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[By Dr. David Edward Marcinko FACFAS MBA CMP]

dr-david-marcinko1Much of what is done in Just In Time labor control  is aimed at reducing  the doctor’s wait time (radiographs, accu-check sugar levels, urine cultures, blood tests, injections, cast changes, etc.), the patient’s wait time (check-ins, check-outs, insurance verification, pre-certification,  etc.),  the move time (procedure set-up time, referrals, transportation, etc.) and quality time (education, emotional support and hand-holding); increasing actual patient physician service treatment time.

This can be expressed as the sum of four parts: 

     Treatment Time

(+) Wait Time

(+) Move Time

(+) Quality Time


Total Time: (Efficient or Inefficient)

Only the patient’s treatment time (doctor-patient interaction) adds value to the medical service. Wait, move and quality time are all non-value added services and should be eliminated to the extent possible, as they represent  needless expenses. All can, and should be performed, by non-physician personnel.


waiting room


Tasks to Delegate

The following represent tasks that the doctor can easily delegate in order to increase his or her office time efficiency:

* Patient scheduling, routine telephone calls, office directions, pre and post operative orders, triage, referral and pre-certification  and prior-approval forms and faxes, co-payment recoupment and office visit charges, pharmaceutical representatives and detail people.

* Initial historical review, vital signs, insurance updates, telephone call-backs,  and data gathering information on all patients.

* Injections, allergy testing, PAP smears, cultures, blood tests and phlebotomy, , gram stains, specimen preparation and other similar routine procedures.

* Prescription writing, acne medication, dermatological preparations, refills, pharmacy interaction and drug interaction explanations.

* Minor procedure assisting, suture removals, x-rays, casting, pathology and laboratory reports, ultra-sound, physical therapy and bandaging.




Tasks Not to Delegate

On the other hand, the following tips to improve physician time management might prove useful:

* Focus on patient and avoid interruptions in the examining room which should not have a telephone or intercom system; a  light or sound signaling system might be considered instead. Listen carefully and repeat  phrases back to patients in order to enhance communications and reduce errors. Reduce socialization time at work, the office or hospital setting.

* Schedule patient/physician call backs in specific time clusters; and/or consider a car phone or portable telephone or other personal digital assistance electronic device. If you have an open door office policy; keep it closed until all calls are returned. Inform your staff to avoid appearing unfriendly.

*  Make a short, intermediate and long terms task list of goals to be accomplished every day. Complete all of the important tasks, and keep track of those yet to be done. Stay flexible. You want to drive the list; not have the list drive you. Avoid an over-achieving mentality. Save something to do tomorrow.

*  Make proper time estimations using the Two-and-a half Rule, since it involves allocating an extra amount of time to perform given tasks, caused by interruptions, unplanned events or other minor problems. In this way, your daily priority task list will be more realistic.

* Use stock letters, paragraphs and/or  “macros” in your dictation system. The use of computerized charting notes is fine as long as the potential for litigation and defending such “canned assembly-line” notations is  considered.

* Avoid practice management, office or business meetings in the evening or after office hours. Rather, hold them before hours in the morning or during lunch time. Have food catered for a staff  treat but do not loose the focus and real purpose of the meeting.

* Review the telephone log and the next day’s schedule before departing for home or the hospital.

* Use the Rule of 7’s,  and realize that if there are more than seven people involved in a committee or office project, there are probably too many. Also realize that when you are appointing committees for TQI endeavors, remember that 5-7 people will provide the same results as a larger group.  If you are a key player, then by all means stay involve. If not, minimize your participation, since the rule reduces some of your non-medical functions. Forget perfection.

* Follow the time efficiency philosophy of professional managers, and “do, delegate or dump”  non-medical tasks; and handle paperwork or other chores only once.

* Reduce the number of needless office, hospital or surgery center meetings; speed read non-medical literature and reduce your material  (operating assets) office needs.

