what are the latest and earliest hours one can keep an office open?

[abcxyz0123]

Just out of curiousity....what are the latest and earliest hours you've heard or seen an office open, that patients are willing to go to. For example, is it possible to do something like...8am to 11pm? I was thinking how I would much rather work a 45 hour work week spead over 3 days and have a 4 day weekend every week, meaning M-W 8am to 11pm, rather than work 5 days a week. But I didn't know how realistic that would be...trying to get patients coming in late at night. Anyone?

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[whopper]

Most of the offices I've seen had the typical 9-5 hours. I've never seen exceptions to the rule, though I'm sure they can exist based on the person running the office.

I don't have a practice, but I'm sure there is a population of patients who don't want to show up during the typical 9-5 hrs. Some of the existing suboxone clinics are designed for people to not miss work, and those people at work don't want their workplace to know they may be getting that type of treatment.

 

[chameleonknight]

Something else to consider is your staff may not want to stay that late or work those kinds of hours.

 

[abcxyz0123]

Something else to consider is your staff may not want to stay that late or work those kinds of hours.

Oh no i thought about that, but I just figured i'd have only a secretary to answer phone calls and do simple filing stuff, and have her only work regular business hours, and then for the later hours just work by myself. Some of the psychiatrists ive shadowed didn't even have a secretary at all, during any hours of the day, so I don't think that would be too much of a problem.

 

[Therapist4Chnge]

I'd guess that it would very much depend on the community in which you practice, the population you treat, and the lifestyle you want to establish. This is where a business plan would be really helpful in flushing out important details about the structure of your PP.

Realistically I'm not sure about the benefit of having hours after about 8pm or 9pm, though I can see some benefit to earlier hours (especially if you treat children, as you can see them and then they can be dropped off at school).

 

[ThinkTooMuch]

Something else to consider is your staff may not want to stay that late or work those kinds of hours.

this should be way way bottom on this list. every paying job will find willing workers.

 

[surftheiop]

this should be way way bottom on this list. every paying job will find willing workers.

but maybe not people your willing to let handle medical records ....

and from seeing my parents run around getting me/my brother to various appointments, i would think the slots between 5pm and 9pm would be really popular. After that I think there would be a big drop off in demand.

 

[michaelrack]

Earliest: 7:30 am

Latest: 8 pm

 

[MDhasbeen]

You've also got to weigh the downside of decreasing the number of days you're available each week. For the average, middle class patient population you'd probably get more total people coming in by making yourself available just from 6 - 10 or 11 PM six nights a week given this group's other weekly appointments and activities outside of work (religious functions, kids' after school activities, heck even things like AA/NA etc). I was always amazed at how often I'd have people requesting just one or two nights of the week when things could work logistically. In the end, I guess it would ultimately be up to you and knowing how you function best. Some people would rather drive themselves hard for a few packed days a week then have an extended weekend, while others would gain far more flexibility with family etc by working curtailed hours a larger number of days/nights each week. Where there's a will in this biz, there's a way to make it work regardless. Supply and demand.

 

[Doc Samson]

I've known folks who are "doctors' doctors" to have at least a couple of nights a week where they work til ~11 pm. If you cater to a population that CANNOT miss work (e.g., physicians, high level executives), then you can easily fill slots outside of office hours - if you can find a way to fill the regular 9-5 slots too, then you're good to go. To make the after hours schedule work, it's a lot easy to be seeing regular weekly psychotherapy patients than Q2monthly psychopharm patients.

 

[peppy]

One concern I would have about seeing patients by yourself at 11 pm is the liability and safety issues of seeing patients alone at a time of night when absolutely nobody else would be around.
If any of your patients were unstable with paranoid tendencies, you could be at risk of being assaulted and not having anyone nearby to help you. It might also be harder to demonstrate your innocence if you were accused by a patient of behaving inappropriately if no staff was around to testify to your interactions (plus the unconventional office hours might look "suspicious").
At best, you would want to be selective about which patients you would agree to see at those unconventional hours (i.e., very stable patients with mild illness) and that might limit you in being able to book a lot of appointments at those times even if there was sufficient demand.

For those reasons, I would not try to see patients at extremely late hours. I think it would be more realistic to work 7am-7pm 4 days a week, or to take a day off during the week and then work Saturday mornings. You could likely find office staff who would be willing to work those hours since I've seen FP and IM doctors working those kinds of schedules.

 

[MoodDoc]

A major concern is safety and liaibility. I am loathe to see patients when there are no other folks around. A few years ago, a very skilled clinician doing an emergency visit with a schizophrenic patient in his empty office on a weekend was assaulted and killed. As well, should a disturbed patient accuse you of something, it is harder to defend yourself if no one else was around.

