Find time, to make time, to fix time

“We need time to fix our time problem. And we can get stuck in this loop where we’re like, ‘I have no time to find time to make time to fix time.’”                                                          – Dr. Scott Cameron

Is your schedule running you—or are you running your schedule?

On this episode of The Allergist, Dr. Mariam Hanna is joined by pediatric allergist and clinical immunologist Dr. Scott Cameron to talk about the chaos of clinical practice and how to take back control. With tips that go far beyond time management, Dr. Cameron shares practical strategies for streamlining clinic operations, handling unpredictable days, and investing in smarter workflows—without burning out.

On this episode:

• The hidden culprits of clinic inefficiency—and how intake forms can help fix them
• How to triage patients better, with tips for predicting complex visits
• How to schedule around unpredictability—like anaphylaxis challenges—so they don’t derail your entire day
• The “project day” concept: why setting aside time for workflow projects can save you hours down the line
• Cutting down on admin overload with physician-driven templates, better patient communication, and targeted uses of AI
• How pairing with trainees can preserve teaching time and clinic flow
• Making time-saving tools work for you: from smart goals and macros to QR codes and intake automations

Get practical. Get faster. Get home on time. It’s all about working smarter—not harder.

Visit the Canadian Society of Allergy and Clinical Immunology

Find an allergist using our helpful tool

Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca

The Allergist is produced for CSACI by PodCraft Productions

Transcript

Dr. Mariam Hanna

Hello, I'm Dr. Mariam Hanna and this is The Allergist, a show that separates myth from medicine, deciphering allergies and understanding the immune system. It's Monday morning. I walk into clinic, coffee in hand, ready to take on the day.

Within an hour, I've fallen behind. Inbox messages from the weekend, pharmacy clarifications, lab results. The oral challenge this morning took 45 minutes straight of crying before agreeing to take the first dose.

Clinic is now running behind schedule. Hi, your next consult is 10 minutes late, I'm told. The waiting room is full.

The screaming hums in the background at this point. I'm exhausted and it's Monday. Does anyone else quote poetry randomly?

Oh, woe is me to have seen what I have seen, Ophelia declares in Shakespeare's Hamlet, and she watched him lose his sanity. Okay, well that's dramatic, but sometimes throw in an anaphylaxis or laundry list of problems on the benign rule-out allergy consult and that's my life. Is the good side?

I'm told I'll get better. Some habits are probably me, I'm a talker. Some I blame on the crumbling healthcare system, it's a disaster.

But hey, some are apparently within my direct control to fix. I've brought in today's guest funny enough on a Monday evening to help us go through workplace efficiency. It's been a long winter.

Vitamin D levels are at an all-time low at this point. And while January is about New Year's resolutions, spring is about cleaning out bad habits. It's my distinct pleasure to welcome today's guest, Dr. Scott Cameron. Dr. Cameron is a pediatric allergist and clinical immunologist with a PhD in immunology from the University of Toronto. His research focuses on oral immunotherapy in children and has contributed to CSACI guidelines and widely viewed anaphylaxis educational videos. Beyond research, Dr. Cameron is committed to medical education training fellows with a focus on practice management and workplace efficiency. He has also successfully advocated for key policy changes in allergy care, including revision of provincial anaphylaxis protocols and the removal of provincial funding for food mix IgE testing, a toastless test. As the head of a busy private practice, he has developed expertise in workflow optimization, EMR efficiency, and the administrative streamlining. These are all buzzwords in today's clinical practice.

All perfect interests, he will share practical strategies to enhance clinical efficiency, not just for my busy practice but I hope for yours as well. Dr. Cameron, thank you so much for joining us today and welcome to the podcast.

Dr. Scott Cameron

Mariam, thanks so much for that wonderful and kind introduction. It's funny that you talk about your terrible clinic day and I think it really resonates with a lot of us.

Dr. Mariam Hanna

So what we'll start off with is what are the most common obstacles, things that that we have in our control that can disrupt an efficient clinic workflow?

