Physicians Practice - February 2008 - (Page 69)

THE GREAT PRACTICE MAKEOVER TOO WELL-LIKED FOR HIS OWN GOOD? POPULAR SOLO DOC GETS SCHOOLING ON HOW TO SPEND MORE TIME ON WHAT MATTERS BY L AURIE HYL AND ROBERTSON “Not long ago, I went to my 35th high school reunion,” says endocrinologist Richard Plotzker. “People asked what I do professionally. I told them I sign stuff.” Not exactly what he (or any other physician) had hoped to do after the years of stress and heartache required for membership in one of the world’s most noble professions. It’s an unfortunate reality, though, that the number of papers a practice is obliged to shufﬂe increases proportionately with the number of patients who come through its doors. Plotzker doesn’t want to ofﬁce will help him feel less harried — and benefit the many other physicians he suspects are in the same overcrowded classroom. I’m dizzy with exhaustion just listening to Plotzker outline a typical day, which starts with 8 a.m. rounds in at least one hospital and ends no fewer than 12 hours later, after two jam-packed clinic sessions, nearly an hour of returning phone calls, and more hospital visits. About a year ago, he started setting aside Thursday mornings to catch up on paperwork, but that time is often ﬁlled with urgent patients instead. particularly the clinic sessions, so they run more smoothly. The question is whether this affable physician — I can’t resist describing him as having twinkling eyes — can adopt the radically different mindset that would allow such a paradigm shift. If he can manage it, this attitude adjustment, combined with a few simple best practices in practice management, will ease his strife considerably. STICKY SCHEDULES A WELL-OILED MACHINE Not discounting the clinical value of physician-patient small talk and relationship-building, the physician’s goal for an exam must be to begin the interviewing and decisionmaking processes as soon as possible after entering an exam room. “My ofﬁce resembles a jungle habitat, with charts piled by task,” he laments. Truly, unless you go completely cash-only, there isn’t much to be done about the mountains of administrative work required of a modern medical practice of any size, in any specialty. But there are ways to tweak Plotzker’s practice operations, know how to attract more patients to his solo practice. Instead, he’s interested in learning how to manage being the most popular kid in class. “I’m always reading about how to increase your business, but the solo docs I know are all struggling to keep up!” He hopes that an honest examination of the processes in his Wilmington, Del., WWW.PHYSICIANSPRACTICE.COM To begin to understand what’s behind the chaotic pace Plotzker’s constantly battling, I sit in on a diabetes follow-up visit. The patient has a medication list longer than a line at the post ofﬁce on tax day, and plenty of speciﬁc concerns about those meds. Plotzker helps the patient get his shoes and socks off for a foot exam, all the while gently questioning him about a host of comorbid conditions. Plotzker recently added clocks to his exam rooms — a ﬁrst in his 17 years of practice — in an effort to keep himself on task. They’re not really visible behind piles of stuff, though, and he doesn’t seem to be consulting them. He estimates that we were in the room with this particular patient for 25 minutes; in fact, it was closer to 40. This may be one clue as to why Plotzker feels he works more and more every year for less and less. Like the vast majority of private practitioners, he ends up coding most patient visits as Level 3. He only starts to think about coding a visit as Level 4 or 5 when it runs longer than 30 minutes — but if he doesn’t know he’s been with a FEBRUARY 2008 | PHYSICIANS PRACTICE | 69 http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - February 2008

Physicians Practice - February 2008 Contents The Bigger Picture: Your Future is in Your Hands Letters Physicians Practice Pearls: Creating an A+ Practice Noteworthy Cover Story: Conquering Time: 5 Keys to a More Efficient Practice In Balance: A Family Affair Technology: Making EMRs Work in the Exam Room In Practice: "I've Got Some Bad News" The Tech Doctor - The EMR: Savior or Poseur? Ask the Experts NEW! Healthonomics: How to Handle Health Savings Accounts The Administrator's Desk: Finishing School for New Managers Human Resources: Is Your Partner Impaired The Great Practice Makeover: Too Well-Liked for His Own Good? Coding Idealab: 'Why I Blog' Classifieds Advertiser Index

Physicians Practice - February 2008

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