94 | Scheduling Tetris

Annie: Well, hey there, Leah.

Leah: Hey there, Annie. How are you?

Annie: I'm hanging in there. You and I have both been very busy and pulled in a lot of different directions. We were saying, chatting about how the holidays have felt extra challenging this year, but even just. The year has been a year.

Leah: Yeah, it totally has and now we're in January and it's just kind of feeling not as fresh start January as I had hoped it would feel. It's kind of like, more life in January.

Annie: Yeah, just okay, back to it.

Leah: Yeah, exactly, exactly. But this time of year, I think, brings a lot of scheduling logistical things, because I think we're getting into the season of like, everybody's sick or people are having to travel and different kinds of things. Like, it's always this time of year that I feel like even more strain on the logistics of scheduling and it gets more and more complicated. The more people you have in your team and the more people that you are serving. Like, I feel like the Tetris gets to the level 99 where you're like, there is no solution. And then you have to spend a lot of time for me. It's a lot of time on the phone with my admin, Amanda, like we're sorting through, okay, we've got these people, we've got this, this, this issues. It's like the places they want to be seen. Ours just gets really complicated.

Annie: What is your scheduling system? Because I know you and I do things a little bit differently, but we both are dealing with multiple locations, multiple people, and our practices are busy. So how do you guys approach scheduling?

Leah: So complicated. Because we have two offices and they're not close together. So like one's in Pearland and then the other one's like 35, 40 minutes away in Houston. Two offices and then we have home visits but each of the providers go to different radius, like different parts because we all live in different areas. Which makes it a little bit complicated. So amazingly, my admin or virtual VA is really good as she's like a systems person. So she has like systems to it. She starts with, like, where they want to be seen, what radius, who can see them, like, if they fall in, they want a home visit, and they fall into which radius for which people, then that narrows down who could see them, if they have an urgent need, or if it's, like, it's a prenatal, and they're only 30 weeks pregnant, it's like, okay, we could push, push that around a little bit more than we could push, like, a newborn, and, Something urgent need to be seen. So there's so many working parts to it. And then to top it all off, we also allow or have not allowed, but we have online scheduling for the office visits, not the home visits. We found that that was like, it never worked out because It's just too hard in Houston because although you're like, Oh, that's really close. You have to really think, okay, this requires you go on this route, which is always traffic y. So you have to plan longer, even though the distance would make it seem like you could get there in this amount of time. But if it's at this time of the day, you're going to have to plan for more time, you know? So we know all the home visits have to go through Amanda.

Annie: So how does that work? Do they text you? And then what happens next?

Leah: Yeah, they're going to text or call. And then Amanda has like that radius thing. So she's going to look at like, where do they fall? Who could see them? And also like, sometimes the people are like, I want to see this particular provider, or they might be like, I just want whoever's. The fastest person that can see me.

Annie: And how does she see, like, and she has everybody's schedule. So she knows when everybody's at.

Leah: So intake queue, everybody blocks off the time that they're available. And then they also have office space just to make it even more exciting. Our office space is only available at certain times. So that's all like blocked off on the calendars too. And so then she can start to see where people will fit in. And then to just like, keep making it interesting. We all have kind of like the way we like our schedule done. Like I like bigger gaps between my visits because I'm just a chronic over time person. So she just knows that she always gives me a long gap, but other people like, they just want to get to the next visit and don't want to have the leisure time in between or the luxury of any empty space there, which I love. I'm like, Oh, I like to just be able to mosey on over to the next place. But like Annie, she wants to get there, get going. And so she'll have tighter gaps, you know? So basically my VA is amazing. And she can somehow work this out with the, like a flow chart, basically in her brain of how she just starts like hacking away at who could be seeing, but she and I usually talk like once or twice a week on the phone when it's a little bit more like, Hey, Hey, Like I can't fit this person anywhere. Can I fit them here? You're going to have to be starting earlier than your normal time. So she does have the leeway. We ask her like, if there's anybody that needs to be squeezed in, we all are pretty flexible in some, on some days where we're like, Hey, I'll stay. I'll work 30 minutes later so that that person could be seen or start 30 minutes earlier. But that sometimes causes problems, too, because then they have to wait for us to reply. Like, so she can't get the person's schedule because she's, like, waiting to see if we can agree to that. Which might take a whole day because we're in visits so if we're at the pediatric clinic, they run our schedule. So, I might be completely full. So, when we're working under them, they do all of our scheduling. So, our scheduling is, like, majorly complicated. I probably now that I think about it, I'm like, yeah, I should, should give Amanda a raise. It's just because it is complicated with three providers and all these locations and then all these, like, different versions of scheduling that we need to do, it always ends up working out. So when it feels crazy stressful and I'm like, Oh my gosh, yeah. We're never going to figure this out. I always just tell myself it always works out. It always works out. We always figure out a plan. Everybody always gets seen or we refer them to somebody who we know can see them. You know, like it always works out. So I just have to like, take a deep breath and be like, okay, we'll figure it out, we'll work it out. It is a stress point, especially when it feels like there's a lot of requests all at one time. You know, I think that's like the hardest part, but so I know you. Have the factor of like interns. I don't have any interns right now. And I feel like that adds another layer because you have somebody else who. Needs to be potentially considered in like your scheduling and all of that. So what do you do? Like, what's your, what's your scheduling?

