A Competitive Advantage: Should Your Practice Offer Extended Hours?

Published: May 9, 2017
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Until recently, few physicians offered after-hours care beyond an automated telephone instruction to call 911 or visit an emergency room. But offering 24-hour access is a policy goal today so practices should consider at least some form of extended hours.

Why Stay Open Longer?

There are several good reasons to offer extended hours:

To compete for patients and drive revenue.

We live in an era of “right here, right now.” When people can book a flight, order from Amazon or step into an Uber car within seconds, they begin to expect a similar experience everywhere.

A medical office with shorter waits and more convenient hours is attractive to busy people. This is why urgent care centers and pharmacy clinics are offering consultations and some treatment during night and weekend hours. While these are popular among patients, a practice that takes the cue can win some of those patients back and bring new ones on board.

To reduce ER visits.

Without access to a doctor’s office, people who are ailing often head for the nearest emergency room; many older people don’t hesitate to call for an ambulance. But a UK study showed a 26 percent reduction in ER visits among patients whose primary-care providers offered extended hours. For children the data are even more dramatic: The Journal of Pediatrics reported that pediatricians with evening hours reduced their young patients’ ER visits by half.

To reduce hospitalization and improve health.

Patients who consult with their regular physician or group tend to require less time in hospitals. The Journal of General Internal Medicine reported that care “outside usual business hours ... is associated with improved patient outcomes.”

To deliver personalized care and create patient satisfaction.

When you keep your patients in house, your staff not only knows them (and vice versa) but also has immediate access to records. The Annals of Family Medicine views evening and weekend appointment options as key to a patient-centered society.

Costs, Risks and Downsides

Moving to longer hours comes with some costs, too. Expenses for staff, utilities, supplies and possibly office rent will rise, although careful planning to see enough patients should generate more than enough revenue to offset these costs.

A less tangible risk is staff morale. If you extend hours without additional hiring, some staff may gladly pick up the slack. But some may resent it, even with a bigger paycheck.

Also consider physician burnout. Doctors can be driven people and jump at the opportunity to work longer hours and see more patients. But whether they admit it or not, the new schedule will affect their work-life balance. (See page 4 for more on physician burnout.)

Before You Leap

A few sensible measures can help you decide whether or not to offer extended hours and implement the change in a smooth and sustainable way.

First, weigh different scenarios. How many more hours would actually help the practice before the returns diminish? Which positions must stay filled during extended times and which aren’t needed? Billing, labs and nutrition counselors, for example, might remain on their present schedules or come in one evening a week.

And how many patients do you expect to use the new extended hours? Conducting a survey can help you gauge this. This kind of planning may feel a bit abstract but it’s crucial to have a good idea of costs and benefits.

Next, align the troops. Get everyone on board, including doctors and staff. To do this, be transparent and willing to accommodate inconvenience one way or another – for example, with flex time or a modest shift differential and a liberal policy on shift trades. And consider generational differences: Younger staff may prefer starting later and ending later. Younger physicians, meanwhile, may volunteer quickly in order to see more patients and build their own base.

Commit to more than a month or two and make this clear from the outset. A popular move that’s quickly withdrawn won’t help your reputation. Then make the change known widely – to have an impact, it has to be advertised.

Leadership Can Make It Work

Extended hours can mean different things to different practices. If practice leadership is aligned, creative and flexible, offering extended hours can please patients and staff while increasing practice revenue.

Healthcare Practice Strategies - Spring 2017