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We recently worked with a smart, energetic practice administrator who was very motivated to improve his practice’s bottom line. He’d already found significant savings by switching billing and phone services (even getting better billing results, to boot). Spurred on by those successes, he’d turned his attention to clinic staffing. While the physicians in his practice mostly used conventional medical assistants (MA) for support, a few of the doctors and non-physician providers (NPPs) had opted to use “scribe assistants.” These hybrid staff help clinicians by both scribing during the visit and handling typical MA tasks like test orders and scheduling follow-up care. Because of the extra duties, and because they were hired through an agency, their hourly cost was a bit higher than for the MAs – a 15-20% differential that caught the administrator’s attention. The administrator estimated the hourly cost of hiring a new MA would be about $20, including taxes and benefits. The scribe assistants, meanwhile, cost the practice about $24 per hour. The scribes did some tasks the MAs weren’t trained or expected to do – notably, scribing. But the administrator believed that at least one of the NPPs who was currently using a scribe assistant could do just fine with an MA (she was a recent grad and tech enthusiast). So the administrator decided to suggest gradually switching some of the contracted scribes with employed MAs – and was surprised that his idea met with resistance. (After all, 18% would be a significant cost savings – yet even some of the partners resisted the idea!) As the administrator repeated his idea at a few monthly meetings in a row, the resistance grew into a testier conflict. Was the conflict a sign the administrator was wrong to bring up the idea of saving money on clinical staff? We wouldn’t say “wrong” per se – but we might have not have prioritized this particular cost-saving avenue. It’s natural for clinicians to be wary of any changes to clinic staffing. Clinical support staff is essential to physicians’ productivity. Anything that disrupts clinic flow can make it harder for physicians to
In the 1st and 2nd editions of Secrets of the Best-Run Practices, the final chapter was “The Practice of the Future.” After much deliberation, we decided to eliminate this chapter in our 3rd edition published a few months ago. This was partly because we touched on some of the most important trends elsewhere in the book – especially those related to technology, but also the possibility of exploring new service lines to make a career change or reinvigorate revenues. But there was another realization that held us back: the unpredictability of the medical market, which we realize is translating to difficult decision-making for many physicians. (A lot could happen by the time the publisher got the book into the market. So it seemed to make sense to focus on the "Secrets" that would apply no matter what.) Still, that doesn’t mean we think physicians should be in an indefinite holding pattern with respect to their businesses. Definitely not! Here are some of our observations on grappling with the future and uncertainty. Indecision We find some physicians are discouraged by political implications and big government in general. They feel they have no power over the way they practice and how much they are paid. This results in frustration that can lead to acceptance of their current situation and sometimes actually believing the future of their practice is not in their own hands. Physicians must remember that not deciding is in fact a decision to maintain the status quo and not take important steps that can improve practice results and their own attitude. Of all the negative effects of our uncertain environment, this one troubles us the most. Too many physicians are missing out on opportunities to improve their practices today, simply because they are distressed about uncertainty about tomorrow. All businesses deal with uncertainty – and most face much more than we do in medicine. Don’t miss out on important opportunities to run your business more efficiently or enhance patient service because you’ve voluntarily committed yourself to a holding pattern. Failure to use data This sense of paralysis about the state