The Most Valuable Asset: Clinicians' Time
By Elizabeth Woodcock, DrPH, MBA, FACMPE, CPC
A clinician’s time is the most valuable asset of the ambulatory enterprise. Time represents the “product” that patients consume – and it’s our job to not only make it available in a timely manner, but also to ensure that it is optimized. What seems like a straightforward concept, however, is far from simple. Let’s dive in:
Defining the Problem: Lack of Clear Expectations
Despite its importance, expectations related to time are typically not defined. Most employment contracts do not address the work-time requirement for physicians. Physicians are expected to fulfill their clinical duties, but the rigor behind that statement is limited. For patient access leaders, our goal is to balance supply (clinicians’ time) with demand (patients’ care needs).
Defining supply is often the first step for a sustainable, system-level access initiative. We need to identify the expectations for clinical effort per week – and the weeks worked per year. The lack of transparency related to expected hours creates a challenge for administrative leaders and clinicians, which may contribute to a negative, if not toxic situation. The absence of expectations decreases the opportunity to create a culture of accountability, which may lead to some clinicians sensing that they are carrying more of the clinical burden than their peers.
Navigating the Challenges of Defining Time
This is no easy task, however. The act of defining expected hours may make clinicians feel unappreciated, and their work ethic challenged. Leaders must approach the task with thoughtful, well-defined messaging to manage the perceptions of the clinician teams.
The process itself is challenging. In addition to clinical work, physicians in academic health systems also participate in administrative, research, and teaching activities. Therefore, the acronym, CARTs, is often applied to the topic. However, it’s important to recognize that the “C” – clinical time – requires further scrutiny in the context of access.
Measuring Clinic Time: The “Little C”
For patient access leaders, our objective is to get patients access to the ambulatory enterprise. It represents the lowest-cost delivery setting, an important landing point for patients, particularly in value-based care. Thus, we need to understand the physicians’ clinic time – at the Patient Access Collaborative, we refer to this as the “little c.”
In addition to the time in inpatient rounds, operating room, cath labs, and so forth, we need to understand the expectations for the physicians’ time in the ambulatory clinic. Once we understand the expectations related to clinic time, it allows us to compare it with the time allocated for each physician in the appointment scheduling system. If the physician is expected to see patients in clinic 20 hours per week (five four-hour sessions), 46 weeks per year, for example, is that what is reflected in the scheduling system? If not, what is the difference? Conducting a gap analysis of expected versus actual work hours provides valuable insight into supply.
Insights and Metrics from Defined Expectations
A well-defined expectation of clinic time opens the door to more insightful performance indicators and enhanced business intelligence. Industry standard metrics, such as schedule utilization, become significantly more valuable with the added context of expected hours.
Deeper analysis and decision support tools also benefit from defined clinical expectations. For example, system-level analyses regarding appropriate patient panel size and capacity to match clinical quality standards of care for follow-up care are only possible with a structured approach to expected clinic time.
Key Findings on Physician Time Allocation
A groundbreaking study by the American Medical Association’s Christine Sinsky, MD, and colleagues provides relevant industry data. Extracting data from nearly 400 health care organizations using the electronic health system, Epic®, the authors calculate patient scheduled hours by specialty for a full-time equivalent physician, defined as 40 hours per week. Overall, the median patient scheduled hours for an FTE physician was 33.2 hours.
In other words, a full-time, 40-hour per week physician should be scheduled for 33.2 hours in clinic, as the other hours – 6.8 – are used for patient care outside of the clinic scheduled hours. Scheduling 40 hours in the clinic would mean, therefore, that a physician would actually work 48 hours, as the researchers determined that physicians perform 0.2 hours of work outside of scheduled hours for every 1 hour of patient scheduled time.
Implications for Capacity Management
There are limitations to this study: the research was performed based on a time period during COVID – and does not count phone calls, care team dialogue, or time that is not accounted for in the EHR system. Furthermore, the researchers did not evaluate the content or components of time.
This fact makes our role as capacity management experts even more important; every minute is precious and must be deployed efficiently and effectively. The study provides a significant contribution to the literature to understand our health system’s most valuable asset – the capacity of our clinician workforce.
Conclusion: The Importance of Defining Time
Unpacking the supply-side of access economics – defining time – is vital to the success of our access efforts. By clearly understanding and managing clinician time, we can better meet patient needs, optimize clinic operations, and ensure a sustainable future for the ambulatory enterprise.