Healthcare Services Growth

Provider productivity is the most uncomfortable topic in healthcare. Say it wrong and you sound like you're treating physicians like assembly line workers. Say it right and you're having a conversation about sustainable practice growth that benefits everyone.

Here's what makes this conversation necessary: Most providers could see 20-30% more patients without working longer hours or sacrificing care quality. That untapped capacity is hidden in workflow inefficiencies, poor technology utilization, and inadequate support staff leverage.

But here's what makes it complicated: The push for productivity is also burning out providers at unprecedented rates. The last thing healthcare needs is more pressure to see more patients faster.

The solution isn't choosing between productivity and wellbeing. It's understanding that real productivity improvements come from removing barriers and frustrations, not from pushing harder.

The Productivity Balance: Efficiency, Quality, and Wellbeing

Before we talk about metrics and benchmarks, let's establish what provider productivity actually means in a healthy practice context.

It's not: Seeing as many patients as physically possible regardless of outcomes or provider satisfaction.

It is: Maximizing value creation per unit of provider time while maintaining quality and preventing burnout.

That definition matters because it shifts the focus from "how many" to "how effectively." A provider seeing 25 patients per day while documenting until midnight and missing their kid's soccer games isn't productive—they're on a path to burnout and departure.

A provider seeing 20 patients per day, finishing documentation by 5pm, and delivering consistently high-quality care? That's sustainable productivity worth optimizing.

The goal isn't just more patients. It's better utilization of provider expertise, less time on non-value activities, and improved practice economics without sacrificing what makes healthcare meaningful.

Productivity Metrics That Actually Matter

You can't improve what you don't measure. But measuring the wrong things creates the wrong incentives.

Patients Per Day/Session

This is the most obvious metric but also the most easily misinterpreted.

Calculate it simply: Total patients seen ÷ Number of clinical sessions

A session is typically a half-day block (3-4 hours of patient-facing time). Some specialties work in full-day blocks, others in hourly increments.

What's good?

Primary care: 15-25 patients per full day
Specialty consultation: 12-18 patients per full day
Procedures-heavy specialty: 8-15 patients per full day

But raw patient count ignores case complexity. A cardiologist seeing 15 complex heart failure patients is more productive than one seeing 20 straightforward hypertension follow-ups, even though the numbers suggest otherwise.

RVUs or Production Per Day

Relative Value Units (RVUs) adjust for complexity and time by weighting different services based on resources required.

Work RVUs measure physician work involved in a service. A complex E&M visit might be 2.5 RVUs while a simple follow-up is 0.75 RVUs.

Calculate productivity as: Total wRVUs ÷ Number of clinical FTEs

Specialty benchmarks vary widely:

Primary care: 4,500-6,000 wRVUs per FTE annually
Internal medicine: 5,000-6,500 wRVUs per FTE annually
Cardiology: 5,500-7,000 wRVUs per FTE annually

Organizations like MGMA (Medical Group Management Association) provide comprehensive wRVU benchmarks by specialty.

For practices not using RVUs, production (total charges generated) works similarly:

Total charges ÷ Number of clinical FTEs

This gives you a revenue-adjusted productivity measure that accounts for service mix.

Revenue Per Provider

The bottom line metric: Total collections ÷ Number of providers

This accounts for both volume and reimbursement mix. A provider might see fewer patients but generate more revenue through procedure mix or payer mix.

Analyze this monthly and annually:

Is revenue per provider increasing or decreasing?
How does each provider compare to practice average?
What explains significant variations?

Don't stop at the total. Break it down:

Revenue per patient visit
Revenue per hour of clinical time
Revenue by service category

These breakdowns reveal optimization opportunities raw totals hide.

Time Per Patient

Sometimes productivity issues stem from appointments running too long, not from scheduling too few patients.

Track actual time spent with patients by appointment type:

New patient comprehensive: Target 45-60 minutes, actual?
Follow-up visit: Target 15-20 minutes, actual?
Procedure visit: Target 30-40 minutes, actual?

