Properly Structuring and Paying Your Staff

One of the most important tasks in a practice is to assemble the right team members in the right jobs. The person who holds the job of the practice bookkeeper must be a person who is detail oriented. The person who holds the position of optician, in addition to also being a detailed person, must also be a people-oriented person.

What happens when we don’t get the right people in the right jobs? Bad things happen. The number one reason why patients leave a practice is because they’ve had a negative interaction with a team member. Patients will even say when they leave the practice, “I love the doctor, but I’m not coming back because of your receptionist.”

So how do we get the right people in the right jobs? Start by defining the work. Create a flowchart describing how a patient moves through your practice. A good way to do this is to identify every place a patient stops on their journey through your practice. At that stopping place, something happens that usually requires a team member. That flowchart could look like this.

Don’t forget to identify the other jobs that need to occur simultaneously in order for the practice to function smoothly. Jobs such as these:

Now define what you want from the Team member at each step. It may look like this.

Pre-Appointment Communication

  • confirmation of appointment date and time
  • patient demographic information
  • identification of the reason for the visit (medical exam versus nonmedical exam)
  • clarification for how the examination will be paid
  • third-party precertification when indicated


  • make the patient feel comfortable
  • confirm third-party precertification is accessible in the patient record
  • completion of patient history information
  • manage communications going into and out of the practice
  • successful transfer to the pre-tester


  • accurate pre-test report results recorded properly
  • discuss with patient and record in the patient notes additional care that may be needed today
  • manage testing to keep the doctor on time


  • identification of all solutions that will improve the patient’s quality of life
  • agreement from patients to follow the doctor’s treatment plan
  • prescribe the recall for the patient
  • successful transfer to auxiliary testing or to the optician

Auxiliary testing

  • accurate auxiliary testing results recorded properly
  • assist in helping each patient follow the doctor’s treatment plan


  • assist in helping each patient follow the doctor’s treatment plan
  • manage the frame board
  • contact lens education
  • handle any objections to the fee presentation

Check out

  • collect all fees due today
  • restate the recall information to the patient

Third-party billing

  • accurately submit third-party billing


  • accounts receivable less than 10 percent of gross revenue collected
  • nothing in accounts receivable over 60 day sold
  • all bills paid promptly
  • accurate paper record of all financial dealings


  • patients seen, goal is achieved


  • new patient goal is met
  • patients purchasing additional services and products, goal is met

Office Manager

  • the practice is fiscally healthy
  • all team members are achieving their goals
  • every job in the practice written up

Now that we know what work must be done in the practice, the next two activities are to determine how many team members are needed and what to pay them. Both of these activities are interrelated. 

How Much Money is Available for Hiring?
Start with how much money is available to hire the practice team. Practice benchmarks for non-doctor team members is 20-22 percent of gross revenue collected. For a practice with a gross revenue collected of $1 million, that means the practice has between $200,000 and $220,000 to hire non-doctor team members.

There are several websites that give insight into how much you should pay your team. Examples of these would be,,, and The Bureau of Labor Statistics maintains a government-run website that lists salaries for typical jobs but tends to run one to two years behind. Most of these websites give ranges of salaries for particular jobs, which is helpful information.

Use an Excel spreadsheet to document what each team member is being paid and your total payroll.

Team Member NamePositionWageBonusBenefitTotal
Practice Director
Office Manager
Chair-side Assistant
Auxiliary Tester
Check Out
Third-party Billing
Total Payroll
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