Health systems have developed sophisticated methods for assessing physician availability. They audit their directories. They query their practice management systems. They ask their physicians directly. And in nearly every case, the answer they receive is more optimistic than the one their patients experience.

3Dhealth’s national outbound call dataset, now spanning more than 101,000 physician contacts across 244 health systems and 16 years, tests that gap directly. Not through self-reported data. Not through scheduling software. Through the same channel patients use: the phone.

What we’ve found challenges the assumptions behind how most health systems define, measure, and report physician access.

The Difference Between Listed and Available

When a health system publishes a physician directory, it typically reflects licensure status, credentialing, and specialty affiliation. What it rarely reflects is whether that physician is accepting new patients today, or whether they have been for months.

Our dataset documents what happens when a caller contacts a physician practice and asks for a new patient appointment. The results reveal a meaningful and consistent gap between the network a health system believes it has and the one its patients actually encounter.

Across the full dataset, 77.7% of physician contacts resulted in an accepting status. That number is encouraging, until you examine the remaining 22.3%.

Nearly 14% of physicians contacted (more than 1 in 7) were not accepting new patients at all. Another 3.5% were selectively open, meaning access was conditional, often dependent on payer type, referral source, or criteria never communicated in any directory. An additional 2.6% of contacts reached only voicemail, with no opportunity to schedule. And 1.1% placed callers on hold for more than five minutes before the interaction could even begin.

These are not edge cases, they are the documented patient experience at scale. A network that appears open in a directory and in leadership dashboards may be substantially closed at the point of contact.

Primary Care Is Closed at Four Times the Specialist Rate

Perhaps the most counterintuitive finding in the dataset is the divergence between primary care and specialist access, and the direction of that divergence.

Conventional wisdom in health system planning treats specialist access as the harder problem. Specialist recruitment is competitive, wait times tend to be long, and referral patterns are complex. Primary care, by comparison, is often viewed as more accessible by design.

The data do not support that framing.

Among physician contacts in our dataset, primary care practices operate with an open practice rate of 72.2% and a closed practice rate of 24.1%. Specialists, by contrast, show an open rate of 90.5% and a closed rate of just 6.0%.

The primary care closure rate is four times that of specialists.

This inversion has significant implications for how health systems approach network adequacy and access strategy. A health system that prioritizes specialist recruitment to address access concerns (while leaving primary care panel closures unexamined) is solving the wrong problem. Primary care is where the access gap is widest and where the patient experience of the network is most frequently defined.

The financial stakes behind that statement are considerable. Each primary care physician, on average, manages 1,460 patients and generates $2.39 million in combined inpatient and outpatient net revenue for the health system.¹ A closed primary care panel is not simply an access problem. It is a revenue problem, a market share problem, and a referral pipeline problem, all at once. When 24% of primary care practices are closed at the point of patient contact, the downstream impact extends far beyond the scheduling queue.

“The front door of most health systems is primary care. If that door is closed 24% of the time, the rest of the network doesn’t matter to that patient.” — Ron Flower, President & CEO, 3Dhealth

Even Open Panels Create Barriers

Accepting status is a necessary but insufficient condition for access. Among physicians who were accepting new patients, and for whom wait time data was documented, the numbers paint a more complete picture of what “open” actually means.

Among accepting physicians, half have new patient wait times of 18 days or fewer. One in four patients waits more than 34 days. One in ten waits 60 days or longer.

These figures vary by specialty. Primary care physicians carry a median wait of 15 days. Medical subspecialists, 23 days. Surgical subspecialists, 15 days. In all cases, the physician’s panel is technically open, and yet access, as a patient would define it, remains weeks away.

This is the distinction 3Dhealth captured in our second 2026 anchor article: Access Velocity. A practice that accepts new patients, but books six weeks out has not delivered access. It has delivered a slot on a calendar. The patient’s experience – and increasingly, their decision about whether to stay in your network – is shaped by velocity, not availability status alone.

Wait time data also helps explain why self-reported assessments fail. When a physician or practice manager is asked whether they are accepting new patients, they answer based on whether their panel is theoretically open. They are not reporting that the next available appointment is a month away. But that is the access reality a patient encounters.

When the Answer Is No, Patients Are Left Without Options

The most consequential finding in the dataset may not be the rate at which physicians are closed. It is what happens when they are.

Across more than 42,000 contacts where a referral or alternative was possible – an APP, a partner location, a different physician – one was offered only 7.2% of the time. In 92.8% of cases where a patient could not be accommodated, no alternative was provided!

No APP. No partner site. No next available physician. No path forward.

This is not a staffing problem. It is a design problem. Health systems that invest in building alternative care options – Advanced Practice Providers, co-located specialties, new patient concierge programs – frequently find that those options are never surfaced when access breaks down at the point of contact. The infrastructure exists. The protocols to activate it do not.

For a patient who has just been told a physician isn’t accepting new patients, the conversation should not end there. It rarely needs to. But without explicit scripting, staff empowerment, and defined escalation pathways, it does – 93 times out of 100.

What Health Systems Are Missing

Three patterns emerge consistently from this dataset:

First, directory accuracy is a lagging indicator. Physician availability changes frequently, new patient volume, panel preferences, payer mix, and practice circumstances shift continuously. Directories reflect what was true at the time of last update. Outbound call testing reflects what is true today. The gap between the two is where access strategy breaks down.

Second, primary care closure is underweighted in access strategy. Most health systems have robust processes for tracking specialist referral wait times and recruitment pipelines. Far fewer have equivalent visibility into primary care panel closures, even though the data show primary care access failures occur at four times the rate of specialist failures.

Third, the absence of an alternative offer is a systemic failure, not an individual one. When more than 9 in 10 patients who encounter a closed panel receive no alternative, that is not a training problem or a staffing problem in isolation. It is a system design failure. The fix requires protocol, not just intention.

Measuring Access at the Point of Contact

3Dhealth’s outbound call methodology is designed specifically to test the access experience as patients encounter it. Not as health systems report it. Not as physicians perceive it. As it actually occurs.

Over 24+ years and across 244 health systems, this dataset has become the foundation for how we define network adequacy, assess panel performance, and identify access gaps that traditional planning tools miss entirely.

Our proprietary data engines and 3Dperspectives platform allow health systems to visualize this access reality at the physician, specialty, and market level, and to model what improvement looks like. Not theoretically. In terms of actual patients reached, panels opened, and alternatives offered.

You cannot fix what you cannot see. For most health systems, the true state of their network has never been measured at the point patients encounter it. That is where 3Dhealth starts, and where better access planning begins.

For questions or more information, please contact:
Ron Flower at RFlower@3Dhealthinc.com or 312-423-2673. To schedule an appointment with Ron, please contact Annalisa Reese at AReese@3Dhealthinc.com.

¹ Merritt Hawkins, “Physician Inpatient/Outpatient Revenue Survey,” 2019. Figures reflect average annual inpatient and outpatient net revenue attributed per primary care physician (Family Medicine and Internal Medicine).