as the only doctor on and keep everyone busy. Two up front, 3 in the back. Ideally cross trained so anyone can be pulled to help where needed. One that floats and also takes care of some admin things during down times. If this means I see 30 pets, majority of them sick in a day and the hospital also sees a bunch of tech appts, it would be absolutely chaos if my staff were not competent and able to mostly self govern.
had baby in January
We're salaried with quarterly bonuses built on across-clinic production, not individually, which I think is a really reasonable way to still encourage people to work hard but there's no need to tussle about who gets credit for what and whatnot. I anesthetized and did 80% of the chart for my boss' pyometra this morning because I had a second - he knocked out two rooms in the late afternoon so I could get another pyo on the table this afternoon. When we had an insulin OD'd hot mess express whose owner loves me come in while I was mid extractions, the tech threw in the IV, he pushed the dextrose and put on the freestyle libre, I called the owner and there's no worry about who gets credit for the labwork or the hospitalization or whatever, animals just get fixed.
