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Making the Best Use of Office Hours

 

​The most common scheduling methodologies are fixed appointments and wave or modified wave scheduling. These formats apply to the timing of appointment scheduling. There are also open access and modified open access—these apply to the style of scheduling. 

  1. Fixed (ie, the time and length are preformatted). For example, appointments are offered every 10, 15, or 20 minutes. When first starting in practice, it would be better to allow more time in developing relationships with patients and families. Then, as routines are developed and patients become more familiar through repeated visits, the length of the time slots for visits can be modified.  

  2. Wave (ie, schedule all the patients for a given segment, usually a half hour or an hour). In this scheduling method, instead of scheduling 4 patients 15 minutes apart, all 4 are set for on-the-hour, and the physician sees each one in sequence of arrival. The first gets seen immediately; the fourth gets seen after the first three. The advantage is that some patients arrive on time and some are late. The wave takes this into account. The disadvantage is if they all arrive on time, and the fourth has to wait 45 minutes or more to be seen. Caveat: One must also be very careful to select the type of patients scheduled in each “wave”. For example, it would be very challenging to stay on time if staff schedules 4 adolescent well-visits during one “wave”. Also, it is important to explain wave scheduling to patients when they schedule to avoid potential frustration at arrival.
     

  3. Modified Wave (ie, same 4 patients, same hour; however, the first 2 are told to be there on the hour, and the second 2 are told to be there in a “second wave,” 15, 20, or 30 minutes after the first 2). This method gains (for the most part) the benefits of wave, but lessens the disadvantages of long waits for later appointments. 

  4. Open Access (ie, offering same-day scheduling for all visits, preventive or illness/injury). While it does not rule out having parents schedule their next well-child appointment well into the future, the goal is to take care of today’s work today and minimize future schedules that are already booked. Most practices can estimate the daily patient flow and schedule providers’ work times to accommodate the need. For established practices, there might be a conversion time because they may already have appointments well in advance. For new practices, starting with a clean slate, it is much easier to implement. Logic says one would still provide the same number of preventive care and interval visits over the span of a month—whether they are pre-scheduled or open access “any available appointment today”. The one disadvantage is that parents may not always be available, primarily for preventive care visits, during time slots that are open that day. 

  5. Modified Open Access (ie, booking preventive care and long consultations at the convenience of the parent with the traditional “first, or later, available appointment basis” but using typical open access style for illness/injury or interval visits). This is the style the vast majority of small practices use because it takes care of today’s work today, especially for those issues parents feel are urgent (ie, illness/injury), yet allows the parent to select a preventive care appointment that is convenient for themselves and their child. It also allows the practice to set aside additional time if it is apparent that the child has multiple or in-depth problems the parent expects to discuss.

Final Considerations in Setting Hours
Setting hours is critically important because parents consider availability and accessibility just as important as care quality and health insurance participation. It needs to be part of the practice’s marketing plan, particularly when building a practice. Decisions will need to be made on what type of scheduling a practice will implement. The greatest mistake is to pick a location without understanding what will be needed to be successful in that location. 

Many experienced pediatricians note that the best way to gain community support for the practice is to take care of the community. One way to do this is to ensure that patients and families are able to access the care they need when they need it.  

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