I am working on implementing a different type of scheduling in primary care. I know that is probably the most un-exciting way to begin a blog post so bear with me for a second because I think it is kind of interesting. Every other primary doc I know of is booked out for weeks. They have different backlogs of patients with half a dozen queues for patients. They have different slots for different types of visits each day, for example: two annual exams a day, one procedure slot, two same-day appointments, two medicare wellness visit slots, six follow up slots. They may be booked out for months for medicare wellness visits but their same-day slots may not even get filled.

I absolutely dread this complexity of scheduling and felt in residency it was an absolute disaster. I hated that if I wanted to take a day off from work in two months I had to reschedule 16 patients because my day would be full that far in advance. If I wanted somebody to get a follow up in two weeks it wasn’t possible without double booking them. It was so stressful. I was constantly doing work outside of clinic because patients couldn’t get into see me. Their blood pressure would be 200/120 but I didn’t have any availability so I’d be making adjustments over the phone. I’d have patients that  I told them they needed a follow up to get refills on their prescriptions, but I wouldn’t have any availability so I’d be refilling their meds without reassessing them just so they’d have the treatment. It was horrible, stressful, dangerous medicine. And not that this is important to patients, but I was spending so much time outside of clinic doing unpaid work, often late in the evening when I wanted to be home with my family.

So instead, now only new patients can schedule appointments weeks in advance. Everyone else cannot get an appointment until two days in advance. If you need a follow up in four weeks, you wait four weeks, call, and I can get you in that day, the next day, or the next day. If you are sick, and need to be seen urgently, I can see you usually within a couple hours.

This type of scheduling is called open access scheduling and in its strictest form means patients only can schedule appointments the day before or same day. The beauty of it is that I can actually see sick patients, and follow ups can actually get into see me. Sick patients will have urgent access to me and will have equal opportunity when competing with patients getting wellness visits. My panel will never be too big because if all my appointments are filling, I stop accepting new patients and switch those appointment slots to same day visits. My patients that are established with me will take priority and should never have to wait. Additionally there are no queues. I don’t care who calls, everyone can get in within a couple days, doesn’t matter what your concern is. There is no triaging for the front desk; all appointment slots are the same amount of time.

The downside of this method of scheduling is for high functioning, busy adults, they cannot plan a doctors visit weeks in advance. The convenient thing is that most of these people really don’t need to see doctors that often because they tend to be healthy and they get the exact same convenience as everyone else when they are sick and need to be seen urgently.

Additionally this method of scheduling forces me to limit unnecessary follow ups. I don’t want patients to have to come back and see me if they don’t need to. I’ll outline titration plans for their antidepressant if is working well for them. I’ll let them check their blood pressures at home and if chronically high, will tell them what dose of their med to go up to. My goal is to have patients not need to see me back and so I try to get everything done in their visit and move on. Admittedly there is always a time crunch in any job like this and patients need to understand there are limitations to the visit.

This method of scheduling, while foreign to all of my patients so far is actually becoming more common and there are good reasons why. It flips the priority from high functioning, busy, fairly well-off individuals to people who are in more desperate need of urgent primary care. It shifts scheduling advantage from well patients to sick patients. And it prevents backlogs of patients needing medical care. If I want to take a day off, I can do so without rescheduling patients that have been waiting months to see me. I’m new to this form of scheduling and am interested to see how it will pan out but am hopeful and I’ll try to give an update in a few months.