Dr. Scott Cameron

Yeah, so I think you mentioned one like this simple consult that you think is going to take 30 or 40 minutes and a laundry list comes in. So part of it has to do with triage. So what information are we getting from our referring physicians and other health care providers and how much does that information let us guesstimate how long we think we need for a visit?

And are there certain visits for us that take longer than another visit? So for example, a simple allergic rhinitis in an eight-year-old might look very different than a severe asthma with three hospitalizations over the last year in the same age group of child. So giving them each the same amount of time doesn't really lead to an easy clinic schedule for us especially if a couple of those more complex patients that are going to need more time are stacked back to back.

So I think triage is one of the areas where we definitely can run into trouble. If we think about some other things, so some of those might be predictable and some might be unpredictable. You mentioned anaphylaxis.

So there's an example of an unpredictable workflow that can come into everybody's office where you know based on how the patient was triaged and for what kind of challenge and what sort of resources we have in the office, how well prepared are we to manage that anaphylaxis and how much does that disrupt the rest of our day? So even with that, looking at patients beforehand and coming up with a high-risk, medium-risk, and low-risk stratification is helpful. Maybe we don't want two high-risk or three high-risk or four high-risk challenges in the same day and maybe we want to distribute these out so that we have less of a chance of severe clinic disruption by an unexpected event like that.

Dr. Mariam Hanna

So I'm hearing kind of two really good examples. One is triaging and inappropriate triaging, but some of it has to do with like intake or triaging them appropriately is what information we've received before them. So I'm gathering that you do intake forms or something that pulls that out for you or you require the physicians to fill that out or how do you do that, Dr. Cameron ?

Dr. Scott Cameron

Great question. So the first thing is that we want the information that we want in order to do a good triage, both in terms of the importance and how urgently that patient needs to be assessed but also which issues do we need to address in that visit. And I think a lot of us have gotten in the habit with healthcare being so broken, and we all have to admit, you know, the stress and extra pieces that COVID brought to this really laid bare to all of us how broken our system is in so many ways.

But what we receive in the information when we're asked to see a patient is usually subpar. So we're often not given a full physical examination with the onset of virtual care. There often hasn't been any initial treatment of the condition with a referral.

And a differential diagnosis often isn't listed by the referring physician. So all of these pieces, as well as some of the social aspects that can make care more complex, if they're not included in the original referral, they make things really tricky. So one of the things our offices try to do is to bring in an intake form.

So they basically get a one-sentence line for each problem and that's it. So by looking at the intake form before the patient comes, you have an idea of what they're hoping to get organized and sorted out during the visit. And this often doesn't match what the referral is for.

And so it allows you to either get some more information in advance of the visit, or it at least lets you know it's going to be a more complex visit than what it says on the initial referral form.

Dr. Mariam Hanna

Yeah, that sounds very helpful. And I think hearing what are the priorities from the physician's referral versus what are the patient priorities that need to be addressed. And addressing both those baskets during your consultation are always something that a specialist needs to do or needs to figure out how best to balance.

So in my training, at the beginning, we would do focused problem lists and we would go through all kind of the atopic issues that the patient had. Increasingly, it became like very apparent to me that when you would have a complex, very atopic patient, that addressing many issues in one consultation became an overwhelming amount of information for the family. While they appreciated your thoroughness, they were overwhelmed and almost didn't know what to do with it.

So am I misunderstanding with this kind of intake form and gathering all this information up front? Do you end up scheduling like really   long consultations with patients to go through all these issues? Or do you break it up?

Or how do you schedule them once you know that?

Dr. Scott Cameron

Great question. So I do think it's important to break it down into sizable chunks and also setting some expectations at the beginning. It's a lot easier when you know what your item list is to address that you say, hey, I see that you really want this addressed today and we also see these other items.

So for me, the most important other item to address is this one. But these other things are things that an allergist and immunologist can deal with. So we might not be able to deal with those today.

