Successive Appointments Research Articles

Addressing Patient Concerns at the University of Michigan Dental School

Effective communication between patients and dental providers is crucial for successful dental appointments, fostering trust and comfort. However, patients often carry unspoken concerns into dental clinics that significantly influence their experiences. The dental profession needs a standardized approach to record and address these concerns, leading to inconsistencies in how patient feedback is collected and acted upon. This can result in unresolved issues and patient dissatisfaction. Recognizing this problem, the University of Michigan School of Dentistry thought to improve how patient concerns are documented and addressed.

Patient Selection Is the Key for Successful Video Appointments: Lessons Learned from the COVID-19 Pandemic.

The use of video appointments (VAs) increased significantly during the COVID-19 pandemic. This study investigated the evolution of VA utilisation in Finland using data from two surveys conducted in 2021 (40 responses) and 2023 (30 responses). Our primary aim was to identify patient groups best suited for VAs. Respondents were either neurologists or neurologists-in-training. Our findings suggest that patients with epilepsy or headaches are most suitable for VAs. VAs were primarily used for follow-up visits during both survey periods, but their application for first visits decreased from 68.20% in 2021 to 27.80% in 2023. Healthcare professionals' concerns about data protection have diminished over time, but there is still need for enhanced training in the use of remote applications. Future research should focus on validating the cost-effectiveness, data security and timeliness of VAs.

Reflections of Women Standard Setters in the United States

SYNOPSIS Motivated by trends toward gender equality on standard-setting boards in the United States, this study interviews women members of the FASB, GASB, and EITF to understand the factors critical to their successful nomination and appointment. Semistructured interviews were conducted with women standard setters to root our understanding in their own experiences and perceptions. Value emerged as a generalizing theme. Participants perceived value to the board in nomination as associated with professional expertise and ties with professional societies. Most participants perceived value in giving back to the profession by serving as a voice for an important stakeholder group as a critical factor for acceptance. Women standard setters consistently downplay the idea that diversity, equity, and inclusion represent primary decision criteria for board membership. Instead, their reflections imply that it is up to the profession to implement practices that promote the advancement of the most competent professionals from all backgrounds. Data Availability: Anonymized interview data are available upon request to the authors and are subject to prior consent by participants to share. JEL Classifications: M41; M48.

Assessing Access to Trauma-Informed Outpatient Mental Health Services for Adolescents: A Mystery Shopper Study.

The authors aimed to examine how access to trauma-informed mental health services in safety-net health centers varies by insurance type and race-ethnicity of the care seeker. In this mystery shopper study, three women (White, Latina, and Black voice actresses) called community mental health centers (CMHCs) and federally qualified health centers (FQHCs) (N=229) in Cook County, Illinois, posing as mothers requesting a mental health appointment for their traumatized adolescent child. Each health center was called twice-once in the spring and once in the summer of 2021-with alternating insurance types reported (Medicaid or private insurance). Ability to schedule an appointment, barriers to access, wait times, and availability of trauma-specific treatment were assessed. Callers could schedule an appointment in only 17% (N=78 of 451) of contacts. Reasons for appointment denial varied by organization type: the primary reasons for denial were capacity constraints (67%) at CMHCs and administrative requirements to switch to in-network primary care providers (62%) at FQHCs. Insurance and organization type did not predict successful appointment scheduling. Non-White callers were significantly less likely (incidence rate ratio=1.18) to be offered an appointment than the White caller (p=0.019). The average wait time was 12 days; CMHCs had significantly shorter wait times than FQHCs (p=0.019). Only 38% of schedulers reported that their health center offered trauma-informed therapy. Fewer than one in five contacts resulted in a mental health appointment, and an apparent bias against non-White callers raises concern that racial discrimination may occur during scheduling. For equitable access to care, antidiscrimination policies should be implemented.

