Working late yet again after another long day, there are probably physicians - Doctor Who fans in their youth - who pause between files and think wistfully about how nice it would be if they could borrow Doctor Who’s time machine. With that kind of help, they could save the world on a daily basis and still get home for dinner.
Unfortunately, time machines - like physicians - are in short supply these days, while the number of new patients needing access to care, and older, sicker patients requiring more care, are growing faster than the health system’s capacity to help them.
However, that doesn’t mean there isn’t a strategy for making more effective use of your time while improving patient satisfaction and your own quality of life. Like the principal of using the right tool for the right job, this strategy focuses on freeing up more time to do the things you became a doctor to do by putting together a team of professionals who are well-trained to handle the things that don’t require your specialized set of skills.
A good case in point is the teamwork of hand surgeon Ekkehard Bonatz, MD, and Physician Assistant Ashley Prichard of Southlake Orthopaedics.
“Ashley makes my life so much easier,” Bonatz said. “She prepares the patient for surgery, and gets everything ready so that when I come in, we can proceed. When we’re ready to close, she finishes the suturing and splinting while I meet with family, handle surgical notes and prepare myself mentally for the next case.
“PA’s are very well prepared. They take many of the same pre-med and medical classes as doctors followed by two years of clinical training. With the nature of my work, Ashley and one of our hand therapists handle most of the postop visits, which gives me more time to meet with new patients.”
Most patients who come to the practice with hand issues meet Ashley Pritchard in the exam room during their first visit. She is likely to be the person who takes their history, listens to their symptoms, orders preliminary testing and explains possible options for treatments Dr. Bonatz may recommend.
When Bonatz comes into the exam room, everything is in place for him to do his own evaluation. Since routine questions have already been handled by Ashley, he can spend his time talking with the patient about more specific details. If surgery is indicated, Pritchard sets up scheduling and gives the patient pre-op instructions. On surgery day, patients see her familiar face in the operating room, and they know she will be with them throughout the procedure and can answer questions later about how the surgery went.
“Patients are usually comfortable with me handling the post op visit and helping them get started with the hand therapist and other care. If the patient is experiencing any problems, I call in Dr. Bonatz. A few older patients may want to speak to the doctor directly, and if they do, I bring him in.” Pritchard said.
On the other side of the coin, Bonatz said, “Ashley has such a good rapport with patients, that sometimes they - especially the younger ones - feel more comfortable asking her questions that they think are too small to ask me. It improves communication and gives patients more face to face time, and improves their satisfaction.”
Pritchard said patient interaction is one of the reasons she decided to become a PA. “I had thought about becoming a doctor, but when I learned more about what physician’s assistants do, I realized that was exactly the kind of work I wanted to do,” she said. “I learned so much from the medical classes, and during the clinical rotations where I gained hands-on experience, I felt drawn to surgery. I’ve been working with Dr. Bonatz for over two years.”
According to Bonatz, “many insurance plans pay for PA’s to be present in more complex surgeries, because having them helping the surgeon during procedures tend to make them safer and more effective. Even if a PA’s time isn’t reimbursed in a procedure, having Ashley’s help is well worth the investment. She’s very capable and has a lot of energy. She helps me manage my time so I’m not so overworked. I can see more patients and still have a more balanced life and time to run in the morning. When we’re on call, she’s able to answer most questions so I get more sleep at night. I’m a happier doctor, and happier doctors have happier patients.”
Physician assistants and nurse practitioners, who tend to work in medical practices, have key roles in extending access to primary care.
“With such limited reimbursement of primary care, there simply aren’t enough primary physicians,” Bonatz said. “In some areas, clinics run by PA’s and nurse practitioners offer the only primary care available. PA’s are also proving their value in emergency departments, where many cases that come in are simple problems that are easily within their capabilities to handle. In a small city in south Alabama, there’s even a hospital run by PAs, with supervising doctors called in from other areas when necessary. Without them, there would be many people without access when they need a hospital nearby.”
In addition to physician assistants, Bonatz and other physicians at Southlake Orthopaedics rely on other members of their team to help them accomplish more and make better use of their time.
“Our hand therapists work with patients beyond those who have surgery, so that extends the range of our practice,’ Bonatz said. “Some of our medical assistants are cross trained as x-ray techs. They get x-rays and enter data in electronic medical records, like medical scribes, so there’s less for us to add later.
“The cost of adding staff to extend your practice can be a consideration, but when it is managed well, it’s a good investment. We can comply with rules and documentation and still have quality time with patients, which is the ultimate goal. You can concentrate on what’s really important and make better use of your face to face time to be a better physician.”