Who Is the Most Expensive Employee in Your Practice? The Answer Might Surprise You.

I have sat across from practice owners, office managers, and leadership teams in one-on-one consultations and group workshops and asked them to look at their roster. Not just the payroll numbers. The whole picture. What each person costs and what each person contributes.

And then I deliver the gut punch.

The most expensive employee in your practice might be you.

Not because of what you earn. Because of the gap between what you earn and what you are actually doing with your time.

The Three Examples That Show Up Over and Over

Let me walk you through what this looks like in practice because it is rarely obvious until someone points it out directly.

The first example is the scheduling coordinator making $25 an hour who is not scheduling. Instead they are cleaning the office, restocking supplies, handling tasks that have nothing to do with what they were hired to do. On paper they look like a reasonable line item. In reality they are one of the most expensive people in the building because the one function they exist to perform, keeping the schedule full, productive, and flowing well, is not getting done. Nobody else in the practice is going to walk up front and evaluate whether the schedule is optimized. Nobody else is going to identify the gaps, work the waitlist, and make sure tomorrow looks the way it should. That is a scheduling coordinator's job and if they are not doing it that chair in your schedule is costing you far more than their hourly rate.

Daily cleanup should be everyone's responsibility. Deep cleaning should be outsourced. The scheduling coordinator should be scheduling.

The second example is the office manager. Your highest compensated non-clinical team member. I have seen office managers spending the majority of their day doing someone else's job because that someone else is not doing it themselves. Instead of managing, leading, and driving the operational performance of the practice they are covering for an underperforming team member through micromanagement and task absorption.

The moment that happens your highest-paid employee becomes your most expensive employee. Not because of their salary. Because of the mismatch between what they cost and what they are able to produce when they are perpetually filling someone else's gap instead of doing the work they were hired to do.

The third example is the doctor. And this one runs further than most owners want to admit.

There are a handful of things only a doctor can do. Diagnose. Treat. Provide clinical direction for the practice. That is the core of the role and it is what generates the revenue that funds everything else.

Everything else can be done by someone else. And yet over the years I have seen doctors doing IT work because no one else was handling it. I have seen doctors doing the bookkeeping because they did not trust anyone else to touch the numbers. I have seen them buried in administrative tasks, vendor calls, HR conversations, and operational decisions that have nothing to do with clinical care and nothing to do with the strategic direction of the practice.

Every hour a doctor spends on something that is not diagnosing, treating, or leading is an hour of production that did not happen. And at a doctor's effective hourly production rate that is one of the most expensive uses of time in the entire operation.

The Question That Follows

If any of this exists in your practice, and I would tell you honestly that in most practices some version of all three exists, the question is not who to blame. The question is what to do about it.

The first thing I do in every engagement is examine whether each person in the practice, from the newest hire all the way to the practitioners, is doing the things they were hired to do. The things their role is specifically designed to do. The things that only they can do.

That last part is the critical filter. What can only this person do? For the scheduling coordinator it is managing the schedule with the expertise and the attention it requires. For the office manager it is leading the team and driving operational performance. For the doctor it is clinical care and practice direction. Everything outside of those core functions is a candidate for delegation or outsourcing.

And once you start looking at it through that lens something else often surfaces. Tasks that are being done by someone, consuming time and energy, that do not need to be done at all. They exist because they always have. Nobody has questioned whether they contribute anything to the practice. And the answer in many cases is that they do not.

What This Is Really About

This comes back to the principle that sits at the center of every engagement I take on. Less stress and more income.

When every person in your practice is focused on their core responsibilities and only their core responsibilities the operation becomes more productive without adding a single new team member or spending an additional dollar on overhead. The scheduling coordinator fills the schedule. The office manager leads the team. The doctor produces at the level their training and their compensation justify.

And anything that does not belong in anyone's core role gets delegated to the right person, outsourced to the right vendor, or eliminated entirely because it was never worth doing in the first place.

The most expensive employee in your practice is not the one with the highest salary. It is the one whose time is being consumed by work that is not their job. Figure out who that is and you will have found one of the highest-leverage opportunities available to you right now.

Let's talk.