APPRAISAL ANALYSIS OF ROY SURYO’S DEFAMATION ACCUSATION TO EKO KUNTADHI AND MAZDJO PRAY

In 2021, the former Minister of Youth and Sports, Roy Suryo reported Eko Kuntadhi and Mazdjo Pray for a defamation case regarding the comments in their YouTube video. The former minister reported that the two had falsely accused him and defamed him regarding the hit-and-run case that he faced with the Indonesian actor Lucky Alamsyah in the same year. However, the case still did not reach any conclusions in 2022. This research then aims to investigate whether the video contains defamation to be considered a criminal case as claimed by the former minister. This study would employ the appraisal framework proposed by Martin and White (2005) in order to analyze the contents of the video, including the comments of Eko Kuntadhi and Mazdjo Pray. To help reach a deeper analysis, the study would also use the intertextuality of the Discourse-Historical Approach (DHA) by Reisigl and Wodak (2009). Both the appraisal and the Discourse-Historical Approach were applied to analyze the utterances made by the two in their video entitled EKO KUNTADHI & MAZDJO PRAY: DEWA PANCI BIKIN ULAH LAGI (PRA KONTRO #36). Findings indicate that Mazdjo Pray and Eko Kuntadhi have body-shamed Roy Suryo through mockery, particularly to his mustache through negative judgment. The duo also used mockery to link Roy Suryo’s mustache to his successful appointment as the Minister of Youth and Sports after succeeding both the official minister, Andi Mallarangeng, and his ad interim minister, Agung Laksono, citing that the only reason for his promotion was due to his mustaches’ likeness to that of Andi’s. The duo also made various comments regarding Roy Suryo’s activities on Twitter, citing that he often utilizes his technological skills only to analyze various pornographic contents to verify the actors and actresses portrayed. Meanwhile, the analysis indicates that the claims for defamation regarding the case are not to be found since the literature describing the events matches the statements.

Developing time management with preclinical dental students via a preclinical exercise in an organization.

Developing time management is an important aspect of a dental student's passage to clinical care and in their growth as a professional. Suitable time management and preparedness can potentially impact the prognosis of a successful dental appointment. The objective of this study was to determine if a time management exercise could be effective to increase students' preparedness, organization, time management, and reflection during simulated clinical care prior to transitioning to the dental clinic. Students completed five-time management exercises during the term preceding their entrance into the predoctoral restorative clinic which included appointment planning and organization, and reflection once finished. Pre- and post-term surveys were used to determine the impact of the experience. Quantitative data was analyzed using a paired t-test and the qualitative data was thematically coded by the researchers. Students reported a statistically significant increase in their self-confidence of clinical readiness after completion of the time management series, and all students completed the surveys. The themes indicated by students through their comments in the post-survey question regarding the experience were as follows: planning and preparation, time management, the practice of procedures, concern about workload, faculty encouragement, and unclear. Most students also reported the exercise to be beneficial for their predoctoral clinical appointments. It was determined that the time management exercises were effective for the students as they transitioned to treating patients in the predoctoral clinic and can be used for future classes to increase their success.

Aspiring teachers, financial incentives, and principals’ recruitment practices in hard-to-staff schools

ABSTRACT The crisis of teacher shortages in Anglophone nation states can no longer be ignored as this long-term issue has been compounded by the pandemic. Growing evidence of the challenges of attracting and retaining a teaching workforce is now foregrounded in education policy internationally. This issue provides increased impetus for studying teacher motivations and principal dispositions particularly in relation to roles in hard-to-staff schools that tend to be in disadvantaged or rural communities in terms of how policies are received and enacted. This mixed methods study examined a teacher financial incentive (TFI) scheme aimed at facilitating the appointment of qualified teachers in hard-to-staff government schools in Victoria, Australia. Although evidence of TFI scheme’s effects and effectiveness as a policy solution to teacher shortages is limited, TFI schemes are widespread internationally. Our study shows that while the Victorian TFI scheme resulted in successful appointments for most participating schools, a financial incentive was only one among many other policy settings, personal and professional factors and other motivations informing teachers’ decisions to apply for a TFI position and the recruitment practices of principals.

