Where Have All My Patients Gone? - Office Practicum

by Dr. Suzanne Berman

Where Have All My Patients Gone?

Whether you’ve been in practice for a long time, or are just starting out, you understand the importance of filling your patient schedule. Maximizing practice revenue means managing that delicate balance between an overfilled schedule where you can’t accommodate the patients who want to be seen against unfilled appointments which are a visual reminder of lost revenue. What do you need to optimize your schedule and improve your bottom line? A thorough understanding of your patient population, awareness of your regional competitive landscape, data, and appropriate tools.

Patient Population

Understanding your patient population starts with gathering demographic and condition-specific information– but that’s not enough.  Knowing how many newborns you are adding to your patient roster each month, how many ADHD patients you have, and how many patients are suffering from asthma are important for developing appropriate programs and creating schedules with time slots to accommodate these patients. You also need to understand why, how, and when these families want to access your practice.

Regional Competitive Landscape

Many pediatricians are asking themselves what has happened to all of the ear infections and sore throats that used to fill up their schedules with the so-called “simple sick.” Studies have shown that a decrease in these types of visits is due in part to more robust vaccines against common bacterial pathogens such as Pneumococcus and H. influenzae. You must also consider the competitive landscape. Does your region have a retail-based clinic on every corner and/or employer-sponsored telehealth services? Does the health system down the street offer urgent care and emergency department walk-in services? Are they advertising these services to your patients? In essence, what is driving families to other healthcare service providers in your community and how can your practice innovate to meet their needs? Should you implement walk-in hours in the early morning and after school? Can families self-schedule appointments on their computers or smartphones? Have you broadened your provider expertise to manage mental and behavioral health conditions and/or children with special healthcare needs?


In today’s successful practices, data is king (and queen). Understanding trends are important. Do your adolescent patients like morning, after-school, or evening appointments? Which of those appointments fill first? Do the majority of your families with young children have two working parents? Would they appreciate the convenience of early morning well visits that take place prior to the start of their workday? Over the past 3 years, how many minutes of sick time have you actually filled on Monday mornings in January? Successful practices have the ability to run reports, analyze data, ask probing questions, and then innovate to adapt to their ever-changing environment.


The aforementioned elements are key to developing an understanding of where you are and where you need to go. However, implementing and maintaining changes requires appropriate tools. Can your staff easily identify patients who are due for well visits according to Bright Futures guidelines (even in those under age three)? Can you contact them via text or portal message, if you notice your sick slots aren’t filling up? We can’t predict when the flu/illness season will hit, or how severe it will be, but being agile and having the tools to quickly adjust and engage families is crucial. You can fill in those empty sick slots with well visits and asthma/ADHD rechecks easily if you have the appropriate tools. How do you not only identify patients who will need a school physical according to your state requirements, but also reach out to them months before the deadline to proactively bring them in for a visit? This work should be done on an ongoing basis as you and your practice team walk the tightrope between filled appointments and adequate access.

Some questions to ask your practice team:

1. How often do we change our schedule templates and what data do we use to do so?

2. What does the competitive landscape look like? Where do our patients go when they don’t come to us and why?

3. How do we extend our medical home to provide true value to our families?

4. Is our practice team empowered to be agile and adjust on the fly for maximum scheduling?

5. Do we have the right tools to gather data and use it to implement improvement?

Get your practice positioned to maximize scheduling before you are sitting at the front desk wondering where all your patients have gone!

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