MEDICAL CARE More doctors join movement to cut patients' waiting



Lengthy waits aren't inevitable, some doctors say.
KNIGHT RIDDER NEWSPAPERS
PHILADELPHIA -- Florrita Bell used to find it frustrating, but normal, to wait weeks for a routine physical or blood-pressure check at Jefferson Family Medicine Associates in Center City Philadelphia.
But now -- even quicker than she gets a hairdresser appointment -- the doctor sees her within a day of calling his office. And she doesn't need to be sick.
These doctors took a bold step for a medical practice: They decided lengthy waits were bad for patients, staff and the bottom line. So gradually over the last two years, they set out to abolish them.
"It awed me," Bell, 52, of Darby, Pa., said about Jefferson's switch. The new system is more convenient and gives her peace of mind, she said. Plus, she gets to be treated by her own doctor. Now, she finds it annoying when she goes elsewhere for care and must wait three weeks for a specialist or four months for a mammogram.
Same-day appointments for routine care are shaking up the widely held belief that lengthy waits for doctor visits are inevitable. While this style of practice is not yet commonplace, experts say, open access to the doctor's office has become the goal for the American Academy of Family Physicians, the Department of Veterans Affairs and scores of physician practices around the country from Minnesota to Texas.
"It is a movement that has been growing. We are near reaching the tipping point," said Pat Rutherford, a vice president at the Institute for Healthcare Improvement, a Boston-based group promoting efforts to reduce delays.
How it works
Open access, as the scheduling philosophy is often called, doesn't operate like an urgent-care center, where patients typically walk in and are seen by any available doctor. The new system aims to match patients to their doctors in a timely manner for whatever ails them.
It is achieved by doing "all of today's work today," rather than pushing it off into the future, said Mark Murray, who pioneered same-day appointments in a Kaiser Permanente primary-care department in the early 1990s and reduced the average wait from 55 days to one. He said he borrowed the concept from studying other businesses, including the auto industry, that improved customer service by reducing waiting times.
To shorten waits, doctors can work harder for a while to reduce the backlog. They figure out the days and times of the year when patients typically need care, and adjust staffing accordingly.
Some resist
But many doctors resist overhauling their schedules, experts say. They fear that too many patients will show up. Or, not enough. And they are daunted by the work involved in reducing the backlog.
"It is like jumping in the pool, especially if you are not a swimmer," said Ron Barg, senior medical director for the University of Pennsylvania's primary-care network. "Some people are worried they are going to drown."
Still, he said, Penn is considering jumping in.
Jefferson has plunged ahead, recognizing that health care needs to become more efficient. "You don't wait for two months to buy something in the grocery store," said George Valko, a family doctor in the Jefferson group owned by Thomas Jefferson University. People "want to have access to their physician's practice every day," he said.
Growth
And the practice handled 72,000 patient visits last year, up from 61,000 before the switch, Valko said.
Valko, the Jefferson group family doctor, said his group has not perfected the system. Some patients say the phone lines are too busy or their doctor isn't available. Some doctors still want to hang on to more long-term scheduling.
But Valko said he would like to get rid of all waits.
"You really want patients to be seen when they want to be seen," he said.

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