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Reimbursement and Practice Management

Patient Access: The Efficient Office

A physician's time is the medical practice's greatest asset. Efficiency in the office is crucial. Building an infrastructure that supports optimal time management is essential.


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Your time is your greatest asset, so efficiency is crucial. Building an infrastructure to support optimal time management is essential.

  • Stay organized. Create a "flow-station" that is adjacent to your exam rooms. Address messages in between patients, avoiding batching work that leads to inefficiency.
  • Document during the patient visit, between patients, or at periodic points during the day. If you can't keep up, hire a scribe. Generally, you can break even on a scribe with two additional patient encounters per day. If you decide to hire a scribe, don't just bring on a fast typist, recruit a candidate who is trained as a scribe.
  • Work with a dedicated, organized team of support staff. Develop protocols about when and how patients will be roomed (including standing orders), as well as the appropriate messaging and triage systems.
  • Find an effective way to communicate with your nurse or medical assistant while maintaining patient flow. Examples include using tasks in your EHR system, visual cues (lights, flags or other signs), and dedicated patient-flow notes, while limiting in-person instructions that require synchronous communication.
  • Allow your clinical team members to work to the top of their license. Let nurses do more themselves. For example, have nurses collect patients' histories, call patients with instructions, triage concerns, and approve prescription refills within their authority, based on protocols established by you or the other physicians.
  • Keep examination rooms well supplied. Each room should have appropriate equipment, supplies, and any necessary administrative forms. Develop a list with the inventory and appropriate levels for each exam and procedure room, accompanied by pictures of each equipment and supply. Snap a photo of the layout of the room, as well as the proper set up for procedure trays to ensure that the process is mistake proof. With all the equipment and supplies at your fingertips, you can achieve peak efficiency.
  • When volume dictates the need, use a "patient flow coordinator." Having an air traffic controller who makes sure rooms are stocked with patients allows you to optimize your time.
  • Pair yourself with a nurse or medical assistant who can anticipate your needs. Have your team hold a "huddle" — a mini-meeting — each morning to discuss the day's schedule and anticipate patients' needs. Spend a minute or two at the end talking about yesterday's mistakes — and how to avoid them in the future.
  • Track outstanding tests. Not only is it crucial for patient care, but monitoring test results can boost your efficiency. Consider the patient who walks in without any results in their chart; you or your team spends precious minutes (or hours) hunting them down. Avoid this downtime (and frustration) by implementing a failsafe system to follow through on all orders.
  • Schedule visits wisely. For example, combine an acute visit with a long, new visit that requires the patient to be with a nurse or medical assistant for the intake period. Meanwhile, you can handle the acute visit and then move on to the new visit — all in the amount of time that a new visit would have consumed.

Working smarter — not just harder — will pay significant dividends.

Pearl: Assure Physician Access for Patient Access

How many days off should each physician get? National benchmarks can help you decide. Per the Medical Group Management Association, neurosurgeons, typically have five weeks of vacation plus CME. The range for all specialties is four to six weeks of leave. Surveying nearly 5,000 physicians, the American Medical Association reports that most physicians work between 40 and 60 hours per week. However, in the 2014 Work/Life Profiles of Today's Physician, almost 25 percent of physicians reported working between 61 and 80 hours per week. Assure the 46-48 weeks of patient care are being maximized by running an efficient office.

Pearl: Benchmark

It seems simple enough to look at benchmark data — find out what other practices do and compare. The Medical Group Management Association, for one, offers average numbers of support staff per full-time equivalent physician by specialty. That's a good place to start — but it should never be the end of the story. Why? The benchmark for others may not be the benchmark for your practice. That's because your support staff is there to support the physician, at the top of their license. If the physician "pace" is five highly complex patients a day, they might only need one staff member, but if the pace is 40 patients a day the physician may need more than the national average. Take staffing benchmarks with a grain of salt, noting that you'll want to keep your volume, caseload complexity, services, technology, space — and especially the physician's workstyle in mind. Remember, even by specialty, there's no "cookie-cutter" approach.

Pearl: Market Awareness

If you're considering opening a new satellite office — or moving to a new community to start a practice, the United States Census is a great place to evaluate market demand without a cost. You can find data for the U.S., broken down by county. Look at the population in your county, estimate the number of patients you need to support your specialty practice, and compare it to existing physicians that serve your vicinity (which you can locate by an online search, or the local hospital’s medical staff directory).

Pearl: Right Work Gets Right Pay

Consider paying a little more. Medical assistants and receptionists, especially, tend to be paid at lower rates. That may be in line with industry benchmarks, but you shouldn't wonder why someone making minimum wage isn’t exactly enthused about putting in extra effort. Assess salaries in your community through one of several Websites that host position-based income data that can be accessed without a fee.

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