Research has shown that family physicians manage an immense administrative burden. One recent study of 142 family medicine doctors found they spend on average one and a half hours after work completing EHR tasks or paperwork. This nightly “pajama time” with the EHR leads to professional dissatisfaction and burnout. So what habits do highly efficient physicians practice to leave their clinical notes at the office when they go home after a long workday?

This article shares practical steps physicians can take to improve efficiency and reduce the amount of time they spend working after hours. It incorporates advice from a group of clinicians who wrote a 2019 article for FPM with technology tips from physicians using our leading Mobile dictation app, Mobius Conveyor

While physician burnout is largely a result of healthcare systems that need to be fixed at the organization and national levels, these changes will take time. In the meantime, clinicians need habits for managing their time, teams, and technology in ways that support their goals.

How do highly efficient physicians work?

Imagine what it would be like to close your office door at the end of the day and not have any work that you need to take home. Incorporating these habits can help you reclaim your time while continuing to practice excellent care. 

1. Pay attention to “how” and “why” as you start your day

One of the most effective habits of highly efficient physicians is starting your day with a clear purpose. This is as much about how you manage your time as it is about why

For example, we all know how arriving at the office just in time for your first appointment can set your day off on the wrong foot. One habit of many highly efficient physicians is to arrive early enough to check your schedule, answer messages, or huddle with your staff before your first visit. In practice, this may just require an additional 15 minutes. But that small shift can set the day on a very different course. 

However, the key to building this habit is knowing why it’s worth doing. Think about a specific end goal that motivates you to get to the office early. Maybe you have young children at home and you want to be back early enough to eat dinner with them. Maybe you’re a runner and you want to get outside before the sun goes down. Pair specific habit changes with a clear articulation of “why,” and you’ll find sticking with these changes a lot easier. 

2. Use previsit planning

Previsit planning can take many forms, but the goal is to consistently walk into each patient visit organized and ready. Highly efficient physicians will anticipate, during the current visit, what labs or X-rays will be needed at the next visit. By pre-ordering those tests a week ahead of the next visit, you save staff time contacting patients or searching for results during visits. 

Another efficient habit is to have a medical assistant do a quick review of the patient’s record on the day of visit (or the day before) to see what prep work can be done based on the patient’s needs. One thing that can help with this is creating prep sheets for common conditions. For example, a diabetes prep sheet can help MAs identify which lab orders to set up ahead of time, which immunizations might be needed, and so on. 

3. Make every second count

Highly efficient physicians build the habit of squeezing small tasks into small amounts of time throughout the day. What do you do when you find yourself with five spare minutes while the next exam room is being prepped? Use that time to complete a prescription refill request, answer a message, or finish charting. 

It’s much easier to build this habit if you have well-established workflows and the right technology. For example, some providers use mobile dictation platforms like Mobius Conveyor to dictate clinical notes directly into the EHR. With practice, you can do this effectively during patient visits or in just a few minutes between visits. Those in-between moments can also be used to securely respond to messages from your staff, send follow-up literature to a patient, or order a test. Having an easy way to access the patient chart from your smartphone or tablet goes a long way to setting yourself up for success. 

Having an easy way to access the patient chart from your smartphone or tablet goes a long way to making every second count.

4. Rethink who does what

Being a highly efficient physician requires being a highly effective manager. Are there times throughout your workday when you wonder, “Why am I the one doing this task?”

If the answer is “yes,” this is a great opportunity to delegate the task to the most appropriate person. For example, have a medical assistant help with documentation, carry out needed screenings, or educate patients about a topic like inhaler use. 

If your staff aren’t working at the top of their licenses, ask yourself how you might empower them to do so. Even if you aren’t their boss, their efficiency will affect yours. So it’s in your best interest to take action on these small training and management opportunities. 

5. Document less but better

Everyone has their own preferences about when and how they document. But it’s occasionally worth considering whether your preferences or processes might be getting in the way of improving your documentation workflow.

Dictation is an excellent example. The simple truth is that we can all speak faster than we type. And with a little practice, you can quickly learn to dictate notes directly into the EHR while in the exam room or immediately after.

Still, many physicians are reticent to change their workflow and incorporate the latest time-saving speech-to-text software solutions. Dr. John Williams, M.D., F.A.C.S., is a leading cancer surgeon and educator who puts it like this:

“It’s easier to not change because of resistance, but it’s so worth the effort to flip that switch and integrate dictation because it’s something you’ll use forever going forward. I would bet there isn’t one doctor who has used a dictation system like Dragon or Mobius and then stopped using it and returned to typing text as the modality for communicating. There’s a reason no-one returns to typing from dictation, and that’s because speaking is natural – it’s human.”

Over-documentation is another time-sucking habit that many physicians develop. It’s easy to get compulsive when you have to worry about medicolegal risk, are trying to gather rich psychosocial information, or feel pressured to check all the boxes you can. But not all EHR boxes need checking, and not all visits require you to write an opus. 

Similar to revisiting your documentation workflow, try to occasionally check in and ask yourself whether you’re documenting more than necessary. Try setting a timer to measure how long it takes you to document on average, or ask one of your most efficient colleagues what they do that helps speed up their documentation.

6. Touch messages once

Whenever possible, try to organize your clinical communication so messages go directly to the person who should handle them. Fewer handoffs is a key principle in quality improvement, so you don’t want to have all messages funneled through you. 

In the same vein, you should aim to check each of your messages only once. Read it, take action (respond or delegate), and move on to the next task. 

At a time when email and patient portals are always at our fingertips, it’s important to combine the right technology with a lot of discipline. Make sure the mobile apps you use for checking messages support all the functions you need and get in the habit of only checking messages when you have time to respond or manage them. 

7. Help each other

If one physician in your practice is consistently struggling to stay on top of their work, it’s up to the whole team to help them succeed. As a group of physicians write in FPM:

“If you see a physician struggling (or if this physician is you), the best approach involves empathy, mentoring, and accountability. The practice may need to set standards for when charts are expected to be closed – and enforce those standards. At the same time, a manager or colleague should work with the physician to figure out what’s going on, what his or her barriers are, and how to get back on track. Maybe the physician needs to have some time blocked out on the schedule to catch up on charting. Maybe the physician needs some EHR training or an MA to help with in-room documentation. Or maybe the physician just needs some coaching because he or she is trying to do too much in the exam room (for example, trying to address everything on the patient’s agenda, over-documenting, and not delegating tasks such as patient education).

The barriers and solutions are going to be personal because we are all programmed differently, but most physicians will need some help figuring things out. Don’t let a colleague struggle alone, and don’t make the mistake of simply applying more pressure on an already pressured physician.”

There’s more to practice than efficiency

In working to become a highly efficient physician, it’s important to remember that there’s more to practice than efficiency. Efficiency can help you practice more effectively and avoid burnout, but be careful not to let it come at a cost.

If we find our desire to save seconds is coming at the expense of quality care or supportive interactions with patients or staff, then we’ve gone too far. Just like building new habits, becoming more efficient requires on-going check-ins to ensure that your clinical workflows are aligned with your goals and values.

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