Survey produces time-saving tips - American College of Physician Executives survey

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Respondents in the ACPE survey ranged in age from 27 to 73 years. Ninety percent were male, 6 percent were female, and 4 percent did not answer the question. The respondents have been practicing medicine from 2 to 40 years. Seventy-eight percent are now in administrative positions. The top three specialties (of a total of 33) were internal medicine (17 percent), family practice (18 percent), and pediatrics (I 3 percent). The types of practice most often listed were group (44 percent), solo (14 percent), and HMO (14 percent). Of the physicians who answered, 44 percent were associate (19 percent) or assistant (10 percent) professors. The survey questionnaire focused on time wasters and time savers in the physicians' professional and personal lives. Some of the most common answers given for time wasters at work included paperwork (26 percent); interruptions (19 percent), such as when colleagues, staff and/or visitors "drop by for just a minute"; meetings (1 3 percent); distractions (10 percent), such as the noise level of adjacent offices and/or rooms; and phone calls (9 percent). Time wasters at home included watching television (17 percent), cooking meals/grocery shopping/household chores (16 percent), receiving telephone calls (7 percent), and sleeping/being tired/relaxing (5 percent). For those physicians who spend time with patients, time wasters during actual clinical encounters were unavailable lab data (23 percent), unavailable charts (14 percent), and "no shows" (9 percent). Many suggestions were given for ways to correct and improve the above-mentioned problems at home, including hiring domestic (12 percent), limiting television viewing (1 1 percent), and organizing and improving habits (6 percent).

With regard to correcting and improving time wasters at work, one pediatrician stated, "If it doesn't require an M.D. degree, let someone else do it." Delegating time-consuming tasks that can be accomplished by other office personnel was repeatedly mentioned as a way to help a physician save time. To most immediately correct problems listed during the clinical encounter, suggestions included hiring more clinic personnel, adding more clinic hours and space, and shortening the time that patients sit in the "waiting room" for their appointments. While 41 percent believe that patient loads are just right, 19 percent believe they are too great and 8 percent too little. Regarding the waiting time for patient appointments, 45 percent of the respondents believe it is just right" and 23 percent think it is "too long." Most physicians mentioned that they spend approximately 50 minutes per day handling problems related to scheduling patients or trying to manage problems encountered before appointments.

The questionnaire asked about specific time management tools used. Seventy six percent of the respondents use some type of calendar as their primary time management tool. Sixty-seven percent schedule the "nonpatient" part of the calendar themselves.

Given the opportunity to rank their degree of satisfaction with dieir professional and personal lives in a range of I - 10 (1 = very dissatisfied through 10 = very satisfied), 18 percent answered in the range 1-5 and 81 percent in the range 6-10 for their professional lives. Regarding personal life, 10 percent answered in the 1-5 range and 86 percent in the 6-10 range. When asked what has suffered most in their lives from "time erosion," 62 percent chose quality of personal life" as their first answer, followed by research (1 1 percent) and higher quality of patient care (4 percent). Respondents were asked to rate their degree of dissatisfaction due to overall personal efficiency, institutional inefficiency, and external demands. Twenty percent believed themselves to be personally inefficient overall, while 71 percent viewed themselves as efficient and 10 percent did not respond. Fifty-four percent are dissatisfied with institutional inefficiency, 37 percent are satisfied, and 10 percent did not respond. External demands, such as HMOs, insurance companies, and government regulations, accounted for a 69 percent dissatisfaction rate, a 20 percent satisfaction rate, and I I percent who did not respond. One physician commented, "Government regulation is making practice burdensome and expensive to comply with requirements; physicians work harder for disproportionately less gain." Another physician's frustration with external demands was clearly expressed by the remark that "a major source of time loss is bureaucratic intrusions by the government and insurers into clinical practice, i.e., compensating for new rules, appealing their errors, and dealing with an incompetent nonclinical bureaucracy consumes an inordinate amount of time."

Seventy-one percent of the respondents practice goal setting in managing daily time planning. Half (51 percent) write down goals, and 70 percent revise them. Eighty-six percent of the respondents believe that work sometimes seriously impairs their personal lives. Eight-nine percent believe work and personal life are sometimes well-balanced. Sixty-two percent believe personal life sometimes impairs job performance, and 91 percent believe external forces sometimes controls their time. "I moved from a 80-100 hour/week primary care internal medicine practice to a 50-60 hour/week medical director position two years ago, which has rejuvenated my professional and personal life with an infusion of time and a reduction of time pressure," commented one physician. "The important thing is to identify priorities," explained another. Respondents agree that "paperwork" accounts for a major portion of time consumption, 33 percent to be precise. Specific types of paperwork mentioned were utilization review issues (10 percent),PRO reviews (6 percent), HMO requests (5 percent), insurance forms (5 percent), and disability forms (3 percent). One physician suggested that time management should be taught to physicians prior to completion of residency training. "All residency training programs should offer a 3-4 week course on practice management, teaching time management, how to quickly complete paperwork, and effective supervision of ancillary personnel." If such a program could improve management of time, 59 percent of the respondents said that any additional time would be used for personal lives and 16% for academic enrichment and learning. We repeatedly heard that one of the most important time management tasks is "delegation." "Delegate as much responsibility as possible to trusted nurses and employees, always realizing, however, that you are ultimately responsible for their actions," said one rheumatologist. Another rheumatologist remarked that he keeps certain hours to be an administrator and certain times to be a physician. "People have learned that I am strict about the two, and there is less interference in clinical time setting." Nothing can be done to change the number of hours in a day. The task of physician managers is to change the way those hours are used, so that maximum results are achieved for the time invested. 13

COPYRIGHT 1990 American College of Physician Executives
COPYRIGHT 2004 Gale Group