motoring
d o c t o r o n a s o a p b o x D r . c h r i s p e n g i l ly
D r . k e l ly s i l v e r t h o r n
Dr. Chris Pengilly is Just For Canadian Doctors’ current affairs columnist. Please send your comments to him via his website at drpeng.ca.
Dr. Kelly Silverthorn is a radiologist and Just For Canadian Doctors’ automotive writer.
50 years of evolution
get paid what you deserve
What would yesteryear’s engineers think of the latest Porsche 911 and Corvette?
Increase your income by being pro-active and working more efficiently
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here are two ways for a physician to increase his/her take-home income—work harder and longer hours or work more efficiently. The formula is to maximize the time for the physician to perform billable work, and to minimize the costs in achieving this.
his year saw both an all-new Porsche 911 and all-new Corvette. Coincidentally (or not), 2013 is exactly 50 years since the original 1963 Porsche 911 and Corvette Stingray debuts. A lot has changed since then. I tried to imagine what those early 1960s engineering teams would think of the new models if teleported Star Trek-style 50 years forward to the 2013 Geneva and Detroit Auto Shows respectively. Our “away teams” would re-materialize at the back of the 2013 show crowds as the drums rolled and the curtains were raised. What gestalt would emerge from our tele-
ported engineers’ first look at the new models? Once they assimilated the 50 years longer, wider and more in the making…the menacing ethos, I do 2013 Porsche 911 Carrera 4S Coupe and original Porsche 911 2.0 Coupe.
hot!
think they’d recognize these distant progeny as the offspring of their original creations. Remember, they’d be unaware of the look of the five intervening generations of Corvette (or 911). Proportions, logos and scripts have shown some consistency through these generations—and for the Porsche at least— headlights and taillights too. I’m surmising the original engineers would have little appreciation of the aerodynamic advances now contained in the body shape and undertray…both of the 1960s models suffered increasing lift with increasing speeds. The modern cars generate desired
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downforce at speed. They also have far lower coefficients of drag. The new cars need these aero advancements to safely reach their top speeds of 290kph and more. Some of the braver teleported engineers would have white-knuckled the earliest 1963 versions of these models to reach their claimed top speeds of just more than 210kph. The show cars would be rotating on an elevated carousel with standing, murmuring crowds all around, and camera flashes popping. The teleported teams would notice how
tires and wheels have changed. Their early products employed 15-inch diameter wheels vs 18-inch plus today. Standard issue wheel widths were five to seven inches then; today, 8.5 inches, front, 11 inches, rear. Tire sidewalls were 75% of tire width then, just 30 – 40% now. The load and speed rating for modern tires are also much higher. I’m confident our early engineers would peer between the wheel “spokes” to see the original Corvette’s 11-inch diameter drum brakes had evolved into ~13-inch disc brakes (ditto the 2013 911 disc diameters). The acronym ABS (anti-skid braking system) would be Latin to our time travellers, as would be the alphabet soup of all the other electronic control systems aboard. And improved braking performance has progressed to a distance of just 100 feet at 60 miles per hour. Being engineers, I’d like to think the timetravellers would next migrate to the show’s floor models and “pop the hood.” Past the bolt-ons, they’d see the familiar. Porsche still runs a rear-engined, horizontally opposed six-cylinder, overhead cam engine—though now water-cooled and four-valves per cylinder. The Corvette engine would be even more unadulterated, still running a front-engined, pushrod two-valve-per-cylinder V-8—
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though the Stingray’s transmission is now one with the rear-mounted transaxle. Would both away teams be surprised today’s cars run on gasoline, albeit now unleaded? If so, at least they’d be impressed by how much more efficiently the fuel is consumed. The original Porsche derived 130hp from its 2.0-litre displacement versus the 350hp from 3.4 litres it gets now. The Corvette improved its base V8 from 250hp from a 5.2-litre displacement to the current 455 hp from 6.2 litres. Yet, fuel mileage and non-CO2 emissions are now light years ahead.
