How can I increase capacity at my practice?
Q: I’d love to serve more patients at my practice, but how can I when I’m already overwhelmingly busy?
DR. ADAM STEWART
A: It’s a question I hear often from other doctors, fretting about how overwhelmed and busy they are. As fellow healthcare practitioners, we can all relate. The life of a physician can be exceedingly demanding. Requests for our time can often surpass the number of working hours in a day.
That said, I am frequently perplexed when some doctors describe many of the elementary tasks, even administrative duties, that burden their time. When they describe all of the work they do, much of it would be best delegated to their staff.
“Why don’t you have your staff do that?” I’ll ask. The typical reply: Their staff is too busy, already over capacity. Moreover, physicians often go on to say they cannot afford to hire additional help.
The reality is that delegating tasks is key to improving efficiency and capacity. This is especially true for healthcare practitioners because in clinic operations the “bottle-neck” is often the physician’s expertise. It may seem counterintuitive, but if need be, hiring additional staff can help to improve efficiency, improve capacity, and thus improve one’s bottom line. Costly and time-consuming tasks can be delegated to the extra staff. It really is an embodiment of the old adage, “You’ve got to spend money to make money.”
You can delegate tasks to save time
Consider this unfortunately classic example: Assume it takes a doctor 45 seconds to measure and record a patient’s blood pressure in a chart. This is a job that could easily be delegated to a staff member. Thus, if a doctor takes the time to train a staff member to perform this task and to develop a standardized office protocol for preparing patients for visits, this would help save time exponentially from that day forward. Multiply 45 seconds by 20 patients per day and a physician could gain up to 15 minutes every day. That’s more than one hour per week. Practically speaking, those 15 minutes per day might equate to seeing an extra patient each day.
This is just one small example. Patients often need more than a blood pressure reading during a visit. Sometimes they need other measurements, such as height, weight, temperature, heart rates, and oxygen levels. This amount of prep time can easily amount to over two minutes per patient. Now the minutes are adding up:
2 minutes x 20 patients per day = 3.3 hours per week
While saving 30 seconds here and there might seem trivial, if that task is repeated a hundred times per day, it translates to hours saved each week — and this is compounded by each and every task that becomes more efficient.
Here are some other routine responsibilities that could be delegated to staff:
Relaying messages to patients, whether by telephone or email
Completing basic preliminary information on forms (like demographic information)
Multi-step, time-consuming tasks in Electronic Medical Records (EMRs), such as setting tracking reminders for tests and referrals, or the actual faxing of referrals
Importing lab data and reports to the EMR
Submitting billings (Note: While physicians should generally record their own billing codes for each visit, the actual task of entering billing codes into the computer and submitting them may be better delegated to staff.)
You can delegate tasks to save money
Of course, if delegating duties can save time, it can also save money. A time savings of 45 seconds may not seem like much, but you may feel differently if you follow the money. Assume that a physician’s time is worth $250 per hour, a nurse’s wage is $35 per hour, and a medical office assistant’s wage is $20 per hour. As we established, one does not need to be a physician or even a nurse to measure a patient’s blood pressure. Yet a 45-second blood pressure measurement can “cost” $3.13, $0.44, or $0.25, depending on who performs the task. Thus, it can make the most financial sense to delegate the responsibility to a medical office assistant.
If the office does not have a medical office assistant, perhaps it is worth analyzing the demand and hiring someone for such a position. It may be a role that pays for itself.
Many physicians make the mistake of feeling they cannot afford to hire additional staff. The truth, more often, is that they can’t afford not to.
It is an opportunity cost for physicians to spend their time on assignments that could be delegated to others whose time does not cost as much. The cost you’re saving by performing these tasks yourself may be dwarfed by the lost opportunity — to see more patients, or simply leave the office in time for dinner most nights. Freeing up our valuable (and costly) time can allow us to spend our efforts on our primary role, which also happens to be the role that generates the revenue: seeing and caring for patients. This helps to increase capacity and thus also improves the health care system at large.
Appropriate delegation can save time and increase capacity. Your practice may be able to serve a greater number of patients, generating higher revenues and earning more money more efficiently. There are usually countless areas where efficiencies can be improved. These benefits are compounded by every duty that can be delegated and the returns may grow exponentially over time.
Adam Stewart is a family physician with a practice based in Madoc, Ontario. In 2017 he was named by the Canadian Medical Association as one of "17 physicians who have helped shape the future of health care." More information on his practice can be found at www.stewartmedicine.com.