From Alan’s Weiss’ classic Getting Started in Consulting:
Medical consultants advise doctors never to schedule wall-to-wall appointments during the day, because inevitably there are emergencies, late patients, complications on routine exams, and so forth. These create a domino effect by day’s end, and some very unhappy scheduled patients. Instead, they advise some built-in slack time that can absorb the contingencies. If not needed, slack time provides valuable respite.
I read this book years ago when I was a resident and came across this passage when reviewing my Kindle highlights the other day.
Perhaps there are consultants in real-life operating as Dr. Weiss suggests, but this common-sense approach to sustainable medical practice is not what many large health systems employ.
In my wife’s old outpatient academic practice, lunchtime wasn’t respite. It was an overbook slot, and her schedule was so jam-packed that there were always patients clamoring to squeeze in.
In order to make that all work, the average doctor spends 1-2 hours charting at home per day.
Contrast that with her current solo practice where she has complete autonomy: her patients aren’t scheduled wall to wall, and she has time for the inevitable emergencies, hospitalizations, collateral phone calls, prior auths, and the other vagaries of modern medical practice.
I’m proud of the practice she’s built–during a pandemic no less!–but it’s crazy that even academic medicine has become so corporatized in its paradigm that it was easier to craft her own business in order to practice on anything approaching the terms that would best serve her patients and herself.