Presently experiencing round two of clinic management's attempts to institute "open access". Doesn't appear as if any of them have actually read or in any way understand the real concept. Clearly when it works well it's good for everyone - That is, my patients see me today or soon - and all of the reasons for which they have made the appointment are addressed at that visit. Sadly clinic management are clueless about how to actually accomplish this - So what we have instead is "anyone who shows up is seen by anyone with an opening" and if there are no openings then they are just doubled in with anyone - Doesn't matter what the purpose of the visits are or what needs to be accomplished in the (very limited) time frame or who is seeing who. Previously we had paired teams - so patients would always see one or another of us. Now it's kind of a free for all. Patients I've known and cared for for the last 10 years are scheduled with someone else, while I'm seeing patients that are yet another's. Patients aren't even told that they are scheduled with someone else and don't find out until they show up. Sad really. Our community clinic used to provide health care that could go head to head with any private practice and come out the winner in terms of quality of care and continuity. Right now corporate style management is rapidly creating a Medicaid mill - and truth be told - quality of care is rapidly plummeting. You would not know this from the Hollywood slick video clips shown at the annual meeting. The administrators with the smiling facades carefully screen the truth. There is a moment of epiphany when it is perfectly clear that while providing care for poor people is what matters most to you, the institution as a whole has morphed to exploiting the poor for its own fiscal aggrandizement. It's only a few more weeks and I will leave this setting for one more in line with my values.