I never call to make appointments with my therapist. I see her every Tuesday at 2 pm, unless one of us is on vacation. It's all recurring. Even then, the future appointments are confirmed with her during an appointment. She doesn't have a secretary. I only call or email her in an emergency or if something major happens where I need her before, or to give a heads up. In those cases, she might fit me in before the next Tuesday or provide support via email.

As for my psychiatrist, he doesn't have a secretary or nurse either. He schedules my next appointments at the end of a previous ones. I usually have two future appointments with him on my schedule. If I'm in a concerning mental state or have questions or need medication refills, he can be called. He almost always responds in less than 24 hours, usually 2 to 8 hours. If I need an emergency appointment before the next prescheduled one, he usually fits me in within a few days max. Often next day. Many times, unless I am in an extremely bad state, he can simply assist me via phone. He might say "Start taking an extra 50 mg of Seroquel XR, then call me again in a couple days to report in." Most of my prescheduled appointments are between 2 and 3 weeks of each other, unless he takes a long vacation or I'm doing extremely well. Then maybe 6. In the case of his vacations, he usually has a backup psychiatrist arrangement. I've had to take advantage of that a couple times in the past. Again, such emergency appointments happened usually 2 days max after calling.

I know the above is quite ideal. I don't take it for granted.