If there's one thing that can harm the success of a medical practice, it's having patients spending too much time in the waiting room. Appointment scheduling is a critical function of a doctor's office, yet many practices schedule in a seemingly haphazard fashion. Often, the practice's scheduling strategy, if you want to call it that, is to fill an appointment into any slot available with little regard for the reasons patients are being seen.

Three Physician Scheduling Philosophies

Broadly, there are three types of physician scheduling philosophies, or schemes, including:

1. Traditional. Sometimes called "standardized," or "cramming," this method has the physician's schedule separated into consistent blocks. For example, an appointment is made four times an hour, each one lasting 15 minutes. The primary reason that this is problematic, and the reason it is sometimes called "cramming," is that it doesn't take into account late patients, no-shows, emergency patients or procedures that may take longer than 15 minutes.

2. Steady Stream. Sometimes called "wave," this scheduling method has a few different approaches. Generally a number of patients, perhaps six, are scheduled at the top of the hour. Ancillary staff, whether nurses or physicians assistants, collect information and take vitals from several patients while the physician is seeing others. A modification of this approach is the six patients are scheduled across the hour, with, for example, two patients at the top of the hour, two more 20 minutes later, and two more at the 40-minute mark.

3. Modified Wave. Like the steady stream approach, patients are scheduled at the top of the hour or throughout the hour, but the last 15 minutes are left open to finish up with patients or deal with any problems that occurred. Many physicians' offices find this method to be effective.

Determining Practice Type

Which type of scheduling method to choose? It generally depends on the type of medical practice you are running and your own personal preferences. For example, not every patient needs 45 minutes for a new patient visit. Some physicians, however, feel they need to spend more than 15 minutes per patient.

Your type of practice can be a factor as well. If the practice does a lot of routine care that generally doesn't require much time, then shorter visits may work fine. Evaluating your own practice can go a long way toward picking a scheduling philosophy. Some questions to consider:

 What is the primary type of care you offer?

  • Do you routinely require X-rays?
  • How long do the various procedures take?
  • How many patients do you see daily?
  • How much ancillary help do you have?
  • Are there staffers who can take vitals and triage patients while you see other patients?

One approach: Since new physician visits generally take longer than routine visits, some offices only schedule one day a week to just see new patients, and schedule them in blocks of 30 or 45 minutes.

The same pattern can be used for follow-up or surgical follow-ups as well, which may only take 10 to 15 minutes. Create shorter blocks on specific days for those types of patients.

Physician Personality

It's important to take into account your philosophy towards patient care, but also your own personality. It's entirely possible that a physician may find the idea of doing new-patient visits all day long a chore, rather than spreading them out over the course of a week.

In addition, if a practice has multiple physicians, they all tend to work differently. A worthwhile, though rather difficult thing to do upfront, is to evaluate how long each doctor spends on the most common procedures and types of patients. For example, take the 10 most common reasons patients come into your practice and evaluate the amount of time each physician typically spends on that type of patient. With that information, it's fairly straightforward for the staff to schedule those patients based on how long it typically takes the doctor to handle that care.

Here are some other factors to consider:

Lunches and break periods. Some physicians want a regularly scheduled lunch while others will just eat when a free spot opens up.

Paperwork and administrative tasks. Many physicians schedule a specific day or a block of hours in which to handle business-related issues, such as billing and insurance problems, correspondence, staffing matters and continuing medical education.

One possible approach, outside of a more sophisticated software solution, is to have two columns for each doctor. The first column receives more complicated cases. That way, if the practice is scheduling for 15-minute blocks, the complicated patients go in that column. The second column has less complicated cases, services that can be performed in five or 10 minutes. Essentially, practices tend to lose money in the complicated column. Then, physicians bounce back and forth between the two types, which leverages time and money.

Scheduling Software

There are of course third-party scheduling software options. Some even allow patients to go online and schedule an appointment. After logging in, patients have their own passwords so the systems are HIPAA compliant. The patients can fill out their medical histories and then pick timeslots.

The practice can block out times on the calendar for online appointments and the patients never see the real schedule -- just the times that are open to them. Some software also has the schedule color coded so online appointments are one color and other types of appointments are different colors. Some systems also automatically send e-mail reminders and thank-you messages.

One advantage is the appointment will automatically sync with the physician's electronic health record (EHR).

Similarly, although rare, some practices utilize 24/7 answering services, and provide the services access to their online scheduling calendar. This step is more proactive than just leaving a message or screening for emergencies. Practices that use this approach may find that referral and acceptance rates have increased while no-show rates have dropped.

Getting Buy-In

The key is to make sure that everyone in the practice -- staff and physicians -- use whatever system is in place in a consistent manner. It is particularly important for staff members to buy into the system because they are the people who do the actual scheduling.

This requires the staff handling the scheduling to triage patients when they call. The staffers will need to ask questions to get a better sense of why the patients are coming in so the schedulers can appropriately place them into the system.

Furthermore, a scheduling policy should include what to do with emergencies, late patients and unexpected problems.

Having control of your medical practice's schedule can maximize time, efficiency and have a direct and positive effect on your bottom line.