Private Practices

Private practice: 4 office-visit changes to make most of doctors' time

Focusing on efficiency before and after the physician enters the exam room can be key to a much better visit for the patient and less stress for the doctor. Learn how to integrate those changes with learning modules that apply across a wide range of private practice sizes.

AMA STEPS Forward™ can help

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A physician having more time to concentrate on patient concerns hinges on incorporating specific techniques that entail increased engagement by medical assistants and nurses.

“Too often physicians are left in the doctor-do-it-all, heroic model. That makes it hard for them to deliver the care they aspire to,” said internist Christine A. Sinsky, MD, who recently retired from private practice and is the AMA’s vice president for professional satisfaction. “The more organized the workflow, the more capacity the physician has to deliver the best care.”

Step-by-step instructions to optimize workflow are available to private practices at the AMA STEPS Forward™ collection of open-access modules, offering innovative strategies that allow physicians and their staff to thrive in the new health care environment. These courses can help prevent physician burnout, create the organizational foundation for joy in medicine and improve practice efficiency.  

STEPS Forward is part of the AMA Ed Hub, an online platform that brings together all the high-quality CME, maintenance of certification, and educational content you need—in one place—with activities relevant to you, automated credit tracking and reporting for some states and specialty boards. 

“Most physicians can save three to five hours a day by reengineering the way the work is done and by strategically delegating the work to well-trained staff,” explained Dr. Sinsky. She recently co-authored, “Advanced team-based care: How we made it work,” in the Journal of Family Practice. The article details the experiences of the Bellin Health system in Northeast Wisconsin.

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“One of the key principles of all this work is empowering the staff,” said Bellin family physician and article co-author James T. Jerzak, MD. “When you empower your staff and you trust them to do meaningful work, it's just amazing.”

STEPS Forward provides an overarching view on how to do that with two modules, medical assistant professional development and implementing team-based care. They take a practice through the process of staff working together to identify and implement training and workflow solutions.

Specific tasks for empowered staff

Practices can then choose from STEPS Forward modules that tackle specific practice workflow situations to be streamlined.

Begin the day by getting on the same page. The module on implementing a daily team huddle explains how to boost practice productivity and morale by gathering a few minutes before patient visits start to go over what to expect in the day ahead, special patient situations and practice improvements.

Start the visit before the patient arrives. As the names imply, pre-visit planning and pre-visit laboratory testing shift important information gathering to well before an exam room encounter. At the end of each visit, setting the next patient appointments establishes the timeline for collecting information. Checklists and pre-appointment questionnaires encourage completeness in gathering the information.

In the same spirit, annual prescription renewal saves time and promotes care continuity by using an annual comprehensive care visit to renew all chronic illness medications to the state’s maximum duration.

Reassign exam room tasks. Expanded rooming and discharge protocols detail a wide range of traditional physician activities that can be done by a medical assistant or nurse, allowing the doctor’s attention to be focused on the patient. On the front end, tasks can include protocol-based screening for conditions, updating patient history, and arranging for preventive services based on standing orders.

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During discharge, staff can handle the printing and review of an updated medication list and visit summary, go over medical instructions and coordinate the next steps of care.

Cut the doctor’s documentation time. Team documentation—“scribing”—frees the physician by having team members help prepare visit notes, entering orders and referrals, and preparing prescriptions.

Expect these changes to require investment, a choice that private practice physicians can exercise as ultimate decision makers where they work. Most modules have interactive calculators to establish savings.

“You're probably talking about adding some staff, which is really a nonstarter for lots of folks until you realize that financially this is actually achievable and sustainable,” said Dr. Jerzak.