When you educate your patients about the essential building blocks of health, chances are you recommend sufficient rest and stress reduction. But do you practice what you preach if you spend months, years or even decades without taking adequate vacation time yourself?
While a vacation is certainly a valid prescription to recharge your batteries, the organizational and logistical challenges that are often involved in taking a break from your practice may discourage some of you from taking the time for R&R that you know you have coming.
However, with a little planning, you too can spend a week or two exploring the Australian outback, lying by the beach with your family, or catching up on your lengthy household “to-do” list that never seems to get completed. You can even schedule some time away from the office that combines continuing education with some “down time.”
Here are some common concerns doctors have about taking time away from the office, along with solutions that should help put your mind at ease:
- I am concerned about what will happen to patient care. Your patients can be taken care of by a well-qualified “relief” doctor while you are away. Your patients’ care can continue, as scheduled, and your protocols can be followed (e.g.-if you use therapies, then therapies should be continued in your absence). If you are a full-spine adjuster, then full-spine adjusting should be the norm while you are away from the office. Simply explain your protocols in depth to the covering doctor prior to your leaving. Even better, have the relief doctor follow your rounds in your office at an orientation visit.
- I don’t want to lose income. As long as your patients’ treatment schedule continues uninterrupted during your absence, the revenue your practice generates should also be uninterrupted. The same mix of services is generated and insurance submission continues. In addition, practice momentum, which is a key ingredient in any practice, is maintained. Therefore, even new patients can be seen and given at least the beginning of a treatment program until you return and the baton is passed back to you. Of course, you will have to pay for the services of the relief doctor, but that is a far better option than closing down your practice completely when you are away.
- What do I do about my staff? All key staff should work during your time away from the office. Specifically, you need to make sure your office manager and/or crackerjack CA are around. It’s important that your patients see a familiar face or two. Your support staff should plan their vacations for a time when you are in the office. On a related note, you should also cross-train your staff and allow only one CA on vacation at a time.
- What if my patients won’t show up for a substitute doctor? Here’s how to make sure they will. First, from as early on as the delivery of the report of findings, emphasize how important regularity of treatment is. Second, set up your office coverage far enough in advance so the “fill-in” doctor can visit you well ahead of time. At that meeting, make sure he or she adjusts you, and you are satisfied with the adjustment. Then as the time draws near for vacation, begin letting patients know Dr. Fill-in will be covering for you while you’re gone during a particular week or two. Make sure you and your staff let patients know just how good the covering doctor is: He or she has adjusted you, and you were happy with the adjustment! By providing coverage to your patients while you’re gone (rather than simply cancelling appointments or putting the office schedule on hold), you are sending an unspoken but powerful message — that you take their treatment very seriously. This generates goodwill and an increased perception of the value of ongoing care.
- What is a substitute doctor tries to steal my patients? It’s unlikely that a true professional relief doctor would try to take away your patients.
However, you can avoid the possibility by following these guidelines:
- prepare a brief contract for the dates of service that includes a non-solicitation clause; or
- use a temp agency whose staffing contract already includes a non- solicitation clause; or
- use a doctor who is not local (downside: you may have to provide lodging); or
- use a retired doctor (who has an active license, of course).
- How does malpractice insurance work with respect to a covering doctor? The good news is that many malpractice policies cover a substitute doctor for 30 or more days per calendar year. However, check with your individual carrier to find out the company’s specific policy. Many malpractice insurance carriers do want to know who is going to be doing the coverage and when. Therefore, notify your carrier prior to being away and follow protocol. This is regardless of whether your covering doctor has his or her own malpractice insurance policy, which of course many covering doctors do.
- How do I get someone right for my practice? This is a central question. You can get recommendations from colleagues or professional associations, or use a temp service that you trust.
Beyond checking a candidate’s availability and thoroughly reviewing references, there are two main considerations:
- personality;
- technique.
Personality, frequently undervalued when compared to technique, is an extremely important factor in patients reporting a good experience with the covering doctor. The ideal personality is someone who can bond quickly, who is supportive, friendly and flexible. The doctor’s technique should mesh well with yours so patients sense a consistency in their treatment.
- How long can I take off and expect things to work? At least two weeks. Keep in mind that a coverage doctor normally should not be expected to hold a health-care class, a spinal screening or any other promotional activity that you ordinarily do to promote your practice. The relief doctor also won’t know the ins and outs of the different insurance plans you accept and those types of things.
For longer periods of practice coverage — usually referred to as a locum tenens — the additional activities can be added (usually at a higher price tag ), and a longer orientation period is needed. It takes a very special covering doctor to maintain a practice over a multi-month period. It takes someone who is a veteran of his or her own successful private practice for many years, and someone who still maintains a high level of energy. It’s not very easy to find that type of candidate. Therefore, the most common recommendation is to plan a few one- to two-week vacations spaced evenly throughout the year.
- How much does it cost? Of course prices vary, but a good ballpark estimate is normally between $300-$500 per day, depending on many factors — the time of year (the July 4th holiday and winter holidays tend to be more costly due to supply and demand), the length of the office day, the volume of patients, geographic accessibility, and the need for a specialized technique. Considering that the average covering doctor will generate between $1,000 and $3,000 per day, this is really an economic “no-brainer.”
- How do I make a smooth transition back upon my return? First, it’s a good idea to take a day to reacclimate once you return, especially if you’ve traveled to another time zone, overseas, etc. Second, make plans to meet with your fill-in doctor by phone or in person before seeing patients. If this is not possible, get into the office early, have your charts pulled for the day, and read the notes made by Dr. Fill-in while you were gone. If there is anything that seems like a potential problem, pick up the phone and call the covering doctor to make sure you know what’s going on.
Of course, it’s a great idea to ask for additional feedback from your patients as to their progress, and to ask if they were satisfied with the care provided by Dr. Fill-in. This will give you key information as to whether you would like to use this particular doctor in the future.
One last bit of advice: Once you set off for your vacation, be sure to leave your work behind — both physically and mentally. Chances are, you’ll return invigorated, refreshed, and ready to approach your practice with a whole new sense of enthusiasm.