Market Forces Pushing Doctors to Be More Available

    Alice Kissell, 58, a longtime asthma patient, still gets indignant when she recalls the brusque receptionists and hours of waiting to see a doctor at her former health maintenance organization in Southern California.

    But a few years ago, she moved to Whitehouse, Tex., a small town near Tyler in the northeast part of the state. Now Ms. Kissell has a family doctor who knows her and who, despite having a thriving practice, seems never too busy to see her.

    It is not just a matter of moving to a small town. Ms. Kissell's doctor, Melissa Gerdes, is one of a rapidly growing number of physicians who have streamlined their schedules and added Internet services, among other steps, to better meet the needs of patients. For physicians like Dr. Gerdes, it is simply good business.

    Those doctors know that as walk-in medical offices and retail-store clinics pose new competition, and as shrinking insurance benefits mean patients are paying more of their own bills, family care medicine is more than ever a consumer-service business. And it pays to keep the customer satisfied.

    Professional societies for family doctors and internists are urging their members to break with tradition by making it easier to schedule appointments — or even making appointments unnecessary in the case of walk-in patients who need immediate attention

    the 119,000-member American College Of Physicians is promoting "patient-centric care," which it made the focus of a policy paper this year, calling for more consumer-friendly scheduling, electronic medical records and electronic prescriptions, among other measures.

    because patients who work may often prefer to fit in a medical appointment around their lunch hours, doctors have started taking their own meal breaks later and postponing tasks like hospital rounds so they can be available at midday.

    And instead of overbooking, as doctors have long done to maximize business, some physicians now are leaving up to 70 percent of their daily schedules available for patients who call before 1 p.m. for a same-day appointment, said Dr. Michael S. Barr, a vice president of the American College of Physicians, which includes 70,000 internists in active practices.

    Although doctors might fear losing income if valuable office time is left open for same-day appointments, surveys by some medical groups have shown the opposite result. The number of office visits declined slightly, but revenues increased as pleased patients had more time to fully discuss their problems, which doctors then treated and received compensation for.

    Another payoff can be a sharp drop in no-show patients, if appointments are available on short notice and patients know they will be seen promptly, said Dr. David G. Bundy, a pediatrician who has studied doctor access as a researcher at the University of North Carolina in Chapel Hill.

    There can be drawbacks. If doctors leave large blocks of their schedules available for impromptu visits, it can become difficult for patients to book routine appointments in advance with some pediatricians, said Dr. Thomas Handler, a health care research director at the Gartner Group, a technology consulting firm. "Open access can work wonderfully for urgent care, and horribly for routine annual visits," he said.

    The same computerization that makes online scheduling possible can also open the door to online consultations, which usually involve questions that patients ask about routine matters like diet or possible changes in the strength of a prescription drug. The patient can go online at any convenient time, and the doctor often replies the next morning. But because health plans only rarely pay for these e-visits, such services have been slower to catch on.

    And for all the new openness that many doctors are adopting, some efforts seem mainly defensive moves against the retail clinics, which are typically operated by nurses. At its annual meeting this month, the American Medical Association called on the clinics to accept a list of principles that would limit their scope to simple services and ensure that a physician oversees the operations.

    Several of the large clinic chains say they are already operating under similar guidelines issued last December by the Academy of Family Physicians.