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When Collom and Carney Clinic Association, a multispecialty practice, interviews new physicians, it always shows the prospective employees the level of productivity the practice’s doctors achieve. "There’s usually one of two responses — either euphoria or fear," says Tom Simmons, CMPE, chief executive officer of the Texarkana, TX, physician practice.
Some physicians say that the practice demands more work than they are willing to do. Others comment that the patient volume must mean good income and that’s the kind of practice they want to join. "We are looking for physicians who want to perform at a high level. The process probably begins and ends at the recruitment stage. We believe that people with indications of high productivity are probably not made, but are born," Simmons says.
The process works. Physicians at Collom and Carney achieve far in excess of their peers. For instance, the salaries of physicians in the internal medicine department are 180% of the median salary for similar physicians included in the Medical Group Management Association (MGMA) annual survey. In 2000, 95% of the physicians in the practice had their highest income ever. "A lot of them have worked harder to accomplish that but we’ve had that trend for the past few years," Simmons says. A whopping 90% of physician pay is based on productivity. "You can’t drive the work ethic if you don’t have the compensation," Simmons says.
Collom and Carney is a 68-physician multispecialty practice with 450 employees, including physicians. The practice owns a chain of dialysis facilities and 25% of an ambulatory surgery center. It has always been in the 90th percentile for income and productivity in the MGMA survey.
When members of the practice interview prospective physicians, they discuss professional and personal goals and show them the level of productivity the Collom and Carney doctors are expected to achieve. For instance, in internal medicine, the average physician admits 10 patients when he or she is on call and does 10 histories and physicals. The practice also looks for the highest achievers among physician applicants. For instance, 30% to 35% of its physicians were members of the Alpha Omega Alpha medical society. "We have found generally that those in the top of their medical class have a strong work ethic," Simmons says.
The practice is located in Northeast rural Texas where there is only a small infiltration of managed care, but the practice still uses many insurance rules and pre-certification practices. Doctors at Collom and Carney spend less than 5% of their time on tasks that involve anything but treating the patients. "When we recruit doctors, we tell them we want to minimize the paperwork hassles they have in practice. Anything we can accomplish for them — anything that does not need to be written and signed by a physician — we handle that for them," he says.
Collom and Carney keeps a close eye on the administrative structure and moves administrative tasks to non-physician employees so doctors can concentrate on seeing patients. When doctors arrive at the clinic from the hospital they already have three to four patients in rooms, with the charts on the doors or pulled up on the computer screen. The nurse has already taken the initial information.
Collom and Carney’s aggregate support cost is 15% to 20% higher than its peer groups in the MGMA survey but the group’s productivity is 70% to 80% higher. "You don’t want to have a doctor who is compensated at $200 an hour doing a $10 an hour job," Simmons says.
If there’s an opportunity to use a signature stamp, rather than a doctor’s signature, the practice takes it. "The point is to alleviate the paperwork nightmare that today’s doctors experience," Simmons says. The nurses call in all prescriptions, return all patient phone calls, and call patients with lab results. "The doctors do call patients back in some circumstances, but we are selective," Simmons says.
The practice employs clerks who handle pre-certification, set up patient examinations, and call the hospital to arrange admissions. "The doctors’ involvement in all those things is just in writing the orders," Simmons says. The clinic is in a community of 56,000 with about 350,000 in the trade area. The physicians see more than 200,000 active patients, about 60% of the local market.
The practice works hard to stay on schedule, although emergencies do crop up from time to time. "If you don’t stay with the schedule, you can’t accomplish any of these goals," Simmons says. On average, patients can get an appointment in one day to one week. The practice hires part-time physicians only when it needs help complementing the work schedule. For instance, in a few locations, the practice may contract with someone to work only one or two days a week. At present, only one physician is part-time. "We are looking for people with a full-time commitment to the practice of medicine," Simmons says.
The practice employees mid-level providers who are used selectively in some departments. "Our use of mid-level providers is uniquely adapted to the needs of each department. They aren’t just thrown into every department," he says. For instance, in the internal medicine department, a nurse practitioner sees patients who can’t get a regular appointment that day, as well as patients of a doctor who is on call and has to be at the hospital the entire day. "In internal medicine, the mid-level providers are a release valve to take care of the overflow of patients. The family practice department doesn’t have the same problem," Simmons says.
Each of the departments at Collom and Carney has its unique approach to management. "You can’t buy a book. There is no cookie- cutter approach to increasing productivity. Every situation has its own set of problems you have to analyze. We can’t draw a lot of parallels between the departments, other than going through the productivity analysis for each one," Simmons says.