Urgent Care Staffing: Models, Tips, and Strategies for Optimal Returns

Urgent care staffing plays a significant role in the success of your business — whether that’s leveraging the best staffing model for visit volume, training for better billing and patient engagement, or even just knowing whom to hire and how to find them.

We’ll start by looking at some staffing models that can keep you right-sized, and then go into roles, training, and hiring tips.

Urgent Care Staffing Models

Unlike a hospital system that hires specialized labor for different tasks (e.g., RTs for x-rays and lab technicians/phlebotomists for blood draws,) urgent cares need to consider how they can operate with the fewest staff members possible based on visit volume. That means cross-training, training up, and practicing at the top of a license.

But you also need to know your historical visit volume data to make the best decisions. What’s best for you won’t necessarily match what works for other clinics. And your state laws will dictate how you can best leverage a single person for multiple duties.

Right-Sized Based on Feet Through Door

Our President of Consulting, Alan Ayers, notes that labor costs are the greatest expense in urgent care, so a profitable center will adjust its staffing levels to revenue. To do so, he advises using the same metric driving waiting times to configure your staffing model:

Patients per hour per provider (P/H/P)

This has you start with your highest labor cost – providers – and build from there so that your patients can be seen in a timely manner, but you’re not overstaffing your most expensive labor.

Urgent Care Staffing Ratios

You have your data, now how do you use it to schedule staff? Ayers offers this general guidance:

1 Provider = 4 patients per hour (1 every 15 minutes)
1 Front Desk = 4 patients per hour (1 every 15 minutes)
1 MA/RT = 2 patients per hour (1 every 30 minutes)

So, an optimized center might have: 1 provider, 2 MAs, an MA/RT and front office staff. Covering all duties with such a lean staff means leveraging things like cross-training the front and back office and enabling a “bench” of on-call, travel, flexi or PRN staff to fill in as needed.

With this model, a provider maxes out over a 12-hour shift at about 50 patients per day. Note that this means a center seeing 65 patients will be less profitable than one seeing 50 patients because when adding a second provider, the productivity of both providers falls. We offer some ideas on how to close that gap in the next section “Cross-training and Backfilling.”

For fewer than 20 patients per day, many urgent cares can get by with a 1:1 staffing model, at least at slower times. Let’s look at some ways to make these models happen without compromising the patient experience.

Cross-training and Backfilling

When running a lean team, you want to ensure you’re not turning away patients you could normally treat because you don’t have someone qualified enough to treat them.

One of the first things you should do is make sure everyone practices at the top of their license. Ayers offers this guidance:

NPs/PAs instead of MDs
MAs instead of RTs
Basic/limited x-ray instead of RTs

This will help you fill more gaps and accomplish more with fewer people. We’ll break this down a bit based on specific needs.

Providers

Provider duties are trickier, but most important to cover on a lean staff, especially if — like some urgent cares — you don’t always have a physician onsite. This is becoming more common, as this JUCM article shows “The centers in which PAs and NPs work without a physician on site at all times has increased dramatically, however, with a corresponding reduction in the percentage of UCCs in which a physician is always on site to supervise PAs and NPs.”

Furthermore, another JUCM article leans on the expertise of Ayers, who “points to the capabilities of advanced practice providers as one rationale some urgent care operators use when opting to stay open for business when a physician isn’t present. You could even go a step further and make the argument that the degree of direct care provided by APPs is one thing that distinguishes urgent care from other settings.”

It continues on to discuss PAs:

“One study of the role physician assistants play in various practice settings revealed that urgent care PAs are entrusted with direct patient care to a greater degree than their peers in emergency medicine, primary care, retail, and student health centers. The graph compares the proportion of PAs who perform procedures (eg, suturing, incision and drainage) in various settings.”

So there are opportunities to train up so that you can rely on fewer MDs. But there is a caveat: plans that require full credentialing don’t have an option for temporary credentialing, so you need to be careful about who is doing what.

Cross-training

As for the rest of the staff, cross-training is key to operating with a right-sized staff. That means not only training MAs on front desk duties, or certifying them to perform some clinical functions normally executed by an RN — but also having the provider take vitals, draw blood, run rapid tests, and in some states, take x-ray.

In fact, JUCM helps define who can take x-rays in which state in their article, “What Qualifies Someone to Take X-Rays in the Urgent Care Center? It All Depends on Where You’re Located.” Note that this is from 2022, and you should ALWAYS check current laws and regulations before taking action.

We also recommend reading this helpful article about how to best leverage your MAs: “Cost-Effective Staffing With Medical Assistants.”

Run Leaner and More Efficiently With Technology as an Employee

So often staff takes on tasks that could be automated — either through integrations within the tech stack or even having patients complete some of the work. Having patients do some of the work (e.g. online pre-registration,) means forms are filled out more accurately and wait time is cut down. Additionally, they’re doing it for free — which they’re used to doing through apps, self-check-out, and more. So you can eliminate a lot of time-consuming steps by handing off manual data entry to patients with technology.

