How many clinic patients do you see a day?

[Guest Paula]

Family Practice/General Internal Medicine.  I must see patients face to face visits for 36 hours a week.  No charting time is built in as the administrators say 30 minutes is plenty of time to chart.  

 

i work M: 8-7

Tuesday: Day off

W, TH, and Fri: 8-5.  

 

Work one half Saturday about every 16 weeks or so.  On-call for weekend nursing home call about once every 16 weeks.  I haven't been on call for a long time so I am secretly hoping someone forgot to add me to the updated list.  I am keeping quiet . 

 

One half hour lunch (which is usually either used to chart or to finish up a patient).

 

Goal is to see 16 patients a day, plus to "squeeze"   into my schedule any patient who is a "quick sick" meaning they are really having  heart attack or in the midst of a rectal abscess and diverticulitis infection.  LOL!

 

Many days I can handle it but there are days when I have no shows and the MA and I are jumping for joy for an opportunity to catch up to all the paper work, charting, answering e-coms, reviewing labs and X-rays, and doing PAs (Prior Authorizations).

[Reality Check 2]

Family Practice/General Internal Medicine.  I must see patients face to face visits for 36 hours a week.  No charting time is built in as the administrators say 30 minutes is plenty of time to chart.  

 

i work M: 8-7

Tuesday: Day off

W, TH, and Fri: 8-5.  

 

Work one half Saturday about every 16 weeks or so.  On-call for weekend nursing home call about once every 16 weeks.  I haven't been on call for a long time so I am secretly hoping someone forgot to add me to the updated list.  I am keeping quiet . 

 

One half hour lunch (which is usually either used to chart or to finish up a patient).

 

Goal is to see 16 patients a day, plus to "squeeze"   into my schedule any patient who is a "quick sick" meaning they are really having  heart attack or in the midst of a rectal abscess and diverticulitis infection.  LOL!

 

Many days I can handle it but there are days when I have no shows and the MA and I are jumping for joy for an opportunity to catch up to all the paper work, charting, answering e-coms, reviewing labs and X-rays, and doing PAs (Prior Authorizations).

 

Obviously a schedule created by someone who has not one ounce of an idea what we do.

Burning me out quickly.

[Avalon]

Recent developments at my place of employment relate to this topic.  We've had a change in staff and I am stepping in for another provider in addition to covering my usual hours.  CP now expects (because the terminated clinician agreed to this) that I conduct well woman exams at a rate of six patients per hour.

 

Let me repeat that a bit differently: I am expected to conduct an annual, well woman exam in ten minutes. That is complete with updating the HPI, reviewing the prior year's note, reviewing the pertinent history, completing the physical exam, documenting my findings, sending any necessary prescriptions, doing any appropriate counseling (e.g., bone health, safe sex, breast self exam, etc.), and completing the billing.

 

Should the patient complain of a "problem" (e.g., anything ​other than the most narrowly defined annual exam), I am now expected to address that, write a separate, billable note for the "problem," and still complete the visit in the ten minute time slot.  CP is increasingly frustrated that I am taking time outside of the room (lunch, at the end of the day, etc.) to complete notes. 

 

This is not consistent with the level of care I expect from myself. Although my staff (several of whom are patients of the practice) are in full support of my resistance, CP is on a rampage, fueled by having lost the previous, high volume (? low quality) provider.  I've only been here one year but am thinking I need to move on.

[RuralER/Ortho]

Recent developments at my place of employment relate to this topic. We've had a change in staff and I am stepping in for another provider in addition to covering my usual hours. CP now expects (because the terminated clinician agreed to this) that I conduct well woman exams at a rate of six patients per hour.

 

Let me repeat that a bit differently: I am expected to conduct an annual, well woman exam in ten minutes. That is complete with updating the HPI, reviewing the prior year's note, reviewing the pertinent history, completing the physical exam, documenting my findings, sending any necessary prescriptions, doing any appropriate counseling (e.g., bone health, safe sex, breast self exam, etc.), and completing the billing.

 

Should the patient complain of a "problem" (e.g., anything ​other than the most narrowly defined annual exam), I am now expected to address that, write a separate, billable note for the "problem," and still complete the visit in the ten minute time slot. CP is increasingly frustrated that I am taking time outside of the room (lunch, at the end of the day, etc.) to complete notes.

