Administration Time and Margin

With the demand of the conversion to an EMR, the staff is expressing concern that they do not have enough administration time to properly document the patient’s experience. They feel that perhaps the service to our patients is declining because the amount of time they have to spend on the phone with them has also declined. They feel that the high standard of service that we have had for many years is starting to be affected by the lack of time, that they need to work with this program and also spend the time with the patients both in person and on the phone.

This is a concept that was written about by Dr. Swenson in a book he wrote about 10 years ago called “Margin.” In it he describes ‘margin’ as the time in our lives when we have nothing to do. It is during this time that we spend on relationships with other people, with ourselves, and with God. Life used to afford a lot of margin time in our day to day activities. People will get go to work at 9 o’clock and get done at 5, come home spend time with their family or at home or in the evening reading a book or just writing letters to friends and family. But society has speeded up the demands of the work and all the things that should be done. This starts to eat away at the ‘margin’ little by little until the point where person has no ‘margin’ at all. This creates an incredible stress and tension on the body and the mind. Dr. Swenson is a family doctor, who saw this in his patients as they come in with all of these ailments that are stress driven.

I see this same scenario playing out in my practice right now. As the ‘margin time’ (administration time to spend with patient care) has disappeared, because of the demands of the EMR system, the time my staff has to work with the relationships with the patient has created a tension that is difficult to describe. In this context, it takes away the joy of practicing medicine for my staff and for myself. Yes, I say for my staff. My staff practices medicine as well, as they interact with the patient, listening to their concerns and offering solutions and options for treatment based on the treatment plan. This time spent with the patient has been diminished because of the demands of EMR.

The question is what are we going to do about it! There are a couple of options we are to currently exploring and this would be the subject of a future blog. Basically, in a nutshell, the options include adding more staff or decreasing the time with the patient, which should decrease the profit of the practice. That is my burden.

Ronald S. Prehn, D.D.S.
Diplomate of the American Board of Orofacial Pain
Diplomate of the American Board of Dental Sleep Medicine

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