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  • Staffing for profit

  • Rama Aysola, M.D.

    Hey RMs!

    Hope you all are well. This is a thought exercise/project for RMs. Here we go:

    You have a 3 shift a day ED. These are 8 hour shifts. I want you to think like a business owner, you own the ED. Of course you want to staff the ED, cover all shifts, and optimize the staffing to maximize your profits.

    You have One CS, 8 part-time and 2 full-time scribes. You also have one QAS, and a couple of floor-trainers. The CS works about 4-5 shifts in a pay period.

    Your CS is expensive at $13.50/hr wage. QAS is $12/hr. Floor trainers (FT) are at $11/hr.

    What percentages of shifts covered would you like your team to work?

    Ex: CS %30 of shifts, Scribes %55 of shifts, FT %15  — just an example of answer.

    Please post your answer on percentages and your thought process on why you want that model. The details of the ED shift coverage is not what is important. What is important is how you want your shifts covered to maximize profits, maintain quality, and keep the site healthy.

    Top two answers will get a $20 Starbucks gift card.

    Would love to hear your thoughts team!!



    Adam Rankin
    Regional Manager

    Total Shifts: 21

    2 Full-Time Scribes: Each works 4 shifts/week for a total of 8 shifts/week covered. 38%

    8 Part-Time Scribes: Each works 1-2 shifts per week for a total of 10 shifts/week covered. 47%

    CS works 2 shifts/week 9%

    QAS works 1 shift/week  4%

    Total shifts covered: 21


    I think you want to start with your least-expensive but able to work most scribes, your full-timers. Coming from that background myself I always worked 4-5 shifts/week, while my CS worked maybe 3. I cost less to pay, but wanted to work full-time. These are your scribes who will cover most of your shifts, and usually are your strongest depending on how long they have been there.

    Next you have your part-timers pick up approximately 10 shifts per week. They again are less expensive, but have more availability to pick up open shifts when needed.

    Your QAS works 1-2 shifts/week. This allows them to do QAS duties including chart-reviews while on the floor, keeping integrity hours down, and ensuring quality is being kept.

    Your CS works 2 shifts/week. This allows them to be there at the beginning of the week, address any problems/concerns, and also keeps them open for other duties. This allows them to be on the floor during “normal business hours” to address any concerns from administration, and also allows them to keep a good pulse on their program without getting overworked. This also keeps cost down significantly only having them work 2 shifts/week because just like the QAS, they can do other tasks while on the floor like making the schedule.

    Rama Aysola, M.D.

    Thank you for your answer Adam! I will not say this is a correct or incorrect, so as not to give hints to any other participants. I would like to keep the post open for about 10 more days for other submissions.


    Michael Melnick
    Regional Manager

    Hi Rama,

    I’m going to view this as a site I just took over from another SPL/RM so I think a restructure.  This is a bit tricky.  Given that the shifts are 8 hours long and I have two full time scribes, that means that they have to work 36 hours each, which is 4.5 shifts, in order to keep their FT status.  If we split a day between them, that would work.  Ideally I wouldn’t have any FT status staff here, but I would make it so that my part timers were able to work 3-4 shifts or 2-3 shifts per week.  I don’t want to take shifts from them so they lose their benefits, but I don’t want to back-fill a full time position, because it paints us into a corner.

    While it is fine in the short term, long term this site has too many trainers.  With the CS, QAS, and x2 FT, that is 4 trainers.  Per the Quantity of Floor Trainers policy, a staff with only 12 scribes only qualifies for 3 trainers (which includes the CS and QAS).

    Since we are only staffing 24 hours per day, we do not qualify for a QAS per the QAS and QAM promotion parameters so something has to change here.

    Assuming the CS is in school, I think it would be ok if they only worked 4-5 clinical shifts per month, as long as s/he was able to do a few shadow half-shifts throughout the month.  For a site that has 24 hours per day, we have about 21 or so hours per month to play with for integrity time.  Assuming 1 hour for CSMR, 1 for the schedule, 1-2 for emails, that still leaves us with 17 hours to play with, or 4 half days, which is perfect.

    Look at the trainers and the QAS and evaluate them for who truly is the best and/or is training.  Just because we qualify for 3 trainers doesn’t mean we NEED trainers.  I would demote the FT to regular scribe, but give them, say, a 50 cent decrease in pay.  Demote the QAS to a Trainer at $11/hr.  S/he doesn’t have to do QA anymore, but would still be expected to help others in need when the CS is not there.

    Another option:  We are “horribly” overstaffed here.  To the tune of 152%.  While that is great for a large site, this isn’t one.  Do I have any TJPL or JPL candidates here?  Let’s look at that QAS and the trainers:  Can any of them be cross-trained and loaned out to a nearby program?  Maybe an OP program?  That would take some of the scheduling burden off of my back and get them their hours.  I could justify keeping their current pay by cross training them, but the QAS position needs to go either way.

    Third option: Trim the fat.  There are usually 1-2 scribes who just…aren’t as good.  Either make them better through remedial training or get them out.

    I didn’t quite answer it the way you were looking for I think, but I didn’t like the parameters I was given, so I won’t accept them.  It’s my site (as owner) and I need to make it profitable, so I need to make some tough and creative choices here.  Getting rid of the FT burden (PTO and insurance) saves money ($400 each for PTO and no clue on insurance costs), losing the QAS pay rate saves about $1250 per year in salary at 3 shifts per week.  Not counting the insurance, it just saved us over $2,000/yr just by eliminating the QAS and FT positions, and cross-training scribes to another site ensures that we both won’t have OT or open shifts..


    Michael Melnick
    Regional Manager

    After the MW call on Tuesday, I’d say you were looking for more of a 70% scribes, 30% leadership as an answer though…

    Rama Aysola, M.D.

    Thanks for the submissions. Great thought exercise and what we are looking for is optimizing coverage of shifts by our lowest cost labor force – scribes, while still retaining quality and hours for management of the site. Great insights!

    70% scribe coverage is a great goal to shoot for!


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