Reducing Internally Generated Demand Through Scheduled Communication Time in a Remote Salaried Family Medicine Clinic.

Abstract

In salaried primary care systems, internally generated demand, such as physician-initiated recalls, can limit timely access for other patients. To evaluate whether reserving protected time for unscheduled physician phone calls decreases recall appointment volume. A quality improvement intervention with a before-and-after analysis. A salaried family medicine clinic in northern Saskatchewan. All clinic patients recalled for visits between October 2024 and February 2025 (1005 recalls). A daily 30-min block was reserved in each physician's morning schedule for discretionary phone-based follow-up. Total number of recalls, recall reasons, and patient demographics before and after implementation. Recall appointments dropped by 28.7%, particularly those related to bloodwork, imaging, and specialist communication. However, the time invested in protected communication slots exceeded the time saved from reduced recalls, suggesting a shift in physician workload rather than an overall reduction. Allocating protected communication time may support more flexible follow-up and improve task completion efficiency, but does not appear to meaningfully expand physician appointment access.