Physician Options
Seminar with a Time-Management Expert

It's a Thursday morning in Deerfield Beach, Fl, on an oppressively hot summer day in June. Inside an air-conditioned Hilton Hotel conference room are forty physicians and practice managers sweating through intensive lectures by suited swami, Greg Korneluk.

"We are the Home Depot of the physician consulting business," CEO Korneluk says of his company, the International Council for Quality Care, based in Boca Raton, Fl. "We don't do the work. We train others to do the work."

In a sort of rigorous fitness program for practices, Korneluk's seminars and strategic teaching sessions "graduate" more than a thousand apostles annually who fan out across the country like missionaries with hundreds of ideas that they predict will result in increased referrals satisfied patients and more efficient and profitable practices.

Some of those in Korneluk's Deerfield Beach audience are repeat clients who swear by his philosophies. Family practitioner Mary Welp, MD, a mother of two from Carrollton, Tx, says that after she started heeding Korneluk's advice last year she achieved such efficiency she was able to cut her work day end from 11 PM to 7 PM. "I had a problem delegating responsibility, specifically phone management," Dr. Welp admits. "Now, in between patients, I hand charts to a nurse and tell her what to say on callbacks. I also handle all prescription refills by fax. That cuts phone calls in half. I have a lot less stress in my life." Another repeater, enthusiastic Niagara Falls, ENT, Leonard Makerewich, MD, says his practice income tripled since he began working with Korneluk in 1982. What's more, he's home by 6 PM nightly, with no incomplete charts or callbacks left to do. "He (Korneluk) took me from seeing 14 patients a day to 65, and every one of them is seen by e," Dr. Makerewich says. "He took nonessential things away, like writing out blood reports and taking a history. He trained me to work at a level where I'm purely using my diagnostic and treatment skills-the things I was trained to do."

Detractors among Korneluk's Competitors

Those meeting Korneluk for the first time were skeptical about whether his theories would work in practice. "Will it really work in the real world?" questioned seminar attendee Gregory Pauly, administrative director for primary care at Boston's Massachusetts General Hospital. Pauly manages 220 physicians at 16 sites.

Korneluk's competitors dispute many of his methods, but often can't argue with his results. "He's trying to differentiate himself in a crowded market of practice management consultants," notes Michael Parshall, vice-president of The Health Care Group, a leading practice management-consulting group in Plymouth Meeting, PA. "However, I've talked to clients who've said he's done a nice job for them," Parshall admits. Some of his teachings require completely remodeling an office to gain efficiency. "He takes an industrial engineer's approach to practice management. I once heard him say you shouldn't have doorknobs on exam room doors because they slow you down," says Parshall.

"Some of what he says is politically correct," adds John D. Blair, director of health care strategies at Texas Tech University, Lubbock, and co-author of Strategic Leadership for Medical Groups (Jossey-Bass, 1998).

Time and Motion Studies

Perhaps the most mainstream of the Korneluk teachings is his Council's mantra: the most successful doctors improve quality and patient satisfaction while increasing volume and efficiency. To physicians, this message often seems to be a contradiction in terms. But through elimination of wasted time and quality improvements, Korneluk claims it can be done.

How Much Time Do You Waste?

1. Excessive walking between patients

2. Waiting between patients and cases

3. Travel between offices and hospitals

4. Excessive medico-legal documentation

5. Phone interruptions from doctors

6. Phone interruptions from patients

7. Handwriting charts and forms

8. Inefficient facility

9. Lack of complete information in chart

10. Not enough support staff

11. Too much support staff

12. Incompetent staff

13. Lack of delegation

14. Drug reps who socialize

15. Staff who socialize

16. Staff turnover and retraining

17. Crisis management

18. Unscheduled, non-urgent patients

19. Junk mail

20. Unproductive hospital committees

21. Unproductive medical society committees

22. Fatigue

23. No established procedures

Source: International Council for Quality Care, Boca Raton, FL.

"Money is the result of delivering quality," he says, "One of the worst things to happen in health care because of managed care is that providers focused on dollars. When doctors focus on economics, dollars go down. When doctors focus on quality, dollars go up.

"Korneluk's doctrine is backed by 13 years of physician time-and-motion research kept in a proprietary database. "You must have data to support your theories or else they are anecdotal," he says. Among the 5000 to 10,000 doctors in Korneluk's database are physicians at the Mayo and Cleveland Clinics. While his detractors question the legitimacy of the database, Korneluk responds that the questionnaire part of his review was validated by professors of statistics at the University of Michigan.

Korneluk says he has studied why the best physicians achieve "Since I was 13, I was always interested in why some people succeed and others lead average lives," he says. "I wanted to find out how successful people get there."

With a clipboard and stopwatch, he has shadowed successful doctors, camping out in their spare bedrooms, watching what time they rise, what they eat for breakfast and most of all, how much time they waste, if any. The result is a system of more than 800 criteria for benchmarking physicians and streamlining practices to cut the fat. The criteria are encompassed in the acronym, "CARES Plus." For each letter of the acronym he supplies dozens of time management and quality improvement tools.

C: care, skill and judgment:

A: access in scheduling, patient flow, and time management:

R: how physicians represent themselves to patients, referring doctors and the public:

E: economics-overhead management, payments and collections: and S: developing loyal staff and support.

S: developing loyal staff and support.

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