The majority of Canadian GPs and FPs are their own bosses. And although that can be a blessing in some respects - after all, everyone's had an awful boss or two - owning your own practice can also be a real challenge. Besides seeing patients, you're ultimately responsible for everything from hiring the staff to making sure the front desk is stocked with enough pens and Post-it notes.

Rick Jamison, the national director of Practice Solutions Consulting, sees doctors inundated by office work all the time. "I have one client in Alberta - he does everything. He changes the light bulbs, does the spreadsheet for distribution of income at the end of the month. Because he loves to do it - that's sort of his hobby. And that's great if you have the time and the interest and the expertise, but a lot of physicians prefer to focus on the practice of medicine."

If you don't want to have to worry about things like finding the right computer cables or changing the toner in the copy machine, it might be time to think about outsourcing some of your office tasks.

TIME IS MONEY

Where do you start? First off, let a third-party company handle your uninsured services billing. By some estimates, the average Canadian physician is missing out on $20,000 to $30,000 per year by not charging for uninsured services like filling out insurance forms and sick notes, or renewing prescriptions by phone. You could try to create your own method for collecting money from patients but outsourcing it will save you time - and therefore, as Benjamin Franklin famously put it, money. "Physicians don't want to have to be burdened reconciling claims and chasing down payments and so on," said Mr. Jamison. Plus, you'll avoid a nightmare of paperwork, collection agencies and, yes, let's face it, some patients' complaints.

Another reason to outsource your uninsured services billing is to avoid suffering the same fate one Ontario doctor did in 2006. After Dr. Thomas J Barnard created his own billing system, his office assistant began telling patients they could no longer be treated by Dr. Barnard if they refused to pay a "block fee" to cover uninsured services. Complaints reached the College of Physicians and Surgeons of Ontario and Dr. Barnard was suspended from practising for two months and fined $2,500. He's not the only doctor in Canada who's found himself in hot water over a homegrown billing system. To avoid legal problems, a quick phone call to a third-party billing service can get you well on the way to a safer, outsourced solution. In a Practice Management article published last year, we compared the costs and benefits of the four largest Canadian companies that can handle your uninsured services billing: CallerMD, DCC1, Doctor Services Group, and the CMA subsidiary Practice Solutions. Read it online here: http://www.parkhurstexchange.com/node/4860.

Uninsured services billing is among the most common office tasks that Canadian doctors delegate to outside companies, said Mr Jamison, but that's not all you can outsource. "Just about anything can be outsourced," declared American Medical News a few years ago -- up to and including watering your plants.

WHAT TO OUTSOURCE

Outsourcing office work often makes more sense for small practices than large ones, Mr. Jamison explained. "If a clinic has a professional manager - somebody with expert training in accounting, financial matters, human resources and information technology - they can do a lot of that stuff internally," he said. "Some smaller clinics, though, don't have the ability to hire somebody as high-priced as a professional manager, so they may outsource bookkeeping and their technology needs."

Besides the obvious ones - things like bookkeeping, taxes and legal matters, that are often too onerous or too complex to do in-house - where else can you save time and money by outsourcing?

Information technology: Unless you're a real computer whiz, it may make sense to bring in an outside firm to set up and maintain your computer network as well as your printing, copying and faxing needs. If you can't tell ROM from RAM, or LAN from WAN, then call in the experts, explain what you need and let them get you up and running. Your choice of IT consultants, if you live in a medium or large city, should be quite large, so make sure to compare different companies' rates and terms before you commit.

Medical records storage: Outsourcing the storage of your patients' records may be useful for a variety of reasons: you may be retiring, closing your practice, switching over to electronic records, or you may have many inactive patients' records collecting dust. In all those situations, you are legally required to hold on to copies of patients' records for as long as ten years, depending on where you live. A lot of the retiring or moving physicians he consults for, Mr. Jamison said, "don't want to be burdened with having to retrieve files from time to time for patients. They don't want to store these records in their home or their garage." Several Canadian companies specialize in secure medical records storage and also manage your patients' access to files for a small fee the patients must cover. Two options, both based in Ontario but serving physicians across the country, are DOCUdavit Solutions, which offers free storage for primary care physicians, and Securit.

Voicemail: Believe it or not, you can even outsource your after-hours voicemail. "I hate voicemail," PhysicianEntrepreneur.com technology editor David Granoff wrote earlier this year. "Half the time you have to play a message back more than once if there's something important," he complained. And even then, he said, "it's usually a long rambling message that could have been summarized in a note that would have taken you a few seconds to read." He elected to forgo the whole headache and instead hired a live operator service to take his messages 24 hours a day and then pass on the essence of the message clearly and concisely. Some companies will even email you the notes on the messages. Mr. Granoff bragged that he pays less than a dollar per day for the time-saving service. (Don't forget to run a few tests of your own to make sure the service is working accurately and keeping pace, he advised.)

Recruiting staff: Larger practices in need of a professional manager or other office staffers might find it useful to outsource the hiring process. "Most clinics will use headhunters or recruitment firms like Practice Solutions Consulting for professional managers," said Mr. Jamison.

Transcription services: Your transcription can easily be done by outside firms, if you're willing to wait a couple of extra days to get the notes back. That's not a problem for some doctors, so getting your transcription completed remotely - even overseas, although Mr. Jamison said there are some concerns about that - may make sense for you.

Purchasing supplies: Hiring an outside consultant to manage your office and medical supplies purchasing could be worthwhile, but likely only for practices that have a very large volume of supplies coming in regularly. "It may be time to work smarter by taking control of the things you do best and letting go of things that can and should be done by someone else," wrote purchasing consultant Michael Lawson in the magazine Tennessee Medicine last year. "The practice and the administrator might be better served by outsourcing supply purchasing services that require expertise beyond what is typical for an administrator or physician."

A WORD OF WARNING

For some physicians, outsourcing certain office services might be a huge time-saver and entirely worthwhile. For others, less so. Most doctors will likely want to outsource a few things - but not everything. "I think physicians generally should take at least a certain level of interest in their business," said Mr. Jamison. Outsourcing too many of your office tasks might mean that "sometimes you are not in control of them as much as you'd like to be or should be."

A good example of one office service that it doesn't make sense to outsource is telephone reminder calls placed to patients a day or two prior to their appointments. "Some services like that are provided," Mr. Jamison said, "but that is becoming more automated all the time with medical practices in this country" as doctors' scheduling is increasingly done on specialized software that can be interfaced with a phone system. But in this case, even if you don't have an automated computer-based phone reminder system in place, simply hiring a staffer to make the calls could be more efficient than outsourcing. "We had a client who was losing $100,000 a year by not phoning patients a day or two in advance of their appointments," said Mr. Jamison. "They employed a half-time clerk to phone those patients a day or two before. It cost them $15,000, and they gained $75,000 a year."

Keep in mind that a major risk in outsourcing office services is that the costs can begin to add up. "You can run up a pretty large tab pretty quickly if you're outsourcing a lot of these services, especially to firms that charge a lot for their expertise, like for recruitment," Mr. Jamison advised.

His advice to doctors? "You can outsource everything if you like and pay 80% overhead, or you can control what you do internally, save some money and know more readily what is happening with your business." No single outsourcing strategy, said Mr. Jamison, can account for different physicians' requirements, interests, skill-sets and budgets.