PookieMD's Blog: Where Physicians Learn About the Business of Medicine

A reader asked how his wife, a solo hand surgeon, should manage her practice, and if she should have an office manager.  He also asked what staffing ratios would be desirable for a hand surgeon’s solo practice.  Good questions!

I propose they model the practice after the micro practice that has been seen in primary care.  In this model, the physician has minimal, if any office help. The doc meets the patient at the door, escorts him to the exam room, takes vitals (not needed in a hand surgeon’s practice), sees the patient, writes the note, codes and bills.  The doc does this all by herself, or with minimal help.  An office manager is NOT part of this equation.   

Here is what I propose for the hand surgeon:

• Have a receptionist/medical assistant..  Your time is best used in the OR and exam room.  Your receptionist can answer the phones, schedule patients, and answer questions. I do NOT think a solo surgeon should need more than this, especially if you use technology as I out line below.  Your assistant should also be in charge of inventoring and ordering office and medical supplies.
• Consider a web site with online patient scheduling .  This may obviate the need for a receptionist, and/or free him up to help you in the exam room.  (For a complete package check out visit micro practice solutions.)
• Get an EMR.    See the post “An Orthopod that loves her EMR…” from June 5.
• Have patients enter their history through a web based application such as instant medical history.  Patients can enter their history at home, or through a computer in the waiting room in your office.  (Hmm, I am wondering a bit about patients in a hand surgeon’s office typing on a computer…)
• Use email to convey results on xrays and labs.  (See previous posts on patients and email.)
• Get an answering machine for use during the day when you are in the exam room.
• You must hire a biller and coder to come in to code and bill.   The coder/biller should come in one or two times per week.  One solution is to get on line billing that you enter, and have the biller/coder come clean up the tough claims.  I looked at medical office on line  and ez claim.
• Hire a bookkeeper to keep the books, supply financial statements and keep things ship shape.  I would use Quickbooks from the start to make it easy.  The bookkeeper can do it virtually, or come in once per week or every two weeks.  (Let me know if you want me to email you the name of mine–she can work virtually.)
• Hire a cleaning service.  Don’t skimp on this one–it’s just gross to go in to a dirty doctor’s office!

WARNING:  Thoroughly check out all online services, and make sure they mesh together with your EMR!  If you hire a biller/coder and bookkeeper, make sure they are familiar with the software systems you have in place, and check their references thoroughly.

Lasty, make sure YOU know where the money is going.  No one but yourself should have a way to get money out of your accounts.  Learn to read financial statements and do it on a regular basis.