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They didn’t believe man could fly, either.

Fam Pract Manag. 2004;11(5):17

Question: Dr. Smith’s patients can usually get in to see him for a routine appointment in about three weeks and for a physical in about three months. This is …

(a) A mark of Dr. Smith’s success and desirability.

(b) A nice cushion between him and the specter of unfilled appointment slots.

(c) A sign that Dr. Smith doesn’t “get it.”

I confess to being a little surprised, after all we’ve heard about open access and advanced access in the past few years, that choices a and b still sound reasonable to some physicians. But they may appeal to more than a few. At least that’s suggested by the report from Geisinger Health System in this issue (see page 35). Steven Pierdon, MD, and his coauthors list three major challenges faced by the team that implemented advanced access in the Geisinger network. “Perhaps the most fundamental of these challenges was getting physicians to accept the concept of advanced access,” the authors write. “Many of our physicians found it difficult to understand how access could be improved without increasing their workload. They struggled to understand how they could reduce the backlog in their practices and ever be able to see a patient for a routine check-up on the same day the patient calls.” This after several years of discussion of the topic in the literature and a growing number of success stories, including several that have appeared in Family Practice Management.

True, they haven’t all been success stories; some attempts to implement open access have failed completely. And true, open access is a bit counterintuitive. How can it be bad to know when you start the day that your schedule for the day is full and, even more, that it will still be full three weeks from now? Isn’t it better to have a winter’s worth of firewood before the cold hits than to cut a day’s worth of wood every day – assuming you can find it?

Success stories

I just want to point out that reports of good results are accumulating. Just look at the articles that have appeared recently in FPM:

In this issue’s article, Pierdon et al report that, over a two-year implementation period for open access, patient satisfaction scores rose by 48 percent, with the increase largely attributable to increased access. Moreover, physician productivity increased 8 percent from one year to the next.

Three issues back, in “The Outcomes of Open-Access Scheduling,” (February 2004, page 35), C. Dennis O’Hare, MD, MSc, and John Corlett, of Allina Medical Clinic in Minneapolis/St. Paul, reported on the extensive benefits they had achieved with open access.

Back in January 2003, John Giannone, MD, reported similarly positive results following the implementation of open access in his office (“Open Access as an Alternative to Patient Combat,” FPM, January 2003, page 65).

Open access deserves your careful attention, at least. It may be time to get past your skepticism and try it. If you want to know more, I recommend the articles I’ve listed above. More, I would direct your attention to the article by Mark Murray, MD, MPA, and Catherine Tantau, BSN, MPA, the gurus of advanced access, that appeared in FPM over three years ago: “Same-Day Appointments: Exploding the Access Paradigm” (September 2000, page 45).

Any questions?

If you are just now beginning to think seriously about open access, I’m sure you will have a number of questions despite the advice that is available so far in the literature. Perhaps we can help. If you like, e-mail me your questions about open access. My address is If we collect enough questions of general interest, we’ll assemble them, direct them to an expert in the field, and publish the answers in an upcoming issue of FPM.

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