[This is part of a new series on specific issues related to provider compensation, designed to be “short and sweet” and prompt thinking before doing.]
When improving productivity will take time away from your providers’ personal lives, expect push-back. When trying to change behavior, we need to look at the reasons for the behavior — and when it comes to “quality of life” and “work/life balance” issues, we need to recognize that frequently these will be more important than money, and that all the incentives in the world won’t change that. Let’s take a look at the “extra effort” that increasing productivity may involve.
Recently I spoke with a Medical Director contemplating a change to their provider incentive program. The current productivity target for family practice medical providers (doctors and mid-levels) is 24 visits per day. While many exceed that figure, many are stubbornly stuck at about 18. The current incentive plan is relatively generous (to the point that some providers need to dial back on productivity to focus on quality), so there is a definite financial incentive. Assuming for the moment that processes and patient load would permit every provider to have an average 24 visit (a very big assumption), there should be no reason other than effort why a provider couldn’t see 24 patients in a day, right?
Here’s one thought. The Medical Director estimated that their providers spend an average of two hours per evening at home working on their charts and notes (many providers tell me its closer to three hours, but lets be conservative). For an “18 visit” provider, this would amount to about seven minutes per visit. If I’m the provider, I should be able to increase my productivity to 24 visits without changing my time in the clinic — however, my math says those extra six visits can add another 42 minutes (three and a half hours a week) of time taken away from my home life.
Now I have to ask myself, what is it worth to give up another three and a half hours a week of my life (a 35% increase) that I can’t give to myself or my family? How much money will it take to make up for missing yet another concert, ball game, helping with homework, watching “Survivor,” or a night out? I already make a lot of money, and I don’t need more. Will $25 more a day do it? $200 a week? $15,000 a year?
Not that easy, is it? What would you do in that position?