Efficiency/Staying Sane

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
P

peytonm

Full Member
10+ Year Member
Joined
Sep 5, 2011
Messages
17
Reaction score
0
Members do not see this ad.
How do you guys do it? I'm a young attending and trying to find focus and work/life balance.

Do you let reps in your work area? Do nurses send messages to you on computer, hand write them, text you, tap you on the shoulder?

Do you work in an office with your door closed? Open work area?

Do you write notes at home? On weekends?

How over the top do you go for a patient? They want their visit moved up, they want different sedation for their procedure (requiring changing locations), do you do it?
 
Yes reps come in. Nurses message me in the computer. Don't work with door closed although thinking I should. No notes at home or on weekends. Some patients I'll move up. Don't give sedation other than po valium. Any more than that is a waste of everyone's time
 
Thanks for insight. When you dictate right after seeing patient, are you signing the note as well right then? I'm finding the dictating right after helps, but if I go back 3 days later to review the note and sign it, it's still creating redundancy.

Are you not doing certain procedures/surgeries due to waste of time?
 
peytonm said:
How do you guys do it? I'm a young attending and trying to find focus and work/life balance. 4 day work week. Minimal to no opioids.

Do you let reps in your work area? Yes

Do nurses send messages to you on computer, hand write them, text you, tap you on the shoulder? Message in EMR so there Is a record for everything

Do you work in an office with your door closed? Typically closed . Open work area?

Do you write notes at home? On weekends? Never

How over the top do you go for a patient? They want their visit moved up, they want different sedation for their procedure (requiring changing locations), do you do it?
Click to expand...

How do you guys do it? I'm a young attending and trying to find focus and work/life balance. 4 day work week. Minimal to no opioids.

Do you let reps in your work area? Yes

Do nurses send messages to you on computer, hand write them, text you, tap you on the shoulder? Message in EMR so there USA record for everything

Do you work in an office with your door closed? Typically closed . Open work area?

Do you write notes at home? On weekends? Never

How over the top do you go for a patient? They want their visit moved up, they want different sedation for their procedure (requiring changing locations), do you do it?
Accomodate as much as possible. Some patients misuse it but most are happy that we were able to address their concern.

Hiring a transcriptionist was life changing. It allowed me to work more efficiently.
 
Last edited:
1. How do you guys do it? 5D. No weekends no call. In at 645, out at 4-430. Work out 4-5 days per week. Running, bike, pullups, etc. Best anxiolytic, antidepressant, mood elevator is 15+ minutes into cardio. Working on cars in off time to clear my mind. Opiates, procedures, lots of talking. Exercises keeps patients better, meds may palliate, procedures if not tolerating exercise.

Work flow: Review last note before going in room, have nurses pull imaging up when checking patient in. Sit down and do history while starting exam. Talk and examine at same time. Match it up with imaging. Let patient know what you are thinking/planning. I scribble orders and ICD10 on encounter form/superbill. Nurses put in orders/codes/charges for back office to handle, print Rx, schedule procedure/imaging. I dictate after every patient. Procedures templated. Dictating kypho takes 5 seconds.

2. Do you let reps in your work area? Yes, if running behind they know it will be 30 seconds. If time allows, 5 min.

3. Do nurses send messages to you on computer, hand write them, text you, tap you on the shoulder? Nurses leave post-its, grab me, emails in system.

4. Do you work in an office with your door closed? I don't have an office, just a desk in the back hallway. Always accessible to my PCPs, other teams.

5. Do you write notes at home? On weekends? Never

6. How over the top do you go for a patient? They want their visit moved up, they want different sedation for their procedure (requiring changing locations), do you do it?

Accommodate as much as possible. If coming from over an hour, will try and get procedure done same day. Sedation? See another doc, it's not my thing unless SCS or kypho. 1 exception per year. Visits moved up for cancer pain and Fxs.
 
peytonm said:
Thanks for insight. When you dictate right after seeing patient, are you signing the note as well right then? I'm finding the dictating right after helps, but if I go back 3 days later to review the note and sign it, it's still creating redundancy.

Are you not doing certain procedures/surgeries due to waste of time?
Click to expand...

Can't sign note immediately because dictation is not instantaneous. I also work off superbill use procedure templates, and have staff enter the charges, book procedures, etc. Despite this, I still have to go back, check that charges are correct, note is accurate before I can sign.
 
How do you guys do it? I'm a young attending and trying to find focus and work/life balance.

