According to the first annual NRM Practice Management
Survey, nearly 60% of physicians are now seeing more than
75 patients a week, with that figure almost doubling for
a few hard-pressed rural GP/FPs. Not surprisingly, given
this kind of workload, almost 30% of those who responded
to the survey cited "time management" as their most pressing
practice problem. A rural Saskatchewan GP put it as succinctly
as you could when he replied: "I have too many new patients."
A Thunder Bay family practitioner looked at the same problem
from another perspective writing simply, "I have too little
time per patient." Heavy demand has made it difficult
for one GP in Victoria, BC, to schedule her patients efficiently
and to manage her work-stressed staff. Of the respondents,
64% were in general practice and 36% were specialists.
Overwhelming amounts of paperwork
showed up as the number two complaint — 26% reported
it as a problem. Typical of the responses was that of
a 38-year-old in general practice in Nova Scotia who
finds he puts off paperwork until it becomes overwhelming.
The top 10 list of things that need fixing included
the need to find efficient staff, handling patient complaints,
lack of hospital resources and the inability to control
on-call hours.
The majority of you practise in
a clinic within a medical centre (38%) or a standalone
clinic (32%). Another 19% work at a hospital. A scant
3.5% of you have your practices in a converted residence,
with another 7.5% of you working in home offices.
Group practice may be the wave
of the future but for the time being 34% of 1,100 respondents
reported they were in solo practice. Groups accounted
for 36%. Partnership appears to be less popular than
it once was with only 6.5% reporting they were in this
form of practice. Professional incorporations are certain
to grow given the lifting of restrictions but, for the
time being, they account for only 6.6% of those reporting.
A further 12% were in hospital practice with the remaining
4.9% on salary.
The survey results conformed to
the country's demographics with 43% reporting they worked
in cities with a population of more than 50,000 and
less than 1 million. About a quarter (23%) live and
work in small centres with about a third practising
in cities with a population of over a million.
Practice management consultants
are fond of urging additional examination rooms on their
clients and they appear to be having some success. The
mean (46%) reported using two examination rooms, but
a significant 27% reported having three or more. The
same number (27%) continues to use only one.
Many physicians struggle to cover
practice and living expenses and are understandably
adverse to the idea of taking on additional staff. Receptionists
remain the most common staffer with almost 50% of practices
employing them. Nurses who, at least in theory, could
provide busy practitioners with some relief by looking
after the more routine medical tasks are in relatively
short supply at only 20%. Support staff, largely non-medical
people in clerical roles, account for another 29%. Only
47 practices of over 1,000 reported having nurse practitioners
(NP) on staff. Though NPs could perform billable tasks
and possibly pay for their keep, there are fewer than
1,000 of them currently practising here. The 70,000
NPs working in the US have proved to be a profitable
addition to many practices there, where they bill patients
directly for their services at levels approaching those
of the MDs themselves. Suspicions remain here that provincial
governments have a hidden agenda whereby they hope to
replace general practitioners in many communities with
NPs, and this has possibly slowed their acceptance by
practitioners.
Future articles based on the
survey will look at practice revenue and income. To
all those who took the time to answer the survey: Thank
you.
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