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Private Practice Administrative Issues Part I

Learning Objectives:
1. Describe strategies to mitigate staffing issues
2. Discuss ways to address scheduling concerns
3. Explain what is included in management of practice supplies
0.25 Credit CME

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Audio Transcript

AMA STEPS Forward® Series Announcement: [00:00] Hello, and welcome to the AMA STEPS Forward® podcast series. We'll hear from health care leaders nationwide about real-world solutions to the challenges that practices are confronting today, solutions that help put the joy back into medicine. AMA STEPS Forward® program is open-access and free to all at STEPSForward.org

Taylor Johnson: [00:22] Hello, and welcome back to the AMA STEPS Forward® Private Practice Attending to Business podcast, a 10-episode series exploring the business side of private practice. In this series, we talk about how to navigate business operations and practice- efficiency solutions to create and support a thriving and sustainable medical practice business. I'm your host, Taylor Johnson, Manager of Physician Practice Development at the American Medical Association. And I'm joined by my colleague and co-host Meghan Kwiatkowski, Program Manager of Private Practice Sustainability, also at the AMA. Collectively, we have two decades of experience in private physician practice, and we continue to support physician practices and our current work at the AMA. Before we start, I want to emphasize that this episode is for general informational purposes and should not be relied on as medical, legal, or other professional advice. listeners are always encouraged to consult a professional advisor for any such advice. This episode is part one of a two-part discussion around administration in private practice. Today, we'll be focused on the areas of staffing, scheduling, and management of supplies. Before we dive into the specifics for this episode, I wanted to talk a little bit about private-practice administration in general. Meghan, can you give us an overview of what we mean when we say private-practice administration?

Meghan Kwiatkowski: [01:47] Sure can. So private practice administration is the management of the combined processes that keep a private practice running smoothly. So those things include, but are definitely not necessarily limited to, hiring and supervising staff, creating and maintaining a positive office culture; developing a referral base; budgeting, billing, and coding, clinic design and workflow, patient scheduling; and supply ordering, which we're going to dive into a little bit today. If any of those areas are off track, it can cause huge inefficiencies in the practice.

Johnson: [02:30] It really can. I know, when I was a practice administrator, I felt like I was balancing a ton of spinning plates all at once. And just when I thought I had everything running smoothly, something starts to shake. Practice managers really must make sure that they have systems and processes in place so that nothing falls through the cracks. A typical example that I wanted to mention would be staffing. If you didn't have just the correct number of staff for your clinic that day, things could be running behind, or you had unnecessary labor costs when staff did not have anything to do. Then to build off of that, additional labor costs would throw off your budget. Another example is inventory management. So private practices don't have the storage capabilities to store back stock of medical supplies that larger hospitals and systems do. So managers need to know exactly the amount to order for their capacity and use needs because you don't want to order too little and run out. But also recognizing that you cannot order more than you can store.

Meghan Kwiatkowski: [03:39] Yeah, those are all really excellent points. Let's go back to the first example that you gave on staffing. So when you were working in a practice, how did you mitigate any potential staffing issues that you ran into?

Johnson: [03:53] So first, we had to identify the support staff that was needed to run the clinic efficiently. I had many discussions with my physicians and current support staff to find out what the needs were and how many staff they were comfortable with. Open communication was key so that my staff could come to me if the current staffing ratio wasn't working out. So it really was a lot of discussion, a lot of trial and error there at the beginning. And then the next step was cross training. Things happen and your staff members get sick or they have other emergencies, and they can't come in for their shift. So when this happened, and we had staff that were cross trained, that would allow me to move my staff from their normal position to cover other positions that needed to be filled in those situations. And I know that at the AMA we have several resources around staffing that could be helpful for our listeners.

Kwiatkowski: [04:50] Yeah, we have several; we have our simple solutions. Just a quick description is the rapid cycle learning opportunities for physicians and their practice staff. We also have our Private Practice playbook, which has a staffing guide. We have our Saving Time playbook and other STEPS Forward® products alongside the Private Practice playbook. We have a STEPS Forward® toolkit that is focused on the recruitment and the retention of MAs. And we also last year did a webinar that was focused on staffing and how private practices could address the current staffing issues that they may be seeing in their practices related to the COVID-19 pandemic as well. Earlier, Taylor, I mentioned that patient scheduling could be a challenge for some smaller practices. Did you experience any difficulties with scheduling in practice? I imagine so but how did you handle that?

Johnson: [05:56] Yes, patient scheduling really is a unique form of art. And you need the perfect combination of strategies for your practice in order to have that schedule run as smoothly as possible. So one of the things we did was to group appointments by type on the schedule. So this helped the flow of clinic because everyone followed the same workflow during each patient block for each appointment type. And then the next thing that we did was pre-visit planning. These were things like having patients fill out forms prior to their appointments, collecting their insurance information to obtain prior authorization if needed before their appointment, and collecting payment for the office visit or procedure over the phone before they arrived so that there was no backup at the front desk. This could even include things like having lab work or diagnostic testing completed prior to their appointment, so that the physicians have the necessary information to make informed treatment plans for their patients at that first appointment, or at that scheduled appointment, which would avoid unnecessary follow-up appointments in the future. All of these things create congestion at the front desk if they're not done prior to the visit. So that's why we really focused on getting a lot of these things done before the patient arrived to avoid that congestion at the front desk, and to really improve the wait times for patients and increase our efficiency for our staff.