Annie: Yeah, well, we have right right now. I've got two interns and then one intern who just got her IBCLC and so she's doing some shadowing and training to start coming to work as a contractor. So I do things totally differently because I don't want to talk to anybody before they book. I don't want to get involved in like a back and forth about time and place because it wouldn't end up being an admin who would do it. It's me. It's me. And I don't want to do it. So we played around. We were having like a nightmare. It was so challenging, like we have an office three days a week. It's only one office location. We only have it. Well, actually we have it every day, but Tuesday and Thursday. So we do also have it on the weekends. I have two people that are working for me right now. They. Don't have much overlap in their service area. I also recently decided I'm not doing home visits anymore. So I'm just in the office three days a week. And then I have these two people doing home visits soon. We'll have a third doing home visits. So the interns come to the office with me and they know that they can go on home visits if they want to. They just have to, they have to do that themselves. They have to look at people's schedules or they have to say, can I come with you to this home visit, you have to be self motivated.

Leah: Yeah, I can't drag like drag you along trying. Yeah, I can't.

Annie: I’m never going to remember to ask you if you want to come. So we were doing it where people had to wait 7 days to book like or like you could only book. You couldn't book more than 7 days out in intake unless it was a follow up or prenatal and then people could pick those like Weeks ahead of time, but then we would have people being like, when are the new appointments going to be open? And it'd be like, you have to check back tomorrow. They're like, is it tomorrow? What time tomorrow? When can we check back? And then we're like, I don't know. It's first come first serve. And we always get more requests than we can accommodate. Because we take so much insurance. And then there's like the home visit, we charge a home visit fee. If they don't want to come to the office, they can pay extra, but then people would like, pay it. But we're like, we don't go to New Jersey and then we have to refund them. And then it's confusing. So what we decided and this has been working is I'm like, we're going to change everything. People can now book up to three months in advance. Like you can go in there and book an appointment with me for March because Oh, the other thing that people would do is like, they're like, they try to book a postpartum visit before their baby comes and we're like, you don't know when your baby is coming. We have that happen too. Oh my gosh. Yes. And then I'm chasing them down. Like, is your baby here yet? We're like, you know what, this is how it's going to work now if you can book. Up to three months in advance and you can book a postpartum visit two weeks after your due date or one day or on your due date, like whatever you think this is happening, it's fine, but we tell them we have a wait list and actually now when people go on the earliest they will see for an office visit with me is February. Because they can book in February and they'll say, we usually have earlier appointments available, but the way you get on the wait list is you have to submit the intake form. So, they request the appointment if these people go ahead, fill out the intake form, then they get on the wait list for an earlier appointment in the order. That they submitted the intake form.

Leah: How did you check that?