Classifying Children's Behaviour at the Dentist-What about 'Burnout'?

In children and young people, complex and prolonged dental treatment can sometimes be met with resistance despite previously successful treatment appointments. While this has traditionally been referred to as a 'loss of cooperation' or 'non-compliance', these children may actually be experiencing 'burnout', of which many may have the potential to recover and complete their course of treatment. Burnout has been defined as "the extinction of motivation or incentive, especially where one's devotion to a cause or relationship fails to produce the desired results". Traditionally, burnout is experienced by those who deliver services rather than be in receipt of a service; however, the burnout concept proposed in this paper explores it as an alternative perspective to other dentally relevant psychosocial conditions and should be considered when employing appropriate behaviour management techniques and coping strategies for paediatric patients. The intention of this paper is not to establish firm grounds for this new concept in healthcare, but to start a discussion and motivate further theoretical and empirical research. The introduction of the 'burnout triad model' and the importance of communication aims to highlight the tripartite influence of patients, parents and professionals engaged in the central 'care experience' and underlines the belief that early recognition and management of potential signs of burnout may help reduce the likelihood of those involved developing the condition.

‘Without support CALD patients will be left behind’: A mixed-methods exploration of culturally and linguistically diverse (CALD) client perspectives of telehealth and those of their healthcare providers

Introduction The rapid adoption of telehealth during the global pandemic has the potential to widen disparities for culturally and linguistically diverse (CALD) consumers. We explored the perspectives and experiences of CALD consumers accessing telehealth during the global pandemic and those of their healthcare providers. Methods A multistakeholder mixed-methods study involving two parallel samples comprising consumer–participants (n = 56) and healthcare provider–participants (n = 81). Multicultural consumer–participants, recruited from consecutive referrals to Health Language Services for telehealth support, were assisted to complete two surveys (before and after their clinical telehealth appointment) in their preferred language. A purposive sample of consumer–participants was interviewed to understand their perceived barriers and enablers of successful telehealth consultations. Simultaneously, all healthcare providers within the local health district were eligible to participate in an online survey if they had provided telehealth care to a consumer during the recruitment period. Closed-ended responses were descriptively summarised, while open-ended responses and interview transcripts were analysed thematically. Results Despite 86% of consumer–participants inexperienced with telehealth, 80% achieved a successful appointment with a healthcare provider. Consumer perceptions were shaped by cultural and diagnostic concepts of legitimacy, in the context of known accessibility and technology literacy challenges. Healthcare provider perspectives were less favourable towards telehealth, with equity of healthcare delivery a major concern. Discussion Our findings highlight unintended consequences arising from a rapid transition to telehealth. Adopting collaborative approaches to the design and implementation of telehealth is imperative to mitigate health inequities faced by CALD communities and maximise their opportunity to realise potential health benefits associated with telehealth.

Atrophy of the Left Hepatic Lobe Causing Twisting of the Right Hepatic Lobe and Biliary Compression with Radiological Findings : A Case Report

A 20-year-old male presented with hepatomegaly, jaundice, and itching. Investigation revealed elevated liver enzyme levels, suggesting direct hyperbilirubinemia. Magnetic resonance imaging revealed a stable orientation of the right hemithorax, a relatively small and rotated right hepatic lobe, and a left-rotated intra-abdominal hepatic lobe, with progressive enhancement related to the foci of the hepatic fibrosis. There was an intrahepatic biliary dilatation, reaching 0.8 cm, that was due to biliary compression. There was no evidence of biliary irregularity to suggest a classic primary sclerosing cholangitis pattern. Percutaneous transhepatic biliary drainage and a cholangiogram confirmed the dilation of the left and right bile ducts with smooth, normal drainage via the common bile duct. The symptom management strategy took the form of surgical liver transplantation. The patient demonstrated improvement following transplantation, and his total bilirubin level returned to normal within months. The patient was then discharged in a stable status, and successive follow-up appointments were scheduled every three months to monitor for disease progression or complications.

