Patient load for a new grad

[NewGradLyn]

So, I have a job offer, and I feel good about it except for one thing: the patient load. Here's the situation:

 

This is an internal medicine practice located near a major metro area. The doctor is going to let me shadow/train for 3-4 months full-time until my credentialing becomes approved. Then, I will start seeing 1 patient every 30 minutes for 1 month. After that, I am supposed to see 1 patient every 15 minutes. The days are 8 hours, so that means I will be seeing 30-32 patients/day in internal medicine. However, I'm sure the long period of training will be very helpful in my transition. The doctor is also a very good teacher/mentor.

 

Is this reasonable given the long training period? Or is it still unreasonable for a new grad?

 

I think this is a great position otherwise. I'd appreciate any advice ya'll are willing to give me. Thank you.

[Guest ERCat]

That sounds absolutely insane as a new grad! I think two patients an hour is reasonable. Yes - even with the long training period (which I hope you're getting paid for). Four months of shadowing isn't going to make you ready to take on that patient load. It's no comparison because I work ER BUT I never handle more than two patients per hour! Not yet anyway.

[marktheshark89]

I think it depends, if its 3-4 months of you doing the H and P and writing notes and presenting to the doc like a student, then this plan MAY be feasible as you'd be practicing what your role will be once you credentialing is completed. i'd ask for more time at the 1 per 30 min scheduling, atleast 2 months or so then slowly transition. I'm 6 months out in primary care and I get 15 mins for follow ups, simple cases; 30 mins for new patient consults or complicated patients/cases, and 45 mins for physicals. I didn't have a training period, but started at 1/hr for a month, then 1/half hour for around 2-3 months, Now im on the schedule listed above which is what the other providers typically do. I am also still building up my patient base so I do typically have a couple unfilled 15 minute slots each day. We also don't schedule anyone from 1230-130 so if needed I can catch up for 30 mins there and still have a solid half hour for lunch.

[Guest Paula]

One patient every 15 minutes is reasonable if the only thing you are doing is refilling prescriptions, and only refilling prescriptions.  

 

I work FP/IM and have been a PA since 2004.  I get 30 minute appointments for every patient.  The downside is a brand new patient to the clinic takes more than 30 minutes, especially the elderly person with a boatload of medicines and no records.  I've learned to be efficient and the MA who works with me does a really good job of gathering HPI (she almost is acting as a scribe) and I can cut and paste her notes into my chart, with tweaking.

 

15 minute appointments will be a road to burn out if the practice, in fact, enforces it.  

 

Has the practice had a PA before?  How were they utilized?  If you are the first PA there you may need to clarify what your role is and expectation of scope of practice. 

[NewGradLyn]

The practice has had PAs before. I asked one of the PAs to clarify, and she said I get 30 minutes for physicals, pap smears, new patients, and hospital follow-ups. There are also six 15-minute blocks on the schedule to allow for catching up on charting. So the maximum patient load per day is actually 28, but she said she has never seen more than 24 patients because there are always a few no-shows. 

 

The PA said a good portion of the appointments are just refills and lab follow-ups. She also said there are a good portion of complex patients as well and they discuss what they can in 15 minutes and schedule patients for additional appointments as necessary. 

 

Is this reasonable? Or not?

[Z PA-C]

The practice has had PAs before. I asked one of the PAs to clarify, and she said I get 30 minutes for physicals, pap smears, new patients, and hospital follow-ups. There are also six 15-minute blocks on the schedule to allow for catching up on charting. So the maximum patient load per day is actually 28, but she said she has never seen more than 24 patients because there are always a few no-shows. 

 

The PA said a good portion of the appointments are just refills and lab follow-ups. She also said there are a good portion of complex patients as well and they discuss what they can in 15 minutes and schedule patients for additional appointments as necessary. 

 

Is this reasonable? Or not?

That sounds appropriate to me

[BruceBanner]

I think 1 hour per pt for new grads in IM/FP.

 

After a month or so 30 mins per pt is appropriate.

 

When I started FP I wasnt a new grad but they started me at about 8 pts a day.

 

Side note, I think this is a problem in the workforce. Practices (private especially) expect new grads to hit the ground running, then fire them or discipline them when they cant keep up or start making mistakes. "Oh yeah, we'll work with you". No they wont. They have business to run and obviously need labor. Most of us are not residency-trained. You wouldn't expect an MS4 or an intern to see 24-30 PPD would you?

 

There is this perennial misconception that we are out-of-the-box ready.

[Reality Check 2]

In true Internal Medicine with aging, sick people - 20-30 minutes per person is a minimum.

 

You can't really accomplish ANYTHING in 15 minutes with an IM patient unless they have a UTI - and then hope they aren't on coumadin and you have drug interactions to deal with.

 

24 per day is rough in FP - even with cute kids with simple strep. I am happy at 18, pressured at 20, grouchy at 23 and flat out pissed and freaked out beyond that.

 

Medicine is not Burger King.....

 

As a new grad - you need to learn HOW to chart - not how to USE the EMR but how to actually chart a decent and respectable note given the potential piece of crap EHR you have. You need to learn how to order labs, xrays, MRIs, answer phone calls, take time to pee, ask questions, find anything in the office, etc etc etc.

 

I am glad the doc is a mentor and teacher. 

 

However, reality and burnout are very real and will kick your butt sooner than later.

 

I would push for 20-40 minute appts and a ceiling of say 20 max if not 18 - 9 in the morning, 9 in the afternoon and a real lunch without phones or walk ins.

 

My very old 2 cents