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Physician Flexibility in Primary Care Practices

Timely access and patient-physician continuity are two key measures for a primary care practice. Timeliness refers to the ability to obtain a physician appointment as soon as possible. Patient-physician continuity is one of the hallmarks of primary care and refers to the ability to provide appointments with a patient's own physician as much as possible. In the last decade, a paradigm called "advanced access" has been adopted by many clinics, which encourages physicians "to do today's work today" rather than push appointments in the future. Advanced access necessitates the design effective capacity management policies. In this study we apply the ideas of process flexibility to capacity management in a primary care practice. This leads to a system where patients can be seen by their primary care provider or additional physicians, the latter incurring a cost due to reduction of efficiency. We model a practice with multiple physicians and their corresponding patient panels as a stochastic dynamic program. Patients call in throughout the day and a decision has to be made immediately whether to assign the patient to a specific physician or refuse her. The study consists of three parts: in the first, we investigate the general benefits and shortfalls of different implementations of physician flexibility; in the second, we develop heuristic scheduling policies that can be implemented in practice; the third part compares the benefits of the system currently used in practice with our proposed approach where physicians are chained and pairs of physician are familiar with a certain panel.
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