According to Mark E. Kropiewnicki, J.D., LL.M., consultant with the Health Care Group, patient backlog of 4 weeks or longer is often the first indicator that a new associate is needed. But don't base your decision on backlog alone. Additional factors to take into account include:

• Referral source satisfaction.
If you weren't available as you once were, you may be losing market share as referring physicians send their patients elsewhere.
• Office space.
Where would a new physician practice? If you can't reorganize your space or rent more square footage, it may make sense to offer expanded office hours and stagger staff rather than increase office space.
• Financial resources.
Check your revenues and expenses to determine whether you can afford a new associate.
• Equipment.
Will hiring a new associate mean buying new or more equipment? Can you afford the equipment purchase on top of hiring a new associate?
• Competition.
Are your competitors gaining on you? Are they better equipped to handle a surplus of patients?
• Managed care payors.
Will a new associate be accepted as a provider by the managed care companies you participate with?