We all have our areas of expertise. As much as I would like to say I’m an expert at side hustles, I would be lying. I enjoy exploring these side gigs and sharing them with you, but I’m still an amateur. I have mastered one thing, however – maximizing my productivity income.
More and more physicians are getting paid based on their productivity. “Eat what you kill” refers to keeping the profits you generate for a group. The more you kill, the more you eat. The more you eat, the quicker you achieve morbidly obese FIRE.
I have been the most productive doctor in my group for 8 straight years. By age 30 I was making more money than the original founders of the business. I generate 100% more RVUs than our least productive full-time physician despite only working 30% more hours. For years my colleagues have marveled at my productivity data, but never quite been able to figure out how I’ve done it.
Today is the day I share the secret recipe.
Case of the Mondays
The easiest way to see more patients is to work when there are more patients demanding to be seen. Every emergency department I’ve ever worked in is always busiest on Mondays. As a result, I make it a point to work as many Mondays as possible. I never trade out of a Monday shift and anytime a coworker is trying to unload one I take it.
When asked why he robbed banks, famed bank robber Willie Sutton replied “because that’s where the money is”. Mondays are my bank vault.
Front Load Your Work
When I show up for a shift I am well rested, clear-headed and over caffeinated. There is nothing I like more than arriving with 20 people in the waiting room and ambulances double parked on the ramp. I start the shift like I was just shot out of a cannon, going room to room bringing order to the chaos. The truth is that I may see half my patients in the first three hours of my day. After that initial strike I can dial it back to a normal pace and still end up seeing way more patients than my colleagues.
Low Lying Fruit
There’s no such thing as a bad RVU. Some docs will leave simple procedures (minor lacerations, I&Ds) or minor complaints (URI, ankle sprains) for the PAs to see. If I’m available and there are paying customers who want to be seen, I’ll see them. These cases take little mental effort, are low risk and break up the monotony of seeing chronic abdominal pain and weak/dizzy octogenarians.
Low lying fruit is also a great way to end a shift. That sore throat who had a positive rapid strep swab in triage? Two minutes to examine the patient, one mouse click to prescribe his amoxicillin, and out the door. The 23-year-old sent to the ED because his outpatient CT showed appendicitis? Shake his hand, mash his McBurney’s point, order the antibiotics and call the surgeon. Don’t look these gift productivity horses in the mouth.
Be the nurses’ favorite doctor
Your nurses are your eyes and ears. They can be your best friend or your worst enemy – the choice is yours. I go out of my way to befriend the nurses and always respond to their concerns. You know why? They are a RVU funnel.
At peak volumes, there are 5 docs and 2 PAs working in our department. We all sit together in one central area. I can’t tell you how many times a nurse has walked past 6 other providers to tell me there’s a patient who needs to be intubated or handed me the EKG that shows a STEMI. Treat your nurses well and you will be paid handsomely.
Befriend the Medics
The medics are productivity delivery people. They drive the money right to your doorstep. While other docs are too busy to answer medics questions, I sit down and go over cases and EKGs with them. When there are new medics who want to practice intubating, I give them first dibs on the airway. A few years ago I got voted the EMS Doctor of the Year. Although there is no cash prize, I feel like it has paid off well ever since.
Embrace your referrals
Anyone who sends you a patient is sending you money. Don’t take these referrals for granted. There are 4 other hospitals within an hour of mine and countless urgent cares. If a PCP wants to discuss a patient they’re sending in, make the time. I end every one of those phone calls with “we’ll take good care of them”. If they want a callback with test results, close the loop.
Don’t ever criticize, question or belittle the physicians sending you business. If a patient or their physician has a concern, address it. You won’t win any prizes for minimizing a patient’s worries or badmouthing their doctor. Eventually they will find someone else to give their business to.
Pick your marks
Although 70% of my productivity has to do with working harder and smarter, 30% has to do with simply working more. When figuring out who to get shifts from, it helps to know your marks. The 3 easiest types of physicians to get shifts from are the old, the exhausted and the lazy.
The old: There are a few late career docs that continue to work purely because they like the job. They’ve achieved financial independence but between a cushy benefits package and plenty of play money to fund travel and hobbies, my group has plenty to offer them. They certainly don’t mind working fewer shifts, even if it hits their paycheck.
The exhausted: You probably think I’m referring to burnt out docs. Although that can be true, the main target is parents of newborns. At least half the group is under the age of 40 and still having kids. As a father of 3, I guarantee being a parent is the hardest job there is. Being a shift working ER doc is tough when you’re a sleep deprived parent. I’ve found that most parents with infants at home are more than glad to give up shifts.
The lazy: Let’s face it. We all have a few lazy colleagues. Their engines have one speed and they just don’t have fuel left in the tank. These coworkers are the easiest to get shifts from because you don’t have to deal with any pretense. Ask and ye shall receive.
Extend your colleague’s vacations
This next trick has a success rate of ~98%. No one can resist longer vacations. If you really want to pick up extra time at work and no one is coughing up shifts, look at the vacation requests. See who is scheduled to work the day before or the day after their vacation. I’ve found that emailing that person and saying – “how would you like an extra day to pack before your trip?” or “how would you like a day to recover after dragging your kids through Disney?” is a surefire way to take that time/money off their hands.
Make them an offer they can’t refuse
Everyone likes a good deal. Have you ever bought something because there was a two for one special? One method I’ll occasionally try is offering to work two shifts for someone in exchange for them working one shift I need to get out of. There’s something so enticing about the offer that they always say yes.
A few times when I’ve been really desperate, I’ve even offered to pick up extra night shifts. That is a last-ditch effort. Anyone who has ever worked shift work realizes that you’ve got to really want those extra bucks to stay up all night.
Be direct with the scheduler
When all else fails, just be honest with whoever does your schedule. I told our scheduler years ago if there was ever a question who to give the extra shift to, just give it to me. A scheduler has one goal – fill the schedule while making as few people angry with them as possible. Knowing that I will work whatever shifts he gives me makes his life easier and my wallet fatter.
Kill More, Eat Better
Many of you reading this aren’t in emergency medicine. A few of you may not even be physicians. I think these tips can be applied to a wider audience. If you have a job where your income is tied to productivity, there are many things within your control to boost it.
Understand when and where your business is coming from. Build relationships with your referral base. Never turn down easy revenue streams. Know your coworkers and what motivates them. When all else fails, just be honest and direct. You’ll be surprised how often this works.
For those of you who think I am a crazy workaholic, that is only partially true. The average ER doc works 30-40 hours a week. Even if I pick up 2 or 3 extra shifts a month, I’m still working less hours than most of my non-medical friends.
These 10 tips have earned me hundreds of thousands of dollars over the years. I hope they work as well for you as they did for me.