Scott Dinehart, M.D., a dermatologist in private practice in Little Rock, AR, focused on employees — keeping track of who’s where when, protecting them from latex allergy, and your computers from their abuse and viruses.
1. Lose the Latex
With the incidence of allergic reactions to latex on the rise, it would make sense to switch to a non-latex glove such as nitrile gloves. From my point of view, it makes no sense to be wearing latex gloves all day when there are alternatives.
Even if you are concerned about the additional costs — and nitrile gloves can cost more than twice as much as latex gloves — you might consider having a supply on hand for those who have shown sensitivity to latex. Maybe you and your staff can simply wear the nitrile gloves occasionally just so you don’t have latex gloves on all the time.
2. Establish a Computer and Internet Usage Policy
If you are like most modern dermatologists, your computer systems have become critical to the success of your practice. The last thing you need is to have a staff member introduce a virus through careless use, downloading music or games, or simply wasting time messaging.
You need to take steps to ensure that your computers remain safe and secure and are properly used. One step often overlooked is to establish and clearly articulate an Internet and computer usage policy for your staff. You might even want to have staff members read and sign a written statement outlining penalties. You should also reinforce that policy during staff meetings and with signs posted at computers.
3. First, Know Who’s On
Nothing can disrupt an office quite like having an employee not show up for work when he or she is expected. And if you have a large number of employees, keeping track of vacations and days off can quickly become a logistical nightmare, not just for you, but for your entire staff. Plus, if someone needs a day off, hours can be wasted determining who is off on a particular day.
One effective way to alleviate this problem is to get a large calendar of scheduled vacations and absences. Post the calendar prominently so that everyone can see not only their own days off, but those scheduled for the entire staff. That way, they can see at a glance who is scheduled for time off on a given day.
Susan Weinkle, M.D., a dermatologist in private practice in Bradenton, FL, and an Assistant Clinical Professor of Dermatology at the University of South Florida, discussed ways to make all employees feel like valued parts of a team.
4. Create an Empowering Workplace
I think that it is very important to create an empowering work environment, from both a professional and a personal perspective. From your receptionist to your surgical assistant, you need to show interest in your staff and encourage them to utilize their own talents. I allow them to pick out certain supplies if there are things they need, and listen if they feel like there’s a better way to do something. I have a new employee who wants everything high-tech, and we have upped the scale on that end and it has helped our practice.
Make them feel as if they are contributing to the success of the practice. While money is important, most people work for more than money. They want a sense of self-pride and to feel that they are appreciated. In this regard, the little things can be very important — a compliment about their work, eye contact, a smile, a chance to laugh. These will all make your employees so much happier.
It works in my practice. I’ve had my nurse practitioner for 18 years and my nurses for 12 years, because it’s fun and rewarding to come to work.
5. Develop a Team Attitude
Your staff contributes almost as much to the success of your practice as do your skills as a physician. It only makes sense then to foster an environment in which your staff works as a team pulling together for a common goal.
You must be willing to delegate responsibility in a respectful way, clearly state your expectations, establish appropriate goals and deadlines and reward your people when they produce.
We have an “attitude adjustment night” at our practice. I take my staff to dinner when we have met specific goals or had a particularly grueling stretch. They appreciate the gesture, and they socialize and develop a greater sense of camaraderie. They’ve actually developed genuine friendships outside the office, which is good for them and in the long run good for my practice.
6. Try Color Coordinating “Team” Uniforms
Too many physicians focus on the medical side of their practice and lose sight of the other important aspects of running a practice. Sometimes you simply need to spend money on your office for non-medical reasons.
I provided my staff with different color uniforms, and we all try to wear the same color every day. That way, I can move them around if I need to and everyone still looks like they belong where they are.
Joe Bikowski, M.D., a dermatologist in private practice near Pittsburgh, PA, and a Clinical Assistant Professor, Dermatology, at Ohio State University, suggested ways dermatologists can be more efficient without sacrificing patient care.
7. Look for Ways to be More Efficient
One of the easiest things that you can do if you have multiple exam rooms is to outfit them all exactly the same way. Each room is prepped for every patient the same way so when I walk in to a room, theoretically I don’t walk out until everything is accomplished.
I have chairs in every room that can accommodate two or three people so that mom can sit with little brother while I do an exam. There is an exam light right next to the chairs in every room. I have a surgical tray set up and ready to go in each room. Since, I do a lot of photography, there is a camera in each room, plus two back-up cameras because I think photography is most important. In every room, the top drawer contains the 16 sample items I use most frequently.
8. Hire a PA or Nurse Practitioner
I’m a major proponent of either a physician assistant or a nurse-practitioner. I use a PA because of the training they have, which allows them to mimic everything I do.