Our teams would be sure to sit in the floor models. Those with three pedals and stick-shift would be familiar to them, though their early 4- and 5-speed transmissions are now both 7 speeds. The teams would have little idea of the numerous airbags surrounding them, or all the crash-worthy engineering and testing now done. The sound and navigation systems would, quite simply, blow their minds…so would the numerous nanny-state warning and hectoring stickers. Hopefully our away teams would find a way to huddle with some of the current engineers. “Ja, the Porsche is still a steel unibody, but different,” and “Yah, the Corvette body is still fibre-based, but different.” The usual laments about corporate politics, office perks and assigned parking stalls probably haven’t changed much in five decades. But pushing past the work stresses and technojargon into their shared passion for these cars, I’m sure the early pioneers would come away confident the current generation carries the flame competently. Few car companies last 50 years. Fewer still are the car models that last 50 years. Still, would our early teams be disappointed that, after more than 50 years of intervening engineering excellence, they’re seeing mostly evolutionary changes rather than revolutionary? True, many advancements would be invisible to their eyes. Would today’s auto engineers think similarly about evolution/revolution if teleported to 2063? But free food is free food, and tired sore feet need a rest. I’m banking on Scotty locking onto the away teams from pre-set coordinates to the show’s hospitality areas.
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> Be accurate in submitting billing and challenge refused billings > Work in a group of 3 or more physicians > Change to an electronic medical record or, if already a user, optimize this > Use voice recognition technology > Charge for uninsured services It may seem obvious but the physician will not be paid for what he/she does not bill. Such errors are easy to make. Sometimes there is a second fee with an office visit that can be overlooked. A particular area of risk is work completed outside the office, where the support staff has no real awareness of what work is being done. Immediately upon returning to the office a note of the work should be made and given to the staff. As the fee schedules have developed over the years they have become more complex, and refused payments are not uncommon. I am surprised by the number of physicians who never see their submissions or remittance statements from the paying authorities. It can be quite an eye opener; it is important that these are analyzed and, when appropriate, refusals vigorously challenged. By reviewing these the physician can learn which services are not being paid and could be billed alternatively or avoided. Working in a single-handed practice makes poor economic sense. The cost of overheads such as photocopiers, fax machines and janitorial services will be divided among the number of members in the group. Staff can be employed more efficiently—a group of four physicians will likely employ four medical office assistants. Each one could have an area of increased responsibility, for example, one concentrates on the billing, one oversees supplies for the office, one has nursing
expertise and the fourth manages the medical record. Another significant saving is that with three or four medical office assistants it is not usually necessary to pay extra staff for holiday relief. Changing to an electronic medical record saves support staff a great deal of repetitive unproductive labour, such as pulling and refiling charts, and the labourintensive chore of filing paper results and letters as well as organizing the chart. In fact, the savings are such that four family physicians may need to employ just three medical office assistants. A good EMR will offer several other advantages. Add-on features improve patient safety while saving money. Most will record all medications as they are prescribed and simultaneously check for potential drug interactions. Timeconsuming and irritating tasks like infant growth charting are automatically graphed. A good EMR should have an easily accessible template to rapidly generate excellent referral or consultations letters and even lengthy medical reports. Handwriting or labouriously typing (unless the physician can type at 70 or 80 words per minute) is time-consuming and tends to lead to too brief recording of medical information. A transcriptionist will demand at least $30 an hour, but save the physician sufficient time to see two or three more patients in a day, which would more than cover the cost. Voice recognition has now reached the point of being very usable and another economy. This requires a powerful computer with a quad processor and about 2GB of RAM. A dedicated medical program is essential, not only for the vocabulary but also the syntax. It is tempting to think that the regular program can be trained to learn the “few medical terms I use” but this is not the case. It will likely lead to frustration and abandonment of what could have been a major money saver in a physician’s practice. The program will cost the physician about $1,600 and two hours dedicated to learning for optimal use of the program. At $30+ an hour for a typist, the program will pay for itself within a few months.
Medicare covers many medical expenses but not all by any means. Patients are becoming aware of this and are surprisingly willing to pay for many of these uninsured services. Many accept the idea of an optional annual user fee, which will give coverage for brief ‘doctor notes,’ repeat prescriptions over the telephone and minor cosmetic procedures such as cryotherapy. These and several other ideas are dealt with in detail in my eBook, The Successful and Audit-Proof Medical Office. After some 30 years in medical practice and peer assessments I have learned a great deal about running a medical practice. This book is the culmination of that learning—my ‘soapbox’—and something I’m happy to now pass on (see page 31).
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FALL 1/6 2013 Just For Canadian Doctors Vertical : 2.25”w x 4.875” h May2013
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