Sorry for the hiatus for the past two weeks, but I had to focus my time launching my group coaching program called Charting Conquered, which started this week!
In today’s post, I will introduce and try to demonstrate to you the concept of building margin, and the impact it can have on not just your work day, but all aspects of your life.
I’ve been away too long and I’m just chomping at the bit to dive right in, so let’s do it!
If You Build It, They Will...Margin
I first heard about the concept of margin from Dr. Phil Boucher, an incredible physician and patient advocate who has too many side gigs to count all the while keeping up with his pediatric private practice and family!
Dr. Boucher referenced a book called Margin: Restoring Emotional, Physical, Financial, and Time Reserves to Overloaded Lives by a Dr. Richard Swenson, who just happens to be a physician, but the target audience is the general public.
So what is margin? I’ll let the author tell you.
Dr. Swenson explains that “margin is the space between our load and our limits and is related to our reserves and resilience. It is a buffer, a leeway, a gap…”
In other words, margin is breathing space or wiggle room.
Dr. Boucher likens it to a ruled page of paper in which you write your content in the main area and leave the margin as extra space to add tidbits here and there, if needed.
And that’s a great way to view it. If you can build in buffer (not the problematic kind discussed here) into your day, even, a little, you can really take the pressure off of yourself.
Removing that pressure or anxiety or sense of chaos can go a long way in helping you enjoy work and home time.
Where Is This Magic Margin You Speak Of?
It’s everywhere. Well…it can be. The rest of this post will focus on margin at work.
It’s important to both see when margin is possible for you as well as for what tasks you typically require margin.
For example, you may have a certain visit type that is allotted a certain amount of time and you almost always finish that visit type early leaving you with a few minutes to spare.
Perhaps you know you need margin for visits with procedures like injections or IUD placements because they take time to set up or require an assistant.
Knowing your schedule inside out and sideways will do wonders for finding margin.
Your margin needs and availability may vary day by day, but some margin a few days is better than no margin every day.
Many jobs unintentionally promote smoking by offering smoke breaks—little nuggets of time away (*smokerscough*margin*smokerscough*) from work.
(No, I’m not encouraging you to take up smoking).
Finding Nemo Margin
So in which parts of your work day can you find margin? I’m more asking you since I don’t know the particulars of your day.
As mentioned above, intimate knowledge of your general schedule and your schedule specifically for the day can illuminate the possibilities of respites.
The former will enable you to understand where your typical wiggle room exists. The latter will enable you to determine which patients scheduled may be more straightforward and where visits may be shorter.
A few additional examples where breathing room may already exist for you:
- Admin time
- Hold slots
- In between patient encounters
Spend some time thinking about your schedule to see when or where you can find margin.
Build Back Margin
So maybe you found some margin or maybe you didn’t. Either way, you may be interested in creating margin.
In which parts of your work day can you create margin? Again, I’m asking you so you can start brainstorming for yourself.
One way that I come across commonly involves the under-billing of office visits. Many physicians undercode a visit because it did not “feel” like a level 4 (established) visit, for example, even if they met all the requirements to bill the level 4.
I’d encourage you to follow the actual guidelines and criteria for coding instead of relying on your “gut.”
If you’re chronically undercoding, then you’re putting more pressure on yourself to see more patients in the same fixed amount of scheduled time (or running way over and eating into your home time) to meet your RVU requirements, especially if you are judged/measured/paid on production.
By billing appropriately, you can more easily meet your RVU requirements, and often lengthen your visit times and see fewer patients, which gives you breathing room (and makes for better served and happier patients).
Ahhhh, breathing room. So you don’t feel like this.
And you can use that breathing room to spend more time with your patients or complete the tasks that need completing.
Or you could use that time to recenter yourself, meditate, or go for a walk—whatever you need.
Have an idea for how you can use margin time in a way that serves you.
Who's On First?
I find that workflows that emphasize other team members handling the inputs coming in (calls, messages, forms, etc.) first helps tremendously with creating margin. Your team can gather more information, fill out pertinent sections on forms, tee up necessary orders, and sometimes handle the entire issue.
An example of this last point is all the COVID vaccine messages and calls with which many of us are being inundated. Staff can have a script for explaining vaccine rollout (for example, that physicians are not involved in ordering the vaccines) and how your organization handles it without it needing to come to you.
Who can you lean on to help you build margin into your day? How can you leverage your team where possible? What tasks can you delegate to others to take some of the burden off of your shoulders? Your team is there to help you care for patients. Empower them to help you.
I mentioned in vague terms your “team,” which likely includes medical assistants and nurses. But also consider front desk staff, billers and coders, as well as your colleagues.
Cover Me, I’m Going In Away
Colleagues? Yes. I don’t mean make them do your work for you (which would be awesome—I mean, inappropriate)!
Many physicians don’t take vacation or stress the entire time they’re on vacation about the load of work inevitably awaiting them upon their return.
Many are punished in this way for taking vacation, and if they’re going to stress while gone, then what’s the point of vacationing anyway?
Wouldn’t it be nice to come back from a vacation and have the majority of the patient care issues including lab results, calls, and messages addressed in your absence, greatly reducing your burden upon returning?
Think about it: you could actually enjoy your vacation! An amazing concept, right?
Work with your colleagues to set up a system of true coverage. This may prove challenging if your office culture does not place a value on this, but I encourage you to open the dialogue and promote the shared benefit for all involved.
Another way to help with post-vacation margin: your first day back only work a half day to ensure you have the buffer you need to address the remaining inbox items that required your specific input or were deferred to you.
Margin Call
Give yourself breathing room by finding and creating margin in your life, especially at work. It can help you manage your day more effectively, recharge and decrease burnout stimuli, and possibly keep you in medicine happier and working longer. It can also benefit your staff and your patients.
Today’s post explored the idea of margin, how it can serve you, and offered a few ideas for how you can build some into your life. Get creative and explore the possibilities.
I’d love to hear your thoughts on this issue. Let me know in the comments section below.
If you haven’t subscribed to my email list, then do so below so you don’t miss my new posts or my weekly updates (only for subscribers).
I’d also be most appreciative if you shared this post with anyone whom you think would benefit from the content or message of the blog.