One family physician thinks we should stop pretending that it is.
Fam Pract Manag. 2008 Sep-Oct;15(8):52.
For years, I have heard my fellow doctors proudly describe their practices as “busy.” The word is even used as an enticement in advertisements from recruiters: “Join a busy, growing practice” or “Come work in our laid-back but busy rural clinic.”
Silly me to question this, but why is busy good?
I understand that “busy” generally equates with higher reimbursement. Reimbursement is when someone other than the person we provided a service to pays us some fraction of our charge, several weeks after the service is provided, after we submit a complicated document that gets picked apart, often rejected and sent back to be redone. But higher reimbursement doesn't necessarily equate with higher income if the overhead costs associated with being busy are too high.
A few years ago, I decided to leave busy behind. I did away with my staff, my 3,000 square feet of office space, my $2,000 copy machines with $600-a-year contracts on them and so on, and I set up a practice in which my supply of visits actually matches the demand for my care, instead of running short. I squeezed down my overhead to half of what most offices spend. I simplified systems, used planned care and created room to breathe and not be busy. Oh, some days I am busy, but that is the exception, not the rule.
I have noticed a funny thing. When I am not so busy,
I refer a lot less, which saves the system money. I provide more robust visits, which come with higher reimbursements. I fully utilize my skills, and my patients like not having every organ outsourced because I'm too busy to work on the problem for them. I like the satisfaction of doing a good job. I also know more about my patients, get back to them in a timely fashion and meet their needs. I am proactive about their care and get their refills set up in advance so I do not get called on Saturday for a statin refill. And I get to talk to the people who are my patients and find out things I wouldn't have known if I had been too busy. For example, maybe they've never understood diabetes even though they have had it for 10 years.
I have to wonder: If we all slowed down, would we make care safer and primary care more valuable? Probably. Would we make less money? Not necessarily, if we're willing to restructure our offices and cut overhead.
My father used to complain about the lack of time his doctor spent with him. His expectations were actually pretty low – a mere seven minutes. “I didn't get my seven minutes!” he used to say. He also never got his lab results in a timely matter. He never once got simple, appropriate care for ulcerations from edematous legs. And he never saw the same person twice in a row. It was a busy office.
Tell me how that helps patients. And tell me, is that why you went to medical school – to be busy?
Maybe busy isn't good. I think we should stop pretending it is.
Copyright © 2008 by the American Academy of Family Physicians.
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