Doctors’ Hours Are No Longer Just 9 to 5

By Todd Ackerman, Houston Chronicle

Charlie Schott was 56 and in need of regular medical checkups when he became fed up with his doctor’s 9-to-5 hours and always-booked schedule.

So, he stopped going. Despite recurring polyps in his colon, Schott went without medical care for 1 1/2 years, until he found a doctor whose office was open evenings and weekends.

"The off-hours my new doctor offers are the only time I can guarantee being able to make appointments," says Schott, a Houston construction manager. "Not all people have the luxury of taking time off from work or planning treatment months in advance."

People like Schott are shaking up the practice of medicine, long dominated by doctors making patients conform to their schedules. Suddenly, faced with less compliant patients and unexpected competition, more and more doctors are doing the unthinkable: changing their hours to accommodate potential customers.

One expert says it’s fast becoming the norm for family-medicine doctors to hold hours on Saturdays and a couple of nights a week. Earlier this year, the American College of Physicians called for more consumer-friendly scheduling.

The trend extends to clinics for the poor and uninsured, as well. In the past two years, the Harris County Hospital District added more than 100 hours a week to its community clinic schedules. Memorial Hermann Hospital launched two new clinics open from 7 a.m. to 7 p.m. Monday to Friday and 9 a.m. to 3 p.m. Saturday and Sunday.

But is it enough?

In August, the hospital district announced a policy intended to redirect to clinics or doctors’ offices those adult patients who show up at its emergency rooms with problems that don’t constitute emergencies.

"There’s no question the new ER policies are putting pressure on us to provide alternatives to our traditional safety net of care," says Ron Cookston, executive director of Gateway to Care, a coalition of health and social service providers aiming to improve access for the county’s uninsured. "That’s why we’ve worked the last 12 to 18 months to extend clinic hours."

Although there are no data on how prevalent the trend is, the local movement toward extended hours clearly is in its infancy. Schedules are a mishmash — different centers stay open late different nights — and there’s no clearinghouse to direct would-be patients to private doctors with extended hours.

But, increasingly, it’s what people are asking for. In focus groups and surveys, people say they’d choose evening and weekend appointments, if available, citing work and child-care issues. A 2000 study in Women’s Health Issues found that half of women under 55 said they’d trade their doctor for another who kept hours beyond 9-to-5 weekdays.

It’s an ever-changing role for doctors: Rockwellian in their commitment to house calls in the first half of the 20th century; masters of machinery that required office visits in the 1960s; corporate in their embrace of HMOs in the ’80s and ’90s. All patients knew was that, at some point, many doctors’ hours seemed like bankers’, plus a day off for golf.

Doctors may chafe at the image — after all, they note, studies show they work an average of 58 hours a week in patient-contact time — but patients increasingly complain about the lack of access and waiting times.

Nowhere is that discontent more evident than the walk-in clinics in retail stores. An antidote to the inconvenience and expense of full-service doctors’ offices — one chain official reports weekends and evenings are among the busiest times — the nurse practitioner-staffed clinics have gotten the attention of many physicians, who’ve since added hours and same-day scheduling.

"That’s the beauty of markets," says Uwe Reinhardt, a professor of economics and public affairs at Princeton University. "They’re forcing doctors, who’ve historically arranged the world to their convenience, to be more customer-friendly. They see the handwriting on the wall."

Reinhardt compares the phenomenon to "America’s unimaginative restaurants and undrinkable coffee decades ago." He says it took consumer demand to increase those standards, just as it’s taking patient demand to upgrade primary care in the United States.

Dr. Barbara Thompson, chair of family medicine at the University of Texas Medical Branch at Galveston, says the focus on patients goes beyond competition. Noting a return to house calls by some family-medicine doctors, she says today’s breed of young physicians is more altruistic, that they’re "overwhelmed by the need out there, by the lack of insurance."

Pompeyo Chavez, UTMB’s family-medicine chief resident, understands the access and financial issues that can make it difficult for some people to get to a clinic.

"We need to get back to our roots," said Chavez, 29, who was born and educated in Peru, where house calls are common. "Continuity of care is something doctors need to provide."

In spite of the hospital district’s attempts to steer patients to clinics, the night scene at Ben Taub’s ER has changed little. On a recent night, the waiting room was full of nonemergency patients. They dozed, stared vacantly, ate meals from McDonald’s, watched television. Most expressed irritation at the wait and ignorance of any other option.

"This is the only place I know," shrugged Donnie Johnson, a construction worker without insurance whose leg was hit by a drywall dolly earlier in the evening.

Meanwhile, a handful of private doctors with extended hours say they’ve been amazed how quickly their weeknight and weekend slots fill up.

Dr. David Bundy, a Cincinnati pediatrician who has written on access to care issues and calls the extended hours the new norm among family-medicine doctors, says the trend is most prevalent among pediatricians because it’s so appealing to working mothers.

Of course, there are obstacles to extended hours. One is finding, or affording, staff willing to work nights and weekends. Baylor College of Medicine, for example, stopped extended hours at its two family-medicine clinics because demand didn’t meet staffing costs. That would, no doubt, come as a surprise to high school librarian Shirley Luken.

"I’d say the options are pretty limited," said Luken, 63, happy to have recently found a doctor with late hours one night a week. "I think there would be a lot of people who don’t like to have their workday disrupted who’d welcome later doctor’s hours."

todd.ackerman@chron.com