How to get out of the office by 5:30 p.m. every day
By Melissa Gerdes, M.D.
Many of my colleagues are vexed by days that stretch on to 6 and 7 p.m. Not only are physicians aggravated by these tiring “extended” days, but so are staff members. As a busy family medicine practice of three part-time physicians and one nurse practitioner, we struggle with this time issue as well. We have tried over our 10-year existence to beat the clock and preserve our time out of the office. Here are 10 ways we are able to leave the office on time (that is 5-5:30 p.m.) every day—seriously.
1. First and foremost, make being on time a priority for everyone in the practice.
Ending the day on time must be a stated goal. For some practices, other goals may take priority, such as spending time with patients, completing paperwork on time, or attending meetings. Be honest. Our practice is composed of young females (physicians and staff) who all have homes and children to manage, so it was naturally a priority to leave the office on time.
2. Start on time and be realistic about your starting time.
If you like to mosey into the office 10 minutes late, drink coffee, then get down to business, start then. Starting on time and creating the start time that realistically works is respectful to yourself, your staff, and your patients. Many offices can solve chronic tardiness by doing this alone.
3. Schedule time for those tasks you have to do when you’re not in the exam room.
Family medicine practices tend to focus on visit time, as this is what pays the bills, but we all know there’s a lot of non-visit work to do every day. Be realistic about this. We estimate that each physician spends 30-60 minutes each day doing this non-visit work in our practice (this number tends to be higher with a heavier Medicare population). Each physician dedicates a block of time free of patient visits each week. Remember, delegating paperwork, phone calls, and other clerical work to staff is critical for managing the volume of this work.
4. Take lunch.
Everyone needs a break. You’ll find that you work more efficiently and can start the afternoon session on time if you are more rested and well fed. We also take advantage of this time to catch up on that non-visit work.
5. Pay attention to the clock and stick to your schedule.
We make it a priority to stay on time during each and every visit. Each appointment is scheduled for 15 minutes. This does not allow time to address any and everything. Patients often have unrealistic expectations about how many problems can be addressed in a visit. We limit the number to two or three problems per visit. This is realistic and billable. If the list is longer, we may accommodate the patient as long as it does not inconvenience others, or we ask him or her to return for another visit. Our front office and nursing staff help with this problem by setting the patient’s expectations for a reasonable amount of items to be covered in a visit or opting to schedule the patient for a longer visit at the start.
6. Share with your patients that keeping on schedule is a priority.
Patients will likely appreciate your attention to this often-overlooked facet of medical care. We have our patients participate in time studies one or two times during the year. They carry around a clipboard while they are in the office, noting the time they start each portion of the visit. We always get positive feedback from patients when we do this. First, they are impressed that we’re interested in knowing about our efficiency. Second, they appreciate our great cycle times, which range from 30-60 minutes. Cycle time is a patient’s total time in the office including ancillary testing and therapeutics. We like getting this information, as it reinforces our efforts and exposes areas that need work.
7. Reserve same-day appointments.
If patients can get their medical needs addressed when they want them addressed, the list of problems tends to be shorter. Patients are happier and less time is spent apologizing for delays during the visit, leaving more time for patient care. There is also less duplicated work (repeat phone calls, long histories) if a patient can be seen when they want to be seen.
8. Empower your nursing staff.
Nurses can do quite a bit of patient care. When public health epidemics arise like H1N1, we educate our nurses to answer questions and give protocol-driven care recommendations over the phone. Nurses and nurse practitioners or physician assistants can also do brief visits driven by protocols and physician oversight for things like strep throat and urinary tract infections.
9. Use a team approach.
As part of our visit-triage process, our nurses review a patient’s preventive care needs—age-based services, such as colonoscopies and mammograms, and disease-based services. Nurses are empowered to give patients immunizations and schedule preventive studies prior to the physician entering the room. This way, dialogue about these services is started for the physician to continue during the visit.
10. Get an EMR.
As we all have young kids, the arrival of the EMR revolutionized our practice style. We all agree, getting home at 5 or 5:30 p.m. is necessary to spend time with family. Then, if we still have some office work to do, we can do it remotely later. This technology has also eased our ability to travel as we can check in with the office periodically.
Hopefully these tips will help your office start, keep, and finish on time. Meeting this goal makes everyone happier. Really.