Though some practices simply pay lip service to patient access — and many make concerted efforts to achieve it — Southern Indiana Pediatrics embodies it. Its offices are open seven days a week, 365 days a year. Even on major holidays, there is always a physician available for appointments. Though this may seem incredible to other practices, for SIP it's an arrangement born of necessity.

"We always had office hours Saturday morning and would often have to come back into our office and see patients later in the day. Sunday, I ended up being open in the morning just to try to take care of questions and calls that came in," explains Laughlin. "I tried to be gone in the afternoon, but when you're covering for a number of other doctors you just can't quite get away."

In pediatrics, sick visits take on a particular sense of urgency. Not only do parents worry about their children, they also have to worry about taking time off from work or other commitments to bring sick children to the doctor. For SIP, it was a question of balancing the needs of their patients with the needs of their employees.

"I always tell my partners and employees that we have to look at obstacles as opportunities," says Laughlin. "When the demands on pediatricians and physicians have increased so much that we basically have to be available 24 hours a day, seven days a week, we need to find a way to do that but still preserve our sanity and do the right thing for patients."

SIP's solution was to eliminate call altogether. With regular office hours during weekdays and weekends, and an urgent care clinic that opens for evening hours, physicians provide ample opportunity for patients to be seen. "Our evening and weekend hours are strictly a convenience for the patients, and a secondary convenience for us so that we can set up a schedule for our physicians. They know they're going to work this block of time on Saturday," Laughlin says.

Without call, physicians are able to preserve some semblance of a normal life outside the practice. They know the exact times they'll be working and can plan accordingly. "When you're finished seeing patients, you're able to go home and rest that evening because you're not going to be called," says Sheryl King, MD, an SIP partner. That's especially helpful to physicians like King, who has five children.

Although patient satisfaction is the primary reason for SIP's extended hours, Laughlin sees other benefits as well. "It spreads out our overhead over that many more hours, so it kind of helps our bottom line," he notes.

As if day, evening, weekend, and holiday hours weren't enough, SIP guarantees same-day visits for sick patients. "The line that we often use is 'Children don't get sick on schedule,'" says DeWeese. A parent who can't get an appointment for three or four days may never make an appointment at all — or, worse, might make an appointment somewhere else. SIP wants to make sure all of its children are seen as soon as possible, although it's not always easy.
"We just work as long as we need to," Laughlin says with a laugh. "We try to provide open slots in our schedule every day so that we can accommodate those patients. We never start the day with no openings."

The telephone provides another point of patient access. Phone calls are answered beginning at 7 a.m. — an hour before the offices open for business; parents can continue to call until 10 p.m., two hours after the offices have closed. For after-hours coverage, SIP contracts with a local hospital to provide pediatric nurse phone triage.

Who's answering the practice phones morning and night? Nurses. SIP physicians have developed a set of protocols that help their nurses answer basic care questions and provide immediate feedback to parents. If parents want to book appointments, nurses handle that duty as well. DeWeese admits this may be a more expensive approach than other practices take, but she believes it's money well spent. Not only does it prevent parents from having to recite a list of symptoms to several different people, it also builds trust between parents and nurses.

"[They] know they can call in anytime during the day and ... they're going to get their question answered by someone who is a professional and qualified to answer those questions," says Laughlin.
It also saves physicians time. "I can take one call and be tied up for 20 or 30 minutes, and basically that's my hour," says King. But with nurses manning the phones, King is free to concentrate on patients who already have appointments.

And SIP's telephone triage might actually save money. "It's one of the things that we think makes this quite a deal because [physicians] don't get paid for [phone time]," says Laughlin. "On the other hand, it does save the patients and insurance providers quite a bit of money when you can take care of problems on the phone that they'd otherwise have to come in for."

Staff that fit

With three separate offices, DeWeese feels it's important to make sure that everyone who works for the practice fully understands and accepts its patient-centered values before they begin working.