business of pediatrics

Solving the Top Stressors for an Independent Pediatric Practice

Every service business has the same basic stresses: obtaining clients, satisfying their expectations, maintaining a relationship with them, hiring the right people for culture and efficiency, and of course, keeping the budget in the black. Pediatric healthcare is at its core a service business, but there aren’t many titles in the nonfiction section that specifically cater to running a successful pediatric practice.

While independent practices enjoy many of the same joys of caring for children in their communities, their location, community, and specialties can create individual stresses on their businesses. Below are some of the most common stressors that arise when running a pediatric practice, and how to relieve the tension and build a better business that’s right for your patients.

No Show Patients

Perhaps you’ve laid down the law and announced your practice would charge fees for no shows, or perhaps you refuse to place fees because you’re concerned for a high-Medicaid community’s ability to pay. Regardless of how you’ve tried to address it, the issue of no shows is one every pediatric practice faces, and it’s a unique problem for pediatrics -- which makes sense when your clients are dependent upon caregiver’s schedules as well as siblings, not to mention the issue of transportation!

PCC’s Chip Hart and his team have tackled no shows using data across dozens of pediatric practices. His conclusion? Families who have missed appointments before are likely to miss them again. Keep tabs on families who are likely to no show, and take preemptive measures such as a follow up call the day before the appointment, or other automatic email or text notifications.

Filling the Schedule

Even if you have a reasonable or even exemplary no show rate, you’re still faced with filling the schedule, whether you’re a practice of 20 providers or your full staff is comprised of one provider, a nurse, and a front desk manager. 

A hard truth is that it’s going to be difficult to marry your ideal schedule with those of the families you care for. Firstly because visits that go over time, are late, or require more resources are normal. Secondly, because in the same case as no shows, young patients are often dependent on caregiver’s schedules and transportation, whether they’re Mom, Grandad, or an older sibling.

After you’ve considered the schedules of most of your families, take a look at some tips to fill your own:

  • Offer late office hours or occasional weekend hours for working parents
  • Offer longer visit times for behavioral visits such as mental health and ADHD checks
  • Layer visits for efficient ancillary care
  • Stack appointment times to account for late arrivals

Workplace Trouble

At the end of the day, it’s often not the practice that gives you trouble, but the people in it. While you can’t always control the tantrum of a toddler (or a parent), you do have a big hand in the culture of your workplace. This is primarily down to the people you hire, the practices and policies that encourage habits, and the environment that all boils down to the thing we call office culture.

Chip Hart has more advice for hiring the right people in his webinar, “Do You Work With the Wrong People?” His recommendations include great HR policies, resolving issues with partners and colleagues, and addressing the job satisfaction of every employee on your staff.

Watch the Webinar

Consider planning an employee meeting where staff can air their concerns and questions on office culture; if your practice is large enough, this might be better achieved by sending out an anonymous survey. Are there team-building measures you could take on in your everyday routines?

Remember, hiring for success is the first step. After that, relieving stress can be as simple as regular meetings and huddles, a focus on communication, and yes, the occasional pizza party -- small, manageable steps that can all make a huge difference in morale and positive office culture.

Integrated Care

Being a part of an integrated healthcare system is difficult. Even if your practice is a PCMH with great patient relationships, the reality is that one provider can’t care for a child’s every need. When a patient needs referral to another specialty or long term care your practice can’t provide, it can be frustrating to watch families struggle to access or afford this care. While pediatricians can’t be everything for every patient, here are some steps your practice can take to make a child’s experience with other providers the best and most integrated experience possible.

  • Consider behavioral healthcare integration
  • Have a list of resources accessible to major payors and Medicaid
  • Determine the needs of your patients by survey or other data-driven research
  • Maintain positive relationships with providers and specialists so you can refer patients to professionals you trust and who will communicate well with your office
  • If you’re looking for some new professional contacts, ask! Patients’ families will be happy to recommend providers or specialists they know and trust. Your colleagues may have great recommendations too.

Parent and Caregiver Relations

While your patients are the ones actually in your care, you have a responsibility to parents and caregivers too. You might be experienced in handling parents’ worries over fevers, coughs, and even long term ailments like ADHD or depression, but no matter your diplomacy skills, a worried caregiver is an awesome force. Regular worry can get even more stressful for providers if a parent has an atypical lifestyle or needs more parenting help than a 15 minute visit can offer or that you as a medical professional feel comfortable giving.

To prevent disputes, dramas, and maintain a growing relationship with your families, make sure your practice has the following: 

  • Clear policies: this goes for everything from vaccinations to no-shows.
  • Resources for new parents: whether it’s breastfeeding classes or recommended play groups for children with disabilities, a little help goes a long way.
  • Boundaries: Caregivers will sometimes disagree with you, so it’s important to know when to educate, when to listen, and in some cases, when a family might benefit from another office altogether.

Some resources you could consider adopting at your practice:

  • Parenting classes such as setting sleep schedules, discipline strategies, and preventing ACEs.
  • Hosting a parenting group.
  • Literature for parents to get their own healthcare or well-being cared for, such as counseling, community flu clinics, or local services for help with addiction or domestic violence.

For more information on dealing with the most common stresses of a pediatric practice, be sure to check out our Smart Pediatrics Resource Center for webinars, ebooks, and videos to help you run a pediatric practice as a both a successful business and a place patients can gladly call their medical home.

Visit the Smart Pediatrics Resource Center

Allie Squires

Allie Squires is PCC's Marketing Content Writer and editor of The Independent Pediatrician. She holds a master's in Professional Writing from NYU.