And if so, I'll send a note back to your primary care provider telling you we weren't able to address them and asking them what they want to do. So that's been our approach for it. And I have to say that I've been trying to get better about that in order to make my consult length more reliable and more schedulable.

Because I think when we try and bite off too much, that's often when we get 30 or 40 minutes behind on a day. So I think whether you're peds trained, adult trained, seeing pediatric or adult patients, being able to have an idea of how long you have with each patient staying close to it's really important. And I think that's a challenge for all of us.

Dr. Mariam Hanna

Dr. Cameron, you said the sentence very nicely about there's more than one issue and needs to be addressed at a subsequent appointment. But I've learned that sentence is golden and that your phrasing of it is really important to say in a consultation when you feel like you've reached that point in your patient interaction where you need to really focus on the key issue at hand to not lose sight of that. So that's a great tip.

Can we get more practical ways to do this? So how are you building in flexibility in your schedule to accommodate these kinds of things when they happen? And what are practical ways that you can suggest or address that with?

Dr. Scott Cameron

So how to schedule the unexpected, which happens all the time. So things like an urgent spot. So once a week, I have an urgent spot that my staff can fill only one to two weeks before the urgent spot comes up.

That way, a regular clinic patient that's not urgent doesn't fill in one of the spots. And instead, they push out several months to when they should be seen based on their triage. And instead, if there's an urgent patient that comes up within a couple weeks, we can get them in pretty quickly.

So that urgent spot allows staff to fill in one to two weeks before. And if you can't fill it one to two weeks before with a real urgent patient, you instead fill it with a preschooler where you know, or sorry, an infant where you know that a parent is likely to be home and very flexible with the last minute scheduling, or you fill it with somebody who is a squeaky wheel and keeps calling your office about a referral and they want to be seen. And so this makes it really easy to schedule this from a staff standpoint, as well as it's important how you sell it.

So the person calling for the appointment should say, wow, we have this urgent appointment because we're booking two or four months out from right now. And Dr. Cameron saw your consult request, and he really wanted to see you right away. And so this is the time and date we have.

Otherwise, you'll be waiting three or four months to get in. And often we find when it's sold that way that it's a special spot for really urgent patients, the patients really see value in it and are likely to say yes when it's offered to them. So one of the other challenges is having a trainee in the office.

And so I find when I have a trainee I always get a bit behind on paperwork because I spend so much time teaching between patients. And one of the things we've started to do for this is to pair book. So the trainee sees a patient at the same time that I do.

And I find when I do that, I have already finished with my follow-up visit, and they are just starting to finish their consult to come back and review. And I find that it gives a ton of time between patients where I still get to do teaching, but I also have time to finish my own letter. So I don't see any more patients when they're with me.

We're just seeing them at the same time. So it creates more gaps in the schedule that allow for teaching or just the inefficiency that comes with having a trainee in the office.

Dr. Mariam Hanna

Okay, we always feel like it's too busy to fix inefficiencies. If I were like, I would like to implement my Monday mornings off and ghost spots throughout the week or towards the end of the week. Like, how do I make time to improve my workflow?

That's more time blocked off to fix my time. 

Dr. Scott Cameron

I think that's a fair point.  We really need to, in order to get past this and to get past this barrier, we need time. So we need time to fix our time problem. And we can get stuck in this loop where we're like, we're way too busy.

I have no time to find time to make time to fix time. And we go around in circles. And so really what we need to do is commit to doing a project day.

And I really want to challenge our listeners to think about doing this for themselves, because I started to do it for myself and I really think all the ideas around making things run really come down to Project Day concept.

So we can look at it as either time saved or money saved as we go. Because I think it feels weird to not make income for a day and just be working on these little projects and not seeing patients.

Because there's this big pressure on us to either deal with our long wait list, deal with our current patients, deal with our documentation, deal with our trainees, deal with our teaching, deal with our research, all of these different areas where we get pulled, but we don't really invest in making ourselves quicker. So let's go through another example. You spend some time to do a pre-done requisition.

