Podcast Episode 5: Online Booking

Enlightened Practice Podcast

In this episode, our hosts discuss the pros and cons of online booking. Dr. Braslow and Dr. Kagan share their experiences and compare what it is to run a practice with and without an online calendar. Does it give you more control over your schedule? Is it harder to keep track of cancellations? Find out in this new engaging episode.

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Transcript of the podcast

(00:02)

Ken: Okay, today, we’re going to talk about online booking, and welcome back, Kari. I hear that you don’t actually use online booking. So, maybe I’ll end up doing more of the talking today, but I’m curious to hear why not, or what you’ve heard about it, or your thought process around what’s kept you from using it.

(00:33)

Kari: Yeah. I’m so excited to hear more about your experience of online booking. I can’t say I have any good solidly formed thoughts about why I don’t do it other than I didn’t start out with it. And then I think from then on the thought of opening it up for whatever reason seems like one too many things for me to take on or try differently, given, you know, other things that I was doing in my practice at the time, all the other admin related stuff that I was managing. Even though, I do think probably this would be one of those short-term pain for long-term gain things on the admin side. But I think it was more so for me, just a default decision, not because I didn’t start out with it, I kind of just never ventured out into it, but I think maybe slightly, a little bit more than that, but again, I’ve never done it.

So I don’t know that this is actually true for whatever reason in my mind. I like to have control over my schedule and I will say it’s quite a lot of admin there involves emailing back and forth with clients, but I usually have a manageable number of clients on my caseload at any given time to feel like that’s doable. But there’s something about having the complete control and me being the one to put the client’s name in as opposed to opening up my calendar and seeing a name that sounds intimidating and scary to me, but it could just be a mental hurdle I’ve created. And I’m so curious to hear your experience.

(02:17)

Ken: Yeah. That makes sense. Especially if your practice is full and stable and there’s a lot less scheduling that goes on anyway, and you’re right, you do give up a degree of control. And if your systems worked for you for this long, why change it? And maybe there’s even a more compelling case for online booking for psychiatrists because with med patients who might only be seen once a month or once every few months you’re still spending the same amount of time to schedule them, but then there’s just a lot more patients to schedule. And if you don’t have to, it’s nice not to. So I would say before I even dive in I have a hybrid setup where it’s not like my entire life is available to schedule. And within my practice hours, I would say maybe 80% are available for online booking, but 20% are not.

And that way I retain some degree of control. I like to hold slots for crisis patients or just anything urgent. And that’s how I can feel good about that. And now you could say, well, then you’re going to maybe see fewer patients that week because all my patients know to go online to book. And if they don’t see an opening, even if I know it’s there then they just keep going, scheduling further out. On the flip side, if I see that somebody has just scheduled, I get a notification as soon as they’ve booked online, but I know I have an opening tomorrow and I don’t anticipate anything urgent between now and later today or tomorrow, then, then I’ll reach out to them and say, Hey, we’ve got an opening and you know, five hours or tomorrow, would you like that? And then almost always, they’re pretty cool, pleased about that, but that way it gives me the luxury of having a buffer and time for crises.

But then the vast majority of the admin work I don’t have to do. So, if you’re looking to try it out, you could just start out offering one hour a week. You know, there’s no rule that your whole practice has to be available online and you could just see how it goes. One of the things that I use in order to maintain more control is this concept of having a cutoff on both how soon and how far out. So what I don’t do is allow anybody to book an appointment for any time that’s available within my online calendar. So you have to book it at least a day in advance. Even if I have availability in three hours, I don’t let you book it because I don’t want surprises. I don’t want to think, Oh, I’m off. And then there’s a patient sitting there waiting for me and they booked it 10 minutes before the session.

(05:37)

Kari: Okay.

(05:38)

Ken: So that’s one degree of control. On the flip side, there are days when, rarely, when I see there’s an opening in the schedule and then I will change the cutoff to no cutoff. So that way, if somebody really stepped right up and they saw an appointment in an hour, they could grab it. I just want to be the one to make that decision consciously and not have it be the default. And then on the other side of things, I don’t let people book 10 years out. My schedule template is always subject to revision and it’s not that it changes that often, but there are always things with the kids’ school or holidays. So I used to let people book like six months out, really for meds.

But I realized that I was canceling a lot of those appointments as I got closer realizing it didn’t work. And so I didn’t want to put myself and the patient through that. So I have the cutoff now at two months. So, you can’t book farther than two months out. It just doesn’t show up when you go to, to book, because I pretty much know my schedule the next month or two out. And the third limitation is, so you can choose to allow individual patients to book online or not, and I don’t allow new patients to book online. I do one-on-one, because I don’t know, it just doesn’t feel right to do that. One of the things I don’t want is to have five new patients in one day that is just completely overwhelming.

