Physician scheduling should be done by a non-physician. It is very difficult to be completely unbiased if a person is in control of his/her own schedule. Try to offer physicians a set day off during the week, but never guarantee anything. Things can change on a moment's notice and no one should be faced with the situation of not having enough physicians to provide care to all patients. Once a practice starts canceling patients, it is very difficult to rebuild those patients' trust in the practice. Patients need to know that the practice is there for them.
Physician schedules should be finalized at least 2 but preferably 3 months in advance so parents can schedule their child's next appointment before they leave the office. Practices should not be continually changing a physician's schedule, resulting in having to reschedule patients. Once the schedule is posted, it should be understood by all that it is set in stone, except for extreme emergencies (illness or death, not a child's school function).
Creating Customized Schedules
The most highly efficient practices use this labor-intensive method. It is unlikely that a new practice will have the experience and data to implement it fully, but some basic techniques can be used and more complex management developed as the practice matures. The base template is the modified open access system. One person in the practice, preferably a physician with business skills, takes responsibility for maximizing the number of visits that can be handled by the practice. This can only be done if the scheduling doctor has several attributes.
- An understanding of the practice's seasonal variations in demand for certain types of visit. For example, each schedule should be customized with more slots assigned to well visits in the summer season and more acute care visits assigned in the winter season.
- An understanding of how each provider works. There are clear differences in provider styles and they cannot all have the same schedule. Some work very quickly, some less so. Some take on more complex specialized patients and need a schedule that reflects this. If there are multiple locations, they may have different characteristics. All of this must be meshed with your productivity schema so that everyone has the opportunity to be rewarded for their own productivity.
- The time and compensation to monitor how the practice is booking on a daily basis and to make requisite modifications to the system on an ongoing basis. There must be an extra salary for this person over and above their patient productivity compensation.
- The authority to totally control the schedule of the providers. No one but the scheduling doctor has the authority to alter the schedule. If other providers need to make changes, they must be authorized by the scheduling physician prior to being implemented. This goes for vacations, days off, and other commitments. If schedules need to be changed, even with short notice, providers must cooperate with these changes as much as possible.
- The data systems needed to figure all of this out and the ability to try to get patients to move their well visits to low-demand periods such as April and May to even out the summer crunch of such visits. This may require active calls to patients to solicit such visit times.
- The ability to customize the schedule with certain types of visits at certain times, with rules about changing such job stream templates for appointment staff to follow. These job streams may vary by season, office, and individual provider.
As is obvious, this type of system is not for everyone. However, if fully implemented, this type of schedule can earn a practice far more revenue than nearly any other single management technique of handling patient care.