Działalność kasztelana krakowskiego Spytka Jarosławskiego (około 1451–1519) w dziedzicznym Jarosławiu i jej wpływ na późniejszy rozwój miasta

W artykule omówiona została działalność gospodarcza właściciela Jarosławia, kasztelana krakowskiego Spytka Jarosławskiego (około 1436–1519). Autor przedstawia jego działania podjęte w celu stworzenia z miasta centralnego ośrodka posiadanych dóbr ziemskich oraz ich wpływ na rozwój Jarosławia w czasach, gdy władał nim Spytek, jak też w okresie późniejszym. The Activities of the Krakow Castellan Spytek Jarosławski (ca. 1451–1519) in Hereditary Jarosław and Their Impact of the Subsequent Development of the Town The paper discusses the economic activities of Spytek Jarosławski (Spytek of Jarosław) in his hereditary town of Jarosław. Spytek was the most eminent representative of the Jarosław line of the Leliwite family (i.e. bearers of the Leliwa coat of arms). He began his career before 1461 at the royal court in the service of King Casimir Jagiellon (Kazimierz Jagiellończyk), obtaining successive offices, which culminated in the highest secular dignity – the Castellan of Krakow. These successive appointments were rewards for his commitment to political activity for the kings. In his hereditary estate he was a good administrator. During his rule in Jarosław, a number of public buildings and foundations came into existence. In 1479 Spytek confirmed the old rights and privileges of the Jarosław burghers and granted them new ones. The period of Spytek Jarosławski’s rule in Jarosław brought about the town’s development in all fields of life. During that time, Jarosław became also a major trading center of supraregional importance in Red Rus’. For the Jarosław Leliwites, the town became the capital of their feudal “state” with their own clerks, vassals, and army. That “state” was a kind of model for later magnate latifundia. Moreover, Spytek Jarosławski, with his brother Rafał, who resided in nearby Przeworsk, founded in 1470the first family (Jarosław-Przeworsk) entail in Poland.

The Behavior of Patients with Obsessive-Compulsive Disorder in Dental Clinics.

Objectives This review documents published obsessive-compulsive disorder (OCD) cases with dental and oral conditions with potential impact on the dental procedure. The research question was, what are the psychiatric and behavioral features of people with OCD that might affect dental sessions? Methods This review followed the PRISMA guidelines (PROSPERO registration No. CRD42020212371). Six databases (PubMed, Scopus, Web of Science, LILACS, Cochrane Library, and PsycINFO) were screened for published clinical studies that report dental patients with obsessions or compulsions behaviors as identified by National Institute of Mental Health (NIMH). Inclusion of the studies was performed according to the eligibility criteria. The quality evaluation was carried out using the Joanna Briggs Institute's (JBI) Critical Appraisal Checklist. The results were qualitatively assessed for synthesis. Results After elimination of duplication, 530 articles were screened, and 35 articles were evaluated for eligibility. 17 studies met the inclusion criteria (8 case reports, 5 cross-sectional studies, 1 longitudinal cohort study, and 3 case-control studies) and were included in the review. All case reports demonstrated symptoms of obsessions or compulsions such as fear of germs and contamination, aggressive thoughts, having things symmetric in perfect order, excessive cleaning or handwashing, repeatedly checking things, and compulsive counting. OCD-related behavior was assessed in the included clinical investigations using standardized protocols such as Florida Obsessive-Compulsive Inventory, Symptom Checklist-90-Revised, 4-item Corah Dental Anxiety Scale, Diagnostic and Statistical Manual of Mental Disorders, and the Crown Crisp Experimental Index. Quality assessment of the 17 included articles revealed 14 articles with low risk of bias and 3 articles with moderate risk of bias. Conclusion The reported OCD symptoms may implement psychological difficulties during dental procedures without affecting the outcome. Although there was no contraindication for planning or performing dental treatments for a patient with OCD, dental-related procedures and protocols might be modified for successful dental appointments.