Annie: I have a task in intake queue. It's like waitlist number one, waitlist number two, waitlist number three. And so then, so then what happens is, and the reason they can't see any appointments until February is because my December people, I took two weeks off for, for the holidays, for Christmas and new years. And so my first day back is early January, but I already am full. For the first two weeks of January, we're recording this at the end of December, are already full with clients. There's like prenatals and follow ups, but I know a bunch of them are probably going to cancel, postpone, reschedule. Then I'm like, okay, what do we do now? It was like people were. You know, texting us like the day before, like on Sunday for Monday, like, I can't make it tomorrow. Can, can we reschedule? And I'm like, that's fine. Because I've got a wait list and I'll slot somebody else in there, but I'm like, I don't want to do that on a Sunday. So now our, our, our system got the wait list. We have all these people stacked up and ready. My admin goes through two business days. So like for Friday, she does this on Wednesday for Monday. She's doing it on Thursday or Friday morning. And. auto confirms, like manually confirms every single person. And they're like, please let us know by 3 p. m. Today, if you intend to be at your appointment on Friday at this time, and if you don't, that's fine. Just let us know. And then if you don't get back to us, your appointment might be rescheduled. And so then she's catching all these people who are like, Oh yeah, 11 doesn't work. I meant to do that. And then she moves them and then she tells me, I have it blocked on intake. You hold for the waitlist and then I can slot waitlist people in there. So that has given me, I feel like a lot better control of my schedule. I feel I've even been able, because we have the intake form, their chart is already set up. I've even been able to accommodate like same day. Like, can you get here in an hour? And it's worked to have them do the intake form because before we were waiting, you don't have, we don't need the intake form until like a day before, but then we're like, I could see you tomorrow, but you haven't even started the intake form or even like make contact with you.

Leah: Right. So it's going to be unlikely that they're going to get that done before an hour visit, you know, an hour away.

Annie: So this has worked. Really? Well, and then we even set up on intake you like automated appointment confirmation. So my admin only has to look and see they got the email, the confirmation email. They opened it and they click confirm. They're confirmed, but if they didn't open the email, we're like, we don't know you made this appointment a month ago. Are you still planning to come? Those are the ones that she texts and has them get back to her. And then for the wait list, I'll text somebody. I'll be like, I had a cancellation. I can see you tomorrow at 11. Please let me know by two o'clock.

Leah: Right.

Annie: Because I have other people on the wait list.

Leah: Yeah. I love having the confirmation like through the system confirmation and you get the little check and I'm like, okay, all these people are confirmed.

Annie: They're good. They're coming.

Leah: Yeah. Yeah. We don't get too many cancellations, which is good for our private visits. Now we get more in the office for the pediatric clinic, which is challenging, but they do a really good job of working to get confirmations. You know, they have a confirmation system as well, and they make phone calls and they try really hard. And I appreciate that, but we do get gaps more often in the clinic than we do for our private visits, but I think one of the differences between us is I don't have people booked that far out other than like prenatals, like definitely prenatals we get, but I don't have a lot of like initials or followups booked that far out. So most people are making it pretty, like a week out or two weeks at the most out. And then I think that that makes it easier. Like they haven't forgotten about it or their schedule hasn't changed tremendously, but we carry a wait list as well for those one off times where A cancellation does happen or I get some open time at the clinic. I'm like, hey, there's a gap here. I could fit somebody in. So we too have a wait list that my admin is kind of like keeping track of. She has a system for that and she can oftentimes get people in sooner. So like we do the same thing. We'll be like. Go ahead and let's just book what we have available. We're going to put you on the wait list have everything ready. Try to get your intake form, everything ready. We haven't required it, but I love the idea of requiring that. We're able oftentimes to get them in sooner or something happens, opens up for our schedule. Like, hey, I thought I was going to have to do this, but I have some space now that I feel like I can make this fit and see people sooner. I am like the bleeding heart. I hate thinking about people waiting. So I'm usually like, when I know there's people on the waitlist, I'm usually keeping my eye out for places to fit them in when I feel like I have the capacity. I'm always like, okay, actually, my family, they're all not having the plans we thought we had this afternoon and we're not gonna do so like I'll just go ahead and see this person or I can actually fit them in because I was already gonna be in this area now I feel like I could work an extra 30 minutes and see them. I'm always having that run in the back of my mind, which is sometimes challenging because I feel like there's always like loose ends. It's, I guess it's kind of what it feels like with scheduling. It always feels like there's loose ends, but I've tried to embrace like anytime there's open spaces, like at the pediatric clinic, I have like a running to do list of what I do, which has really helped me. So instead of feeling frustrated that I have a gap at the pediatric clinic, I have not blocked off as much like admin time. As I used to, I used to block sometimes a half day or a whole day a week to run my business. Now I just have my tasks for admin work and I just tell myself I'm at work. You know, even though I'm at the pediatric clinic, I'm at work. And if a visit gets canceled, like, last minute, or sometimes we get, like, no shows, like, we don't even know, they just don't show up. I always have my computer there, and my little list, so I'm like, oh, today I need to look at this admin thing, or that admin thing. And it's actually helped me a little bit with that, because I'm already in work mode, I'm not at my house, because Admin work at my house, like, never seems to work for me because I'm like, Oh, okay, I'll go start a load of laundry and then I'll sit down and do that. And then I'm like, Oh, but there, here's this stuff on the floor right here that I was going to put away. So like, let me go do that. And then I'm going to go sit down and do it. And then I'm like, Oh, but I did want to get this thing out because it's here in the closet already. And then I just trail off and I'm like, there's my admin work for the day was housework.