And I can even tell on days when it’s current patients, but these are really complex patients. I don’t want a new patient on that day. Also, new patients are more likely to be responsive in scheduling. One of the challenges I had before online booking is I would offer a time slot and then I wouldn’t hear back from someone, and I would never know what to do with that because meanwhile, somebody else might want the slot. And because I offered it, do I have to keep it for you? Or as a courtesy do I keep it for 24 hours? What is the etiquette here? And then it was painful when they would reply back and either it’s too late and I gave up and offered it to somebody else and now I’m double booked. I want them to have a clinical relationship with me and I don’t want the business side of scheduling to affect them building rapport and trust and connection with me.

(08:43)

Kari: Right.

(08:44)

Ken: So what we used to do is say okay, the slot will hold for 24 hours. But then people would reply like 27 hours later and they’d say, Oh, you know, sorry, I didn’t see it. Is it still available? And then I would feel bad saying no. And then I would offer it to multiple people on one slot because I didn’t want the slot to go unfilled. And I’d say, just so you know, the slot has been offered to multiple people. So the first one who responds gets it, but then I thought, Ugh no, I don’t want my patients competing with each other.

So then what I do now because I have online booking is if somebody emails my office with, “Hey, can I set up an appointment?” We’ll say, sure, here’s a particular time that’s available, but could you go book it yourself online because anyone can book online- and by the time you get this email the slot may have already filled. So we encourage you to book this online right now and also in the future, just go book online. And for some people it’s just a reflex to contact the doctor’s office directly that just not, I guess, many other kinds of practices for online booking. And so it doesn’t even occur to them or some people like that personal touch when scheduling, but the vast majority of my patients just love it. I mean, we used to have 27 rounds of email back and forth. How about this date? No. How about this date? No, it was just such a non effective use of time. So, by having the parameters in place I felt much more controlled and then there’s another layer of parameters and that deals with cancellations and rescheduling.

(10:51)

Kari: Yeah, that’s what I was going to ask about.

(10:52)

Ken: I have in general in my practice, as you recall from the previous podcast a two business days cancellation policy. So online booking, I used to not allow people to cancel at all online. They’d have to reach out to me, but then I realized, why am I making people do that? So I didn’t have a good reason. So then I set it at 48 hours as the cutoff. So, you could cancel up until 48 hours before the appointment and that seemed to work. But then people would be able to cancel Tuesday’s appointment on a Sunday. And I thought, oh God, this is the same issue with the two business days. So now my cutoff is 96 hours, four days. That way it guarantees the “two business days” is covered. Part of the challenge is that we could build in logic to say two business days, but the definition of business day can vary.

Like are certain of the minor holidays are those considered business days? And if I don’t work on a particular day of the week, but it’s a Monday through Friday, is that a business day for me, a business day for the world? So there’s just too much complexity to make it worthwhile. So, anyhow 96 hours is the limit.

(12:36)

Kari: Then they have to email you.

(12:37)

Ken: Then they have to contact me, right. And that doesn’t come up very much. I think maybe because they go to cancel and they realize they can’t and they just show up for the appointment. So that’s nice. We both get a notification, the patient and I when the appointment is booked. So I know who’s coming in to see me and we have a button where you can just turn off online, booking globally with just a click, if there’s some crisis. And I’m just closing my schedule completely until I figure this out, you just click a button and it’s closed off. Okay. So that’s some of the intricacies.

(13:17)

Kari: I have a question, about another intricacy. What do you do if a client cancels out an appropriate amount of time and they don’t reschedule, that’s one of my fears if you will, maybe irrational fears is that I might lose track of a client. Let’s say they cancelled and they just haven’t put themselves back on the calendar for whatever reason or maybe it’s even some kind of like in their own way terminating.

(13:51)

Ken: Yeah, I can talk about that. I’m curious how you handle that without online booking.

(13:58)

Kari: So, I guess the equivalent of that without online booking would be a client no showing for an appointment. And then I would follow up over email a few different times and then eventually send a letter letting them know that their case will be closed and they’re welcome to get back in touch. I guess the fear that I have of the online booking is like, you know, right now if a client cancels, I guess you would be informed as well with online booking. Like, obviously I know about it because they would email me and let me know that they’re canceling. And then usually right then and there we’re rescheduling or we’re in contact in some way, like they’re on my brain in other words. I know this client canceled and I need to get back to them to reschedule or whatever it is. My concern would be that a client cancels and I lose track of that like if they never reschedule and I have that moment later on where I’m like, oh my God, I haven’t seen this client in a month. You know what I mean?

(15:04)

Ken: Right. That’s a good point. Yeah. So for meds patients, it’s a little different than for therapy patients. For my meds patients I hear from them the day before their meds are run out or the day of. And so in that case, of course I’ll send them a refill, but I’ll ask them to schedule at that point. And then I send them enough of a refill to get to our appointment. And then we’ll process this. Oftentimes it’s a reflection of some of the issues we’re dealing with. This is often ADHD patients or patients who just live very logistically complex lives. And so I try and take that material and bring it into even a meds check. I always try and sneak in a little therapy, even within the med checks. For a therapy patient, they can cancel. They can’t cancel all your future slots online.