If appointments consistently run over scheduled time, you have three options:

Lengthen scheduled appointment times (reduces capacity but improves workflow)
Improve efficiency to meet scheduled times (maintains capacity)
Adjust what happens during appointments (delegate to support staff)

Option 2 and 3 are where real productivity gains happen.

Benchmarking and Standards

Numbers without context are meaningless. You need benchmarks to know whether your productivity is excellent, average, or concerning.

Specialty-Specific Benchmarks

Different specialties have vastly different productivity expectations. Primary care physicians seeing 20 patients per day are average. Interventional radiologists seeing 20 patients per day are extraordinarily productive.

Resources for specialty benchmarks:

MGMA (Medical Group Management Association) DataDive
AMGA (American Medical Group Association)
Specialty-specific societies (AAP, ACC, ACR, etc.)
Regional healthcare networks

Key metrics to benchmark:

Patients per provider per day
wRVUs per FTE
Gross charges per provider
Net collections per provider

Look at both mean and median. If median wRVUs are 5,200 but mean is 5,800, that suggests a few highly productive providers pulling the average up.

Internal Comparison

Your own practice data is often more useful than external benchmarks because it controls for patient population, payer mix, and practice patterns.

Compare providers within your practice:

Why does Dr. Smith see 22 patients per day while Dr. Jones sees 16?
Why does Dr. Brown generate $15K per week while Dr. White generates $11K?

Sometimes variations reflect legitimate differences (different specialties within group, different patient populations). Sometimes they reveal template problems, scheduling inefficiencies, or workflow issues that can be addressed.

The goal isn't making everyone identical. It's understanding variation so you can identify and spread best practices.

Improvement Targets

Once you understand current state and benchmarks, set realistic improvement targets.

Conservative approach: Improve by 5-10% annually Aggressive approach: Improve by 15-20% through major workflow redesign

Example: Practice currently at 5,000 wRVUs per provider per year

Conservative target: 5,250-5,500 (5-10% improvement)
Aggressive target: 5,750-6,000 (15-20% improvement)

Break annual targets into quarterly milestones. Productivity improvements take time to materialize as you implement workflow changes and build new habits.

Fair Measurement

Productivity measurement must account for factors beyond provider control:

Schedule availability: Provider with 3.5 days of clinical time can't match productivity of provider with 4.5 days, all else equal.

Patient population: Provider seeing predominantly complex Medicare patients won't match volume of provider seeing straightforward commercial patients.

Scope of practice: Provider doing procedures generates higher revenue per patient but sees fewer patients.

Administrative responsibilities: Medical director or department chair role reduces clinical productivity for legitimate reasons.

Adjust expectations accordingly. Raw metrics without context create unfair comparisons and resentment.

Workflow Optimization

Most productivity improvements come from workflow redesign, not asking providers to work faster.

Pre-Visit Preparation

Support staff can complete much of the preparatory work before the provider enters the room:

Chart review: MA or nurse reviews upcoming patients, flags issues, prepares relevant records.

Standing orders: Pre-visit labs or diagnostic tests ordered based on visit reason and protocols.

Medication reconciliation: Initial pass completed by support staff, provider verifies.

Screening questionnaires: Patients complete health risk assessments, review of systems, or condition-specific tools before visit.

This front-loaded preparation means providers walk into rooms with context and preliminary information, reducing time spent on administrative data gathering.

One family practice reported saving 3-5 minutes per visit through systematic pre-visit prep. Over 20 patients per day, that's 60-100 minutes—enough time for 3-5 additional patients without extending hours.

Rooming Efficiency

Time between when one patient leaves and the next enters is pure waste.

Optimize through:

Parallel processing: While provider sees patient in Room 1, MA rooms next patient in Room 2.

Room turnover protocols: Clear process for who cleans, restocks, and prepares each room.

Equipment positioning: Frequently used supplies and equipment positioned for easy access.

Communication systems: Staff communication (Teams, Slack, pager) that notifies provider immediately when next patient is ready.

Goal: Zero minutes of provider idle time waiting for next patient.

Documentation Strategies

Documentation burden is the #1 productivity killer and burnout contributor.

