Office Hour May 18, 2026: Staffing, SOPs, and Service Lines

Grand Opening Event Summary

Florence shared that her grand opening event went well with approximately 120 people attending, including family and friends. She explained that she started seeing patients before the official grand opening on Sunday to accommodate more people without needing to close her office. Florence mentioned she was waiting for photos from a photographer who attended the event.

Health Services Space Development Plans

Florence discussed her progress on a project involving eight rooms with cabinets and sinks, considering potential uses for a larger room and open space, including renting for physical therapy or hyperbaric oxygen therapy services. She explored the demand for complementary services in her area and shared insights from observing a similar practice in Brooklyn that eventually closed. Florence expressed interest in partnering with an independent physical therapy group, particularly one specializing in vestibular therapy and gait training, and mentioned attending a networking event where she met new chiropractors offering comprehensive services.

Staten Island Clinic Expansion Plans

Florence discussed her new clinic on Staten Island and the challenges of staffing and managing multiple locations. She explained that she is currently using her existing staff who live nearby, but this arrangement is only manageable for limited hours and may not support full-time operations. Florence considered expanding services like infusion treatments but noted logistical challenges, particularly with IVIG requiring a full-time nurse. She plans to hire additional staff, including front desk personnel, to support expanded hours and potentially open 5 days a week by June.

Recruiting and Career Development Plans

Florence discussed her recruiting efforts, mentioning a potential contact through a friend who became a program director at a hospital with a new residency program. She also shared plans to reach out to contacts at Downstate and mentioned an opportunity to speak to residents in July. Florence expressed concerns about working with a neurologist colleague due to differences in their medical approaches and the high cost of malpractice coverage for part-time work.

Malpractice Insurance Cost Discussion

Florence discussed the high cost of malpractice insurance, revealing she pays around $31,000-$32,000 for full-time coverage and $17,000-$18,000 for part-time coverage up to 20 hours per week. She proposed that a potential part-time employee should carry their own malpractice insurance due to the significant cost. Jennie suggested Florence consult with other local practitioners about their malpractice coverage approaches and noted that primary care premiums in Montana are under $10,000, significantly lower than New York rates due to lack of tort reform and limited insurance carrier options.

Resource Scheduling and Insurance Updates

The team discussed resource availability and scheduling, with Florence indicating she could potentially work two days including Mondays once everyone returns from vacation. Charu provided an update on EFT insurance setup challenges, reporting that Aetna was finally processed and Oscar insurance approval was confirmed after a 6-week wait, though Medicare and Echo insurance processing still required monitoring. Charu expressed concerns about managing practice responsibilities alongside patient care, noting difficulties with completing medical notes due to being pulled away for non-patient tasks.

Nurse Workload and Management Solutions

Charu discussed challenges with her nurse's workload, questioning whether she needs to hire an MA to free up the nurse for more management tasks. Jennie suggested focusing on revenue-generating activities that the RN could handle, such as chronic care management and nurse visits. Charu expressed frustration with frequent interruptions during patient care and suggested establishing clearer communication protocols, including specific times for staff to bring up non-urgent matters.

Workflow and Patient Rooming Process

Charu discussed challenges with task completion and workflow management, noting that incomplete tasks from previous days were causing disruptions and requiring her attention instead of focusing on current priorities. She expressed concerns about the nurse's patient rooming process taking too long, with one recent case taking 45 minutes when only 8-10 minutes were available before the next appointment. Jennie suggested creating a collective process with the team and establishing essential information requirements in the chart to streamline patient preparation, while also recommending that the nurse focus on obtaining basic vitals and medication lists rather than comprehensive histories before the doctor's visit.

Nurse Workflow Optimization Discussion

Charu and Jennie discussed workflow challenges with their nurse, focusing on time management during patient visits and task prioritization. They agreed that the nurse should focus on patient preparation while the VA handles document tasks like refills, with Charu planning to address these issues directly with the nurse on Wednesday. Jennie suggested asking the nurse about what tasks she feels are prioritized and juggling during clinic days to better understand the current challenges.

Standard Operating Procedure Development Planning

Jennie advised Charu to use Claude to create a standard operating procedure (SOP) for chart preparation, suggesting she walk through the process and document steps, templates, and document locations. Charu realized she needs to establish clear processes and priorities for her nurse's tasks, particularly around daily intake preparation, as current ad-hoc approaches are causing delays and workflow issues. As next steps, Charu will meet with her nurse to define must-do items and establish clear priorities, with plans to report back on progress at the next meeting.

Patient Volume and Staffing Challenges

Charu discussed challenges with increasing patient volume exposing inefficiencies in current processes, and Jennie suggested focusing on defining repeatable systems to handle growing patient numbers. Vineka sought advice on leveraging AI to streamline the hiring process for a cross-trained MA position, as they are facing significant staffing shortages due to recent departures and medical errors. Jennie recommended using ChatGPT to screen resumes more efficiently before interviews, suggesting this could help identify better candidates faster while reducing time spent on poor candidate fits.

Medical Assistant Hiring Process Improvements

Jennie advised Vineka on improving the resume screening process for hiring medical assistants, suggesting she create specific criteria to filter candidates and potentially use pre-interview questionnaires to better evaluate candidates before interviews. Vineka shared her challenges with finding qualified candidates, noting that out of six recent interviews, none were suitable for a second round. The group discussed training approaches for TMS equipment, with Jennie suggesting Vineka could use monitored training videos and quizzes to ensure staff comprehension, and Vineka mentioned she would explore using Hubstaff for tracking training completion. The team also celebrated Vineka's achievement of winning "Best of Salt Lake".