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Discussion

Scheduling?

I'm currently working for a FQHC as an FNP. Right now, we are currently seeing scheduled patients about every 20 minutes. We have a 40% no show rate. For that reason, the Medical Director enforced double/triple booking. That's fine when you have 3/ 2:00 patients, and only one shows up. But when they all 3 show up at the same time, I get grief from the patients. This happened today. A patient had a same day appointment (triple book) and she had to wait 1 hour and 22 minutes before I got to her. I had a (scheduled) NP/foster care PE and a NP routine gyne both at 2:00pm. She threw all kinds of F bombs at me for the wait time. So, we've had this conversation several times with the Medical Director stating, it is not fair to the patients to book 3 patients in one slot. His response was that most offices across the country double and triple book...that's just how it is when you have to report numbers to the Feds. So Im wondering, how common is this and what is your policy on double/triple booked patients?

Secondly, we are switching over to an open access scheduling starting April 1st. For anybody who is not familiar with this type of scheduling...patients never get a scheduled appointment. For example, for routine diabetic checks, you tell them to come back in 3 months and they are supposed to call in 3 months to say..."I would like to see my doctor today." If the schedule is full for the day, they can get on for the next day. The idea is, first call, first serve and call back the next day if there are no open slots. Anybody else do open access scheduling? And how does this work for your underserved, non-compliant, very complicated patients? I've been chosen to be the first to try it out. In my experience, with this particular population. They are train wrecks when they come in. Their blood sugar is 500, blood pressure is 200/100 ect. So the very non-compliant chronic patients come in when they're near death and it takes at least an hour to get their medications back on tract. If they were scheduled, we would never see them because they can't keep appointments so they would go to the ER. Sorry for such a long post. Interested in your thoughts.

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    I used to work at a FQHC, double booking was the exception rather than the rule. First f bomb and I hit the door. Or you could direct them to the MD, always a fun time. Yeah, to bad we don't treat patients anymore, we treat numbers. We have to see so many, their bgl has to be in this range, their weight has to be in this range. Their pain number has to be treated.

    Good luck with your FQHC experience. I used to work in a prison. I quickly assertained that the FQHC was the farm team for the big show at the state pen.

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    Glad to know this is not the norm and there is a light at the end of the tunnel post loan repayment. This is my first NP job. Great learning experience. But I was beginning to think that if this is what an NP has to do everyday, I'm going back to being an RN:-( Hell, it's almost the same salary.

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    In my opinion, open access scheduling should drop the no-show rate dramatically. If I call in at 10:00 for an appt today, I obviously know it's going to fit into my schedule, I have transportation available, and I'm not likely to forget I've scheduled the appt. Sure, you're going to have those patients who get hit by a bus on the way to the office, but other than that the no-shows will be reduced.

    There is data available out there if you try a literature search that shows how this has improved patient flow and office efficiency.

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