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July 16, 2003

Advanced-Access Scheduling in Primary Care—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(3):333. doi:10.1001/jama.290.3.333

In Reply: Dr Shuster's skepticism about advanced access is easy to understand and is a familiar first reaction to the apparently implausible aim of offering patients the care they want exactly when they want it. His critique, however, misrepresents of the basic approach.

Advanced access has the fundamental goal of trying to balance supply and demand. As Shuster notes, demand and supply are quite variable, but much of that variation is predictable. We usually find that there is far more supply than demand in most health care settings; it is only the faulty scheduling systems that create an illusion that supply is inadequate. Practices that fail to use prediction feel continually surprised and stressed. Proper scheduling systems, balancing supply and demand, bring delays to a minimum, allowing patients many more options for scheduling exactly the appointment that meets their needs, an option they do not have when schedules are filled far out into the future. We believe, perhaps disagreeing with Shuster, that the right time for a patient, in the final analysis, should be the patient's choice.