Because I do no major surgical procedures, I have been able to train my PA to everything I do medically. He has learned all the drugs and how to use them appropriately. He does not have his own schedule; we exchange patients back and forth. My patients have learned to accept him, and sometimes they like him better than they do me. However, those who prefer to only see me may do so. Having us both see the same patients is a very nice check on his competence, and sometimes he picks up things that I miss.
It’s a physical and emotional support to me. Despite the fact that I handsomely reward him, he is worth every penny to me.
9. Streamline Your Total Body Skin Exams
Total body skin exams are a challenge, but you can take a few steps to ease the pain, both for yourself and your patients.
First, get the appropriate exam table, one that goes up and down and tilts back and forth electrically. You should have a fully articulated exam light over every table.
When we do a total body skin exam, the patient disrobes and is covered with a drape. I always have a chaperone for these exams, regardless of the gender of the patient.
I start at the bottom, between the toes, the bottom of the feet, I work my way up the entire front of the body, turn the patient over, and work my way down the body starting with the scalp, which includes checking behind the ears. I make sure to examine the mucous membranes of the anus, the vaginal area and the mouth and the eyes. I make sure all patients have the opportunity to point out anything they wish to show me.
David Pariser, M.D., a senior physician with Pariser Dermatology in Norfolk, Virginia, and a professor in the Department of Dermatology at Eastern Virginia Medical School, offered up tips based not only on his experience with patients but also on his experience with commercial airlines.
10. Pre-Screen All Patients
If you accept insurance patients, particularly managed care patients who require a referral, you can save yourself a lot of headaches if you do as much work up front as possible. I recommend hiring a full-time person who does nothing but pre-screen patients one or two days before their appointment to verify insurance. This way you can cut down on patients who show up without the referral form, stopping the flow of the day, arguing with your staff and calling their primary care physician.
The type of information collected includes the availability of insurance referral, how many visits they are allowed, what the co-pay is. This way both you and the patients know what to expect.
Your day will go much smoother and it will improve your quality of life.
11. Overbook Instead of Confirming
I am a proponent of overbooking, airline style, instead of calling to confirm appointments. If you try to pre-confirm your patients, most of the calls are to answering machines, and you don’t know whether you’re going to get the people or not.
In our practice, we simply overbook. We have statistics about which days of the week and which offices tend to have the most or fewest no-shows, and from that we know how much to overbook. Occasionally, everybody shows up and, just as the airlines give away something when everybody shows up for flights, we give away something, too — a nice goodie bag full of the free samples of shampoo, moisturizers, and sunscreens from our partners.
Brett Coldiron, M.D., who practices dermatology and internal medicine in Cincinnati, OH, takes a creative approach to problem solving — sometimes just for fun.
12. Put A Computer Inside Your Desk
Ideally, you would have a system integrated into your desk with the monitor under a glass so that it does not clutter up your desk. Then you would have a keyboard in your lap drawer. My desk is cluttered already, so I have a system buried in the desk. I can check my e-mail or work on a talk while I’m doing my other paperwork or dealing with staff that’s running around me. It makes me very efficient. I can check my e-mail 10 times a day if I need to. Whenever it pops up, I’m there to answer it without its being intrusive or distracting to other people.
13. Use Counterintuitive Thinking to Help Patients
My office is in a congested, downtown area by a hospital and all the labs. I used to have free parking in front of my office, but people would pull in there at 5 a.m. and park all day for free, and my patients couldn’t use it. So I actually had meters installed. With the meters, the spots are more available to my patients because they turn over every 30 or 60 minutes. Now we put some quarters out front for our patients. One of the spots is a handicapped parking meter, which no one except my patients can use. While this might not directly apply to your practice, it’s an example of looking at a problem in a different way to make patients comfortable with coming to your office.
14. Have A Little Fun With Your Patients
It does not have to be all business all the time with your patients, especially your regular patients. I like to have a bit of fun with my patients just to make it easier for them to come to the office. I think that making the experience more pleasant makes patients less likely to forget an appointment because they have some more pleasant impressions and will remember the fun stuff. For example, I have golf prescriptions that I write for my patients — both men and women — and they get a big kick out of this. I also have other “prescriptions” like beauty parlor visits and things like that. I believe anything you can do to break down a patient’s reluctance to come to the office is a good thing, and having some fun is one way to do it.
Mark Nestor, M.D., Ph.D., a Clinical Associate Professor of Dermatology and Dermatologic Surgery at the University of Miami School of Medicine in Florida, places special emphasis on effectively communicating with patients.
15. Educate your Patients
You can use a variety of ways to inform your patients about the procedures you do in your practice. Pamphlets in the office and newsletters sent home are great ways to let your patients know about other services you provide. What we have done at our practice is to put a flat-screen monitor in each exam room. These monitors run a 300-slide PowerPoint presentation with before-and-after photos of all the procedures I do. We have found this to be very effective. You would be amazed at the number of patients who come in for a medical procedure and end up having an additional aesthetic or medical procedure.
