How many clinic patients do you see a day?

[rev ronin]

I believe "on average" w/o procedures, reimbursement is around $85 per patient. This family medicine. So if my numbers are ballpark close then you are bringing in $1870 a day. Maybe a practice owner could correct this $$.

They might not be, if he has a high proportion of medicaid patients. :-(

[Maverick87]

7.5 hours M-F

 

That's a lot better than some of the jobs I've seen.

 

One job wanted me to see 4 patients per hour without a lunch break. It was "part-time" so I wouldn't get any benefits. It would have been 28 patients in a 7 hour day without any break. Another one technically gave lunch breaks, but had walk-ins during these breaks. The providers that worked there told me that they sometimes would see 40 patients in a day. Yikes.

 

My new job is looking to be about 25 patients in a 10 hour day, which isn't too bad I guess. We'll see.

[Greg Cain PA-C]

It was somewhat previously agreed upon.  When I initially took the job several years ago, PAs were seeing 22.  As a new grad, I was advancing up to that number, but renegotiated 15 since I was still learning leaps and bounds.  They now want to bring it to 22.  I agree with you, it's not the type of medicine I want to practice, and I am concerned it will adversely impact my work life balance

 

 

Start looking now, unless this was a previously agreed upon change.  I wrote my patient volume expectations into my current contract.

 

 

New grad is a different story, but with 1 year + experience in IM or FP (as a practice owner) if you can't see 20+ patients a day then I don't need you as an employee.  If we assume a salary of $100k then it takes an average volume of 12-14 patients per day simply to cover your salary, work comp ins., payroll taxes, malpractice ins, etc (this doesn't include your share of the building/facility expense, nursing expenses, supplies, or billing costs which are generally 6-8% of gross receivables).  At 20 patients a day you are making roughly $30-$40k profit for the practice a year.  You are making much more off of your labor than anyone else.  If you begrudge that profit then I would encourage you to break free of the bonds of employment and start your own practice.  This is not meant to sound or be antagonistic, but rather just simply the facts.  The only reason anyone will ever hire you as a cashier at Walmart, a PA, an MD or the CEO of Walmart is with the tacit expectation that you will generate more revenue than than you consume (not just in salary but ancillary expenses as well and in the PA world that total number is $250-$300k per year including your salary).  I know these numbers intimately because I write the checks every month and have analyzed the numbers to the moon and back looking for cost savings.

 

Addendum:  The above applies only to a small private internal medicine practice that sees mostly commercial patients in a rural setting.  I have no idea how these numbers might apply to urban, hospital, specialty or large multi-specialty groups. 

[mmiller3]

That's a lot better than some of the jobs I've seen.

 

One job wanted me to see 4 patients per hour without a lunch break. It was "part-time" so I wouldn't get any benefits. It would have been 28 patients in a 7 hour day without any break. Another one technically gave lunch breaks, but had walk-ins during these breaks. The providers that worked there told me that they sometimes would see 40 patients in a day. Yikes.

 

My new job is looking to be about 25 patients in a 10 hour day, which isn't too bad I guess. We'll see.

The part in red--is that even legal? I thought a 30 minute break was required by law for any 6-hour + shift?  Maybe I am misinformed...

[WanderlustPA]

I know this thread is old, but I'm bringing it back. I'm jealous of a lot of your schedules. My practice is 10 minute acute visits and follow-ups, 20 minutes for procedures or complex problems like chest pain or abdominal pain (supposed to be, sometimes these still get scheduled as 10 min appts depending what the patient tells the scheduler), and 30 minutes for physical exams. I honestly hate the 10 minute appointments, and as others have pointed out, I really don't feel like I can give quality care to a patient in 10 minutes. My schedule tends to be a log-jam first thing in the morning, as well as at the end of the day, and the middle of the day will vary. There's no built-in time for charting. My busiest day I saw 31 patients, and that was only like 2 months into seeing patients as a new grad. I've had several mornings where I've seen 16-18 (8am until the last appt 11:30am). I do like the office, but the fast pace is burning me out already, in just over a year of practice.

[Katera]

Let's just be honest ladies and gentlemen.  There is a reason that our profession along with docs has one of the highest rates of drug abuse, anxiety, alcoholism and burnout.  And it is only going to get worse.  Now that corporate overlords are taking over just about every aspect of not just FP, but Urgent Care, ER and even specialties......profit is king.  I had one of these non-clinical "administrators" put a note on the fridge in the break room berating us for "over-time".  This was in Urgent Care...you know, where the guy with the Lac walks in 5 minutes before we close?  The best part was him referring to us "the providers" as "LABOR".  "Management is not happy with the recent uptick in over-time incurred by "labor" staying late.  Nice.

