Are you a new family physician who struggles to stay on time in clinic? Are you a resident who worries about managing a full patient panel alone? Do you ever ask yourself: “How will I possibly pay off my student debt if I am limited to only seeing 10 patients a day!?”
It can be incredibly daunting to go from splitting a full patient list with your preceptor to your first day as a locum or new staff in a clinic with a full list of 20-30 patients whom you may know nothing about… This blog post is aimed at providing a quick (but by no means exhaustive) list of tips, tricks, and pearls to foster time management and efficiency in clinic! These pearls have been collected from multiple docs in their first five years of practice as well from some seasoned past preceptors – let’s learn from their experience of trial and error.
- Pre-planning: A little planning goes a long way
- On or prior to your first day speak with the front desk staff about expectations:
- If a patient is late and you are already back-logged be firm about having them re-book or that you will see them at the end of the day. (understanding life happens and you will sometimes make exceptions, just don’t make it a habit and patients will respect your time)
- Set boundaries early regarding double booking and walk-ins/add-ins
- Be clear about how much time you would like patients to be booked for. Consider less time for prescription refills (5-10 mins) and more time (30 mins) for complete physicals, patient with long insurance forms, AISH forms, etc.
- Early on find out how many patients you can comfortably manage in a day/per hour. This may increase as you get more comfortable or as you get to know your patient panel and you can change your appointment slots accordingly.
- Plan breaks into your clinic day. Every 2-5 patients block off an appointment slot to catch up or act as a buffer for appointments that go over time.
- Purposefully leave day-of appointment slots free if you’d like your patients to be able to see you on short notice or for small emergencies (and avoid being put behind schedule by “squeezing little Timmy in to look at his sprained ankle”)
- Educate your patients at your first meeting – tell them to show up 10 minutes before their appointment in order to get vitals etc. so you can see them at their given appointment time. Train your staff to facilitate this process.
- Identify the complex patients that might require more time and ask staff to book two time slots for them.
- On or prior to your first day speak with the front desk staff about expectations:
- Delegate, delegate, delegate: get comfortable asking for help or asking others to do tasks that don’t need to be completed by you.
- Have your MOA or nursing staff proofread and format your referral letters prior to sending them. Also have them collect information such as lists of medication or long past medical histories to attach to letters rather than you having to type it out.
- Have your nurse or MOA collect information and start the paperwork for first prenatal appointments, or complex care plans prior to you seeing the patient.
- Train your staff to get patients and equipment ready for you. E.g. if it’s a complete physical for a female who is due for a pap, make sure they are already undressed with a drape before you get into the room. If you’re doing a procedure, have the staff have all your equipment and gloves out and ready to go.
- Have staff communicate lab/test/imaging results to patients if a phone call needs to be made
- Paperwork/Charting
- Build time into your schedule to do paperwork, review labwork and answer faxes (eg. A half day once per week or 30-60 mins every morning before clinic). If you don’t it quickly becomes overwhelming and WILL interrupt your work day.
- Don’t reinvent the wheel – using a template, stamp, or quick text (based on your EMR functionality or ones you have personally created/saved) for encounters you see often (eg. Complete physicals, URTI, biopsies, sutures, IUDs…) saves you time not having to re-type everything by just having to modify it slightly per patient
- Try to type while you are speaking with the patient;
- Ergonomics of the room may not be ideal for this and certain clinical scenarios may require more of your full attention but typing as you are collecting information from the patient will cut down on time spent charting after the patient leaves.
- Try to finish charting a patient encounter before moving onto the next patient (much more efficient to do it while your memory is fresh) rather than at the end of the day.
- Hate typing or slow at it? Consider investing in software that allows you to dictate all patient encounters.
- Billing
- As a new grad billing is a steep learning curve – try to complete it on a daily basis while everything is fresh in your mind. Not only will you learn quicker but you will also be more efficient.
- Once you know your billing codes a bit better do your billing as soon as you finish the patient encounter so none of the work is left for the end of the day.
- Know which services are uninsured services and have a guide visible for patients and staff that lists the costs you/your office will charge for these services.
- Getting the chatty or long-winded patients out of the room
- When patients say they have a “list of things” hear them out but then ask them to identify which ones they want to focus on today as you want to ensure to give due attention to their most pressing concerns and book follow-up for others if you have to
- Senior patients – ask them “what has changed since the last time I saw you” and you’ll often be able to avoid rehashing their chronic, unchanging hip pain or the lump they’ve had on their wrist since they were 4 years old.
- Have the printer(s) located outside the visit rooms this allows for a very natural “come with me to get your prescription/x-ray req/lab req on your way out the door!”
- Remember to be polite and courteous
- Have front desk staff warn patients of time delays Eg. “Dr. X is 45 minutes behind schedule but you are next in line” – this will manage patient expectations as well as prevent a frustrated patient stewing in your waiting room for 45 minutes while waiting to be seen.
- When you are behind schedule acknowledge your patients who have waited and apologize or thank them for their understanding.
- Patient’s time is valuable too and simple acknowledgement goes a long way in securing a strong doctor/patient relationship.
And finally BE HONEST with yourself if you are feeling overwhelmed in clinic and/or constantly running behind schedule and modify accordingly. Be supportive and appreciative of your staff while being clear about expectations; they are there to help. The smoother your clinic days run the happier you, your staff and your patients will be.
If you are interested in reading more on the topic the PDF below entitled “Doctor on Time” by J.W. Crosby has come to me highly recommended as a must read for new in practice family doctors!
Author: Jennifer Ortynski Bsc, MD, CCFP
I had no idea about this lol. Pretty interesting subject for sure though.