After a little over a year of not taking new patients, I opened my practice again on a wait-list basis last week. I sent the email and posted the blog at 8:00 AM. By 10:00 AM, 200 people had signed up for the wait list, and by the end of the week, that number had climbed to almost 600. I closed the wait list on Sunday evening.
As I explained in my previous post last week, I have a small private practice and only see patients for two days a week. In order to leave enough time in my schedule for follow-ups for existing patients, I can only see between 4–6 new patients a week. Given my other obligations (speaking at conferences, a book tour when my book is published, etc.) and vacation time the maximum number of new patients I can see in a year is about 200. This means I currently have 3 years worth of new patients on my wait list.
For the last few days I’ve been thinking a lot about how to address this dilemma. It’s clear that as a single, individual clinician I won’t be able to serve all of the people who wish to work with me. Over the long term, my plan is to create a clinician training program to train others in my approach. It would be mostly virtual, with perhaps one or two in-person retreats. I also intend to build a referral network of like-minded practitioners, perhaps organized by focus on specific health conditions. That way both my patients and I will be confident that they’ll get the kind of care they are seeking, even if they can’t see me individually. I’ve also been thinking of developing an advanced “health mastery course” for patients with guided, in-depth training on nutrition, lifestyle and supplementation, as well as modules self-care for specific health conditions like hypothyroidism, digestive problems, adrenal fatigue, skin disorders, etc. These would be similar in scope and format to the Healthy Baby Code and High Cholesterol Action Plan. I’m excited about these solutions, as I think they will both enable me to help an exponentially greater number of people than I can help working one-on-one in my private practice.
Unfortunately, these programs will take some time to develop. I can’t see either being available before 2015, and that’s assuming I’m able to start working on them relatively soon. This leaves me with the question of how to decide which patients on my wait list to extend an invitation to. It doesn’t seem fair to simply start at the top of the list and work down, because the amount of time that separates, say #1 from #80 on the wait list is literally a few minutes in terms of when they signed up. I considered a pre-screening process, but there are many problems with that idea. It’s not easy to discern who is in the greatest need of help from a simple questionnaire, and adding a competitive element didn’t feel right to me. It’s also adds an enormous amount of administrative work for my staff, which is already maxed out.
So, what I’ve decided upon for now is to use a lottery system. We’ve put all of the people on the wait list on a CSV file. We will use a random number generator to generate an out-of-sequence numbered list, and then cross-reference that with the CSV file to determine each person’s position on the wait list. When spots become available in my practice, my office manager will send an invitation (which include an Informed Consent and Patient Guide that must be signed electronically) via email. Prospective patients will have 3 days to accept the invitation. If they don’t respond, she’ll remove them from the wait list and move on to the next. I’m aware that this is an imperfect solution, but after agonizing over this for days and talking with several colleagues and advisors, I haven’t been able to come up with a better one.
Unfortunately, with my book coming out in December, the situation was likely to get much worse before it got better. This is why I decided to shut the wait list down, even though it was only open for about 6 days. I’m sorry if you missed the chance to join the wait list while it was open, but it just doesn’t make sense to continue adding people to it when there are already 3 years worth of new patients on the list.
In the meantime, if you’re looking for a clinician that is experienced with or at least endorses the Paleo diet, check out the Paleo Physician’s Network or Primal Docs. They’re both free directories with a listing of Paleo-oriented practitioners around the U.S.. I can’t vouch for individual clinicians on this list, but at least you’ll be starting from a shared awareness of Paleo nutrition and lifestyle.
NOTE: the lottery process has been updated above thanks to a suggestion from Alex in the comments section.