Office Hour June 15, 2026: The Leverage Equation: Building Teams, Systems, and Physician Capacity

Finding Medical Staff Recruitment Challenges Florence discussed her ongoing challenges finding help at work and her experience with a recruiter who provided only one potential candidate, a third-year resident looking to move to New York. Florence decided not to pay for the candidate's travel expenses since she was interviewing multiple locations simultaneously, though she would offer to pay for dinner and transportation once in the city. The conversation ended with Florence sharing a previous experience with a large neurology practice in North Carolina that would fly in candidates for multiple interview rounds when interested. PA Hiring and Supervision Challenges Florence and Jennie discussed a potential new hire's timeline for starting work after completing residency, with Florence noting that the candidate plans to begin next summer. Florence shared her current challenges with managing two PAs, particularly highlighting one PA's lack of confidence in making independent decisions about patient care and referrals. While the newer PA shows good learning retention and has developed solid neuro exam skills, she currently sees about 12 patients daily rather than the target of 15, and sometimes requires excessive supervision. Medical Documentation Workflow Challenges Florence discussed challenges with using dictation software for medical charts, particularly issues with ICD-10 coding and the time required to generate and populate notes in the EMR system. Jennie shared her experience using a scribe feature in ECW that allows copying entire notes into the system, which has been a game-changer for her workflow efficiency. The discussion highlighted the need to balance completing patient orders with finishing documentation, as both tasks require time and proper coding. Scribe Software Management Strategies Jennie shared her strategy for managing charting by completing patient conversations and then pausing the scribe software to input notes for the previous patient before moving to the next one. The group discussed technical aspects of using different scribe platforms like Komir and Nabla Copilot, including how to pause and resume recordings and access the software across multiple devices. Florence raised concerns about billing for phone encounters, and Jennie clarified that while telephone-only visits are no longer billable except for behavioral health, patient-initiated digital e-visits through portals may still be billable. Patient Scheduling and Workflow Optimization Florence discussed challenges with patient scheduling and managing messages, explaining how she has implemented protocols for staff to triage calls and handle routine requests. Jennie advised on optimizing time management and suggested using the "Add Context" feature in their EMR system to efficiently document patient interactions without creating new notes. The discussion also covered strategies for delegating non-revenue generating tasks to staff members and the importance of prioritizing revenue-generating activities while maintaining proper documentation. Medical Documentation and Authorization Challenges The group discussed challenges with medical documentation and prior authorizations. Vineka shared that while regular progress notes are adequate, they need to be modified for prior authorization submissions, and Jennie suggested creating templates or macros in the EMR system to handle specific insurance requirements. Florence described her experience with imaging requests for dementia patients and the challenges of dealing with multiple imaging recommendations from facilities. The discussion concluded with Florence sharing her approach to training new VAs through scenario-based role-playing and recorded training sessions to ensure consistent protocols.