Factors to consider in setting office hours

If medicine was simple, every office would be open from 10 a.m. to 4 p.m. without having to bother providing night or weekend hours.

Of course, there are many factors at play when you're trying to put together a schedule, and everything from patient schedules to staffing costs to family demands help dictate when your office should be open.

Setting office hours is a personal choice loaded with business implications, and physicians should be aware of all of them before making a decision that sets the tone for each practice, health care consultants said.

Availability should be the top priority for any physician, especially one just starting a new practice, said David Hunt, a principal with Parrish, Moody & Fikes PC, an accounting and consulting firm in Waco, Texas.

"The issue of extra hours becomes critical if you're trying to set yourself apart from competitors," Hunt said.

There are two schools of thought about setting initial office hours. The first is to start with a limited set of hours and expand as the patient load increases. The other is to start with an expansive offering of availability in hopes of quickly building a solid reputation with patients regarding availability and wait times.

Some doctors actually incorporate both ideas into office hours, dividing the schedule according to patient demand and personal obligations. The key is not necessarily being open more often than the next practice; it's being open at the right times, said Steve Gaydos, a consultant in Barrington, Ill. "Most of my clients in primary care try to stay open one or two evenings per week and one or two Saturdays a month per doctor," he said.

Daniel Grzegorek, DO, an internist with a solo practice in Willowbrook, Ill., has a different schedule each day of the week. His office is open Wednesday nights, but rather than keep the office open for 10 straight hours, he has appointments from 10 a.m. until noon, and then again from 4 p.m. to 8 p.m. "Because of family, it's difficult to do," said Dr. Grzegorek, who has four children. "That's why I stay open later on just one night."

He also is available from 10 a.m. until noon two Saturdays a month by appointment only, but so far he has found that patients prefer evening hours. The schedule likely will evolve over time, which might include cutting back to one Saturday a month and changing some daytime hours.

"I don't see anyone in the early, early morning," Dr. Grzegorek said. "To me, 10 a.m. seems like a good start time. I can get my hospital work done in the morning."

On the other hand, pediatricians might find success with early morning hours during the week, consultants said. But whatever physicians decide, consultants stressed that nothing should be etched in stone.

Patients will give you a good indication about new scheduling opportunities with their early responses. If certain time slots, such as new evening hours, fill up quickly and are booked more than a few weeks ahead, that could convince you that another evening is necessary, Gaydos said.

Scheduling beyond core daytime hours will require juggling staff schedules, but salary costs are the only overhead item that would increase during nights and weekends, consultants said. Most offices can get by with a skeleton crew, only a receptionist and a nurse, after the typical closing time.

But there's an inherent risk to evening and weekend hours. The staff could simply be wasted, Gaydos said. "A lot of doctors end up dropping Saturdays because they have to staff up that morning, they schedule patients and then half of them don't show up."

Of course, expanding schedules is easier if there are several physicians in the practice. Doctors in solo practice could hire moonlighting residents or try to establish a network similar to a call group, consultants said.

Even a retiring doctor could help, said consultant Hunt. "One doctor bought a senior doctor's practice, but the senior doctor wanted to stay on in some fashion. He was used for nights, weekends and mornings. It worked out great for everyone."