Kwiatkowski: [07:29] Yeah, I would also add to your point about pre-visit planning. It really does help combat physician and staff burnout. It may appear to be more work when scheduling the appointment, but it actually creates less work for the physician and staff when you're trying to coordinate follow-up care. And I do want to mention just a couple of additional resources that the AMA has in this area as well, which are STEPS Forward® toolkits on pre-visit planning, pre-visit lab testing, and prescription renewal. We'll make sure to, of course, link all of these resources in the podcast description for our listeners who might be interested. Taylor, we've definitely covered quite a bit. But I know we also have one more consideration to discuss for this episode.

Johnson: [08:20] Yes, the last thing I wanted to cover in today's episode is the management of practice supplies. Speaking from the perspective of a small practice, we didn't have an inventory-management system like a Pyxis machine, or anything that tracked inventory when it was pulled. All we had was the inventory tracking inside our EHR that we used for vaccines and injectable medications. So we really had to do a lot of manual tracking for inventory. If this type of situation is the case for some of our listeners, we found the most efficient way to do this was to create a spreadsheet with all the supplies that we could possibly need in the clinic. That spreadsheet was then given to our clinical staff and the clinical staff would use that to do inventory once a week. After they've completed their inventory, they would give that to me, the practice administrator, and then the practice administrator would order anything that the clinic was running low on. If for some reason we used more than usual of a specific supply and we began running low in the middle of the week, the clinic staff was instructed to alert me so that I could place a special order for that supply so that a patient didn't show up for their appointment and was not able to complete a test or a procedure because we were out of a certain supply and no one notified anyone. Another helpful area was partnering with a vendor to order our supplies. The vendor that we chose was recommended to us through a group-purchasing organization. So if you are a part of those, I would definitely start there when looking for a vendor to partner with.

With that vendor, we were able to get better pricing on our supplies, and the vendor had an online ordering platform that allowed me to create an inventory list specific to my practice for the items that we ordered frequently. That made it so much easier for me, after I had the inventory list for my staff to go in and not have to search through the online catalog to find the specific supplies that I needed to order. The vendors platform also had functionality that told me the last time something was ordered; just in case there was an error on the inventory sheet from my staff, I would know to ask them about that, if we hadn't ordered something in a really long time and it still was not listed as we were running low. So having multiple checks and balances, I think is key when you don't have a system that can help you track your supplies.

Kwiatkowski: [10:58] Making sure your practice is fully stocked is just so essential. If your inventory is incorrect or isn't current, it can have patient-care implications. But I would definitely be remiss if I didn't mention our Private Practice playbook right off the bat when we talk about resources. We do have a section that is focused on equipment and supplies and questions to ask around procurement of those supplies. I also want to mention as a benefit of AMA membership, Medline is a preferred provider of the AMA, and they offer significant cost savings on many medical, surgical, and pharmaceutical supplies. The AMA has several benefits in this vein in support of its members; ways for practices to save money, which I know you and I know and our listeners again certainly know that being financially sustainable is so crucial. And so for our listeners who are members, if you aren't aware of the Medline benefits, certainly check it out.

Johnson: [12:00] I think this episode was chock full of information on mitigating staffing issues, addressing scheduling concerns, and managing practice inventory. Keep an eye out for our next episode that will be focused on additional administrative issues that will cover topics like payer audits, prior authorization, and the revenue cycle. So our listeners can look forward to that. The tools and resources mentioned in today's episode are linked in the podcast description and available on the AMA website. CME is also available for this episode on the AMA's Ed Hub and linked in the podcast description. I'm Taylor Johnson and this has been Private Practice: Attending to Business. Thank you for listening.

AMA STEPS Forward® Series Announcement: [12:46] Thank you for listening to this episode from the AMA STEPS Forward® podcast series. AMA STEPS Forward® program is open-access and free to all at stepsforward.org. STEPS Forward® can help put the joy back into medicine by offering real-world solutions to the challenges that your practice is confronting today. We look forward to you joining us next time on the AMA STEPS Forward® podcast series STEPSForward.org.

Audio Information

Credit Designation Statement: The American Medical Association designates this enduring material activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

If applicable, all relevant financial relationships have been mitigated.

Disclaimer: AMA STEPS Forward® content is provided for informational purposes only, is believed to be current and accurate at the time of posting, and is not intended as, and should not be construed to be, legal, financial, medical, or consulting advice. Physicians and other users should seek competent legal, financial, medical, and consulting advice. AMA STEPS Forward® content provides information on commercial products, processes, and services for informational purposes only. The AMA does not endorse or recommend any commercial products, processes, or services and mention of the same in AMA STEPS Forward® content is not an endorsement or recommendation. The AMA hereby disclaims all express and implied warranties of any kind related to any third-party content or offering. The AMA expressly disclaims all liability for damages of any kind arising out of use, reference to, or reliance on AMA STEPS Forward® content.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Enduring Material activity for a maximum of 0.25  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 0.25 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 0.25 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 0.25 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 0.25 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 0.25 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.


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