Improve your well-being by having staff work at the top of their license

December 19, 2016

What if you found a way to improve the efficiency of your practice, reduce your workload, and even grow revenue, as well as increase your satisfaction and improve employee retention?  It may sound impossible, but all of this is actually doable by redesigning your practice team to work at the top of their license. 

What do we mean by “working at the top of your license?’  You and your staff should work on the most complex, challenging tasks that each of your licenses, training and abilities allow – rather than spending time on tasks that could be done effectively by someone with less training.

Do you find yourself doing tasks that your medical assistant (MA) or registered nurse (RN) could perform instead?  If so, you aren’t alone. In his keynote plenary session at the Annual Scientific Meeting in San Francisco titled “Why Reinvention of the Doctor-Patient Relationship is Key to Physician-led Health Care Reform,” Mark T. O'Hollaren, MD, FACAAI, noted that only 27% of physician time is now spent with patients; the remaining 73% is spent doing administrative and computer tasks. It is likely some of those tasks could be efficiently performed by someone else, which could free up your time to see more patients, improve patient and provider satisfaction and potentially improve revenue. Most of all, it could improve your overall work experience and quality of life.

Dr. O’Hollaren gave a fascinating example of this from a pilot study done at a health system in Oregon. Physicians went from working with one MA each to working with two MAs; in exchange, they were asked to see two additional patients per day to offset the extra expense. The result? Physicians were actually able to see five extra patients per day AND trim 15 hours per week from their administrative workload! How was this possible? The MAs, working at the top of their license, were able to take on tasks previously done by the physician, including working as a scribe, confirming tests were completed, and other follow-up work. 

What are some things your MAs and RNs can do to improve the efficiency in your office and reduce your administrative workload?  Practice Management Committee members and experts at three allergy practices, Kelly Davis, BS, CMPE – Covenant Allergy & Asthma of Chattanooga, TN; Laura Meadows – Allergy Partners of Lynchburg, VA and Kay Tyler, MBA – Family Allergy & Asthma of Louisville, KY, shared some of the ways MAs and RNs take on larger roles in their practices:

  • Room patients based on expanded rooming protocols
    • Identify the reason for visit / chief complaint
    • Perform medication reconciliation
    • Perform review of systems
    • Record past medical, family & social history
  • Perform tests based on standing orders
    • FeNO
    • Spirometry
    • Peak flows for asthmatics prior to getting allergy shots
  • Provide immunizations based on standing orders
    • Flu
    • Pneumovax
  • Refill prescriptions based on protocols
  • Triage calls based on protocols
  • Educate patients on the following topics:
    • Environmental controls
    • Immunotherapy
    • Use of inhalers/nebulizers

These changes involve creating written standing orders and protocols that clearly spell out the rules and policies for conducting patient care in various stipulated clinical situations (rooming a patient, refilling prescriptions, performing tests, etc.)  They may also involve providing additional training to staff taking on new responsibilities. The Practice Management Committee suggests creating a taskforce of physicians and staff to work together to create standing orders and protocols as well as identify potential training needs. Try to adopt one or two changes at a time to ensure successful implementation.

The Practice Management Committee and the new Taskforce on Physician Well-being will continue to look for solutions you can implement to improve your quality of life. Check out future Practice Excellence articles for more on this topic.