Major Office Issues Help!!!!

HippyDippyLPN · Sep 18, 2012

Well I just started in a family practice less than a month ago but I will tell you the tips I do know, our office runs pretty efficently. We have three md's, all but one is closed to new patients right now so they see 20-40 patients each a day. I think what works to keep everying smooth is that 3 days/week we have late nights. The md who is having a late night does not come in till one so that only leaves two md's in the AM which frees up some of our staff.

We have two rn's, one LPN, and three MA's. Some of the MA's will circulate up front though so they don't always counts. We have one nurse or MA to each MD and they focus just on the md's needs at that time. They do not get asked to take phone calls unless there is a large gap in patients. Whoever is not assisting the MD does phone triage and the other does the nurse visits (pre appt blood work, immunizations, etc) The two floats that do phone triage/nurse visits will also give a hand to the nurses/MA assisting the MD if they get caught up on the work (which is rare). We are electronic so this really helps because we just task the md's with RF or questions (unless it needs asap attention of course) instead of having to chase them down in between pt's. Our pre certs are done online, no more waiting endlessly on the phone w/ insurance.

That's really it in a nutshell. All the staff is experienced though and speedy but safe so thats what makes the difference I think. You guys need more help for sure, there is no way with 5 md's your 3 rn's and 1 ma will cut it. Have you tried hiring an LPN instead of an MA? Sure you have to pay more on the hour but the extra skills an LPN brings over an MA might be worth your $ in a busy office like yours.

amandap213 · Sep 18, 2012

We never have more than 1 nurse/MA per doctor, the max doctors we have here at one time is 3. The nurses share the nurse visits. Also, I do all phone triage, the nurses/MAs do no phone calls.

morte, LPN, LVN · Sep 18, 2012

I am thinking you need to take an unbiased look at the office. If previously well functioning employees are souring, maybe it is the office culture/work load.

amandap213 · Sep 18, 2012

That's why I posted the question, this is my first office job, Employees are not necessary souring, they arent up to par skill wise. I have MAs that struggle with BPs, it takes over a month to train on the basics, alot of charting errors. I posted the question to see how other offices run, to get ideas on things to change, how to make workflo better. When I am filling in back there, I have no problem getting things done and keeping up. Logistically me being back there is not a permanent fix because I have my own tasks to complete. I just need ideas to take back to the doctors to try and improve things.

RxOnly · Sep 18, 2012

I am an LPN in a newly established internal medicine office. All of our doctors are getting slammed with new patients and our staff has varied levels of experience.

First off, I think that the patient load you described sounds like a LOT. I worked in a family practice office for a different company years ago and had a lot of trouble keeping my head above water with that amount.

Here's how it is where I currently work, and it seems to be OK so far:

Currently we have 3 MDs. When fully up-and-running we will have 6.

Each MA is assigned to one particular MD. They float around when necessary if coverage is needed, but generally the same MA and MD will work together. The MA is responsible for rooming patients and taking vitals, as well as simple procedures such as ear irrigation and rapid streps. They also forward requests for Rx refills to the MD.

For every 2 MDs, there is one LPN to do immunizations (per company policy only an LPN or RN may administer medication) and do telephone triage and other odds/ends. The LPN will also assist if the MAs get busy. We also have a small lab in the office and a phlebotomist, which frees the medical assistants up quite a bit.

At full capacity we will have 6 secretaries. The plan is for three to remain on the phones in the back and the other 3 to do check in/out. Currently we have 4 secretaries and they rotate to meet office needs.

Our MDs see max 20(ish) patients daily.

Overall it works really well because not every MD is here every day, which frees up an MA to assist when things get busy or to fill in if someone calls out. We do have one MA that took a long time to train. Some people don't learn as quickly, but with a lot of encouragement she's significantly improved her skills.

I hope this helps and I hope you have some say as to how your office is staffed!!!

HippyDippyLPN · Sep 19, 2012

are you guys electronic? even if there is never more than 3 md's seeing pts at a time you still have questions, rx refills, etc from all 5 md's. I cant imagine how one person takes care of it all. Most days we have two float nurses doing the triage and such just for the 3 we have. If your MA's are having trouble with BP's I can see where you are running into issues. Maybe what you guys need is a refresher for the ones who are having trouble with the basic skills. Possible you all could have a day where you the RN go over any basic skills the staff seems to lack? Also if you are EHR the errors could possibly be resulting from lack of knowledge on how to work the system? We have an EHR teacher who does refreshers/training for newbies. Who is training the newbies? If they have experience it really should not take a month to get them up and running assisting the md alone. There has to be a disconnect somewhere, every new MA you hire shouldnt have trouble taking a BP know what I mean? Whether your hiring practices need to be looked at, how you are screening new employees, or who is training them or how you are training them.

amandap213 · Sep 19, 2012

We are electronic, but the nurses do not answer questions, do Rx refills, or any of that, I do all that. They just have to room patients and do procedures. We have had refresher courses and actually have had 3 different people work with 2 MAs on BPs, and still had trouble. That is why I am concerned though, I do the training along with 2 other RNs and the doctors. When I have interviewed MAs, I have had some that can't read the stadiometer, put BP cuffs on wrong. Where do you find good MAs? We developed a test for nurses and only bring in the ones that do satisfactory on it. But it seems like we are scraping the bottom of the barrel.

Sally Now · Sep 20, 2012

Which electronic system do you use? I am in agreement, the demands placed by 'meaningful use' and CQM have gotten out of hand. If you are rooming patients, there is not enough time for all of the refills, results questions, etc. I'm trying to sort this out in my practice now. Add to that all of the med reviews/risk assessments involved with rooming a patient, and that can take 15-20 minutes. We have 3 physicians who are there 4 1/2 days per week; each has an MA. When fully staffed, we will have an extra MA, and my plan is that she will handle all Rx refills, coordinate results/problem questions (scheduling next step labs, referrals, tests), handle routine questions, and back up for in-house orders (immunizations, MAR, EKG, etc). As the RN, I will continue triage and continue to work on CQM/Medical Home/BPA implementation. However, I often must serve as back-up for the 'extra MA' duties.

HippyDippyLPN · Sep 20, 2012

For your MA situation maybe you could do an open interview day. Put a notice in the paper, whatever gets it out. Have potential hires perform tasks like BP etc. That way you dont even waste your time training the ones who cant grasp basic skills. And like I suggested before try LPN's who have worked in LTC. They are used to having a large load of patients, having to be efficent but not make errors, and are used to having to be organized to get it all done. I have found my own LTC care experience as an LPN has greatly helped me in the clinical setting, I am more familiar with meds, procedures, and can handle large volumes of patients w/o loosing my wits. If your practice will only hire MA's, develop a test similar to the nurse one for them. Scout out the most reputable MA schools in the area and tell them you are open to doing their externships. This is a great way to see how someone trains without having to pay them. If they work out once they are done with school, you can hire them on and not have to spend a penny on training them since they already are.

Blindsided · Sep 22, 2012

For those of you who still have paper charts, please tell me how the medical records are handled in your office. I have never worked in a place so chaotic, where the nurses have to pull so many of their own charts. It is a constant drain on your time and energy.

HippyDippyLPN · Sep 22, 2012

My last job was a paper office and the front office would pull charts for us. If a pt left a message for the nurse the front desk staff would pull the chart, write the message down, and stick it on the phone desk for us. Us nurses never pulled charts when we needed one we would our chart lady pull for us.