How to Navigate Scheduling Issues for Nurse Practitioners
Listen
Watch
Show notes:
Once I was on the job, I realized how crucial it is to understand those pieces and how I fit as a clinician in the primary care office ecosystem.
This is particularly relevant when it comes to scheduling patients. It seems like a minor thing, but it causes a lot of nurse practitioners painful headaches, and can be tricky to both understand the problems and navigate out of them unless you understand the full picture of how it fits into the day-to-day running of the practice.
Time Management for New NPs: Scheduling Issues
In this week’s video, I’m building off of last week’s video where I talked about the business foundations of primary care. I cover:
The foundational pieces to understand when it comes to scheduling patients
The way that it can look ideally, and the less-than-ideal “real world” way it can look
Examples of issues new nurse practitioners face, and ways to navigate out of them
If you liked this post, also check out:
-
WEBVTT
1
00:00:08.500 --> 00:00:16.560
Hey there, welcome to the Real World NP podcast. I'm Liz Rohr, family nurse practitioner, educator,
2
00:00:16.780 --> 00:00:22.740
and founder of Real World NP, an educational company for nurse practitioners in primary
3
00:00:22.740 --> 00:00:29.120
care. I'm on a mission to equip and guide new nurse practitioners so that they can
4
00:00:29.120 --> 00:00:34.820
feel confident, capable, and take the best care of their patients. If you're looking for clinical
5
00:00:34.820 --> 00:00:40.680
pearls and practice tips without the fluff, you're in the right place. Make sure you subscribe and
6
00:00:40.680 --> 00:00:45.760
leave a review so you won't miss an episode. Plus, you'll find links to all the episodes
7
00:00:45.760 --> 00:00:58.380
with extra goodies over at realworldnp.com slash podcast. Hey there, it's Liz Rohr from
8
00:00:58.380 --> 00:01:04.019
Real World NP, and you are watching NP Practice Made Simple, the weekly videos to help save you
9
00:01:04.019 --> 00:01:08.840
time, frustration, and help you learn faster so you can take the best care of your patients.
10
00:01:09.440 --> 00:01:13.820
In this week's video, I'm going to be building off of last week's video where I talked about
11
00:01:13.820 --> 00:01:18.580
the business of primary care. And in this video, I'm going to be talking about scheduling.
12
00:01:19.260 --> 00:01:22.640
First, I'm going to start by talking about the business context of scheduling,
13
00:01:22.640 --> 00:01:28.040
and then I'm going to talk about the examples of how it typically plays out in primary care.
14
00:01:28.120 --> 00:01:33.600
And then some particular pitfalls that I see happen among new nurse practitioners
15
00:01:33.600 --> 00:01:39.220
that you might find yourself in and hopefully understanding this whole picture will help you
16
00:01:39.220 --> 00:01:44.360
navigate out of it and advocate for yourself if you need to. So the business side first,
17
00:01:44.600 --> 00:01:49.400
when it comes to the business of primary care, basically every year they need to make a budget.
18
00:01:49.520 --> 00:01:54.340
They have to make a prediction of how much money they're going to make in the next year
19
00:01:54.340 --> 00:01:59.590
so that they can budget appropriately for all the staff, any additional things that they're
20
00:01:59.590 --> 00:02:03.430
going to be doing, et cetera, et cetera. And like I said, in last week's video,
21
00:02:03.430 --> 00:02:07.610
I talked about how the primary revenue source for clinics is patient visits.
22
00:02:07.910 --> 00:02:12.230
When they're thinking about the schedule, they're thinking about it in that global perspective
23
00:02:12.230 --> 00:02:16.690
of how many providers do we have? How many visits are they going to have
24
00:02:16.690 --> 00:02:20.090
in the context of a year so that we know how much money we'll make?
25
00:02:20.230 --> 00:02:26.310
And so from that regard, the business itself of primary care is looking at a couple of
26
00:02:26.310 --> 00:02:32.650
metrics. So one is how many patients per day or week, potentially. They're also looking
27
00:02:32.650 --> 00:02:36.850
potentially at RVUs, which I talked about a bit in last week's video if you haven't watched that
28
00:02:36.850 --> 00:02:42.970
already. But RVUs is that combination calculation of how many patients you see in a day compared
29
00:02:42.970 --> 00:02:47.650
to how sick they are because you get more money for more complex patients. And there
30
00:02:47.650 --> 00:02:52.310
are other kinds of visits that reimburse more money, which I'll touch on in this video as
31
00:02:52.310 --> 00:02:57.730
well. The other thing they're looking at is the no-show rate. So what percentage of patients
32
00:02:57.730 --> 00:03:02.410
scheduled that day arrived compared to who did not come to their appointments?
