One of the major mistakes many physicians make is thinking patient flow problems happen because of major time-consuming issues or emergencies that throw a schedule off kilter. That may be the issue some of the time, but it is not typically the case, according to author and practice management consultant Elizabeth Woodcock. Patient flow is derailed in minutes and seconds. The good news is that it is not all up to physicians to manage.  Much of what keeps a practice moving smoothly occurs before physicians even arrive.


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“Appointment scheduling is often an administrative afterthought and, in my opinion, is more important than billing; it is the lifeblood and ebb and flow of the practice,” Woodcock said. “If you don’t get people on the schedule, you don’t get a charge or a receivable.”

Schedules are often set in a practice arbitrarily, but Woodcock said they should reflect physicians’ work style and patient demands. For instance, if a physician can see 4 patients an hour, but the office schedules 7, it is not going to work out well. If a doctor is really efficient and can see 8 an hour, but schedulers only book 6, that’s not good either.

Start at the beginning

A sure way to get off schedule is to start the day late. If a physician wants to see his or her first patients at 8:30, and a patient is scheduled for 8:30, it will not work. “Once you get them to the front office, registered and get office stuff done, it will be a great day if you get them in the room at 9,” Woodcock said.

Woodcock recommends scheduling 20 minutes prior to the time that a patient is to meet with the doctor, especially in specialty practice offices, where patients are more likely to have mobility or other issues. If the first appointment of the day is 8:30, they should be scheduled at 8:10.

Woodcock also advises against scheduling a new patient first thing in the morning. New patients are more likely to be a no-show or be late than established ones. If that spot is lost, there is no way to fill it.


If office staff cannot fill a spot first thing in the morning, they should fill them later in the day. In a typical day, most offices have 7% to 10% no-shows. If a group is on the high end of that, Woodcock said overbooking is a financial imperative. “Strategic overbooking in today’s world is a necessity,” she said.

Some practices, particularly larger ones, use predictive analytics to figure where to overbook. Emory University, she said, has software that alerts a practice in advance to patients it thinks will not show up based on factors like insurance, employment, and marital status.

Smaller groups can lean on good schedulers, who “99% of the time can nail who is coming in and who isn’t,” she said. They should take a moment to look at the next day’s schedule and figure out where to overbook. Woodcock has tips for 2 typical types of patients who are frequent no-shows: Post-hospital discharge patients that came in already for a complication or other issue; and patients who are unemployed or uninsured (there is only a 15% likelihood they will show).

If analytics are unavailable, a safe bet for overbooking is schedule patients at 10 a.m. and 2 p.m. “These are the ideal overbooking slots if you have to throw a dart at a dartboard,” she said.  

Two times not to overbook are 1 p.m. and 4 p.m. because if everyone shows up at 1 p.m., the whole afternoon is thrown off. If they all show up at 4 p.m. everyone will be there late.

Check in

Most offices have someone who checks in each patient. This is a good place to use automated flow tools, but there has to be someone in the office who knows how to use this task in the electronic health record system.

A staff member will have to initiate the process, she said, so someone should be accountable for this step. A HIPAA-compliant screen can be set up in a nurses’ station to show if a patient is there and ready to be seen.

“You have to deploy these tools you have on hand,” Woodcock said. “It’s about ensuring the staff knows how to use them because it doesn’t happen by magic.”