It's the last working day of the month. The visiting orthopaedic surgeon, who comes Tuesdays and Fridays, is sitting across your desk with a photo of his own notebook on his phone. His count of patients seen doesn't match yours. Your cash book has one total, the receptionist's token register has another, and nobody can say whether the three plaster applications last Friday were billed under his name or the GP's. The conversation is polite. It is also the third month running you've had it.
Polyclinic management looks like a scheduling problem from the outside. Inside, it's an attribution problem. Who used which room, who saw which patient, and which bill line belongs to which doctor all have to be settled before the money can be split. If the answers are written down at month end, from memory, they will be disputed.
Why the numbers drift apart
A polyclinic with visiting specialists usually keeps three separate records without meaning to. The room diary says who is meant to be in room 2 on Thursday morning. The token register says who actually walked in and which doctor called them. The billing book or cash drawer says what was collected. Each is kept by a different person at a different moment, and none of them is built to answer the question the specialist cares about: what did I earn this month?
The drift comes from ordinary days. The dermatologist runs late, so the GP takes overflow patients in her room for forty minutes. A specialist's patient comes back for a dressing on a day he isn't in, and the GP does it. A child's review is waved through free because the guardian says the doctor told them to come back. A bill is paid half now, half next week. A medicine is dispensed from your shelf on the specialist's prescription. Every one of these is a small judgement call made at the reception counter, and none of them is written against a doctor's name.
Then there's the agreement itself. Fee-share arrangements are usually agreed in a single sentence over tea, something like 'a fixed share of consults to you, the rest to the clinic'. That sentence says nothing about procedures, lab samples drawn in your clinic, medicines, discounts, free reviews or unpaid bills. Month end is where those gaps get argued.
A worked example of one specialist's month
For example, take a three-doctor family clinic with two GPs and a visiting orthopaedic surgeon on Tuesdays and Fridays. In this example the agreement is a 70:30 split on consultation fees in the specialist's favour, at a consultation fee of ₹800. In this example he sees 80 patients across eight sessions, so the consult pool is ₹64,000 and his share is ₹44,800 on paper.
Now add the edges. Suppose six of those 80 were free reviews within his stated window, and in this example nobody wrote them down as reviews, so they sit in the token register but not in billing. Suppose four procedures were done in his sessions and the agreement never said how procedures split. Suppose three bills, worth ₹2,400 in this example, were part-paid at month end. Each item is small. Together they decide whether the statement you hand him matches his notebook, and whether next month starts with trust or with another photo on a phone.
The fix isn't better arithmetic at month end. It's deciding each of these cases in advance and recording the doctor against every line on the day it happens.
The fee-share table: decide every line type once
Replace the one-sentence agreement with a short table that both sides sign. One row per line type, one column for who earns it, one for the split, one for notes. A useful set of rows:
- Consultation by the specialist in their session: the agreed split.
- Review visit within the specialist's free window: no fee, but recorded against them so the patient count matches.
- Procedure done by the specialist: a separate split, or a fixed amount per procedure, written down.
- Procedure done by a GP on a specialist's patient on a non-specialist day: clinic's, unless agreed otherwise.
- Lab samples drawn in your clinic and sent out: who earns any margin, if anyone.
- Medicines dispensed from your shelf on the specialist's prescription: clinic's, by default in many arrangements, but say so.
- Discounts: who absorbs them, and who is allowed to give them.
- Unpaid or part-paid bills: does the split follow money collected or money billed?
The last row matters more than it looks. Splitting on collected money is fairer to the clinic; splitting on billed money is simpler for the specialist. Either works if it's written. How the specialist's share is paid, invoiced and treated for tax is a separate question: confirm the arrangement with your CA before the first payout, not after.
Scheduling shared rooms
Rooms cause the daily friction; the fee split causes the monthly one. A few rules settle most of it:
- Keep a weekly room grid, rooms down the side, half-day sessions across the top, printed and pinned at reception and shared on the staff WhatsApp group. Fill specialist sessions first because they're fixed; GPs flex around them.
- Confirm visiting sessions the day before. The receptionist sends the specialist a one-line message with the number of booked patients. A cancelled session discovered at 10 am means a waiting room of people who came for him.
- Write the overflow rule. If a specialist is late by more than an agreed time, can a GP use the room? Who moves when the specialist arrives? Decide once.
- Book specialist patients by appointment, GP patients by token if that suits your flow. Mixing a fixed-day appointment list with a walk-in token queue is its own discipline; we cover it in token versus appointment queues.
- Leave a turnover gap between a procedure session and the next consult session in the same room. Ten minutes of cleaning written into the grid is better than a specialist waiting in the corridor.
Recording the doctor on the day
The single habit that ends month-end arguments: every token, every bill and every bill line carries a doctor's name when it's created. Not at month end, not when someone has a quiet afternoon. At the counter, before the patient leaves.
On paper, that means a doctor column in the token register and a doctor code on every bill. Free reviews still get a bill with zero amount and the word 'review', so they show up in the count. Part-paid bills get a balance column. At the daily close, the receptionist counts tokens per doctor and bills per doctor; if they don't match, the gap is chased that evening while everyone still remembers who saw the patient.
Software helps here mainly by making the record a single one instead of three. MyCliniCore keeps appointments with GP types such as consultation, follow-up, procedure and health check, the consult note, the prescription PDF that prints the doctor's registration number and qualification, and a GST-aware invoice against the same patient record, so the question 'who saw this patient and what was billed' has one place to look. The fee-share table is still yours to write; no system decides your agreement for you. You can see the rest on the features page.
The month-end statement
Give each visiting doctor the same statement on the same date every month. A simple layout: sessions attended, patients seen split into consults and reviews, procedures, amounts billed, amounts collected, outstanding balances, the share by line type from the signed table, and the total payable. Send it a few days before payout and allow a short window for queries. A specialist who can check your sheet against their own notebook, line by line, stops keeping the notebook after a few months.
Keep the statements. When an agreement is renegotiated, a year of per-doctor sheets is the only honest basis for the conversation.
If you run a polyclinic or a family clinic with visiting specialists and want to see how this would look in your own setup, MyCliniCore is now available for general practices and polyclinics, and the team sets it up with you. Tell us about your clinic.