Dr. Neil Baum's 10 tips for being on time as a physician

"There should be no interruptions when doctors are involved in patient care," according to Neil Baum, MD.

"Timeliness is next to Godliness" - a modified Biblical proverb

American health care is in disarray and in dire need of repair. Nearly every health care worker agrees that there is uncertainty about the future of health care in America. Medicare cuts are looming in our future, and private payers are likely to follow the lead of Medicare and decrease reimbursements. This is compounded by rising costs of overhead expenses. The result is that doctors are being squeezed, and their incomes may decrease. That’s the bad news. The good news is that there are opportunities for doctors to become more productive, to see more patients, and to avoid the erosion of their incomes. Many of these ideas can easily be implemented in any office, with minimal or no expenses and without adding additional staff. This article will review ten suggestions that have been tested in my and other practices and may help make us more efficient, more productive, and, yes, more profitable.

1. Develop a time management philosophy and make staff and patients aware of your desire to maximize your time during the office. It all starts with a commitment to being an on-time physician. The doctor must commit first to this concept and then obtain the commitment of the staff that being on time, becoming efficient, and being more productive is vital to the success of the practice. You can’t have a staff trying to be on time if the doctor(s) don’t embrace the same philosophy. You may want to create this in writing and have everyone sign the commitment. This topic deserves frequent mention at staff meetings as a constant reminder of the importance of time management, which ensures that it is a goal vital to the practice’s success.

2. Have everything you need ready. This includes equipment, supplies, pathology, lab reports, and imaging studies before the doctor sees the patient. Doctors can’t be efficient if they don’t have everything they need at the point of contact with the patient. We all know about the delays that can take place if the doctor plans to do a procedure and doesn’t have the right tools to accomplish the procedure. The same applies if the doctor needs the results of a CT scan or a pathology report to discuss with the patient regarding their medical care. All these issues can be resolved using checklists placed on the chart or in the EMR. These checklists can be reviewed the day before the patients’ appointments, and any missing reports or equipment can be obtained before the patient is placed in the exam room. There is no downtime when the doctor is eyeball-to-eyeball with the patient.

3. The doctor must start on time. Although this is consistent with adopting the philosophy in point number 1, this is the implementation process and having the doctor walk the talk. If the patients are to be seen at 9:00, the doctor must arrive before that start time and be ready to commence with patient care at 9:00. There is a better time to look at emails or return phone calls. If the doctor doesn’t arrive until 9:30, you can be sure delays and interruptions will occur. As a result, patients who have later appointments will be seen 45-60 minutes after their designated appointment times. This leads to anxiety and frustration among the staff and lowers patient satisfaction and the doctor’s online reputation. You might also inform patients that you are trying to be on time and request that they arrive 5-10 minutes before their appointment. BTW, this only works if the doctor is on time.

4. Avoid interruptions. There should be no interruptions when doctors are involved in patient care. I suggest creating a written policy of exceptions to this rule. Acceptable interruptions include calls from the emergency room, the intensive care unit, or the operating\recovery room. I suggest not taking calls from your stockbroker, insurance agent, spouse, or children. Each physician must decide if you will take calls from a colleague or from referring physicians. I recommend that your receptionist tell the doctor who is calling you that you are with a patient, and you will interrupt them if it is an emergency. Otherwise, the doctor will return the call when he is between patients. Most doctors calling to speak to a colleague will accept this response and will not request that you be interrupted.

5. Instruct new patients to arrive 20-30 minutes before their appointment to fill out paperwork or complete the paperwork online if your website provides the forms for patient demographics and a health care questionnaire. This approach makes it possible to avoid delays if patients complete their paperwork in the reception area. The receptionist should inform patients that this paperwork must be filled out before being escorted to the exam room. Consider explaining to the patient what will happen during the first exam, such as x-rays or blood tests, or providing a urine specimen so that there are no surprises for the patient upon arrival. You might also want to estimate how long the visit will last so the patient can plan their schedule before or after the doctor’s appointment.

6. Managing patients that take longer than the allotted time. It is common to have a patient who requires more time than you allotted. You are presented with a decision as you would like to provide that patient with additional time. Still, you don’t want to be late for patients scheduled after the patient who needs extra time. I suggest that you mention to the patient that you understand that they need additional time; however, you would like to be on time for the patients who have later appointments. You can offer the patient to make another appointment, come at the end of the day when you will have open-ended time to spend with the patient or offer to call the patient at home to answer their additional concerns or questions. Patients will rarely object to one of these options.

7. Cushion your schedule to allow the doctor to take a short break or catch up if there are delays or patients take longer than expected. It helps if you have a 5-10-minute cushion each hour. It can be used to see an urgency or emergency, return phone calls, or complete paperwork. Doing so makes you more likely to remain on schedule for the subsequent hour.

8. Obtain prior authorizations before the patient’s appointment. Nothing can be more frustrating than having a patient occupy a seat in the reception area because they don’t have authorization from their primary care physician or insurance carrier. Obtaining approval can take 30-60 minutes. This delay can create havoc with your schedule. This delay can be avoided by telling the patient that they are responsible for obtaining the authorization and that failure to obtain the authorization will result in a delay in being seen by the doctor.

9. Allow for emergencies and urgencies. Every physician will have one or two patients who call and request a same-day appointment. In the past, I have told these patients to come in, and we will “work them in.” As a result, inserting these emergencies or urgencies will throw off your schedule and make you late for appointments at the end of the morning or at the end of the day. You can alleviate this situation by having time slots that are left open in the mid-morning and mid-afternoon.

10. Estimate how long each visit will take. Follow-up and post-op patients require less time than a new patient. It may be challenging to determine how long a visit is needed for a newly diagnosed cancer patient. Consider seeing this patient at the end of the day to be thorough and answer all their questions.

Bottom Line: Being on time for patient appointments is crucial for establishing trust, maintaining efficiency, and promoting a positive patient experience. Seeing patients on time is an effective marketing strategy. Patients expect to be seen on time by the dentist, the stockbroker, the lawyer, the hairdresser, and their physician. Suppose you develop the reputation of being an on-time physician. In that case, you will have a more enjoyable practice, less stress, less risk for burnout, and even arrive home in time for dinner.