Strategies that work:

Templates and dot phrases: Pre-built text for common scenarios that providers customize.

Voice recognition: Real-time dictation that creates draft notes as provider talks.

Scribes (human or AI): Dedicated documentation support that allows providers to focus on patient interaction.

Documentation during visit: Complete note while with patient rather than saving for later. This is controversial (some patients feel ignored) but reduces after-hours work.

Batch documentation time: Block 30-60 minutes at end of session specifically for finishing notes rather than letting them pile up.

The specific strategy matters less than having a strategy. Providers who finish documentation the same day report higher satisfaction and better work-life balance than those who let notes accumulate.

Support Staff Utilization

Your schedule optimization efforts multiply when support staff handle everything that doesn't require provider-level expertise.

Tasks to delegate:

Medication refills (within protocols)
Referral coordination and prior authorizations
Patient education using standard materials
Test result communication (normal results)
Chronic disease monitoring (within protocols)

This isn't cutting corners. It's appropriate scope-of-practice allocation. MAs, RNs, and LPNs are trained for these tasks. Using providers for them is inefficient and expensive.

Technology Enablers

Technology should enhance productivity, not hinder it. Unfortunately, many practices experience the opposite.

EHR Optimization

Your EHR/EMR selection & optimization efforts directly impact productivity.

High-impact optimization opportunities:

Smart sets and order panels: One-click order sets for common scenarios (diabetes follow-up, hypertension management, annual physical).

Custom templates: Note templates that match your documentation style and specialty needs.

Favorites lists: Frequently prescribed medications, common diagnoses, preferred labs in easy-access lists.

Macros and shortcuts: Text expansion for phrases you type repeatedly.

Mobile optimization: Tablet or smartphone access for reviewing charts and entering notes between patients.

Most practices use about 30% of their EHR's capability. Investing time in optimization training pays dividends daily.

Scribes and Documentation Support

Medical scribes—human or AI-powered—can dramatically improve provider productivity and satisfaction.

Human scribes:

In-person or virtual
Document in real-time during patient visit
Typically increase provider productivity 10-20%
Cost $15-25/hour for in-person, $20-30/hour for virtual

AI scribes (ambient documentation):

Record and transcribe patient visit
Generate structured note using AI
Provider reviews and edits
Monthly subscription model ($300-600/provider)

ROI calculation: If a scribe costs $40,000 annually and enables a provider to see 2 additional patients per day, that's roughly 500 additional visits annually. At $100 average reimbursement, that's $50,000 in additional revenue—a clear positive return.

Beyond revenue, providers report significantly reduced burnout and improved work-life balance when freed from documentation burden.

Order Sets and Templates

Standardization speeds decisions without sacrificing quality.

Condition-based order sets:

CHF exacerbation: Standard labs, medications, follow-up
Diabetes management: A1C, foot exam, retinal screening
Preventive care by age: Appropriate screenings and counseling

Procedure templates:

Pre-procedure orders and instructions
Post-procedure care and follow-up
Complication monitoring protocols

Documentation templates:

Chief complaint-specific history templates
Procedure note templates
Counseling and education documentation

Building these collaboratively (providers + nursing + quality team) ensures they reflect current evidence and actual workflow.

Mobile Access

Providers don't work only from their desks. Mobile access to patient information and documentation improves workflow:

Reviewing charts between patients
Responding to messages during breaks
Checking test results
Entering quick notes or orders

Mobile-optimized EHR interfaces make these tasks efficient rather than frustrating.

Support Staff Leverage

The providers generating highest productivity almost always have the best support staff utilization.

MA and Nurse Protocols

Standing orders and protocols allow MAs and nurses to act independently within defined parameters:

Chronic disease management protocols:

Blood pressure management algorithm
Diabetes monitoring and medication adjustment
Asthma action plans

Preventive care protocols:

Age and gender-appropriate screening orders
Vaccination catch-up protocols
Health maintenance reminders

Triage protocols:

Which symptoms require same-day appointments
Which can wait for next available
Which require immediate provider contact

Clear protocols reduce "Can I ask the doctor?" interruptions while ensuring safe, high-quality care.