16. Make Sure Your Patients Know What “Non-Medically Necessary” Means
I have found that patients are happy to pay for things such as salves, skin tag removals, acne, peels, blue light treatments, and so on, as long as I’ve explained beforehand that because they are not medically necessary, they aren’t covered by insurance.
Generally, patients are more comfortable about non-covered procedures because these days lots of things are not covered by insurance. If I explain that a condition can be improved by procedures such as eye peel treatments for rosacea or melasma and other types of laser procedures, but that these procedures may not be medically necessary, patients are typically happy to pay for it. However, it is very important to make sure you get consents and waivers.
17. Make Sure Patients Understand the Meaning of “Consent”
The best thing you can do is create a consent form that lists the reasons for, the benefits of and potential risks associated with each of the specific procedures you perform, whether it’s removing a basal cell cancer, laser resurfacing, whatever. Have the patient sign and date it, and have it witnessed. The consent form also documents that the procedure was performed, and you should reference it in your charts.
In addition, if you are doing a non-covered procedure, patients should sign a waiver stating that they understand that the procedure is not covered by insurance, that they have to pay for the procedure, and that there is no refund on the procedure.
Bill Kalogredis, J.D., is an Officer of Kalogredis, Sansweet, Dearden and Burke, Ltd., a law firm near Philadelphia that specializes in healthcare law. His suggestions run the gamut, from a lawyerly warning to check reference before hiring, to an admonition to update the waiting room, including reading material!
18. Check References Before Hiring Anyone
This may be obvious, but a lot of people say, “Why bother?” It is true that prior employers are often reluctant to say much, especially if it’s negative. But if nothing else, you can verify the information on an application, such as their duties and responsibilities, the dates of employment, and their level of training. Even if you don’t get direct answers to your questions, you might get some reaction that will give you a feel for whether they liked that person or not. If someone is less than enthusiastic about a former employee, that can tell you a lot. If you ask if they would hire that person again and they hesitate, what more do you need to hear?
19. Establish a Practice of Giving Merit Raises
Like it or not, personnel management is a huge part of a practice. But if you have the right people in place and they’re happy, you’re going to end up having a much happier office and your life will be so much better. One way to keep your folks happy is by providing merit pay raises and not across-the-board raises for everybody. You might balk at this idea because you are afraid to hurt someone’s feelings because they didn’t get as big a raise. Well, look at it this way, do you want to reward your best people and keep them happy, or do you want to lower standards and expectations just to keep your less-productive people happy? It seems like an obvious choice, which is why I’m a big proponent of merit raises based upon performance and not just giving everybody in your practice the same raise just because they work there.
20. Throw out the Old Magazines
Sounds pretty corny, but think about when new patients come to your office. The first impressions are going to be how nice your receptionist is when they walk in. When they’re sitting in the reception area, what do they see? Do they have to pick through tattered, 3-year-old magazines or a nice selection of more current information, or perhaps maybe even medically relevant information. So the impression created by having these old tattered magazines in your reception area can be a negative one. Taking it a step further, you might want to consider some different, more upscale magazines such as art or architecture, or travel or lifestyle magazines, especially if your practice has a lot of cosmetic patients.
Scott Dinehart, M.D., a dermatologist in private practice in Little Rock, AR, focused on employees — keeping track of who’s where when, protecting them from latex allergy, and your computers from their abuse and viruses.
1. Lose the Latex
With the incidence of allergic reactions to latex on the rise, it would make sense to switch to a non-latex glove such as nitrile gloves. From my point of view, it makes no sense to be wearing latex gloves all day when there are alternatives.
Even if you are concerned about the additional costs — and nitrile gloves can cost more than twice as much as latex gloves — you might consider having a supply on hand for those who have shown sensitivity to latex. Maybe you and your staff can simply wear the nitrile gloves occasionally just so you don’t have latex gloves on all the time.
2. Establish a Computer and Internet Usage Policy
If you are like most modern dermatologists, your computer systems have become critical to the success of your practice. The last thing you need is to have a staff member introduce a virus through careless use, downloading music or games, or simply wasting time messaging.
You need to take steps to ensure that your computers remain safe and secure and are properly used. One step often overlooked is to establish and clearly articulate an Internet and computer usage policy for your staff. You might even want to have staff members read and sign a written statement outlining penalties. You should also reinforce that policy during staff meetings and with signs posted at computers.
3. First, Know Who’s On
Nothing can disrupt an office quite like having an employee not show up for work when he or she is expected. And if you have a large number of employees, keeping track of vacations and days off can quickly become a logistical nightmare, not just for you, but for your entire staff. Plus, if someone needs a day off, hours can be wasted determining who is off on a particular day.
