Solutions for an Overbooked Medical Practice

Are your appointments booked? Do you have a waiting list? (Hopefully you are making a profit, but if not that is for another post another day.) Then congratulations! The solutions are much easier and faster than if the problem were the opposite (empty waiting rooms and silent phones).

Even though you see results faster when the problem is too much business, it can still be difficult to see where your issues are when you are in them. You can call it the “fish in water” phenomenon, where fish are so deep in water, they don’t even notice the water anymore.

Luckily there are some solutions that run through most of these issues:

1. Productivity: Make sure that you are productive. You may be saying, “well, I am on time” or “there not enough hours in the day” or “we don’t want to work longer hours.” Good news, I don’t want you to work longer hours either. 

Consider that even if you are on time, you could see more patients or open up more slots for follow ups by reviewing the manner in which your patients are scheduled. A new patient should have their own slot because they take a little longer, returning patients can typically have a shorter time slot scheduled, and certain post procedure patients can have a nurse appointment scheduled.

You will also want to take a long hard look at what you are doing with each patient. What are you spending the most time with? Are you fiddling with an EHR more than assessing and diagnosing a patient? Are you spending five to ten minutes after each patient entering notes or writing in the chart? These are areas where you can improve, so that you can see more patients without shrinking your effective time spent with them. By the time you have spent five minutes per patient on the first three patients of the day taking notes or searching for tests, you have just wasted an entire follow-up appointment slot.

2. Staffing (non-billing provider level): Part of ensuring that you are spending the highest-quality time with each patient is making sure that your staff is carrying the appropriate amount of the load. You need to make sure that you are only providing the highest level of service for your patients to maximize your time. I will use the example below

Try to picture walking into an exam room with a patient who is there for a minor procedure, maybe for the draining a cyst on his shoulder blade. When you walk into the exam room, the patient has already had vitals taken, pre-procedure form and consent signed, changed into a gown, and is lying on the exam table. Your mayo stand is prepped and ready (possibly even numbed the patient), sterile gloves ready, and your medical assistant (MA) or nurse is already gloved and waiting on you to begin.  All you have to do is step in, greet the patient, and begin your work. After you stitch or pack the wound, you thank the patient, let the nurse know when follow up should be scheduled, if there are any post-procedure instructions/medications, and then move along to the next patient. (The nurse will then bandage, enter the notes (using a pre-made system on paper or EHR), and escort the patient to the checkout desk).

Can you imagine if all of the patients were like that? Your time as a physician is much too valuable to your patients to spend it entering notes, draping patients, etc. There is a bit of a learning curve to get a staff to the point of “Radar O’Reily” accuracy, and often times I see that it is as much of a challenge for the staff to step up as it is for the providers to let go of those simple duties. Ensuring your staff is bearing the right amount of the burden can free up space to add additional appointments.

3. Serving your ideal patient: You want to make sure you are marketing toward and set up to see your ideal patient. You may still get appointments from people who do not fit your ideal patient profile, but those patients will eventually weed themselves out. By determining who your ideal patient is and actively pursuing that type of patient, you will free up your schedule to see more of the patients that you enjoy seeing, those patients that make it worthwhile to go to work every day.

Make a list of traits of your ideal patient; you may consider adding these:

• age group

• sex of patients

• particular disease process

• lifestyle (can vary a lot on the age group)

• commercial payer vs. government payer vs. cash

• takes responsibility for care (unless you thrive on the challenge of winning someone over to taking responsibility, and that is okay too)

• sees the value in what you do

• says “thank you”

• income level

4. Staffing (NP, PA, MD level): If you have everything above lined out and you are still over booked, then it is likely time to consider adding an additional provider. Be sure and comb through the role you envision for them, so that you aren’t paying an NP to do what an RN, LVN, or MA could do for you.

NPs and PAs would ideally be used to see follow-up patients. You could also have the NP or PA see any patients in the “urgent add on” patient slots (at the very least they could triage them).  You could also have the NP/PAs follow patients in the hospital.

Adding an additional MD-level provider is another option; this option would open a new slate of appointment slots and absolutely solve your overbooked issue. When adding a new provider it is important that you don’t simply add their name to the signage and expect other providers to begin referring patients or allowing them to see their referrals. 

You must take a few steps to ensure that people know that no matter who they are referred to in your clinic the patient will receive the best care. Here are a few steps: 

1. Ensure that marketing is focused on positioning your clinic as the group as a whole and not a particular physician.
2. Send out letters to referring doctors introducing the stellar new physician and outlining all of their experience and other reasons you know they will take great care of their patients.
3. Hold an open house for providers in the evening to introduce the newest NP/PA/MD on your team, you can’t expect a referring doc to send patients to someone they have never met.

Sometimes it can be hard to see where simple solutions are when you are immersed in the problems. The solutions outlined above are just a few I see as the most common solutions from client to client. When you are overbooked, be thankful for the problem and begin reviewing solutions, better yet have these plans in place before a problem arises. 

Do you have a question about a practice management issue in your clinic? Would you like some ideas on how to fix a problem? Submit your anonymous questions to Ask Audrey and practice management expert Audrey “Christie” McLaughlin, RN, will answer them in a future Practice Notes blog.