Fixed costs don't move when patient volume fluctuates

Last year was the first time in America cancer care spending overtook cardiovascular spending. Heart disease has been the leading cause of death and the dominant cost driver in this country for decades.

That line just moved.

Hospital systems are already building infusion suites, chemo chair capacity, and physical space for treatments that run six to eight hours in response. They are doing so against build timelines of one to three years, while patient volume continues climbing.

The industry frames this as a structural problem: aging populations, federal funding gaps, forces outside our control. When Becker's Hospital Review asked 96 health system executives about the road ahead, workforce shortages and reimbursement pressure dominated the conversation. Those factors are real. But the more solvable problem sits underneath those symptoms.

Most hospitals haven't scaled fast enough or built systems dynamic enough to meet demand.

A capital project doesn't wait for your staffing plan to catch up. Patient demand doesn't follow your construction timeline. If your workforce model doesn’t move when the schedule does, the cost falls on the program and the patients it serves.

📊 By the numbers:
Heart disease and stroke cost the U.S. healthcare system $233.3 billion per year, while cancer care is expected to exceed $240 billion by 2030.

Source: CDC

Building for Peak and Off-Peak Seasons

Some demand shifts aren't surprises. A 20% patient volume increase every winter is predictable. You can see it coming months out.

A fixed model: The model most programs already have wasn't designed to adapt. A W-2 physician's compensation and schedule are fixed from day one. When the intake surge ends, physician compensation and scheduling does not adjust with it. Ultimately, you either overstaff the off-season or understaff the surge. Many programs end up doing both, in alternating years.

A flexible model: A model created for seasonal demand scales with it. Independent contractors structure their schedules around the peak from day one—working more during the surge, taking time off when volume drops. The cost drops when the volume does because it was never fixed to begin with.

If demand is predictable, your staffing model should flex with it.

The Cost Reflects Reality, Not the Forecast

If you know a capital build is coming, you also know the timelines will move.

Deadline slippage on major construction projects is normal. An 18-month project runs 24. A completion date shifts two quarters. Programs hire W-2 physicians against the original forecast under the assumption the project finishes on time. When it doesn't, those hires are on payroll before the work exists to support them.

If the project runs long, every dollar spent on recruitment, turnover, and HR traces back to the initial forecast, not the reality.

Anticipating and planning for a moving timeline means:

• Independent contractors cover the lull, with coverage adjusting every two to three months as the project shifts.
• Permanent W-2 hires come in during a planned three-to-six month transition window once the project completion timing is certain.

The program comes out the other side with the right permanent team, patient access protected throughout the lull, and none of the sunk cost of a permanent hire brought on six months too early.

Talking points for your board:

– Patient access stays protected through the transition. Alternate clinic space, extended scheduling, and fractional coverage matches the demand at any given point in time.

– When the timeline moves, the plan adapts. Coverage adjusts every 2–3 months. Permanent hires come in during a planned 3–6 month window once the project completion timing is certain.

– Recruitment, turnover, and HR costs from an early W-2 hire are avoided entirely.

Planning Before The Pressure

Executives running 60-to-80-hour weeks don't have capacity to build a stage-by-stage staffing plan once a major project is underway. They're already at max before the first wall goes up.

We come in before construction starts and ask one question that informs the entire plan: what are the three things you most want to protect through this transition?

Patient access comes up first in almost every conversation. From that answer, we build the plan together. Can volume shift to alternate clinic space? Can schedules extend to evenings or weekends?

Independent contractors can structure their week to include both. W-2 staff generally can't.

We help executives work backward from their project completion date in stages, with quarterly touchpoints to adjust as the timeline moves, because it will.

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