The Access Paradox: Why Making Patients Prove They Deserve Your Time Destroys Your Practice

On removing the barriers we've unintentionally created between patients and the care they need

I discovered we were making patients prove they deserved our time rather than proving we deserved their trust.

This realization came during a routine practice review when I traced the journey of a patient who needed an urgent consultation. She called on Monday morning with significant pain. She finally saw us on Thursday afternoon—three days later.

Not because we were fully booked. Not because her case was complex. But because our "efficient" system required her to:

• Call her dentist for a referral
• Wait for her dentist to send imaging
• Have our team review the imaging before scheduling
• Call back to confirm insurance information
• Wait for us to verify her coverage

Each step seemed reasonable in isolation. Together, they created an nearly insurmountable barrier between a patient in pain and the care she needed.

I would be lying if I didn't admit that recognizing this pattern fundamentally changed how I think about practice operations. We had spent years optimizing our processes for our convenience while unconsciously creating obstacles that prevented patients from accessing our expertise.

The Privilege We've Forgotten

As surgeons, we possess specialized knowledge and skills that can transform patients' lives. We relieve pain, restore function, and improve quality of life through interventions most healthcare providers can't perform.

This expertise is a privilege that comes with responsibility—the responsibility to make our care accessible to those who need it.

Yet too often, our systems reflect the opposite mindset. We create processes that work for us, expecting patients to navigate complex requirements, insurance procedures, and administrative hurdles. We operate from a position of scarcity, protecting our time and convenience, rather than abundance, focusing on how we can serve more effectively.

When someone needs oral surgery, they're often experiencing pain, anxiety, and uncertainty. They're placing their trust in our expertise during a vulnerable time. The fact that they choose our practice among all available options is a privilege we should never take for granted.

The Control Trap

As surgeons, we naturally seek to control variables that affect our efficiency and outcomes. We create protocols, establish prerequisites, and build safeguards to ensure optimal conditions for our work.

This instinct serves us brilliantly in the operating room.

But it can inadvertently create devastating barriers to patient access in our scheduling systems.

The challenge is finding the balance between reasonable preparation and unnecessary obstacles.

Consider these common scenarios where our desire for control limits access:

Imaging Requirements

"We need a current panoramic X-ray before we can schedule a consultation."

Seems efficient. Means patients must visit their dentist first, wait for images to be taken and forwarded, then wait again for our scheduling team to review them. A patient with urgent need might wait weeks when we could obtain necessary imaging during the consultation visit.

Referral Prerequisites

"We only see patients with written referrals from their dentist."

Protects our schedule from inappropriate referrals. Prevents direct patient access in emergency situations or when their dentist is unavailable.

Insurance Pre-Authorization

"We must have insurance authorization before scheduling surgery."

Prevents financial surprises. Delays urgent care by weeks when we could schedule the patient promptly and work on authorization simultaneously.

Complete Medical History

"We need all medical records before the consultation."

Ideal for preparation. Often delays scheduling while we wait for records from multiple providers when we could conduct an effective consultation with available information and request additional records as needed.

Every requirement we add is a potential barrier that might prevent a patient from accessing needed care.

The Controlled Flexibility Solution

The most accessible practices have learned to embrace what I call "controlled flexibility"—accepting certain unknowns while maintaining clinical excellence.

This requires a fundamental shift: instead of requiring perfect information before we act, we become skilled at managing uncertainty once patients are in our care.

One of our partner practices made this transformation dramatically:

Before:

• Required comprehensive imaging, complete medical histories, and insurance pre-authorization before scheduling any consultations
• Average time from patient inquiry to consultation: 3.2 weeks
• Surgeons felt "in control" but schedule utilization was suboptimal

After implementing controlled flexibility:

• Immediate consultation scheduling: Consultations within 1-2 days for urgent cases, gathering necessary information during the visit
• Imaging flexibility: Taking necessary X-rays during consultation rather than requiring pre-existing images
• Medical history management: Scheduling with basic health screening, obtaining detailed histories during consultation
• Insurance parallel processing: Working on authorization while patient is being scheduled, not before

Results:

• Time to consultation: Days instead of weeks
• New patient volume: Significant increase
• Patient satisfaction: Dramatically improved
• Clinical outcomes: Remained excellent because they developed systems to handle uncertainty effectively

The Real-World Impact: Clinical Access Transformation

Dr. Jones' practice initially believed their growth bottleneck was limited patient demand. Early efforts focused heavily on marketing.

The diagnosis was wrong.

Deeper analysis revealed that access—not demand—was the true constraint.

The Three-Part Solution:

1. Opening the Schedule Expanded scheduling capacity by adding additional columns and dedicated spaces for emergencies and same-day local patients. This new availability quickly became known in the community, and referring offices began sending more urgent cases.