33
00:03:02.870 --> 00:03:07.210
And an approximate goal, industry standard goal, I believe is around 10%.
34
00:03:07.870 --> 00:03:12.990
So if you have 20 patients booked in a day, then it's expected that two patients will not
35
00:03:12.990 --> 00:03:18.050
come. And that's just across the board. So those are the things that they're looking
36
00:03:18.050 --> 00:03:21.290
at from the administrative side of running the business of primary care.
37
00:03:21.670 --> 00:03:27.850
Some other scheduling considerations that they might be thinking about is how many minutes do
38
00:03:27.850 --> 00:03:33.650
you have per patient? So in my current clinic, there are 15 minute visits are the short visits
39
00:03:33.650 --> 00:03:38.230
and there are 30 minutes for the quote unquote long visits, which I'll talk about those in
40
00:03:38.230 --> 00:03:43.230
a second as well. But your clinic might have 20 minutes and 40 minutes. You might have 15,
41
00:03:43.230 --> 00:03:48.190
30, 45, et cetera, et cetera. Like you might have 30 minutes as your short visit and 60
42
00:03:48.190 --> 00:03:51.750
as your long visit, in which case that sounds really lovely and you're probably not in
43
00:03:51.750 --> 00:03:57.730
primary care. But those are other considerations too. So how does this all fit together?
44
00:03:58.050 --> 00:04:02.750
So when you're a nurse practitioner, a lot of the time, and if you don't have this,
45
00:04:02.870 --> 00:04:07.610
I definitely recommend considering asking for it. Most of the time there is a template for
46
00:04:08.390 --> 00:04:17.550
So for me, for example, in my clinic, full time providers are 32 clinical hours and eight hours
47
00:04:17.550 --> 00:04:23.670
of administrative time. And so we have the option of either having a full day off,
48
00:04:23.870 --> 00:04:29.870
quote unquote off that we're using towards our administrative time or embedding those
49
00:04:29.870 --> 00:04:35.970
periods of blocks of time during our day. The other thing that we have in that template
50
00:04:35.970 --> 00:04:40.890
of what days that you typically work are a cadence of regular types of visits.
51
00:04:41.470 --> 00:04:45.590
So what are those different kinds of visits? That really varies from clinic to clinic.
52
00:04:45.830 --> 00:04:51.030
But you've kind of identified these buckets of categories of what patients are allowed to be
53
00:04:51.030 --> 00:04:56.670
booked where because there are calendar rules that everybody in the clinic supposedly abides
54
00:04:56.670 --> 00:05:01.570
by. So what are the kinds of visits that you might see? So in our current clinic,
55
00:05:02.250 --> 00:05:09.370
what I typically have are I'll just go through the general types and give you a sense of what
56
00:05:09.370 --> 00:05:14.970
our rules are so that you can potentially optimize what you currently have or create
57
00:05:14.970 --> 00:05:19.750
something new if you don't have it already. Because the rationale for having a template is
58
00:05:19.750 --> 00:05:24.710
that everybody is clear on the expectations. Everybody's clear on what's happening
59
00:05:24.710 --> 00:05:30.370
and what's not happening. And actually, I want to pause here and say the biggest struggle that
60
00:05:31.570 --> 00:05:36.490
nurse practitioners have as it relates to scheduling really comes down to the bottom
61
00:05:36.490 --> 00:05:42.210
line about expectations. So number one, there are no expectations set. So there's no clarity.
62
00:05:42.370 --> 00:05:46.470
It's just a free-for-all. It's just chaos. Number two is that there are expectations,
63
00:05:46.510 --> 00:05:50.310
but they're not really being communicated to you or to the other staff members.
64
00:05:50.650 --> 00:05:54.270
And then the third thing is if there are expectations that are communicated,
65
00:05:54.270 --> 00:05:58.750
that are not followed through on, that are boundaries that are being violated
66
00:05:58.750 --> 00:06:03.650
and they're not following through. Those are the main sources of frustration.
