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Fam Pract Manag. 2001 Feb;8(2):58.

Setting up a practice

Q

I’m a family physician starting a private practice that will serve an adult population only (no pediatric or obstetric patients). The practice will have one physician and one nurse. What is a recommended minimum setup for the office (i.e., how many forms, supplies, etc., should be on hand)?

The quantities you’ll need will depend on your particular situation, but you can get a general idea of what you might need by identifying the number of patients you expect to see on a daily basis. If you don’t know how many to expect, the following exercise will give you a rough idea.

According to national statistics, family physicians see an average of 100 patients per week and perform an average of one procedure per week. Modify these numbers based upon how quickly you expect the practice to grow, and consider the following questions:

  • Is the area highly competitive?

  • Is there a high ratio of patients to primary care providers in your area?

  • Are credentialing delays likely to affect your patient volume?

Now you can calculate the quantity of forms you’ll need based on your projected patient volume.

To get an idea of how many supplies to order, contact two or three medical supply vendors and ask for a “purchase plan.” The purchase plan should list items that the vendor suggests ordering monthly, quarterly and semiannually. Compare the vendors’ purchase plans and the suggestions made by their sales representatives, and you should have a pretty good idea of what to order.

Physicians make more changes in forms, materials and procedures during their first two years in practice than in subsequent years, so think carefully about what you’re ordering. You don’t want to be stuck with inventory you don’t need.

Closing time

Q

There’s continuing debate in our urgent-care center about whether closing time means the time after which we no longer allow patients to enter the center or the time our staff goes home. The administration doesn’t want to pay overtime but does want patients who enter before the office closes to be seen. This means that staff members must often leave late, complicating child care arrangements and making it difficult to keep personal appointments. How can we fix this problem?

Proper patient care does require extending the normal workday at times, and this is especially true in an urgent-care center, like yours, that relies on walk-in business. Paying overtime is an obvious solution for the hourly support staff, but it doesn’t help the physicians or other salaried staff and, as you point out, it’s generally not the first choice of the practice administration or the staff.

The most successful solution for dealing with this problem in urgent-care centers is the staggered workday, in which all staff members generally work eight hours a day and 40 hours a week, but their schedules are staggered to provide coverage for an extended workday. With this approach, office hours are firmly set (e.g., 8 a.m. to 7 p.m.), and patients can check in right up until 7 p.m. Some of the support staff begin work at 6 a.m., two hours before the office opens, some begin at 8 a.m., and others come in at 10 a.m. The physicians have the option of working the extended hours, adding additional physicians and/or utilizing the services of physician extenders to meet the patient demand.

Physician departure letter

Q

I sold my family practice to another physician two years ago. I’ve been practicing with him part-time since then but will be leaving the practice permanently in less than six months. I’d like to write to patients I’ve seen in the last five years. How much notice should I give them, and what should I include in the letter?

If you’re confident the practice will be able to absorb your patients, and it sounds like you are, you don’t have to worry about abandonment to the same degree that you would if you were closing a solo practice. However, in my opinion, consideration for your patients and an orderly transition still requires at least 30 days notice.

Begin the letter by specifying your departure date. Show your support for the physician who purchased the practice, letting your patients know you’ve done your best to leave them in good hands. Consider including brief bios of the remaining staff and, if appropriate, indicate how patients can select another health care provider in the practice. Finally, consider taking this opportunity to thank your patients for all they’ve taught you and to tell them how much you’ve enjoyed being their physician.

I strongly recommend that your letter be drafted with the assistance and cooperation of the new practice owner. That way your words will accurately reflect the plans and image the practice wishes to present.


* Denotes member of FP Assist, the AAFP’s online clearinghouse for consultants and attorneys.


 

Copyright © 2001 by the American Academy of Family Physicians.
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