Dear [CEO]: The Letter I Gave My Boss This Week

I was behind on my charting, as were several of my colleagues. My boss asked me for ideas how to fix this problem. This is what I wrote:

A better day for medical providers:

1) Encounter Productivity Achieved

2) Charts done on time

3) Inboxes Cleared.

Those are the three basic tasks of a medical provider, yet most medical organizations only schedule providers for one of them, the patient visits, and somehow expect that by pure magic, superhuman willpower or personal sacrifice, the other two things will get done, and continually act surprised when that doesn’t happen.

Our clinic has recently heard from two departing providers that the non-patient visit work was a significant source of personal frustration.

Here is my suggestion for better efficiency and less professional stress with less risk for burnout:

1) Adopt a 20-40 minute grid.

2) Keep encounters at 15 or 30 minutes

3) Separate patient and computer time

In a 20 minute slot, the first 15 minutes are for the face to face visit and the remaining 5 are for charting. It is important not to suggest to the patient that the entire time slot is for face to face work, because that creates an untenable backlog for the provider.

In a 40 minute slot, 30 minutes are for face to face and 10 for documentation and ordering.


A) Schedule ONE, TWO or THREE very special 40 minute slots per day (30 minutes for the patient and 10 for the provider), for very complex visits. There needs to be an understanding/protocol for which patients get these visits.

B) Schedule FIFTEEN, SEVENTEEN or NINETEEN 20 minute slots (15 minutes for the patient and 5 for the provider). If occasionally a patient requires the full 20 minutes, there is opportunity to postpone the documentation until the one hour block of desk time.

TOTAL 18, 19 or 20 patients/7 hours of face to face time depending on provider target.

FORMULA: (15×20)+(3×40)=420 Minutes

(17×20)+(2×40)=420 Minutes

(19×20)+(1×40)=420 Minutes

(For a 10 hour shift, 9 hours could contain 19x20min + 4x40min = 23 encounters.)

C) Schedule ONE HOUR of desk time (in the case of an eight hour day) so inboxes can be cleared daily. This would also be an opportunity to communicate with outside providers during their normal business hours.

A SCHEDULE LIKE THIS WOULD CREATE AND REINFORCE GOOD HABITS AND GOOD TIME MANAGEMENT. The hour devoted to provider “desk time” would also allow medical assistants a predictable opportunity to concentrate on tasks that require some uninterrupted time.

P.S. This was my 500th pst on A Country Doctor Writes.

1 Response to “Dear [CEO]: The Letter I Gave My Boss This Week”

  1. 1 wjvalko October 4, 2018 at 10:50 am

    Unfortunately, very few of my patients come in with 15 minutes or less worth of issues (and, at my location we’re not allowed to combine appointments). Other than keeping a stopwatch next to the exam table, what tips can you share to make this work?

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