Psychiatrist Doug Bey on how his staff helped him and his practice survive and thrive after his two heart attacks.
When I first established my private psychiatry practice in Normal, Ill. in 1970, I realized that I didn't know anything about running a small business. I read books and attended classes on practice management. I sent my staff to medical business seminars and hired a business consultant to work with us.
Probably because of me setting the example, we had a Type A, workaholic practice. We used the latest billing and scheduling software, instituted "wave" scheduling, had job descriptions and written protocols, and considered ourselves to be on the cutting edge of business efficiency. At one point we had three psychiatrists, five psychologists, three social workers, four RNs, and six business-office employees. We averaged more than 30 psychiatric inpatients and consulted at four hospitals. Weekday office hours were from 8 a.m. to 10 p.m. and Saturday hours were from 8 a.m. to noon. I was a micromanager.
Not surprisingly, in 1990 I had two heart attacks, a balloon inserted into a clogged artery, and bypass surgery. Six years later, I had a second open-heart procedure, and in 1997 a stent. I was off from work a good deal of the time during this period and my near-death experiences altered my "lizard brain." I downsized the office, stopped doing hospital work, and threw out all of the job descriptions and protocols. I stopped trying to manage the office and turned everything over to the staff. I remarked to one of the nurses: "I don't seem to be doing much, but things seem to be getting done." She replied, "You're getting smarter!"
My wife, Deborah, was the head surgical nurse and later chief nurse of the chemical dependency unit at a local hospital. She coauthored of one of my books, "Loving an Adult Child of an Alcoholic." After my illness and convalescence, she remained as the only nurse in our office. My office manager, Wendy, was the sole business-office employee to survive the downsizing. She had been in charge of collections for a savings and loan business prior to coming to our office in the 1990s.
I told Wendy and Deb that I was leaving the office to them. I would see outpatients but I would turn over the decisions about office hours, fees, patient scheduling, work schedules, office duties, and billing up to them.
We needed another business-office employee, and I left this up to them as well. Wendy and Deb recruited and hired Vicky, who had been the manager for a busy surgical practice before joining us. The three of them decided that I should be in the office three days a week and that I should continue to attend cardiac rehabilitation three days a week. They worked out their own arrangements for coverage, vacations, sick days, and leave. Their main guideline was that the patients received good care, and they made sure the office was always covered and patients were served properly.
In our office the administrative personnel have a good deal of contact with the patients and their families on the phone and in the office. Patients get to know them personally and, since we are in a relatively small town, many are already acquainted with the staff in some way or another. Patients and families feel more secure knowing who they are talking to when they call or visit the office. A deep acquaintance with the patients enables staff to know the needs of each patient when they call.
For example, one patient may call screaming and shouting on the phone and the staff knows that she does not represent an emergency; she has periodic crises and can be reassured and calmed down on the phone. Another patient may call and softly say, "I'm a little nervous," and the staff will know she is very ill and in an emergency and will have her come in to see me that day. They screen new patients to make sure they are appropriate for our outpatient practice and refer those who would be better served elsewhere.
My staff members frequently return from their vacations with little gifts of T-shirts or souvenirs for chronically ill patients who are socially isolated. They have driven patients to the hospital when they are in crisis and have visited them while they were inpatients. They have called patients to let them know the results of their laboratory tests and just to talk to them when they know they are having a rough time or are unable to make it to the office because of illness or the weather. They have made house calls to shut-in patents.
These activities were not done at my request. Wendy, Vicky, and Deb acted on what they felt was in the best interest of our patients.
I've looked back and wondered why I didn't start out practicing the way I do now. I've concluded it wasn't possible. At the time, I was trying to institute and follow the practice-management recommendations I was learning from books and seminars. I was worried about economic survival. Psychologically, I was too driven and compulsive to turn over the practice management to the staff. Back then the staff was too young and inexperienced to function without structure. To be where I am now, I had to change and I had to locate a unique group of people who were self-starters and dedicated to patient care.
Wendy, Vicky, and Deb are mature, experienced, self-governing workers who have taken the responsibilities and stresses of the business aspect of my practice off my shoulders. They are dedicated to serving our patients and their families. Their close, personal relationships with the patients have been therapeutic and provided a sense of security and well-being for our clientele. They've structured my work so that I have a healthy balance of work, exercise, and recreation. They have removed stress from my practice and left me with the labor I enjoy.
Doug Bey, MD, is a graduate of University of Illinois College of Medicine in Chicago and the Menninger School of Psychiatry. He served as 1st Infantry Division psychiatrist in Vietnam before beginning his private practice of psychiatry in Normal, Ill. He has four children, one godson, and five grandchildren. He continues a part-time private practice with his wife Deborah.
This article originally appeared in the January 2011 issue of Physicians Practice.