How you design your schedule has far-reaching consequences

“Doctor, how would you like your schedule template?”

As a hematology/oncology physician in a non-profit hospital group, I am reimbursed by wRVU. This is the standard mechanism of reimbursement for large multispecialty groups and academic centers. In this scenario, the more wRVUs you make, the more you get paid. However, there are only so many hours in the day. One of the first decisions each doctor makes when joining a group is how to make their template schedule. This seems simple at first, but actually has far-reaching consequences.

If one schedules new patients for an hour and follow-ups for 30 minutes, you’ll have more than enough time to see the patients, ask about their grandkids, and also write up an audit worthy note. However, as Parkinson’s law instructs us, a task expands to fill the time allotted. It has been my experience that 60 minutes may be too long to give most patients as they tend to veer towards speaking about their neighbor’s health issues or the illnesses or their pets.

Scheduling patients too close together may make the numbers look good, but is a recipe for disaster. One can see a new patient in 30 minutes and give them the impression that you are listening, allowing time for open-ended questions and emotional support. But once you leave the room, the next patient is usually waiting, and there is no time for a quick text to their surgeon or to finish your note, leaving that for later. Most physicians are reluctant to reduce the necessary time with their patient. However, they are more than willing to reduce the necessary time with themselves. Therefore, lunches are missed or crammed into 10 minutes. There is no time for a quick walk outside before the afternoon clinic. In short, you incur the suffering to reduce the patients.

Modern clinics make an effort to be fully staffed with MAs, RNs, and schedulers during banking hours. They are usually reluctant to flex these hours as it is expensive to pay these salaries. The hope is that the physicians will skate through as many patients as possible during clinic hours, then spend time before or after clinic doing notes and making calls. Let me argue why this is not a good long-term strategy.

Being rushed takes a physical and emotional toll on humans. Being rushed every day has a cumulative effect. Over years, this can lead to reduced pleasure from work and burnout. A more reasonable strategy is to decide to earn less and see patients at a pace that is reasonable and comfortable. I am not advocating a 40-minute new patient/20 minute template. I am advocating taking the time to know yourself and what you are capable of in the clinic in which you work. Some clinics are very efficient. Some clinics are not. Given the dramatic change in the last few years between physicians being primarily self-employed to physicians being employees, you may not have any control over the efficiency of your clinic.

It is difficult to know when deciding to join a group how efficient they are and how flexible they will be once you are seeing a full panel and request concessions to help improve your efficiency. However, you are in control of the pace of your clinic, and I strongly recommend you consider making less money each year so that you aren’t faced with the daily drudgery of being rushed and behind. It is penny-wise and pound foolish to do otherwise.

Bruce Hough is a hematologist-oncologist and founder, Hem-Onc Staffing Solutions.

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