The impact of scheduling policies on surgical clinical access.

We present a simulation model that features a single surgeon who splits his available time between a clinical office and surgery. Using a first-come, first-served queuing discipline, the model allows us to investigate how clinical access responds to surgeons' time allocation policies, patients' office visit frequency, access priority rules, frequency of emergencies, surgery length, and other factors. We demonstrate through simulations that linear functions oversimplify how patients' wait times increase as demand approaches capacity. There is a critical access point at which loss of new patients occurs. Around the critical access point, patients' clinical access rises in a nonlinear fashion. This point defines the beginning of the collapse of the system. Clinical monitors of access such as third-available appointment lack the sensitivity to correctly identify the approach of the critical access point before it has been exceeded.