How many clinic patients do you see a day?

[sas5814]

When I was in FP in a rural health clinic we saw 30 a day on average.

[PA-C]

I work three 12 hr days in derm, 1 hr lunch break and 11 hours of appointments. I typically see anywhere from 45 - 55 patients a day. Appointments are either 10 or 15 min long. The max number of patients that the schedule would allow for is 66 if every appointment was 10 min long.

[PACdan]

23 minutes ago, PA-C said:

I work three 12 hr days in derm, 1 hr lunch break and 11 hours of appointments. I typically see anywhere from 45 - 55 patients a day. Appointments are either 10 or 15 min long. The max number of patients that the schedule would allow for is 66 if every appointment was 10 min long.

Unless you are doing only sports physicals or immunization visits all day long (and even then) this is wholly unsafe and unsustainable. Why would you subject yourself to this breed of medicine?

45-55 a day? 10 minute appointments? What is being accomplished besides more billing and revenue for some business owners...

The sad part is some admin or clinic director will come upon this and think "wow, what a great idea to make more money, I'll have our PAs do this" and they'll use it as proof positive "see, others are doing it".

Anything over 3 an hour avg in primary care is pushing the revelance of the primary care in the first place. No wonder there is such widespread burn out. We should oppose any group or business that tries to push this insane scheduling. It only enriches them and does both the provider and patient a disservice.

[mgriffiths]

1 hour ago, PA-C said:

I work three 12 hr days in derm,

32 minutes ago, PACdan said:

Unless you are doing only sports physicals or immunization visits all day long (and even then) this is wholly unsafe and unsustainable. Why would you subject yourself to this breed of medicine?

I highly doubt PA-C is doing sports physicals or immunization visits while working derm.

[DizzyJ]

1 hour ago, PA-C said:

I work three 12 hr days in derm, 1 hr lunch break and 11 hours of appointments. I typically see anywhere from 45 - 55 patients a day. Appointments are either 10 or 15 min long. The max number of patients that the schedule would allow for is 66 if every appointment was 10 min long.

I hope you are making at least $300K for seeing 2-3 providers worth of patients per day. 

[sk732]

I seem to recall my preceptor in anaesthesia telling me why he became an anaesthetist - he was an ophthalmologist and quit after his first year of residency, since, as he put it, he was tired of seeing and charting on 80-90 patients a day.

I'd have to GUESS that many dermatologists likely spend more time on charting than the 30 or 40 seconds it takes them to identify a rash or mole...unless they do a lot of surgeries.

SK

[PA-C]

12 hours ago, mgriffiths said:

I highly doubt PA-C is doing sports physicals or immunization visits while working derm.

Right, none of that in derm. I do agree that the patient volume per provider is a lot though. I am definitely more comfortable with the days where I have ~44, rather than 50+ in 11 hours. While the schedule technically allows for a max of 66, the most I've ever seen on a provider's schedule so far is 57. The most I've had is 53.  Each provider has several MAs that also function as scribes and do 90% of the charting for us, so that is extremely helpful. It's still easy to run behind though, especially when a patient with a 10 minute "lesion" appointment shows up 5 minutes late and brings up their acne, hair loss, and new rash and expects all of it to be addressed at that visit.

[kmash]

I'm a scribe pending PA school in January and in the ED, we see 15-20 patients in a 10 hour shift.  If they are time consuming patients (conscious sedation, reductions, extensive lacerations, PO contrast), then we'll see about 15.  I love staying busy though cause it makes the day fly by.

[rev ronin]

So since I originally answered this question, I've switched practices.  I still see 12 in Family/Occupational medicine, but am seeing 18-20/day in sleep medicine, and feeling really good about both numbers.

[BruceBanner]

I've changed practices as well; in university health we see between 16-30 in an 8 hour day. Usually around 20-25. It's generally really easy stuff though; colds/flu, STI checks, rashes, minor injuries.

[WeBuyAndSellJunk]

18-22 in an 8 hour day. Community health center with large migrant population in the SE.

I see everyone saying that 10 is a great patient load for a half day, but I feel like this patient population deserves/requires(?) way more time than the typical 10-15 minutes you get with them. I enjoy the complexity at times, but the disorganization that is apparent within the clinic and within the patient population also results in a lot of challenges and time crunches. The further I get along (4th year practicing), the more I can directly relate my burn-out and anxieties to this place versus just medicine or being a PA. No wonder there are incentives to work in places like this and they still can't find people.  

