Learn to Delegate Duties in Your Medical Practice
If you're the owner or co-owner of your own medical practice, you may spend a lot of time worrying about the details of your business, from the billing and office décor to patients and personnel management.
But while staying involved in the day-to-day details may seem like a good route to quality control, it's really a good way to mess up your practice.
Here's why: As a physician, your training and experience make you well qualified for examining and treating patients. That training and experience means that your salary is among the highest in your office. And paying a $100,000-a-year staffer (that's you) to order supplies, take preoperative histories, give shots, send out bills, or haggle with HMOs doesn't make financial sense. Instead, you need to use less expensive staffers to take on duties that don't require your skill set, and save your time for doing what brings the real money into the practice: caring for patients and caring for them well.
Time-motion studies
How does a classic "type A" employer even begin to delegate? A 2002 article in Physician Executive suggests starting with a "time-motion" study of what you (and other physicians in the practice) do during the day. That is, for several days, you carry around a notebook and write down everything you do at work (including reviewing charts, greeting patients, returning phone calls, refilling prescriptions, dealing with sales people, filling out forms, looking for supplies, making coffee, everything). As you note the types of tasks performed, also record how much time you spend on each task.
After several days, review your notes and categorize each task as
- something only a doctor can do;
- something staff, whether it's a nurse, physician's assistant, or bookkeeper, could do; or
- something no one should have to do because it's a waste of time caused by inefficient space, organization, or technology.
Rigorous honesty
Charting your activities and the time they take is pretty straightforward, as long as you can remember to do it in the course of a hectic day. Deciding what can be delegated can be harder because some doctors just can't let go of managing every task. Other physicians are so focused on eliminating "overhead" that they don't want to hire staff.
But consider this: Another person may be able to do a lot of these tasks better, faster, and cheaper than you can, which means that what might seem like overhead is actually the necessary expense of running a smooth operation. A bookkeeper or accountant, for instance, may be able to handle your financial matters in half the time that you would, and at half your hourly rate. An advice nurse can return patient calls; that nurse's time, again, costs your practice less than your time (and some nurses, frankly, have a better rapport with patients than do the harried docs).
Likewise, a nurse practitioner or PA can examine, diagnose, order tests, and treat many of your routine patients, which would allow you to focus more fully on more complicated cases. Indeed, delegating patient care to NPs and PAs can boost your patient satisfaction, as it means routine patients will be seen more quickly, and more complicated cases will receive more of your focused attention.
Good leadership
The general rule of thumb is to delegate tasks to the lowest-paid staff member who can do it competently. But don't forget the legal angle: Different states have different laws about who can delegate what to whom and you need to be very clear about those. (e.g., In your state, can unlicensed medical assistants give shots, as long as they're properly trained? Can a nurse practitioner delegate to a nurse or a medical assistant?) Consult with a health care attorney or your local medical association to get an accurate list of what you and your staffers can and cannot do.
And then don't let go entirely. Delegating doesn't mean throwing tasks to the winds. To be aware of what's happening in your practice, you'll want to have daily or weekly staff meetings; keep an open flow of communication with your office manager or head nurse; and keep tabs on patient comment forms. Leadership isn't hovering, but it isn't turning a blind eye either. A good leader delegates tasks, trusts the staff, and stays in the loop.