[EMSGuy1982]

Let's just be honest ladies and gentlemen. There is a reason that our profession along with docs has one of the highest rates of drug abuse, anxiety, alcoholism and burnout. And it is only going to get worse. Now that corporate overlords are taking over just about every aspect of not just FP, but Urgent Care, ER and even specialties......profit is king. I had one of these non-clinical "administrators" put a note on the fridge in the break room berating us for "over-time". This was in Urgent Care...you know, where the guy with the Lac walks in 5 minutes before we close? The best part was him referring to us "the providers" as "LABOR". "Management is not happy with the recent uptick in over-time incurred by "labor" staying late. Nice.

Sounds like someone needs to be knocked down a few pegs.... and it's not the "labor".

[BruceBanner]

From 9:15a - 6:00p, I have 16 available slots. Some of that time is dedicated charting time, and I get an hour block for lunch. But it varies depending on how many procedures I have (40 minute visits), no shows, walk-ins, etc. Average in an 8 hour workday is probably 12-14 visits.

 

In primary care, depending on the level of charting detail expected, I think 15 should be the max. For me personally, I think 8-10 should be the max, lol. Every no-show is like Christmas for me.

[BruceBanner]

Let's just be honest ladies and gentlemen.  There is a reason that our profession along with docs has one of the highest rates of drug abuse, anxiety, alcoholism and burnout.  And it is only going to get worse.  Now that corporate overlords are taking over just about every aspect of not just FP, but Urgent Care, ER and even specialties......profit is king.  I had one of these non-clinical "administrators" put a note on the fridge in the break room berating us for "over-time".  This was in Urgent Care...you know, where the guy with the Lac walks in 5 minutes before we close?  The best part was him referring to us "the providers" as "LABOR".  "Management is not happy with the recent uptick in over-time incurred by "labor" staying late.  Nice.

 

Yep, the ones demanding more production in less time are never the ones, you know, actually seeing patients.

[PAMEDIC]

I work in a rural FM/UC clinic and I think I might have one of the sweetest setups ever. I work 6 days on, 8 days off. My M-F is 11.5 hours and Sat 9.5 hours.
I only see patients on a walk-in basis, which I think is amazing. It means if it is a simple case, the visit is pretty short. If it is something pretty complicated, I am able to devote the appropriate time to that individual as is necessary.

If you are willing to come in and wait a bit, you will be seen that day. No scheduling hassles. No no-shows. No worries.

I usually see around 22-24 patients a day. My high is 36. My low is 4.

 

I love this setup.

[rev ronin]

I love this setup.

Yep.  I love walk-in only as well.  What I find to be the real challenge is "scheduled plus"--if I (through my staff) committed to my patient that I would see her at 10:30 AM, then I (and my practice) should be doing everything in my power to be ready to see the patient as soon as my on-time patient is roomed.  Emergencies can't be avoided; stupid scheduling decisions can.

[Reality Check 2]

I am stuck with 10 min appts for everything, 20 min for extended med checks and 30 min for physicals.

 

I am hard pressed to get more than 10 for most things - our front desk has way too much control.

 

So, the 10 min cough turns out to be CHF and the chest hurt turns out to be unstable angina and I am thusly screwed for the rest of the day.

 

I really really hate it and would abolish it quickly.

 

I don't think any appt should be less than 15 - Meaningless Use takes so much time and EHRs are burdensome if they are structured to the point that you can't get through the screens except in one order or have to recreate the wheel to get anything done - or it just flat doesn't work sometimes.

 

Today - I am at 21 and more will be added after lunch. It is a Tuesday but really a Monday after a holiday with doc off today. 

 

I hate these days.

[Katera]

The other wonderful corporate Urgent Care invention is the scheduling of online appointments for UC.  It's hilarious to see a patient who scheduled online walk-in to UC and say I have a 3:00pm appointment with a full lobby.  Of all 3 different UC's I have worked with who did appointments, none of them moved the pt up in line.  They simply get in line.  Boy are they pissed!  

[Reality Check 2]

The other wonderful corporate Urgent Care invention is the scheduling of online appointments for UC.  It's hilarious to see a patient who scheduled online walk-in to UC and say I have a 3:00pm appointment with a full lobby.  Of all 3 different UC's I have worked with who did appointments, none of them moved the pt up in line.  They simply get in line.  Boy are they pissed!  

 

That just reeks of "Welcome to Olive Garden. I am Jane, I'll be your server today. Can I interest you in an appetizer while you wait?"

 

And I CANNOT get our front desk to grasp that double booking is RUDE. Someone who made their appt 2 days to 2 weeks ago is on time and ready to be seen and someone else checks in for the same visit time. Very demeaning to the scheduled patient's time and promptness.