One effective way to alleviate this problem is to get a large calendar of scheduled vacations and absences. Post the calendar prominently so that everyone can see not only their own days off, but those scheduled for the entire staff. That way, they can see at a glance who is scheduled for time off on a given day.
Susan Weinkle, M.D., a dermatologist in private practice in Bradenton, FL, and an Assistant Clinical Professor of Dermatology at the University of South Florida, discussed ways to make all employees feel like valued parts of a team.
4. Create an Empowering Workplace
I think that it is very important to create an empowering work environment, from both a professional and a personal perspective. From your receptionist to your surgical assistant, you need to show interest in your staff and encourage them to utilize their own talents. I allow them to pick out certain supplies if there are things they need, and listen if they feel like there’s a better way to do something. I have a new employee who wants everything high-tech, and we have upped the scale on that end and it has helped our practice.
Make them feel as if they are contributing to the success of the practice. While money is important, most people work for more than money. They want a sense of self-pride and to feel that they are appreciated. In this regard, the little things can be very important — a compliment about their work, eye contact, a smile, a chance to laugh. These will all make your employees so much happier.
It works in my practice. I’ve had my nurse practitioner for 18 years and my nurses for 12 years, because it’s fun and rewarding to come to work.
5. Develop a Team Attitude
Your staff contributes almost as much to the success of your practice as do your skills as a physician. It only makes sense then to foster an environment in which your staff works as a team pulling together for a common goal.
You must be willing to delegate responsibility in a respectful way, clearly state your expectations, establish appropriate goals and deadlines and reward your people when they produce.
We have an “attitude adjustment night” at our practice. I take my staff to dinner when we have met specific goals or had a particularly grueling stretch. They appreciate the gesture, and they socialize and develop a greater sense of camaraderie. They’ve actually developed genuine friendships outside the office, which is good for them and in the long run good for my practice.
6. Try Color Coordinating “Team” Uniforms
Too many physicians focus on the medical side of their practice and lose sight of the other important aspects of running a practice. Sometimes you simply need to spend money on your office for non-medical reasons.
I provided my staff with different color uniforms, and we all try to wear the same color every day. That way, I can move them around if I need to and everyone still looks like they belong where they are.
Joe Bikowski, M.D., a dermatologist in private practice near Pittsburgh, PA, and a Clinical Assistant Professor, Dermatology, at Ohio State University, suggested ways dermatologists can be more efficient without sacrificing patient care.
7. Look for Ways to be More Efficient
One of the easiest things that you can do if you have multiple exam rooms is to outfit them all exactly the same way. Each room is prepped for every patient the same way so when I walk in to a room, theoretically I don’t walk out until everything is accomplished.
I have chairs in every room that can accommodate two or three people so that mom can sit with little brother while I do an exam. There is an exam light right next to the chairs in every room. I have a surgical tray set up and ready to go in each room. Since, I do a lot of photography, there is a camera in each room, plus two back-up cameras because I think photography is most important. In every room, the top drawer contains the 16 sample items I use most frequently.
8. Hire a PA or Nurse Practitioner
I’m a major proponent of either a physician assistant or a nurse-practitioner. I use a PA because of the training they have, which allows them to mimic everything I do.
Because I do no major surgical procedures, I have been able to train my PA to everything I do medically. He has learned all the drugs and how to use them appropriately. He does not have his own schedule; we exchange patients back and forth. My patients have learned to accept him, and sometimes they like him better than they do me. However, those who prefer to only see me may do so. Having us both see the same patients is a very nice check on his competence, and sometimes he picks up things that I miss.
It’s a physical and emotional support to me. Despite the fact that I handsomely reward him, he is worth every penny to me.
9. Streamline Your Total Body Skin Exams
Total body skin exams are a challenge, but you can take a few steps to ease the pain, both for yourself and your patients.
First, get the appropriate exam table, one that goes up and down and tilts back and forth electrically. You should have a fully articulated exam light over every table.
When we do a total body skin exam, the patient disrobes and is covered with a drape. I always have a chaperone for these exams, regardless of the gender of the patient.
I start at the bottom, between the toes, the bottom of the feet, I work my way up the entire front of the body, turn the patient over, and work my way down the body starting with the scalp, which includes checking behind the ears. I make sure to examine the mucous membranes of the anus, the vaginal area and the mouth and the eyes. I make sure all patients have the opportunity to point out anything they wish to show me.
David Pariser, M.D., a senior physician with Pariser Dermatology in Norfolk, Virginia, and a professor in the Department of Dermatology at Eastern Virginia Medical School, offered up tips based not only on his experience with patients but also on his experience with commercial airlines.
10. Pre-Screen All Patients
If you accept insurance patients, particularly managed care patients who require a referral, you can save yourself a lot of headaches if you do as much work up front as possible. I recommend hiring a full-time person who does nothing but pre-screen patients one or two days before their appointment to verify insurance. This way you can cut down on patients who show up without the referral form, stopping the flow of the day, arguing with your staff and calling their primary care physician.
