Do you have too many patients in your practice? Too few? Unless you're near one extreme or the other – say, just building a new practice or so overwhelmed with work that you're considering closing your practice to new patients – you may not think about it or even know how to think about it. And chances are good you don't know how many patients you have anyway.

That doesn't mean the answer is not important, though, wherever you are in the life cycle of your practice. Too few patients and you'll be bored or, very likely, out of business. Too many and you'll exhaust yourself trying to care for them or be unable to see them when they need you, thereby reducing quality of care, continuity of care and patient satisfaction. Surely, somewhere in the middle, the right number lies.

It does seem reasonable that there's an optimal size for your practice, or your “patient panel.” It would be the largest number of patients you can take good care of in the time you have available and with the resources you have available. The number may differ from physician to physician. Even within one physician's practice, it may vary over time, for example, with the aging of the practice. Still, your ideal panel size is likely to change gradually enough that you can use it for planning purposes.

You can use it, that is, if you can figure out what the number is and how many patients you actually have in your practice. The first seems tricky, and the second, at least outside of a closed-panel HMO, seems almost impossible.

In this issue, Mark Murray, MD, MPA, well-known as an expert in advanced access, provides a remarkably practical way of determining both how many patients you really have and how many you should have. And while the answers are prerequisites to establishing open access, they're also important to improvement in any practice. Murray's article is ground-breaking in the way it combines a clear outline of how to think about panel size with a clearly delineated process for determining your current effective panel size. Applying his advice in your practice can benefit you and your patients both.