Friday, September 7, 2007

Summertime Blues, Part 2

Our last team meeting was a little glum. As noted previously, summer slowed our efforts to work down our backlog.

Now we're trying to come up with a plan that will address our new target (almost 100 extra patients per week) in order to work down the backlog by the end of November. We thought about adjusting our target date: if we push it back by another few months, that would ease the work. It would also prolong this initial phase of eliminating the backlog. Already, I'm feeling enthusiasm is dampening in the office. As the project proceeds (drags on?), it's harder to keep the energy up. Moving back the target date will be like dying the death of a thousand cuts. We need a new plan. Something bold.

We already thought about asking the "half-timers" to work a few extra days seeing backlog patients. Donna mentioned that, many years ago, the urologists in our office had come to work on Saturday mornings to see patients. Amanda wondered whether working one evening a week would be more acceptable than working a weekend. Either one would be a tough sell, given the hours we're already working. Maybe we just need to see what happens during September and October, now that we're back up to full steam again.

So... yesterday was our office meeting. We reviewed the (lack of) progress over the summer and I fielded the ideas for ramping up our work on the backlog. My two senior partners recently started job-sharing a position, one month on, one month off. We discussed the possibility of them coming back to work a few days before their scheduled work time in order to see some extra backlog patients. In a full office day, at a rate of four patients per hour, we may see up to 30 patients. However, this is usually a mix of new and review patients, with the shorter review visits balancing out the longer visits for new consultations. If they were seeing all new backlog patients, perhaps two or three patients per hour would be more manageable. Even so, having them in the office a few extra days would help a lot.

They're both preparing for retirement and looking forward to a reduced workload, after several decades of busy practice. So, what's in it for them?  How about the satisfaction of seeing this project through and then reaping the benefits (please, let there be benefits at the end of this!) of Advanced Access? Yeah, right... With retirement right around the corner?

But... they’re going to try it! Can you believe that? Here are two guys who have distinguished themselves professionally for years; they have nothing to prove. Yet, they're willing to pitch in for the future benefit of our patients. Give Peter Barrett and Larry Taranger a pat on the back the next time you see them. (We still need to work out their compensation for this. I wonder if they like butter tarts?)

The other option we discussed was adding evening offices. My proposal was that we would take turns seeing patients in the evening, perhaps from 6 to 8 pm. Ouch. Cold reception to that one. One of my partners said very bluntly that he's working too hard already and doesn't think he can work harder, especially when there's no guarantee that this project will succeed. Cutting into his family time was not acceptable. I know how he feels. We've all been working hard on our backlog and now I'm asking everyone to work even harder. If we continue to work at our current pace, it will be months and months before the backlog is gone. I think the enthusiasm (or even just plain tolerance) for this project will have evaporated by then. I propose hitting it hard now, suffering for a shorter period and getting it over with.

Coming back to work in the evening remained a non-starter. However, someone suggested we extend our afternoon office hours to 6 pm. That seemed more palatable. We're going to run some numbers taking into consideration the extra days the half-timers will work and the possibility of extended afternoon office hours. We'll see if this will let us hit our target for elimination of the backlog by the end of November.

Maybe I can do more personally to help with the backlog. When I took on the position of division head for Urology, I asked for half a day per month set aside from clinical duties to pursue administrative work. (Half a day a month?  Yeah, I really drive a hard bargain. Anyone want to sell me swamp land in Florida?)  I split this up into two 2-hour sessions that are usually carved out of my office time. Four hours a month translates to another 16 patients I could be seeing if I give up my administrative time. It's a tough decision. Should I give up this time temporarily, while we're working all-out to get rid of the backlog?  If I did, that would push more of my administrative work into evenings and weekends. Plus, it takes away that "free thought" time when I can contemplate (read: daydream about) current and future departmental projects. I also use these sessions to meet with other health region staff during their office hours. I've had some really useful meetings with health records analysts that have broadened my understanding on what information is available if we know what to ask for. I'm also planning to meet with the VP Research to see how we can expand research projects in our division. Without having "protected time" set aside during the work day, it's very difficult to arrange to meet these people.

Most physicians are so busy with their clinical work that they don't have time to consider how to improve what they're doing. We're working very hard at what we've always done. It's status quo in overdrive.

You can't teach a drowning man the breast stroke. He needs time to catch his breath first.
I think I'll keep my breathing room for now.

P.S. Thanks, Steven, for this link to a Slate article about Advanced Access.

1 comment:

  1. Originally posted by Joy Dobson (Anesthesiologist, Regina Qu’Appelle Health Region) 9/19/2007 9:30 AM

    Keep plugging away Kishore! I recently received a notice of a new cardiologist joining a group in Regina and the card said "Please refer to the group for earliest available appointment or to specific cardiologist if preferred."