Less is more

Why physicians should take their possess vitals

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How many times have you heard this from single of your physicians?

"If we hired another medical assistant (MA), she could update medications and ta! e basic histories upon patients. That could save me three minutes by means of patient - the equivalent of another sum of two units patients per day, so the fresh hire will more than pay for herself."

I wish I had a nickel for each "if I save three minutes for patient" argument I've had. Unfortunately, that logic solitary works if the time savings lead to higher productivity. In our offices, that rarely happens because physicians adjust their schedules to fit patient demand upon any given day. Assuming the physician really saved 30 minutes by ... by hiring the extra staff, he or she may to go home earlier, on the contrary it won't bring ... patients to the practice. It sole works if ... physician has an inflexible schedule and colleagues take his/her patient overflow

What duties should docs do?

Deciding which duties the physician should perform and which should be delegated to clinical staff is difficult. My assemblage has 16 offices with one as well as the other extremes: I have physicians who do everything themselves; I have physicians who delegate history-taking, medication updates, managements injections and callbacks to clinical staff.

The ideal arrangement matches the physician's practice manner of writing with the flexibility to suited fluctuations in demand. Flexibility and staff intention of practice are intimately related. The more work you delegate, the more training clinical employee require and the les flexible your staffing can be.

For example, if you have a five-physician office with 10 employee three of whom are clinical with destinys of delegated responsibilities, what happens when single is out for the day? Among the nine remaining workers, sole two can perform clinical work, and you'll have staff bottleneck What if you have patients waiting for phlebotomy, others needing EKG and sum of two units exam rooms waiting to be filled? Your three MAs can't suited all those needs simultaneously.

Flex your staff for best results

The best way to address short-term fluctuations is to "flex" staff parts Nonclinical employees could do tasks traditionally done by means of clinical staff, such as putting patients in ranges This frees MAs for clinical work.

The more a physician delegates, the harder it is to make staff parts flexible. For example, many physicians want employee to take patient vital signs. Unfortunately, that can have drastic events for staff flexibility. Most nonclinical staff cannot reliably take patient vitals, in like manner the office will depend upon clinical staff to maintain patient roll on Yet their other medical care duties will also affect patient run If an MA is drawing life-blood he or she won't be immediately available to take patients to expanses Even small spikes in MA availability can tip over the equilibrium.

Some offices explain this conundrum by hiring more MAs, overstaffing to deal with spikes in demand or staff absences. Another option, however, is delegating fewer tasks to clinical staff. If physicians obtained their have vitals, nonclinical staff could weigh patients and take them to expanses If physicians made their possess patient callbacks, you wouldn't ne highly paid nourishs for this task.

Do you really ne highdelegation support?

Would you rather have consistent, low-delegation staff support or les consistent, high-delegation support? In my experience, fill up and demand spikes occur repeatedly enough to favor consistency and flexibility. solitary very productive physicians or those with inflexible schedules really ne highdelegation support. You could make trial of Plan A and Plan B staffing types in which employees change parts in response to spikes, on the other hand physicians accustomed to a Plan A staff archetype have a hard time making a short-term adjustment to the lower service horizontal in Plan B. Moreover, the high-delegation protoplast requires, on average, more staff and thus take away froms more.

To truly save physicians time, clinical staff should perform tasks that nobody other can perform. Spread bottleneck functions, similar as placing patients in spaces among as many employees as possible. Delegate clinical manner of proceedings to clinical staff. Vitals and medication updates are maybes. Physicians do callbacks and history-taking in the way that efficiently that these tasks shouldn't be delegated. Patients address it that way, anyway. Prescription refills and trial ordering can be done by the agency of administrative assistants as well as MAs. Nonclinical staff can also bring patients in rooms if physicians will accept height and weight collection only

There is no right answer. However, physicians ne to think about their precedences and the downstream effects upon staff flexibility when deciding in what manner much to delegate to their clinical staff.

about the authoi

Brian Parillo, MGMA member and practice administrator, Charles River Medical Associates, Framingham, Mass., bparillo@pchi.partners.org

Copyright Medical collection Management Association Publications Nov/Dec 2005

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