"The patients that come in on extended hours are the profitable patients," said Berenson. "People that are more likely to come in the additional hours have the more acute care problems (headache, back pain, whatever it might be). That's the gravy of the practice. That's the sort of revenue, if the physician practice isn't open, that the urgent care center will see instead."
Twenty-five years ago, in his own practice, Bergeson initiated increased access by offering appointments on Saturdays and rotating duties among the six physicians in the group. Even though they were making enough money and staying busy, after Bergeson left the practice the rest of the physicians stopped offering the Saturday appointments. They simply didn't want to be there on the weekends.
Czapp, at The Anne Arundel Physician Group, also noted that after one of its practices adopted Saturday hours as a pilot program, the extended hours were stopped because neither patients nor physicians wanted to be in on the weekends.
Balancing the lifestyles of the physician with the needs of the community is the strategic challenge of expanding patient access. According to Czapp, active physician participation in scheduling decisions is key.
"Access is really about an attitude, and not so much an office hour, because you can have lousy access even during your current office hours if you turn people away and you teach them to get care at an urgent care center and not with you," she says.