Task Delegation

Map every task in your workflow and ask: "What's the minimum credential level required for this task?"

Many practices discover providers doing tasks that MAs, nurses, or administrative staff could handle:

Scheduling follow-up appointments
Completing routine forms
Calling pharmacies for clarifications
Explaining billing or insurance issues

Create standard operating procedures defining who handles what. Train staff appropriately. Monitor adherence.

Team-Based Care Models

Advanced team-based care assigns specific roles to each team member:

Provider: Diagnosis, treatment decisions, complex counseling RN/LPN: Care management, patient education, protocol-based treatment adjustments MA: Rooming, vitals, point-of-care testing, medication reconciliation Admin: Scheduling, insurance verification, care coordination

Everyone works at top of license. No one does tasks below their capability level (except when truly necessary). This approach to team structure & delegation maximizes both efficiency and satisfaction.

This model requires more upfront investment in staff training & development but generates significant productivity improvements.

Cross-Training

Cross-training creates flexibility:

MAs who can also handle phones during high call volume
Front desk staff who can room patients when needed
Nurses who can cover for each other across different provider teams

This prevents productivity drops when key staff are absent and smooths workflow during demand surges.

Burnout Prevention: Sustainable Productivity

None of this matters if providers burn out and leave. Sustainable productivity requires protecting provider wellbeing.

Sustainable Productivity

Research consistently shows productivity-wellbeing balance through:

Autonomy: Providers have input on schedules, templates, and workflow design.

Control over pace: Ability to adjust when running behind rather than relentless pressure to stay on time.

Reasonable expectations: Productivity targets based on benchmarks, not arbitrary demands.

Adequate support: Sufficient staff to handle delegable tasks.

Technology that helps: EHR and tools that enhance rather than hinder workflow.

Practices that optimize these factors see productivity improvements without increased burnout. Those that push productivity without addressing these factors see short-term gains followed by turnover.

Work-Life Balance

Provider satisfaction and retention depend heavily on work-life balance:

Predictable schedules: Advance notice of clinical sessions allows life planning.

Protected time off: PTO policies that actually allow disconnection.

Reasonable on-call burden: Fair call distribution, backup coverage.

After-hours limits: Expectations about evening and weekend work clearly defined and respected.

Productivity improvements should enhance work-life balance (finish documentation during work hours, not at home). If productivity pushes squeeze personal time, you've optimized the wrong direction.

Provider Satisfaction

Track provider satisfaction through:

Annual satisfaction surveys
Regular check-ins with medical director
Stay interviews exploring what keeps providers engaged
Exit interviews when providers leave

Key satisfaction drivers related to productivity:

Feeling adequately supported by staff
Having tools and technology that work well
Reasonable patient load and complexity
Time for quality patient interaction
Autonomy in how they practice

Production per visit improvements mean nothing if providers are miserable.

Measuring Success: The Right Way

Effective productivity management tracks both quantity and quality:

Productivity metrics:

Patients per day trending up
RVUs per provider increasing
Revenue per provider growing

Quality metrics:

Patient satisfaction scores maintained or improved
Quality measure performance (HEDIS, MIPS, etc.) sustained
Complication rates stable
Care gaps closing

Provider satisfaction metrics:

Turnover rate low
Satisfaction survey scores high
Documentation completed same-day
After-hours work minimal

If productivity improves but quality or satisfaction decline, you're optimizing the wrong things. Real productivity improvement lifts all three simultaneously.

The practices that sustainably improve productivity share common characteristics: They measure what matters, they optimize workflows rather than people, they leverage technology and support staff effectively, and they maintain focus on provider wellbeing.

They understand that productivity isn't about squeezing more from providers—it's about removing barriers that prevent providers from doing what they do best.

Your providers probably already have capacity to see more patients and generate more revenue. The question is whether that capacity is hidden behind inefficient workflows, poor technology, and inadequate support—or whether you've built systems that let expertise shine through.

That's the difference between pushing harder and working smarter. And that's the difference between temporary productivity gains that lead to burnout and sustainable improvements that benefit everyone.

Tara Minh

Operation Enthusiast