 

Someone who manages to walk in the front door grasping chest or bleeding on the counter can't be ignored or really controlled but those who call and "JUST HAVE TO BE SEEN". We need to do a better job of scheduling and education. Those who want to be worked in have usually been sick a long time and just didn't manage it well or have some benign problem that can wait. No effective triage in my world.

[EMSGuy1982]

The other wonderful corporate Urgent Care invention is the scheduling of online appointments for UC. It's hilarious to see a patient who scheduled online walk-in to UC and say I have a 3:00pm appointment with a full lobby. Of all 3 different UC's I have worked with who did appointments, none of them moved the pt up in line. They simply get in line. Boy are they pissed!

The "online check-in" setup is reminiscent of the same setup that GreatClips, a place to get your hair cut has for their business. Sadly, people are sorely mistaken when they show up. Haircuts and medical care are not the same services. :-)

[Reality Check 2]

I trained in a Level I Trauma Center and HIPPA did not exist then. The ER was a very open place and ambulances rode by the waiting room patients constantly.

 

A man complained about the wait time for his 10 days of belly pain with normal vitals. My second year resident who was pit boss that night very calmly pointed to the gurney rolling by with the multiple gunshot victim and told the man that "this man has been shot and might be dying. We have to attend to him before you and I am sorry." He was the cutest little 2nd year resident who looked all of 10 years old.

 

The man with belly pain was not impressed and asked if you had to get shot to get in line first. We weren't sure if he was just complaining or hatching a plan... The hospital is in the neighborhood good for getting shot so he wouldn't have had to go far. 

 

Such is life - everything is an emergency to everyone at some point. 

[Moe 103]

I worked in a busy peds practice with 85% Medicaid and we saw ill visits q 5 minutes and 2 well visits q 15 minutes. Add emergency visits to that and every day was a busy day. I left because when I tried to negotiate a raise, their response was we pay 15% higher than the national PA average. With most of the responses here having at least 15 minutes per visit, I should have been paid 300% above the national average. Taking the poor Medicaid reimbursement schedule that is unrealistic, but they are still grossly underpaying their PAs.

[ohiovolffemtp]

The newest curse are the web sites, phone apps, and electronically updating billboards that advise "door-to-provider" time in the ED.  Becomes a great tool for patients with minor complaints to beat you up with when you've either had a sudden rush of sign-ins or a critical patient.

[Guest ral]

Currently job searching, and just received an email from a recruiter. His client is looking for someone from 9-6, with a 1.5 hour lunch break, to see 45 pediatric patients a day. He sells the opportunity by saying that MA's do all the charting. I couldn't help but respond, explaining that his client either smokes large amounts of crack cocaine, or does very sloppy work. I usually just move along, but have recently decided I am going to point out the ridiculousness of certain ads/offers. I have responded similarly to ads for extremely low salaries. If we don't start standing up for ourselves, the profession will become diluted with cheap assembly line type labor.

**MODERATORS: maybe we could have a sub forum for unrealistic job advertisements, either by crazy high workload expectations, or terribly low compensation. Perhaps if employers, recruiters, agencies, etc. see that we are following along, and discussing/calling them out, our postition will strengthen. Just a thought.

[rev ronin]

**MODERATORS: maybe we could have a sub forum for unrealistic job advertisements, either by crazy high workload expectations, or terribly low compensation. Perhaps if employers, recruiters, agencies, etc. see that we are following along, and discussing/calling them out, our postition will strengthen. Just a thought.

I worry that any such listing will give recruiters ideas...

[HMtoPA]

I work FM, with 20-minute slots, 7:40am-3:20pm - so 20 patients/day max. Empaneled with ~1100 patients. Two of my slots are supposed to be going away, so I'll be left with 18 patients/day but expected to take walk-ins as well. I basically chart through lunch, and then stay until 5:00pm doing afternoon charting, so it ends up being 9-10 hours/day sitting at my desk or with a patient in one of the exam rooms - overall, it's not too hectic a schedule, I guess - I've only been in FM for 6 months, so I'm sure I'll get more efficient as I get a little more experience under my belt - but I do often feel like I've been through a meat grinder by the end of the day, or especially by the end of the week. Luckily, we have dedicated admin time on Thursday afternoons, so I only have to see up to 12 patients before lunch and then get a few hours to get caught up or attend to whatever random training the taskmasters have dreamt up.

 

What gets to me is the non-clinician administrators who are chock-full of "good ideas" but of course don't actually have to execute any of their plans, nor deal with a patient in anything other than abstract terms. This current state of affairs amazes me - I can't understand why so many skilled professionals are beholden to these do-nothing/know-nothing personalities. They need us and we certainly don't need them - yet they somehow call all of the shots. Very strange.

