Dale Westrom, MD, PhD
Why did Dr. Westrom start his walk-in clinic? In 2007, Dr. Westrom read an article by Jack Resneck stating that it was easier to see a dermatologist for Botox® than a changing mole. Dr. Westrom who felt that the article reflected very poorly on our profession took this article very seriously.
Dr. Westrom practices with four dermatologists and a nurse practitioner. He typically sees six patients per hour, so he and his office manager decided that he would stop at 3:45 and open the walk-in clinic from 4:00-5:00. Dr Westrom’s practice averages about 15 patients per session. (4 days a week in one office and 3 days a week in another office) In the walk-in clinic, he tends to see more new patients and more cash-paying patients.
The walk-in clinic would best be characterized as “speed derm”. The key to its success is making a timely and accurate diagnosis, treating the skin condition or doing a biopsy and then setting up any necessary follow-up visit and moving onto the next patient. The urgent dermatology care clinic is not for patients with complex problems requiring a lengthy consultation. This point is emphasized to referring physicians/clinics and to patients who sign in. “This is a great way to build one’s practice through new patients and retaining current patients,” added Dr. Westrom. The clinic works well for patients who have irregular schedules and cannot necessarily plan several weeks out as well as for those patients who recognize that their problem “can’t wait” to be seen.
The patients who come into Dr. Westrom’s clinic receive a notice explaining that “the purpose of this clinic is to evaluate and treat single urgent skin problems, e.g. changing or new growths, infections, severe rashes, etc. The intention of this clinic is to detect skin cancers early, treat infections before they spread, and control rapidly developing rashes. Patients will be seen in the order that their paperwork has been completed and the chart is “put up”. “First chart up…. first seen”. Understandably, established patients will usually have most of their paperwork completed before they sign in so they may be seen before someone ahead of them on the list while that person’s paperwork is being completed. Everyone who signs in by the end of the scheduled clinic hours will be seen, no matter how long it takes. Because of the urgent nature of their clinic and the fact that it is being conducted at the end of the day, no HMO patients will be seen without a referral in hand unless they sign a waiver and agree to pay privately (no retroactive referrals will be accepted).”
In a walk-in clinic, patients will be seen on a first ready/first served basis. It is important that the staff understand that during the walk-in clinic, no appointments may be scheduled. When running a walk-in clinic it is important for you and your staff to consider the variety of insurance reimbursement profiles regarding procedures. Staff training and standardizing procedures are extremely important with walk-in clinics.
The walk-in clinic has been publicized via announcements to patients and other healthcare facilities, the yellow pages, and online. Dr. Westrom noted that the vast majority of patients who are treated at his urgent dermatology clinic are very polite and appreciative.