Of all the resources necessary to run a practice and care for patients, a physician's time is the only one that is irrevocably limited. While a practice can increase its capacity for patient care by adding a physician, the sole way for an individual physician to increase productive capacity is the more effective use of her time.
The bad news for maxed out physicians is that improved effectiveness requires thoughtful analysis of the status quo, as well as a willingness to make changes. The good news is that almost all of the analysis can be outsourced or delegated, and the changes improve the environment for patients and staff as well as the physician.
Here are six ideas for increasing physician capacity.
1. Refuse to do tasks that do not require a physician, except in emergencies or special situations.
The specific tasks are a subjective judgment and will vary among physicians. The constant element is the need to define and delegate them with specificity. The accompanying message is critically important to a harmonious practice: "My time is limited and I need your help" as opposed to "I am too important for this menial task."
2. Train staff well and hold them accountable to specific standards of performance.
For optimum productivity, the physician needs to know without asking what staff has done in a given situation. For instance, the physician should be able to be confident, for every patient in an exam room ready to be seen, that a medical assistant has taken and recorded vitals, captured the chief complaint, and verified that the patient's chart is complete regarding results from previous orders and referrals. That can only happen when expectations are explicit and consistent. It will only happen when the physician declines to proceed with the patient until the expectations have been met.
3. Limit the number of physician interruptions by batching questions and documents for review and signature.
Time and mental energy are required for every change in task. The person must disengage from one activity and engage with the next. The overhead involved in redirecting focus is the same whether the new task lasts five seconds or five minutes. Accumulating questions and documents for the physician and presenting them in a batch eliminates all but one instance of the switching overhead. An additional benefit is to staff, because they also have fewer interruptions.
4. Minimize variability in the clinic schedule.
An annual exam is a different type of appointment from an office procedure, which is a different type from a recheck. Limiting the type of appointments for a given clinic session improves practice productivity by minimizing the changes in mindset involved in switching from one type of appointment to another. Of course, a switch in the type of appointment is preferred to an empty slot.
Another type of variability to avoid is running behind schedule. Habitual tardiness encourages patients to ignore their scheduled appointment time and arrive late, and that can result in physicians being idle waiting for a patient's arrival. Patient complaints about long waits are also a drain on the physician's time. Scheduling appointments at intervals that reflect the actual amount of time the appointment takes, as opposed to an ideal, and leaving open slots for the typical number of work-ins go a long way to getting a clinic schedule under control.
5. Minimize variability in the exam rooms.
Knowing what is in the exam room, and where it is, significantly increases physician productivity. The physician spends no time hunting for supplies or equipment. It is even better if things are within easy reach of the physician during the exam. In an ideal world, the physician's exam rooms are identical, not mirror images of one another. Identical exam rooms make reaching for an instrument or particular supply essentially automatic, dependent only upon muscle memory.
6. Limit the physician's work hours to allow adequate time for sleep, play, and social interactions.
Physicians who are tired and out of shape move more slowly and process information less effectively than if they were well rested and fit. The more hours a person works, the less productive the person is per hour. Time for rest and exercise is an investment of time that increases the value of the time spent in work and, typically, produces a net gain in production. Healthy people also have longer productive lives.
As human beings, physicians are social animals to one degree or another. If the only opportunity for a social interaction is in the exam room, the physician is very likely to take advantage of it and allow appointments to run long. Other social interaction promotes the focus of the appointment on the business at hand.
None of these changes is particularly difficult. They all, however, require an assessment of the status quo and a commitment to improving it. The results improve revenues, quality of life for physicians and staff, and increase patient satisfaction.
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