American College of Physicians: Internal Medicine — Doctors for Adults ®

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More hands make light work

From the December ACP Observer, copyright © 2006 by the American College of Physicians.

A 30-plus-hour week of scheduled patient care with over 100 patient visits is a reasonable primary care physician schedule. Anything more aggressive is likely to result in high stress, deteriorating patient satisfaction and potential lowering of clinical quality. If you're in the latter category, you may need to add a provider. If there is more work than the current staff can accommodate but not enough to justify adding another full-time physician, consider adding a part-time physician or a mid-level provider.

Part-time physician employees, scheduled to work on typical high-volume days, can lighten your workload. The busiest times in most offices tend to be Mondays, Fridays, vacations and weekends. Managed appropriately, part-timers are just as motivated and productive as full time physicians. Part-time positions are in demand among women (22% of all female physicians work part-time), doctors with young families and senior physicians cutting back at the end of their careers.

When negotiating part-time employment, pay attention to special circumstances surrounding on-call duties, benefit packages and scheduled hours. Job sharing can help smooth out wrinkles.

Mid-level providers, such as physician assistants or nurse practitioners, can absorb excessive physician workloads while increasing the practice's productivity, revenue and patient satisfaction scores. They cost roughly half as much as a full-time internist and can substantially improve access for your patients. Mid-level providers are trained to evaluate patients (interviews and physical exams), diagnose diseases (including ordering laboratory tests and interpreting results), develop and implement therapeutic plans, and provide preventive health services and counseling. Their ability to handle routine office visits, rounds and calls leaves doctors more time to spend on complex cases.

"PMC Tips" is a regular feature on small-practice management from ACP's Practice Management Center. Modules on hiring part-time physicians and hiring mid-level providers can be found here.

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