 

This is not consistent with the level of care I expect from myself. Although my staff (several of whom are patients of the practice) are in full support of my resistance, CP is on a rampage, fueled by having lost the previous, high volume (? low quality) provider. I've only been here one year but am thinking I need to move on.

Brush up your CV. That sounds miserable and in no way sustainable.

[ventana]

Recent developments at my place of employment relate to this topic.  We've had a change in staff and I am stepping in for another provider in addition to covering my usual hours.  CP now expects (because the terminated clinician agreed to this) that I conduct well woman exams at a rate of six patients per hour.

 

Let me repeat that a bit differently: I am expected to conduct an annual, well woman exam in ten minutes. That is complete with updating the HPI, reviewing the prior year's note, reviewing the pertinent history, completing the physical exam, documenting my findings, sending any necessary prescriptions, doing any appropriate counseling (e.g., bone health, safe sex, breast self exam, etc.), and completing the billing.

 

Should the patient complain of a "problem" (e.g., anything ​other than the most narrowly defined annual exam), I am now expected to address that, write a separate, billable note for the "problem," and still complete the visit in the ten minute time slot.  CP is increasingly frustrated that I am taking time outside of the room (lunch, at the end of the day, etc.) to complete notes. 

 

This is not consistent with the level of care I expect from myself. Although my staff (several of whom are patients of the practice) are in full support of my resistance, CP is on a rampage, fueled by having lost the previous, high volume (? low quality) provider.  I've only been here one year but am thinking I need to move on.

 

 

just because another worker okayed it does not mean you have to 

 

it is your schedule, simply professional state that is not your standard and you will not do it

sounds like a time for a sit down talk with the boss/owner/doc and in a very professional manor - pointing out that you would not want to miss something and get them sued (or that you have never heard nor seen anyone able to provide good medicine with this schedule - and look the person doing it QUIT/LEFT)

 

 

I would identify the problem,  ie lack of staff and being expected to overproduce

provide a solution - I will see X number of patients - broken down by annual versus sick call versus routine follow up with a max of 20 patients per

Provide the solution to the problem

then no matter how much kicking, screaming, crying, ranting, raving and threatening the doc/boss/administrator does stick by your guns (make sure your proposal is reasonable so they can not call you a primadona - which they will do)   they will likely realize it - and you will have won the power struggle - if not QUIETLY look for another job - DO NOT TELL THEM A THINK till you submit your resignation 

 

 

BTW who do you thinks is getting 100% of the extra revenue by you doing all this?  or basically fraudulently billing for services that were pretty much not completed - the doc - no wonder they are trying to force this - they are making a TON-O-MONEY off you

 

 

I you are in a typical PCP office I would say 20 or maybe 25 patients a day in a HUGE overproduction practice as the MAX (likely the more sane level is 15-18!!)- over that is simply fraud and crappy medicine 

read the literature on what PCP should be, and realize you are merely a profit center...

[ohiovolffemtp]

EM: anywhere between 1.5-1.7 hour if mostly level 2-3's, up to 2.5/hour (patients + procedures) if level 4's.

[Guest Paula]

Obviously a schedule created by someone who has not one ounce of an idea what we do.

Burning me out quickly.

 

 

Yup, I'm doing a slow burn....can feel it coming.....wishing....wishing...wishing ....I was old enough for medicare so I can retire from the rat race of the administrator/corporate medicine rampage that is harming our patients and country.

[Maverick87]

My situation is awesome. I work in a specialty. We have a situation where the physicians see each patient. The PAs start the patient off, come up with a plan, and execute the plan. The physicians pop in midway through and talk to the patients, confirm our plans, etc. This way, we see the patients, do most of the work, and also learn a ton with limited liability.

 

I, personally, see anywhere from about 10 to about 20 patients per day. If we (the PAs) get too far beyond with patients, the physicians jump in and see them. We work as a team.

 

I also get to do research (I'm currently participating in Phase II clinical trials).

 

And, get this, my opinion matters here. I've noticed things that were less-than-efficient and brought it up to the practice owners. They decided on the spot that it was a good idea and implemented it immediately.