4.5D/week
No nights/no weekends helps with burnout.
But I am seeing a lot of patients and my NP is seeing more than she can handle. Hopefully, will bring pain physician buddy on soon to see patients also part time. Check out the goat thread on the private forum for my stress reliever/hobby.


Do you let reps in your work area?
Yes, brief fir drug reps. Device reps get as much time as needed.

Do nurses send messages to you on computer, hand write them, text you, tap you on the shoulder?

Computer unless it needs an immediate answer.


Do you work in an office with your door closed? Open work area?

Typing notes at stand up counter the vast majority of the time

Do you write notes at home? On weekends?

It has been very bad at times with 6 hours/week of home notes. But I have taken to doing the majority of the notes immediately and that has helped dramatically. Also, work on notes at lunch if possible but many times see a few patients during lunch.

How over the top do you go for a patient? They want their visit moved up, they want different sedation for their procedure (requiring changing locations), do you do it

Almost always unless the patient is a repeat offender trying to take advantage of me. A 2:30 patients shows up at 12:30? I see them immediately typically. Show up a day early by accident? I will see them unless I am grossly overbooked. The way I look at it is I can’t go home until all of these patients are seem so what does it really matter. Patients appreciate it. Many PCPs try to control the situation and won’t see a patient early even though they don’t have anywhere close to a busy schedule.
 
Last edited:
How do you guys do it? I'm a young attending and trying to find focus and work/life balance.
dont bring work home. but dont stay too late. make sure you are not overbooking your patients. you should expect to be done with your patients 1 hour before you go home, so that you can get rest of work done. ie if you want to get home by 5:30, last patient at 4:15-4:30. i expect to be in the office until 6pm, so any time before then is bonus time.

get comfortable stools in each of the exam rooms. im not one for big chairs - too hard to get out of, esp in emergency. and much harder to pick up and throw at someone.

if you can afford one, get a scribe to do all notes except signing them.

do not routinely make phone calls to patients - takes too much time, they read in way too much and not time or cost efficient. have office staff call, and standard part of their blurb must be "make an appointment to see the doctor if you have more questions/for details"

Do you let reps in your work area? Do nurses send messages to you on computer, hand write them, text you, tap you on the shoulder?
the nurses send me messages that a rep is here. if too busy, or behind, then no they arent allowed back.

Do you work in an office with your door closed? Open work area?
own office, door always open (except when im eating particularly odoriferous food.)

Do you write notes at home? On weekends?
never take work home. never do work on the weekend. be efficient and use canned scripts for EMR to save time (but always summarize personally, for future reference so you can not only remember the patient but also identify your plan - for example "patient with clear L4 radic and concurrent MRI, saw X pain clinic and failed TF, here with daughter (who has fibro), no interest in COT but thinking of CBD")

truly the only advantage of being hospital employed is the fact that you are really not expected to take work home. as a PP guy, i understand that you need to keep afloat and go the extra mile.

there are many derogatory aspects of being hospital employed - ask drusso (in a private email, please, we have heard it ad infinitum before about how reprehensible and horrid the lives of those of us who are HOPD are). being able to have a great home life is one of the positives. another advantage is that you have a lot of Medicaid patient, so there is built in empty space on the schedule due to the high no show rate - and i refuse to triple book them on the hopes that they wont show.

How over the top do you go for a patient? They want their visit moved up, they want different sedation for their procedure (requiring changing locations), do you do it?
i make as much change as possible without inconveniencing other patients or affecting my percieved standards of care (ie never sedation at all for trigger points or MBB, for example).
 
Those of you who never take work home and don’t do work on nights/weekends but use a scribe/transcriptionist - when are you reviewing and signing the notes? I’m moving toward having a scribe in the room with me and dictating the a/p as soon as I leave the room. Right now what I’m struggling with though is going back in and finalizing notes after they’ve been transcribed. I’m spending at least an hour a night and time on weekends dealing with signing charts and reviewing EMR message from schedulers and referral coordinators. I have patients scheduled 8-5 (last appointment 4:30) and am usually leaving at about 5:15-5-30. Currently I see about 22 patients a day on average in clinic (new patients 30 minutes follow ups 15).
 
How do you guys do it? I'm a young attending and trying to find focus and work/life balance.