You can only cancel one at a time. So, they typically would be scheduled to come back and see me the next week. So, I don’t worry too much about it but if I saw like all of a sudden one person, this has never happened but you know, if they started cancelling appointments, I think I would just reach out and say like, would you like to chat? So I’m trying to think of a scenario where maybe it’s a therapy patient, but I don’t have a regular schedule with them.

(16:39)

Kari: Yeah. I guess that was what was on my mind. I have a couple of clients where we schedule as we go, which is not ideal, but it sometimes unfolds that way for whatever reason. Maybe we’re meeting once a month and it’s kind of just like, okay, we’ll, you know, be in touch in a couple of weeks.

(17:01)

Ken: right.

(17:03)

Kari: It’s just me. I guess it’s a bit of just a very tiny little thing, but it was a thing that came up in regards to losing control of my schedule. Although, hearing you talk about the parameters that you set up. I didn’t know all of those existed. So that actually makes a lot of sense, it helps to routine control over the schedule. And then I guess it’s just for these few random cases it’s probably not different either way. There’s always the possibility of losing touch in a way. I, for whatever reason in my mind, I feel like if there’s an email exchange, the client sticks more in my brain than if I just, like, got a quick notice that they were canceled at some point.

(17:55)

Ken: I see it at least on the patient side it’s an at-will relationship. They’re welcome to come and go as they please, I’m here for them. But if they don’t want to continue working together for whatever reason then I don’t try and sell them on it. I’m happy to process it with them and talk about all the reasons they don’t want to work together with me or just to process the chaos in their lives, or the challenges in their lives, or if they’re moving or whatever. But I think in some sense having the ability to just cancel the appointment with abundance is very empowering for clients. And so there’s some psychological value in that. So it’s just a scenario that doesn’t come up that much in my practice. So, I guess that’s a good point actually, you should probably pay attention to that scenario.

(18:53)

Kari: Well, I think actually this is a big selling point for me to consider online booking because I do often feel this burden or not burden but this responsibility of keeping track of making sure I’m doing my due diligence to follow up if someone cancels and I feel a tremendous amount of responsibility for the most part. My schedule is usually pretty predictable because it’s weekly appointments, but there are the occasional, you know, once a month those who are more at risk of falling through the cracks. And I often feel like the responsibility. And I think that there’s a lot to say for putting that responsibility in the client’s hands. I think clinically speaking, that can be really valuable for the client to take that initiative to like, really feel motivated enough to go onto the online booking and do it as opposed to me kind of like facilitating the whole process. So, it sounds really relieving to just be like, whenever you’re ready just go ahead and schedule as opposed to me sending the follow-up emails and making sure I remember to do that and all of that.

(20:18)

Ken: Right. And everything’s in this way documented automatically. So, there are occasional cases where patients say, Oh, I didn’t know I had an appointment or I didn’t know it was canceled. I’ve had patients cancel and then show up, but I wasn’t there because they canceled. So, it’s nice to be able to have a historical record automatically generated to review. I’ll say one other thing about online booking from a new grad perspective and there’s two particularly valuable elements of it. One, is if your schedule is wide open the amount of back and forth with the number of new clients you may have, just multiply those two things together and you’re going to spend a lot of time emailing or calling. Calling is even worse because they never pick up the phone. You can never pick up the phone and you just go back and forth.

And there are patients who will leave a message saying, hi, sorry I missed you. Call me. It’s like what I just wanted to know would this time work. Yes or no. And that’s all you had to say on the voicemail. Now I’m looking at 27 rounds of phone tag with them. So just relieving the administrative burden is very meaningful. And the other thing is it’s great marketing patients really like online booking and featuring that as part of what you offer them. You can have a lot of self-service options, it’s appealing to many people. So, so that’s why I like it. It’s not a hundred percent perfect. Occasionally somebody schedules and I’m like, wow, why did I have that schedule open? I wasn’t planning on seeing a patient on New Year’s Eve at 11:00 PM, but then we just cancel it. I just reach out to them and just say, I’m really sorry. I don’t know what happened. I shouldn’t have had that slot available. I’m happy to find you a new time or you can reschedule online. So that comes up. That’s only come up a handful of times. 

(22:27)

Kari: Yeah, which can happen without it too.

(22:32)

Ken: Right. All right, well Kari, it’s always a pleasure chatting and will be curious to hear your online booking experiment. If you try it out maybe you let me know in six months or a year what your findings are. Look forward to chatting with you soon.

(22:49)

Kari: Thanks for talking about it. Take care.

(22:53)

Ken: Sure. Take care, bye.

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