 

This is the benefit of working for a group that is owned by entrepreneurial physicians. They know how to run a business and they treat their staff well. I love this job!

[Guest Paula]

^^^^^^and the physician can bill incident to each time since they "pop" in and see the patient?

[SedRate]

^^^^^^and the physician can bill incident to each time since they "pop" in and see the patient?

I believe you can bill incident-to as long as the physician consulted on the patient initially, the PA is following the physician's treatment plan, and the physician is active in the patient's care. I believe there is another stipulation but it's not coming to mind right now.

[SedRate]

Ah, here we go: PA must be an employee and supervised by the physician and the physician must be physically available in the same office if the need for their services arises.

[Guest JMPA]

My situation is awesome. I work in a specialty. We have a situation where the physicians see each patient. The PAs start the patient off, come up with a plan, and execute the plan. The physicians pop in midway through and talk to the patients, confirm our plans, etc. This way, we see the patients, do most of the work, and also learn a ton with limited liability.

 

I, personally, see anywhere from about 10 to about 20 patients per day. If we (the PAs) get too far beyond with patients, the physicians jump in and see them. We work as a team.

 

I also get to do research (I'm currently participating in Phase II clinical trials).

 

And, get this, my opinion matters here. I've noticed things that were less-than-efficient and brought it up to the practice owners. They decided on the spot that it was a good idea and implemented it immediately.

 

This is the benefit of working for a group that is owned by entrepreneurial physicians. They know how to run a business and they treat their staff well. I love this job!

this is what we call a glorified scribe, he "pops" his head in to bill full rate while you do all the work. this is a complete waste of your training and will not help you in outside "real" practice of medicine. i look down at PAs who belittle our glorious profession by such degrading behaviour

[south]

this is what we call a glorified scribe, he "pops" his head in to bill full rate while you do all the work. this is a complete waste of your training and will not help you in outside "real" practice of medicine. i look down at PAs who belittle our glorious profession by such degrading behaviour

 

Nice attitude.  You honestly think that something besides exactly what you might be doing (that makes someone quite happy) isn't "real" medicine. Sad, but oh so adorable.  

 

Unless trolling. Then I did not fall for your clever ruse!  Good day!

[Guest JMPA]

Nice attitude.  You honestly think that something besides exactly what you might be doing (that makes someone quite happy) isn't "real" medicine. Sad, but oh so adorable.  

 

Unless trolling. Then I did not fall for your clever ruse!  Good day!

it saddens me to think that there are people who believe that this is acceptable behaviour. PAs should not infringe on the scribe profession.

[south]

it saddens me to think that there are people who believe that this is acceptable behaviour. PAs should not infringe on the scribe profession.

 

Having been both, I am unaware of any scribe who sees patients, does physical examinations and provides prescriptions.

 

For some reason, the fact that another practice functions differently than yours is very bothersome to you.  Even though there are entire specialties that work like this.  

 

Wait a second...only a Sith thinks in absolutes!

[jlumsden]

I am transitioning into a new job.   Two months in.  The goal is to see 15+ patients in a ten hour shift.  I am at about 10-11 on a good day.   We leave a good portion of my schedule open for patients who need same day appointments, as their PCPs are usually full.  There is time built in to chart, catch up on patient messages, cover other providers' boxes, and attend grand rounds or other trainings.

[Maverick87]

this is what we call a glorified scribe, he "pops" his head in to bill full rate while you do all the work. this is a complete waste of your training and will not help you in outside "real" practice of medicine. i look down at PAs who belittle our glorious profession by such degrading behaviour

 

Look down on it all you want. I love the setup.

 

If you'd like a shit job where you work your ass off and incur a doctor's liability without the pay to go with it, have at it, hoss. I'll take the fun, interesting, less stressful job with cool bosses and research component.

 

PS: Calm down with obvious bitterness. It's not a good look, friend.

[Maverick87]

Having been both, I am unaware of any scribe who sees patients, does physical examinations and provides prescriptions.

 

For some reason, the fact that another practice functions differently than yours is very bothersome to you.  Even though there are entire specialties that work like this.  

 

Wait a second...only a Sith thinks in absolutes!

