The Inexorable Limit of 24/7/365

Physicians often come to my practice inquiring about ventures to enhance their income. Some are joining a venture, while others are starting one.  All, hopefully, come because they are concerned about the many strict regulations governing the medical profession.  

Few understand one harsh reality of medicine - doctors are selling their knowledge and skill, but they are also selling their time. They are, in some analyses, hourly workers.

It is when physicians consider their income in terms of hours worked versus earnings that the financial model for medicine is most striking.

Physicians are trained from early in their career to work hard to help their patients, and that hard work mantra is echoed when they ask how to build their practices and generate the income needed to repay the tremendous debt they incur to enter the field.  (While the high costs of education are not intended to serve as a barrier to entry, they do, but that is a topic for another day.) 

The solution most often offered is to merely work harder. It is simple: See more patients, make more money. This is where some physicians can become derailed, trying to see too many patients, and shortchanging the patient his or her time. One patient an hour is not likely to keep a practice open for long, but an average of five an hour is a start.  That number itself is deceptive, since some patients have simple problems that require only a modest amount of time to address, while others have complex problems that consume a lot of time.  This does not include the "Bonus Time" doctors get to work in order to fulfill the requirements of their electronic health records system. (See my blog lamenting all the extra time those time-saving EHRs demand of practitioners here. )

By trying to see too many patients, doctors may cut corners, and quality suffers.  No one wants that, and no one should accept that. 

At the other extreme are those practitioners who succumb to the temptation to make fraudulent claims for services. This may take the form of billing for services that were not rendered, overutilization (and overbilling) for services, incorrect reporting of diagnoses, unbundling, and of course, good old-fashioned kickbacks and bribery, to name but a few.  The cost of this is staggering - no one knows the exact figure, but it could be up to 10% of all healthcare costs. This cost in dollars? In 2011, it was upwards of $272 Billion.  

So doctors are left trying to figure out a way to earn more while still delivering high quality care lawfully. That is why our firm will counsel physicians to think of themselves as an hourly employee - balancing the hours they work versus their earnings.  The infographic below, from the website, demonstrates this reality of time and money by comparing doctors and high school teachers. (And before anyone gets upset, I am the proud son of a teacher, who would never have become a thoracic surgeon/attorney without the moral and financial support of my parents.)

There is a solution for physicians, but it does require they lift their nose from the grindstone for a bit to consider the many opportunities available to them. For example, by offering additional services that do not require a tremendous investment of physician time, practices can grow their bottom line. Investment in ancillary medical ventures, such as surgery centers or urgent care centers, can also be a boost.  Most exciting, however, is the opportunity for investment in the technology that is driving  medicine..  

Physicians will often mention how they have an idea for a device or technique that they would love to develop if they only had the time to do so. Biomedical scientists also have incredible gifts for innovation, but frequently lack the expertise to translate their ideas into practical and usable forms for application in healthcare.  The opportunity for scientists, physicians, entrepreneurs, business experts, and legal counsel to interact to jointly navigate the many challenges that will sink any idea on its way from the drawing on the back of a napkin to market is invaluable.  

So doctor, the next time you are looking at your bottom line and are considering just how many more hours you need to work to reach some income milestone, remember there are only twenty-four hours in a day, and but seven days in a week. Time is your most valuable asset. Use it wisely. Leverage that vast repository of knowledge you paid so much to acquire and spent so long learning to multiply its impact on your bottom line and on your quality of life.

In the end, this will allow you to pay more attention to your patients by working better and smarter – not longer and harder.  


The Spiers Group is well positioned to help providers explore opportunities for more efficient and satisfying practices.  Contact the firm to discuss your needs and see how we can help you.