I don’t think that you should go with the underutilized doctor on a rotating basis, but maybe do something along slightly similar lines. If I remember correctly you said that you were averaging six emergency visits a day. Why not block out three slots for emergency visits each day (late morning, early afternoon, end of day, or whatever your records indicate are the most frequent times)? I think that with some form of the triage described, the average number of visits may come down from six a bit. If three slots are open, then regularly scheduled patients’ waiting times would not be as impacted as they are now, and at those times when there are six or even twelve emergency visits in a day, the three slots will take some of the edge off and your explanations to your patients, and their understanding that you will provide them with the same service, will go a long way. In the event that there is not an emergency visit in a certain slot then paperwork, rest, or moving patients in the waiting room up in the queue.

Some really good thoughts in there. Here is the unfortunate difference between Brandon’s experience and mine: we have too few providers to leave open slots that stay open. Remember the part of the post about how hard it is to provide a great experience to your patients when you are bankrupted and closed? We run there right now. Once we expand both flow (increased staff) and space (more exam rooms) we will be able to enact some version of what you and Brandon suggest. Equally unfortunate is the fact that there is no premium fee associated with premium service, only an incentive (hopefully) for those receiving that care to refer more business to us vs. lower service level providers.

Thanks for your thoughts.

I don’t know the climate, but given that ER’s charge extra, perhaps you could charge a mild premium–say 10%–for immediate, unscheduled service, which will offset periods when your floater is surfing the internet.

Obviously, you have a fixed amount of time per day. Efficient scheduling, coupled with a robust practice, will ensure the schedule is booked morning to night daily. Gaps need to appear, lest the whole tightly-bound system come unraveled on a regular basis. A doctor with gaps in his schedule would meet that need. So, potentially, would extended office hours after your normal close time, which would be the honor and priviledge of each of you on a rotating basis. That doesn’t sound like a fit for the image and reality you are trying to provide, though.

Actually, one last, totally random thought: you could do house-calls after you are done. You may not be able to FIX the problem, but the patient would LOVE this, and of course you could work them in the next day. Again, this would be faciliated by leaving a few gaps in the schedule.

You keep your schedule full by doing a great job. You get a mild upcharge, hopefully, by being superior. The only way to continue being superior is to sacrifice absolute efficiency–solid, paid visits, one after the other, all day every day–in favor of relative efficiency, which is providing the best possible experience for THEM, not for you.

I’m likely rambling, but I figured I’d pipe in my two cents.

Great comment! We addressed the paperwork issue since your last visit. We sought and obtained a new interpretation of medicare/insurance/HIPPA regulations which allows us to use prior information absent any changes.

We have invested in new equipment. We are in the process of expanding staff. Next step is increasing internal exam space, a step we anticipate prior to our Spring “surge”. “Come right in” seems to be winning the contest right now, so it seems that some version of gentle phone triage in combination with structural changes is our next step.

Thanks.

Good evening. As I sit here and recover from Pony’s challenge of five rounds of Fight Gone Bad, I wonder if you’ve found any possible solutions to your scheduling dilemma. The reason I mention it is that I was a family practice clinic manager for about four years when I was on active duty, and we had similar scheduling issues.

Because our primary job was to care for the active duty population and their families, our providers’ schedules were consistently full with routine and follow-up appointments. Each provider was allowed four AM same day or “urgent” appointments and four same day appointments right after lunch. Most of these appointments were utilized for “sick call” for the active duty folks, which were mainly to determine whether or not they should be at work for the day.

The appointment lines opened at 0645 and by 0700, our schedules were filled, which resulted in a significant number of off-base referrals for care that could have otherwise been provided in-house, especially during cold and flu season. Our administration didn’t like this at all. We had one on-call provider for each week, but that really wasn’t effective because having a true on-call provider meant that the person on-call would spend the week with an open schedule, which was unpredictable at best.

We tried many different approaches from increasing appointment times and working people in to leaving half of the day completely open for a couple of providers, but the solution that seemed to work best was manipulating the types of appointments for one provider on a given day, with the understanding that he or she would be responsible for overflow. The appointments scheduled for that provider would be routine or follow-up appointments, which meant the appointments were generally finished well before the allotted time was up. Basically, each provider had one day per week where he or she did nothing but routine/follow-up appointments all day and worked in unscheduled patients in between appointments.

This allowed us to work in unscheduled patients with that provider without sacrificing the number of available appointments, and it seemed to satisfy the greatest number of people.

I hope my description wasn’t too confusing. Without knowing how your appointment templates are set up with regard to number and type, I don’t really know if this would be a viable option for you. I just thought I would share what worked for us.

By the way, thanks for the newbie posts on the main page. I’ve been doing CrossFit since June of last year, and your posts have been really helpful.

Have a great evening.

Brandon

Not sure if it works for specialists like you but how about a mix of “normal” patients and boutique/concierge/retainer patients who pay the annual “fee” to have immediate access and an education program to explain the difference to patients and the reality as to why? BTW I am with Jamie on his wait scenario and how frustrated I get. I’d rather reschedule and not have to wait than get in right away and wait–something about instant gratification, I guess.