Jarrod Shapiro, DPM PRESENT Practice Perfect Editor Mountain View Medical & Surgical Associates, Madras, Oregon

The devil is in the details. This seems no truer than in a physician’s daily schedule. When running a practice, there are so many miniscule, mundane, yet critical details that seem to make or break a practice. Take, for example, Medicare forms. There seems to be no more boring, arduous task than filling out these voluminous forms. The smallest detail omitted will lead to delays, more paperwork, and lack of reimbursement. What about other details that appear, at first glance, to be unimportant but in practice, become highly significant? The physician’s schedule tops this list.

For those of you in residency or fellowship, you may think this is a no-brainer. You argue, "Why worry about my schedule? I'll work as hard as possible to build a practice and maintain a full schedule." I'd argue, in return, that your schedule requires more planning than you realize.

	Today's Premier Lecture is Tibialis Posterior Dysfuntion: The Coumnar Appraoch by John Schuberth, DPM.

I think it all boils down to preparation and efficiency.  If you like to fly by the seat of your pants, then by all means, disregard the above considerations.  If you prefer smoothness and a sense of professionalism in your practice, then I’d recommend considering some of the above factors.

Here’s what I would view as an ideal model for my schedule.  This is only one method; many exist based on what the doctor’s needs may be.  As a small disclaimer, the schedule below is NOT my actual schedule.  As an employee of a larger organization, I have some limitations over the control of my schedule.

An Idealized Office Schedule

The basic patient schedule is 9 AM – 4 PM Monday, Wednesday, and Thursday, 8 AM – 12 PM Friday (administrative/personal time Friday afternoon) and Saturday.  Tuesday elective surgery (which allows for a 3 day first postop visit).  Non-elective surgery scheduled as needed.  One of these days would start early (7:30AM) and one would end late (6PM) to accommodate working folks and children in school.  Saturday, as I’m told by several long-practicing physicians, is a good day for working patients and is usually busy.  Optimally, the time allotted for each patient visit would vary based on the complexity of the visit.  For doctors just starting out, I’d recommend giving your new patients 30 minutes.  Patients love when their doctor can spend extra time with them.  Follow-up visits would vary also, with simple visits (ex. warts, palliative care) having shorter visits than complex visits (ex. wounds or complex orthopedic issues).  I give preoperative visits about 20 minutes, because I spend a lot of extra time on a formal consent process.  Uncomplicated postop visits, on the other hand, usually require no more than 10 minutes.

Again, these times depend on how much support you have from staff.  A simple first postoperative bunionectomy visit with staff redressing the foot, for instance, would require less than 5 minutes of your time. 
A recommendation I’ve found to be highly useful in practice is to avoid scheduling new patients as the first or last patient of the day or just before lunch.  A new patient always has a chance to be more complex and time consuming than you originally thought.  This method will prevent unnecessary backups and delays.

With some forethought and planning, the schedule can be a tool to make a physicians life more efficient, organized, and less stressful.  Good luck with your schedule plans.

Keep writing in with your thoughts and comments or visit eTalk on PRESENT Podiatry and start or get in on the discussion. We'll see you next week. Best wishes!

Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]

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