Time Management in Podiatric Practice

Welcome back everybody to Podiatry Today Podcasts where we bring you the latest in foot and ankle medicine and surgery from leaders in the field. Today we've got an episode with Dr. Melissa Lockwood on time management in your practice. I think this is an issue that affects everybody no matter what type of practice you're a part of, so I'm really excited to hear what she has to say. I'm Dr. Jennifer Spector. By the way, I'm the assistant editorial director for Podiatry Today. So let's talk a little bit about Dr. Lockwood. Dr. Lockwood is the founder of Heartland Foot and Ankle Associates in central Illinois.

She is a diplomate of the American Board of Podiatric Medicine and a fellow of the American College of Podiatric Medicine, along with being a fellow of the American Society of Podiatric Surgeons, she is also a member of the Board of Directors for the American Society of Podiatric Surgeons. We're thrilled to have her with us today to learn more about her experience as a practice owner and what she's learned along the way about time management that might apply to others practicing right now. Thank you so much, Dr. Lockwood, for being with us today. What do you think are some of the most common pitfalls that podiatrists run into when it comes to time management in their practices?

Melissa Lockwood, DPM:

I think the most common pitfall would be that they feel they can do everything or that I can't ever hire, train, and retrain someone to do the project or task as well as I could. So letting go of the as well as I could mentality is probably the absolute best thing I've ever done for myself. Hands down, that's the number one pitfall. The second one would be what I just alluded to, where you have to put in this time commitment. So it's kind of an oxymoron. You want more time, but in order to get more time, you have to slow down and commit to training someone to do what you need them to do in an effort to retake your time.

So almost making that commitment to yourself of, I'm going to spend the next 30, 60, 90 days, look at my calendar, figure out when there's a good time for me to be able to train the team, to train this person, and then set that expectation up with whoever you're going to give this project to. But those are the top two. You have to let go of it being perfect and it being only you're the only one that can do it and then also you have to put the time in to train somebody to do it.

Jennifer Spector, DPM:

Kind of like saving for retirement. You have to invest before you can reap the interest, but it's definitely something I think it's hard for a lot of docs to grasp.

Melissa Lockwood, DPM:

Yes.

Jennifer Spector, DPM:

So that being said, what are some unique and effective ways that you've implemented to improve time management strategies in your practice?

Melissa Lockwood, DPM:

So from the minutiae of things as simple as scheduling meetings or email management, I took a list of everything that was causing me stress, whether it be personal appointments, staff appointments, even scheduling calls like this where we're chatting and it's like, oh, I shouldn't have scheduled it here because the one time you let me schedule something is when it gets scheduled when I shouldn't have it. But at the same time, just really understanding that I needed help and I needed somebody to assist me in managing it and managing me. So that's probably the biggest thing that doctors need to get over themselves on is that you probably need somebody to manage you, to help you be the most effective provider, clinician and practice owner, CEO, that you could possibly be in a private practice setting.

In a, hey, that might not apply to me. I'm in a hospital-based group, or I'm in a multi-specialty group. I would challenge back that it applies to every single one of us. Having someone have your back and understand how you're supposed to be or how you would like things to be scheduled from a time management perspective can be hugely helpful. Whether it's scheduling within the clinic for your time with patients, how much time you spend with a particular patient for a certain chief complaint or things like that, or in your personal life and your administrative time within the practice. But we have to make sure that we've got someone there that's helping manage you. Dr. X.

Jennifer Spector, DPM:

How many CEOs out there of Fortune 500 companies don't have that?

Melissa Lockwood, DPM:

Right. And they don't think about it but we don't think about it. So probably the best thing I ever did was invest in myself and invest an executive assistant. We have a virtual executive assistant. So COVID really opened my eyes to so many different ways to be able to skin that cat, or there's lots of ways to boil that egg actually, truly. I mean, there's so many things that you could do virtually in a hybrid situation now and how that one team member even working 10, 15 hours a week can just take what feels like 40 hours of work off of your plate.

Jennifer Spector, DPM:

So for some folks that may feel a little overwhelmed by it all and have no idea where to start, what one thing do you think that DPMs could do today to improve their time management?

Melissa Lockwood, DPM:

Set some time aside for yourself, and you're going to want maybe an hour or two look at your calendar for the next 30 days and set a time for yourself. And all you're going to do on that particular day is write down everything you don't want to do. And then I would even challenge, you're going to also write down everything that you're doing that you think somebody else might be able to do, but you're not sure how yet. So those two things, just literally get it down on a piece of paper or type it however you want to do it, spend that time and then sit on it, sit on it for another 30 days and really go back and look and be like, okay, could I delegate this? Could I send this to someone else?

It could be as simple as I know some practices... This is something I struggle with because my team members have asked for this now. They want to learn. They want to grow in their medical field knowledge and their training. They've asked me, can you teach us how to do the injections for numbing toes? I have held onto that probably for too long. I'm like, why can't I teach you? Physician extenders learn how to do this all the time. And yes so let's do this. They're the ones that are making the impressions for the orthotics. I'm just double checking the prescription. They're taking the x-rays. I have a medical assistant staring at me right now. She just took the x-rays. So they're doing that.

