Enhancing Access in Academic Medical Centers Through Incentive-Based Evening and Weekend Clinics

Academic medical centers face mounting challenges in providing timely access to ambulatory care.

University of California (UC), Davis Health's innovative "Access Plus" program was a pilot program designed to expand ambulatory care hours into evenings and weekends while addressing physician work-life preferences.

Launched in January 2023, the program offered physicians the option to provide care during extended hours for enhanced compensation. The initiative specifically targeted new patient appointments and UC Davis Health employees and families, creating a strategic approach to enhance physician and employee support for the initiative, reducing median days to be seen while supporting workforce wellness.

Over 18 months, 138 physicians participated, out of 800 physicians with an ambulatory practice (17.3%), and the program served 4,312 patients, including 3,236 new patients, achieving a median 21-day reduction in wait times for new patients. While the direct program was essentially cost-neutral (negative contribution margin of <1%), the initiative generated substantial downstream revenue, resulting in a total contribution margin of $13.3 million.

The UC Davis Health experience demonstrates that academic health systems can successfully expand traditional operating hours through well-designed programs that balance physician preferences with organizational goals to meet patient needs. This approach not only improves patient access but also maintains physician acceptance and has paved the way for other health system initiatives to enhance ambulatory care delivery, leveraging physician workforce engagement.