• Porter Hospital clinic moves to open scheduling
    By Gordon Dritschilo Herald Staff | July 12,2006
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    CASSANDRA HOTALING / RUTLAND HERALD

    Ingrid Kaufman (left) and Paula Duchaine work in the front office at the Neshobe Family Medical Center in Brandon on Tuesday.
    It's three doctors and a lot less waiting at Porter Hospital's Neshobe Family Medicine.

    The clinic run by Porter Hospital switched over to an "open schedule" system in October. Instead of making appointments weeks and even months in advance, patients call ahead and are generally seen the same day.

    The staff makes exceptions for people for whom an appointment scheduled in advance is more convenient, such as elderly patients who need rides, and doctors allow patients to schedule their own follow-up visits, recommending a time span and making reminder calls when the advised time arrives.

    Doctors and staff at the clinic said medical-industry conventional wisdom has long held such a system to be unworkable. Reality, they say, has proven otherwise.

    "The belief has always been that if you open it up like this, you'll have total chaos," Dr. Jeff Wulfman said between appointments Monday afternoon. "You'll have days where you're twiddling your thumbs and days where everyone wants to come in."

    Wulfman said the clinic's experience has been quite the opposite.

    "Some days, I'll come in in the morning and my entire schedule, except for two spots, is open," he said. "By mid-afternoon, it's full."

    Another of the practice's physicians, Dr. William Barrett, said he can only think of one day since the new policy began when they could not fit in everyone who wanted an appointment.

    "We had a man who needed a physical for on-the-road truckers," he said. "He called this morning and we saw him this morning. If you're sick, you can be seen that day. Need a pre-operative exam? We can do it the day you call."

    Barrett said the new system means a better quality of care.

    "It's freed up a lot of time and allowed us more time to spend with each patient," he said. "Under the old system, you had to estimate months in advance when you'd need to see someone and it wasn't always easy to estimate how long you'd need to see them."

    Ingrid Kaufmann, the clinic's office manager, said at 1:44 p.m. Monday that with only two of the three doctors on, they still had a total of three openings that afternoon.

    "When you have a day when you're full and have patients who want to be seen, it's easier to put them on the schedule," she said. "The day flows much better. We have morning openings and afternoon openings. If you called at 1 o'clock, you could still get in that day."

    Kaufmann said the practice has roughly 2,600 patients and each physician sees about 22 patients a day. She said while those numbers haven't changed, the percentage of missed appointments dropped from 10.4 percent to 2.6 percent.

    The change also drastically shortened the time to the next available appointment. Kaufmann said before, the third person calling to make an appointment on a given day would have to wait 41 days before seeing a doctor.

    "Now it's down to zero," she said. "That tells you how clogged up the schedule was. In October, only 33 percent of the schedule was open for the next month. As of May, it was 89 percent available."

    The doctors said the patients seem happier with the new system.

    "Whatever needs to be done today is done today," Wulfman said. "People with acute problems, typically in the past, would call and we'd say, 'We're booked, maybe we can get you in tomorrow.' Instead of waiting three weeks for a five-minute appointment, you wait five minutes for a 20-minute appointment."

    It's also making the physicians' lives easier.

    "I'm getting done by 5:30 or 6," Barrett said. "I've been in practice for 30 years and I've never been out by 5:30 or 6."

    So why doesn't every doctor's office function this way?

    "For 30 years, it's just been done that you scheduled patients in advance," Kaufmann said. "I don't know why more people aren't doing this. I don't know why we didn't do it for years. Once you look into it, it becomes clear that this is how most physicians should be booking."

    Barrett said he thought open scheduling would likely become much more widespread, with 10 to 15 percent of practices in the country having implemented it or preparing to.

    "You talk to practices who have never heard of this and they look at you like you're crazy," Wulfman said. "We talk to other practices around the country who have adopted this and they say they're never going back."

    Contact Gordon Dritschilo at gordon.dritschilo@rutlandherald.com. Dawn Bailey works in the front office at the Neshobe Family Medical Center on Tuesday.
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