67
00:06:04.170 --> 00:06:08.210
So all of this, this entire video, this entire conception of scheduling,
68
00:06:08.890 --> 00:06:15.630
comes down to that. So going back to the visit type, so in my clinic, there's a
69
00:06:15.630 --> 00:06:19.330
cadence of the way that my schedule looks. So if I come in on a Monday, I'm working an
70
00:06:19.330 --> 00:06:25.850
eight-hour day. It's going to be two established patients, one sick patient, one physical,
71
00:06:25.850 --> 00:06:32.190
et cetera, et cetera. And there's a set amount of time every single time that is allocated for
72
00:06:32.190 --> 00:06:39.210
each type of patient, right, with flexibility as we need to. But our clinic has established
73
00:06:39.210 --> 00:06:44.210
patients. So those are patients that have been in the clinic before, been seen at least one
74
00:06:44.210 --> 00:06:51.210
time. The rules about that are that they can be any sort of sick appointment that is not
75
00:06:51.210 --> 00:06:56.470
and doesn't require a same-day visit. So it's like stomach pain for the last year with no alarm
76
00:06:56.470 --> 00:07:02.610
signs or symptoms that could potentially wait for an established patient slot or chronic care
77
00:07:02.610 --> 00:07:09.610
like diabetes, hypertension, things like that. The calendar rules in our clinic to reduce that
78
00:07:09.610 --> 00:07:16.070
no-show rate is we actually only book patients three weeks out at a time. So any patients who
79
00:07:16.410 --> 00:07:22.750
either at a month or two months, three months, et cetera, they get put on a callback list inside
80
00:07:22.750 --> 00:07:27.570
the electronic health record system, which gets sent to our administrative staff. And when it's
81
00:07:27.570 --> 00:07:32.570
coming up on their time to come back, they do manual phone calls out to that patient to bring
82
00:07:32.570 --> 00:07:37.470
them back in. It's a system that's working for us. You might have other systems that are
83
00:07:37.470 --> 00:07:42.130
working for you, but that's the main rationale is that the longer out you book the visits,
84
00:07:42.130 --> 00:07:46.570
that higher of that no-show rate is and the less money that is coming into the clinic.
85
00:07:47.590 --> 00:07:52.690
And so the other types of visits, so they're sick visits. And so those are meant for that day
86
00:07:52.690 --> 00:07:57.990
or the day before booking. They should stay open until that day so that you can accommodate
87
00:07:57.990 --> 00:08:04.070
patients who have an urgent sick matter to attend to. However, providers can override this
88
00:08:04.070 --> 00:08:09.290
if they need that slot for somebody who needs a one-week follow-up for some sort of more urgent
89
00:08:09.290 --> 00:08:15.770
condition that you're seeing in the clinic today. But yeah, that's typically gone through
90
00:08:15.770 --> 00:08:20.870
triage of the nurses that determine who gets that slot, but that's the staffing of our current
91
00:08:20.870 --> 00:08:27.110
clinic. So what are some of the other options? Physicals, either well child checks or adult
92
00:08:27.890 --> 00:08:35.090
physicals. And these in our clinic, unfortunately are 15 minutes. Most visits that I've seen in
93
00:08:35.090 --> 00:08:38.809
other clinics are the quote unquote long visit, the 30 minute ones. And the ones I've said so
94
00:08:38.809 --> 00:08:46.710
are all 15s. The caveat is that if a patient needs a PAP exam, they get an extended quote unquote
95
00:08:46.710 --> 00:08:52.190
long physical block. For us, we have some calendar rules about that. And I want to talk
96
00:08:52.190 --> 00:08:59.210
about expectations for a second. So for us, number one, 15 minute physicals. Number two,
97
00:08:59.590 --> 00:09:05.190
that we have five of those per session. And number three, actually, I guess it's just those
98
00:09:05.190 --> 00:09:10.570
two. But the two points are that is a little bit painful for me to say out loud.
