FM - low pt volume in contract?

[PACdan]

Hey all,

 

Soon to be new grad (~6 months) and I have a question about patient volumes, contracts, and reality. I was recently in a small FM clinic and loved it. Primary care has been my interest from the get-go, and this solidified it for me. However, this practice was really a dream set-up. Established pts. got minimum 30 minutes visits, but the schedule was usually blocked off for 45. All new pts. got 1 hour. We usually saw ~10 a day, with 14 being the upper limit (16 once). I liked the flow, the time to really talk with the patients, chart, and look stuff up.

 

I feel as a new grad especially, a low daily pt. volume will contribute to a more conducive learning environment, allowing me to research, ask a mentor, etc. I worked in an ED where providers picked up pts at their own pace, you could get 6 per shift or 16, but it was up to you and how swamped/difficult things were atm. Clinics usually aren't as dynamic.

 

I've seen jobs in FM advertised like this: "8-12 patients per day" or "see no more than 12 patients per shift". But I often wonder how much of that is a sales pitch vs. reality. I would certainly think it prudent to get such a statement in the contract vs. relying on the job listing. And it's not as though I'm adverse to helping out even if my # has been seen, I just want to avoid getting into some place that says "okay, we have your 22 patients scheduled for today" after a month or two in. Especially for the first couple of years.

 

So, my questions:

 

How does one approach a possible employer about firm daily patient limit?

Is this something to get in the contract?

Is taking a lower salary a fair exchange for seeing less pts per day?

 

Thanks.

[rev ronin]

I negotiated 2 per hour, 25% charting time.  That means 12 patients in an 8 hour day.  I often do more in walk-in, where I chart as I go, but the point is to see no more patients than I can both 1) care for well, and 2) chart for well.

[PACdan]

Rev,

 

That sounds ideal to me! I remember you became a PA as a second career, was this something you negotiated as a new grad? If so, that's encouraging. I feel as if it's a coin toss between places that care only for volume/revenue and places that care about doing it "right", although I hope my impression is incorrect. Either way, I don't feel that I can see a great many patients in a day and still deliver the care they deserve. I'm just not shaping into that type of provider.

 

Thanks for the reply

[rev ronin]

No, it's something I negotiated after having my patient load unilaterally increased by Group Health without additional compensation and without any change in the responsibilities I was required to complete each visit.  At the time, that was a salaried position, and so I exercised my right to unilaterally modify MY end of the contract.

 

Simple business, really: I don't take pay cuts to my base salary based on company performance.  Had there been a bonus structure that responded to company profitability, like Intel had, and had Group Health managed to respond to changing economics appropriately, the outcome might have been different.

[GetMeOuttaThisMess]

25 yesterday in "snot/cough" clinic over what amounts to a 6.5' schedule (first pt. seen 15" after walking in, hr. down at lunch but was done w/i 5" of lunch break, and last pt. done within 15" of closing). This allows me to "educate" pt. for those few who seem to actually want to know but at least I can document that they were told and then chart with Cerner using drop in defaults for PMH, ROS, PE, and D/C instructions. Now I hear collaborating docs want us to add belly sx. w/o lab capability as well. Fine. "You have abdominal c/o? I'll send you over to our collaborating doc's office. You have a PCP? Hmm, should've gone to see them then, and yes, the collaborating doc's office will bill you." This is not what the original idea was for the clinic. I've got a knack for finding something that sounds great (15-20 and no PCP reaponsibility/high acuity pts.) that shortly thereafter goes to pot.