Just See More Patients: The Efficiency Fallacy

By a Physician Access Leader

The story I’d like to share with you today comes from a place of deep reflection on my experience with a health system struggling to solve its persistent access challenges. When I was hired as the system’s first ambulatory physician leader, I dreamed of finally making the changes I’d been imagining for so many years as a physician. I envisioned a role centered around making an impact with tact and empathy - delivering genuine clinical quality, providing patient safety, and optimizing the ambulatory operation for the first time. 

I quickly learned that my job description looked a lot simpler than I had expected. In fact, my leadership’s primary expectation could be summed up with four words. 

“Just see more patients.” 

There is nothing unreasonable about this request. After all, what good is the highest quality care if a great number of patients can’t access it? 

What struck me as odd was the finality of their demand, as though “just see more patients” were as simple as that. No matter what changes I made, or how my interventions worked out – each meeting with my superiors centered around those four words. 

I share this experience because I know many of you have been in the same position – caught between top-down mandates and on-the-ground realities, trying to reconcile the gap between what leadership expects and what is actually possible. I hope this story helps you feel understood when you’re asked to bolster numbers that don’t always reflect the complexities of patient care. More importantly, I hope it provides you with a toolbox—a way to push back against reductive directives and reframe the conversation into a nuanced, strategic discussion about what access truly means and how we can achieve it. 

The Access Disconnect: A System at Odds 

My health system faced a dual crisis: while we maintained an excellent standard of care, getting an appointment was nearly impossible – and patients knew that. Our patients as well as our referring providers expressed their frustration, and despite years of investment in staffing, equipment, operational programs, and countless other resources, the access needle had hardly moved a bit. Ambulatory volume was stagnant, at an average of just 3.5 patients per provider per day (feel free to read that again – yes, it really was 3.5 per day). When you walked the halls of those clinics, there was no doubt about it: they were shockingly quiet. 

Perhaps the most frustrating part was that these problems didn’t persist due to a lack of effort or concern. In fact, clinicians, administrators, and health system leaders were all deeply invested in solving the problem. However, our efforts were largely in vain – because we were putting band-aids on a bullet wound. The conditions for our access crisis included: 

• A unified, system-wide approach to access was lacking. Each specialty and practice functioned as an isolated ecosystem, without the benefits of collective process improvements.
• Ambulatory growth had outpaced our infrastructure. Over the last five years, ambulatory care expanded greatly without foundational strategies in place to accommodate growth.
• We were constantly reacting rather than strategizing. Instead of focusing on access optimization, we were consumed by daily crisis management.
• Repeated failed initiatives led to fatigue and mistrust. Several rounds of optimization efforts had been attempted but were abandoned before achieving results, leaving clinicians and administrators skeptical of new initiatives.
• National best practices weren’t being used. No external benchmarking was brought in to inform a strategic access plan.
• Physician employment structures created misalignment, and there was no standard clinical FTE expectation, allocation of time, or reporting structure.
• Well-intended resource investment had created inefficiencies. Although the system continuously provided the ‘best’ resources, they often disrupted workflows rather than enhancing them because they were selected in isolation, typically for one requesting clinician.
• Clinical and operational leadership lacked real collaboration, and many of the ambulatory spaces were run by administrators with limited clinical experience. While clinicians were adamant about running their clinics to ensure the best outcomes, our administrative personnel lacked the expertise to challenge or refine these assumptions with best operational practices. 

Replacing a Slogan with a Strategy 

As I watched all this happening around me, the answer to my frustrations became clear. “Just see more patients” is clearly not the solution – but it could be an outcome. Achieving it would require a deliberate, system-wide plan that addresses these foundational barriers. 

In this effort to rally our disparate stakeholders around a central strategy, we began with a series of quick fixes, such as standardizing clinician schedules to national benchmarks. But once again, these efforts fell short – as so many had before – because our health system lacked the necessary infrastructure: standardized appointment templates, optimized scheduling practices, and clear guidelines for balancing new versus returning patients. 

Not only did our early interventions not improve access, but they actually resulted in fewer arrived visits. The early days taught us a painful lesson, but one our leaders needed to hear: that without a comprehensive strategy and a long-term outlook, even the best-intentioned interventions are going to backfire. 

So how does this story end? In my next blog post, I’ll share the tale of how I began to right the ship as a hopeful physician leader in the wide world of access.