Managing seasonal variation

Be aware that demand for your time from a population of patients ebbs and flows with seasons as well as day of week and time of day. We're all familiar with the Monday bolus due to being closed on Saturday & Sunday.
We know about 'flu season, camp physical season, school physical season.

Be aware that "too many patients" in your panel is a major driver of dissatisfaction and dysfunction.
How this dysfunction manifests itself:
a: longer and more phone calls with patients playing phone tag and "find the appointment"
b: Playing "how sick are you, do you really deserve today?"
c: Working late into the evening trying to catch up with patients, documentation, billing

Now we all have to deal with variation. The smaller the practice, the wider the variation from day to day. The goal is not to avoid all variation, but to keep the average at a tolerable level and to have strategies (contingency plans) in place to deal with big variation.

[Of note: I too practice part time. There are times in my schedule when I am not available. Some patients don't like that. If that dislike exceeds what they like about my practice, they may leave. The bulk find the 24/7 access to patient portal, message, email, cell phone outweighs the inconvenience of my part time status.]

If you fill your practice to your target flow during a slow season, you'll overheat during heavy seasons.
If you fill your practice to your target flow during a heavy season, you'll be light during slow seasons.

What a solo doc to do?
Here are some suggestions:
1: Aim for the middle and deal with the variation.
2: Aim for the light side and fill these light times with other work.
3: Aim for the heavy side and get extra help during these times.
"Extra help? How does a solo-solo doc do that?" It could be a part time secretary to answer phones & do admin stuff. It could be sending patients to after hours or a colleague, you'll have to be inventive here. The "extra help" scenario is not simple from an operational standpoint, which is why I typically advise not aiming for the heavy side unless you like working extra hard during the busy seasons.
Gordon

From: joanne holland <joandvmmd@yahoo.com>
Sender: Practiceimprovement1@yahoogroups.com
Mailing-List: list Practiceimprovement1@yahoogroups.com; contact Practiceimprovement1-owner@yahoogroups.com
Date: Mon, 1 May 2006 09:53:59 -0700 (PDT)
Subject: Re: [Practiceimprovement1] Ebb and flow of demand by season
Reply-To: Practiceimprovement1@yahoogroups.com

From the old doc in Drain, Oregon,

About the problems breaking even, and having a variation of the number of patients you see by hour, day, week and season:

Remember, most of our practices are new. There is a several year start up curve, that takes between two and five years to get your practice to the point it will grow to. You will grow quickly to start with, assuming you started in the right place and have something people want. Then at maybe six months, the curve slows down but contiinues to go up over the next two to four years. You practice the way you want to, and the practice itself "calls out" the kind of patient that likes that practice style. If you change systems, you will "call out" a different type of patient and some of the ones that liked it the way it was will leave.

It is asking a lot to have a solo practice make us the entire amount we would want to have in the long run, after a few weeks or months of work. This is small business, and by definition that makes it risky. If you want total security, you have to work for someone else and take their systems. The low overhead thing is what this group is doing different, that makes solo practice possible. The massive delay in insurance and medicare payments makes it much more difficult.

Skip this if you don't like to see someone on a soap box:

Most small businesses have immediate feedback: I buy shoes and I pay for them or go barefoot until I do. If I want medical treatment and have no insurance, I have to balance my need against my other priorities (like shoes), remembering that the costs are enough to make most people gasp. If I want medical treatment and have insurance, I get the treatment and it may be six months before the last dollar comes to the "provider", and the payment may not have much to do with the charge. We have turned our health care over to the hands of money managers: people with training and mandates to make as much money as possible. Of course this is an insane system.

Joanne Holland DVM/MD