 

[notdeadyet]

And I would think it would take a very rare psychiatrist that could deliver their best care after 14 hours on the clock.

 

[abcxyz0123]

And I would think it would take a very rare psychiatrist that could deliver their best care after 14 hours on the clock.

Why not? Plenty of docs work far more than this.

 

[OldPsychDoc]

Why not? Plenty of docs work far more than this.

Yeah, but you can stitch lacs or float lines without needing to pretend to care about the person in front of you. For me, by the 10th hour (or the 8th day on my post-call weeks) I pretty much don't care about petty problems anymore.

 

[whopper]

One concern I would have about seeing patients by yourself at 11 pm is the liability and safety issues of seeing patients alone at a time of night when absolutely nobody else would be around.

I'd very much agree with this.

A concern for outpatient I'd have is seeing patients who may not be stable in the office. I wouldn't worry so much about anxiety or minor depression cases, but cases where the patient has a past history of violence, antisocial PD, histrionic PD, Borderline PD, psychosis &/or mania with a history of dangerous behavior can be working without a safety net.

In residency, I've known 3 cases where patients decompensated in a manner that would've warranted security show up, and Haldol IM be given, but since it was outpatient, the police had to be called, and they didn't show up for about 15 minutes. During that time, the patient was doing things that were not safe, but the staff & doctor could only sit there & try in vain to verbally redirect the patient, while the patient was doing things like screaming & overturning a table with about $100 worth of pharm rep food, while the pharm rep is in horror hiding under another table in the room, while suggesting to the staff to give the guy geodon (yeah that was the funny part of the story. They should've grabbed the pharm rep & threw him at the patient).

And I know of one situation in an (P)ACT team where someone decompensated & pulled a knife on the resident & mental health worker accompanying the resident. The health worker actually karate kicked the knife out of the patient's hand, and the patient grabbed another knife. They decided to split after that and called the police.

IMHO any outpatient office that sees the above type of patient needs a safety alert system, where the doctor could signal someone else to possibly call 9-1-1, & possibly contact law enforcement ahead of time & have preplanned strategies to work with them should things go awry.

Outpatient office violence is rare, but it can happen, and when it does, if there's no precautions, everyone is caught with their pants down. The incidents I mentioned above happened in the course of 4 years. That's 4 incidents in outpatient in 4 years. That IMHO warrants planning.

 

[nancysinatra]

And I know of one situation in an (P)ACT team where someone decompensated & pulled a knife on the resident & mental health worker accompanying the resident. The health worker actually karate kicked the knife out of the patient's hand, and the patient grabbed another knife. They decided to split after that and called the police.

Sounds like just another day on Knight Rider, actually! Whopper, you could handle that.

 

[whopper]

I wasn't wearing my red turtleneck & black leather jacket, brown fro wig, and there wasn't a synthesizer 80s soundtrack in the background wih the -boo boo boo" noises every second. It also wasn't me in the knife situation.

The one situation I was in, some guy came to the office decompensating, and I told the staff to get all the Zyprexa Zydis samples we had, and we gave him about 40 mg worth of the stuff. It calmed him down. However, now thanks to JCAHO, no more samples at that office. That and it was around X-Mas time so there was plenty of food lying around, I got some of it and offered it to him while the Zyprexa was taking effect.

I was very bugged with the above situations because the program had a "ok, so he pulled a knife" neutral attitude to the situation. At the end of the year day where the residents got to complain I brought this up & nothing happened.

There were however some changes in guard at the program, and the newer people started a violence prevention training, which I've never seen any other program do.

 

[OldPsychDoc]

...During that time, the patient was doing things that were not safe, but the staff & doctor could only sit there & try in vain to verbally redirect the patient, while the patient was doing things like screaming & overturning a table with about $100 worth of pharm rep food, while the pharm rep is in horror hiding under another table in the room, while suggesting to the staff to give the guy geodon (yeah that was the funny part of the story. They should've grabbed the pharm rep & threw him at the patient).....

Oh, that's going into somebody's screenplay right now, I'd wager.

 

[nancysinatra]

I wasn't wearing my red turtleneck & black leather jacket, brown fro wig, and there wasn't a synthesizer 80s soundtrack in the background wih the -boo boo boo" noises every second.

But if you did, that would say "safety first" to everyone, 80s style. Really if anyone wants to have their office open late or on weekends that's all they need to do! What was the name of that car he drove that could fly when he pressed the Turbo button on the dashboard? If you equipped your office so it could take off like that if a patient gets a little iffy, I say go for it!

This just made me think of something which I think I'll start another thread on--unacceptable office decor. Thanks!