Hi, it's Dr. Weitz. Thank you so much for joining me for this episode of the private medical practice Academy. One of the first questions that everyone seems to ask is how much staff do I need, but honestly, you're not going to be able to answer that question until you've worked through understanding the flow of your clinic. You need to think through every step that occurs or that may need to occur.

And then you need to drill down and identify each task that is going to go into completing that step. Doing this is going to help you in multiple ways. First, you can identify the skill sets that are needed to complete each task. And from there, you're going to have to think about how long does it take each task to be completed and how many tasks are in the step.

And from there, we're going to be able to determine how many hours each step requires. So why are you going through this exercise? Well, because ultimately in order to figure out how much staff you need, you need to know how many man hours worth of work you have for each task each step. And then ultimately to be able to write a job description,

to be able to fill the positions that you have a need for now doing this may seem very daunting, but don't worry if we break it down into bite sized pieces, where we analyze each and every task that you need to have done, it will become much more manageable. But first I want to tell you an embarrassing, personal story. I started out as a surgery intern at UCF,

as you can imagine, a lot of my time was spent managing patients on the floor. And even when I got to go to the, or it was just to essentially hold hooks, typical job for a surgical intern, through a series of events that I'm not going to bore you with. I decided to do anesthesia on my way to a pain management fellowship as forward to my first day of anesthesia residency.

The way it worked at UCF is that you were paired one-on-one with a faculty member for the first month of your anesthesia residency. So imagine I'm now in the, or with the patient and my attending and the attending tells me, okay, now let's put on the monitors incredulous. I looked at him and said, what monitors, what are you talking about?

You may now be just as flabbergasted as Dr. Yost was with me on that date. But honestly I had absolutely no clue. And if you're wondering how that possibly could be, it was easy because as a surgery resident, I was never in the room. At the beginning of the case, I was always out scrubbing. I never needed to pay attention to what anesthesia was doing,

because basically that was their job. And I was completely un-involved except now I was anesthesia and I was on my first day of residency, petrified that they were going to fire me, not to mention that I was embarrassed and humiliated. And as you can imagine, it didn't take me very long to figure out I had to get myself up to speed. So why am I telling you this?

Well, it's not because I'm so proud of my ignorance. No, quite the opposite. I'm sharing this because so many of us are tied up in our own little bubbles that we don't really pay attention to things that are going on around us, unless you've been actively managing your own business. You're probably not aware of every step of everything that goes on in your office.

And to be honest, by the time that we got to 50 employees, not including physicians and mid-levels, I also no longer knew the details of every single task that needed to occur in my office. But that's because by that point I had put in place all of the processes and the people to basically manage the day-to-day tasks. So let me be crystal clear.

When I first started out, I knew every last thing that happened in my business, how it happened and who did it, and by who did it, I don't mean the name of the person. Obviously you're going to need to know the name of the person who is doing each task, and that comes under the category of how do I actually interact with my staff,

but that's a topic for another day today. We're going to talk about the process by which a referral comes to your office. Patients essentially come in two flavors first that they are self-referred I E they find you and they want to make an appointment, or they may come from my referral source at this point. Let me suggest to you that you grab a pen and a piece of paper,

because I have a series of questions that you're going to want to answer. The first thing you want to think about are those patients who self refer, I'll skip over the whole marketing piece and how they found you, because that's a different process. And I'll cover that separately. In another episode for now, let's assume that the patient has found you and knows that they want to see you.

How does that patient make it that first appointment? Are they going to schedule directly using one of the online scheduling services or do they enter their data through a portal on your website? How does that integration happen within your practice management software and who is going to oversee the scheduling piece? Yes, absolutely. Part of it, if not, most of it can be automated,

but don't fool yourself automated doesn't mean set it up and ignore it in thinking about your clinic flow and the tasks that need to happen. There are going to be two common themes that you hear from me. Number one, yes, you can and should automate as much of every process as you can. This is going to help you control your costs and streamline your processes.

The second is a huge caveat. You are running a customer service driven business. Someone has to be overseeing each of these processes, even when they're automated. No one wants to hear that their referral didn't get processed or that their appointment was inadvertently canceled, or that they were double booked on a day that you aren't even in clinic. And then the list goes on and on.

