Most health systems plan their physician workforce in FTEs. So do we. Every Provider Development Plan we build uses the FTE as a measure of clinical time, and we spend considerable effort getting it right.

Getting it right means adjusting each physician for part-time effort, administrative responsibilities, teaching obligations, and research commitments, then calibrating what remains against specialty-specific productivity benchmarks. The output is not a head. It is a measure of clinical time available to patients.

That work matters, because everything that follows is built on it.

A Primary Care physician at the 25th percentile of MGMA productivity serves about 990 patients. At the 75th percentile, about 1,700. Same specialty. Same 1.0 clinical FTE. Both properly adjusted.

Roughly 700 patients separate two physicians who are identical on paper. Across a 100-provider network, that is tens of thousands of people whose access turns on something the FTE was never built to measure.

A properly adjusted FTE tells you exactly how much clinical time you have. What that time produces is a second question, and it needs its own measures. We call the gap between the two the FTE Fallacy.

Two Questions, Not One

Every Provider Development Plan starts with supply and demand. Do you have enough physicians, by specialty, for the population you serve? We answer it by inventorying every practicing office-based physician in a defined market, regardless of affiliation, and modeling demand against age and gender specific utilization at the sub-market level.

That is a real question with a real answer, and no plan should skip it. 3Dhealth projects the national physician shortage will reach 101,000 by 2030. Supply and demand is how a health system knows where it sits inside that.

That is the first question. The second follows from it: what does each of those physicians deliver in patient access? It has three measures:

→  Verified Access: is the practice open to new patients, confirmed by calling rather than by asking

→  Access Velocity: how long a new patient waits to get in

→  Served Lives: how many patients that FTE is actually managing

Two clinical FTEs can be the same number and differ on all three. A workforce plan needs both answers. Provider Development Planning is how we produce them.

Where Measurement Starts: Visit Volume

Before measuring access, it helps to see what one clinical FTE produces. Median office visits per year, five-year MGMA average, are the capacity assumptions our own demand model runs on:

Same unit. A 6.5x spread.

Cardiac Surgery is the instructive case. At 819 median office visits a year, its visit-based capacity is structurally low, because most of the specialty’s work happens in the operating room rather than the office. A Cardiac Surgeon producing a sixth of a Dermatologist’s office visits is not producing a sixth of the access. Office visits are simply the wrong measure for that specialty, which is precisely the point: no single number describes what every clinical FTE delivers.

And visit counts are not access in any case. They are activity. A physician logging 5,000 visits a year might be seeing 1,250 patients four times each, or 2,500 patients twice. Same visit count. Twice the people.

Visit volume is where measurement starts, not where it ends. It is the raw material from which Served Lives is derived, and it is the reason the three measures are needed.

“We spend more time getting the FTE right than anyone. That is exactly why we don’t stop there.”
Ron Flower, President & CEO, 3Dhealth

Verified Access
Is the practice open to new patients?

Ask a health system whether its physicians are accepting new patients and you will get an answer. Ask the physicians and you will get a different one. Call the practice the way a patient would and you will get the truth.

None of those answers are dishonest. A physician reporting that a panel is open is answering whether it is theoretically open. The patient is asking whether they can be seen. Those are not the same question, and only one of them can be verified.

3Dhealth’s national outbound patient access call dataset spans 115,000+ outbound telephone calls across 244 health systems over 16 years. Not surveys. Not directory audits. Calls placed the way a patient would place them.

Across that dataset, 76.2% of calls reached a practice accepting new patients in some form. The remaining 23.8% is where access strategy breaks down: 13.4% not accepting, 3.9% held longer than five minutes, 3.7% voicemail only, and 2.7% open on conditions the patient could not have known in advance.

The divergence between Primary Care and specialists runs opposite to conventional wisdom. Primary Care practices are closed to new patients 23.6% of the time. Specialists, 6.6%. Most access strategies are built around specialist recruitment, and Primary Care is the front door. When it is closed, the rest of the network does not exist for that patient.

The most consequential finding is not the closure rate. It is what happens when a panel is closed. Across more than 54,000 calls where a patient could not be accommodated and an alternative existed, an APP, a partner location, another physician, one was offered 6.8% of the time. In the other 93.2% of cases, no alternative was provided.

The infrastructure existed. Nobody surfaced it. That is a design problem rather than a staffing one, and it is invisible to every measurement method except calling.

Access Velocity
How long does a new patient wait?

An open practice is not the same as an accessible one. Two 1.0 clinical FTEs, both properly adjusted, both fully open to new patients, can deliver very different patient experiences based on one factor: how long the wait is.

