American Association for Physician Leadership

Quality and Risk

Creating the Almost Perfect Medical Practice: Part I

Neil Baum, MD

August 8, 2018


Creating a perfect practice may be as elusive as trying to reach absolute zero. (The laws of thermodynamics emphatically state that absolute zero, –273o Kelvin, cannot be reached using only thermodynamic means.) However, it is possible to have an almost perfect medical practice. To achieve this goal, it is important to start with the necessary ingredients or to identify the foundations that make up a perfect practice.

This article is the first of two parts.

It is important first to identify the criteria of an ideal practice and then to prioritize those areas that you deem most important for your practice. This will enable every doctor to identify the areas that will make his or her practice nearly perfect.

1. In an ideal practice, the doctors serve the patients they enjoy providing care for.

You can have a full practice, but if your patients are not the type for whom you enjoy providing care, you will not be a happy, fulfilled doctor. Therefore, it is important to think about the medical conditions that you enjoy treating, the kind of patients that you would like to have, and the lifestyle you would like to live. This process takes careful planning and decision-making. If you are a sports medicine orthopedist, for instance, you will look for patients with elbow, hip, knee, and ankle problems. If you are a pediatrician and enjoy taking care of teenagers and the unique problems of adolescents, then you can seek out those patients and refer younger children to your partners or other pediatricians. This approach can be used by primary care doctors, internists, and specialists. Although it is nice if 100% of your patients are the ones that you would most like to treat, it is unlikely that you can ever achieve that goal. However, if 90% of your patients fall into the category of those that you like to treat, and only 10% are not in the favored category, then you are likely to be satisfied and enjoy your work.

2. In an ideal practice, patients have ready access to the practice and the doctors.

You have to determine how many patients you are comfortable seeing in an hour, a day, a week, or a month. It is important to leave time slots for emergencies or urgencies so when a patient needs to be seen immediately, he or she can be added to the schedule seamlessly, rather than being squeezed into an already full schedule. That prevents unanticipated appointments from wreaking havoc with the schedule and keeping those patients who had scheduled appointments from being seen on time. It also makes sense to leave a few time slots during the week open for new patients. If a patient calls for an appointment and is told that the first new appointment is more than a few weeks away, it is likely that he or she will call another physician where there is more reasonable access to the practice. There should be room for an ample number of new patients to replace patients who are leaving the practice for one reason or another. I don’t believe an ideal practice can ever be totally closed.

3. Ideal practices have loyal employees and no expensive turnover.

Employee commitment is one of the most important requirements for creating an almost perfect practice. Employee commitment is delicate: it must be earned and can easily be destroyed if the physicians and the administration do not pay attention and listen to the employees’ concerns and issues. Employees with a high level of commitment will be loyal to you and your practice. They will not look elsewhere and leave the practice, resulting in costly turnover.(1)

4. Ideal practices control their accounts receivable.

Any monies left in your accounts receivable (AR) are dollars that belong to you and are being used by someone else, usually an insurance company or the patient. The goal is to keep most of your AR in the 30- to 60-day bucket. Money that has been in AR for more than 120 days is historically difficult, if not impossible, to collect. An ideal practice looks at the AR on a monthly basis and monitors AR and tries to maintain the majority (i.e., 60%–65%) in the 30- to 60-day category, with less than 10% over 120 days.

5. Ideal practices submit clean claims and have few or no denials or rejected claims.

A claim to an insurance company should be made within 24 to 48 hours after the service is provided. This includes surgical procedures. A clean claim usually is paid in 10 to 14 days. Most claims that are denied are a result of improper data input by the billing clerk. For example, if a patient has a hyphenated last name, and the hyphen is not used in the submission, the claim is often denied. Therefore, attention to minute detail is necessary for anyone charged with submitting claims to insurance providers. Denied claims are an unnecessary cost and take time to resolve, but they can be processed in a timely fashion if the claims are scrubbed clean. It is estimated that the cost of dealing with a denied or rejected claim can be about five times the cost of submitting a clean claim. The perfect practice has no denied claims. If your denial rate is higher than 3% to 5%, using a claim scrubber is a worthwhile investment.

6. Ideal practices answer the phone in no more than three rings and do not use a phone tree.

Patients want to speak to a human, not listen to an endless menu of choices from a phone tree before reaching someone in the office who can help with their problem. The take-home message is that trees are for fruit and acorns and not for patients. Also, an ideal practice doesn’t turn the phones over to an answering service during lunch. Lunch hours can be staggered so that the phone is always answered during office hours.(2)

7. Ideal practices do not make excuses.

Ideal practices do not make excuses when a problem or error occurs. They apologize and fix the problem. It is not a sin to say “I’m sorry” to a patient when a mistake has been made. If a lab result or the result of an imaging study was promised to a patient and the patient was not contacted, then it is important to make amends with the patient. I suggest that the doctor him- or herself call the patient and apologize, even if the error was the result of a mistake made by a staff member.(3)

The buck stops with the doctor, and patients really appreciate hearing from the doctor when mistakes have been made.

