Updates - from patient schedules to physician mindsets

Two recent articles got my entrepreneurial physician juices up, one being entirely pragmatic, and the other a thoughtful examination of what makes physicians tick these days.

Slate magazine ran an article on open access scheduling for medical practices last week called "Available Jones, M.D. What if all patients could be seen on the day they call?".

The author Marina Krakovsky writes:

....the main reason most doctors defer today's work to some time in the future is that today's schedule is clogged with appointments made weeks ago. Doctors following the same-day scheduling model, on the other hand, are free today because they saw yesterday's patients yesterday.

Using open access, doctors might still schedule some early-morning appointments in advance, for follow-up visits or for patients who actually prefer a future appointment. But the key is that they keep most of their time free for same-day visits and fill up their schedules as the day goes.

In order to make this model work, physicians need to know:

• their typical weekday schedule patterns (Which is the busiest day of the week? And the lightest? etc.)
• their panel size (number of patients they provide service to)
• what the typical waiting time is before a patient gets on the schedule for an appointment

The problems typical schedules cause are high rates of no-shows (calculated to be up to 30%) and loss of revenues, plus backlogs that inconvenience patients (and incentivize them to use local retail clinics!) and physician stress and burnout due to the overwhelm of never being able to catch up.

The article provides a number of links to valuable information for anyone seriously looking into an open access model for scheduling patients.

I'd love to hear your thoughts on this model - who has tried it? And how has it worked for you and your patients?

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In an entirely different vein, HealthLeaders Media author Richard Reece MD has probed and analysed the mindset of physicians coping with today's healthcare challenges. In "Five Physician Mindsets", Dr. Reece explores the impact of trends on physicians' practicing lives. Here, in summary, are the mindsets he has identified:

Physician mindset number one -- Physicians on the ground prefer incremental changes through expanding coverage through tax incentives and market-driven changes rather than through a single-payer system.

Physician mindset number two -- Physicians are adapting to downward pressure on their incomes and harassing rules and regulations by becoming hospital employees.

Physician mindset number three -- Physicians regard consumer-driven care with skepticism and tend to be reactive rather than proactive in adapting to change.

Physician mindset number four -- Physicians do not look upon EMRs, physician websites, or Internet outsourcing as the Holy Grail, but are slowly adopting.

Physician mindset number five -- Physicians are beginning to recognize economies of scale and organizational structure are important if physicians are to retain control of their destinies.

My experience is somewhat different - at least with regard to mindsets number 2 and 5 - as the physicians I most often speak to are moving into smaller and even solo practices in droves, and willing to take home less pay in exchange for the freedom of being their own bosses. I recognize the inherent bias in my audience, and that I have no real way to contest Dr. Reece's hypotheses.

I'd love to hear from you. Is Dr. Reece correct? And if so, what does this mean for you as a physician?