How many patients a day?

[Miaow]

For those who are clinic based, is there a set expectation as to how many patient you need to see in a day? My template was recently set to see 25 patients in a day with hours of 8 - 4. I'm curious to know if others have the same requirements. Thanks!

[airslant]

21....We are designed for 2 new patients, 1 hospital follow up, 5 walk ins, and 13 follow up appointments for a total of 21 appointments. I really saw 24 today though because I'm hustling for three potential $50,000 rvu bonus.

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[marktheshark89]

I don’t have a template but we get 15 mins for brief visits/follow ups, 30 mins for preop physicals/new patients/DOT physicals/hospital follow ups, and 45 mins for annual physicals. In an 8 hour day, depending on the mix of the above, it can range from 15-30 with it most commonly falling between 20-25 daily. 

[Guest UVAPAC]

I think it all depends on the field which you work in, obviously there are patients that require more time...

In my occupational medicine clinic we get 15 minutes regardless of the type of visit.  (PE/DOT PE/new worker's compensation injury, follow up worker's compensation injury, consultation, return to work).  There have been numerous times where we get a walk-in laceration requiring 10-15 stitches, and then can set you back quite a bit on a busy day.

I would say that there are days when I see 15 patients and days where I have seen as many as 30 patients a day.  (In my office we also are responsible for PPD plants, and vaccine administration.  The MD's refuse to plant PPD's or immunizations, so they are all placed on PA/APRN schedules, but does not count as us seeing a patient).  

[PAMEDIC]

Usually 8 a day in my FM clinic. Sometimes more. Sometimes less.  Because of no-shows, I saw 4 yesterday.

 

Edit: I think I have the best job in the world. :)

[Miaow]

We have 15 minute OB visits (which are often double booked) and then 15 minute GYN problem visits. Annual exams and procedures are 30 minutes. I'm always frustrated by the annual, preventive visit that people use as an opportunity to bring a laundry list of problems too and try and get it all taken care of in one visit. 

[GetMeOuttaThisMess]

Saw 25 yesterday in 6.75 hours yesterday but that was with charting so I was waiting to walk out the door at closing. We typically have 3 hours for walk-ins and 4.5 hours for appt slots. 9 walk-ins today so far and 10 on schedule as of now for afternoon. I’ve already set a record for highest provider volume in a month at 412 as of this moment.

 

 

[camoman1234]

15 minutes ago, GetMeOuttaThisMess said:

Saw 25 yesterday in 6.75 hours yesterday but that was with charting so I was waiting to walk out the door at closing. We typically have 3 hours for walk-ins and 4.5 hours for appt slots. 9 walk-ins today so far and 10 on schedule as of now for afternoon. I’ve already set a record for highest provider volume in a month at 412 as of this moment.

 

 

That is a recipe for burn out...I did that for about 1 year and it literally drove me crazy. There is a provider that works in a different clinic that "see's" 600 per month...The owner of the all the clinics wants me to see 28+ a day and I see a traditional family medicine clinic, not pain scripts and trigger points masked under a family medicine clinic. I refused to see that many as there is not enough time nor is this good care. 

[GetMeOuttaThisMess]

That is a recipe for burn out...I did that for about 1 year and it literally drove me crazy. There is a provider that works in a different clinic that "see's" 600 per month...The owner of the all the clinics wants me to see 28+ a day and I see a traditional family medicine clinic, not pain scripts and trigger points masked under a family medicine clinic. I refused to see that many as there is not enough time nor is this good care. 

 

Nah, it’s snot/cough. Wait a couple of months and I might not see 100 in a month.

 

The last 45” I read a book.

[mgriffiths]

In family medicine: I work 8-3 right now and see on average 15-20 per day, but the majority are quite complex and are longer visits.  It is supposed to be 15 minute same-day/office visits, and 30 minute physicals/DM/etc.  I probably have around 12-15 scheduled and around 5 walk-ins.  Winter is my slow time though due to snow-birds, spring/summer/fall easily 20-25 with around 10 very simple walk-ins per day.

 

38 minutes ago, Miaow said:

We have 15 minute OB visits (which are often double booked) and then 15 minute GYN problem visits. Annual exams and procedures are 30 minutes. I'm always frustrated by the annual, preventive visit that people use as an opportunity to bring a laundry list of problems too and try and get it all taken care of in one visit. 

