Finding Work Balance within Your Medical Practice

I feel caught in a vortex of competing demands at work - the major three areas in which my professional success is determined. First, of course, is productivity. While we are moving toward total-cost-of-care reimbursement, we are still firmly entrenched in fee-for-service payment models. 

Therefore, like it or not, my “productivity” is a function of how many patients I can see in clinic.  Second is my quality indicators.  My company is ahead of the curve and has been paying for quality performance for a number of years. While a lot of my quality performance is beyond my control, my name is still the one next to the score. Finally, a new one for our medical group this year is patient satisfaction. As you might expect, there is a lot of grumbling about this issue.

I feel like I am supposed to provide a lot of care (office visits) so I’m compelled to keep patient appointments to a reasonable length of time. However, I need to improve my quality numbers, so visits are max-packed with preventive healthcare and I need to do motivational interviewing to get my patients closer to their chronic disease health goals. Finally, I need to do all of the above in a way that makes the patient think I’m at the very top of my profession. It’s exhausting, overwhelming, and feels like a constant tug between competing demands. It leads me to question whether I should add more hours to my day so that I can see patients at a more leisurely pace. Or, I ask myself, how hard do I push my patients with uncontrolled diabetes to get to goal?  And what is my motivation if I get paid based on their success or failure? Finally, how in the world do I keep the patient “satisfied” knowing that factors like the outdated wallpaper in the exam room, the nurse chewing gum, or the steep co-pay will all affect how my patient views my doctoring skills?

I alternate between trying to meet these new challenges and getting ready to throw in the towel, frustrated that I’ll never reach the goals set for me. 

Last week, we had a patient satisfaction expert come to our medical group to tell us how to do it. One piece of advice was something called “ask-tell-ask.” We are supposed to ask our patients their understanding of the diagnosis (treatment discussions come later), then tell them what we heard them say, then ask them for clarifying information, followed by an admonition to “tell me your questions.”

So, I tried it. Unlike the expert’s example, my patients didn’t tend to have a single diagnosis. And our conversations, no doubt improving the patient experience, took a long time. So long in fact that I had a patient in the morning and afternoon clinic sessions leave without  being seen because I was running so late.

What this means: It’s back to the drawing board for me! I could schedule each patient with a 30- or 40-minute visit and run less behind while providing a very satisfactory visit for the patient. However, based on our current billing structure, this type of care would require me to add a number of hours to my schedule because I am not sufficiently productive with a pace this slow. If anyone has this figured out, I’d love to hear some suggestions.