Fellow physicians, I see you lighting your torches and sharpening your pitchforks, but just hear me out: sharing a cell phone number with your patients can be one of the best decisions you’ll ever make.

Most doctors, when confronted with the idea of giving patients their phone number, will have immediate and reasonable fears involving potential intrusions on private time, increases in uncompensated workload, and substandard care delivered via telephone. Stick with me through this five-point argument, though, and I bet you’ll reconsider those positions. The undesirable outcomes of sharing your phone number with patients are both unlikely and far outweighed by the benefits.

Today, I’m also joined by Dr. Kenneth Rictor of Scotland Family Medicine. Dr. Rictor has been a solo family medicine practitioner for nearly three decades in Scotland, Pennsylvania, including most recently in a direct primary care model, and he has been giving his patients a direct contact number for years. He also recently transitioned his patient communications to Spruce Care Messenger, and he’ll share his experiences with giving out a number (and why he keeps doing it) as we go through the five reasons that you should, too!

Point 1: Patients Love It and It’s Good for Them

If you’re going to give out a phone number, it’s nice to know first whether patients actually see value in it. Happily, the research indicates that they do. In one study of patients in a spinal surgery clinic, for example, 72% of surveyed respondents reported feeling that their treating surgeon cared more about their well-being if he or she offered a personal phone number.¹

Other studies have similarly indicated a general desire of patients for their doctors to be available by phone, with listed advantages including less waiting, reduced travel time and expense, and the possibility of increased contact frequency.²

Physician phone availability also appears to provide objective benefit to patients. In one study, a full third of patients utilizing a physician call-in service reported that they otherwise would have gone to an emergency department. Eighty-seven percent of the call-in patients also rated their satisfaction with the experience as “good” or better, and 90% of them experienced improvement in symptoms afterward.³ Other work indicates that patient perception of the therapeutic relationship is strengthened simply through knowing that a physician is available if needed, leading to improvements in health and well-being even when no interaction occurs.⁴

There are also likely to be non-health benefits of increased physician availability. One study quantified the time and financial expense of an in-person ambulatory care visit, beyond the direct clinic time and fees, and found that a typical appointment costs a patient 37 minutes in travel time and $43 in missed earning opportunity.⁵ Being able to handle some issues via phone could easily lessen this burden.

Point 2: Patients Won’t Actually Call You All That Much

Perhaps surprisingly, both experimental and anecdotal evidence indicates that patients won’t actually call you all that much. If you have set expectations and provided alternate accessibility options, most patients will triage their issue correctly and direct it to the appropriate level of care at a reasonable time of day.

Only 3% of patient calls in some settings were both after hours and directly to the doctor.

One study supporting this notion examined what happened when perioperative surgical patients were given phone numbers for their surgeon, their surgeon’s secretary, and their surgical scheduler.¹ In five months of observation, 38% of these patients did not call any of the numbers even once. Of the calls that were made, only 17% were to the surgeon directly, and 83% of these were during business hours. Furthermore, the majority of patients who called their surgeon directly did so only after their issue could not be addressed by the secretary or scheduler.

In another report, an experienced emergency medicine physician detailed his personal experience with giving his cell phone number to patients, relating that maybe 1% of them actually called him when specifically asked to do so.⁶ He further reported no instances of abuse in the eight years that he had been giving his number out, while observing a large amount of immediate patient satisfaction when he did so.

Point 3: Abuses Are Rare and Containable

The available evidence suggests that most patients will be respectful of your phone and time, but there will inevitably be occasional high-utilizers. Luckily, this population seems to be quite small. In one study of after-hours calls to a family group practice, for instance, just 0.6% of patients were responsible for 23% of all calls.⁷

With only 0.6% of patients making 23% of all calls, frequent utilizers are rare and easy to identify and address.

With a low number of truly frequent callers, the problem becomes addressable. Perhaps most importantly, patients who call often for actual urgent or emergent issues may help you identify care plans that are failing. If a diabetic has lost blood sugar control, an extra call may help you find an occult infection or other precipitating factor before the patient has a costly and damaging hospital stay.

Patients who call frequently for unimportant or non-urgent issues are more problematic but should still be containable. In some cases, a discussion of boundaries and expectations may accomplish the goal (e.g., “I don’t always check patient voicemail on evenings or weekends.”) Other times, you can leverage modern technology to provide great availability without putting a new burden on yourself, which brings us to the next point…

Point 4: Modern Technology Makes It Painless

Nowadays, “giving out your phone number” doesn’t actually have to mean giving out your phone number. There are apps for every modern smartphone that will provide you a second phone line with its own number, and many of these also support voicemail, texting, and other telephony features.