The type of information collected includes the availability of insurance referral, how many visits they are allowed, what the co-pay is. This way both you and the patients know what to expect.
Your day will go much smoother and it will improve your quality of life.
11. Overbook Instead of Confirming
I am a proponent of overbooking, airline style, instead of calling to confirm appointments. If you try to pre-confirm your patients, most of the calls are to answering machines, and you don’t know whether you’re going to get the people or not.
In our practice, we simply overbook. We have statistics about which days of the week and which offices tend to have the most or fewest no-shows, and from that we know how much to overbook. Occasionally, everybody shows up and, just as the airlines give away something when everybody shows up for flights, we give away something, too — a nice goodie bag full of the free samples of shampoo, moisturizers, and sunscreens from our partners.
Brett Coldiron, M.D., who practices dermatology and internal medicine in Cincinnati, OH, takes a creative approach to problem solving — sometimes just for fun.
12. Put A Computer Inside Your Desk
Ideally, you would have a system integrated into your desk with the monitor under a glass so that it does not clutter up your desk. Then you would have a keyboard in your lap drawer. My desk is cluttered already, so I have a system buried in the desk. I can check my e-mail or work on a talk while I’m doing my other paperwork or dealing with staff that’s running around me. It makes me very efficient. I can check my e-mail 10 times a day if I need to. Whenever it pops up, I’m there to answer it without its being intrusive or distracting to other people.
13. Use Counterintuitive Thinking to Help Patients
My office is in a congested, downtown area by a hospital and all the labs. I used to have free parking in front of my office, but people would pull in there at 5 a.m. and park all day for free, and my patients couldn’t use it. So I actually had meters installed. With the meters, the spots are more available to my patients because they turn over every 30 or 60 minutes. Now we put some quarters out front for our patients. One of the spots is a handicapped parking meter, which no one except my patients can use. While this might not directly apply to your practice, it’s an example of looking at a problem in a different way to make patients comfortable with coming to your office.
14. Have A Little Fun With Your Patients
It does not have to be all business all the time with your patients, especially your regular patients. I like to have a bit of fun with my patients just to make it easier for them to come to the office. I think that making the experience more pleasant makes patients less likely to forget an appointment because they have some more pleasant impressions and will remember the fun stuff. For example, I have golf prescriptions that I write for my patients — both men and women — and they get a big kick out of this. I also have other “prescriptions” like beauty parlor visits and things like that. I believe anything you can do to break down a patient’s reluctance to come to the office is a good thing, and having some fun is one way to do it.
Mark Nestor, M.D., Ph.D., a Clinical Associate Professor of Dermatology and Dermatologic Surgery at the University of Miami School of Medicine in Florida, places special emphasis on effectively communicating with patients.
15. Educate your Patients
You can use a variety of ways to inform your patients about the procedures you do in your practice. Pamphlets in the office and newsletters sent home are great ways to let your patients know about other services you provide. What we have done at our practice is to put a flat-screen monitor in each exam room. These monitors run a 300-slide PowerPoint presentation with before-and-after photos of all the procedures I do. We have found this to be very effective. You would be amazed at the number of patients who come in for a medical procedure and end up having an additional aesthetic or medical procedure.
16. Make Sure Your Patients Know What “Non-Medically Necessary” Means
I have found that patients are happy to pay for things such as salves, skin tag removals, acne, peels, blue light treatments, and so on, as long as I’ve explained beforehand that because they are not medically necessary, they aren’t covered by insurance.
Generally, patients are more comfortable about non-covered procedures because these days lots of things are not covered by insurance. If I explain that a condition can be improved by procedures such as eye peel treatments for rosacea or melasma and other types of laser procedures, but that these procedures may not be medically necessary, patients are typically happy to pay for it. However, it is very important to make sure you get consents and waivers.
17. Make Sure Patients Understand the Meaning of “Consent”
The best thing you can do is create a consent form that lists the reasons for, the benefits of and potential risks associated with each of the specific procedures you perform, whether it’s removing a basal cell cancer, laser resurfacing, whatever. Have the patient sign and date it, and have it witnessed. The consent form also documents that the procedure was performed, and you should reference it in your charts.
In addition, if you are doing a non-covered procedure, patients should sign a waiver stating that they understand that the procedure is not covered by insurance, that they have to pay for the procedure, and that there is no refund on the procedure.
Bill Kalogredis, J.D., is an Officer of Kalogredis, Sansweet, Dearden and Burke, Ltd., a law firm near Philadelphia that specializes in healthcare law. His suggestions run the gamut, from a lawyerly warning to check reference before hiring, to an admonition to update the waiting room, including reading material!