Comparing 2 Appointment Scheduling Policies Using Discrete-Event Simulation.

Two of the most important policies for dealing with the negative effects of high rates of no-show patients and appointment cancellations include double-booking and walk-in admission policies. This study aimed to compare these policies to identify their differences and their effects as well as the best circumstances for using each one. The main approach used in this study was discrete-event simulation using the Arena software application. Moreover, the average waiting time (considering patients' lateness) and the number of missed patients (considering no-show and cancelled patients) were accounted for in the performance evaluation criteria for both of the selected policies. When the patients' arrival rate was high, the double-booking system resulted in higher productivity, while when it was low, the walk-in admission policy was the best policy for patient admission. The successful appointment rates of the current system, the walk-in admission system, and the double-booking system were 61.18%, 89.45%, and 93.24%, respectively. Although both double-booking and walk-in policies reduced the negative effects of cancelled and no-show patients, they had significantly different results in different situations. In general, there is no best system for appointment scheduling, and the choice of the superior system depends on the demand rate and its fluctuations.

Sir Rex Edward Richards. 28 October 1922—15 July 2019

Rex Richards was renowned for his research in the field of nuclear magnetic resonance (NMR). Very early on, in the late 1940s, when NMR was in the domain of physicists, he foresaw that the technique might play an important role in chemistry. He embarked on a highly successful research career in which he combined the design and development of new NMR spectrometers with novel applications, initially in chemistry and subsequently in the biological sciences. One major outcome was the establishment of the Oxford Enzyme Group's NMR research programme. Another was the development of 31 P NMR spectroscopy as a non-invasive method of probing the biochemistry of intact biological tissue. Rex was an outstanding teacher and mentor. He also had highly impressive administrative skills, as recognized through successive appointments at the University of Oxford as head of the Physical Chemistry Department, then warden of Merton College and finally vice-chancellor. He was subsequently appointed director of the Leverhulme Trust and became widely respected in the arts world, as reflected by his remarkable array of committee memberships at the National and Tate Galleries.

Differences in Access to Outpatient Care in the State of Ohio for an Orthopaedic Sports Medicine Patient

PurposeTo evaluate the impact of either Medicaid or private insurance on securing an appointment in an outpatient orthopaedic clinic and to determine waiting periods until an appointment as well as the relationship between population metrics and access to care.MethodsA total of 88 clinics were called. There were 2 fictitious patients, one with an anterior cruciate ligament (ACL) injury and the other with a medial meniscus injury, with each calling as having Medicaid or private insurance. Clinic responses were recorded for whether an appointment could be made, when it was scheduled, and with what provider.ResultsA total of 32 of 88 (36.4%) of the clinics scheduled an appointment for the Medicaid patient reporting an ACL injury versus 71 of 88 (80.6%) of the clinics that scheduled an appointment for the same patient with private insurance. A total of 34 of 88 (38.6%) of the clinics scheduled an appointment for the Medicaid patient reporting a medial meniscus injury versus 71 of 88 (80.6%) of the clinics that scheduled an appointment for the same patient with private insurance. Mean waiting period for ACL patients with Medicaid was 8.6 days and 4.5 days for patients with private insurance, whereas medial meniscus patients with Medicaid was 7.7 days and 5.4 days for patients with private insurance. In total, 60 of the 66 (90.9%) patients with Medicaid who received an appointment were scheduled to see the orthopaedic surgeon (30 in both ACL and medial meniscus groups). In total, 126 (71.6%) patients with Medicaid and 34 (19.3%) patients with private insurance of the 176 encounters faced barriers to scheduling an appointment. Rural communities were associated with appointment acceptance for patients with Medicaid (P < .05), and patients with private insurance had successful appointment scheduling in all community types (P < .05).ConclusionsThis study suggests that patients with Medicaid are less likely to receive orthopaedic care for multiple sports medicine injuries, are more likely to encounter barriers, and endure longer waiting periods. There are different patterns of insurance acceptance according to population metrics.Clinical RelevanceServes as a baseline evaluation of the difference in access to health care that may be impacted by increases in Medicaid coverage and/or changes in government policies.

