Plan ahead for times you need to take a sick day

A column about keeping your practice in good health

By Pamela Lewis Dolancovered health information technology issues and social media topics affecting physicians. Connect with the columnist: @Plewisdolan  —  Posted July 23, 2007.

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For most physicians, sick days are an anomaly. Patients, unlike paperwork, can't be put off until the next day. And as busy as most practices are, playing catch-up on another day could be virtually impossible.

But there will be a day when the doctor must succumb to human limitations and admit he or she just can't get out of bed. Taking a sick day can be a hassle, but formalizing the procedure for handling a sick day can lessen the burden, experts say.

Obviously, sick days are much more difficult to deal with in solo practices. But Nick Fabrizio, senior consultant for Englewood, Colo.-based MGMA Consulting Group, says taking a sick day is usually a big issue in small, multiphysician practices because doctors feel guilty dumping their patients on colleagues.

But the policies don't have to differ much from a solo practice to a multiphysician practice. Having a policy can help negate that guilt because everyone would be able to take advantage of the same policy at some point.

The first step to taking a sick day should be scanning the list of patient appointments determining who can wait, who can't, and who can be seen by a midlevel (nurse practitioners and physician assistants). "It's a balancing act," said Fabrizio.

The practice really needs to know the patients and also have defined scopes for its midlevels, he added.

A patient coming in for a diabetes check-up along with two or three other things should probably be seen by the doctor who knows the patient best, Fabrizio said, so that would be the patient to reschedule. "But an acute care patient can see anyone," he said.

Fabrizio strongly recommends using the midlevels on physician sick days to reduce the number of patients the physician will have to catch up on when he returns, or the number his partners will have to squeeze in.

At the very least, the midlevel can help triage to determine which patients need special attention and can't wait, said Charles Y. Thomason III, president of Atlanta-based Medical Management Associates.

Once it's been determined how each patient will be handled, all available staff need to work the phones to cancel or reschedule patients as quickly as possible.

"All employees possible should get on the phone and handle that chore," said practice consultant George Conomikes, of Solano Beach, Calif.-based Conomikes Associates. This is when it pays to plan ahead and have an organized office staff armed with updated patient contact lists, says Thomason.

But there are always going to be those appointments that are too early to cancel ahead of time, Fabrizio said. Sometimes, the doctor might need to put in an hour or so taking care of the early birds before retiring for the day, he said.

How severe cases are handled is probably the starkest difference between solo practices and multiphysician practices, and also the part of the policy that will take the most careful consideration.

While Thomason says most solo doctors have informal agreements with neighboring physicians to whom they can refer patients in times of emergency, Conomikes says he wouldn't recommend taking advantage of those agreements for sick days -- only for scheduled vacation time.

"It's not up to a practice to impose on another practice and expect them to see their patients," he said. "If worse comes to worse [patients] go to an emergency room or a walk-in clinic."

But Thomason said when the assumption of reciprocity is there, it's a nice option to have for the most severe cases.

Even though most doctors are hesitant to burden their partners in a multiphysician practice, having the backup does make it easier. But even with that backup, the "well patients" should still be rescheduled because each physician likely has a full schedule already, Conomikes said.

The extra patient load will likely cause a backup of patients waiting longer than usual for appointments. But experts agree alerting the patients to what is going on will help ease tension in the waiting room.

"Be honest with the patient," Thomason said. "You don't want a physician with the flu treating you. The best reaction you will get from the patient will come when you are honest with them."

The final piece of the plan, especially for non-solo practices, Thomason said, is determining how the doctor's time off will be compensated, or how the physician's unmet obligations will be handled.

"Many groups don't have an adequately detailed policy in terms of how their pay is impacted," Thomason said. Also, "Does that physician make up his on-call hours with the person who covered for him ... or is he relieved of those obligations?"

The policies usually reflect the pay structure (salary versus fee-for-service) set up in that practice, he said.

Pamela Lewis Dolan covered health information technology issues and social media topics affecting physicians. Connect with the columnist: @Plewisdolan  — 

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