18. Check References Before Hiring Anyone
This may be obvious, but a lot of people say, “Why bother?” It is true that prior employers are often reluctant to say much, especially if it’s negative. But if nothing else, you can verify the information on an application, such as their duties and responsibilities, the dates of employment, and their level of training. Even if you don’t get direct answers to your questions, you might get some reaction that will give you a feel for whether they liked that person or not. If someone is less than enthusiastic about a former employee, that can tell you a lot. If you ask if they would hire that person again and they hesitate, what more do you need to hear?
19. Establish a Practice of Giving Merit Raises
Like it or not, personnel management is a huge part of a practice. But if you have the right people in place and they’re happy, you’re going to end up having a much happier office and your life will be so much better. One way to keep your folks happy is by providing merit pay raises and not across-the-board raises for everybody. You might balk at this idea because you are afraid to hurt someone’s feelings because they didn’t get as big a raise. Well, look at it this way, do you want to reward your best people and keep them happy, or do you want to lower standards and expectations just to keep your less-productive people happy? It seems like an obvious choice, which is why I’m a big proponent of merit raises based upon performance and not just giving everybody in your practice the same raise just because they work there.
20. Throw out the Old Magazines
Sounds pretty corny, but think about when new patients come to your office. The first impressions are going to be how nice your receptionist is when they walk in. When they’re sitting in the reception area, what do they see? Do they have to pick through tattered, 3-year-old magazines or a nice selection of more current information, or perhaps maybe even medically relevant information. So the impression created by having these old tattered magazines in your reception area can be a negative one. Taking it a step further, you might want to consider some different, more upscale magazines such as art or architecture, or travel or lifestyle magazines, especially if your practice has a lot of cosmetic patients.
Scott Dinehart, M.D., a dermatologist in private practice in Little Rock, AR, focused on employees — keeping track of who’s where when, protecting them from latex allergy, and your computers from their abuse and viruses.
1. Lose the Latex
With the incidence of allergic reactions to latex on the rise, it would make sense to switch to a non-latex glove such as nitrile gloves. From my point of view, it makes no sense to be wearing latex gloves all day when there are alternatives.
Even if you are concerned about the additional costs — and nitrile gloves can cost more than twice as much as latex gloves — you might consider having a supply on hand for those who have shown sensitivity to latex. Maybe you and your staff can simply wear the nitrile gloves occasionally just so you don’t have latex gloves on all the time.
2. Establish a Computer and Internet Usage Policy
If you are like most modern dermatologists, your computer systems have become critical to the success of your practice. The last thing you need is to have a staff member introduce a virus through careless use, downloading music or games, or simply wasting time messaging.
You need to take steps to ensure that your computers remain safe and secure and are properly used. One step often overlooked is to establish and clearly articulate an Internet and computer usage policy for your staff. You might even want to have staff members read and sign a written statement outlining penalties. You should also reinforce that policy during staff meetings and with signs posted at computers.
3. First, Know Who’s On
Nothing can disrupt an office quite like having an employee not show up for work when he or she is expected. And if you have a large number of employees, keeping track of vacations and days off can quickly become a logistical nightmare, not just for you, but for your entire staff. Plus, if someone needs a day off, hours can be wasted determining who is off on a particular day.
One effective way to alleviate this problem is to get a large calendar of scheduled vacations and absences. Post the calendar prominently so that everyone can see not only their own days off, but those scheduled for the entire staff. That way, they can see at a glance who is scheduled for time off on a given day.
Susan Weinkle, M.D., a dermatologist in private practice in Bradenton, FL, and an Assistant Clinical Professor of Dermatology at the University of South Florida, discussed ways to make all employees feel like valued parts of a team.
4. Create an Empowering Workplace
I think that it is very important to create an empowering work environment, from both a professional and a personal perspective. From your receptionist to your surgical assistant, you need to show interest in your staff and encourage them to utilize their own talents. I allow them to pick out certain supplies if there are things they need, and listen if they feel like there’s a better way to do something. I have a new employee who wants everything high-tech, and we have upped the scale on that end and it has helped our practice.
Make them feel as if they are contributing to the success of the practice. While money is important, most people work for more than money. They want a sense of self-pride and to feel that they are appreciated. In this regard, the little things can be very important — a compliment about their work, eye contact, a smile, a chance to laugh. These will all make your employees so much happier.
It works in my practice. I’ve had my nurse practitioner for 18 years and my nurses for 12 years, because it’s fun and rewarding to come to work.
5. Develop a Team Attitude
Your staff contributes almost as much to the success of your practice as do your skills as a physician. It only makes sense then to foster an environment in which your staff works as a team pulling together for a common goal.
You must be willing to delegate responsibility in a respectful way, clearly state your expectations, establish appropriate goals and deadlines and reward your people when they produce.