And I mean obviously with state regulations, there are some instances where the DPM has to do something, but if it doesn't require a DPM license in a clinical sense, how can we creatively have someone help you do it? And that's what you need to do. That's the one thing. Look at the ideas and it's going to feel crazy overwhelming. And once you've had that list, look at the top three things that annoy you the most and work on those three because the other 97 things, they're going to feel better by the wayside just by getting those top three things fixed.

Jennifer Spector, DPM:

So to wrap things up today, how do you feel a DPM could effectively analyze their time management and their return on investment based on that practice model that they're in?

Melissa Lockwood, DPM:

And this is huge. You have to look at a couple of essential key metrics within the practice, and there's four basic ones and then four advanced ones. So the basic ones are every month you should know how many total patients you saw, how many new patients, and I would challenge new patients/new problems you saw. And there are ways in some of these electronic health record systems to be able to delineate that because sometimes in a new problem for an established patient can be just as, I'll use the word lucrative as a brand new patient itself. So you want to definitely know because you're going to need to know the percentage of new patients' initial problems to total patients because that barrier right there, if you're seeing too many established patients for follow-ups and not enough new patients, that can be a barrier to having this ideal schedule, ideal lifetime management, because you'll feel overworked and you are because every single patient is going to take a piece of you and a piece of time and a piece of your brain to try to figure this out.

So you want to make sure that you're getting a good ratio of new patients to total patients. You'll want to know exactly how much you've billed out for a previous given month and how much you've collected because those percentages together are going to give you a baseline of what you could be aiming for to see how your time management net return on investment. If I'm giving this administrative work to X person and they're training on it, am I able to be more effective financially? And the way that you tell that is by that percentage of collections, and that's the four basic numbers. You should know those no matter what. And then hopefully this physician extender or this CEO administrative assistant, that person is collecting this data for you and helping you decide it and helping you analyze it. But then the second level thing is you should know exactly how much every time you are in clinic, not administratively, because you don't make your money administratively, although it feels like that's burdening you and taking the time away.

Clinically, how much are you collecting per hour that you are working and you're in the clinic? The reason you want to know that number, let's just say it's $500. If you could increase that number by a hundred dollars and let's say this person that you're having help you do this costs you 50 bucks, you still net 50 bucks. Now, I would challenge that by doing these things and helping get the efficiencies in place from a clinical schedule and an administrative schedule, they're going to be probably doubling your dollars per hour that you're making clinically because you're able to focus. However, let's just assume they only bring you in $50. That's for every hour you're working clinically. And if you're working clinically, you got the great schedule 10 hours a week, that's still 500 bucks or 5,000. The law of multipliers is just huge right there.

So you have to know those four basic numbers. And then based on those four numbers, you can calculate out how you calculate out your dollars per hour. You just take your total collections and you divide that by the number of clinical hours you had the previous month. You do want to include if you're a surgical based practice, so this can be applied to any practice format. You do want to include the time that you're utilizing or blocking for surgery, even if you don't have surgery, because that's still technically something that you are supposed to be doing something clinical and earning revenue at that point. But really it's your clinical hours plus your surgical hours divided by the total collections of any given timeframe. You don't want to do it any shorter timeframe than a month at a time because you'll just go crazy. You'll be like, I only made $10 this. Well, that's because of the collections process, but yeah.

Okay. So no matter what clinical practice type setting that you are in, if you have control over nothing else, having control over the actual clinical schedule is critical to being able to establish proper time management. So when you're talking with as an associate doctor to your private practice owner, really knowing these basic numbers that we just mentioned and then being able to extrapolate that data and say, but if I saw five patients an hour at this dollars per hour versus four, could I be more effective? And what we're seeing trending wise is that there's a sweet spot for most clinicians, and that is anywhere between four to maybe five to six patients an hour. When you start to see more patients than that, your ROI just dive bombs. And it's also about the type of patients.

So four to six routine at-risk foot care patients per hour is not the same as four to six potential new patients or a musculoskeletal follow-up from a financial standpoint. And the only reason that matters here is that if you're able to effectively blend the different types of patients while you're in their clinically, it's going to free up more time for you to potentially not be in clinic so much. That's an ultimate goal for all of us, whether it's I take Fridays off or I'm doing this administratively. So I just want to make sure I really clarify that if you have to negotiate anything with any of these practice models, negotiate the control over your schedule and you'll be forever grateful for it.

Jennifer Spector, DPM:

We'd like to thank Dr. Lockwood so much for sharing her insights with us today. I'm sure there's something that every DPM can benefit from in your discussion. And thank you so much to the audience for joining us. We hope that you'll check out other episodes past and future of Podiatry Today Podcasts on your favorite podcast platforms like Spotify, Apple Podcasts, and SoundCloud, or just by going to podiatrytoday.com.