EDIT: It is kind of like doing all of the crap work of a fast track ER with all of the expectations of being the PCP also. All of this for like 3/5 the pay. Maybe I have some serious compassion fatigue... lol

[GetMeOuttaThisMess]

23 minutes ago, printer2100 said:

It is kind of like doing all of the crap work of a fast track ER with all of the expectations of being the PCP also. All of this for like 3/5 the pay. Maybe I have some serious compassion fatigue...

THIS sums it up pretty well.  

[WeBuyAndSellJunk]

I think the hardest part is trying to figure out at this point if another primary care job would have the same complexities and stresses. I am shying towards a specialty, but love my 4d work week and PTO/holiday schedule. 

[sas5814]

6 minutes ago, printer2100 said:

I think the hardest part is trying to figure out at this point if another primary care job would have the same complexities and stresses. I am shying towards a specialty, but love my 4d work week and PTO/holiday schedule. 

That is always the issue isn't it? 90 days after I took my current job, which is pretty low stress and pretty well paid, They made some major changes to how we are scheduled and the number of hours we have to work monthly to maintain our full time status. (I'm in urgent care). So I occasionally think about doing something else just because they unilaterally made all these changes effectively shoving my employment contract in the shredder. Then I assess some of the things that are important. I am never on call...I hate call. We are part of a huge hospital sytem so they don't want us trying to figure out things like chest pain....just send them to the ER. Unlike several private UCs I worked in we don't follow people's long term problems like diabetes and HTN. We DO follow evidence based medicine and if that means someone gets mad because they didn't get an antibiotic for their cold...oh well.

So rather than bail I'm trying to help design a better schedule that meets the needs of the organization and the providers. It may come to a break point where the bad outweighs the good but if there is a perfect job out there I haven't seen it.

[mgriffiths]

1 hour ago, sas5814 said:

if there is a perfect job out there I haven't seen it.

This is SO TRUE!

[GetMeOuttaThisMess]

This is SO TRUE!

Shhh! Don't let the secret out that we play musical chairs with a lot of these positions. I'm not getting out of my chair till I'm ready to leave the party.

[Colorado]

I haven't started yet, but have shadowed and seen the numbers (pts seen/day, time spent on pts)

I work ten, 4-hr sessions/week). I am expected to see 9 pts per session (so 18/day)

Productivity bonus is based on the # of pts I see per session and varies from $40/pt to $55/pt with no cap on the amount of bonus I can make annually. FP-Schedule pts and walk-ins. Speaking with others, everyone gets a decent amount.

In big numbers, if I see an average of 22/day over the course of a year, thats around $34K bonus on top of my base salary. I haven't seen this kind of structure before, usually RVUs and % of collections types of bonus structures. Is anyone else familiar with this or have thoughts on it to contribute?

[mgriffiths]

On 1/24/2017 at 7:55 AM, Avalon said:

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.

I work in family medicine, and currently see approximately 15 patients per day.  Obviously it varies based on patients.  But, Michigan just passed a law stating that any patient on chronic opioids must be seen monthly.  That increases the patient load for every provider in our office by 3-5 patients per day (I know opioids are bad everywhere, but in rural location and in last 5 years have had 4 providers jailed for inappropriate prescribing and our practice inherited almost all of those patients).  The plan is that I will do two "narc days" per week.  These will simply be for fulfilling state requirement and refilling narcotics, NOTHING ELSE.  The plan is 10 minutes appointments, but these will be quick and I will be able to template almost the entire note.  That is doable - will be hard day - but doable, 10 minute physicals with well woman exam...that's dangerous.  Just the process of getting set up for a well woman exam can take 10 minutes if the patient is nervous or has a problem.  I almost have to think the previous provider was charting things he/she was not actually doing, i.e. FRAUD.

[lkth487]

On 1/29/2017 at 10:32 AM, JMPA said:

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

Harsh man. 

[lkth487]

People get to make whatever life decisions they want.  Outside of the ICU, the specialty at my institution with most PAs is pedi heme/onc, and with those kids, a pedi heme/onc or a BMT attending sees every patient.  But I think all of the PAs that work at the institution feel valued and do have a lot of responsibility. 

[lkth487]

To answer the original question, the senior residents, PA and NPs have the same number of slots at our outpatient clinic (for pediatrics).  Generally an even split between wells and urgents.  It's very manageable and I feel like I have plenty of time to spend with the patients who need it.