99
00:09:11.050 --> 00:09:17.250
And also, I'm okay with it because those were the expectations that were set when I accepted
100
00:09:17.250 --> 00:09:23.530
this job. Because that is the demand of what the patients need. And so when I came into this
101
00:09:23.530 --> 00:09:28.710
job, I could have more clearly asked about those kind of calendar rules about how many
102
00:09:28.710 --> 00:09:33.250
physicals we see per day and per session per four hour block of time. I wasn't really clear
103
00:09:33.250 --> 00:09:38.490
about that. So I kind of happened into it. And I was like, oh, that's a lot. But that's on me.
104
00:09:38.610 --> 00:09:42.990
I didn't ask about that. And that's the standard of practice. So it is what it is.
105
00:09:43.010 --> 00:09:47.430
That's the demand. I will do what's needed. So the other thing as it relates to expectations
106
00:09:47.430 --> 00:09:53.450
in this example is that my clinic only books us 20 patients per day. And they do not double
107
00:09:53.450 --> 00:09:57.770
book us. And they give us adequate time for a break in the middle of the day for our lunch
108
00:09:57.770 --> 00:10:03.330
period. And so all of these are these moving parts and shared agreements that we have and
109
00:10:03.330 --> 00:10:09.470
expectations that are set, communicated and abided by. And so I can accept that,
110
00:10:09.910 --> 00:10:14.110
which kind of like I'm getting a little bit ahead of myself. But the bottom line as it relates
111
00:10:14.110 --> 00:10:22.130
to scheduling, if you either have to accept it or not accept it, identify if there's an issue
112
00:10:22.130 --> 00:10:28.870
for you, you have to determine number one, is it no expectations, unclear expectations or not
113
00:10:30.230 --> 00:10:36.110
supported, but not like stood by expectations? Like what is the problem there? And once it's
114
00:10:36.110 --> 00:10:39.970
clearly communicated and abided by, is that something that you can live with? Right.
115
00:10:40.950 --> 00:10:45.770
So I guess I can skip ahead. The majority of the visits that I have are either established,
116
00:10:45.770 --> 00:10:52.530
sick visits, physicals. And I also have procedural visits, which are 30 minute blocks.
117
00:10:53.050 --> 00:10:58.050
And then one other potential, there's a couple of other different types of visits, but
118
00:10:58.050 --> 00:11:01.750
it just, it just depends on, again, the shared agreements of your practice.
119
00:11:01.950 --> 00:11:07.810
So for example, annual Medicare physicals are very long and they require a lot of documentation.
120
00:11:08.890 --> 00:11:15.450
And so potentially there should be some rules around those more complex visits such that
121
00:11:15.450 --> 00:11:19.990
you're not getting overloaded. Because I guess, again, like going back to the moral of the story
122
00:11:19.990 --> 00:11:24.510
here, it's about expectations. But then the other piece of it is it's a balance on the
123
00:11:24.510 --> 00:11:30.470
business side and on the like human side, right? Because the business, when they're in dire
124
00:11:30.470 --> 00:11:34.570
straits and they need money, they're going to ask providers to see more and more and more and
125
00:11:34.570 --> 00:11:40.270
more and more and more patients. Right. But like, there is also a limit there because
126
00:11:40.270 --> 00:11:47.650
we are humans and we need a quality of life. And also it benefits the business to retain us
127
00:11:47.650 --> 00:11:52.670
as staff members. It is way cheaper for them to retain us than it is to hire a brand new staff.