After dealing with similar frustration and regularly having my schedule trashed, I have stopped catering.  Pelvic exams are always a separate visit, granted as a guy most of my patients would prefer re-scheduling with one of the female providers anyway.  When I have patients that come with a laundry list I limit it to the two that I feel are the most important and then let them choose one.  When I first started in FM if I had the time I would slowly work through their full list, but the problem is you set an expectation and then when you don't have the time they get upset.  Best to set the expectation at the very beginning.

[Acebecker]

I am template for 15/day currently and increasing that to 18/day in 2 wks.  Just don't have enough patient slots to take care of my panel.  I'll have to shorten some, but still have 30 min for multiple problems and then 45 min CPX.  I have 7 15 min slots/day, 1 15 min charting block, 2 45 min CPXs (may add a 3rd, depending), and then 9 30 min visits.

 

[Guest UVAPAC]

5 hours ago, Miaow said:

We have 15 minute OB visits (which are often double booked) and then 15 minute GYN problem visits. Annual exams and procedures are 30 minutes. I'm always frustrated by the annual, preventive visit that people use as an opportunity to bring a laundry list of problems too and try and get it all taken care of in one visit. 

There is nothing more annoying than "double booking."  I understand an urgent visit that needs to get seen, but if you double book several time slots within a day it is physically impossible to give them the proper amount of time... and when providers rush mistakes often get made... 

 

[camoman1234]

1 hour ago, UVAPAC said:

There is nothing more annoying than "double booking."  I understand an urgent visit that needs to get seen, but if you double book several time slots within a day it is physically impossible to give them the proper amount of time... and when providers rush mistakes often get made... 

 

"But what if there are no-shows" (the owner of my clinic says) and I say "what if there are no no-shows" then he states "then you will have to work hard that day...haha what a joke

[rev ronin]

2 hours ago, camoman1234 said:

"But what if there are no-shows" (the owner of my clinic says) and I say "what if there are no no-shows" then he states "then you will have to work hard that day...haha what a joke

Chart on the clock, overtime after 40 hours per week for time-and-a-half, solves that problem nicely.

[Guest UVAPAC]

6 hours ago, rev ronin said:

Chart on the clock, overtime after 40 hours per week for time-and-a-half, solves that problem nicely.

That would absolutely solve the problem.  My job is considered "salary-exempt" and therefore there is no such thing as overtime. I am told if I end up staying late, I can come in 20-30 minutes late another day to make up for it.  (I have never once actually been offered to come in 20-30 minutes late by management.)  

 

Therefore if I get a walk-in patient at the end of the day, as much as it pains me, I generally tell patients we are closing and they must got to an urgent care or emergency department for evaluation.  

[ventana]

left a job that was booking me 30/day

was making 84k yr 

generating just under 300k per year in receipts

got a $200 Christmas bonus

 

I left, I was making them over $100k profit per year.....   

 

seems now the magic number is somewhere around 15/day for primary care

[LT_Oneal_PAC]

Military family medicine. 20 min appointments from cold to annual to neutropenic fever to appendicitis which will be admitted straight from the hospital based clinic and not sent to the ER. See 20 per day. 8-4

[ALC0313]

Anywhere from 10-20 a day at our OBGYN office but there is not a set expectation. OB slots are 10 minutes but those visits are tough to gauge. If it's a normal pregnancy and no questions/concerns it takes 5 minutes, but the next one could be high risk or a primip that wants to talk about her birth plan and suck up 30 min.

We have the same issue with people wanting to use their well woman exam to address all their issues because it's a free visit for them. When that happens we change the visit type to an office visit problem and charge them a copay, or let them know we can do their annual exam now and reschedule to address the problems.

[mmiller3]

20 hours ago, PAMEDIC said:

Usually 8 a day in my FM clinic. Sometimes more. Sometimes less.  Because of no-shows, I saw 4 yesterday.

 

Edit: I think I have the best job in the world. :)

I won't ask what you are making, but is this a FT position? How are you economically viable at 8 PPD? No benefits?

 

I have 28 open 20-minutes slots available, but I will turn some of them into 40 minute appointments (new pt physicals over 40, new depression, multiple complaints, etc.). I see 20-25 on a normal day, and 12-18 on an abbreviated day (Fridays we leave early).