So these are all tiny things that are going to take you 20 or 30 minutes to do. But if you take a project day to do it, you're going to easily five recs a day saves you 15 seconds per requisition. So let's say it takes you an hour or two on a project day.

This is going to save you 35 hours over five years. So there's a huge savings in time. What I ended up doing that I'm most proud of is my intake form.

So my intake form saves me 10 to 15 minutes per new pediatric consult that I do. And so it took me two project days with a programmer and probably about two thousand dollars worth of cost to have the programmer do it. And that saved me 10 minutes twice a day.

So when I work this out, this is 66 eight-hour clinic days worth of time that I've saved myself by investing in two clinic days. So and these are the small changes that you can make that could eventually add up to this. Many of us are working enough.

We don't need to see more patients. We just want to be done our non-fun administrative work faster. And so my goal isn't to see extra patients with this time.

It's to get home sooner, spend more time with my kids. And so I think what we need to do in order to become more efficient is keep that goal in our mind.

Dr. Mariam Hanna

Okay, so I'm liking this idea of project day, but how do I prioritize what I need to address first?

Dr. Scott Cameron

So I think the first place to start is by making a SMART goal. So if we're going to take our first step in making a project day, we need to identify some things we can do. And so a SMART goal is a structured way to set and achieve a specific objective.

An acronym stands for Specific, Measurable, Achievable, Relevant, and Time-bound. So if we say that we want to shave two minutes off of each patient interaction through the day and we see five new patients a day. So we had all of these different ideas to do that by making new prescription forms that are pre-filled, by making asthma action plans that are pre-filled, and some requisitions.

So we need to make sure that we don't break the rules for the project day to be successful. So rule number one, Mariam, no patient care happens on your project day.  No urgent spots…

Dr. Mariam Hanna

You can't multitask, no quick phone calls… 

Dr. Scott Cameron

No faux emergencies, no frantic parents.

You put them on to your next day. Your next day is crappy, but today is your project day. You are absolutely unavailable for patient care and your staff know it and you know it.

Number two, this is not a catch-up day. It's not time to write a grant. It's not time to finish your letters. It's not time to finish your billing. This is a day to invest in yourself and to pay it forward to your future self, so you don't get to play catch-up with the day.

Dr. Mariam Hanna

So now I'm booking a project day and a catch-up day, Dr. Cameron. Alright, alright.  Okay, keep going.

Dr. Scott Cameron

So number three, no patient management. It is so important I made it a rule repeating rule.

Dr. Mariam Hanna

Yeah, I was going to say that was number one. Okay, so that's number three as well. Okay.

Dr. Scott Cameron

Rule number four, staff can work at the same time, but they're also working on workflow, efficiencies and projects to make them or you faster. So they're not allowed to do patient care or they're going to be bugging you about patient cares. And then rule number five, every project day has one easy task that gets done first.

Dr. Mariam Hanna

It's beautiful, including the repeating rules. But okay. 

So other than handouts, can you give me some other ideas to involve staff in efficiency improvements or what you've done with them as well? Like how much do they talk about like scheduling or patient scheduling and patient flow versus what you're dealing with in terms of what you would like as a template?

Dr. Scott Cameron

So you say to them, hey, every time you think to yourself, I'm really annoyed about whatever, I would like you to put it on this list. So I'll give an example of this. We get lots of requests for epinephrine auto injector refills.

And the email requests that we get will usually say, hi, I'm mom's name. I would like Pete, not the child's last name, just their first name. I would like Pete to have an epinephrine auto injector refill.

They don't tell me the weight. They don't tell me the pharmacy. They don't tell when he was last prescribed or whether or not he has asthma or any other things.

And so I get a task on my list that says, please write a new epinephrine auto injector prescription for this patient. Now I have to go into the chart and review all of those different things and figure it out. And so this becomes what I call a multi-touch project where I need to go and do several steps in order to get to the next piece.

So our staff were getting annoyed that I kept tasking them back saying, what's the weight? What's the pharmacy? What's this?

