Understanding Trends in Chair Utilization and Underutilization as Graduation Approaches

There were a few examples of patients misusing the access they had to their students which resulted in security-related interventions. Students spent up to 4 hours per week communicating with patients which was a major administrative burden. We suspected that some students booked fewer patients at certain times of the year - for example, the days before and after holidays. An underutilization of clinical resources has implications for patient access and overall clinic efficiency [1]. In order to better understand the trends in booking patients, we studied appointment trends over multiple years. Our research protocol was reviewed by the University of Michigan Medical School's committee on human subjects research and the study was deemed “not regulated” (HUM00268105). We extracted data from the electronic health record for monthly fulfilled appointments in the predoctoral clinic from January to July. We did this for 10 consecutive years—from 2014 to 2025 and we found a decline that consistently began around the middle of February. However, we had new clinics (with different number of chairs) beginning in 2020. Therefore, we limited our analyses from 2020 to 2025. During the study period, Figure 1 shows the number of appointments consistently peaked in February and the average number of appointments was 2224.5. The lowest number of appointments in a month was consistently in April with an average of 1232.4 appointments. April's average number of appointments was only 55.4% of the February average which demonstrates underutilization and lost opportunities. What did not go well: In 2022, we used this data to educate our school community and encouraged better utilization of chairs to ensure access to care. However, there was no improvement in 2023 (Figure 2). What went well: In 2024, we assembled a diverse committee of students, staff, and faculty to resolve this problem. The committee helped to develop an operational model that included Schedulers. Previous research has shown that centralized scheduling enabled the booking of late cancelations and smoothed the variability that can arise [2]. On January 2, 2025, we moved to having Schedulers book predoctoral appointments. This system also increased transparency as students had to document absences—historically, students could simply not book a patient and be absent. With schedulers, we have already seen the most appointments booked for January−March during the period of the study. Students were less accessible to communicate outside the clinic setting—just like a dentist. The Scheduler system eliminated the time spent by students in calling patients. Every student now has more time each week to be able to focus on learning and resting which may help to prevent burnout [3]. By controlling scheduling, the Schedulers will help to smooth the variability of access for patients throughout the year and this is already beginning to occur in the first three months of the initiative.