Factors That Influence The Appointment Of Service Providers In Gauteng Department Of Roads And Transport

Many South African roads experience inadequate construction and maintenance. The road construction scantiness is evidenced by the Moloto Road, Gauteng, Mpumalanga and Limpopo. This was dubbed the “notorious road” for the high number of fatal accidents. An assessment of factors influencing the appointment of service providers might be a profound strategy to ensure efficiency and effectiveness in the construction and maintenance of South African roads. The factors under study included financial stability and resources indicators, quality, environmental and safety indicators, management ability, technical capacity and past experience and performance in appointing service providers.&#x0D; This study sought to determine the importance and influence of the factors affecting the successful appointment of service providers within the Gauteng Department of Roads and Transport.&#x0D; A quantitative descriptive approach, with the use of a structured questionnaire was utilised to collect data from a sample of 155 employees of Gauteng Department of Roads and Transport within the City of Tshwane. Descriptive and multivariate analyses including factor correlations and regression analyses were conducted.&#x0D; Some important factors identified when choosing service providers were financial stability and resources indicators, quality, environmental and safety indicators, management ability and experience and performance. Technical capacity was found to be less important. A significant positive relationship was found between factors for choosing service providers and the selection of competent service providers.&#x0D; The results of this study greatly corresponded with the literature review. The same factors were identified as influencing the successful appointment of service providers in this department.

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Clinical evaluation of efficacy of transcortical anesthesia for the extraction of impacted mandibular third molars: a randomized controlled trial.

BackgroundThis study aimed to compare the pain levels during anesthesia and the efficacy of the QuickSleeper intraosseous (IO) injection system and conventional inferior alveolar nerve block (IANB) in impacted mandibular third molar surgery.MethodsThis prospective randomized clinical trial included 30 patients (16 women, 14 men) with bilateral symmetrical impacted mandibular third molars. Thirty subjects randomly received either the IO injection or conventional IANB at two successive appointments. A split-mouth design was used in which each patient underwent treatment of a tooth with one of the techniques and treatment of the homologous contralateral tooth with the other technique. The subjects received 1.8 mL of 2% articaine. Subjects' demographic data, pain levels during anesthesia induction, tooth extractions, and mouth opening on postoperative first, third, and seventh days were recorded. Pain assessment ratings were recorded using the 100-mm visual analog scale. The latency and duration of the anesthetic effect, complications, and operation duration were also analyzed in this study. The duration of anesthetic effect was considered using an electric pulp test and by probing the soft tissue with an explorer.ResultsThirty patients aged between 18 and 47 years (mean age, 25 years) were included in this study. The IO injection was significantly less painful with lesser soft tissue numbness and quicker onset of anesthesia and lingual mucosa anesthesia with single needle penetration than conventional IANB. Moreover, 19 out of 30 patients (63%) preferred transcortical anesthesia. Mouth opening on postoperative first day was significantly better with intraosseous injection than with conventional IANB (P = 0.013).ConclusionThe IO anesthetic system is a good alternative to IANB for extraction of the third molar with less pain during anesthesia induction and sufficient depth of anesthesia for the surgical procedure.

Comparative evaluation of 2% turmeric extract with nanocarrier and 1% chlorhexidine gel as an adjunct to scaling and root planing in patients with chronic periodontitis: A pilot randomized controlled clinical trial.

