The Part-time Puzzle

Your best employee is going back to school. Your family-focused billing clerk wants to reduce her hours. Or the medical assistant who has been with your practice for the last 20 years is ready to retire.

All you see is the gaping hole their absence will leave behind, but you should be seeing opportunity, says Deborah Walker Keegan, a former administrator, founder of Medical Practice Dimensions in Arden, N.C., and coauthor of “Rightsizing: Appropriate Staffing for Your Medical Practice.”

In today’s demanding healthcare environment, she notes, savvy administrators are using former employees on an a la carte basis - piecing together part-time schedules that take the heat off their overworked staff and save their practice cold hard cash.

“In healthcare, particularly medical practices, we use much more of the traditional staffing model designed to meet our needs at peak times of operation so the staff is not fully deployed for much of the week,” says Walker Keegan. “It’s time to really embrace part-time workers and the virtual employees who work from home.”

Why? For one, she notes, it’s a bargain. At many practices, those who work less than 30 hours a week typically do not receive retirement or health insurance benefits, a major component of compensation costs. But benefit arrangements vary. Some eliminate full-time benefits at 32 hours per week, but phase out paid time off more gradually - after, say, 24 hours a week.

Another upside to using part-time workers is that they can be scheduled when your practice needs them most - on Monday morning when the phones are ringing off the hook, over the weekend to finish extra filing, or on your busiest days of the week when all your physicians are seeing patients. “That can help you avoid costly overtime,” says Walker Keegan.

Cindy Rowe, administrator and chief executive of EyeHealth Northwest, a network of ophthalmology and optometry clinics and surgery centers in Portland, Ore., says the ability to retain valued employees for even a few hours per week offers another important perk as well. “There are a lot of people out there looking for jobs right now so it’s not a problem to fill vacant positions, but you can’t replace experience,” she says. “It takes a long time to become a really valuable member of the team. We try to keep good people because you know who you’re dealing with and because they have a great deal of institutional knowledge.”

Indeed, part-time workers who know the ropes can easily pinch hit when others take vacation, or handle responsibilities such as entering charges, taking copays and deductibles, and completing patient financial clearances, says Walker Keegan, noting front-desk functions, like checking patients in, are better left to your full-time staff.

It’s worth noting, as well, that part-time positions need not be created from the employee’s volition alone. When Summit Medical Associates, a 15-physician internal medicine practice in Hermitage, Tenn., implemented their electronic medical record system recently their need for staffing slowly dropped. “Two of our people who were with us for 15 years were downsized,” says Patsy Brown, administrator of the group. “They’re both in their 70s but they’re such workhorses that we asked them to go part-time. We created new positions for them so it’s a win-win situation for all of us. They love the reduced hours.”

Of the 85 employees who work for her practice, Brown says a handful work part-time, though job-sharing arrangements, in which two employees split the responsibilities of one full-time staff member, have not been successful so far. “I’ve tried staying back from it and saying, ‘I don’t care who’s working as long as the position is covered,’ but then I’d get complaints that one person only worked two days last week when she should have worked three and someone else saying they’re tired of picking up her day,” she says. “That doesn’t work for me as well as part-time positions.”

While many managers are also opposed to the concept of telecommuting, Walker Keegan says it’s worth considering for part-time employees you know and trust. “It saves your practice money in the infrastructure needed for square footage to have someone working offsite,” says Walker Keegan. “There’s a value to virtual employees.” Job functions particularly well-suited to employees who work remotely, she says, include: account follow-up work and patient collections involving calling patients at home, open claims, and appointment reminders, if your practice still does them by phone.

Stay organized

For all the benefits of using part-time staff, however, it also creates a few administrative challenges as well. “It’s usually worth it, but it is definitely more work and it adds to the balancing act of managing a practice,” says Rowe. “You have one more personality to deal with, another job file to maintain, another review to do and more coordination.” Often, she says, success or failure depends on the people involved and their areas of expertise. “We just try to reduce their responsibilities or give them a smaller piece of the puzzle and sometimes that’s possible and sometimes it’s not,” says Rowe. “If they have a supervisory role, obviously that’s difficult, but we’ve managed to work part-time positions out pretty successfully a number of times.”

Ultimately, the key to making the most of your low-cost labor is to stay organized. “You have to anticipate when you’re going to need them,” says Rowe, so they’re not sitting around waiting for assignments when they arrive. Before incorporating part-timers into your schedule, look carefully at your weekly work flow. If your staff is usually dragging on Friday or swamped Monday morning, bring them in those days to help out “Those are the times your staff really needs a jolt of energy and attention,” says Walker Keegan. “You have to staff for your work load, rather than staffing in a flat static model.”

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 12 years. Her work has appeared on CNNMoney.com, Bankrate.com, and Healthy Family magazine. She can be reached via physicianspractice@ubm.com.

This article originally appeared in the September 2010 issue of Physicians Practice.