Same here- we often call patients back as they arrive, so that there aren't spaces where the MD's are waiting for a patient to see- but it's true, as they catch on to that they do start manipulating the system by showing up early. However, as they start showing up, the front desk gets their charts to the nurses, and then the nurses put them in order before starting to call patients back. So if the nurse's 10:00 patient is here, but it's only 9:15, and the 9:15 and 9:30 patients are here, they get called back first. If NO one is here, we'll go ahead and call the earlybird back, but even if they get into an exam room, and then someone scheduled before them shows up on time, we tell the doc so he can go in and see the scheduled patient first. If the patient(s) prior to the early bird then don't show up, no problem. Worse-case scenario is that the earlybird in the exam room might have to wait awhile, in which case we just let them know what the situation is. It's amazing how entitled people can be, though- sometimes when you call someone in from the waiting room, the person who's there 2 hours early can get really indignant and say "I was here first!!!"