Is there a downside to open access scheduling?

The term “open access” in the context of primary care means that patients are able to get an appointment whenever they wish.

The ultimate in open access is 24/7 availability. No, I don’t offer this, although I come pretty close. I’m available by cell phone virtually 24/7 and I’m also almost always willing to come in and see someone if they really need to be seen. This seldom happens. Most of the problems that arise after office hours are acute enough to require a higher level of care than I can provide in the office; hence, I recommend evaluation in the ED.

Most other issues can wait until the office is open. For things like colds, flu, and other self-limiting conditions, patients are often satisfied with advice over the phone. Still, I am always willing to meet them at the office for ear infections, UTIs, and the like. No muss, no fuss, and boy are they grateful.

Over my 20+ years in practice, I’ve done a fairly decent job of training my patients to call during regular hours for things like refills of ongoing prescriptions. They’re usually due for an office visit, though, as that’s how I’ve set up my refill policy (once or twice a year for hypertensives, two to four times a year for diabetics depending on their numbers) and I let patients know this. Therefore a refill request also means making an appointment. All of this is a piece of cake with my electronic medical record. I can log on from home or anywhere else and crank out those refills with three clicks. I can also tab over to the schedule and make an appointment for them.

The primary focus of open access is on offering same day, next day, or short term appointments to anyone who wants them. When doctors first contemplate the concept, they freak out: essentially, it means seeing all the add-on patients who call in addition to those on their already full schedule. The best way to start is by not filling up the schedule in the first place. Most offices do this anyway, intentionally leaving room for those add-ons. The trick is to leave more and more space for them until you’ve caught up with your already-scheduled appointments.

Open access in its purest form means not having any appointments scheduled in advance. This doesn’t really work, as many people like to schedule their followup appointments at the end of their visits. Once you’ve gotten to full implementation, it’s not really a problem. Three months out, the schedule is usually completely blank. Even a few weeks tends to be quite open.

So here we are. We’ve worked down the backlog. We are an office with full open access. You call, we offer an appointment whenever you want. Today, tomorrow, no problem.

Here’s the problem: what happens when the phone doesn’t ring?

First we agonize. What are we doing wrong? Why aren’t people calling? Is the practice going to go bankrupt? Why aren’t they calling? Is it Obamacare?

It helps to flip back to the same month last year and see almost exactly the same numbers for visits, charges, and collections. It tends to be cyclical, but it’s still scary.

And yet we sit. Twiddling our thumbs. Consider getting into marketing.

What do we do when the phone doesn’t ring?


Or not.

The phone always starts ringing again. Once the weather warms up (cools down/dries up). It will pick up again.

It always has.

Lucy Hornstein is a family physician who blogs at Musings of a Dinosaur, and is the author of Declarations of a Dinosaur: 10 Laws I’ve Learned as a Family Doctor.

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    We have been open access at my clinic from day one. Schedule starts out with zero every day and fills up to at least 30 by the end of the day. Never an issue. Works great. Just be ready to do some old fashioned work and customer service – and don’t turn anyone away.

    • southerndoc1

      You don’t schedule any follow-ups for diabetics, depressives, serious acute illnesses?

      • NPPCP

        Hi sotherndoc, Follow up is a loose term. Diabetics know the intervals at which they must follow up and why. And I tell them “if your rx is about to run out, it means you need to come in.” I tell them you need to see me in about 6 months. They just show up. Serious illnesses follow up the next day, or that week, or whenever I need them to. We tell them “come in tomorrow morning” or “you will be doing this or that, come in after that”. They just show up as I requested. Chronic serious things that could turn bad (depression and such) – same story. We are sending you for counseling or starting this medication or doing that – you need to follow up in 2 weeks (two Fridays from now). They just show up. It is a wonderful system. And they almost always show up.

        • Dr. Drake Ramoray

          I have thought about this method a lot, and it remains one of my open questions in my possible concierge model. I am happy to see it being successful for someone.

        • DinoDocLucy

          Actually, the Neurology department at CHOP used to have that very policy (no appointments more than 2 weeks out) and they just switched back. Apparently it was extremely unpopular.

    • DinoDocLucy

      RIght. Bring in everyone who calls with a little cough and runny nose for two days just to fill up the schedule. Never mind that they don’t really need to be seen, just reassured and given a little advice over the phone.

      I’m glad your phone is ringing at least 30 times a day (for one doctor??) In my solo office, I’d be happy with 15-20 of them. I’m talking about the deafening silence of a non-ringing phone.

      • NPPCP

        They don’t call Lucy. They just show up. I don’t tell anyone to come in. I’d love 15-20 a day. In today’s environment you can’t even break even with that. :/

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