Patient-Controlled use of Non-Physician Providers : Appointment Scheduling in Mixed-Provider Settings

The aging population and increasing chronic disease load are rapidly changing the face of primary care delivery, with mid-level (e.g., nurse) practitioners providing growing proportion of patient care. Potential differences in the quality of care offered by physicians and nurse practitioners may affect patient preferences, thus leading to patient choice behavior. This paper focuses on the problem of appointment scheduling for the physician--nurse teams in the presence of patient choice and no-shows. We propose a novel model that accounts for decision-making by patients in a system with two provider types. We prove that the presence of patient choice, in general, breaks down the multimodularity of a medical practice's cost function, creating challenges for the numerical identification of optimal appointment schedules. At the same time, we derive sufficient conditions under which the multimodularity is restored. To counter the computational challenges arising in the general setting, we propose an easy-to-implement heuristic and prove its optimality in the absence of patient no-shows. Our numerical study shows how the ratio of qualities of care delivered by nurses and physicians affects the profitability of the medical practice, enabling the analysis of the trade-offs involved in hiring a nurse practitioner