Originally created 08/25/04

'Same day' doctor appointment slowly catching on



If Steve Lunt, aka the "Handyman of Rochester," made his clients wait weeks for an appointment, he'd be out of business before long.

But that's how Lunt's health care used to work, and it's the same for millions of other Americans.

"You're just a number," said the 47-year-old Lunt from Rochester, N.Y., said. "You go sit in the waiting room for an hour after waiting two weeks to get an appointment."

Life changed for Lunt and his wife when they called Dr. Gordon Moore, who is among a growing number of doctors nationwide who have adopted same-day service.

The idea, which experts say is gaining steam, is that scheduling patients immediately for even routine physicals will keep them healthier and happier, while saving money in the long run. If people know they'll get quick appointments, the reasoning goes, they're less likely to ignore their health problems, which will reduce costly emergency-room visits.

"We've seen it work in every kind of clinic imaginable," said Marie Schall, a training director at the Boston-based Institute for Healthcare Improvement, an organization pushing for same-day service, known in the industry as "open access."

The American Academy of Family Physicians and the U.S. Department of Veterans Affairs also adopted open access as their goal.

Moore, 43, who treats the Lunt family at his Ideal Medical Care clinic in the suburbs of Rochester, made the transition three years ago. Tired of working long hours with patients double- and triple-booked into time slots, Moore left the physicians' group he was with and started his own family practice.

"People used to be shocked when they'd call up - and half the time I answered the phone - and we'd say, 'Come in at 3 p.m.,"' said Moore.

"I don't have cranky patients. I don't get the no-show thing I used to have," he said. "My schedule is much more reliable. Doctors make a fine income, that's not the problem. The problem is imbalance and burnout. I have three small children. I want to be there for them."

The majority of patients, however, still wait for their care. A recent survey in 15 cities found that the average wait for a cardiology exam was 19 days. The average wait was 24 days for a dermatology appointment, and 23 days for an obstetrics-gynecology exam, according to the survey by Merritt, Hawkins & Associates, a national firm that recruits medical workers.

Boston, despite a worldwide reputation for medical care, had the longest waits in three of the categories surveyed.

Kurt Mosley of the Dallas-based MH&A said the biggest hurdle for open access is persuading doctors to rethink their scheduling habits.

"You have to get rid of the backlog first. You have to stop (long-term scheduling) cold turkey," Mosley said. "Doctors aren't used to that. You have to have an office manager who takes control and says, 'You're not going to fill up your schedule on this day."'

Schall said doctors also worry their incomes will drop dramatically if they leave slots open. But past experience has shown that if doctors study the volume of callers seeking appointments at different times of the week, then adjust staffing, appointment slots will fill up, and practices become more efficient and able to take more patients, she said.

"It's all very data-driven and based on predictions and having a clear understanding of your supply and demand," Schall said. "The evidence shows that really they can make out better."

Moore said he's ablt to address several needs of patients all at once, rather than refer them to a specialist or schedule a later appointment.

It may seem counter-intuitive, he said, but he's making more money now that he's cleared his appointment book.

The movement is growing slowly but steadily, said Mosley, whose own doctor in Texas has adopted the practice. It came in handy last month when he noticed a bruise on his leg before leaving town on a business trip. He called his doctor, got a same-day appointment, and learned the bruise was from a spider bite.

"He got me on antibiotics right away," Mosley said. "I would have been on the road and my leg would have ballooned like a sausage."

Moore said in his region the move toward same-day service has meant a drop in emergency-room visits.

Lunt, who has diabetes and high blood pressure, said the personal touch improved his health. Moore sent him to a specialist who changed his blood pressure medicine.

"It's been down ever since," he said, "and I'm taking a third less medicine than I was."

His wife, Mary Lou, 45, sees open access as a return to basics. She and her husband were so pleased about their care that they dropped their pediatrician and brought their two children to Moore.

"I don't understand why more doctors aren't doing this," she said. "It's very empowering to the patients. It's changed our lives, really, at the risk of sounding dramatic."