Median new-patient wait by specialty, at the point of contact:

Read the two columns together. Dermatology produces the most office visits of any specialty here and takes the longest to get into. Cardiac Surgery produces the fewest and is among the fastest. Volume and speed run close to inverse, which is why measuring one tells you nothing about the other.

In 3Dhealth’s consumer research, 55% expect a new-patient Primary Care appointment within four days. Family Medicine sits at a 15-day median, Pediatrics at 13, and Primary Care is the fastest part of the network. Specialists run longer, and some run much longer: Rheumatology at 42 days, Neurology at 44.

More FTEs are sometimes the answer to a long wait. They are almost always the slow, expensive answer. If supply and demand shows a genuine shortage in a specialty, recruit, because nothing else closes that gap. But if supply is adequate and new patients still wait six weeks, that is not a supply problem. It is a deployment problem, and hiring will not fix it.

Three levers move a wait time before a new hire can:

→  Panel design: reserving capacity for new patients instead of protecting established ones

→  Scheduling architecture: holding same-week slots instead of booking months out

→  APP integration: routing appropriate visits to APPs at the top of their license

Each can compress a wait faster than a physician can be recruited, credentialed, and ramped. That is why Access Velocity is measured on its own. It tells a health system whether the problem it has is the problem it thinks it has.

Served Lives
How many patients is that FTE actually managing?

Served Lives is the true number of patients a clinical FTE manages, derived from observed productivity rather than from attribution windows. Attribution counts anyone seen in the last 18 to 36 months, which inflates panels with patients who have not returned in years. Served Lives counts who is being cared for now.

Served Lives per clinical FTE, by MGMA productivity percentile:

The within-specialty variation is the finding that matters most, because it cannot be explained away by specialty difference. Roughly 700 patients separate a 25th and a 75th percentile Primary Care physician at the same 1.0 FTE. That is a 70% increase in reach within the same staffing footprint.

Across specialties the variation compounds. Which is why the question “we need three more physicians” has no single answer. Three Primary Care FTEs at median productivity serve roughly 3,900 patients. Three OB/GYN FTEs serve roughly 9,400. Both are three physicians. The access they unlock is not comparable, and those panels are not interchangeable, because they serve different patient groups with different needs and different visit cadences.

Supply and demand answers how many physicians a population needs, by specialty. Served Lives answers how much access each of those hires actually buys. We translate every open position into the Served Lives it represents so the decision can be made on both.

What the Three Measures Do Together

Verified Access and Access Velocity both come from calling practices the way a patient would. Served Lives is built from observed productivity, converted into a patient count. Measured together, by specialty, they describe a clinical FTE as a defined set of access outputs rather than a single integer.

That changes what a workforce decision looks like. The same investment that produces one additional specialist FTE may, depending on local conditions, produce far greater community access if redirected toward opening panels that are quietly closed, compressing waits that can be compressed, or expanding APP utilization in Primary Care.

Workforce planning becomes less about filling specialty slots and more about defining the access each clinical FTE is expected to deliver, then choosing the specialty, deployment model, and operating design that delivers it.

“Recruit to demand, not to the request.”
Ron Flower, President & CEO, 3Dhealth

Why This Matters Now

Recruiting into the market ahead will be harder and more expensive every year. Which makes the access a health system already owns more valuable every year.

Even if every open requisition in the country were filled tomorrow, the FTE Fallacy would continue to undermine access if those physicians were deployed on the assumption that one adjusted clinical FTE is interchangeable with another.

The systems that come through the next decade successfully will do two things. They will recruit to demand, not to the request. And they will get full value from the physicians already on staff.

That second part is measurable. Open the panels that are quietly closed. Compress the waits that can be compressed. Move physicians toward the productivity their peers already reach. Every one of those is faster than a search, and the capacity is already paid for.

Hiring is one lever. Use it. Then use the levers you already own.

Beyond the Headcount

The FTE is not the problem. Treating it as a universal currency is.

A properly adjusted clinical FTE, calibrated against specialty-specific capacity benchmarks and translated into Served Lives, is one of the most powerful units in modern healthcare planning. But its power lies in its specificity, not its uniformity. The moment a system assumes that all clinical FTEs deliver equivalent access, the rigor of the adjustment is undone.

Our Provider Development Planning methodology holds that specificity through the entire planning process, from supply and demand through Verified Access, Access Velocity, and Served Lives. The result is workforce planning that does what a properly adjusted FTE makes possible: a clear, quantified line from a hiring decision to community access.

The systems that recognize the difference will plan better. Their communities will get more access. And the same dollars will go further.

For questions or more information, please contact: Ron Flower at RFlower@3Dhealthinc.com or 312-423-2673
To schedule an appointment with Ron, please contact Annalisa Reese at AReese@3Dhealthinc.com.