Dec. 01 2015

What Science Says About Scheduling Your Doctor's Appointment

Scheduling a medical appointment isn’t easy—for patients and doctors alike. Professor Nan Liu seeks a better way.

We’ve all been there: a patient dutifully checking in to the doctor’s office, on time, only to be stuck in the waiting room for what feels like an eternity. It’s an all-too-common scenario, resulting in a high amount of frustration from patients and health care providers alike. One can’t help but wonder: why does it always take so long to be seen, and can’t anything be done to make things better?

As it turns out, patients are not the only ones examining this issue. Nan Liu, assistant professor of Health Policy and Management, has spent his career bridging data analytics and systems modeling—particularly as it relates to healthcare management and customer behavior. His recently published article in the journal of Production and Operations Management focused on the issue of appointment scheduling.

Transmission reached out to Liu to find out more.

Why do healthcare providers always seem to run so late?

Let’s start with the fundamental issue, which is when patients don’t show up. No-shows are problematic because they lead to providers not getting reimbursed—a total financial loss—not to mention a significant waste of the provider’s time.

Right here in Washington Heights, community healthcare centers have a very high no-show rate. This is a management problem, but also a public health concern, particularly in any underserved community, where the lack of being seen can lead to worse health care outcomes.

But how does a no-show impact a patient’s wait time?

Traditionally, there have been two approaches: the first is to control the panel size, meaning that each physician has a pool of patients and they manage their time against that number. The second tactic is overbooking, which is sort of like overselling airline seats. It’s a way to hedge against the risk that some patients won’t show up. But just like that airport announcement that says, ‘Today’s flight is oversold, we’re looking for volunteers, etc.’ this strategy is not exactly foolproof.

There’s got to be a better way. Right?

I wanted to explore another option: the appointment scheduling window, which is how far in advance a patient should book their time with a provider. It’s meant to be a substitute strategy to overbooking, and does offer certain advantages because it aligns with the public health goal of expanding access to care and reducing delays for everyone.

So what is that “golden” time window, and how does it work?

It depends. If your healthcare center typically schedules appointments two weeks ahead of time, and you are still experiencing a high no-show rate, then you need to shorten your window, perhaps to seven days.

The other factor to consider is whether or not you take walk-in patients. If you do, that can create a bit more uncertainty. For example, those patients who cannot get appointments may come as walk-ins. If you see too many walk-ins, this would suggest using a longer appointment window, say something like three weeks, to absorb excessive patient demand.

That sounds like a lot of work. Can this sort of analysis be easily done?

There’s actually a simple formula I derived using Queueing Theory—the mathematical study of waiting lines—that can easily be plugged into an Excel spreadsheet. All you need is some basic data, including how many patients are seen per day and year, and how many patients are no-shows. I’m happy to show any healthcare center how to come up with their optimal appointment scheduling window.

Are there any other interventions?

Sure. Things like emails, text reminders, and phone calls are still effective. But in underserved populations, this is not always possible because many patients don’t have phones or computers. The appointment scheduling window simplifies things for the patient and the healthcare provider. Ultimately all of us want healthier outcomes and better experience of care, and this is one way to go about it.