What Scheduling Strategy is Right For Your Practice? 3 Options

In today’s competitive climate, many doctors are content to have a steady stream of patients each day. However, failure to implement a structured appointment system could mean missing out on revenue. Clinical management expert and AAO2015 presenter Zachary Cain notes that an effective scheduling program is essential to achieve smooth practice operations and the satisfaction of both the staff and the patients.

There are many different ways to design an appointment schedule, and Cain cautions against a one-size-fits-all approach. It’s tempting to simply schedule a patient every 15, 20, or 30 minutes. This revenue-driven method, known as standard scheduling, may add up to high productivity and financial success for some practices. For others, it results in long patient wait times, reduced patient satisfaction, and little to no time for walk-ins or emergency appointments.

A customized scheduling template designed with your practice needs and physician work styles in mind can do more than alleviate patient wait times and staff stress. Altering the composition of your schedule often frees up blocks of time, allowing for additional appointments. Depending on your average revenue per appointment, it could add up to real income over the course of a year. So which scheduling strategy is right for your practice? Below, Cain suggests some alternatives:

Integrated Scheduling

Also known as long/short scheduling, appointment slots are set aside for either long, full exams or short follow-ups. Many times, one type of appointment is allocated to the first half of the day, while the other type fills the second. For practice with multiple doctors, the day is coordinated so each doctor gets a mix of appointment types (for example, in a two-doctor practice, Doctor 1 might see all long appointments in the morning and short appointments in the afternoon. Doctor 2 would do the opposite).


  • Helps doctors get in the mindset of doing quick appointments or full exams.
  • Frees up the pretest area, since short appointments usually don’t need pretesting.
  • Allows for more efficient use of tech time (shorter appointments usually require little tech time).
  • Eliminates any guesswork in scheduling staff, since you can anticipate the flow from hour to hour.


  • Short appointments sometimes turn into long appointments.
  • Must be careful to assess your overall patient needs to avoid an imbalance of available appointments.

Top of the Hour

The goal of top of the hour scheduling is to allow the physician’s schedule to “reset” every hour. It allows for a set amount of appointments per hour, leaving an open block of time at the end of each hour for administrative tasks or to be repurposed for the physician’s needs at that time. Sometimes, all patients for an hour are scheduled at the beginning of that hour and seen in the order they arrive. Other times, complex appointments are scheduled for the first half of the hour, with the remainder of that hour’s patients arriving on the half hour.

Before a practice decides to implement top of the hour scheduling, Cain suggests conducting a detailed review of historical data to determine average number of patients seen, patient contact time, and to predict the number of work-in visits needed and the likelihood of no shows.


  • Emergency visits or same day appointments are more easily accommodated due to the time at the end of the block.
  • Physicians are less likely to fall behind on administrative duties, thus achieving more complete and accurate patient records.


  • Patients may become upset if they notice that other patients were given their same appointment time. An explanation will require some finesse from your front desk staff.
  • Not finishing the block on time will result in back-ups over the course of the day.

Cluster Scheduling

Cluster scheduling involves grouping patients with similar exam types, conditions, or treatments, and scheduling them within a certain time block during the day. For example, a practice might have “injection afternoons” or “procedure afternoons.” Aside from the normal considerations like exam room availability and number of support staff, you’ll also need to take into account things like the number of surgical instruments on hand, as well as the turnaround time for sterilization.


  • Streamlined appointment types allow a large number of patients to be seen in a short amount of time.
  • Diminished wait time for patients who return on a monthly basis for chronic treatments.


  • Performing repetitive tasks can increase the risk of physician or tech error.
  • Staff shortages (like call-outs) particularly affect this type of scheduling.
  • Patient availability and timeliness is more of a factor, as are geographic considerations. For example, you might practice in an area with harsh winters, which may cause chronic backups due to late patients.

Zachary Cain’s 6 Steps to a No-Fail Scheduling System

  1. Establish a target goal of patients to be seen each day.
  2. Create appointment types based on practice needs using realistic physician times for each appointment type.
  3. Build a high performing team of administrative and clinical staff.
  4. Allow for work-in visits from established and new patients.
  5. Communicate throughout the day.
  6. Request feedback from physicians, patients, and staff

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