Friday, August 10, 2007

Summertime Blues

Summertime is giving us some insight into a source of our waiting list backlog. When we started this project in the spring, our capacity appeared to exceed demand. The problem, we thought, must be a mismatch between the two, and that it should be straightforward to fix once we get rid of our backlog. We were making good progress with our backlog until summer came along. As you would expect, having half the doctors away for most of the summer reduces our capacity. Our ability to work down the backlog is reduced further because those of us who are working are often fully booked at the hospital taking advantage of the OR time that those on holidays have left unused. Not only have efforts to work down the backlog stalled, I wonder if the backlog might be creeping up over the summer.

This Advanced Access project is like a fitness program. You set a target weight (appointment wait time) and then match your intake of calories (demand) to the amount of exercise (capacity). Of course, it takes some extra effort (reduce calories and/or increase exercise) to get rid of the flab (backlog), but once it’s gone, balancing calories and exercise should maintain your target weight. If you're like me, though, a week at the lake can throw off the whole program. Lounging at the beach plus marshmallow roasts pack on the flab and it can take weeks to get back on track again. It’s looking like the same thing has been happening every summer at our office, i.e. we shed the flab during the rest of the year when we're all working full-tilt, only to pack on the backlog during summer holidays.

We may need to reconsider how many physicians can take holidays at a time, or reconfigure our office hours to make sure our backlog doesn't creep up every summer.  Otherwise, we'll be starting from scratch every fall. It would be nice if the number of new referrals fell off over the summer, but that's not the case:

Also, in January, one of our urologists started working half-time, and as of July, two other partners are working half-time. We have a new partner joining in mid-August, but our capacity will still be down 0.5 FTE. Our most recent calculations show we have to see 97 extra patients a week just to work down our backlog by the end of November.  Considering the number of doctor-days in the clinic, each urologist will need to see between 4 and 5 extra new referrals each day they are in the clinic to work down the backlog in a 12 week time frame. That's a lot of work! Perhaps we can convince the "half-timers" to help us out by working a few days extra. If they came to work for 2 days during their month off, they could see up to 60 new patients each. That would really add up.


  1. Originally posted by Sheri M. (Five Hills Health Region) 8/10/2007 11:30 AM

    The difference between Man and Machine is that Man is not a Machine....I read that somewhere. Hi Kishore. See, the thing is - you and your fellow docs are not machines. So, try as hard as you might (and I know you all do) you can't always keep up with the demand for your services. The new referrals keep coming. And they will continue. You can't offer your services 24/7.You are not a machine. You and your fellow docs need breaks. You need time to get away and re-energize yourselves. It sounds like you may be feeling guilty for taking a bit of time off during the summer. Don't fall into that trap. Everyone needs a break during the summer. Summertime always causes backlogs. Not just in healthcare. It's just a reality and we all need to accept that. Keep trying to do your best, but remember that all work and no play makes Kishore a dull boy. On the flip side of the coin...perhaps looking at the nature of the new referrals you receive may provide insight? Are you facing an epidemic of query prostate Ca dx? Whatz up with our men? Is everyone's prostate going wonky or what? And if so, what is that saying about our society? Are there any preventive measures we could be looking at? Can we be educating our public better - towards better prostate and/or urological health? I honestly don't know. Is the whole topic too sensitive, and so no one wants to talk about it? Is it the case of the 9,000 pound elephant standing in your living room but no one seems to see it? The other thing is, that the general population (i.e., consumers of healthcare) aren't as helpless as we may present. I firmly believe that we (Josephine and Joe Public) are actually capable of learning how to manage our bodies in ways that might just prevent some of our problems in the first place (I said some, not all). Or at the very least, we can learn how to better "quell our anxiety" when it rears its ugly head upon facing the uncomfortable truth that one or more of our body parts have gone berserk! At the end of the day, Kishore, you are helping to save lives, improve lives, and practice your passion to help your fellow man. What else matters?

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