What's that? And so we made a template. And the template is something that our MOA in the office thought would be a good idea after her and I discussed things.

And I said, I'm really noticing that this is a lot of back and forth emails. What do you think about just making something where we ask the same questions every single time? And it's just an email template.

So we don't ask anything else. The email template goes out. They have to fill it out or we don't do the prescription refill.

And so we started doing that. And now this template comes back with all of the details that shows up on the chart. And now that's my task.

And so I know exactly what medications they're asking for a refill for. I know exactly what they're on right now. I know what their pharmacy is.

I know the child's weight. And it's all included. And my staff don't have to type that email every single time.

So templates are a great place to support your staff with making their clinic workflow easier. You know, the patient that you saw two years ago that you sent back to the family doctor that suddenly has a new rash and they think that you're their allergist and you're going to see them about the new rash. That's a common email for your staff to have to deal with.

So being able to have policies and procedures that everybody agrees to and a clear, nice email that goes to the patient explaining what the process is prevents some of those snide, snarky emails that sometimes come back. And I think also contributes to your staff's enjoyment of the job. So one other place where we use this, we took our original draft and ran it through ChatGPT and said, hey, we have this email that we send to patients when they ask for this.

And we would like the email to be more polite, patient centric, but still explain our limitations. And it's amazing some of the language that you get back. And just it would have taken me 30 minutes to reframe the email in a better way.

And it's at least a draft that looks different written by something else that is useful.

Dr. Mariam Hanna

That's fantastic. Now, I think you've already told us, but of all the workflow changes you've made, which one has been your biggest return on investment?

Dr. Scott Cameron

Yeah, so I'd say the intake forms for sure. I also made an allergic rhinitis intake form because I found that was the easiest set of questions I could ask that would shave, again, an achievable goal. So after doing the intake form, I said to myself, wow, that took two days.

That was a lot, but look at all the time I saved. So rather than trying to do one form that does all things, why don't I take allergic rhinitis and try and shave 10 or 15 minutes off every patient I see with allergic rhinitis? What can I do to do this?

And one of them was an intake form. So now the patient gets a general intake form, an allergic rhinitis intake form, and my allergic rhinitis intake form basically writes the paragraph about the allergic rhinitis. So it saves a ton of time.

Now, there are other ways to shave. So one other thing we really like is doing some educational videos and putting them on QR codes. So you can have a patient go out to the waiting room while they're waiting for their epicutaneous testing.

And in the meantime, they're watching a video on how to use an autoinjector. And so our YouTube video that we did, some of the asthma videos on how to use inhalers, and just having all of those as QR codes so the parent can actually watch the video on their own phone, and then forward the video to their partner who's usually not at the visit. So those are some easy to do things that save you a couple minutes on every patient regardless.

And then yeah, some of those other little things like the like all of the requisitions. So I think you got to pick something small though for your first one Mariam. I wouldn't do the intake form.

I would definitely pick. I tell you every single time I fill out one of those specific IGE forms that I don't have to look for the boxes. I'm like that was worth my time.

Dr. Mariam Hanna

So yeah. That's true. My ambitious plan is to remove that form altogether and just write the word of what it is that I would like.

And so that it doesn't look like the buffet menu. But I guess in the interim, I should learn to find the box more quickly. Okay, what's your personal efficiency goal right now, if I may ask?

What's Dr. Cameron doing on his next project day? Or what's the project currently?

Dr. Scott Cameron

Oh, great question. So my next one is going to be an asthma follow-up intake form, because I see so many of my patients for asthma follow-up, and I want to know if they're having problems with how they take their inhaler with technique, what their adherence is like. I get an ACT and CACT score from them to look at asthma control.

And all of these things take time along with the spirometry. So I think if I had them come in and do an intake form follow-up that wrote part of my note, I could spend the majority of my time in that visit dealing with the challenges they're having in achieving asthma control, rather than assessing whether or not they have control. And I've already done some of this by making sure that we have spirometry and the asthma control test done first.

