Whether it’s taking down histories, ordering tests and other diagnostic procedures, referring patients, prescribing medications, filling out forms, completing mandatory reports or signing cheques — there’s no escaping the myriad administrative tasks that eat into a doctor’s day.
Furthermore, with thousands of different OHIP fee codes, just selecting the proper code to get paid can be a daunting task.
Physicians’ administrative work even makes national news. When Canada Post announced its plans in 2014 to require doctors’ notes for individuals to continue receiving home delivery--and surveys cited excessive administrative work as one of the top reasons for frustration and discontent among physicians-- the headlines, blogospheres and 6 o’clock news took note.
Several decades ago the personal computer debuted, amid much fanfare about the “paperless office.”
When many organizations began transitioning from paper to electronic documents in the ‘80’s, there was an initial reduction in paper, but the truth is that today, more paper is being used than ever before. Case in point: according to wired.com, more than 1 billion photocopies are made every day.
Michael Evans, Associate Professor of Family and Community Medicine at the University of Toronto and staff physician at Toronto Western Hospital, wrote in “The Battles of a Doctor’s Day”
(Globe and Mail, April 2009) that his office’s new policy of no phone-in prescription refills angered patients, adding, “We get 100 requests a day. It’s a logistical nightmare and we don’t get paid for it (like almost all of the other paperwork or phone calls we do”).
Physicians want to treat patients, perfect surgical techniques, conduct research, teach—not be stuck at a desk in a pile of paper.
However, your thriving medical practice demands that you and your employees know exactly where every file, paper, form and bill belongs. Research shows that the average employee spends more than 1 hour a day (6 weeks per year!) searching for things.
Consider how many times you get interrupted during a typical day because some form is incomplete. Research also shows that when you are interrupted, you don’t immediately go back to the task you were doing before the interruption. In fact, it’s been proven that people take on two additional tasks in between being interrupted and returning to whatever they were doing before.
Dr. Derek Puddester, MD, MEd, FRCPC, ACC and Associate Professor of Psychiatry at the University of Ottawa and an international expert in physician time management offers a unique perspective: “Administrative work is what it is… work! So I treat it just as I treat any clinical task or skill. To me, it must be honoured and treated with respect. It’s part of how I provide top notch care to my patients. If I take a minute to be mindful of this-- on those days I’m feeling, frazzled, frustrated and hard done by because of the time it takes to complete administrative tasks--it usually puts me in a better frame of mind.”
Keeping on top of practice admin work is key, but Karen Malabre, Manager, Association and Affinity Claims at Sun Life Financial, also shares some insight about why it’s important to ensure your own personal admin tasks, such as disability, critical illness or other insurance forms are completed accurately and submitted on time.
Karen says that, “Contrary to the ‘Hollywood perception’ (movies such as Erin Brokovich or The Rainmaker) that insurance companies are in business not to pay claims, I want our physicians to know that we bend over backwards to pay. Even though some of the questions on claim forms may seem unwarranted or not to make sense, we need that information to pay your claim.”
A 10-point prescription for paperwork:
1. Assess/reorganize your filing system Remember the study about the average person wasting one hour each day of every week searching for papers? Set aside some time to go through each and every file in your office with a view to purging as much paper as possible.
Dr. Puddester offers a word of caution about “the cloud”: It’s not the end all and be all, particularly for our profession. He says, “Storing sensitive documents on any U.S.-based “cloud” system—such as iCloud or Drop Box—is risky, because they are not subject to Canadian privacy and confidentiality regulations. Make sure your cloud storage tool is Canadian—and that you’re up to speed on any legal requirements concerning cloud storage.”
2. Check out OntarioMDOntarioMD, a subsidiary of OMA, offers information technology resources to support your practice and patient needs. The OntarioMD.ca portal offers, among other things, clinical practice guidelines, patient handouts, forms and flow sheets. OntarioMD also offers collaboration tools for information sharing and learning with your colleagues.
3. Ensure that making personal insurance claims is as efficient as possible OMA Insurance has retained an independent company, Sealey/Manning Inc. (SMD) to assist you during the initial stages of submitting your personal insurance claims—to ensure forms are completed properly, which means the shortest possible wait time for reimbursement. Call 905.822.6415 to be put in touch with an SMD representative.
4. Make an “appointment” Every day, your time can be frittered away in hundreds of different directions. To maximize your efficiency, make an “appointment” on your calendar to tackle administrative tasks that can’t be completed by your staff. Treat this appointment just as you would one with a patient.
5. Get tough about interruptionsTrain yourself (and your staff) to have everyone book an appointment with you, no exceptions. (This includes patients, sales reps and even your family. Talk to your spouse or other family members about checking in with each other at the same time every day—once--instead of numerous texts or telephone calls.)
Create a patient handout and a portion of your website homepage to explain this. Support your staff and yourself by talking to your family about your policy and the reasons behind it…and not making exceptions. Give it a try. Once everyone gets used to it, you will have a much calmer and organized day.
6. Avoid “voicejail”Telephone tag is frustrating and time consuming. When you reach voicemail, always include a convenient window of time your call can be returned in your message. When recording your own personal voicemail message, include alternatives for the caller other than leaving a message for you. (Example: “Push 2 to speak to Jill, who will be happy to help you.”)
7. Have your inbox within easy reach of your desk phone.If your inbox is within reach, you can complete easy paperwork (like reviewing lab results) if you get put on hold.
8. If you haven’t converted to an EMR already, make the switch.Not only does it reduce paper and save you money, but EMRs can help you provide better patient care and enable compliance more easily.
9. Attend an OMA Billing SeminarEnsure you’re doing everything you can to streamline your administrative tasks and maximize your income
10. Use pre-printed patient advice sheets.Spend some time writing or collecting advice sheets for everyday acute and chronic conditions, as well as information on local support groups, diet, exercise, volunteering and applying for home care. While spoken advice can quickly be forgotten or not remembered correctly, printed material with the most relevant sections highlighted for each patient can be referred to time and time again at home. Keep copies of these documents just outside of each exam room in a hanging wall tray and have your staff ensure they’re always current and well-stocked.
Sleep, health, fitness, proper nutrition and leisure time are just as important for you as they are for your patients. It’s easy to forget when so many people are depending on you. Leave your paperwork at the office when you leave. Let your phone go to voicemail if you’re off call—it’s worth remembering that if you were out of the country, on vacation or in hospital yourself, someone else would handle things.
Dr. Puddester says, “Like any clinical skill, time management must first be learned—then perfected. And as physicians, we must keep up to speed by consistently refreshing our time management skills, just as we do all others.”
Examining your current work habits with a view to fine-tuning them, brainstorming about ways that administrative tasks can be better managed, delegated or reduced and revisiting your time management strategies and practices are three things you can do to take back some control. We hope you’ll find some of these tips and ideas practical and easy to incorporate into your practice.