[Cideous]

3 hours ago, UVAPAC said:

That would absolutely solve the problem.  My job is considered "salary-exempt" and therefore there is no such thing as overtime. I am told if I end up staying late, I can come in 20-30 minutes late another day to make up for it.  (I have never once actually been offered to come in 20-30 minutes late by management.)  

 

Therefore if I get a walk-in patient at the end of the day, as much as it pains me, I generally tell patients we are closing and they must got to an urgent care or emergency department for evaluation.  

 

 

And ^^^ THIS is how most Corporate Urgent Care chains get around the OT at >40 hours.  They list you as "salary" on your contract, but with a straight hourly wage for >40 hours per week etc.  So whatever your hour wage works out to, you only get paid that post 40 hours.  It's how they are able to keep you there an hour late each night for that 7:58 pt (you close at 8:00) and not have to pay you OT.  Several do this exact practice in Texas.

[PAMEDIC]

42 minutes ago, mmiller3 said:

I won't ask what you are making, but is this a FT position? How are you economically viable at 8 PPD? No benefits?

I have an unusual job. I work in a clinic that sees nothing but medicaid patients. We are a rural FM clinic that was setup to help control the costs of medical care in our rural area by providing PCP coverage to challenging patients in an effort to keep them out of the ER. The clinic is funded by a contract with the state's managed care organization based on a capitation basis. This means we get a fixed fee per month based on the number of patients assigned. If I see 100 patients a day or 4, the clinic gets the same amount.

The reason it is setup this way is medicaid patients are notoriously difficult and unreliable. There are days where I will have 50% no shows, despite our calls and letters reminding people of their upcoming appointments. I deal with lots of complex socio-medical cases that I would normally think an IM doc would handle, but the IM and other FM clinics in the area (and there aren't that many) won't take them.

My ideal day would be 16 patients a day, but it rarely seems to work out.

My compensation is above average. And every year, the clinic is up for review and the bean counters always say they are very happy with the service we provide and the money we save the state and taxpayers.

 

[mmiller3]

28 minutes ago, PAMEDIC said:

I have an unusual job. I work in a clinic that sees nothing but medicaid patients. We are a rural FM clinic that was setup to help control the costs of medical care in our rural area by providing PCP coverage to challenging patients in an effort to keep them out of the ER. The clinic is funded by a contract with the state's managed care organization based on a capitation basis. This means we get a fixed fee per month based on the number of patients assigned. If I see 100 patients a day or 4, the clinic gets the same amount.

The reason it is setup this way is medicaid patients are notoriously difficult and unreliable. There are days where I will have 50% no shows, despite our calls and letters reminding people of their upcoming appointments. I deal with lots of complex socio-medical cases that I would normally think an IM doc would handle, but the IM and other FM clinics in the area (and there aren't that many) won't take them.

My ideal day would be 16 patients a day, but it rarely seems to work out.

My compensation is above average. And every year, the clinic is up for review and the bean counters always say they are very happy with the service we provide and the money we save the state and taxpayers.

 

I am envious, I won't lie.

Think of me if the bean counters ever decide they need another PA...

[camoman1234]

On 1/30/2018 at 10:40 PM, rev ronin said:

Chart on the clock, overtime after 40 hours per week for time-and-a-half, solves that problem nicely.

No time and a half for me, so that won't work for me.

[rev ronin]

9 hours ago, camoman1234 said:

No time and a half for me, so that won't work for me.

I won't ever take a salaried position again, full stop.  I would encourage other PAs to not do so either: We are not independent practitioners, and the 'exempt' medical provider of yore is very different than what we have today.

[ProSpectre]

On 2/1/2018 at 6:33 PM, rev ronin said:

I won't ever take a salaried position again, full stop.  I would encourage other PAs to not do so either: We are not independent practitioners, and the 'exempt' medical provider of yore is very different than what we have today.

Would you mind explaining your thought process here? I know from reading on forums like this and speaking with practicing PAs that I intend to look for hourly positions after I graduate; I'd just like to understand the less obvious downsides to salaried positions a little better. I understand it allows many of the problems noted in this thread to occur, but are there other downsides that I may be missing (or other benefits to hourly pay)?