EPtalk by Dr. Jayne 3/19/26

Mr. H asked earlier this week, “If medical practices really care about patient health and access, why are their offices closed 75% of the time?” Several readers added comments, so I thought I would share.

A member of our hospital medical staff wanted to experiment with evening hours for patients who couldn’t leave work during normal office hours. The plan was to staff the clinic from noon to 7 p.m. one day each week.

The first roadblock was the building management team. They were unwilling to leave the front doors of the medical office building open after its published 6 p.m. closing time. Concerns were also expressed about how the extended hours would negatively impact janitorial contracts.

The staff was split 50/50 about the idea. Those who didn’t have children at home were excited to have a morning free to run errands. Parents who had to arrange childcare noted a lack of flexibility with care providers and the extra charges assessed for extended care, even if children arrived later in the morning. Needless to say, the plan was dead on arrival.

In contrast, the majority of the local Direct Primary Care practices offer non-traditional hours, either scheduled or on demand. They are typically located in a freestanding building or a strip mall rather than a medical office building, which makes it easier for after-hours access.

They don’t bill insurance, so they have smaller staffs. They usually need just one person to support the physician who is seeing patients. Smaller patient panels allow the physicians to cover their own their own call  without an exchange or call group. They are more likely to be able to help patients resolve issues outside of traditional office hours.

The practice modality continues to grow in our area. Spending $70 per month to cover all your primary care needs starts to look like a great deal when you’re in a high-deductible health plan.

I worked in the emergency and urgent care space for a while. I have been surprised in recent years not only by how early some primary care offices close, but also by the difficulty in getting in contact with a physician once the phones switch into after-hours mode.

Back in the day, we had a Rolodex at the ED charge nurse desk that had so-called back-line telephone numbers. These bypassed voicemail at most of the local practices, which made it easy to reach people until about 5:30 p.m. Those cards also had the numbers for the exchange services that were used for after-hours calls. Sometimes they included the physician’s pager number, and when physicians received pages to call the ED, they typically did so promptly. There was a level of trust that we wouldn’t abuse the phone numbers, and in return, they would be accessible to us.

These compendia may not exist in the era of for-profit urgent care centers. Physicians end up asking staff to look up a provider on the web, call their office, and listen to the voicemail to get the exchange number.

Physicians may or may not respond to text messages. I used to deal with a couple of physicians who wouldn’t call back until they were texted three or four times. Sometimes that would occur after the patient had already left the building. If physicians won’t respond to other physicians who are calling about patients in an emergent or urgent situation, they probably won’t consider adding non-traditional office hours.

From Edward Louis: “Re: vendors behaving badly. This one should go in the hall of shame. Our organization started receiving responses back for a Request for Information (RFI) that we issued for a major operations refresh involving one of our largest business units. One of the vendors reached out to a current supplier to ask about integration with them for the conversion. If they’re willing to violate our non-disclosure agreement during the RFI process, they’re certainly not going to get our business.”

That’s not only an integrity issue. It also illustrates a lack of experience with that particular integration. I agree with excluding them, but I would also be breathing a sigh of relief at having dodged other potential issues.

An Associated Press article that hit the wires yesterday trended on Facebook after it was picked up by local news organizations across the country. Tallahassee Memorial Hospital has filed a lawsuit trying to evict a patient who refuses to leave the hospital even though she was discharged in October 2025. The article was light on the details given patient privacy concerns, which made people scratch their heads.

Unfortunately, this situation happens and usually involves medical complexity, lack of qualification for skilled nursing care, lack of family or friend caregivers, refusal to go to a nursing facility, or a combination of these.

I’ve seen pediatric patients who can’t go home due to living conditions, so they stay in the hospital until the case works its way through the family court system. One of my patients in residency had resided at the local hospital for 18 months. If you’re looking to see what’s in the medical literature on the topic, “nonmedical discharge barriers” as a keyword search will provide some interesting case studies.

Several people forwarded me an article about Pope Leo’s comments that access to healthcare is a “moral imperative” and that nations should provide universal healthcare. The speech was given at a conference that was organized by both religious and healthcare groups.

The Pope commented on the release of the second “World Health Organization European Health Equity Status Report,” His speech included comments on the need to address mental health issues, specifically for the young. I don’t think we will see universal healthcare in the US any time soon, but calls for it certainly aren’t going away.

This Friday is Match Day, when most US medical school seniors learn where they will spend the next several years completing residency training. Unfortunately, the number of graduating seniors and recently-graduated physicians exceeds the available training spots. Competition for the most lucrative specialties is always fierce.

Students found out Monday if they matched. Those who didn’t can enter a secondary pathway to try to obtain a position at a program that might have unfilled spots. Back in my day, it was called the Scramble. People literally got on the phone and called across the US to see what was open. Now the process is slightly more humane.

If you have people in your life who are part of the process, be kind to them this week. Many lives will be altered on Friday. The Match and its aftermath are ridiculously stressful.

If you are a physician, what’s your Match Day memory, good or bad? Leave a comment or email me.

Email Dr. Jayne.