2. The entity and physician have more-or-less equal impact.
3. Responsibility rests mostly with the physician.
4. The healthcare environment itself has the most impact or
influence and productivity improvement resists the actions
of either the physician or employer.
A closer examination of each of these areas of responsibility
serves to focus the most relevant organizational resources
on those elements undergirding physician productivity that
is below the organizational standard, and for which they bear
both the most influence as well as the greatest opportunity for
Productivity Impacts with Significant
These factors have both the greatest influence on physician
productivity and, most importantly, are tied to organizationally
established standards under management’s direct control.
Establishing Work Standards
Clarifying the Definition of Full-Time Clinical Practice and
Clinical Effort: The employing entity is largely responsible
for establishing, monitoring, and enforcing this standard,
which relates to the number of clinical hours per year satisfying the requirement for the full-time physician’s ( 1.0 F TE’s)
clinical effort. In the context of this overview, “clinical effort”
is defined as that portion of the physician’s professional time
available for direct patient booking and excludes time spent on
other valuable clinically related roles such as meetings, time
spent conversing with patients remotely, or executing other
administrative tasks related to their clinical practice. Adjustments to the provider’s 1.0 FTE designation should only be
based on recognized and approved non-clinical activities such
as teaching, research, or administrative tasks/roles.
As a starting point, the employing entity needs to have a
clear definition of both what constitutes full-time clinical
effort (hours/week) as well as what is meant by clinical effort.
To illustrate, using 36 hours/week as the physician’s full-time
effort, and absent other professional responsibilities such as
teaching, research, leadership, this number is predicated on
nine, four-hour clinical sessions per week with care provided
in an outpatient office or an alternative venue (e.g., diagnostic laboratory, operating room, etc.). Monitoring compliance
with this standard is arduous but critical. Particular attention
should be paid to the duration of clinical sessions, which may
easily slip below four hours.
Clinical Call: Clinical call is a professional responsibility
required of virtually all physicians. With the exception of
adjusting call to align with the physician’s clinical F TE status,
this factor is not regarded as a component of clinical effort as
it relates to the calculation above.
Physician Booking Capacity over a Selected Interval:
Establishing expectations for the number of clinically booked
patients/month (or year) builds both on the hours/week
That said, while data analyses may point to clear improve-
ment opportunities, given the importance of non-measurable
intangibles, such analytics, may not fully unearth definitive
causes, or may only partially do so.
Setting an Organizational
While management and physicians may disagree about the
need or appropriateness of establishing a productivity standard, the standard itself, or how the goal was determined, the
importance of this action step should not be understated.
Without a clear productivity target, physicians and employers
lack a common goal, creating a setup for future conflict and
misunderstanding. Ideally, this benchmark should be developed jointly by all stakeholders, management, and physicians.
While it is prudent to avoid setting unrealistic productivity targets, fiscal realities often require practice groups to
establish clinical productivity “stretch-goals.” Such goals
might be considered a target outside normative expectations, such as productivity that exceeds average or median
levels based on national benchmarks. An example can be
cited from my professional experience. A multispecialty
group under our management team embraced a standard at
the 60th percentile for all practices, the rationale being the
lower-than-average patient care revenue associated with the
group’s disproportionate Medicare and Medicaid share. Not
everyone supported this action, seeing it as formulaic, but the
reasoning and rationale for doing so were well understood.
Further, while this goal was not uniformly met throughout the
organization, overall financial performance did improve.
The Differential Diagnosis of Below-Target
Addressing physician productivity that is lower than the
agreed organization standard is best approached by attaching
causation to four categories or areas of influence:
1. The employing organization has the most impact or
In most practice
continue to be