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.