See More Patients Sooner Without Working Longer Hours

Kenneth J. Terry, MA


February 06, 2013

Doctor, I'm Sorry I Didn't Make An Appointment

The predominant method of scheduling in primary care practices today is carve-out scheduling, says Bruce Bagley, MD, Medical Director for Quality Improvement at the American Academy of Family Physicians and TransforMED.

Practices that use this method book the majority of their appointments ahead but leave a block of time open each day for patients who call or walk in to the office, seeking healthcare that day. The number of open slots can range from just a few to a substantial chunk of the daily schedule.

Mullins says she and her 2 physician colleagues try to leave at least 30% of their slots open for same-day access; the practice's nurse practitioner offers more open spots. In addition, the practice has "quick-fix" visits for people who come in with upper respiratory complaints. These are 5-minute visits that the practice stacks up at lunchtime or at the end of the day so people can get in and out quickly.

This approach, she says, allows most people to be seen the same day they call in. "If a patient called in to be seen tomorrow, they could get an appointment at our office almost 100% of the time. That's not always the case. Eventually, we run out of spots."

The key to carve-out scheduling, Bagley says, is to predict how many open slots the practice will need on any given day. "If you know you're going to have people call in on a Monday, you may need 20 slots that aren't already scheduled on Monday morning." Fewer openings may be required on a Wednesday than on a Monday or in the afternoon than in the morning.

This approach has some disadvantages, he notes. "Once you use up all those slots, you begin to tell people, 'I can't give away any more slots today because we're booked. Why don't you call in early tomorrow morning when there are lots of slots open, and we'll get you in.' So you've doubled the work of taking the phone calls, and you've put the patient off."

Also, people tend to game the system by, for instance, calling in before office hours on the day they want to be seen and leaving a message, he says. Rosemarie Nelson, a Medical Group Management Association (MGMA) consultant in Syracuse, New York, agrees that carve-out scheduling lends itself to gaming: Some patients, for instance, will keep bugging the schedulers to squeeze them in until the schedulers yield and fill slots that were supposed to remain open on subsequent days, she says.