Reducing Internally Generated Demand Through Scheduled Communication Time in a Remote Salaried Family Medicine Clinic
Bibliographic record
Abstract
BACKGROUND: In salaried primary care systems, internally generated demand, such as physician-initiated recalls, can limit timely access for other patients. OBJECTIVE: To evaluate whether reserving protected time for unscheduled physician phone calls decreases recall appointment volume. DESIGN: A quality improvement intervention with a before-and-after analysis. SETTING: A salaried family medicine clinic in northern Saskatchewan. PARTICIPANTS: All clinic patients recalled for visits between October 2024 and February 2025 (1005 recalls). INTERVENTION: A daily 30-min block was reserved in each physician's morning schedule for discretionary phone-based follow-up. MAIN MEASURES: Total number of recalls, recall reasons, and patient demographics before and after implementation. KEY RESULTS: 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. CONCLUSION: 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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.005 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".