2. Addressing Financial Barriers Analysis showed one of the top three reasons patients didn't book was price sensitivity. Introduced two additional financing options, resulting in higher patient conversion and reduced scheduling friction.

3. Closing the Phone Gap Phone AI revealed 25% of calls were being missed. Added part-time team member focusing exclusively on call management and patient follow-ups. Implemented additional AI phone agents to capture overflow calls and launched online booking for patient flexibility.

The Results:

• 30% increase in visits per doctor day
• 18% increase in collections
• Clear demonstration that improving patient access drives meaningful growth

What Patients Actually Want

We surveyed patients about their preferences regarding access versus preparation. The results surprised many surgeons.

Overwhelmingly, patients preferred:

• Quick access with potential for follow-up visits over delayed access with complete preparation
• Taking necessary X-rays during consultation rather than waiting for referral images
• Discussing insurance coverage during the visit rather than waiting for pre-authorization
• Scheduling surgery tentatively while working out final details rather than waiting for complete medical clearance

Patients are willing to accept some uncertainty in exchange for prompt access to care.

When someone has dental pain or needs emergency extraction, they prefer to see you quickly and work through any complications rather than wait weeks for "perfect" preparation.

The Access Audit Challenge

Before you can improve patient access, you must understand what patients actually encounter when they try to reach you.

Call your practice as if you were a nervous patient needing a consultation. Ask yourself:

The Phone Experience:

• How many rings before someone answers?
• Are callers placed on hold immediately?
• How many transfers are required to schedule an appointment?
• What happens when they call after hours?
• How knowledgeable is the person answering?

The Information Journey:

• How easily can patients find your contact information online?
• Is your website mobile-friendly?
• Are your services explained in patient-friendly language?
• Are directions to your office clear and current?

The Scheduling Process:

• How far out is your next available new patient appointment?
• What information do you require before scheduling?
• How many steps are involved in getting an appointment confirmed?
• How do you handle urgent or emergency situations?

The Ripple Effect

When we remove barriers to patient access, benefits extend far beyond convenience:

For Patients:

• Reduced anxiety about seeking specialty care
• Faster access to needed treatment
• Greater confidence in the practice's commitment to their care
• Improved outcomes through earlier intervention

For Referring Doctors:

• Easier referral process increases likelihood of continued referrals
• Faster patient access improves referring doctor satisfaction
• Positive patient feedback strengthens referral relationships
• Enhanced reputation in the referring community

For Your Practice:

• Increased new patient volume
• Higher patient satisfaction scores
• Improved team morale from positive patient interactions
• Enhanced reputation and word-of-mouth referrals
• Better financial performance through increased access

Building Systems for Uncertainty

Success with controlled flexibility requires developing systems to handle uncertainty effectively:

Clinical Protocols: Establish clear guidelines for what information is truly essential versus merely preferred. Create decision trees for managing common uncertainty scenarios.

Efficient Consultation Design: Structure consultation visits to gather necessary information, perform clinical assessments, and develop treatment plans in a single visit when possible.

Same-Day Flexibility: Reserve capacity for urgent cases and develop systems to accommodate same-day consultations when needed.

Team Training: Ensure your team understands which cases require immediate access versus those that can be scheduled routinely.

Risk Management: Develop protocols for identifying and managing cases where incomplete information might pose clinical risks.

The Advanced Clinical Skill

This approach requires developing what are actually advanced clinical skills:

Efficient information gathering during consultation visits rather than requiring everything in advance

Adaptive treatment planning with incomplete information that gets refined as additional data becomes available

Risk stratification to quickly identify which cases require additional information versus which can proceed with standard protocols

Team coordination to support flexible scheduling while maintaining appropriate clinical safeguards

These skills enhance rather than compromise our expertise. The ability to make sound clinical decisions with incomplete information and adapt as circumstances evolve is the hallmark of experienced clinical judgment.

The Service Privilege

Every barrier we remove, every process we simplify, every interaction we improve is an opportunity to honor the privilege of our expertise.

When we make it easier for patients to access our care, we're not just improving customer service—we're fulfilling our fundamental obligation as healers.

The question isn't whether you have the right to protect your schedule and establish requirements. You absolutely do.

The question is whether those requirements serve patient care or simply serve your convenience.

What would change in your practice if you shifted from making patients prove they deserve your time to proving you deserve their trust?

Dr. Josh Everts bridges the operating room and the boardroom as Chief Clinical Officer of OMS360. He believes the best business leaders think like experienced physicians: diagnosing carefully, adapting continuously, and maintaining humility about complexity while projecting confidence in their decisions.