128
00:11:52.810 --> 00:11:57.490
It is way more expensive to hire a brand new person. So it's a very fine balance,
129
00:11:57.630 --> 00:12:01.170
but it's a mutually beneficial relationship because we want to take care of patients,
130
00:12:01.310 --> 00:12:05.730
but we also want to support the clinic business so that it remains open and we can
131
00:12:05.730 --> 00:12:10.850
take care of our patients. So I guess I'll move on to the pitfalls. I'll wrap up here with the
132
00:12:10.850 --> 00:12:16.810
pitfalls that I see. Just a couple of examples. So as it relates to what I talked about with the
133
00:12:16.810 --> 00:12:22.410
administrative time blocks, one of the potential pitfalls is that the administrative staff,
134
00:12:22.430 --> 00:12:28.350
whether it's a call center or the front desk, they're going to be booking patients into your
135
00:12:28.350 --> 00:12:34.110
administrative time slots, or they're going to be double booking you. And there's either
136
00:12:34.110 --> 00:12:37.710
no expectations about that. There's no communication about it. There's no workflow
137
00:12:37.710 --> 00:12:42.710
around it because that happens. The reality is that that happens, but there should be
138
00:12:42.710 --> 00:12:47.610
a shared agreement among your clinic of what the workflow is, what the step-by-step,
139
00:12:47.610 --> 00:12:53.550
repeatable process that everybody understands so that nobody's frustrated or mad. I mean,
140
00:12:53.550 --> 00:12:58.590
we can still be frustrated if we're feeling overworked, but if we've agreed to a set of
141
00:12:58.590 --> 00:13:03.330
expectations, it is what it is. We either decide that we accept it or we decide that
142
00:13:03.330 --> 00:13:09.730
we don't. So another example that I'm working with, she and I were talking about this the other
143
00:13:09.730 --> 00:13:17.470
day, is that annual Medicare physicals reimburse at a very high rate. It's about $300 per visit.
144
00:13:17.850 --> 00:13:24.030
And so it sounds like this private practice was trying to book a lot of physicals,
145
00:13:24.070 --> 00:13:29.930
like five annual Medicare physicals in a row, and it was exhausting and she's feeling
146
00:13:29.930 --> 00:13:34.070
really burnt out. And so this is the conversation that we had is the background. This is the
147
00:13:34.070 --> 00:13:39.310
background foundational information. This is the rationale of where they're coming from. And also
148
00:13:39.310 --> 00:13:44.810
here are some other things that we can do to communicate and set expectations that will be
149
00:13:44.810 --> 00:13:49.690
followed up on. And I mean, I think the first thing when it comes to being frustrated
150
00:13:49.690 --> 00:13:55.290
with the situation, aside from identifying the objective information and potential solutions,
151
00:13:55.290 --> 00:14:03.150
is to think about, assume the best of intent and ask questions first, but always bring that to
152
00:14:03.150 --> 00:14:09.190
your supervisor and let them know. They don't know unless we talk to them. We just have to
153
00:14:09.190 --> 00:14:12.910
be explicit. We have to be plain. It's a very just plain conversation. It doesn't have
154
00:14:12.910 --> 00:14:18.730
to be emotional. We can just say, hey, listen, I noticed that yesterday and today I've
155
00:14:18.730 --> 00:14:24.370
had five annual Medicare physicals in a row. I'm really exhausted and this is really,
156
00:14:24.370 --> 00:14:30.410
tough. What are the policies and procedures around booking these types of visits? Can you
157
00:14:30.410 --> 00:14:34.330
help me understand the situation a little bit more? And then you can have a conversation about
158
00:14:34.330 --> 00:14:40.330
it. Because if it was me running a clinic and I was really short on money and I was worried
159
00:14:40.330 --> 00:14:45.010
about having to lay people off, I would have a direct conversation with my providers and say,
160
00:14:45.030 --> 00:14:50.670
hey, listen, we're having a bit of a hard time right now because of COVID. We need to see
161
00:14:50.670 --> 00:14:55.390
whole bunch of physicals to try to make up for it. This is not forever. This is a short term
162
00:14:55.390 --> 00:15:00.370
thing. Here are the guidelines and rules about it so that we're all on the same page. And then
163
00:15:00.370 --> 00:15:04.990
we will check in in two to three weeks or four weeks time, see how everything is going.
164
00:15:05.330 --> 00:15:10.830
What do you need to support you to do this job? Right. So that's ideal world situation.
165
00:15:11.190 --> 00:15:15.690
But yeah, I clearly have a lot of things to say about this, but I'm going to wrap it up
166
00:15:15.690 --> 00:15:21.230
because what am I doing in this video? Hopefully this is helpful. If you haven't grabbed the
167
00:15:21.230 --> 00:15:25.570
ultimate resource guide for the new NP, head over to realworldnp.com slash guide.
168
00:15:25.930 --> 00:15:29.630
You'll get these videos sent straight to your inbox every week with notes from me,
169
00:15:29.870 --> 00:15:33.110
patient stories, and bonuses that I really just don't share anywhere else.
170
00:15:33.470 --> 00:15:36.590
Thank you so very much for watching. Hang in there and I'll see you soon.
© 2025 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details.