 

Exactly. I've interviewed at multiple specialty practices and a good portion are run this way.

 

Ultimately, this setup is a great business move for the physician owners: they get to see more patients and get to bill higher.

 

And it's good for us: no liability at all, little to no stress, work is finished at work (and I have legit 40 hour week). Plus, I get paid well and have great benefits. And, as I said, I'm intimately involved in research to the point that I actually feel like I'm making a difference in medicine as a whole, instead of just churning out patients.

 

Way way better than my previous military primary care job where I had complete autonomy, but was getting crapped on constantly and regularly working 60+ hours per week with that feeling of impending doom before going to work.

 

I'm never leaving this job!

[Guest JMPA]

Look down on it all you want. I love the setup.

 

If you'd like a shit job where you work your ass off and incur a doctor's liability without the pay to go with it, have at it, hoss. I'll take the fun, interesting, less stressful job with cool bosses and research component.

 

PS: Calm down with obvious bitterness. It's not a good look, friend.

typical nurse response

[Maverick87]

typical nurse response

Typical wanna be doctor response.

 

Know your role or go to medical school.

[GetMeOuttaThisMess]

Being the "old man" provider from wagon wheel days, I've done it both ways.  The former when first out of school and primarily functioning as what we know today as a scribe/non-licensed PA who couldn't see a patient solo anyway (we weren't licensed then and not only couldn't prescribe but had to get APAP or lab hospital orders verbally ok'd or co-signed to be acted upon), and the latter present day where the two docs have never seen a patient in our facility.  The former in spine and later cardiology specialty settings, and the latter in a snot/cough setting for governmental entities.  In between, primarily EM when PA's were in the formative specialty years for this setting, it was a mix, depending on which physician was working.  I think my ability to be "first on the scene" as the initial PA in the cardiology and EM settings were an advantage since I set the bar for those who followed.  Personally, I'm in it today primarily as a mercenary looking for the monthly paycheck and benefits.  That being said, I really enjoy helping those who "want to see the light" and understand what it is that's going on with them, or picking up on a diagnosis that others missed either because they didn't know (experience does help) or didn't care to look.  Most today don't care why, they just want to feel better (sorry folks, but primary Gen X'ers and Millineals).

 

There are benefits in each setting as has already been described.  In my present setting with my background, I like the low/no stress setting but am thankful for the higher acuity experience where I know what to look for when snot/cough is not just snot/cough.  To each their own and be thankful for the paycheck, and even more so if respected for the service that you offer your respective employer.  Now back to our regularly scheduled programming.

[Contrarian]

8:30am - 4:30pm

1 hour lunch

 

30 minutes for follow ups.

60 minutes for New to me patients.

 

Usually 8-14/day

 

Sit, listen, talk/teach.

 

Luv Psychiatry...!

 

; - )

[mmiller3]

8:30am - 4:30pm

1 hour lunch

 

30 minutes for follow ups.

60 minutes for New to me patients.

 

Usually 8-14/day

 

Sit, listen, talk/teach.

 

Luv Psychiatry...!

 

; - )

I wish I could find a psychiatry position open to training. It seems all the positions in Illinois are either looking for experience, or open to NPs only.

[pacificcoast7]

I'd say the key to finding a job in primary care is go for the critical access hospitals. The schedules are great and generally benefits and pay above average. I work 4x 10 days with 2hr admin a day. I see typically 7-10 patients per day though I have seen as little as 2 and as much as 15. I have no idea how someone manages to see 20+ patients in a day. About 50% of my visits are simple acute care visits which helps me stay on schedule. I love the job and the time we get with patients. The location is rather cold and remote but I see it as the cost of not being overworked and underappreciated.

[marktheshark89]

I have 15 minute appointments for follow ups, established patients, easier complaints. 30 minute appointments for preops, school or work physicals, more complicated patients, or new patients, and 45 minute appointments for annual physicals. We also have walk-in patients that whichever provider has the time to see will see. I'd say my average is 20-25 per day, but it varies. I get paid much higher than average for primary care, but even with that and my overhead there is around 150k profit from me that gets split with my practice owners. I am working towards partnership though, so eventually I will get a piece of that as well.