Annie: I'm the same way like I, I'm like, if I'm in the office and I have a cancel it and I tried not to have any open spot, but I can't, I'm like, I'll just sit here and like run through, I'll run through my tasks on intake queue, I'll update thing, whatever I have to do, but like, I, I found that, 'cause the other thing I do and the reason also why people can't see is not because I have appointments scheduled through January. It's because I have blocked off. That's for follow ups. And so I wanna make sure, like every week I wanna make sure the following week has free space because otherwise I, and this I did notice, and that was why we were doing the, you can't book more than seven days in advance, was to make sure that we scheduled our follow-ups first. But now I'm like, no, I'm just gonna like hold the space. I have a sense in my mind of how many I need to do, but then as soon as that days are set, then I open it up. Then it either goes to the wait list or open to the public.

Leah: Yeah.

Annie: And that has worked a lot better than the hunger games of like you can get to the follow up first. It's, I don't know, we had even, like, we're asking IntakeQ, like do they open at midnight or is it like seven days prior to the. Open appointment time. Because people are really trying to get that granular IntakeQ was like, Are you seriously asking us this and like, and like intake use support, sometimes you go back and forth and you get the most maddening answers are like, did you even read my email? And I think we might've even given up trying to get that question answered. Like, is it 9am? Is it 12, oh one good night? I don't know. We could tell people when to scramble to their computer. When does scramble. And we also, and so we also have like the autoresponder of like, we'll say like, here's where you book online. If you have additional questions, put them here. Someone will get back in one business day. And so if they write and they say, I don't see anything until February, then we'll say, you can book that, fill out the intake form, get on the wait list, or you can contact the New York lactation consultant Association warm line text line where they have like just the referrals and that's where it's just like, or you can you can see about finding somebody else. I can't help. I'm not going to help you with that. I can't help you with that but here's a way to find somebody sooner. If you want to work with us, this is how it works. And my admin does spend time like 24 hours after they booked the appointment. If they haven't started the intake form. She reminds them or we have a whole system to have, like, the first text is this is city lactation with a question for you. Please confirm your name and date of birth and then they'll write back and say, Oh, yeah, this is me. And she'll say, Great. Just the intake form was sent to your email. Let me know if you have any questions. Please fill it out. As soon as you do, you get on the intake form or sometimes She gets nothing back from them, and if they don't respond in 24, like, to that text, she'll send them an email, if they don't respond to her email, she just cancels the appointment.

Leah: Yeah, actually, like, you, maybe we're, like, scrambling. Yeah, you probably booked with, like, three people.

Annie: Yeah, and it's fine, like, Go ahead. Like nothing, no results.

Leah: And you can fit them in.

Annie: And I also like when it comes to charging a cancellation fee, I do have a really hard time with that. And I just have had, and I know it's like, this is a kind of a contentious thing. And I will say that there's like value in my time and like, yes, if somebody cancels and I can't fill that spot, that's money that I couldn't make that you prevented me from making. But I almost always can fill that spot. And the few times that I have tried to charge a cancellation fee, I've never had anybody just accept that. I've had people threaten chargebacks. I've had people like, which can like, Hurt your business. I've had people just send put nasty reviews on Google just about our schedule. And I'm like, I, I can't take that. And our cancellation fee is just not enough money to be worth it.

Leah: Life changing difference.

