The manager of several hospital affiliated urgent care centers asked me for some advice about his staffing model. The centers are open 7 AM to 10 PM M-F, and 8-5 on weekends. Staffed with mostly NPs, they rotated through the centers, alternating 7-3 and 3 – 10 PM shifts during the week, which seemed to work pretty well, and some physicians who worked 9-5 shifts during the week, but he never seemed to have enough weekend coverage. Their average volume was about 60 patients per day.
I asked why he had weekend coverage problems when he seemed to have enough staff to cover during the week.
“Weekend coverage is voluntary, and I never have enough volunteers”
Therein lies the problem. Not in staffing, but in the hiring process. This is urgent care. We are not a 9-5 operation, and any staff, NPs, MAs, Physicians, receptionists working in an urgent care center should be expected to work their share of weekend and holiday shifts.
But what about the flexibility all those part timers and moonlighters who do weekends give you?
This is a debate I go through all the time.  Yes, it is fine to have SOME part timers, per diems to help fill in some gaps from time to time.  But when you rely on staff who don’t consider your urgent care practice their priority, you are just asking for scheduling problems.

These full time, dedicated providers are career-oriented urgent care professionals who have the responsibility to staff the center, as a team.

Here is how to avoid this problem from the get-go:

  1. Hire full time, dedicated staff who’s #1 priority is your urgent care practice.  Not just for scheduling issues.  How many times are you going to deal with:  “I’ll leave those labs/consult reports/imaging reports for the full timers to follow up on” or “I’m just doing the minimum for you today Mrs. Jones so the regular doctor can follow up with you next week.”  Your “full time, regular docs” wind up picking up a lot of slack for that “convenient” weekend moonlighter help.
  2. Require all full time staff to work their share of weekends and holidays.  So for my new centers opening this fall with only one provider on duty at a time, that means every other weekend and holiday, what amounts to 3 holidays/year.
  3. The Providers are responsible for making the schedule.  The full time, dedicated providers are responsible for making sure all operating hours are covered.  In a new center, this generally means the 2 full time providers are going to split the schedule as they see fit and agree upon.  Some like to work full 12 hour shifts, some split 8-2, 2-8.  I don’t care, as long as it’s covered and agreeable.
  4. Cross cover for illnesses.  It’s actually pretty rare for a physician to call in sick.  But when it happens, you need a plan agreed upon in advance.  The “partner” in the center is the first one who should come in and switch shifts with the ill member of the team.  I know, “when you’re off duty in urgent care, you’re off, you’re not on call.”  Again we could debate this, but here’s the argument:  These full time, dedicated providers are career-oriented urgent care professionals who have the responsibility to staff the center, as a team.  If one of them needed coverage, they’d want their partner to be there for them.  If they truly have an event they must be at on their off day, we want to know in advance that they are unavailable for cross coverage that day/morning/afternoon, and arrange for someone who is off in another of our centers to be available.  This all takes some advance planning and buy-in from your providers (and just as well from other staff members), but alleviates a lot of frantic anxiety when the “I’m sick and can’t come in” call happens.
  5. Use part timers/per diems appropriately.  It’s fine to be able to call on part timers/per diems to fill in some of these gaps, or for illnesses, or vacation coverage, when absolutely needed or as back up to the full time staff.  But don’t rely on them primarily, you are not their priority.  You cannot count on them for those unforeseen illnesses or other events causing schedule problems.  Again, their availability needs to be known in advance and secondary to your full time staff coverage.
  6. Vacations need to be scheduled in advance.  This may be obvious, but take it a step further.  If you are running multiple centers, you need to be able to call on the other providers to fill in for vacations, so they all need to be staggered appropriately.  So create one master vacation calendar on a first come, first served basis, with some caveats:
    1. Whomever wants to schedule their vacation is responsible for arranging their own coverage, among their partner and from the other centers, and all are expected to participate.
    2. There should be fair rotation through holiday times like Christmas week, July 4th as for the vacation coverage schedule.
    3. As the owner/administrator, you do need to make sure there is an adequate pool of full time staff available for this, or secondarily, part time, per diem staff for extra vacation coverage.

When you do hire part timers/per diems, you still need to make an investment of proper training for your particular center.  The EMR system, how you handle call backs, labs, referrals, outside diagnostics.  They should be oriented as to any unique services you offer, and if they can’t provide those services, they should at least be familiar enough to “stop gap” any issues arising from them.  Create a knowledge base (preferably online) they can reference, or be able to contact another provider with any questions.
Running 7 days a week, extended hours in urgent care always presents us with scheduling challenges.  But that doesn’t mean scheduling should be a daily catastrophe.  Start with the hiring process and setting expectations from day one, with rules as above that everyone understands and agrees upon from the outset, and you’ll minimize your scheduling headaches.

How do you handle the schedule in your urgent care center?


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