American Association for Physician Leadership

Effective Patient Scheduling

John Guiliana, DPM, MS

Hal Ornstein, DPM, FASPS

Mar 14, 2024

Volume 2, Issue 2, Pages 88-89


In the physician’s office, the schedule itself is the most powerful and influential aspect of the physician’s day — and it can control you or you can control it. This article offers a few thoughts on keeping control of your schedule and making it work for you. In addition, it also offers an Action Step that will assist you in developing a plan to improve patient flow.

Who in the White House has more power than the President? The Chief of Staff. Why? Because the Chief of Staff controls the President’s schedule—decides who sees him and for how long, who can talk to him on the phone—and controls the agenda.

Here are a few tips on managing your caseload.

Time Blocks

There is a tendency to let patients decide when they can come into the office. The staff offers a number of open slots, the patient picks one, and that’s when they come in. This can lead to a very fragmented schedule.

When possible, try to schedule certain types of procedures in blocks—physicals or new patient appointments on certain days, easy check-ups or procedures opposite more time-consuming procedures, so you can move from one room to the next without having a 15-minute lag period after you’ve seen one patient for a five-minute procedure. This requires that your staff try to determine why the patient is coming in and then slot similar patients in similar ways.

Sorting Out Same-Day Patients

Many offices have problems accommodating “same-day patients,” or those patients that call up on the spur of the moment with an emergency. Sometimes these are new patients, and they try to accommodate them. This becomes a problem if your schedule is already full, and an emergency arises.

One way to deal with this is to leave one of the first time slots in the morning open and one of the last morning timeslots open. Do the same thing in the afternoon—leave an early slot open and a late slot open. Therefore, you have four open slots. With the early morning slot, if someone calls first thing in the morning, you can schedule them in, or from the night before, if you have a very late-in-the-day call. If a patient calls later in the morning, you can fit them into the late-morning slot just before lunch, or the just-after-lunch appointment timeslot. Many patients with problems will call during the lunch period, and you can fit them in.

The late-afternoon slot typically is not difficult to fill, because if no emergency is showing up, you can offer it to anyone who calls during the day who is willing to come in on short notice.

It’s a good idea, however, to have a written policy in place that discourages habitual same-day callers. Every physician has regular patients whose every concern is an “emergency,” even if it’s for a routine appointment.

Work Smarter

There are several things you can do to help stay on track and work more efficiently. Some of them are really just common sense.

  • Start on time. If your first patient is scheduled for 8:00, don’t show up at the office at 8:00. Try to get there at least 15 minutes early so you can take a breath before plunging into your day. If you run late on your first patient, you’ll be behind all day.

  • Chart as you go. It’s far more efficient to chart as you go along, either dictating between rooms, while in the room, or by having a charting system in the rooms so you can chart during the examination. There are a lot of good reasons for this, but one of the most important is that you’ll make fewer mistakes and forget fewer details if you don’t wait for later in the day—or week—to write up your notes on a patient.

  • Schedule breaks. It’s easy to get into a habit of taking breaks between patients, even if it’s for a few minutes—chat for a minute with a staffer, have a cup of coffee, check your email or your Facebook page, make a personal phone call. But think about it this way: If you take a three-minute break between each patient and you see five patients an hour over eight hours, you’ve just wasted two hours of your day. Better to schedule a break to get these minor tasks done and control the time than watch it add up like a drippy sink.

  • Set targets. To get a real handle on your scheduling, you need to set a target number of patients per day based on the number of hours available. This helps in setting expected revenue goals. Once you have that number, you need to evaluate your no-shows and late cancellations. Whoever on your staff is assigned the responsibility of scheduling also needs to know what those per-day patient goals are and commit to meeting them.

  • Keep busy. Evaluate your daily routine. Are there periods when you have nothing to do or when there are no patients scheduled? Why? Is it intentional? Necessary? If not, can you organize your schedule to accommodate work-related activities? Having a sense of what’s going on in your day on a regular basis will go a long way toward how to approach your patient scheduling.

Action Step: Ask each of your front office and clinical team members to make a list of five ways they feel you can more effectively schedule your patients. For one month, perform a time-and-motion study, analyzing the flow of your staff and patients, then develop a plan to improve the patient flow.

Excerpted from 31½ Essentials for Running Your Medical Practice, by John Guiliana and Hal Ornstein.

John Guiliana, DPM, MS

John Guiliana, DPM, MS, is the managing partner of a four-doctor podiatry practice in Hackettstown, NJ. He holds a master’s degree in healthcare management and is a nationally recognized professional speaker and author on medical practice management. He is a frequent contributor to Podiatry Management, Podiatry Today, and is author of Talking Practice Enhancement, an American Podiatric Medical Association news column.

Hal Ornstein, DPM, FASPS

Hal Ornstein, DPM, FASPS, serves as Chairman and Director of Corporate Development of the American Academy of Podiatric Practice Management and Consulting Editor for Podiatry Management Magazine. He has given over 200 presentations internationally and has written and been interviewed for over 250 articles on topics pertinent to practice management, patient satisfaction and efficiency in a medical practice. Dr. Ornstein has been in private practice for 18 years and serves as Medical Director of Affiliated Foot and Ankle Center, LLP with their main office in Howell, NJ.

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