Strategies to Improve Electrophysiology Clinic Access

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EP LAB DIGEST. 2026;26(5).

Bradley P Knight, MD, FACC, FHRS

Dear Readers,

Access to doctors and health care providers is clearly a growing problem when the local news channel sends out a survey to their viewers with the title - “Survey: How long have you had to wait to get an appointment with your doctor?”¹ Limited access to health care has long been recognized as a significant public health issue, historically focused on rural and urban health care deserts and barriers faced by underserved populations. However, the problem has now become a mainstream concern affecting all Americans, to the extent that entire industries—such as concierge medicine—have emerged to help patients bypass long wait times.² 

What are the solutions to shorten the time it takes to get an appointment with an electrophysiologist (EP)?

1. Require EPs to spend more time in the office seeing patients. This has been a common approach, based on the premise that EPs have spare capacity and could increase outpatient volume. Unfortunately, this is not a viable solution in 2026 at most hospitals. EPs are already very busy caring for patients, must devote the majority of their time to performing procedures that already have long wait times, and are now almost universally compensated under productivity-based models that inherently incentivize seeing more outpatients. At most places, the juice has already been squeezed from this lemon.
    
2. Have EPs see more patients in the same amount of time. This is also an enticing approach, but it assumes that EPs are not already highly efficient in clinic. In reality, clinic time is already constrained: EPs have limited time with each patient, are expected to supervise mid-level providers and trainees, and must troubleshoot device clinic problems.³ If this is going to be a point of emphasis, then they will need more support. There must be better technology to assist with documentation, as well as additional staff—such as medical assistants and nurses—to help EPs see more patients in the same amount of time while maintaining high-quality care and patient satisfaction. Current, rigid electronic health record-based scheduling systems with fixed time blocks also need to become more flexible to allow physicians to see more patients per clinic.
    
3. Hire more advanced nurse practitioners (APNs) and physician assistants (PAs). There are certainly tradeoffs with more mid-level providers, but this has become the most effective method to improve EP clinic access over the past decade. It works best when the mid-level provider sees patients under the care of an EP while the EP is also in the office. This creates a true team-based approach and allows the EP to provide personal face time and attention when needed. When it works well, it works very well.⁴ Unfortunately, this model often requires EPs to supervise the APNs or PAs without receiving RVU credit, and can result in more work with less compensation.
    
4. Have general cardiologists expand their heart rhythm expertise and provide longitudinal care for those patients. Not long ago, EPs typically saw only patients who had been first evaluated by a cardiologist. Referrals from cardiologists usually included a brief letter summarizing the patient’s history and the specific reason for referral. In many cases, the EP saw the patient in consultation, provided recommendations, and the patient might undergo an ablation procedure or device implantation before returning to the general cardiologist for follow up. Things are much different now. Patients are usually advised by their cardiologist to establish ongoing care with an EP for continuous management of heart rhythm problems, including atrial fibrillation (AF). Most graduating cardiology fellows have little to no experience initiating antiarrhythmic drugs or managing patients with arrhythmias longitudinally. We need more general cardiologists trained to provide basic heart rhythm care. One specific idea is for some general cardiology fellows to focus on noninvasive EP patient care during their third year of training and develop a practice focused on AF.⁴
    
5. Telemedicine. Virtual appointments were the obvious solution to clinic access during COVID, and currently a majority of patients seen in EP clinic could be managed virtually. Unfortunately, telemedicine is now discouraged by many organizations because of lower reimbursement compared to in-person visits. This approach needs greater support if the primary goal is to improve clinic access.
    
6. Better patient triage. Improving triage is fundamentally the highest-yield solution to address long EP clinic wait times. Currently, almost any patient can make an appointment to see an EP. Many patients are self-referred or referred directly by their primary care physician, and a majority of these patients should first be evaluated by a cardiologist—or may not need to see an EP or cardiologist at all. Meanwhile, patients who require urgent interventions, such as a pacemaker, may have to wait months to be seen. This problem is further aggravated by clinic scheduling systems that rely on low-cost central call centers, where non-medical staff perform triage using basic questionnaire templates. 

Examples highlighting why outpatient appointment triage by health care professionals is the most critical solution to long wait times are evident on a weekly basis. While patients with urgent heart rhythm problems—already diagnosed by a cardiologist—are working through back channels to secure clinic appointments, young and otherwise healthy patients are often scheduled in the EP clinic for symptoms such as palpitations that have not yet been evaluated, or for benign findings like a 4-beat run of “supraventricular tachycardia” or nocturnal atrioventricular nodal Wenckebach on a heart monitor.⁵ The health care system views these visits as billable new patient appointments and is not incentivized to limit such scheduling. However, if access to an EP is going to improve, health care professionals must play an early role in the triage process. A nurse, for example, could efficiently determine which patients truly need to be seen by an EP, who requires urgent evaluation, and whether any testing or treatment should occur prior to the appointment. 

It takes far too long for Americans to get an appointment with a doctor—just ask the local Chicago NBC news team, which is apparently hearing plenty of complaints. In EP, it is taking too long for patients with serious heart rhythm problems to be seen in clinic. There are many ways to improve EP clinic access including better clinic efficiencies, more outpatient mid-level providers, and telemedicine, but the most effective intervention would be better triage of patients by a health care professional such as a nurse so that those with legitimate heart rhythm disorders can access EP care sooner based on their medical necessity and urgency. 

Disclosures: Dr Knight has served as a paid consultant to Medtronic and was an investigator in the PULSED AF trial. He has served as a consultant, speaker, investigator, and/or has received EP fellowship grant support from Abbott, AltaThera, AtriCure, Baylis Medical, Biosense Webster, Biotronik, Boston Scientific, CVRx, Philips, and Sanofi; he has no equity or ownership in any of these companies. Dr Knight reports payment or honoraria from Convatec for a lecture. 

1. Survey: how long have you had to wait to get an appointment with your doctor? NBC 5. Published March 31, 2026. Accessed April 14, 2026. https://www.nbcchicago.com/consumer/survey-how-long-have-you-had-to-wait-to-get-an-appointment-with-your-doctor/3916319/
    
2. Knight BP. Concierge medicine is not helping the U.S. healthcare system. EP Lab Digest. October 2019.
    
3. Knight BP. Modernizing the ambulatory care model to improve physician efficiency. EP Lab Digest. January 2017. 
    
4. Knight BP. Changing the outpatient model for patients with atrial fibrillation. EP Lab Digest. July 2018.
    
5. Knight BP. The problem of highlighting benign nonsustained supraventricular tachycardias on heart rhythm monitoring reports. EP Lab Digest. July 2022.