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The concept’s founder explains how to do “today’s work today” and improve patient access to your practice.

Fam Pract Manag. 2005;12(3):59-64

Same-day scheduling, also known as “advanced access” or “open access” scheduling, allows medical practices to dramatically decrease patients’ waiting times for appointments. Very simply, it requires that practices do today’s work today by offering a same-day appointment to all patients who call. The result is more timely care, increased patient satisfaction and improved practice efficiency.

While the concept has great potential and has garnered much interest, it is often misunderstood. The key mistake practices make is thinking of same-day scheduling as a ready-made product or a specific solution guaranteed to reduce a practice’s waiting time. In reality, there is no such product or solution; however, there is a proven process and a set of proven principles, which if applied in a customized fashion to each environment, will result in improved access to care. The course of action is similar to any quality-improvement process and involves four steps:

  • 1) Assemble a team to address the problem;

  • 2) Set an aim or a goal;

  • 3) Make changes;

  • 4) Measure to see whether your changes have resulted in an improvement.

The principles to apply throughout this process are fairly simple:

  • 1) Understand, measure and achieve a balance between supply and demand;

  • 2) Recalibrate the system (or reduce the backlog);

  • 3) Reduce the number of queues by reducing the variety of appointment types or lengths (queuing theory);

  • 4) Create contingency plans for times of heightened demand or lessened capacity;

  • 5) Influence the demand (e.g., by matching patients with their own physicians, making the most of current visits and rethinking return-visit intervals);

  • 6) Manage the constraints or bottlenecks (e.g., remove from the physicians any work that can be done by someone else).

Same-day scheduling, then, is really all about the process and the principles, not about a specific product or solution. It will require some thought, customization and experimentation to apply these principles to your specific environment. If you’re ready to embark on that, read on. What follows are commonly asked questions about open-access scheduling submitted by FPM’s readers.


  • Under advanced access, practices do “today’s work today” by offering a same-day visit to all patients requesting an appointment.

  • Advanced access is not a specific product or solution, but it involves a proven set of principles, which can be applied to individual practice environments.

  • To begin eliminating waits, practices must ensure that the physician’s supply of appointments is balanced with patient demand for appointments.

Getting started

An appropriate panel size

Standardized appointment lengths

The trouble with carve-outs

Reducing backlog

Scheduling patients in advance

Patient preference

Part-time physicians

Preparing for visits

Keep your appointment book

Going it alone

Dealing with vacations

A team approach

Ready, aim, fire

The secret to failure

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