If joining an established practice, work hours are set by the practice, based on negotiations at the time of contracting. If taking over an established practice, the community will likely expect the practice to continue the same hours or to expand them—reducing them from the outset would likely have a negative marketing effect.
Most pediatricians go into practice with the idea of balancing work and family time. Ideally speaking, the decision about office hours should be part of a market analysis, done as the first step in assessing and selecting the community and location in which to practice, not after commitments have been made on practice location and space. Quality of care provided, bed-side manner, and availability are major determinants in the practice’s success.
Here are some things to consider:
- The style of practice desired, and if you have a family, what your family can accept: It is critical that the family unit have appropriate expectations, a full understanding of what is being undertaken, and a realistic estimate of the effort needed to succeed.
- Competition in the surrounding community: If there are no other pediatricians in your community, there may be more flexibility in how hours are set. On the other hand, this might not be possible in highly competitive areas. That might mean expanded hours or night, evening, and weekend hours, which would require more work time.
- The resources that exist for coverage: What type of coverage options exist, and are there some mutually beneficial coverage arrangements that can be made?
- What are the community resources? Are there local retail-based clinics, urgent care centers, or after-hours centers? Do they see children? Are cooperative working agreements possible?
- Understand the community needs—socioeconomic, prior health care availability, customs, and traditions.
Options to consider when setting office hours include:
- Early Bird Hours (eg, walk-in, first-come first-served, minor problems and quick fixes designed to get children into school and parents off to work). A pediatrician could potentially see 5 to 10 patients quickly, relieving the crowding in the morning and afternoon schedules. Parents look positively on the quick-in-and-quick-out as a benefit, and enjoy the consideration shown by not making them take a half day off from work or having the child miss school if not necessary. Early bird hours could begin at 7:30 or 8:00 am, depending on school start times. Caveat: For early bird hours beginning at 8:00 am, set the walk-in registration time from 7:45 to 8:15 am. Do not set the early bird time from 8:00 to 9:00 am. This will prevent 5 to 10 people walking in at 8:55 am, expecting to be seen by 9:00 am.
- Teen Time (ie, evening hours for adolescents). They appreciate it when they come into a true adolescent practice and not to see a “baby doctor.” Office décor is also important!
- Talk Time (ie, certain hours set aside in advance for parents who need extended talk time for chronic diseases, educational issues such as learning disorders or attention-deficit/hyperactivity disorder, or behavioral issues). By having a specific period set aside, practices are able to meet the needs of the parents and patient and avoid having the staff schedule a standard appointment time that is inadequate, which leads to pediatricians running late and patients and families with later appointment times being frustrated.
- Specialty Time (ie, focus on a specific clinical interest area). This can be done one patient at a time or in groups, depending on the topic.
- Group Baby Care. Some practices set aside an hour and schedule 5 to 6 similar-aged infants for the same time. The nurses begin the visit by obtaining a history of each infant. The physician examines the infants in sequence, expanding on history issues. Next, all of the families sit down as a group with the physician for question-and-answer time and anticipatory guidance time. Many parents ask the same questions; many forget what to ask but hear another parent ask it for them. This format also allows for group support as the parents develop social relationships with other parents with similar-aged children. Consider this option as an elective solution—parents can opt in or out at any time; however, it is common for many groups to continue this format into the early school years.
In the sample schedule below, office hours would essentially be Monday through Friday from 8:00 am until 5:00 pm (last appointment, 4:30 pm). As the practice develops, the schedule can be modified. As partners, nurse practitioners, or physician assistants (PAs) are added, the schedule can be further modified.
|Sample Office Schedule |
|Solutions||Day of Week||Hours|
|Early Bird Time||Monday-Friday||8:00 am (parents to arrive no later than 8:15 am)|
|Regular Appointments||Monday, Wednesday, Friday||9:00 am - 4:30 pm|
|Regular Appointments||Tuesday, Thursday||1:00 pm - 4:00 pm|
|Talk Time||Tuesday||9:00 am - 12:00 noon|
|Teen Time||Tuesday||4:00 pm - 7:00 pm|
|Baby Groups||Thursday||9:00 am - 11:00 am|
|Toddler Groups||Thursday||11:00 am - 12:00 noon|