Sunday, August 29, 2010

Summer in the Pool

Summertime has traditionally been a challenge for our efforts to improve access. As we are working with half the number of urologists, patient wait times usually increase in the summer and early fall. This reduced office capacity is slightly tempered by the fact that the hospitals close some operating rooms in the summer, meaning that surgeons can spend more time seeing patients in their offices. Of course, this just transfers the bottleneck of patient flow further up the line by lengthening waits for surgery. Zero sum game.

Here’s how things look at the end of the summer:

As anticipated, wait times climbed after the success of the springtime “blitz”. I expect them to fall again as all the docs get back from holidays.

But, here’s an interesting chart that Erin, one of our office staff, has put together:

The top line is the clinic average for 3rd next available appointment (3NAA). The bottom line is the shortest 3rd NAA. Erin selected the doc with the shortest wait for each date and plotted it against the average wait. Because we offer pooled referrals, I think the lower line more closely reflects actual patient experience.

Our pooled referral philosophy is this: We will automatically assign a newly referred patient to see the urologist with the shortest wait time, unless the patient/referring physician choose otherwise (they rarely do). If the patient requires the special expertise of one of us, we will make the appointment with that urologist. If a patient already has a relationship with one of our urologists, we will maintain continuity of care for them, and schedule them to see their regular urologist.

This comparison graph alone should convince patients and physicians of the benefits of a pooled referral system.

I wonder about the “zero” 3NAA points. This means that the doc had 3 open slots on the day of measurement. Because our demand comes from external physician referrals, it’s unlikely we would have filled those slots.

Once we receive a referral, we would have to contact the patient immediately in order for them to be seen on the same day. Unless the referring physician had phoned us about an urgent/emergency consultation for a patient who was still in their office, and then sent that patient right over to see us, they would likely wait for at least a day or two before being seen. As such, we may be wasting some capacity. We’ll review this to make sure we’re filling all available slots.


  1. If all the urologists in Saskatoon work in a group practice in one clinic, how can a patient get a second opinion,without causing any unintended displeasure to the first physician? Thanks

  2. Uh-oh! Someone's spotted the 800-lb. gorilla in the corner. Yes, there is a potential darkside to pooled referrals/group practices. While there are plenty of benefits for both patients and physicians, a geographic monopoly of specialty services can sometimes be a problem for patients.

    This deserves a post of its own, so tune in next time...