Seven Habits for Reducing Work After Clinic

Authors and Disclosures

Sumana Reddy, MD, FAAFP, Peter Rippey, MD, CAQSM, Arnold Cuenca, DO, CAQSM, FAAFP, Sumi Sexton, MD, Troy Fiesinger, MD, FAAFP, Kenneth G. Adler, MD, MMM and Brandi White

About the Authors
Dr. Reddy is a family physician in a small independent group family practice in Salinas, Calif. Dr. Rippey practices family medicine and sports medicine in a hospital-owned clinic in Bluffton, S.C. Dr. Cuenca practices family medicine and sports medicine in a large multispecialty group in Mission Viejo, Calif. Dr. Sexton is a family physician in an independent, multispecialty group in Arlington, Va., an associate professor at Georgetown University School of Medicine, and editor-in-chief of American Family Physician. Dr. Fiesinger is a family physician in a large primary care group in Houston. Dr. Adler is a family physician in a physician-owned, predominantly primary care medical group practice in Tucson, Ariz., and is the former medical editor of FPM. Drs. Reddy, Rippey, Cuenca, Sexton, and Fiesinger are all members of FPM's Editorial Advisory Board. Brandi White is senior editor and web content manager for FPM.

Author disclosures
no relevant financial affiliations disclosed.

Sidebar 1

Key Points

• While changes are needed throughout the health care system to reduce administrative complexity, physicians must find ways to regain some control over their time and not burn out.

• Time management tactics, improved delegation, message management, and more efficient documentation practices can help reduce the amount of time physicians spend working after hours.

• When addressing the problem of work after clinic, practices should be careful not to apply more pressure on already pressured physicians; a better approach involves empathy, mentoring, and accountability.

Sidebar 2

What do you Think?

What strategies have helped you improve your efficiency and reduce work after clinic? Let us know at fpmedit@aafp.org or by commenting on the online version of this article.

Sidebar 3

A Word About Panel Size

There are limits to the number of patients you can effectively care for. For most physicians, having too many patients will exacerbate the work-after-clinic burden.

To assess whether you have too many patients on your panel, you can compare your practice to benchmarks from the AAFP for family physicians:

• Average panel size: 1,974 patients (the number of patients attributed to the physician and seen in the past two years)¹

• Hours worked each week: 51 hours (10 of which are after hours)²

• Hours spent weekly in face-to-face patient care: 28 hours²

• Patient encounters per week: 82 (72 in the office)²

Whether your panel size is manageable may also depend on factors such as your scope of practice, years of experience, patient severity of illness, teaching or administrative responsibilities, and organizational decisions, such as requiring physicians to see their colleagues' overflow versus protecting physicians' schedules.

1. AAFP Practice Profile 2017.

2. AAFP Practice Profile 2018.

Sidebar 4

What's Being Done to Address Administrative Complexity?

Reducing the administrative burden on family physicians is a strategic objective of the AAFP. It has combined advocacy efforts with five other specialty societies, representing more than 560,000 physician and medical student members, and drafted the Joint Principles on Reducing Administrative Burden. The issues the AAFP is addressing include advocating for less onerous documentation and billing guidelines, interoperability of EHRs to support care across the continuum, a core set of primary care quality measures that would be used by all payers, reduced prior authorization demands, and other issues.

As part of its Patients Over Paperwork project, the Centers for Medicare & Medicaid Services (CMS) recently made some changes to ease physicians' documentation requirements:

• For the history and exam, physicians are now required to document only what has changed since the last visit or pertinent items that have not changed; they do not need to rerecord these elements if the record contains evidence that they reviewed and updated the previous information.

• For both new and established patients, physicians no longer must re-enter information in the medical record regarding the chief complaint and history (including the history of present illness) that either ancillary staff or the patient have already entered.

• Teaching physicians no longer need to personally document their participation in the medical record for E/M visits and to document the extent of their participation in the review and direction of services furnished to each Medicare beneficiary; the notes of a resident or other member of the medical team may suffice instead.

• Physicians do not have to document the medical necessity of furnishing a visit in the home rather than in the office. If the encounter is medically necessary, where it occurs is immaterial.

For more information on these changes see "The 2019 Medicare Documentation, Coding, and Payment Update," FPM, January/February 2019. More documentation reforms are expected from CMS later this year.

Sidebar 5

A Starter List of EHR Macros

Using EHR macros in your documentation can save time because you don't have to type out words or phrases that you use repeatedly. For example, once you set up your macros, you can type "bcc," and your EHR will input "Birth control counseling provided, with discussion of barrier methods, hormonal methods including combination pills and progesterone only methods, implants patches, ring, and IUDs. Discussed the pros and cons, effectiveness, and side effects."

A starter list of macros that can be helpful in family medicine can be downloaded from the online version of this article at https://www.aafp.org/fpm/2019/0500/fpm20190500p10-rt2.xls.

Got a macro you'd like to share? Comment on the online version of this article, or send it to fpmedit@aafp.org. We may edit submissions for inclusion in the macro spreadsheet.

Sidebar 6

Strategies and Resources