Utilizing a Flex Clinician to Manage Absences and Support Wellness

Health care workers often feel obligated to work while sick, due to guilt about requiring colleagues to cover their absence.¹ This can be unhealthy for their patients and colleagues, and is one of the many factors that contributes to the national problem of clinician burnout. Attempts to mitigate burnout with family-friendly policies and scheduling flexibility typically focus on clinic start and end times, telehealth sessions that allow for remote work, and adjusting the length of appointments.² These policies, while useful, don't address clinicians calling out sick or other unexpected absences. Common strategies for those situations include opening a scheduling template at a later date to reschedule appointments or having other clinicians use their administrative time to cover, both of which can also contribute to burnout.

The COVID-19 pandemic drew attention to the need for better systems to manage the impact clinician absences have on colleagues and patients, but there is still not much described in the literature about best practices for this. In this article, we describe an approach we implemented at a large, urban, academic primary care practice that improved clinician wellness, enhanced patient access, decreased bumped appointments, and maintained patient satisfaction in the event of a clinician call out. It's a flex clinician model that we believe could also be modified to fit smaller practices.

Our practice has 14 patient care sessions per week, with 12–16 clinicians scheduled per session. We average 250 patient visits per day. Clinicians within our university's Department of Family Medicine also manage an inpatient adult hospital service, an inpatient labor floor service, a second smaller faculty primary care practice, and clinical coverage at several partner federally qualified health centers. In the past when a clinician called out, all primary care clinicians would be asked to voluntarily cover the clinician's appointments to avoid bumping patients, and all faculty physicians were asked to forfeit administrative time to cover any precepting absences. If no clinician volunteered, we bumped patients and rescheduled them for the next available visit, which could be days or even weeks away.