Remember: the buck stops with the doctor, and patients really appreciate hearing from the doctor when mistakes have been made. It is even a nice gesture to send a written apology note to the patient who feels a mistake or an error has been made and also make a note in the patient’s record or in the electronic medical record that acknowledges that the error occurred and that action has been taken and the patient has been notified.

An ideal practice anticipates problems and tells patients in advance what may happen during or after treatment. There is a natural tendency for doctors and staff to become defensive or to offer reasons why something didn’t go as planned. Making an excuse or offering up explanations in self-defense is the worst customer service mistake, whether you are the receptionist, the nurse, or the doctor. Ideal practices avoid surprises. If there is a problem, the best solution is bringing up the issue before the patient does. I am a firm believer in making use of the two magic words, “I’m sorry,” and apologizing profusely. You gain the patient’s confidence and rapport by acknowledging the patient’s feelings. Whenever possible, give the patient a reason for the problem. Remember the saying that holds true: patients don’t care how much you know until they know how much you care. You can show you care by listening to the patient. Avoid being defensive, acknowledge the patient’s concern with empathy, and find a solution that is acceptable to the patient.

Ideal practices avoid surprises that can upset a patient. The best and most compliant patient is the one who is educated and has all the information that is needed to feel comfortable proceeding with the treatment plan. I find it useful to provide patients with FAQs of anticipated risks and complications associated with the procedure or surgery. FAQs that cover many of the possible risks and complications can inform them before they undergo a procedure or surgery. I also provide FAQs for the medications most commonly used by our practice; this also reduces the phone calls from the patients to the staff or doctor.

8. Ideal practices survey their patients and place an emphasis on patient satisfaction.

Most physicians assume that most of their patients are satisfied and appreciate the care they receive from doctors, nurses, and allied health professionals. Patient satisfaction is an elusive concept, one that often is difficult to measure. However, systems and metrics do exist that provide objective evidence of patient satisfaction that go beyond mere patient satisfaction surveys. For example, our practice surveys patients on every visit by giving them a survey card. Action is taken for all positive or negative comments (Figure 1). Also note that on the front of this card is an opportunity for patients to write down what questions they would like answered during the visit to make their doctor-patient encounter complete (Figure 2).

Doctors and staff must understand that a major component of quality of healthcare is patient satisfaction.

The need to improve quality in healthcare delivery is increasing. The CMS, hospitals, and insurance providers alike are striving to better define and measure quality of healthcare. Doctors and staff must understand that a major component of quality of healthcare is patient satisfaction. Furthermore, patient satisfaction is critical to how well patients do; research has identified a clear link between patient outcomes and patient satisfaction scores.(4)

9. Ideal practices monitor the practice’s online reputation.

Whenever a negative review is given, the practice sees this as an opportunity to improve its services to the patients. Even an ideal or almost perfect practice cannot make everyone happy and satisfied, although that is the goal or objective. It is possible for an unhappy or disgruntled patient to make damaging, disparaging remarks with a simple click of a mouse. Just a few negative comments online can significantly affect your online reputation and take you from five stars to two in no time. Therefore, it is imperative that you “dilute” those negative responses with an abundance of positive comments and compliments. That is why I try to capture every positive response—of which I receive several every day—with a testimonial that is posted on my website, or by having the patient complete a brief survey he or she is still in the office that goes to,, and a few other online reputation management sites.

10. In an ideal practice, the doctor is not interrupted when he or she is engaged in a patient encounter in the exam room.

Doctors should not be interrupted when they are with a patient. The only exceptions are calls from the emergency department, operating room, or intensive care unit. If another physician calls and wishes to speak to the patient, the receptionist might respond, “The doctor is with a patient (doing a procedure) and will be available in [state number of minutes] and will call you back shortly. However, if it is an emergency, I can interrupt him/her at this time.” Now the physician or other caller has been given an explanation and has the option of interrupting the physician if he or she deems it is urgent to speak to the physician.

11. In an ideal practice, the doctors have great communication skills and are able to motivate patients to make positive lifestyle changes.

Doctors in ideal practices are able to motivate patients to make positive lifestyle changes (e.g., improved nutrition, regular exercise, smoking cessation). Having great communication skills means being in the present and looking at the patient, not keeping your back to the patient and focusing on the computer and the electronic medical record.

Bottom Line: I hope you can honestly state that you are accomplishing or performing many of these suggestions, all of which can contribute to creating an almost perfect medical practice. In the next article in this series, I will offer eight more ideas that will make you perfect in the eyes of your patients.


  1. Hills L. Increasing medical practice team commitment: 25 strategies. J Med Pract Manage. 2016;31(4):223-228.

  2. Peller S. Own the Phone: Proven Ways of Handling Calls, Securing Appointments, and Growing Your Healthcare Practice. Phoenix, MD: Greenbranch Publishing; 2014.

  3. Groopman J. How Doctors Think. New York: Houghton Mifflin; 2007.

  4. Manary MP, Boulding W, Staelin R, Glickman SW. The patient experience and health outcomes. N Engl J Med. 2013;368:201-203.

Neil Baum, MD

Neil Baum, MD, is a professor of clinical urology at Tulane Medical School, New Orleans, Louisiana.

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