**I'm always working even when I'm not in the office seeing patients: Administrative work, marketing, personal/professional education, policy & advocacy, staying abreast of recent scientific advancements, networking, rain-making, socializing, church and spiritual activities, etc. It all feeds one beast. My phone is always on and I answer it or text day and night. I can remote into my office server/EHR from anywhere in the world and basically do anything--Kid's on the ski team and I'm volunteered to gate judge? No problem. I can sign notes on my phone in between runs. Wife works in the office and we're face-to-face 20 hours a week. We have a weekly family strategic planning meeting to make sure that family calendar and work calendars are in sync. Go out dinner/lunch, talk about difficult patients, expense the meal. We have a family assistant/"nanny" who can help with pick-up/drop-off's, child supervision, meals, and event logistics. We coordinate family vacations with out of state/country CME events. There have been times we've done some home-schooling when the schedule has been too packed. Now, I've got the kid on the payroll in order to get her retirement and Roth started. It's really a family business.

Clinically, I do what the others do. Templates, macros, etc. I'm up at 0500 every day. In the office at 0715. Home at 1830. Usually have community commitments or conference calls in the evening. Lather, rinse, repeat.

Do you let reps in your work area? Do nurses send messages to you on computer, hand write them, text you, tap you on the shoulder?

**Reps are by appointment only and I never meet with them one-on-one. I have a staff person coordinate. One rep meeting per quarter. They can bring lunch or educational material for the office and set up in the break room. They get from noon-1pm and then they need to be out of there. My RN is my life-line. She sits 4 feet away from me. Wife on one side; RN on the other.

Do you work in an office with your door closed? Open work area?

**Open office/work area for maximum "situational awareness" of what's going on in the clinic at all times.

Do you write notes at home? On weekends?

**Usually don't need to, but if I do, no big deal.

How over the top do you go for a patient? They want their visit moved up, they want different sedation for their procedure (requiring changing locations), do you do it?

**Scheduler does this within established policies and protocols. There is a clear hierarchy of authority. If the scheduler can't make a decision, then it goes to the RN. If the RN can't make a decision, it comes to me. Ditto for the administrative stuff: First the team-leaders (front office, back office, billing), then the manager, then me. The trick to living this way is to push down as much work as possible to the lowest paid employee, have well-developed "standard work" routines, and discipline.
 
Last edited:
drusso said:
How do you guys do it? I'm a young attending and trying to find focus and work/life balance.

**I'm always working even when I'm not in the office seeing patients: Administrative work, marketing, personal/professional education, policy & advocacy, staying abreast of recent scientific advancements, networking, rain-making, socializing, church and spiritual activities, etc. It all feeds one beast. My phone is always on and I answer it or text day and night. I can remote into my office server/EHR from anywhere in the world and basically do anything--Kid's on the ski team and I'm volunteered to gate judge? No problem. I can sign notes on my phone in between runs. Wife works in the office and we're face-to-face 20 hours a week. We have a weekly family strategic planning meeting to make sure that family calendar and work calendars are in sync. Go out dinner/lunch, talk about difficult patients, expense the meal. We have a family assistant/"nanny" who can help with pick-up/drop-off's, child supervision, meals, and event logistics. We coordinate family vacations with out of state/country CME events. There have been times we've done some home-schooling when the schedule has been too packed. Now, I've got the kid on the payroll in order to get her retirement and Roth started. It's really a family business.

Clinically, I do what the others do. Templates, macros, etc. I'm up at 0500 every day. In the office at 0715. Home at 1830. Usually have community commitments or conference calls in the evening. Lather, rinse, repeat.

Do you let reps in your work area? Do nurses send messages to you on computer, hand write them, text you, tap you on the shoulder?

**Reps are by appointment only and I never meet with them one-on-one. I have a staff person coordinate. One rep meeting per quarter. They can bring lunch or educational material for the office and set up in the break room. They get from noon-1pm and then they need to be out of there. My RN is my life-line. She sits 4 feet away from me. Wife on one side; RN on the other.

Do you work in an office with your door closed? Open work area?

**Open office/work area for maximum "situational awareness" of what's going on in the clinic at all times.

Do you write notes at home? On weekends?

**Usually don't need to, but if I do, no big deal.

How over the top do you go for a patient? They want their visit moved up, they want different sedation for their procedure (requiring changing locations), do you do it?

**Scheduler does this within established policies and protocols. There is a clear hierarchy of authority. If the scheduler can't make a decision, then it goes to the RN. If the RN can't make a decision, it comes to me. Ditto for the administrative stuff: First the team-leaders (front office, back office, billing), then the manager, then me. The trick to living this way is to push down as much work as possible to the lowest paid employee, have well-developed "standard work" routines, and discipline.
Click to expand...
Drusso! Damn, you're in by 715am and leave at 630pm? That's almost a 12 hour day!
 
callmeanesthesia said:
Those of you who never take work home and don’t do work on nights/weekends but use a scribe/transcriptionist - when are you reviewing and signing the notes? I’m moving toward having a scribe in the room with me and dictating the a/p as soon as I leave the room. Right now what I’m struggling with though is going back in and finalizing notes after they’ve been transcribed. I’m spending at least an hour a night and time on weekends dealing with signing charts and reviewing EMR message from schedulers and referral coordinators. I have patients scheduled 8-5 (last appointment 4:30) and am usually leaving at about 5:15-5-30. Currently I see about 22 patients a day on average in clinic (new patients 30 minutes follow ups 15).
Click to expand...

