Staffing cost and provider productivity in a medical practice
Updated 16 October 2026
Payroll is the largest cost in most medical practices, and providers produce most of the revenue. Three ratios describe how the two fit together. Collections per provider shows what each clinician brings in. Full-time equivalent (FTE) staff per provider shows how much support sits around each clinician. Payroll as a share of collections shows what the practice spends on people for each dollar it collects. This page covers those ratios, the productivity measures beneath them, and the choices on hiring and pay. Some examples use clinic figures from franchise brands' Franchise Disclosure Documents (FDDs), which franchisors give buyers before a sale.
Three ratios
The practice tracks collections per provider each month and over time. It counts support FTEs per provider. It divides total payroll by total collections. The third ratio is the cleanest single check on staffing, because it ties every wage to the cash that pays it. For providers paid on productivity, the practice also tracks relative value unit (RVU) production and the ratio of RVUs to pay. An RVU is a unit that weights each service by the work and resources it takes.
The figures are an illustration. A practice collects $4,200,000 a year with four providers, so collections per provider are $1,050,000. It employs 18 support staff, or 4.5 per provider. Total payroll is $1,260,000, which is 30% of collections. The practice now has three figures to compare month by month and against its own budget.
Measuring what the schedule produces
Productivity measures what the schedule produces. Visits per provider per day are compared with the practice's own benchmark. Work RVUs (wRVUs), the work portion of the RVU, measure effort for pay models tied to it. Collections per provider link work to cash. Panel size and panel growth matter in primary care. Schedule use compares booked slots with available slots by day and by provider. No-show and cancellation rates show lost revenue that rarely appears in a report.
AFC Urgent Care's FDD reports 79 affiliate-run centers in groups by sales. Averan's AFC Urgent Care page finds direct patient care costing $59.22 a visit at the highest-selling group and $80.68 at the lowest-selling group. A provider on the floor for a full day costs an AFC Urgent Care center the same at 22 patients as at 57. The $21.46 gap per visit is the cost of an emptier day.
Wages as a share of sales
The right payroll share depends on the care model. A model where the clinician delivers every visit carries a higher wage share than a model with large supply or advertising costs. A practice compares its payroll share with practices that run the same model. It also compares the share at its own sales level, because fixed staff take a larger share of a smaller practice's revenue.
The Joint Chiropractic's 492 clinics with a full profit and loss averaged $578,201 of sales in 2025, and wages took 47.9%, or $276,787. The Joint Chiropractic's wage line ranged from $83,088 to $676,823 across those clinics. It covers chiropractor and coordinator wages, taxes, bonuses and malpractice cover. At 47.9%, the schedule sets most of a Joint Chiropractic clinic's result.
Support staff around each provider
The right ratio of support staff to providers varies by specialty. A more useful test asks whether each support role pays for itself in throughput, patient experience or revenue cycle results. The practice asks four questions. Are there enough medical assistants to keep the provider in the room with patients? Is the front desk staffed to verify eligibility and collect at the visit? Is billing staffed to the claim volume or to a past headcount? Does one person on each team own the workflow?
Medi-Weightloss's FDD splits 56 clinics into thirds by sales. Compensation takes 33.4% of sales at the top third of Medi-Weightloss clinics, or $615,821, and 41.2% at the bottom third, or $210,276. The bottom third of Medi-Weightloss clinics spends about a third as much on staff in dollars and gives up eight more points of revenue to pay it. The Medi-Weightloss compensation line includes the medical director and excludes the owner's pay.
When to hire and when to restructure
A hire solves a capacity problem. It does not fix pay design, scheduling or productivity. Before adding an FTE, the practice checks whether current providers and staff work at the expected level. If they do not, a hire multiplies the problem. The practice also checks whether the gap is new patients or returning patients, because the two need different staff.
Medi-Weightloss clinics open more than two years averaged 501 visits a month on 17 new patients. Medi-Weightloss clinics open one to two years averaged 289 visits on 22 new patients. Averan's Medi-Weightloss page puts that at 29.5 visits per new patient against 13.1. The mature Medi-Weightloss clinic needs its staff scheduled for returning visits more than for intake.
Provider pay models
Most practices use one of three models. The first is salary with a bonus. The second is pay based on production, measured in wRVUs or collections. The third mixes the two. No model fits every practice. The model should reward the behavior the practice wants. If the practice wants growth, pay rewards growth. If it wants quality, pay includes quality measures. Many groups start new providers on a guaranteed salary and move them to production pay after a set period. Admin work that builds the practice, such as leadership, quality and training, is paid separately to protect clinical time. An underproductive partner is addressed in a direct conversation backed by data.
The figures are an illustration. A new provider has a $250,000 guaranteed salary. The production model pays 30% of collections. The two pay the same at $833,333 of collections. Below that figure the practice carries the guarantee, and above it the production model pays the provider more.
What this means for a practice owner
Collections per provider, support FTEs per provider and payroll as a share of collections describe staffing in three figures. Productivity is measured by output, using visits, wRVUs, collections and schedule use. The payroll share is compared with practices on the same care model. Each support role is tested against the throughput it adds. A hire follows a check on current productivity. Pay rewards what the practice wants.
Getting the staffing figures built
Averan Advisors reports provider productivity and payroll ratios each month through its controller service and models hiring and pay decisions through its fractional CFO service. The Medical Practice Numbers Check includes a provider productivity section.
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