ASK DR. BAUGHAN                                                  May 19, 2000

WHEN A PRACTICE GETS TOO BUSY

A physician leaves town.  Another retires.  Almost overnight a medical practice goes from comfortably active to way too busy.  The phones jangle continuously.  The front office does not have time to breath between calls.  Patients cannot get appointments for weeks, then a month or more.  They get frustrated and angry.  Their frustrations spill over onto the office staff, the nurses, and the doctor.  Everyone’s stress level rises.  Something’s got to be done, but what?

The obvious answer - recruit a new partner.  Unfortunately, not so simple.  Most times it takes a year to find, interview, check references, negotiate contracts, make moving arrangements, get a New Hampshire license and hospital privileges for a new doctor.  Do we get the first physician we can find?  A partner is almost like a spouse.  You will live with that person almost as many hours in a day as a spouse.  You need to be compatible.  You also have a responsibility to your patients to find someone of good quality and compatible attitudes with the community.  There is a financial risk.  Nowadays, no doctor will move to a new area without a guarantee of an income.  So you have to pay them until they see enough patients to generate their own income.  Is the practice big enough to support a full-time doctor, or is the overload only enough for a half-time doctor?  We are actively recruiting, so if you know any good doctors who would like to move here, let me know.

Another strategy - find a nurse practitioner or physician’s assistant.  We are lucky to have someone who has lived and worked here most of her life just graduating from nurse practitioner training this weekend.  Congratulations to Emily Beaulieu!  Emily has been Dr. Welch’s nurse for the past 5 years and will be starting as a family nurse practitioner in July.  She will be a big help.

Several other “solutions” are less appealing.  Many doctors see patients more quickly.  Fifteen minute visits become ten minute visits.  You learn not to sit down.  Visits become more impersonal and rushed.  The satisfaction and quality of practice declines.  Over the years I have found that if I am seeing more than 25 patients a day I am not taking the time the patients need and deserve, or I am seeing patients that really do not need to be seen.  Rushing through patients is too mutually dissatisfying.  If patients do not really need to be seen, somehow I need to educate them how to take care of themselves with talking, handouts, or weekly columns.  Or maybe a change in custom can lead to efficiency and good quality, such as monitoring blood pressures at home with reliable instruments and touching base by phone.  The same can be done for cholesterol management.  Time pressure can sometimes foster useful innovation.

The temptation to work longer hours or more days is strong.  But if I got into this profession because I care about health, then it would be hypocritical not to take care of my own.  I moved here to enjoy life, the natural beauty, and my family.  If I just work all the time, I might as well be in – (shudder) - a big city.

Please accept this somewhat self-disclosing column as a recognition that patients in the valley are frustrated at the difficulty in getting the personal, timely care they deserve.  We are working on the situation, but results are not appearing as quickly as we all would like.  If anyone has suggestions on how to make this business work more efficiently, I would love to hear from them.