I am getting the impression while reading this article that the author has a somewhat simplified idea of how a medical office functions. Patients do not queue up for doctor visits the way one queues up for concert tickets or roller coaster rides. The vast majority of patients schedule appointments several days or even weeks in advance to accomodate their own busy schedules. They know that they have time on Thursday afternoons to see the doctor and they make an appointment accordingly. A smart patient does not call on Thursday morning to get seen the same day because they run the risk of there not being an opening and having to reschedule on a workday.

I think that the real reason waits in physician offices can be quite long is that it is often very difficult to predict how long a particular patient's visit will last and the schedule will be pushed back accordingly. A patient who comes in with an "ear infection" may take five minutes, twenty minutes, or even hours of attention. The patients scheduled afterward are going to be delayed. Also, a fair number of patient arrive late and are still accomodated. Open access scheduling will do nothing for that.

The person calling on Thursday wishing to be seen that day may be just as smart as all of the other patients; he may have taken quite ill overnight, and may be in need of urgent care.

While there are appointments that patients can schedule weeks in advance for convenience, they are the rarity in my experience as a patient. I recently needed to see a dermatologist, and it was necessary due to the nature of the condition to see one quickly. I found a practice with a large number of offices, and I made it clear I would gladly travel to all but one of them (an hour's drive was my limit). They accommodated me, and I was very pleased with the physician and his staff-he really listened, and gave me recommendations for treatment. I have since pointed three people toward this doctor.

On the other hand, my rheumatologist seems to feel that his patients have lots of time to spare. He has very limited office hours, and I have yet to see him within 45 minutes of my scheduled time. One hour-and-a-half wait almost sent me over the edge, as it interfered with my job. I tried all the tricks-first appointment, different days- it's always the same. So, while I like this doctor, I'm looking for a new one.

My primary care doctor's practice has a combined access schedule. Each day there are doctors who exclusively see walk-ins. The other practitioners see the scheduled patients, and they don't have to worry about keeping time open on their schedules for emergency patients. A scheduled appointment may take longer than anticipated, but the wait times are still kept to a minimum. Walk-ins are accepted from 8am to 11 pm (with one hour shift change/dinner break at 4) M-F, and from 3-11 pm on Saturday and Sunday. When I go as a walk-in, I know I may have to wait, especially if there's something going around. I'm just grateful for the availability, and I have liked all of the practitioners that have joined this group. Obviously, this won't work for a doctor who is not part of a large group, but it is a good option for a large general practice.

Like most patients, I schedule my appointments weeks or months in advance. This isn't because I want to; it's because my primary care doctor's office schedules me as I check out. I have no idea what my commitments will be on a given day six weeks or months from now, so I take whatever they give me, and usually have to reschedule. Sometimes I cancel at the last minute, because it's pretty easy to lose an appointment card. Yes, I write the appointments in my planner, but some appointments are so far off I don't even have a planner for that month yet. The only reminder is a call the day before my appointment, usually with a message left on my machine.

My vet has a much better method for routine visits. He sends me a postcard a couple of weeks before one of my cats is due for an exam, telling me the date of the last visit and what needs to be done. Two weeks is a reasonable window for both of us; I usually get a choice of dates and times.

If doctors wouldn't try to schedule appointments so far ahead that most normal people have no idea what they'll be doing that day, let alone at that hour, they could save a bundle on the office staff they pay for telephone reminders and rescheduling. Don't fool yourself that your patients want the advance scheduling; they're just too resigned to the system to complain.