Watching the clock is another hard habit to form, but it pays off for you and for patients who value their time.
A female GP and friend, currently on a hiatus due to burnout, reached out the other day for advice.
“Feel free to ignore, but here is what I’m aiming to do on my return to work next year,” she said.
There followed her draft for billing and gap fees.
This is a friend who has historically struggled with time management and effective boundaries. For years I’ve said to her (when asked) that she needs to work on both to lower her risk of burnout.
She struggles to keep appointments to 15-20 minutes and tends to run over. The vast majority of her appointments are 30+ minutes.
When she was bulk billing everyone, this was the penalty she paid for the time she gave away, essentially for free. When her practice moved to gap fees of $20-30 across all appointments, she still lost out as the gap fee didn’t rise in line with the time spent.
Additionally, she, like many female GPs, tended to bill compassionately based on emotion.
“They said they were struggling with their bills, so I bulk billed them.”
“They are already paying so much in non-GP specialist fees, I’ll bulk bill them so as not to add to their burden.”
Et cetera.
No-shows and late cancellations incurred no penalties despite the fact that, like many female GPs, she books out a few weeks in advance.
Her plan was to insist on a higher gap fee for long consultations, the bulk of her appointments, instead of a flat gap across all appointment types.
Many GPs baulk at the idea of billing for longer appointments as they feel bad for charging more for more time spent with a patient. Many practices get around this by having a flat gap fee across all appointment types, but obviously that doesn’t scale well.
If we have a theoretical rebate and flat gap fee as follows:
- 23 $42.85 + $30 gap = $72.85 for up to 20 mins = $218.55 per hour
- 36 $82.90 + $30 gap = $112.90 for up to 40 minutes = $169.35 per hour
If she doubles the gap to $60 for long consults only, it would be
- $82.90 + $60 = $142.90 for 40 minutes = $214.35 per hour
Still less than standard consultations with the smaller gap – but better.
If she manages to stick to the plan and run on time, i.e. 15-minute standard appointments with $30 gaps, she gets
- 4 x $72.85 = $291.40 per hour
My colleague was also planning to bulk bill all telehealth appointments. My questions:
- Are people likely to opt for telehealth appointments to get out of paying a gap fee?
- Is she likely to run over time for those too?
- Why reward people who have avoided travel costs, when it costs her and the practice the same amount to operate?
Then there’s the late cancellations and no-shows and the $0 income generated for those 15-30 minute appointment slots.
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Even at bulk-billing rates, without bulk-billing incentives, a couple of those per day adds up to ~$428 per week, or close to $12,000 actual GP income per year.
So, here’s my advice to my colleague and to all GPs struggling to charge and make it work.
We get bogged down in trying to make it fair for patients.
We’d do better to watch the time we waste in running over our booked appointment slots or not charging appropriately for them.
If we can run to 15-minute appointment slots and charge a $30 gap, fabulous.
In truth, many of us struggle to do this and don’t want to make our patients pay for it. It’s a lost cause, especially if you allow yourself to regularly be talked into longer appointments than booked while charging the same gap, or worse, bulk billing.
Time management is the biggest skill we are not taught as doctors.
In hospitals it mattered less, except in time-sensitive specialities such as O&G; otherwise, in the nine months I did emergency locums I was actively encouraged to “slow down … they’ve only been waiting two hours”.
This does not work in general practice, where time is our greatest asset. Patients prefer it when the doctor runs on time, as they value their own, and will often pay a premium for that.
I told my colleague I thought she was coming at it from the wrong angle: focus on the time allocated to each appointment type and the billings per hour presuming she stays on time. Failure to do this will mean more of the same: running late, billing less per hour, spending hours on unpaid admin and, inevitably, burnout.
We only ever feel ready to make a change when the pain of changing is outweighed by the pain of staying the same.
Dr Imaan Joshi is a Sydney GP; she tweets @imaanjoshi.
