Expanding office hours

Keypoints:

Doctors sometimes forget that medicine is a service as well as a profession. If you need a reminder, consider the rapid growth of urgent care clinics, walk-in clinics, "doc-in-a-box" clinics, and particularly the new miniclinics sprouting in retail chain stores around the country. These clinics appeal to patients because they offer both convenience and longer hours.

To meet this growing competition, the American Academy of Family Physicians recently called on its members to embrace "a new model of patient-centered care" based in part on convenience and accessibility. To achieve that goal, the AAFP recommends offering same-day service, open-access or flexible scheduling, and expanded office hours.

Some doctors have already discovered that expanded hours and flexible scheduling not only please current patients and attract new ones, but also bring added personal benefits: reduced stress at work and more time at home. We recently took a look at several such practices, to see what adjustments they made to their schedules-and what happened as a result. What works for them may work for you, too.

Despite the advantages of longer hours, most practices resist them. "I've urged many of our groups to extend their hours as a way to increase revenue," says David Scroggins, a practice management consultant in Cincinnati. "But most of them are reluctant to do that."

Adding hours doesn't have to be that difficult, though, Scroggins says. "If there are four or five doctors in the group, they can rotate the schedule so that each one takes only one evening or morning a week. The easiest way to handle the late hours is to have whoever's on call cover them, since they'll be on duty anyway. Besides, it's much easier to see a sick patient in the office than to take a phone call at home and have to rush to the ED unless it's really necessary. That's particularly important for pediatric groups because parents become alarmed when their kids are sick, and they don't want to wait."

Some practices have also experimented with weekend hours. "One of our groups opens a few hours on Saturday and Sunday mornings with a small clinical staff," says Scroggins. "The on-call doc handles those patients, and it's actually better for him because now he's got support staff."

Other groups expand their hours out of necessity. For example, when Oxford Pediatrics and Adolescents, a four-doctor group in Oxford, Ohio, brought in another physician to handle their growing volume, they soon found they didn't have enough exam rooms with their usual 9-to-5 schedule. To solve the problem, they decided to stay open until 8 p.m. four days a week and to stagger the doctors' hours so that there were never more than four of them in the office at one time.

"We weren't sure how popular the evening shift would be," says James Davis, MD, one of the group's pediatricians, "but within a few weeks we realized that patients were grabbing those evening appointments."

Few of the doctors wanted to cover the late shift, however, since it meant giving up evenings with their families. Luckily, an older doctor who had wanted to slow down anyway chose the 3 to 8 p.m. evening shift instead of a full-day schedule. (The four full-time doctors take turns leaving the office early, at 3 p.m.) When he's on vacation, his colleagues take turns covering for him. They adjusted the staff schedule to cover the extra hours, without causing any overtime. Some employees weren't enthusiastic about the new schedule, but they've managed to divide the extra hours so that no one has an unreasonable share.

Increased productivity equals a higher net

As a marketing tool, expanded hours can attract patients who prefer to come in before or after work. "It's also a way to increase your productivity and income," says Judy Bee, a practice management consultant in La Jolla, Calif., "since those people might otherwise have just called for advice, which produces no revenue."