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?

Panic.

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.