Annie: I mean, I, I definitely understand and respect the whole concept of the cancellation fee. It's just that this system has prevented that like we don't have have to worry about lost income for a lost appointment spot because I'm filling all the appointment spots.

Leah: Yeah, and I feel like for me having this kind of mindset of like in my gaps is where I'm going to fit my admin work And I sometimes need to block other time if I'm like, Whoa, this week is going to be crazy. I'm going to have to block time for my admin work. I feel like I'm also not losing money now. Like, because I'm not having to block time to do my admin work. If I have a gap, I know where I can do that work. You know, maybe one or two hours a week that I get that time kind of handed to me. Then I don't have to like block a complete. Another day where I would lose even more visit opportunities, you know? So for me, it kind of works out well. And I feel like. We get a fair amount of people that ask about cancellation fees. Like, do you guys have one? Like, when do we need to cancel? Sometimes it's because they have maybe looking for other options. Like, is there somebody that can see me sooner or something like that? We have a cancellation fee, but again we usually don't end up having to apply it because either they let us know in enough time and we've don't charge them or we're just like, okay, it's fine. I'm not. Like you, I'm just not going to chase that down and make a big deal out of it. But we've actually had other people who are like, I'm canceling. I'm so sorry. I realized that I'll have to pay the cancellation fee. If they say that, I'm like, okay, I'll take it. And I appreciate you being, like, understanding that it's your responsibility in pieces of this too. And then we also, like, if they are sick or their kids are sick or something like that, like, I don't charge a cancellation fee.

Annie: Yeah, we don't charge a cancellation fee.

Leah: Because I don't want to see you. No. But I don't want you to, like, push through and power through because you don't want to have to pay the fee. Absolutely not. Please just, like, be, by all means, I will take some time.

Annie: If you or anyone that you share space with is sick, please cancel. No fee. Don't, don't.

Leah: Because that's going to cost me so much more money. Like them being like, well, I don't want to have to pay the fee. So just go ahead and come. And then I'm going to be out like so much money. It's for me, it pays off to like, just be like, it's fine. And I don't think. We haven't had an experience where I feel like people are taking advantage of that. Like, Oh, I'm sick. I can't come to the appointment. You know, I mean, like people, I think in our line of work, like genuinely want the help. So I think we have less of a risk of people taking advantage of like, I'm sick, so I can't pay the cancellation fee, like don't charge. I don't think anybody's doing that. And again, even if they were, I'm like, okay, well, obviously this visit isn't needed for you. You know what I mean? So I'm like, yeah. Yeah, we don't, we don't really encounter any struggles around that either.

Annie: With this new system that we put into place, like, the primary goal was to get people confirmed ahead of, like, the cancellation window, is to be like, I actually don't want a last minute cancel, even if I were able to charge the card and like not have anything happen. And some of that I think is probably just my own fear because it happened, but it has happened. And I'm like, I just would rather mentally be like, okay, my appointments for Monday by Thursday afternoon, everyone has said they can come. And the people who can't come, I already know. And I'm not having to wait till Sunday afternoon to then deal with it. And then also feel like I do want to fill the spot. I do have a wait list. I feel like that has psychically worked so much better for me just to just to know that I have my appointments filled. And then I also when it does come to those cancellations, I do think for me that empty spot and feeling good about those empty times in my schedule is really taking like a zoomed out view of my. Appointments and like, how many have I done this month? Have I hit my quota for the month already? Oh, am I a little under what? Then I'm looking ahead at this. I was going to take leave early this date. Well, now I'm not going to, cause I'm going to make that up. But I do feel like when I look at the bigger picture, that also helps me not feel like every minute has to be a dollar.

Leah: Yes. Yeah. It does make a big difference. And I think, I feel like we need to keep. Addressing this because it's where this like little seeping in of stress. It's just kind of tacking away at our resilience, it's just like a little place It's not like big huge stress all the time But it's like this little place where it's just like ticking away At your resilience to like be able to come back from other bigger stressors in your life If you always have this like little Scheduling stress. That's always kind of flittering in the back of your mind. So I love the ideas that you've shared. Cause it's making me think of like, Hey, are there other things that we could be doing other strategies that we could address? Cause I do think it's just, it's an ongoing thing. It's never going to go away. You know, it's like, it's always going to be there. And I don't think there's any perfect system. And I feel like. Everybody has to probably have very unique system for their lifestyle and their work schedules and their other responsibilities and boundaries that they need to have. I don't think there's like any one perfect scheduling system out there for everyone. So I think it's like, I encourage everyone to keep. Kind of thinking about this and thinking, and I love that you came up with something really creative and new and unique, and then it's opened up the sense of lower stress and more freedom.

