By Pawan Toshniwal, Founder and CEO, 2Care.ai
LinkedIn: Pawan Toshniwal
LinkedIn: 2Care.ai
Ask a practice administrator where their patient access problems come from and you’ll hear the familiar list: not enough providers, too many no-shows, a schedule booked out for weeks. All true. But if you want to see where patients actually slip through, skip the waiting room and go stand next to the front desk phone at 8:30 on a Monday. Count the lines on hold. Read the sticky notes around the monitor with callback numbers scribbled on them. That’s where access is won or lost, and it’s the part of the practice almost nobody measures.
The industry spent the better part of a decade trying to make the phone matter less. Portals, online booking, text-to-schedule links. Some of it helped. Most of it didn’t move the needle the way we all expected. MGMA found in July 2025 that 71% of medical groups still have fewer than one in four patients booking digitally. Patients still call, because their question doesn’t fit a drop-down menu, and frankly most of the questions that matter don’t.
The seat nobody can keep filled
Look at who answers those calls. The same person is checking patients in, verifying insurance, scanning referrals and picking up the phone in between, often all at once. When the room fills up, the phone loses. It has to.
And the seat keeps emptying. The Bureau of Labor Statistics counts roughly 1.0 million receptionist jobs in the U.S. and projects about 128,500 openings a year through 2034, mostly to replace people leaving the role. Median pay is $17.90 an hour. So practices live in a loop: hire, train for a couple of months, lose that person, start again. Every gap in that loop is a stretch of calls going to voicemail, and not every patient who reaches voicemail calls back. Some of them call the practice down the street.
What strikes me is how much of that volume is routine. Booking, rescheduling, do you take my insurance, what time do you open Saturday, can I get a refill. Important to the patient, but not work that needs a trained person’s judgment. Meanwhile the calls that do need judgment, the anxious parent, the patient whose symptoms don’t sound right, sit in the same queue as the parking question.
What AI should change, and what it shouldn’t
This is the problem I’ve spent the last few years working on, and the first lesson we learned was that answering the phone isn’t the hard part. Plenty of things answer. A phone tree answers. An answering service answers. Then they take a message and hand the work back to the same overloaded front office the next morning.
The useful version finishes the job while the patient is still on the line. The caller explains what they need in plain speech, the agent reads the practice’s live schedule out of the EHR, books within the practice’s own rules, and writes the appointment back as structured data so nobody retypes it. We connect directly with 95+ systems today, Epic, athenahealth and eClinicalWorks among them, because a booking that lands anywhere else is just a different kind of message. The confirmation text, the reminder and the WhatsApp reply two days later asking whether to fast all know about the same booking. A caller more comfortable in Spanish can switch mid-call without being transferred. Then there’s the outbound work that never survives a busy day: the recall list, the waitlist that could fill tomorrow’s cancellation, the balance reminders. Running that on rules the practice sets is where a lot of the value quietly sits.
The thing I’d put at the top of any buyer’s checklist, though, is what the system refuses to do. A healthcare line gets calls software has no business handling. An AI agent on that line shouldn’t diagnose, shouldn’t comment on medications and should never tell a worried caller a symptom is probably fine. Clinical questions belong with a nurse or provider, and emergencies with a person within seconds, transcript attached so the patient isn’t asked to start over. If a vendor can’t show you exactly why each call was handed off, keep looking. The same goes for data. A system that transcribes calls and writes into the patient record is handling PHI. It should sign a BAA, encrypt everything, and tell you in writing that your patients’ calls aren’t training somebody else’s model.
The phone is infrastructure now
I don’t think most practices have caught up to this yet. The phone still gets treated as an overhead line rather than the main channel patients use to reach care. Practices that start treating it as a system instead of a seat to fill will spend less time chasing turnover and more time on the patients who actually need a person.
Patient access was supposed to go digital, and in plenty of ways it did. The phone just never stopped ringing. The practices that come out ahead over the next few years won’t be the ones that finally get patients off the line. They’ll be the ones where a call at 7 p.m. ends with a booked appointment instead of a voicemail.