When Your New Physician Is Underperforming

Your practice did its essential due diligence when interviewing new physicians. You vetted each candidate and carefully made your decision. The new physician has been on board six months now, and still isn't up to speed. He rarely sees more than 12 patients a day, and even then he falls behind. At this rate he is unable to cover his salary, let alone his share of the overhead costs. So what can you do?

First of all, provide proper orientation, education, and training for your new physician, so he clearly understands your expectations and knows the processes essential to complete a patient visit. Next, give him the tools he needs to succeed. If you have an EHR system he isn't familiar with, provide sufficient training to efficiently use the system during the patient visit - including becoming familiar with existing templates and understanding essential documentation for accurate coding and collecting payments.

Next, set goals for patient volume, increasing the number of patient visits each month until he achieves your practice's expected average. Of course, the appointment schedulers must be dedicated to filling his schedule each day, based on the established goals.

Next, have a skilled nurse shadow the physician for a morning session, and, on a separate day, an afternoon session. Here's what to look for:

1. Has the patient been properly prepared for the visit? This means not only taking vitals, but also documenting an explanation for the visit; making sure the patient is properly undressed and robed; and making sure everything in the room is "doctor ready" for the visit.

2. Does the physician make use of his time during the visit by listening to the patient and not asking a question that has already been entered in the chart by the nurse?

3. Does the physician leave the room to get something that should have been in the treatment room already?

4. Did the nurse anticipate the physician's needs? For example, if the patient came in with fluid on the knee, was everything set up to drain the knee?

5. Is the doctor able to document in real-time in the EHR?

6. Was the doctor mindful of how to properly close the visit; delegating nonphysician responsibilities to the nurse?

7. Does the physician move swiftly from one treatment room to the next, or is time lost in between?

These issues have become more pressing as new physicians learn to adapt to electronic documentation and try to do so without compromising the quality of the visit - and while ensuring that patients feel they are getting the attention they deserve.

Once you have this information and have pinpointed the problem, it's time to identify the best solution. Your new physician needs your support, so prepare a plan to give it.

Perhaps you will want him to shadow one of your most-efficient physicians and learn how to apply the same methods to improve his own efficiency. Maybe, he simply needs more training on the EHR, or would benefit from some customized templates to speed up the documentation process.

You might even want to provide a scribe to document patient visits. This may seem costly, but if adding a skilled assistant for this purpose increases production by 15 percent to 20 percent you will be further ahead and patients will be seen on time - making for a much happier and more efficient practice style for your new doctor.

You may want to recast this dialogue to focus on how the physician gets paid. Your concern for physician productivity becomes the lagging physician's concern when you factor in productivity and/or financial goals as part of his compensation package. Failure to do so may make it harder to get the new physician to understand why you are pressing him to be more productive. It can result in disenchantment for both practice leaders and the new physician. This often leads to the new physician leaving the practice, something your practice doesn't want, as physician turnover is very costly.