Overwhelmed by phone calls? Adding lines, staff not the answer

A column about keeping your practice in good health

By Victoria Stagg Elliottis a longtime staff member. She covered practice management issues and wrote the "Practice Management" column from 2009 to 2013. She also covered public health and science from 2000 to 2009. Posted June 29, 2009.

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Telephones ringing off the hook and stacks of messages needing to be returned are not signs that a medical practice is popular.

Actually, this scenario can lead to just the opposite, as some patients get frustrated by being put on hold or having to redial because they are getting busy signals. Taking a lot of phone calls and spending significant time returning messages also may cut into time for patient care and the services that keep a practice financially afloat.

"It can become very overwhelming," said Charles Stern, MD, director of family medicine at Scott & White Healthcare in Waco, Texas.

Experts stress that arranging for more phone lines and hiring staff to answer them are not the solutions to phones ringing off the hook.

There is not one way for all practices to tackle this problem, so an analysis of what's causing the phone to ring so much is the most important step in regaining order. While you don't get paid for answering the telephone, it can help drive business, so you want to know what is stressing the practice's efficiency.

Physicians should perform a "telephone traffic study" to identify the largest categories of incoming calls and identify how their numbers can be reduced.

"You have got to get some kind of good introspection into your own practice patterns," Dr. Stern said.

Patient education

For example, after Dr. Stern carried out such a study, he realized that many incoming phone calls at his practice were the result of patients not being told what to expect and how to react to the natural course of their illnesses.

Patients with respiratory complaints were often told to call if they did not feel better. Some would call the next day. The number of calls went down when patients were given more information about what they could expect as they recovered, the kinds of symptoms that should trigger them to reach out for additional medical care, and a more exact time frame for when they should realistically expect to feel well.

L. Gordon Moore, MD, a family physician in Rochester, N.Y., discovered that many of the calls to his practice were the result of patients repeatedly calling because their messages were not returned in a timely manner.

"Delays drove a significant number of phone calls," said Dr. Moore, a clinical associate professor of family medicine at the University of Rochester School of Medicine and Dentistry and a faculty member at the Institute for Healthcare Improvement. "Addressing that improved the real efficiency in the practice."

Patient education and managing expectations are often the key for reducing many types of calls. For instance, physicians who have worked on this issue have generally discovered that patients are less likely to telephone for test results if they have a good idea of when they should receive them, and how this information will be delivered, whether by traditional mail, e-mail or telephone.

"Setting patient expectations is particularly important," said Ken Cohen, MD, an internist who has a pamphlet for patients outlining what to expect with regard to communication and response time for certain services. He is the medical director of New West Physicians, a large primary care practice with 13 locations in the metropolitan Denver area.

Prescription requests are often another big category of incoming calls. Experts suggest allowing for as many refills as are medically appropriate to be written at the same time. Patients also should be educated about the need to have the pharmacist contact the physician directly either by fax or through an electronic system.

Using the phone for appointments, another common source of calls to physician offices, also can be reduced. Online appointment systems are a possibility. Even appointments far in the future can be scheduled when the patient is in the office to reduce their need to call back. Some physicians take advantage of e-mail, but they say it's important to take into account the patient population and the technology available to them.

Jasmine Moghissi, MD, a family physician in solo practice in Fairfax, Va., has been e-mailing patients for the past decade. "The patients love the idea of doing e-mail. They're on the computer all the time, but I live in the very high-tech area."

Experts also suggested staggering employee schedules to allow the phone to be answered early, late and during lunch. This reduces the staff time needed to return messages. Patients may also appreciate being able to connect with the office when they are less likely to be at work.

Victoria Stagg Elliott is a longtime staff member. She covered practice management issues and wrote the "Practice Management" column from 2009 to 2013. She also covered public health and science from 2000 to 2009.

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