Time is Money:
As a medical doctor in this country, you probably feel that you don’t have enough “face to face” time with your patients and , let’s face it , the only thing that you can sell is time.
Most of us use the basic calculation of 15 minutes per patient, 4 patients per hour, and try to consult for 7 hours per day minimum. This equates to 28 patients per day, with 1 hour for lunch. It does not include emergencies and unplanned events, or the time taken to perform managed care tasks which are not directly related to your patient’s health.
At a consultation fee of R 400.00 per 15 to 45 minutes and working 22 days per month and 11 months per year, this equates to a gross annual income of R2,710,400.
Practice overheads run at 60%, thus you are left with R1,084,160.00 annually on which you pay 40% tax ,leaving you with R650, 496.00 per annum or R54,200 per month.
I am not going to comment in this article on the ridiculous situation of being paid the same fee for a 15 minute consultation, as for a 45 minute consultation, except to state that for years on end, the funders have got away with “murder of the General Practitioner branch of the profession”, by doing this.
You can however, at a take home total of R 54,000.00, not afford the time to do everything yourself, especially administrative duties not specific to primary preventative healthcare for your patients.
The following suggestions may be of use to you in optimising your time and your take home pay:
You may therefore wish to consider the benefits of a practice manager to optimise your time available to be spent with patients, and to remove the more menial tasks demanded by MCOs from your day to day duties.
If this does not appeal , then try to either outsource these duties or if menial, allocate them to clerical staff whom you have need to send for training until they are used to doing this well. There are free courses for doctors’ receptionists, booking of appointments, how to answer the phone, and how to operate your accounting and receipting system and how to assist you in keeping to time in the practice.
Note keeping as a time saver:
As the era of hand written notes comes to an end, and recorded consultations and/ or notes recorded during or after the consultation takes their place, you need to remain ahead of the curve and watch the various offerings with care and caution. Real time recording of your entire day of consulting (with patient’s permission) is no longer a distant possibility and this can act as a back up to your dictated electronic notes.
Patient handouts for preventative conditions will enhance your waiting room and elevate your practice to a repository of information and reference. Many Pharmacos hand these out freely and encourage you to display them in your waiting area.
Booking systems are a great way to school your patients to managing their time in the waiting room and your ability to work to time in your surgery. Combine this with a ”switched on” receptionist and practice manager, and patients will support your ability to see them on time.
Get your reception to call all appointments at the beginning of the day to confirm attendance, and send out confirmatory sms messages. HPCSA says that you cannot charge a consultation fee for an appointment not cancelled timeously, however you CAN change an administration fee of a reasonable amount, for no shows and the fact that you have had to reschedule your day and attempt to fill that unexpectedly empty slot in your day. This must however be clearly stated on your booking engine, or by your receptionist when she takes a booking.
Schedule a facility slot for emergency time every 2 hours, which can double as a tea break if no emergency arrives.
Establish speciality clinics on your quieter days; Hypertension , Diabetes , Allergies etc , and expand these to take up any slack that you have in your practices and utilise electronic reminders for patients to come in every 6 months to receive their check- up and repeat their chronic medication prescriptions. Stand firm on not repeating chronic medication without a reassessment after 6 months have passed. Issue a 2 day supply to tide the patients over until you can re-evaluate them.
Levies and co-payments:
Many of our colleagues couldn’t bother to collect co-pays and levies. This is money wasted and is income which is legitimately yours. Just because your colleague down the road writes these off in order to attract wayward patients, is not a reason for you to follow suit. I realise that your fear is you may lose your patients, but sooner or later the other colleagues will feel the pinch.
Better to discipline your patients and give good service, than sausage machine them and write off levies in return for increased feet through the door. A R 10 levy or co-payment lost on 28 patients per day for 22 working days a month is well over R 6,100.00, or 15 consultations a month. At 28 patients per day, you actually are losing the equivalent of an extra 6 days of income per year which could pay towards your annual holiday!!
Many colleagues decide to buy expensive ultrasound or point of service machines without working out a cost benefit analysis. Similarly you may decide to invest in expensive motor cars, holiday homes, Kiwi fruit farms and even Movies designed to fail etc., just to claim tax deductions. Remember that you have to finance these items usually at interest of over 9% pa, and your chances of getting a successful tax deduction could be slim. Even if they succeed, the MCOs may try to pick holes in your use of POC machinery and investigate you for possible over-servicing. Beware that funders are cracking down hard on Ultrasound machines and POS machines which are used indiscriminately.
For all of these ideas, thorough evaluation with your tax consultant, and with your IPA, in advance of your purchase will assist you in working out your real return on investment.
Forming Group practices:
Group practices are seen in a good light by the planners of the future NHI. They also make sense from an economies of scale point of view.
Beware of start-up funders:
Be wary of new start up health care companies who coax you into their “network” of doctors, saying that they have a whole tranche of new patients for you to see. They usually don’t, but will use your name and your practice to then attract patients from nearby businesses (many of whom are your private patients) by stating that you will be there to service the new network.. Chicken and egg situation??
Paying peanuts gets monkeys…………
Screen your staff well before hiring them. Check references and exit salaries. Don’t take their last salary on face value, check it with their previous employer or on their payslip.
Pay your staff a fair wage and they will feel that they have skin in the game with you. If you are overstaffed, you may want to expand your practice to maximally utilise their services, failing which you may need to reduce the staff numbers using the LIFO principle … Last in, first out. In reducing staff numbers however ensure that you enlist the services of a skilled labour consultant lest you end up before the CCMA.
Remember that salary increases should not be based on the amount of time that the employee has been in your organisation but rather on their capability to do the job you require with excellence.
Consider the above suggestions, and feel free to respond to us with further suggestions from your practices which I would appreciate sharing with our network doctors.
Tony Behrman and the Qualicare team
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