Home Practice Management
Hospitalist Staffing Requirements
Determining staffing requirements can seem to be a complex issue, and
each site can have different workforce needs. But there is also enough
similarity among programs that you probably will not have to reinvent
the wheel. There are formulas for determining staffing needs and plenty
of models around to look at and build on. Many consultants offer their
own. In general, staffing needs to allow for enough time to see each
patient approximately twice a day. In practice some patients may need to
be seen only once daily, but others may need more frequent visits. In
addition, staffing needs should take into consideration enough time to
do appropriate admissions/discharges, review ancillary data, meet with
family members, communicate with primary care doctors and other
referring doctors, and to complete paperwork.
I. Some general advice
All hospitalist programs need to answer these questions before they
can move onto the nittygritty of determining how many fulltime
equivalent physicians (FTEs) they will need.
A. What does the practice want to accomplish? Does it want to provide
24 hour coverage, seven days a week, 365 days a year? Or does it just
plan to cover days? Or nights? Or weekends and holidays?
B. Know your community. Know your referral sources and your
competition. Who else sees hospitalized patients at your hospital? How
are ER admissions handled? What is the acceptance of primary care groups
in town? What are the policies of your major insurance companies and
HMOs? Are there any limitations (insurance coverage, privileges) on your
ability to accept all patients referred to you?
C. Will the hospitalists have duties other than seeing patients, such
as teaching, taking outpatient rotations, or doing hospital
administration? Will you be responsible for case management or for
staffing hospital committees (e.g. P&T, UR, QA, Patient Safety)
D. Are there seasonal issues in your community that would affect
demand for hospitaListserveices? For example, is there a big influx of
seniors to your town in the winter, or exodus in the summer? Does the
flu season lead to an increased number of admissions in the winter
months?
E. What are your preferences for scheduling?
10hour or 12hour shifts? Fiveday or 14day shifts?
F. How will salaries be determined, and if not simply by the
individual's billings, how much are you willing to payincluding
benefits and how will the group earn enough money to cover the staffing
expense.
II. Specific models
There have been several presentations nationally concerning staffing
analysis. Below you will find a sampling of three different approaches
to establishing staffing needs for a hospitalist program.
A. Nelson Model
To utilize this model you will:
 Need to Know: Total Number of Annual Admissions and Consults your
hospitalist practice will handle
 Need to Assume: Each hospitalist has a daily census of 10 patients
and average length of stay (LOS) is 4.8 days per patient
This strategy starts by determining the workload one hospitalist can
do. As detailed by Dr. John Nelson, cofounder of SHM, at a 1998 meeting
in Scottsdale, Ariz., begin by assuming that the average census is 10
patients per hospitalist, each with an average length of stay (ALOS) of
4.8 days. If you presume that work will be performed 365 days a year,
this means one hospitalist can accomplish approximately 760
admissions/consultations per year.
The next step is getting the total number of admissions/consultations
for the year and then dividing that figure by 760 to learn how many FTEs
would be required. (See Expected Volumes section in Starting a
Hospitalist Program in another section of the Resource Center.) Since
the denominator of 760 would be lower if someone other than a
hospitalist is responsible for night and weekend admissions, Dr. Nelson
recommends dividing the admissions/consults annually by 500800 to give
a range of FTE required to provide sevenday/week coverage.
A sample staffing calculation:
 Admissions: 3,000
 ALOS: 4.8 days
 Each hospitalist handles 760 admissions/consultations per year
 3000 admissions/760= 3.95 FTEs
 Rounding this up=4 FTEs
 If each hospitalists handled 600 admissions/consultations per year,
then 3000/600= 5 FTEs
B. Wachter/Lurie Model
To utilize this model you will:
 Need to Know: Total Number of Annual Admissions and Consults your
hospitalist practice will handle and the average length of stay
(LOS)
 Need to Assume: Each hospitalist has a daily census of 10
patients
Another staffing strategy appeared in Effective Clinical Practice
(vol. 2 #3,1999). (add link to fulltext of article) Drs. Jon Lurie and
Robert Wachter calculated the number of hospitalists needed on the basis
of annual admissions and average length of stay. They then converted the
admissions and ALOS numbers into an average daily census by using the
following formula: annual admissions x length of stay/ 365 days = number
of patients/day
They then calculated the number of hospitalists needed by dividing
the average daily census by the number of patients per hospitalist. To
this number (rounded up to nearest FTE), they would add one additional
hospitalist if night and weekend coverage is needed.
 A sample staffing calculation:
 Admissions: 3,000
 ALOS: 4.5 days
 Average census: 3,000 x 4.5/365 = 37 patients/day
 Assume 10 patients per hospitalist = 3.7 hospitalists needed
 Add one additional hospitalist to help with nights and weekends =
4.7 FTEs needed
Round off = 5 hospitalists needed to cover this service load
C. Hoffey Model
To utilize this model you will:
 Need to Know: Total Number of Annual Admissions and Consults your
hospitalist practice will handle
 Need to Assume: Each hospitalist works 5 days per week, 46 weeks per
year, has a 10 hour work day, and spends 2,56 clinical hours per
admission or consultation
This strategy starts with a model of how hospitalists realistically
schedule their work. William Hoffey, Ph.D., a consultant to
hospitalists, assumes that one FTE physician works 5 days per week and
46 weeks per year for a total of 230 workdays per year per hospitalist.
His model also assumes that each physician has a 10hour workday but
that only 6.57.5 hours are spent providing direct clinical care for a
total of 1,610 hours of clinical care provided by one FTE hospitalist
per year
If each FTE hospitalist spends 2.56 clinical hours per admission or
consult (his firm's estimation), he determines the staffing requirement
by taking the total number of admissions/consults per year, multiplying
that figure by 2.56 and then dividing that total by 1,610.
A sample staffing calculation using this method would be:
 Assume Admissions and Consultations of 3000/year
 Assume 2.56 clinical hours per case
 3000 X 2.56= 7680 clinical hours of work needed
 Assume each hospitalists hours works as listed above
 5 days X 46 weeks X 7 hours= 1610 clinical hours per year
 7680/1610= 4.77 FTEs needed for 3000 admissions
Rounded off to 5 FTE
