Hate staying late? Do scut work throughout the day

A column about keeping your practice in good health

By Mike Norbutcovered practice management issues during 2002-06. Posted June 28, 2004.

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You scramble through a harried morning of patient visits, skip lunch because you're behind schedule and run through your afternoon appointments with only a few minutes to pause for important phone calls or staff questions.

You see your last patient out the door at 5 p.m., and you sit down -- to what? About three hours of paperwork, dictation and phone calls. Then you leave behind an hour's worth of work for staff to do in the morning, which puts you behind the next day, starting the vicious cycle all over again.

Sound familiar? It doesn't have to be that way, consultants say. By pulling your work in throughout the day, you can avoid late starts and even later evenings, and increase office productivity and efficiency.

It requires a change in philosophy more than anything, said Elizabeth Woodcock, principal of Woodcock & Associates, a consulting firm in Atlanta, and author of Mastering Patient Flow: More Ideas to Increase Efficiency and Earnings, published by the Medical Group Management Assn.

Doctors have a tendency to feel as if they're losing productive time if they're not in the exam room, Woodcock said. Meanwhile, they have started to get so busy after a couple of years in practice that they start to batch their paperwork -- essentially organizing it to do later. Bins are color-coded to signify different priorities, phone messages are placed in order of importance and charts are piled up for one long dictation session.

Staff members, of course, follow the physician's lead, setting up their own batching systems and putting off work that can't be done until the doctor has looked at it.

That results in a lot of duplicative work -- such as answering second and third phone calls from patients who are growing impatient about not receiving a return call -- and lost time, Woodcock said.

"It's a vicious cycle in inefficiency," she said. "The practice cannot decide without the physician's help to avoid batching, because if that physician is not into pulling the work in, you'll still have duplicative work."

To correct some of those "hidden" inefficiencies, Woodcock suggests making time each hour to handle the busy work. By leaving openings in the schedule, where you spend time returning calls and completing charts, you can avoid work piling up later.

Although it might appear on the surface to be a gamble -- an open exam room during the day usually means lost revenue -- the idea is to make the office more efficient, she said. By getting today's work done today, you don't start off late tomorrow, and the physician isn't stuck doing work at 7 p.m. that a nurse could have handled at 2:30 p.m. The physicians who do their work before it piles up can leave in time for dinner, and many actually can see more patients over the course of the day, Woodcock said.

"Time is spent doing productive things," Woodcock said. "Staff is there for you, and encounters go faster because the nurse is there to help. You see your 8 a.m. appointment at 8 rather than 8:45."

Richard Honaker, MD, a family physician in Carrollton, Texas, leaves one or two slots open during his busiest days to help handle his work. Otherwise, he squeezes work in between his appointments.

"I get a good hour or two of work done in five- or 10-minute increments during the day," said Dr. Honaker, who also is CEO of the nine-physician group, Family Medicine Associates of Texas. "If it weren't for doing work between patients, I would be there until 8 every night."

Dr. Honaker said most of the physicians in the practice follow the rule that if the stack of work grows over the top of their inbox, that's a signal that they need to address it. Predictably, one physician who doesn't follow that rule is generally the last to leave every night, he said.

The reason to do work during the day is "so at 4:30, you don't find out there's four people who need to get in right away, so the doctor ends up staying late for them," Dr. Honaker said. "It's better to catch them early."

Leaving slots open is a way to ensure that you have time to pull the work in during the day, but you also can achieve that through discipline and effective scheduling. If you know it takes you 10 minutes per patient on average, you can schedule five patients and know you have an extra 10 minutes throughout that hour to handle other tasks, Woodcock said.

Even dedicating a few minutes doing a task immediately can save money down the road. For example, take dictation. If you wait until the end of the day to do all of your dictation at once, you will need to open each chart and review it to jog your memory before recording. If it takes a minute to review each chart and you have 30 charts to work through, that's half an hour spent on simply remembering what you did during the day, Woodcock said.

"That's an extra two patients a day, and that could be an extra $10,000 in profits per year," she said. "Had you built time in during the day to dictate, you wouldn't have lost that."

Of course, there are still cases where no amount of advice will help. If you take 15 minutes per patient but schedule appointments 10 minutes apart, you'll fall behind almost immediately. And if you have tried these ideas and you still end up working until 8 p.m., that could be a sign that you need more help.

"Do you actually have too much work?" Woodcock said. "If you aren't able to handle it during the day, that's an opportune time to hire another [physician or staff member]."

Mike Norbut covered practice management issues during 2002-06.

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