* Keep your office staff and family informed of your desire for office and time efficiency; do not forget your loved ones, religious affiliation, personal or physical (exercise) needs. Maintain a healthy, happy and psychologically fit lifestyle.

Results of JIT Implementation

When correctly applied, JIT labor and inventory controls may reasonably be expected to yield the following benefits:

1. Greater doctor and employee productivity through improved  office physical layout.

2. Reduced treatment and business management time resulting in the potential to see more patients, or the same number of patients with less time urgency and personal stress.

3. Inventories of durable goods are reduced and expensive storage space is made available for revenue generating activities.

4. Patient quality and services are rendered in a cost effective and value added manner.





The most appropriate response to diminished or declining patient volume is the transformation of as many fixed office costs as possible, to variable costs. This cost reduction strategy does not call for cost cutting per se, but for a change in the relative ratio of fixed to variable costs. It can be accomplished by (1) using temporary staffing, with its associated risks and benefits,  (2) outsourcing as much as possible, with its associated risks and benefits, (3) leasing or renting rather equipment rather than buying, and (4) using JIT purchasing and labor.


The reviewed time management techniques represent powerful techniques for increasing practice profits in the competitive environment. Implementation will decrease personal stress and assist the efficient physician develop the most economically profitable service  and operational  flow process possible for the office.


Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com


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3 Responses


    Just in Time (JIT) means that medical inventory is received, or labor is acquired or outsourced, just in time to go into production or report to the medical office for employment. In JIT, equipment or human resources are “pulled” through the office flow process, as needed.

    This approach is contrasted to the “push” approach used in conventional medical offices. In the push system, equipment is stored, or labor is on-site, with little regard to when it is actually needed. In the JIT “pull” system, the overriding concern is to keep all employees busy and inventory to a bare minimum, to reduce direct labor and direct equipment costs.

    The key elements of a JIT inventory-labor system include four parts:

    1. A dependable relationship with few suppliers who can make many small lot deliveries. Or; a few employees willing to work on a prn basis, with little advanced notice.

    2. A flexible work force that is cross trained so that each can operate in many different service settings (i.e., front office employee who can substitute for a back office worker).

    3. Improved office treatment room lay-out (cells) to reduce the distance patients and employees must travel. This might mean an X-ray machine, veni-puncture or cast cart in each treatment room or a computer terminal nearby for management information system (MIS) needs.

    4. Implementation of a total quality control system where employees constantly strive to delight the patient in an way possible. When, problems occur, each must be given the authority to solve the problem through real-time interactive skills.

    Dr. David Edward Marcinko MBA


  2. Commercial Member Annual Pharmacy Trend in Double Digits

    According to the fifth annual Medical Pharmacy Trend Report by Magellan Rx Management:

    • Since 2010, medical pharmacy allowed amounts have experienced 9 to 13% year-over-year increases in the commercial population.
    • Oncology and support medications represented 52% of medical pharmacy spend for commercial members and 60% for Medicare members.
    • 60% of payors representing 90% of covered lives reported that oncology practices in their service areas were being purchased by hospital systems.
    • 49% of commercial expenditures were billed from hospital outpatient settings where drugs were typically reimbursed at 2 to 3 times the average sales price. This is an increase from 42% in 2010.

    Source: Magellan Health, Inc


  3. Drug Supply Expenses Increased by More Than 10% per Physician Last Year

    Medical Group Management Association (MGMA) recently released its 2017 MGMA DataDive Cost and Revenue Survey. Here are some key findings from the report:

    • From 2015-2016, drug supply expenses increased by more than 10% per FTE physician.
    • Drug supply cost increased by 53% for multispecialty practices in the past 5 years.
    • In the last 5 years, drug supply cost 87% more per FTE physician in primary care.
    • Physician-owned practices spent $14,000-19,000 in IT expenses per physician/year.
    • Physician-owned primary care groups with a mix of 30% or less yield $159,307 more in revenue per physician than those with a mix of 50% or more.
    • Hospital-owned practices yield $221,497 more in revenue per physician.

    Source: MGMA, July 2017


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