Applying an Open-Access Model to a Psychiatric Practice

Richard J Moldawsky, MD

Winter 2007 - Volume 11 Number 1


It is generally agreed that access to timely medical care is a key to providing quality service. Many practitioners and organizations, including Kaiser Permanente (KP), struggle to achieve this. Psychiatric care is no exception. Employers who provide insurance for their employees have emphasized initial access and much energy is aimed at getting that first appointment for the prospective psychiatric patient; however, there has been comparatively little attention to follow-up visits. Increasing the number of intake appointments per week, using unbooked return appointments for new patients, and appropriating time allocated for activities other than direct patient care (eg, paperwork time, meetings) have improved a member's chances of seeing a psychiatrist for the first time more quickly. The second and subsequent visits are harder to secure.

After 23 years practicing outpatient adult psychiatry at KP, first in Los Angeles County and now in Orange County, I have seen the continuing high demand for, and emphasis on, initial appointments resign doctors and their patients to some very long waits between visits. Most episodes of care that involve psychiatrists as treaters--not simply evaluators--require return visits, care beyond the skills of psychotherapists or referring physicians.


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