As a business owner and physician, you need to have a major handle on your schedule. This is more important in DirecT Care than anywhere else because patients often have access to you around the clock. I've personally witnessed the torment physicians can undergo when trying to "be everything, to everybody, all the time." Clearly, no one can be so this mentality always results in failure - "I'm not parenting well enough; I'm not doctoring well enough; I'm not taking care of me!" Sound familiar?
Here are my hacks to managing a DPC schedule (without staff), a family (I have three kids and a wonderful/helpful husband!), and my own needs.
- Buffer everything!: My basic schedule includes buffers for before patients and after patients. We use an online scheduling system that links into our EMR. So, when a patient goes on to book they only see slots I have left open. If someone books 1pm, I can choose to approve or deny. Once approved, I automatically add a non-patient buffer block for the half hour before. This eliminates the possibility of another patient being able to book something within the half hour before a visit is scheduled by someone else. This lets me ensure that longer visits (one hour is my generic block) have the time they need without another patient booking to close. The buffer also usually gives me extra time to finish up paperwork, call in referrals, research related topics, etc. When I don't feel rushed, and don't put off patient-related to-do's to later, I feel like I've checked off the whole task list for that patient (note included) right then and there and can move on to the next!
- Schedule urgent visits yourself: If it is the day before and I have any openings, I block them. I don't want patients being able to log in today and pick a visit today for something non-urgent. And if it is urgent, I want to discuss that with them first and be sure coming to see me is what makes the most sense. If it's a UTI and a patient just needs a urine sample and an antibiotic - I can do that from my desk and they can save themselves another stop. If it's a likely fracture, I can get the x-ray first. If it's a specialty issue, I can coordinate with or refer them to where they would be best helped, Etc etc. Granted the choice of where they go and how much you do in person can only be made by you - so I strongly suggest you be your own triage-person - and save yourself time and unnecessary headaches.
- Block time for you: Everyday my schedule starts with a two hour block. During those hours I exercise, run errands, handle personal matters, go to the doctor for me, etc. It took me a couple years to realize scheduling time in for my needs was just as important as for everyone else's!
- Consider a "day off": or two! My current schedule allows three days of in-person openings for patients to book (M/W/F). I let patients know when they join or ask that routine checkups, physicals, and non-urgent needs will schedule about 2-3 weeks out. (As above, I always tell them to reach out to me directly for urgent needs and that while I may not always be in, I am always reachable to figure out the best steps). The other two days of the week I am "off" - this is not something I advertise to patients but what it lets me do is have two days to either (1) do things I enjoy/spend time with family, or (2) squeeze in urgent visits if they are essential. I usually spend 1-2 hours on these days checking faxes (online e-fax of course!), reviewing labs, answering messages, etc. but a majority of my day is my time. When someone needs that acute visit, I can often see them tomorrow, but if not I have lots of time to do it today when necessary.
- Take vacation: don't be afraid to take time off. As any established DPC doctor will tell you, we all deserve it at some point and patients will congratulate you for taking time for yourself! I always email to warn a week and a day in advance that I will be out. If I'm taking my own call, I remind them to send an email and that has an auto-response reminding them that non-urgent issues will be responded to next week. I do have a partner who covers for me once in a while for vacation and I think having that option is worth it's weight in gold if you can coordinate it. Many non-partnered/non-group physicians do this with a nearby DPC doc who they pay for coverage, for example.
- Accept the urgent care: in a practice with no staff, I cannot be 100% everywhere all of the time. So there are occasions where someone needs stitches and I'm at a soccer tournament with my family, for example. The biggest piece of advice I can share here is, let it go and realize it is OK! Patients are reasonable and understand you have commitments outside of their every medical need. They know you are almost always able to help them quickly and they appreciate you advising them on where to go when you can't!
It's time to say goodbye to staff double-booking you when you have explicitly asked for patient A to always have 45 minutes. It's time for you to realize that a huge benefit to DPC is that YOU make your schedule. Make your Direct Care practice the one you want it to be by establishing a schedule that is sustainable and ENJOYABLE for you!
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I am a Family Physician, wife to a doc, and mother of three with a mission to convince you as a doctor that you are worth more than the system is giving you and that you are already well-equipped to make a big change without adding more burdens! My passion is helping existing or start up Direct Care practices learn to troubleshoot, streamline, and simplify.