Annie: I have to give credit also to Kara who worked through me because Kara has amazing boundaries. She's got a great sense of like what feels fair and what feels right, and especially also in terms of the cancellation fee and and so she and I had a lot of conversations back and forth about how to really balance this idea of like how do we have scheduling policies that have grace built into them for the. What postpartum families are dealing with and so that we're not like, yeah, I mean, it's a big piece and just feeling like, like the scheduling process is part of them being taken care of by us, but also making sure that we are not just anything goes, you can treat us however you want, like, I don't like this is a business and we are trying to make money and we can't have policies that impact the bottom line of the business. So this system and we've been using it now for about six months was definitely came out of a conversation I was having with Kara, who she works the most for me. So I just really want to kind of like, just give appreciation to her for having such great ideas and being somebody I can bounce the stuff off of. And bringing her perspective. So I just really appreciate you, Kara, if you're listening,

Leah: I love it. I know. And I think that's another thing is like this chance to like bounce these ideas off of each other and like talk through this stuff is so valuable because there's a lot of creativity that you can tap into to try to make scheduling work for both. The families that we're serving, but then making sure that we're not just losing ourselves in this act of service and forgetting that we have our own needs and our own responsibilities and our own families that we need to care for. That has got to be a consideration when we're, when we're making our scheduling choices and things. And I will just say like for anybody who's starting out. It evolves too. You know, I feel like when you're starting out, you're just like, see everyone all the time. You need me to come at 9 p. m. I will be there at 9 p. m. You remember we've talked about that so many times or maybe you're like, I have a young family and I have to have really tight boundaries right now. Like I've got to go home and feed my own baby or something. And it's such an evolution. Like we've done countless number of strategies. So also like, don't get too locked into like, I found the perfect one, but for some reason it just doesn't feel right anymore. I'm like, it could be that it just needs to evolve for this stage of life you're in or your needs or your financial goals it can keep evolving. And I know mine will too. I know we'll keep evolving and probably admin Amanda will listen to this and be like, Okay, Leah, we're changing everything. I like Annie's stricter version of this. We're implementing this today. So that might happen. So hopefully she doesn't listen to this. No, I'm just kidding.

Annie: I'm sure if she does, she'll come up with a system that makes it really easy for you. The system queen.

Leah: Oh my gosh, like the system queen ever. And there will be a spreadsheet involved that I don't understand. But anyway, it's been so fun talking about this. It's a great way to start the year and just really remembering, like, that this is such a big part of our business, but it's also a big source of stress. And like, I'm so glad that we talked about this today, because I feel like there's definitely some ideas that I walked away with that I'm going to kind of make some shifts in, in what I'm doing as well.

Annie: It's always good to talk it through and also just hear how you're doing things. And like you were saying, they're just, there isn't one way, right way to do things when it comes to scheduling. It is so situational. So yeah, if you would like to continue the conversation about all things, private practice, our next deeper dive is coming up on January 27th. We are doing a deeper dive into queer families with Jacob Engelsman, IBCLC. We are really looking forward to this conversation. You can join, just come to the Deeper Dive or you can sign up for our Deeper Dive membership where it gets you access to all of our live Deeper Dives, plus our archive, which goes all the way back to January 2020, which was legit a million years ago.

Leah: Five years! Are you kidding me right now?

Annie: Crazy, I know. And we have not missed a month. So since then, anyway, we'd love to have you join us and we're planning out our 2025 schedule of deeper dives. We've got some exciting speakers lined up that we're getting ready to announce. So make sure you are subscribed to my mailing list. And if you're listening to the podcast and we just thank you so much for being out there and supporting us and supporting each other and supporting families and supporting your own families and reaching your goals and all the good things. I hope it all happens for you this year, 2025.

Leah: It's the year. So everyone take care and we'll look forward to seeing you again very soon.

Annie: See you soon.

Leah: Bye.