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10 Steps to a better practice


Focus on the simple things that can improve patient care and efficiency.

Key Points

Ask 10 doctors about their toughest practice challenges and you'll get 10 different answers. Ask 100 of them and common themes start to emerge: Many agree that the single greatest factor that could improve their practice-often even their lives-is anything that could rid them of that constant, nagging feeling of falling behind. Whether the issue is cramped quarters, piles of paperwork, crowds of patients, or phones that never stop ringing, it's growing ever more difficult to get-and keep-a practice under control.

To help you out, Medical Economics asked physicians and practice management experts for advice on getting control of your practice. Many of the following strategies may be just what you need to get your practice back on track or take it to the next level.


Practices building new offices have taken up this once-radical idea, Korneluk says. Meanwhile, an ear, nose, and throat practice in Lincoln, Nebraska, went ahead with plans for a waiting room that it hardly uses; its physicians have told Korneluk it is "a waste of space."


It can be hard to know what is slowing down the schedule, says Kenneth T. Hertz, a consultant based in Alexandria, Louisiana. So when he assesses a practice, Hertz takes out his stopwatch and times each step in the patient visit. At a family medicine practice in Vermont, he pinpointed a slowdown in the exam room. Patients were taken to exam rooms and then waited up to 30 minutes to be seen by a doctor.

"[Exam rooms were] tied up, and patients were very aggravated," he says. Where was the doctor? He was answering phone calls. Callers were instructed to contact him at another time.

Schedules can also be bogged down simply by daily lunch breaks. Lori Foley, a principal at Gates Moore & Company, a practice management consulting firm based in Atlanta, recalls an orthopedic practice in the southeastern U.S. that completely shut down for lunch.

"Ramping down the whole practice before lunch and then ramping up afterwards is very inefficient," she says.

Foley convinced the practice to operate through lunch, staggering staff lunching times. Physicians now work straight through, grabbing lunch between patients. The practice has more visits and is thriving.


No one likes phone menus, but is there a better alternative? Medical Plaza Family Medicine of Florence, South Carolina, has found one. Patients are directed to call separate numbers for each physician in the four-member practice. Each doctor's own staff makes it a point to answer every call. They help each other out by answering calls that come through the main number. In many practices, it can take hours for a phone message delivered to the front office to make it back to the doctor, but calls to Medical Plaza always hit their target, says Richard Alexander, MD, a partner in the practice. In fact, he says, he often overhears the conversation because he is just a few feet away.

Contrary to popular belief, receptionists at the front desk should not be answering calls, says Cynthia L. Dunn, a Medical Group Management Association consultant based in Cocoa Beach, Florida. She believes practices should hire a separate operator for around $30,000 a year and locate that employee away from the front desk. The result is a much quieter reception area with fewer mistakes because there are no phone distractions.

In the waiting room of a busy family practice in the western U.S., Dunn saw a patient approach the receptionist, who was talking on the phone through a hands-free device, and try to talk to her. "[The receptionist] just began talking louder," Dunn recalls.

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