Realistic Patient Scheduling for Your Medical Practice

One of the primary frustrations in any medical practice is the apparent inability to schedule effectively. The most often cited culprits are late patients, inefficient front-office staff, uncooperative insurance companies, EHR inefficiencies, and inconsiderate physicians.

While each of these could be causal, they are often symptoms of a single root cause: failure to acknowledge and account for the lead times between the stages of each patient visit. Consider Mary Doe, a considerate patient who has the first appointment of the day at 8 a.m.

Registration

Mary will appear at the reception desk at 8 a.m., her appointment time. She may have arrived earlier. It does not matter because the door would have been locked.

Mary probably knows it will take time to do some paperwork, but she has assumed that the practice wants her there at her appointment time. She is unaware of the time it will take to get her information updated in the practice management system. Depending upon the office and whether Mary is a new or existing patient, all of this can take between 5 minutes and 50 minutes.

Mary will be frustrated because she actually expected to be in an exam room soon after 8 a.m., and the physician is frustrated because he did, too. And the frustration will intensify throughout the day because the office will inevitably fall farther and farther behind schedule, because all of the delays are additive.

A solution would be to schedule two appointments for Mary: one for the front desk and one for the physician. The length of the front-desk appointment would depend upon whether Mary is a new or existing patient. When making the appointment, the scheduler should explain to Mary that there will be some paperwork to be handled before she can be seen. (An alternative is to schedule a single appointment for Mary and advise her to arrive 15 minutes to 45 minutes earlier so she can be seen "on time.")

Ancillary services

Depending upon the type of practice, Mary may need to have a test, X-ray, or blood drawn before being seen. In that instance, she needs yet another appointment slot. Mary should be told the sequence of events at the time she makes the appointment and be given an estimate of the time she can expect the appointment, in total, to take.

In some specialties, the physician sees the patient before these other services are performed. If the patient is coming back to the physician after these services are complete, Mary needs another appointment slot on the schedule.

As many as four appointment entries for a single appointment probably sounds crazy, a foolish waste of limited resources. I understand. Before you reject it out of hand, think about what it buys the practice and, especially, the physician:

• Providers and staff can be scheduled more effectively. It may be easier for everyone to have the same work hours, but it is not required.

• Appointments on the physician's schedule reflect when the physician is needed.

• Patients are more satisfied, because their experience is in line with their expectations.

• The office has a reasonable chance of staying on, or close to, schedule.