We have an “attitude adjustment night” at our practice. I take my staff to dinner when we have met specific goals or had a particularly grueling stretch. They appreciate the gesture, and they socialize and develop a greater sense of camaraderie. They’ve actually developed genuine friendships outside the office, which is good for them and in the long run good for my practice.
6. Try Color Coordinating “Team” Uniforms
Too many physicians focus on the medical side of their practice and lose sight of the other important aspects of running a practice. Sometimes you simply need to spend money on your office for non-medical reasons.
I provided my staff with different color uniforms, and we all try to wear the same color every day. That way, I can move them around if I need to and everyone still looks like they belong where they are.
Joe Bikowski, M.D., a dermatologist in private practice near Pittsburgh, PA, and a Clinical Assistant Professor, Dermatology, at Ohio State University, suggested ways dermatologists can be more efficient without sacrificing patient care.
7. Look for Ways to be More Efficient
One of the easiest things that you can do if you have multiple exam rooms is to outfit them all exactly the same way. Each room is prepped for every patient the same way so when I walk in to a room, theoretically I don’t walk out until everything is accomplished.
I have chairs in every room that can accommodate two or three people so that mom can sit with little brother while I do an exam. There is an exam light right next to the chairs in every room. I have a surgical tray set up and ready to go in each room. Since, I do a lot of photography, there is a camera in each room, plus two back-up cameras because I think photography is most important. In every room, the top drawer contains the 16 sample items I use most frequently.
8. Hire a PA or Nurse Practitioner
I’m a major proponent of either a physician assistant or a nurse-practitioner. I use a PA because of the training they have, which allows them to mimic everything I do.
Because I do no major surgical procedures, I have been able to train my PA to everything I do medically. He has learned all the drugs and how to use them appropriately. He does not have his own schedule; we exchange patients back and forth. My patients have learned to accept him, and sometimes they like him better than they do me. However, those who prefer to only see me may do so. Having us both see the same patients is a very nice check on his competence, and sometimes he picks up things that I miss.
It’s a physical and emotional support to me. Despite the fact that I handsomely reward him, he is worth every penny to me.
9. Streamline Your Total Body Skin Exams
Total body skin exams are a challenge, but you can take a few steps to ease the pain, both for yourself and your patients.
First, get the appropriate exam table, one that goes up and down and tilts back and forth electrically. You should have a fully articulated exam light over every table.
When we do a total body skin exam, the patient disrobes and is covered with a drape. I always have a chaperone for these exams, regardless of the gender of the patient.
I start at the bottom, between the toes, the bottom of the feet, I work my way up the entire front of the body, turn the patient over, and work my way down the body starting with the scalp, which includes checking behind the ears. I make sure to examine the mucous membranes of the anus, the vaginal area and the mouth and the eyes. I make sure all patients have the opportunity to point out anything they wish to show me.
David Pariser, M.D., a senior physician with Pariser Dermatology in Norfolk, Virginia, and a professor in the Department of Dermatology at Eastern Virginia Medical School, offered up tips based not only on his experience with patients but also on his experience with commercial airlines.
10. Pre-Screen All Patients
If you accept insurance patients, particularly managed care patients who require a referral, you can save yourself a lot of headaches if you do as much work up front as possible. I recommend hiring a full-time person who does nothing but pre-screen patients one or two days before their appointment to verify insurance. This way you can cut down on patients who show up without the referral form, stopping the flow of the day, arguing with your staff and calling their primary care physician.
The type of information collected includes the availability of insurance referral, how many visits they are allowed, what the co-pay is. This way both you and the patients know what to expect.
Your day will go much smoother and it will improve your quality of life.
11. Overbook Instead of Confirming
I am a proponent of overbooking, airline style, instead of calling to confirm appointments. If you try to pre-confirm your patients, most of the calls are to answering machines, and you don’t know whether you’re going to get the people or not.
In our practice, we simply overbook. We have statistics about which days of the week and which offices tend to have the most or fewest no-shows, and from that we know how much to overbook. Occasionally, everybody shows up and, just as the airlines give away something when everybody shows up for flights, we give away something, too — a nice goodie bag full of the free samples of shampoo, moisturizers, and sunscreens from our partners.
Brett Coldiron, M.D., who practices dermatology and internal medicine in Cincinnati, OH, takes a creative approach to problem solving — sometimes just for fun.
12. Put A Computer Inside Your Desk
Ideally, you would have a system integrated into your desk with the monitor under a glass so that it does not clutter up your desk. Then you would have a keyboard in your lap drawer. My desk is cluttered already, so I have a system buried in the desk. I can check my e-mail or work on a talk while I’m doing my other paperwork or dealing with staff that’s running around me. It makes me very efficient. I can check my e-mail 10 times a day if I need to. Whenever it pops up, I’m there to answer it without its being intrusive or distracting to other people.
