"Top Family Doctors 2002: The Doctor Will See You — Now" Restructured office visits with "open access" and evening hours eliminate the wait and let patients and doctors use their time more efficiently. Delaware Today, November 2002 When Dr. Bonni Field, a Wilmington pediatrician, left a group practice eight years ago to become a solo practitioner, she knew she needed to make some changes. "I really had no family life," she says. One of the busiest time slots at the group practice had been the 4:30 p.m. appointment, which seemed perpetually overbooked. The first patient who was given that appointment would be seen quickly, but the sixth and seventh patient would have to wait nearly two hours. By the time Field arrived home at 7, "my kids already ate Trix for dinner and I was too exhausted to make a real dinner." So when she went solo, she adopted somewhat peculiar office hours that she thought would let her spend more time with her three young children and give parents more flexibility, too. She began seeing patients from 8:30 a.m. until early afternoon, then dashed home just in time to greet her children as they came home from school. For the next few hours, she could enjoy time with her children, and after dinner, she would go back to the office and see walk-in patients during evening hours, usually until about 9 p.m. Her no-appointment-needed evening hours thrilled parents. Without office visits available at night, she says, "parents who pick their child up from daycare at 5:30 p.m. end up sitting in the E.R. all night or listening to a screaming child all night." When she first began this bifurcated workday, she feared parents might abuse the evening hours, but just about all of the parents have judiciously used the service. In fact, she says, it's allowed the entire family to become more involved in the child's healthcare, since both parents can accompany the child without having to miss work. "In the evening, the whole family comes, and afterwards, you hear, 'Okay, who wants to go for ice cream?'" she says. "It becomes a family event." Just as important as evening hours, she says, are walk-in hours that allow parents to bring their sick child to the doctor as soon as the child becomes ill. Field holds these walk-in hours in the morning and evening, five days a week. Known among primary-care providers as "open access," this system guarantees that a patient who is sick will be seen by a doctor on the same day he or she calls the office. Dr. Ed Sobel, a family physician at Family Practice Associates in Wilmington, says his practice switched nearly two years ago to an open-access system he calls "Easy Access." The office staff leaves a certain number of time slots open each day for walk-in patients who are feeling ill. During the rest of the time slots, for which appointments are required, the doctors conduct physicals, check-ups, and other procedures not related to an acute illness. "Our first goal was to see patients in a more timely manner," Sobel says. "Secondarily, from a business standpoint, we wanted to fill empty time slots and reduce the amount of no-shows." Experience had shown that patients who scheduled an appointment days in advance for illnesses such as a sore throat were likely to either get better or go to a hospital emergency room before the appointment, resulting in a no-show. With the Easy Access system in place, he says, "If you call, we'll see you the same day, guaranteed." The practice has seen a 50-percent drop in no-shows since Easy Access began. However, it's taken time for patients to adapt to same-day service, Sobel says. "Just today, a patient called in and asked for an appointment tomorrow. We said, 'No, come in today.'" Patients are so used to waiting several days to be seen by a doctor that they're startled to be examined, diagnosed, and ready to pick up their prescriptions just hours after they call the doctor, he says. But in the beginning, even his staff took some time to transition. "It's a big leap of faith," he says. "I remember when we started this, we were thinking, 'There's going to be a lot of open appointments, it'll ruin us, the patients will be unhappy.'" Instead, he's heard only good things from patients about Easy Access, and in hindsight, he says, "It's a logical, intuitive way of doing things ... it's the right way to do things." Field's leap of faith also paid off. "With the walk-in hours, [parents] have time to wait. They don't have to book now because they're afraid they won't get an appointment later," she says. "It takes so much of the pressure off." Shaun Gallagher is Delaware Today's managing editor.