This is not how you get and retain business. So when you're going through the process of identifying tasks and the steps that need to happen, stop yourself from thinking, Oh, the computer's going to do that. Computers, do what people tell them to do. You will have to identify a process and a person who is going to take on making sure that the computer is doing it.

Stop. So to go along with this, yeah, the person may have made an appointment through your portal or through an online scheduling service, but ultimately somebody has to make sure that a patient record was created in the EMR and that it's populated with the correct demographic and insurance information. Maybe you're planning to accept patients only by referral from another provider. Think about how is that referral going to come in?

Is it on a referral form that the other physician office faxes to your office? Okay, now you should be thinking to yourself, I need referral forms. Yes. You need referral forms. So how is the referral form going to get to the potential referral source? Is someone going to drop them off at the referral sources office? If so, who is that?

Someone and are they dropping them off with the front office staff? Or are they going to actually hand them to the provider? Now, some of this comes under marketing again, but I want to say a couple of quick words about it. If you're not the person who's going to be dropping off the referral pads, make sure that you script out what you want,

the person who is doing the drop-off to actually say you also want to make sure that who's ever doing the drop off, brings something with them at the risk of sounding like your mother. You never want to go anywhere empty handed. You can have pens or post-it notes made with your name and logo for very little money. Why is this important? Well,

because even in offices where the provider says, I want to refer to you, the reality is it's their staff that ultimately is controlling the referrals. And what do I mean by controlling it? The staff is really who makes the referral happen? They're the ones who either fill out the form, fax the form, enter it into a portal or somehow or another,

get the information to your office. So remember the staff, if you just bring a referral pad, there's a very high likelihood that it does to get shoved in a draw. It's the seemingly trivial things like a pin that seems to remind staff of you and that referral form. Now let's consider the version where it, you send the referral pads to your potential referral sources by snail mail.

Personally, I wouldn't suggest that you do this because I'll make you a bet that I know where they're going to go. You guessed it in the garbage. Why? Because in my experience, this is completely impersonal. And unless there's a connection, people are going to see this essentially as junk mail. I know you're thinking, well, I'm going to have my referral form on my website.

You probably think I don't need to have a referral pad. They can just go to my website or my somebody in my office. Again, the nameless, somebody can fax them a referral form, just like you don't want to do more work than you have to. And your staff doesn't want to do more work than they have to. Your referral sources are not going to go out of their way to figure out how to refer to you.

You need to figure out how to make it easy for them. So when you tell me that they're going to find the referral form on your website. I have a very basic question for you. How is the referral source going to find a referral form on your website and then submit it to you? Look, I'm not asking you how they know to refer to you.

That's a marketing question. I'm asking how easy is it for them to find the referral form and then get it to your office. You need to think through the logistics of this, can the referral source complete a form on your website? And then how does it get transmitted to your office? Do they have to print out the form and fax it? Can they just EFX it can it just go through a portal and then,

okay, the referral is quote unquote now in your office. But the real question is where is it? And on some level, it really doesn't matter if the form is faxed, emailed, sent through a portal. Ultimately somebody has to do something with it. And what is that? Something that referral needs to be converted into an appointment for that patient and a patient record needs to be created in your EMR.

Let's also consider whether you want medical records before you actually see the patient or even schedule them. How are you going to educate your referral sources to send the relevant medical records with the referral? Do you tell them that you want this information by including it on the referral form? Or are you going to ask for the medical records after you received the referral?

And if you're asking for them after you received the referral, what's the process for this? Who's going to be contacting their office. How do you request them? How do you know that you got them? And then ultimately, how do they actually get into the patient record in your EMR? So a couple of things about getting medical records. First of all,

you need to think about whether they're coming by paper or they're coming electronically. And then if they're coming by paper, how do they get scanned into the system? And then if they're coming electronically, understand that they still have to be moved into that. Patient's actual record in your EMR. As an aside, I want to point out that if one provider sends medical records to another,

this is usually done as a courtesy. If the patient requests, the medical records and then has to get them to you, there is going to be a cost to the patient. Yes. Understand that it takes time, effort, and essentially money for someone staff to send medical records to you. So you need to think through this, how much do I really need or want those records?