 

There is talk about us moving to 30-minute slots (!), seeing 14-16/day. Sounds great, but I'll believe it when I see it. Even if it does happen, I'm sure there will be strings attached - probably an expectation to see another 5 walk-ins/day or something. This whole thing about pandering to patients as "customers" and bending over backwards to schedule every minor sniffle with a same-day appointment, all in the name of "access," is one of the banes of modern family medicine.

 

Oh, and I didn't even mention the number of T-cons with which I'm being constantly interrupted. The nurses do a pretty good job of screening and deflecting, but a lot of things they simply have to take to us (the providers). I get it, I'm here to help - but when you're constantly having more and more heaped upon your plate, it devalues your time as a professional. Would you walk into a lawyer's office unannounced with the expectation of a face-to-face consult within minutes? It's crazy. I mean, overall I'm nit-picking, and I get paid well enough for what I do - but I definitely see how folks can get burnt out after a few years of this.

[mackjacks]

I do walk-in family medicine, almost all Medicaid. It varies from 8 on a slow day to 38 (my personal highest #) on a busy day -- several of these were probably peds. 75% of the time it is myself and another provider, so the 38 could have been a comfortable 42 (21 each) if we had two providers on schedule. I had to tell those last 4 to come back another day, as myself and the staff were already staying late. One day this week, 21 was a nightmare with complex patients with multiple complaints and comorbidities - no way I could have seen 38 solo on a day like that.

[ventana]

 

There is talk about us moving to 30-minute slots (!), seeing 14-16/day. Sounds great, but I'll believe it when I see it. Even if it does happen, I'm sure there will be strings attached - probably an expectation to see another 5 walk-ins/day or something. This whole thing about pandering to patients as "customers" and bending over backwards to schedule every minor sniffle with a same-day appointment, all in the name of "access," is one of the banes of modern family medicine.

 

Oh, and I didn't even mention the number of T-cons with which I'm being constantly interrupted. The nurses do a pretty good job of screening and deflecting, but a lot of things they simply have to take to us (the providers). I get it, I'm here to help - but when you're constantly having more and more heaped upon your plate, it devalues your time as a professional. Would you walk into a lawyer's office unannounced with the expectation of a face-to-face consult within minutes? It's crazy. I mean, overall I'm nit-picking, and I get paid well enough for what I do - but I definitely see how folks can get burnt out after a few years of this.

 

 

30 min is very reasonable - many local practices are going to it - no way to do Primary care medicine with EMR and meaningless use and all the other crap that they have piled on with out atleast a 30 min slot

 

interruptions...

I used to get a lot more then I do now..... the difference?  I am no longer allowing it..... I counsel the person that interrupted me after a 'senseless' interruption that it could have/should have waited.  honestly we are not an ER so there really is no such thing a life and death - it ALL can wait!  (course the AMI sitting in the waiting room can't wait, but your office staff should handle this LONG before you arrive - ie call 911!)

 

As for administrators - yup no clue - - -  recently had a discussion because they were trying to figure out why it took so much time to sign off lab results  they said "look, when they are all normal don't you just initial them?  that takes 2 seconds"     I had to explain to them that this is almost never the case and the specific example they were using was a depakote level with a previous low white count whom we were titrating up based on the lab values while also monitoring for myelosuppression....   Admin truly does not get it - and it has become the providers responsibility to stand together and push back hard to get to a reasonable schedule so that we can practice good medicine and care for our patients.  A good administrator will listen, a bad one will not.

[Reality Check 2]

My solo private doc will NEVER get it. 10 min slots and 20 min "complex" slots. 26 yesterday for me - 28 for him. It was STUPID.

 

No one is just sick - 1 DVT >80 yrs on for some asinine reason getting testosterone from him. One complete bladder obstruction with a prostate the size of Alaska. 2 pneumonias and one lung cancer. Out of 26 people - that isn't medicine - it is McDonalds.

 

Everyone thinks they have the mumps and the number does continue to grow. 

 

Throw in phone calls, confused pharmacies, lab results which are never normal and everything else including a clueless office manager and staff members having personal crises in the midst of it all. 

 

So I continue my search for something reasonable and fear it isn't out there. 

 

But, I can't see doing this at this pace with these conditions for 20 more years. Not sure I will make the rest of the year. It isn't safe, it isn't healthy for me and it isn't a good precedent to set for anyone else. 

 

Another vote for autonomy and independent practice rights - if I could keep myself in business at a reasonable pace and find qualified support staff.

[SoCal_PA]

In my 10 hour ER shift, I average 2 patients/hr but recently it has been 3. Many times, I am signed up for 6-8 at once. As a new grad, it is hard to keep up with patient care and charting and I often stay 1-2 hours after shift to finish up