Context:Nanoparticles, owing to their smaller size, penetrate regions inaccessible to other delivery systems, such as periodontal pockets. Thus, the present study aimed to comparatively evaluate efficacy of 2% curcumin with nanocarrier and 1% chlorhexidine gel as a local drug delivery (LDD) in the treatment of periodontal pockets.Materials and Methods:Forty-five chronic periodontitis patients with pocket depth 5–7 mm in two or more teeth were selected. Full-mouth scaling and root planing (SRP) was done for all patients followed by random allocation to the three treatment groups, namely SRP group (Group 1), 2% curcumin with nanogel (Group 2), and 1% chlorhexidine gel (Group 3). Clinical parameter assessment and microbiological analysis of subgingival plaque samples for Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Tannerella forsythia (Tf) was done at baseline, 21st day, and 45th day.Results:The results showed that when the two LDD agents were used as an adjunct to SRP in chronic periodontitis, there was an improvement in all clinical parameters. Evaluation of microbiological parameters also showed a significant reduction in Aa, Pg, and Tf levels. Comparison of 2% turmeric extract with a nanocarrier system with 1% chlorhexidine gel showed that both the agents had a comparable antibacterial effect on the three selected periodontopathic bacteria.Conclusion:The present study showed that both the LDD agents showed an effective improvement of clinical and microbiologic parameters. 2% curcumin delivered with a nanocarrier system showed results comparable to chlorhexidine gel and hence shows promising future as an LDD agent in the treatment of periodontal pockets.

Do Type of Insurance, Geographical Variation and Type of Practice Impact Access to Foot and Ankle Care?

Category:Foot & AnkleIntroduction/Purpose:Medical coverage gap in United States refers to people who are uninsured because the state they are living has still opted-out of Medicaid expansion under Patient Protection and Affordable Care Act (PPACA) and they are too poor to be benefited from subsidies designed for middle-class Americans. A large percentage of this population lives in south. Despite increasing participation of the states in expanded Medicaid, it is still unclear that if such an expansion has led to improve the access to care. However, approximately one in three American is covered under Blue Cross Blue Shield (BCBS) private insurance. The purpose of this study is to determine the access to foot and ankle care based on medical insurance, nature of illness and Medicaid expansion of the state.Methods:Five pairs of Medicaid expended (California, New York, Ohio, Minnesota and Washington) and non-expanded (Utah, Texas, Alabama, Missouri, and North Carolina) states with different geographic location were selected for the study. Twenty providers from each state were randomly selected via American Orthopedic Foot & Ankle Society (AOFAS) directory with private or academic affiliations. Each provider’s office was contacted by fictitious call for the earliest available appointment in foot and ankle clinic. A standardized script was used by the same researcher every time for a 30 year old male patient with acute Achilles tendon rupture or chronic bunion with either Medicaid or BCBS insurances. Available appointment for physician was considered as an access to foot and ankle care. We registered time until appointment (if given) and reason for denial (if denied) on phone. We also recorded requirements for insurance details, PCP (Primary Care Physician) referral or imaging records.Results:200 providers’ offices were contacted on phone for foot and ankle clinic appointment. Successful appointment was given by 36%(72/200) offices irrespective of condition and insurance. 29% of calls with Medicaid could successfully schedule an appointment compared to 43% when calling with BCBS(P=0.03). Success rate for appointment was same for Achilles rupture and Bunion (36% each). The mean time until earliest appointment was 10.7(range 1-37) days with Medicaid and 10.5 (range 1-45) days with BCBS. For Medicaid patients, no significant difference was found in appointment rates between expanded states (30%) and non-expanded (28%) states (P=0.82). Overall appointment success rate was highest in Utah (65%) and lowest in New York (10%). Differences were observed across geographical locations, as well as between academic and private institutes.Conclusion:In our study, access to foot and ankle care clinic seems to be significantly better with BCBS private insurance compared to Medicaid. Sample size is surely a limitation, but we have included more states than similarly-designed studies for better geographic variability. There was no significant difference for appointment wait-time between Achilles tendon rupture and Bunion as well as Medicaid and BCBS insurance. Medicaid expansion facility in the state has not been associated with higher success rate but associated with lengthening of wait-time. Inability to provide insurance details or PCP-referral is definitely an important barrier for the access to podiatric care.