> Starting and Running a Practice

Overbooked and Overextended: How to Avoid Scheduling Nightmares

One of the pearls of practice management that can make or break the workday, but is never mentioned in a medical textbook, is how to triage patients when your clinic is booked out for an extended time. How do you decide what patients get in sooner and who can wait? Should there be a tier system for scheduling based on urgency? How do you handle cosmetic patients who all want to get in yesterday! Dr. Bhatia’s advice covers:

• Understanding the Level of Urgency
• How to Handle the “Urgent” or “Work In” Patient
• The Importance of Setting Expectations
• Scheduling Pharmaceutical Reps

Many dermatology clinics have a good problem – patients need to be seen and soon, and if this doesn’t happen in a timely fashion they will either give up and go somewhere else, fall through the cracks, or get care from someone else who might not be adequately trained. On a bigger level, the sinking reputation of dermatology having an access issue and similar negative perceptions will perpetuate further into our referral base. But in reality, some of us are not in the office five days a week and meetings/vacations are a part of our calendar too.

Understanding the Level of Urgency

Part of the importance of triage is understanding what “urgency” truly means, for example terms like “skin falling off” and “new blisters” should prompt a work-in visit that day. Something bleeding, changing colors, and that won’t heal might be able to wait a day, and acne/psoriasis/rosacea flares, although important, can also be scheduled sooner than later. Routine skin checks, monitoring for high risk meds, and some other similar visits can probably fall into regular scheduling. Again, these variables will depend on the size and availability of the dermatologists in the office.

How to Handle the “Urgent” Patient

One of the better ways to handle the potential “work-in” or “urgent” patient is to allow for an open slot every other hour on the top of the hour so that it is understood by everyone in the clinic that a new patient visit might show up during the workday. These appointment times can also be filled for the next day, which allows some flexibility but is also predictable. Some clinics go as far as working these patients in during the lunch hour or after hours, but this rarely a good idea because it sets back the time for admin, phone calls, paperwork, and a breather.

Setting Expectations

The most important caveat to working patients in is to manage their expectations. They might have to sit in the waiting room a little longer than usual to adjust for patients who were already scheduled, and in this era of high co-payments and deductibles it is critical that the patient is told by everyone in the front and back office—prior to seeing the doctor—that there is very little chance that any procedures will be performed the same day. Imagine the patient who walks in with an inflamed cyst and needs surgery, and because of a $75 copay demands that it be excised that day. Not only could that potentially be a surgical nightmare, but it would absolutely derail the schedule, set everyone else behind, and if turned away lead to bad online reviews, which is total quicksand. These expectations need to be set on the phone, at the time of triage, and when the patient is brought back to the exam room so that everyone is on the same page. We all know that patients will turn everyone in the office against each other with the “he or she said you could do the surgery today” game.

Scheduling Pharmaceutical Reps

Finally, the other way to control the schedule is to have only certain times when the pharmaceutical reps can be seen, so these expectations are set in advance also. Many reps have routes and schedules that they have to follow, so they might pop in if your clinic fits their routine. However, that often doesn’t work if the clinic is busy, so make it clear that reps will only be seen on certain days or certain times of the day, such as on the hour or half hour. This will ensure no one’s time is wasted, the clinic doesn’t get behind, and a patient doesn’t get angry after waiting 30 minutes and then watches a rep walk right in and go right back, which is certainly not good for business.