Staying on Schedule (cont.)
Me and my shadow
Although surveys have not been conducted
on the average length of time patients wait to see their
doctors, one fact is clear: Patients today are now much
less tolerant of physician delays than in the past.
Anecdotally, some
physicians estimate that as many as 20 percent of patients at a
practice will switch doctors because of long delays. In an
attempt to minimize wait times and patient complaints, some
doctors are experimenting with different approaches while
others have made drastic changes, like converting to a boutique
or concierge practice where patients pay their physician an
annual fee to reserve time slots throughout the year.
There’s no magic
solution but individual physicians are discovering what works
best for their practices. Consider Dr. Anita Jackson-Kelley, an
ear, nose, and throat physician in Raleigh, North Carolina, who
sees as many as 40 patients a day.
She uses
“shadows.” These clinical staff
members—nurse, medical assistant, or lab
technician—follow her from patient to patient and
understand her field of medicine and practice patterns. For
example, while Jackson-Kelley is telling a patient about the
need to take antibiotics for a sinus infection, the shadow is
already gathering samples or placing a prescription pad in
front of her. Shadows also escort patients to the checkout area
and guide the doctor to the next room.
“They know more
about what you should be doing than you do,” she says,
explaining that their added value is efficiency and time
management.
She also hires
aggressive and motivated front desk employees who greet
patients and ensure that the office flow is smooth. Usually,
they coordinate patient activity with clinical staff, monitor
how patient appointments and walk-ins are spaced throughout the
day, and know how to interact with patients when the doctor is
faced with unexpected delays.
“They’re
smart enough to know that if I’m running late in surgery
to tell patients, ‘The doctor’s going to be late.
She wouldn’t want you to wait so why don’t you grab
some lunch and come back at 1:30pm?” she says.
“That’s the type of professionalism you’re
paying for—somebody’s who’s always on the
lookout.”
Mixed bag
Another way to stay on time is to focus
employee responsibilities. One group practice with
approximately 100 providers dedicates each nurse and medical
assistant to a specific task. For instance, one nurse would
perform triage, another would handle prescription refills, and
an MA would be responsible for nothing more than escorting
patients into exam rooms, taking vital signs, and recording
chief complaints. Duties would then be rotated every day or
week, allowing clinical staff to be very focused and efficient,
says Dr. Jay Anders, an internist who formerly worked at the
practice.
Anders, now the chief
medical officer at InteGreat Concepts, Inc., an electronic medical records company
headquartered in Scottsdale, Arizona, also scheduled 20 minute
catch-up breaks for himself in the morning and afternoon and
switched from double-booking patient appointments every 15
minutes to scheduling one appointment every 10 minutes.
No matter how hard he
tried, his schedule was always off by at least 30 to 40 minutes
when double-booking. He believed asking patients to wait any
longer than that wasn’t fair to either them or him, since
delays extended his already long workdays and could contribute
to physician burnout.
“[Double-booking] disrupts flow because
you’re not really sure what a patient is going to come in
with,” he says, adding that this new system prevented him
from falling behind. “In a double-booked day, one slow
patient would wind up being a problem.”
He also identified
patients who usually required more time than just 10 minutes
for appointments. He kept a tickler file of such patients and
had schedulers automatically give them 20-minute appointments.
Not only were his patients happy, so were employees who came to
work every day knowing they were going to deal with a realistic
schedule instead of constant patient complaints.
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He believes other doctors
could benefit from this type of scheduling. “It’s
really easy to focus
on that disorder,” he says.
“You really get sharp on it. You’re really on top
of diabetes and not trying to shift where you’ve got to
suture [a patient] in one office and handle a diabetic in
another office.”
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Dr. Charles Sophy, a
psychiatrist and family practitioner in Beverly
Hills, California, devotes each weekday to patients
with specific conditions or illnesses.
“You’re not trying to shift where
you’ve got to suture [a patient] in one
office and handle a diabetic in another
office.”
© 2006 steve
goldstein
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The same holds true
for common dermatology procedures like removing skin tags or
warts. Whenever possible, patients requiring such procedures
are scheduled on the same day so they can be moved in and out
in a timely fashion.
Sophy’s nurse
practitioner (NP) is another reason he stays on schedule. She
runs Saturday clinics that specifically target patients with
certain conditions. On one Saturday, for instance, she may run
a free hypertension clinic and invite all patients with high
blood pressure and suggest they bring other family members and
friends who may be at risk for the condition. Another clinic
may target patients with diabetes.
He believes these
clinics offer multiple benefits: They’re a
user-friendly way to monitor the health status of patients,
save physicians valuable time from performing routine exams
during busy weekdays, and are also a great marketing tool since
they attract new patients.
Still, some physicians are
reluctant to hire NPs, physician assistants (PAs) and other
midlevel providers because their salaries eat into their
profits. However, many don’t realize that the break-even
point for such providers is around three to four patients a
day, according to Randy Bauman, the president of Delta Health Care,
a national health care consulting firm in Brentwood, Tennessee.
According to the 2005 Physician
Compensation and Production Survey Report developed by the
Medical Group Management Association, for every $1 billed by a
primary care practice, a PA or NP typically receives almost 27
cents in compensation. That number ranges depending upon the
type of practice. For example, PAs in a family practice earn
nearly 25 cents in compensation off every income dollar while
PAs in a surgical practice receive almost 32 cents.
“The most
profitable way to see a patient is for you to see them,”
says Bauman. “But when you reach capacity, the second
most profitable way to see a patient—as long as
you’ve got the volume—is to have somebody else see
them, pay them less, and make a [profit] on it.”
Not many practices
track how long patients wait to see a provider, despite the
fact that payers routinely include standard wait times in
physician contracts. Bauman believes practices inadvertently
violate that standard every day and are clueless about how long
patients wait.
Even small changes can
make a difference in wait times. For physicians without an
electronic medical record system, he suggests using a carbon
prescription pad to avoid rewriting the same
information—and preventing potential medication
errors—in the patient’s chart.
Another area is the
sample supply closet. Where is the closet located? Near the
exam rooms? At one physician’s practice, Bauman says it
was placed at the other end of the office, far away from the
exam rooms. So every time the doctor wanted to give patients a
handful of samples, he had to walk out of the exam room and
pass by the nurse’s station where he was interrupted with
questions or phone messages. Ten to 15 minutes later, he would
return to the exam room with the samples.
“Physicians just
don’t think about this,” says Bauman. “A lot
of times, they don’t get good mentoring about what it
means to be a physician and to be efficient with their time.
Time, of course, is their most valuable commodity.” g
Carol Patton is a Las Vegas-based
free-lance writer. This is her first article for Unique
Opportunities.
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