13. Use Counterintuitive Thinking to Help Patients
My office is in a congested, downtown area by a hospital and all the labs. I used to have free parking in front of my office, but people would pull in there at 5 a.m. and park all day for free, and my patients couldn’t use it. So I actually had meters installed. With the meters, the spots are more available to my patients because they turn over every 30 or 60 minutes. Now we put some quarters out front for our patients. One of the spots is a handicapped parking meter, which no one except my patients can use. While this might not directly apply to your practice, it’s an example of looking at a problem in a different way to make patients comfortable with coming to your office.
14. Have A Little Fun With Your Patients
It does not have to be all business all the time with your patients, especially your regular patients. I like to have a bit of fun with my patients just to make it easier for them to come to the office. I think that making the experience more pleasant makes patients less likely to forget an appointment because they have some more pleasant impressions and will remember the fun stuff. For example, I have golf prescriptions that I write for my patients — both men and women — and they get a big kick out of this. I also have other “prescriptions” like beauty parlor visits and things like that. I believe anything you can do to break down a patient’s reluctance to come to the office is a good thing, and having some fun is one way to do it.
Mark Nestor, M.D., Ph.D., a Clinical Associate Professor of Dermatology and Dermatologic Surgery at the University of Miami School of Medicine in Florida, places special emphasis on effectively communicating with patients.
15. Educate your Patients
You can use a variety of ways to inform your patients about the procedures you do in your practice. Pamphlets in the office and newsletters sent home are great ways to let your patients know about other services you provide. What we have done at our practice is to put a flat-screen monitor in each exam room. These monitors run a 300-slide PowerPoint presentation with before-and-after photos of all the procedures I do. We have found this to be very effective. You would be amazed at the number of patients who come in for a medical procedure and end up having an additional aesthetic or medical procedure.
16. Make Sure Your Patients Know What “Non-Medically Necessary” Means
I have found that patients are happy to pay for things such as salves, skin tag removals, acne, peels, blue light treatments, and so on, as long as I’ve explained beforehand that because they are not medically necessary, they aren’t covered by insurance.
Generally, patients are more comfortable about non-covered procedures because these days lots of things are not covered by insurance. If I explain that a condition can be improved by procedures such as eye peel treatments for rosacea or melasma and other types of laser procedures, but that these procedures may not be medically necessary, patients are typically happy to pay for it. However, it is very important to make sure you get consents and waivers.
17. Make Sure Patients Understand the Meaning of “Consent”
The best thing you can do is create a consent form that lists the reasons for, the benefits of and potential risks associated with each of the specific procedures you perform, whether it’s removing a basal cell cancer, laser resurfacing, whatever. Have the patient sign and date it, and have it witnessed. The consent form also documents that the procedure was performed, and you should reference it in your charts.
In addition, if you are doing a non-covered procedure, patients should sign a waiver stating that they understand that the procedure is not covered by insurance, that they have to pay for the procedure, and that there is no refund on the procedure.
Bill Kalogredis, J.D., is an Officer of Kalogredis, Sansweet, Dearden and Burke, Ltd., a law firm near Philadelphia that specializes in healthcare law. His suggestions run the gamut, from a lawyerly warning to check reference before hiring, to an admonition to update the waiting room, including reading material!
18. Check References Before Hiring Anyone
This may be obvious, but a lot of people say, “Why bother?” It is true that prior employers are often reluctant to say much, especially if it’s negative. But if nothing else, you can verify the information on an application, such as their duties and responsibilities, the dates of employment, and their level of training. Even if you don’t get direct answers to your questions, you might get some reaction that will give you a feel for whether they liked that person or not. If someone is less than enthusiastic about a former employee, that can tell you a lot. If you ask if they would hire that person again and they hesitate, what more do you need to hear?
19. Establish a Practice of Giving Merit Raises
Like it or not, personnel management is a huge part of a practice. But if you have the right people in place and they’re happy, you’re going to end up having a much happier office and your life will be so much better. One way to keep your folks happy is by providing merit pay raises and not across-the-board raises for everybody. You might balk at this idea because you are afraid to hurt someone’s feelings because they didn’t get as big a raise. Well, look at it this way, do you want to reward your best people and keep them happy, or do you want to lower standards and expectations just to keep your less-productive people happy? It seems like an obvious choice, which is why I’m a big proponent of merit raises based upon performance and not just giving everybody in your practice the same raise just because they work there.
20. Throw out the Old Magazines
Sounds pretty corny, but think about when new patients come to your office. The first impressions are going to be how nice your receptionist is when they walk in. When they’re sitting in the reception area, what do they see? Do they have to pick through tattered, 3-year-old magazines or a nice selection of more current information, or perhaps maybe even medically relevant information. So the impression created by having these old tattered magazines in your reception area can be a negative one. Taking it a step further, you might want to consider some different, more upscale magazines such as art or architecture, or travel or lifestyle magazines, especially if your practice has a lot of cosmetic patients.
