For those of us who have very busy practices, how we deal with same day call-ins and open access can make or break the practice we have worked so hard to create. When I opened my solo private practice in late 2003, I was able to quickly build a very solid base of patients. Of course starting a practice in my hometown was the key to my quick success, however a little over one year into my practice, I found that it was very difficult to see my regular patients in follow up, add new patients to the panel, and provide open access for same day call-in service simultaneously.

I added a nurse practitioner to my practice 17 months after I opened my doors. The nurse practitioner I chose already had a solid patient panel in her previous practice and a large percentage of her patients chose to follow her to my practice. Even though it was a difficult decision to make, I never did regret adding a midlevel provider to my practice. I was able to continue seeing my routine patients and provide timely follow up for their problems and the nurse practitioner was able to provide service to her prior patients and see the same day call-in patients for acute care. The patients coming to see the midlevel provider enjoy the ability to have a consult with me if the need arises during their visit.

This routine worked well for about three years. Not only was I able to comfortably continue to provide non-pressured care for my existing patient panel, but was also able to see new patients at a rate of about one to two additions per day. Surveys for patient satisfaction were at an all time high and the word of mouth advertising quickly spread throughout our community. It was not long before I found my practice bursting at the seams again and also found that the availability of same day call-in slots was starting to become something of a premium.

Just a little after four years following the addition of my first midlevel provider brought with it a very difficult decision. Should I close my practice to new patients or continue to strive to provide access for new additions? It was a very difficult decision to make, but after a great deal of prayer and planning, I chose to add a second nurse practitioner. The addition of my second midlevel provider not only allowed me to continue providing access for routine primary care follow up, but it also allowed me to continue to provide access for new additions to our practice at the rate of one to two new patient visits per day.

It is now almost two years since the addition of my second midlevel provider and surveys in our office still show that patient satisfaction is higher than ever. Although I am able to continue to add new patients to my existing panel, the rate has now peaked and I am able to add about one new patient every one or two days. My patients have no problem with seeing midlevel providers because the service they receive is perceived by them to be higher than what they would normally expect to see in our hospital's emergency department or any of the local acute care facilities. A review of my schedule during any routine day finds that my appointment slots are filled at a rate of 95 to 98 percent and both midlevels I have are seeing about 90 to 92 percent of their capacities. Even though my practice continues to thrive, I will add a second physician before bringing in another midlevel provider. I am presently on track to add a second physician later this year.

Although it can be a difficult decision to make for most physicians in primary care, the choice to use midlevel providers to provide open access for same day call-in visits can bring a high level of patient satisfaction to the practice. It is important to remember that when adding a midlevel provider to your practice that you have a very rigid protocol in place for the midlevel to follow so that the care that is provided can be easily supervised and monitored by the physician(s).
I have never looked back after adding my two midlevel providers and would recommend this to any of my physician colleagues finding themselves under the constant pressure of searching for the ultimate balance between providing timely follow up and at the same time allowing for open access for acute care visits.