Over the last decade the term access has been used to describe the ease with which insured populations receive care. This has become a significant market issue and continues to be an important clinical issue. This article suggests that relying on clinical definitions of good access is no longer useful. The authors recommend a definition based on the patient's perspective: "The ability to seek and receive care from the provider of choice at the time the patient chooses." The authors describe a model for analyzing access systems and identify three major types. The strengths and weaknesses of each are described and the most successful access system is described in detail. This Second Generation Open Access system offers an appointment today for any problem, exceeds all regulatory requirements for access, matches patients with their PCP at unprecedented rates, reduces overall utilization, and improves patient, staff, and physician satisfaction.