The patient's walking in, and I'm like, they're good, they're bad, it's terrible. And so being able to focus on the control piece is really nice, but then not having to spend 10 minutes after they leave documenting the encounter is amazing. So I think that, and then the one after that is going to be using AI for some of my follow-up visits.

So I don't feel like some of the templates that are available do exactly what I want to do yet, but I think they'd be nice for documenting a follow-up encounter, where I may not be sending that out as a letter.

Dr. Mariam Hanna

Yeah. If you use AI scribe, do you think that would replace some of your intake? Would some of the questions that happen on an intake form just be the parent's narrative or the patient's narrative automatically?

Dr. Scott Cameron

What a great question. So the difference when you do AI scribe or any of the different AI models is you have to ask the questions in front of the patient. So if I have them answer the questions at home before they come into my office, I have to spend less time with the patient.

And so I think when we're asking very specific, non-open-ended questions, that's great. But again, one of the key pieces about that is confirming some of the information. So what we find is the person filling out the form isn't always the person coming to the visit.

So dad might've filled out the form and mom comes to the visit. So it's very important to clarify the answers that you received from the form, which also might've been sent to you a month in advance. So being able to clarify the data that's there, that's been entered and that it's correct, and that there's no additional things with some open-ended questions is really important, but it does cut down on the time in the room and it makes you faster with your letter.

In contrast, doing the AI scribe cuts down your time at the end of the visit by polishing up and putting together at least a draft of the letter, but it doesn't save your information gathering time. So I think that there's a role for both. And there's also really a role for using macros.

So I have a ton of macros in my practice for my treatment plans, and I have different macros for every different situation for treatment plans so that I don't spend all my time writing out a really clear treatment plan, especially when it's a pretty standard thing that we see on the regular.

Dr. Mariam Hanna

One of the senior fellows I worked with in her final year did macros. She had more than 300 macros pre-written out. She'd sit in a conference and write macros as she was learning new things because that was already going to be implemented into her practice by the time she got home so that she can write as per these guidelines, as per this statement, and it was already getting implemented.

That's how she was learning in conferences. So macros, I am a true believer that those are huge in terms of clinical practice. Okay, time is of the essence and it's flown by.

Time to wrap up and ask today's allergist, Dr. Scott Cameron, for his top three key messages to impart to patients and physicians on today's topic, workplace efficiency in the clinical setting. Dr. Cameron, over to you.

Dr. Scott Cameron

So my top three take-home messages I want everybody to get after they've heard this podcast. Number one, you need to spend some time to save time. Book yourself a project day and if any of what we've talked about has inspired you, put the day on the calendar and make it happen.

Number two, you need to set a smart goal in mind for this. Start thinking about what you want to accomplish to make yourself faster and keeping a list. But remember, it needs to be an achievable goal with the resources you have.

Number three, you need to measure the project day wins to yourself, your team, and your family. So you're further motivated to take your next project day and invest in yourself. And you and your team start to see this as an opportunity to invest not only in the quality of care that you provide, but also in your management of patient lists and personal time and getting home to see family.

So thanks so much for your questions today and I really appreciate all the listeners who thought this would be worthwhile to hear about.

Dr. Mariam Hanna

Thank you for joining us. This podcast is brought to you by the Canadian Society of Allergy and Clinical Immunology and produced in collaboration with PodCraft Productions. The opinions shared by our guests are theirs alone and do not necessarily reflect the views of the CSACI.

Please remember that this podcast is for informational purposes only and does not provide individualized medical advice. For show notes and relevant links from today's discussion, visit www.csaci.ca. While you're there, check out the Find an Allergist tool to connect with a specialist near you. If you enjoyed this episode, we'd love your support.

Leave a review and a five-star rating wherever you listen to podcasts. It helps others find the show. And remember, make a smart goal, have time to take time, to start time, to save time.

It's important. Thanks for listening and we'll see you next time on the Allergist.