Your tech should also eliminate other non-value-add tasks like duplicative entries, payment reminders, and any other process that do not need to be repeated every visit (e.g., asking for a credit card.) Technology doesn’t just improve speed and accuracy; it truly acts as an employee who takes care of time-consuming, monotonous tasks so the rest of your staff can focus on what matters most.

Here are just a few examples of how your technology can ease staff responsibilities:

Patient engagement tools automate online pre-registration, post visit surveys, and other reputation management activities. Preregistration alone saves an average of four minutes per patient
Your PM should have real time verification for insurance, credit card on file, SMS text reminders for balance due (also reducing paper statements), and coding recommendations to improve the accuracy of claims
Same-time documentation functionality that allows more than one person in the patient chart can save valuable time and ensure charts are completed daily
Integrations between PE, EMR and PM reduce duplicate entry

Learn more about an integrated system purpose-built for urgent care here >>

Position Yourself for More Patients From the Start

Before we jump into training and hiring tips, there is something else that should be top of mind as you staff your clinic(s.) We’ve talked a lot about the degrading scope of practice in urgent care, and how taking higher-acuity patients can help you increase your revenue.

If you’re building out training plans right now, anyway, fold in whatever is needed to increase your acuity and position yourself for more patients from the beginning. Here are some examples of higher acuity cases you should be able to treat:

Risk stratification of high-risk complaints like chest pain (history/physical/EKG/chest Xray)
Abdominal pain (history/physical/UA/labs)
Shortness of breath (history/physical /chest Xray /labs)
Head trauma (history/physical)
Syncope/dizziness (history/physical /blood sugar check/EKG)
Wound management and laceration repair
Abscess Incision and drainage
Eye injuries and irrigation
Severe nose bleeds (nasal packing placement)
Allergic reactions (Epinephrin administration)
Evaluation/Xray and splinting of sprains/strains/fractures
Advanced respiratory support for asthma and COPD (O2 therapy, nebulizer, medications)
IV therapy for dehydration, infections, migraines

There is excellent data provided around this in the JUCM article, “How Urgent Care Can Address its Degrading Scope of Practice”

Hiring and Interviewing Urgent Care Staff

Startups might have the greatest burden to bear when it comes to staffing, but those of us who’ve been through the pandemic know that things like labor shortages can not only happen, but sorely impact your business.

There’s also higher turnaround in some positions, especially like RNs who leave in pursuit of higher-paying positions or advanced credentials. So challenges around staffing don’t stop when you’ve staffed for volume. Filling your roster can be an ongoing process that few people have time for.

We’ll cover some tips on your hiring strategy to help you better refine your search and fill roles, and we’ll detail some interview tips to find the right people for your patients’ first point of contact, the front desk.

Hiring Strategy

No matter how efficient you make your existing team(s), your hiring efforts are likely to remain ongoing. This can be frustrating and time-consuming. By optimizing the way you go about hiring, you can shave some time off the process and also sift through fewer applicants who are not a fit.

Here are some tips from our H ow to Operate Your Urgent Care in an Understaffed Environment webinar to help you improve your hiring strategy, even when you’re not critically understaffed.

Hire cost-effective staff to increase productivity

Adding lower-cost positions to take on some of the work that bottlenecks the patient journey can make your overall clinic more efficient. For example, an extra front desk representative can help you expedite the registration process — which reduces wait time and improves the patient experience. Consider what positions you can fill that will help others do their jobs.

Hire students who are about to graduate

Externships can be a win-win situation when you find a student who is a great fit for your clinic. They’re typically unpaid, and if they’re good, you can hire them when they graduate. They’ll require less training than other new hires. And while they can’t perform certain tasks unsupervised, simply having an extra person relieves stress for the rest of the staff. Have them contribute in whatever way is most helpful, including registration or other patient engagement responsibilities.

Choose job boards wisely

Posting open positions to sites like Indeed helps you cast a wider net, but also help you weed out candidates you do not want. You’re able to set certain filters for better candidates. On Indeed, that includes “dealbreakers” — so if someone does not have a necessary license or certification, for example, that applicant won’t make it to your inbox.

Respond to applicants quickly

Your applicants are in high demand. A good candidate probably has a number of choices; get with them immediately so they don’t move on before you get a chance to speak with them. Having a person dedicated to reaching out or simply an allotted time to correspond with applicants can help you respond faster.

Interviewing Tips

Your interview strategy will change based on the roles you need to fill, your team culture, and state regulations. But one of the more challenging roles that most urgent cares need to fill is front desk personnel.

These people are paid the least, but relied on the most for the patient experience, dealing with dissatisfied patients, accuracy of claims, and more. it’s very important to hire the right people for this role. We cover this more in-depth in our blog 5 Essential Qualities of Front Office Staff & How to Interview for Them, but here are a few characteristics to look for and how to flush them out.

They can handle multiple responsibilities efficiently