The National Review of Medicine
Practice Management Survey conducted last spring highlighted
the fact that you're working too hard. Almost 70% of
the 1,057 respondents identified excessive patient loads
as their most pressing practice problem. It's not too
late to take part in this year's survey (see page 8)
but early results confirm that sky-high patient loads
continue to be a focus of concern.
On the obverse of the patient-load
coin is income: the more patients you see, the more
money you make. Notably, only a handful of your colleagues
have complained about low incomes. Clearly, what most
physicians would like is to have a more reasonable patient
load and more to show for it at the end of the day.
Shorter hours, higher income! What
physician wouldn't want that? The healthcare system
isn't about to deliver this Nirvana regardless of what
combination of public and private services emerges in
your province, and it now appears the doctor shortage
is likely to continue for another decade. So if you
want to work less and earn more, the ball is squarely
in your court.
TAKE
A GOOD LOOK
There are a few things you can do to work smarter. A
good place to start is by taking a close look at your
practice profile. Review your roster and slot patients
into categories that compare time spent with the amount
billed. This may seem hard-hearted on the face of it
but the exercise will help you focus your attention
on those areas of your practice that are the most income-efficient
and highlight areas in which you expend maximum effort
for minimum returns.
The suggestion here is not that
you turn your practice into some fast food emporium
in which every gesture, every ounce is evaluated for
what it contributes to the bottom line. Far from it.
For years dental practices have evaluated their patient
mix according to earning potential. Indeed, many of
your colleagues do it as well. You're likely aware of
it yourself, even if you don't practise profiling in
quite such a deliberate way. You know that Mrs. C —
who arrives with her lists of ailments and vials of
pills — 'wastes' far more of your time than Mrs.
B who breezes in and out with little more than a, "Thanks
for your time, doc".
CODE
IT
Instead of going through all of your patient files in
one sitting, consider flagging files as they come up.
You're likely doing this to some extent already. Consider
colour coding patient records with those small round
stickers they sell at office supply stores. Red for
a time waster; green for in and outs; yellow for somewhere
in-between. Initially, the exercise will simply help
you better appreciate where your time goes. But in the
longer term, you may want to begin structuring your
practice day so that you have more time available to
see 'green' flagged patients — without, of course,
neglecting your 'reds'.
THE
EARLY BIRD
To up your quota of 'greens', consider scheduling your
first patient of the day at 7am or earlier. It's an
almost sure-fire way to boost your practice's bottom
line when you make it easier for working people to see
you. Very busy patients may want to come in before they
begin their workday, and they'll typically be grateful
that you provide such convenient hours. And because
these patients are in a hurry to get to work, they're
not likely to waste your time discussing a list of vague
symptoms.
Private firms like the Royal Bank
and Best Buy invest heavily in identifying their best
customers — those who generate the most profit
and give the least hassle. Dentists do it and there's
nothing unethical about you doing it as well —
it's just an extension of good patient practice. Once
you're used to starting early, consider cutting time
off at the end of the day. Some practices do double
duty by closing early some days and re-opening again
in the evening. If you're already working a 10- or 11-hour
day, there may be benefits for you and your patients
by splitting it up into chunks — say, 7am to 1pm
and 5:30 to 8:30 or nine. And be sure to use the extra
time at least once a week to do something you enjoy.
Allowing a 10-hour day to turn into one of 12 hours
by doing practice-related tasks when you're closed to
patients just defeats the purpose.
NIX
NO-SHOWS
Dealing with patients who fail to show up is a challenge
to any practice. No-shows can leave holes in your schedule
that are hard to fill. Resist the temptation to overbook.
If patients expect your office to be "standing room
only" they'll hardly feel guilty for playing hooky.
A better solution is to try to
track who's not showing up, figure out why, and then
try to address the issue. Anecdotal evidence singles
out young men as the most likely no-shows. After all,
they didn't want to come in the first place. If a simple
reminder doesn't work, try to call at least two days
in advance of the appointment to confirm. An up-to-the-minute
system that works particularly well for inner-city practices
that cater to office workers is to collect patient e-mail
addresses and send a reminder message that way. If you're
one of the 3% of practices that's made the switch to
electronic record keeping, you can arrange for a service
that will automatically dial flagged patients and remind
them of upcoming appointments. Though not yet widely
used in Canada, such services in the US go for about
$100 a month and are popular with many practices.
Another wrinkle that's on an upward
swing south of the border is charging no-shows a fee.
It's a tactic that would be hard to enforce in this
country, where the charge can't be tacked onto a bill,
but you can still dream. You could also try making the
switch to same-day bookings (see "See
patients sooner with same day scheduling", NRM March
30, 2006, Vol 3, No 6, Page 11).
TAKE
WHAT'S YOURS
A myriad of services you commonly provide are either
not covered in provincial compensation plans or, more
commonly, are covered but physicians fail to bill. It's
worth having a consultant come in every couple of years
and check your practice habits against billing codes
to make sure you're being paid for all of the chargeable
services you perform — just $20 a week in missed
charges adds up to over $1,000 in a year.
While you're at it, review your
practice methods to see if there are perfectly legitimate,
billable services that you're neglecting. Some of your
colleagues are far more aggressive at billing every
charge that could conceivably be covered than others.
There's a fine line to draw here. Every province does
random checks to make sure that charges are within the
norms. It's up to you to decide how close to the line
you want to play it, but it makes little sense to fail
to do billable procedures or tests because you want
to save the province a few bucks.
CUT
COSTS
Watching support staff twiddle their thumbs with no
work to do is an utterly frustrating sight. You can
almost smell your money going up in smoke. If these
staffers are paid by the hour, there's a simple solution
— ask them if they'd like to leave early or take
Friday off. You might be surprised at how eager they'll
be to sacrifice money for more time off. It's a win-win
proposition.
With salaried employees, it's a
tad trickier to cut costs when there's a shortage of
work. Talking frankly about reducing their hours and
salary may get you somewhere, but ultimately you may
come to some unpleasant conclusions and end up handing
out pink slips. It's not uncommon for compassionate
doctors to fritter away a healthy proportion of their
practice's income on redundant support staff.
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PATIENTS & PRACTICE
