Chapter VII ▪ Business Planning
National Association of Community Health Centers 46
The other method for determining optimum staffing is to estimate the number of encounters to be demanded
by the patient group, and divide that number by the average annual productivity for the type of primary care
provider. According to the Medical Group Management Association (MGMA) (www.mgma.com), on average,
primary care providers generate the following:
Specialty Average Annual
[MGMA] Ambulatory Encounters
Family Practice without OB 4,300-4,400
Family Practice with OB 4,500-4,700
Internal Medicine (General) 3,600-3,700
Pediatrics (General) 4,800-5,000
Obstetrics/Gynecology 3,200-3,300
Physician Assistant 3,400
Advanced Practice Nurse 2,800
Certified Nurse Midwife 1,700
These encounters do not include hospital visits or surgery. Planners should be mindful that currently the mini-
mum Medicare cost-reporting productivity benchmark as a FQHC is 4,200 ambulatory encounters per year
per full-time physician and 2,100 encounters per year per full-time mid-level provider (or 6,300 per team of 1.0
physician and 1.0 mid-level—note that mid-level providers are usually factored as one-half of a physician FTE
for productivity and compensation). Some states have adopted minimum productivity standards for Medicaid
as well. The state PCA can provide this information.
It is important to determine the “provider model” in order to accurately project the number of providers needed,
e.g., Family Practice providing Pediatric and Obstetric services, Family Practice providing adult and no Ob-
stetric services, Internal Medicine providing adult services and with mid-level providers, etc. Note that some
Internal Medicine physicians are also trained in the area of Pediatrics and others can be trained with an em-
phasis on primary care. Some health centers with large elderly populations are also employing the services of
Gerontologists to meet the special health and chronic medical needs of persons over age 65. State PCAs can
also provide health center data on numbers of patients and encounters per full-time equivalent provider.
2) Estimate providers’ compensation packages -- Good reference sources to obtain current information in-
clude local hospitals, MGMA, state/ regional PCAs, and NACHC. Competition for primary care providers is
intense, and wages, salaries and fringe benefit packages are constantly being enhanced to support recruitment
and retention efforts. Health center leadership must consider base salary, incentive and possibly sign-on or
relocation bonuses, loan repayment, and fringe benefit (often exceeding 20% of salary) packages that provide
an ample allowance for Continuing Professional Education (including travel) for physicians and midlevels. Fed-
eral, state and local taxes, group insurance (life, health, dental, disability) plans and retirement contributions
represent the major non-salary staff costs. Available health center data indicate that provider compensation
represents on average 30%-35% of total operating expenses.
3) Estimate clinical and administrative (including management) support staff -Typically, support staff is
budgeted based on the number of full-time equivalent providers that they will be required to assist. The number
of support staff per FTE provider (with mid-levels factored a .50) can vary based on the range of services of-
fered by the health center, i.e., those with a laboratory, radiology and pharmacy service will have more support
staff. Planners should contact other health centers, health center practice management networks where they
exist, refer to MGMA, and the state/ regional PCAs and NACHC for comparable data. In the year 2009, the
BPHC reported 2.4 clinical and 2.9 administrative (including facility) support staff per each 1.0 FTE provider.
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4) Determine support staff compensation: salaries/wages and fringe benefits for support staff should be
based on actual average wage rates (and typical fringe benefit plans) in the local area or job market and region-
al data for positions not represented in the local area—NACHC and many state/regional PCAs also conduct
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Clinical support staff was defined as patient support staff. Administrative includes management and support, IT, facility, and fiscal and billing staff.
The 2009 UDS had subcategories for administrative staff. Providers include only physicians.