Should doctors extend their practice hours?

In a world in which consumers book travel, shop and attend school all day, any day of the year, consumer demand for easier access to medical care can come as no surprise. Additionally, the Affordable Care Act adds to the pressure on primary care providers to offer extended office hours. It includes provisions that promote the medical home model, which strives to improve access to primary care in ways that include longer office hours.

Patients are not patient

 “Our patients’ number one complaint is that they can’t get in when they’re sick. Number two, they don’t like waiting,” says Kathy Severa, the practice administrator for Family Medicine Associates (FMA) in Lawrence, Kansas, a four-physician, independent practice. The practice solved both problems, she reports, with three different options that extended hours.

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“Patients can be seen at any time that’s convenient, and the doctors aren’t trying to squeeze patients in to keep the flow going,” she says.  

First, one physician starts seeing patients at 7 a.m., and the practice closes at 5:30 p.m. Monday through Thursday and at 5 p.m. Fridays. Second, each doctor keeps several time slots open for same-day appointments. Third, they offer a walk-in clinic that also opens at 7 a.m. It serves both FMA’s patients and the general public.

Nathan Bloom, MD, is one of the four FMA physicians. He says that the three options enable the practice to provide “more personal, efficient, cost-effective care” to patients who might otherwise use emergency rooms or urgent care clinics. He also says that extended hours help him and the other FMA physicians to avoid problems and waste that can arise when care occurs in a piecemeal fashion  at various sites, where the providers lack familiarity with the patient and have no access to patient records.

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Brian Adamczyk, MD, is interim Medical Director for Henry Ford Allegiance Medical Group (HFAMG). It’s a multispecialty group with 100 physicians in 40 locations in Michigan. Fourteen locations are primary care practices. Some clinics employ as many as 15 providers while others employ only one or two. Dr. Adamczyk, for instance, works as a sole physician along with a physician assistant, and opens doors to patients at 7 a.m..

Despite the scale differences across the HFAMG practice locations, its policy is to encourage all the practices to offer extended hours and to stay open through lunch, even though this can mean that some physicians have no break for a midday meal. At one central location, the group has an extended hours clinic that’s open from 5 a.m. to 9 p.m Monday through Friday, and from 8 a.m. till noon on Saturdays.

Next: Advantages of extending hours

Extended hours offer many advantages

Extended hours can bring with them many advantages, such as increased access and patient satisfaction, reduced emergency room visits and financial benefits. Consider the following:

-       Avoidance of mixed messages: If your website says you provide excellent service to patients but they have to miss school or work to come see you, can you honestly assert that, especially if other local providers do offer longer hours?

-       Growing your patient base: New patients often choose a practice based on online research or checking out in-network providers. Extended hours can be the difference that brings them your way. Adamczyk reports that new patients have joined HFAMG because of the extended hours.

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-       Image enhancement: Increasingly, patients read online reviews of physicians before choosing a provider. When your patients rave about the convenient, high-quality care you offer, their accolades attract others. Image enhancement also comes through old-fashioned word-of-mouth from happy patients.

-       Avoidance of attrition: When patients cannot easily see you at hours that suit their busy lives, and other practices do offer early morning, evening and weekend hours, they may vote with their feet and leave your practice. 

-       Providing better care: Serving patients where they feel comfortable, where they are known, and where all their records are housed may mean better, more economical care.

The challenge of extended hours

Assigning personnel to cover longer hours while allowing physicians to maintain decent work-life balance can be tricky. Both Severa and Adamczyk agree that the main difficulty with extended hours is staffing. When it comes to weekday evenings and weekends, providers want to see their families, but providers must adapt, says Severa.

 “In today’s competitive environment, if you want to serve your patients in a way that is ongoing and convenient, you just have to wake up” to extended hours, she explains.