The increased demand over the past decade for gastrointestinal endoscopy, particularly colonoscopy, has led to a greater use of open-access scheduling models in gastroenterology practices. Open-access procedures help to increase the overall capacity of a gastroenterology practice. Eliminating preprocedure office visits in selected patients provides an efficient means to meet the growing need for colorectal cancer screening and possibly other endoscopic services, such as screening for Berrett's esophagus; however, it also presents unique challenges with regards to assuring proper procedure indication, minimizing medicolegal risks, and communicating with patients and referring providers before and after the procedure. When done properly, there is a high degree of satisfaction among patients and referring physicians with open-access models.