And what's the best mechanism for getting them. If I ask for them from the referral source, then I risk making them mad because it's costing them money in order to send them to me. On the other hand, if I asked the patient to get them and the patient has to pay for it, then the patient may get mad. There's not really an easy answer to this,

but I know that a lot of times you still want the medical records. So just making sure you ask specifically for what you want and that you actually have reviewed them before the visit. Now, let's think through the actual logistics of what happens to the referral in those medical records, how do you convert that into a scheduled patient? Look, I get it.

The patient who found you can just schedule online, but what about that referred patient? How are they actually going to get scheduled? Of course you can direct them to your online scheduling software or to your portal. But again, who's going to be the person who tells them, or how are they going to hear how to get to that scheduling component? Sure.

You can tell the referral source that at the same time they referred the patient, they should direct them to your scheduling software, but let's be real. You're relying on somebody else's office to try and get that patient to actually schedule an appointment with you. This may or may not happen. And if you're trying to grow your practice, this is not a terribly efficient way.

You are going to need somebody in your office. Who's responsible for making sure that that appointment actually gets scheduled. Look realistically, that new patient is not going to know about your website. So did somebody from your office called the patient to make the appointment, or is the patient sent an email or a letter and told to use the online scheduling software? These are all possibilities,

but you need to think through the actual logistics and the goal here is to make sure that you don't lose people through the cracks. I also want to point out to you that there are a couple of other, you need to think about these sides. Simply getting that appointment scheduled. If you're taking insurance, you're going to need to collect the patient's insurance information in order to verify and check eligibility,

you're going to want to tell the patient how much money they're going to owe you at the time of their visit and what forms of payment you accept. If you're out of network for their insurance, this needs to be conveyed at the time the appointment is made. The patient may decide that they don't want to see an out of network provider and pay the additional cost.

You don't want them to cancel it the last minute or walk out of your office on the day of the visit, because they weren't told that you're out of network. Look aside from the fact that they're going to be furious. They could potentially make a scene in your waiting room and they will undoubtedly complain to everyone. They know, including all of their doctors.

The major reason that you don't want to do this is because you're going to end up with an open appointment that you could have filled with somebody who would actually pay you. If you're running a cash only practice, then you're certainly going to want to inform the patient of your charges and the payment options. At the time they make their appointments. You can post your charges on your website or inside your portal,

or you can wait until you send them an email, welcoming them to your practice and then outline your charges. But in any case, you're going to want to convey this information ahead of the visit so that the patient arrives prepared to pay you and doesn't have sticker shock. One of the most important tasks that you're going to need to have happen is verification of the patient's contact information.

Did they enter the correct email and cell phone number? Don't assume that the information that you have is correct, regardless of who entered the information to make this appointment, whether it was done via referral form, whether it was done through an online portal, bottom line is every time that data needs to be entered, there is a room for human error. Obviously there are a lot of processes that can be automated,

but if you don't have the correct email or cell phone numbers, then you're not actually going to have any way to contact these patients. So you can have all sorts of wonderful ways of automating your processes to remind people about appointments and so forth. But if you don't have their contact info, Oh well, you're out of luck and it's going to affect your bottom line.

So as you can see, I've given you more questions than I have given you answers. And the reason for that is that you have to actually sit down and go through every step of this process and write out each task and how you envision it's going to happen. And as a gentle hint, I would suggest to you that you take a look at what's happening in your current position and how this actually occurs.

Sit down with the staff and walk through what they're doing. So to come full circle to my story about anesthesia. And my first day, when I'm telling you is that there is probably already a process that is happening at your current job for how patients get scheduled for that initial visit. I would suggest to you that you look at that process, decide which of the steps you like,

which things you think you can improve on. And then ultimately you're going to build out the process for your own business. From there, once you've done that, it will become much easier for us to write a job description and ultimately determine how many FTEs it's going to take to complete each of these tasks. Thanks for joining me. The shortest sign up for my newsletter below,

and I'll be sending you tips on how to start your practice best run your practice, grow the practice, and then ultimately be able to leverage your medical practice into multiple other businesses. I hope to see you soon.