To the Editor:

We, too, have made the switch to open access at our rural clinic in eastern Kentucky with surprisingly similar results to Dr. John Giannone’s [“Open Access as an Alternative to Patient Combat,” January 2003, page 65]. We have seen provider productivity increase as patient satisfaction has increased. Providers and staff like the system, and staff retention has improved. They no longer have to tell parents all day long that we cannot see their sick child. Our system works in an office with busy obstetric care and pediatric care components.

As our patients’ out-of-pocket costs and time constraints increase, they almost universally welcome the offer to be seen the same day they call. With open access I am never overbooked and have more time to spend with my patients, a system change that improves face-to-face time!

I feel the key has been to constantly tweak the schedule as we learn about the system. My telephone nurse and I talk several times a week to review future schedules and make adjustments based on historical data from the last 18 months. That is critical.