Having this type of “virtual” second phone line then makes it easy to set boundaries while still increasing overall access for your patients. You could, for instance, configure things so that calls to your personal number ring through at all times, while calls to your practice line go straight to voicemail and don’t interrupt you until you’re ready for them.

Some apps even make it possible for your whole care team to share a number, allowing you to set up a workflow that makes sense for your practice. You could implement an on-call rotation without changing the number that a patient dials, for example, or you could designate care coordinators to triage incoming patient communication, only contacting physicians when absolutely necessary. The possible models are endless, but they all serve to distance you from the obligation of answering every phone call, while still letting you give your patients more and better ways to be heard.

It is crucial to note, however, that if you are subject to HIPAA, you should only use apps and other services that will sign a business associate agreement (BAA) with you. If you’re unclear on this topic, see our previous articles on whether HIPAA applies to you and what BAAs are. For the most part, it’s safe to assume that you need to pay attention to this, which unfortunately eliminates many common “second-line” services, such as Google Voice, Sideline, and Line2. Using any of these could easily ruin your HIPAA compliance and make you vulnerable to large fines.

I had multiple resources for contact to cover all methods. I had an office phone number, a number for texting, Skype or FaceTime for video chats, a portal email, an office email, and a private email. This led to scattered and insecure communication and a limited ability for notification. I needed an app that consolidated all those options so that communication was as easy as pressing an app icon on your smartphone. – Dr. Rictor

Point 5: It Might Actually Save You Time and Work

As we’ve covered, the evidence suggests that you can give your cell phone number to patients without bringing certain doom upon yourself, but what if the reality is even better than that? What if giving a more direct phone number to patients could actually end up saving you time and decreasing your workload? It turns out that might be the case.

First off, when patients decide to reach out to you via phone (or telemedicine or any other similar modality), they are likely doing so in place of an office visit instead of in addition to one. In one general practice study, 95% of patients calling a physician consult line reported that they would have sought in-person care otherwise, indicating that the availability of a call-in line created very few “extra” consults.⁸ What’s more, the people who chose to call were often ones who had a legitimate but frequent need for medical consultation, such as parents of young children and patients on long-term medications. Handling these straightforward but high-utilization cases via the phone would almost certainly yield a decrease in overall workload.

Another major benefit to giving patients your cell phone number is that you are opening up the possibility of texting. It’s no secret that texting has become extremely popular for all sorts of uses, while fewer and fewer people are even bothering to check their voicemail.⁹ Fitting with these clear societal trends, practices that have incorporated texting into their patient communication workflows have reported very positive experiences, including increased efficiency and reductions in frustrating “phone tag” episodes.¹⁰ The AMA has even gone so far as to publish an article titled, “Texting can increase office efficiency, bottom line,” and that was several years ago at this point.¹¹

Importantly, you should make sure that you consider the HIPAA issues involved in texting your patients, but most patients will be more than happy to have the option. When needed, you can also use a secure messaging platform to keep things protected.

If you practice in any type of capitated environment, then the efficiency gains of improved patient communication will translate immediately into a better financial situation for your practice. The situation is less clear in traditional fee-for-service models, but there is still likely to be a benefit, especially as forces such as MACRA increasingly tie payments to quality outcomes. If nothing else, handling simple issues outside of the office through better communication will free up in-person clinic spots for more complex patients, allowing you to preserve the higher level of care for those who really need it and to bill accordingly.

It feels somewhat counterintuitive, but the bulk of current evidence suggests that giving patients your phone number may be a good idea for both you and them. With proper boundaries and the assistance of modern technology, you’re unlikely to experience significant negative impacts, and you’ll be opening the door to better care and outcomes.

References:

1. Chin, K. R., Adams, S. B., Jr, Khoury, L. & Zurakowski, D. Patient behavior if given their surgeon’s cellular telephone number. Clin. Orthop. Relat. Res. 439, 260–268 (2005).
2. Car, J. & Sheikh, A. Telephone consultations. BMJ 326, 966–969 (2003).
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8. Brown, A. & Armstrong, D. Telephone consultations in general practice: an additional or alternative service? Br. J. Gen. Pract. 45, 673–675 (1995).
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10. Papa, A. & Lefton, C. Discharge Texting: The Evolution of ED Callbacks. J. Emerg. Nurs. 41, 345–346 (2015).
11. American Medical Association (AMA). Texting can increase office efficiency, bottom line. amednews.com – American Medical News (2009). (Accessed: 15th February 2017)