I dont review and sign. An RN signs off the note in ehr. If transcription error, i do an addendum. Happens 1-2x per year. Much more effective than 30 min every day to click and scroll.
 
Great to hear about others work flow. I think there are some common threads that lead to a successful practice.

Do you let reps in your work area? Do nurses send messages to you on computer, hand write them, text you, tap you on the shoulder? I never talk to reps except device reps once a quarter at most. I use walkie talkie headphone to speak to staff.

Do you work in an office with your door closed? Open work area? Large private office with floor to ceiling glass and 270 view of mountains. My therapy dog shares office space with me

Do you write notes at home? On weekends? dragon dictation into emr so immediately ready for review. head to cabin most weekends with family at noon on friday to keep sanity

How over the top do you go for a patient? They want their visit moved up, they want different sedation for their procedure (requiring changing locations), do you do it? Flexible with patients time and concerns
 
Last edited:
nvrsumr said:
Great to hear about others work flow. I think there are some common threads that lead to a successful practice.

Do you let reps in your work area? Do nurses send messages to you on computer, hand write them, text you, tap you on the shoulder? I never talk to reps except device reps once a quarter at most. I use walkie talkie headphone to speak to staff.

Do you work in an office with your door closed? Open work area? Large private office with floor to ceiling glass and 270 view of mountains. My therapy dog shares office space with me

Do you write notes at home? On weekends? dragon dictation into emr so immediately ready for review. head to cabin most weekends with family at noon on friday to keep sanity

How over the top do you go for a patient? They want their visit moved up, they want different sedation for their procedure (requiring changing locations), do you do it? Flexible with patients time and concerns
Click to expand...

I think if I had a 270 degree view of the mountains from my office, staying sane would be a little easier... nice!
 
A lot of this is going to depend on what type of practice you’re involved in.

If you’re part of a large group and not involved in the admin side save yourself from the headache -maintain personal space- take care of patient- move onto the next. Especially early on out of fellowship, the more you will give of yourself early in those situations the more the staff will expect that to be the norm, and if you change how you operate in that space you can get labeled as “difficult dr”. Let the people tasked with managing staff deal with them. Keep your door closed so you can get a couple minutes of privacy throughout the day. In those senarios often times the less you expose yourself and focus on quality patient care the better you will do. That first year out of fellowship the most important thing is keep your head down and get better at being a pain physician.

If you are in a private practice and you’re invested in building the business you better have eyes and ears everywhere. All bets are off at that point. Control your emotions in front of the staff and don’t get too friendly with anyone that works below you. In the current climate many things that you considered camaraderie as a fellow as it pertains to the staff can be taken out of context with you now being the boss and navigating that can quickly turn into a nightmare.
 
guns....gym...fishing.....wearing MAGA hats at Lincoln Memorial on MLK weekend.....plus steve does SPG blocks on himself on youtube
 
yup...and he thinks im crazy for doing PRP to myself

250F5A72-71AA-4764-983B-41E71497F0EA.jpeg
 
that was the subq local....PRP is on the table
 
so the self SPG block isnt what gets the attention/comments? Steve is more of a man than me for doing that.
 
peytonm said:
I think if I had a 270 degree view of the mountains from my office, staying sane would be a little easier... nice!
Click to expand...
I have a 180 degree and it doesn’t help. Maybe because I am never at my desk and when I am I usually see people cross country skiing or mountain biking. Maybe the key is that missing 90 degrees.
 
You must log in or register to reply here.

Similar threads

M
Medicare going to decrease payments in 2.5 efficiency penalty on most specialists
Replies
36
Views
3K
Dr. Ice
D
bedrock
Lumbar RFA efficiency
2
Replies
90
Views
8K
nvrsumr
N
2
Pearl for new grads on safe, efficient, and effective practice
2
Replies
65
Views
6K
promethius
P
E
Clinic efficiency
Replies
12
Views
3K
ED50
E
Ligament
Telemedicine; I need ways to be more efficient
Replies
15
Views
2K
SommeRiver
SommeRiver
Top