How to run an OPD queue with two to four doctors One front desk, a line for each doctor, and written rules for the cases that cause arguments.

To run a multi-doctor OPD queue, keep one front desk and one shared patient record, but a separate line for each doctor: every token is tied to a named doctor when it is issued, the slip shows that doctor, and the desk can see all the lines at once. Then write down the rules for the cases that cause friction (walk-ins with no preference, follow-ups, a doctor running late, moving a patient from one doctor to another, priority) so that every receptionist answers them the same way.

This guide is for a clinic with two to four doctors sharing one reception. The general OPD flow is in OPD workflow, step by step, and the causes of long waits in reducing OPD waiting time. Here we stay on what changes when there is more than one doctor.

How should tokens be numbered when several doctors sit at once?

There are two workable schemes. Pick one, use it every day, and print it the same way on every slip and board.

Sample names only. Whichever you choose, the rule that matters is that the number tells the patient where she stands in her own doctor's line. A patient who cannot work that out comes to the counter to ask, and the counter is where the queue slows down.

Which doctor does a walk-in patient see?

Ask once, at registration, and write the answer on the token. Then apply a fixed order of rules:

1. The patient names a doctor: that doctor, even if another line is shorter. Tell her the honest wait.
2. A follow-up or a patient bringing reports: the doctor who saw her last, unless that doctor says otherwise. The shared record means the other doctor can see the history, but continuity is the default patients expect.
3. A specialty question (a child, a skin complaint) in a clinic where doctors have different specialties: the doctor the clinic has agreed handles it.
4. No preference: the doctor whose line will clear soonest, which is not always the shortest line. A doctor with six quick follow-ups may finish before one with three new patients.

The doctors should agree rules 2 to 4 among themselves and tell the desk. A receptionist deciding them on the spot, patient by patient, is how one doctor ends up with every new case.

How do you set each doctor's hours and load?

Give each doctor a written session: start time, end time, and roughly how many patients that session can hold based on the clinic's own register. Regulation 2.1.1 of the 2002 conduct regulations asks a doctor to "add to the comfort of the sick by making his visits at the hour indicated to the patients"; the board, the booking line and the token slip should all show the hour the doctor actually starts.

• Stagger start times if one desk serves all doctors. Two doctors starting at 10 AM means a double rush at the counter at 9:45.
• Mark a visiting consultant's days on the board and in the booking diary, and do not book patients for them on other days.
• Close each doctor's line for new walk-ins at a set time before the session ends, and tell late arrivals the option: the other doctor today, or a token for the next session.
• Put leave on the board the day it is known. A patient who comes for a doctor who is away is the hardest conversation at the desk.

What should the desk do when one doctor is late or absent?

Tell the waiting patients early, give them a real choice, and protect their place. A script the desk can use:

1. As soon as the delay is known, announce it to that doctor's line with the expected start time. Update it if it changes.
2. Offer each patient two options: wait, or move to another doctor today.
3. A patient who moves joins the other line by her original arrival time, not at the end. Otherwise moving is a penalty and nobody accepts.
4. Do not move follow-up patients without asking; many will prefer to wait for their own doctor.
5. If the other doctor's fee is different, say so before the move. Regulation 1.8 asks a doctor to "announce his fees before rendering service".
6. If the doctor will not come, offer the next session's token or a call-back, and note each patient's phone number so no one is forgotten.

How does a patient move from one doctor to another inside the clinic?

Through the desk, never by the patient walking from room to room. When one doctor asks a colleague to see a patient, the desk moves the token to the second doctor's line and tells the patient where she stands. Set a rule for where she goes in that line: most clinics put an in-clinic referral after the patient currently inside, since she has already waited once.

Agree the fee before it happens. Is the second consultation charged in full, at a reduced fee, or included? Write it on the rate board. And keep the money plain: regulation 6.4.1 of the 2002 regulations bars a doctor from any "gift, gratuity, commission or bonus" for referring a patient and from "splitting or refunding of any fee", while 6.4.2 allows "payment of salaries by a qualified physician to other duly qualified person rendering medical care under his supervision". How doctors share the clinic's income is a question for your CA and lawyer; how a visiting consultant is paid is covered in TDS when a clinic pays a visiting consultant.

Who gets priority, and across which queues?

Write a priority rule that all the doctors sign off, and apply it the same way in every line. Regulation 2.4 asks a doctor to "respond to any request for his assistance in an emergency", and 2.1.1 says that "in case of emergency a physician must treat the patient". An emergency goes to whichever doctor is free first, not to the end of the named doctor's line.

Beyond emergencies, decide who else moves up (for example, very elderly patients or a child with high fever, if the doctors agree) and put the rule on the board, so patients see a rule and not a favour. A relative of a staff member is not a priority category.

How should patients be called?

Call the token, the patient's name and the doctor's room, in that order, every time: "Token 23, Sunita, Room 2". With several doctors, the room number is what stops two patients standing up for the same call. Do not call out the complaint, the test or the diagnosis in the waiting area. Regulation 2.2 of the 2002 regulations says confidences entrusted by patients "should never be revealed" unless the law requires it, and regulation 7.14 bars disclosing a patient's secrets outside three narrow exceptions.

How many people does the desk need for two, three or four doctors?

Whatever the split, one person owns token issue at any moment. Two people issuing tokens from two registers is how two patients end up holding the same number.

How do per-doctor fees and the day close work?

Each doctor's fee is set and displayed; the payment goes into one drawer and one day book; the day closes with totals by doctor and by payment mode. Where the Clinical Establishments Act applies, rule 9(i) of the 2012 central rules asks the clinic to display "the rates charged for each type of service" in the local language and English, so put each doctor's consultation fee on the board by name. Each receipt carries the name and registration number of the doctor who saw the patient (regulation 1.4.1).

1. Bill each visit against the doctor who saw the patient, not the one she asked for at registration if that changed.
2. Record any waiver or reduced fee with the reason and who approved it.
3. At close, count the drawer, then match cash, UPI and card to the visit list.
4. Total patients and collections by doctor, and check the count of tokens issued against patients seen and patients who left without being seen, per doctor.
5. Have the owner or a named doctor sign the day's sheet.

The full closing routine is in closing the day across cash, UPI and card, and the reports an owner should read each evening are in daily reports for a clinic owner.

The rules to write down before the busy season

• Token numbering scheme, and how it is printed on the slip and the board.
• Each doctor's session times, last walk-in time, and visiting days.
• Where "any doctor" walk-ins, follow-ups and report visits go.
• What the desk says and offers when a doctor is late or absent.
• Where a moved or referred patient goes in the new line, and what she pays.
• The priority rule, signed by all the doctors.
• How patients are called: token, name, room; nothing clinical aloud.
• Who issues tokens at each hour, and who takes payments.
• Day close: totals by doctor and by mode, signed.