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Paigems

How much work do you do at home?

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I'm a relatively new grad and have been working in primary care for about 7 months now. I see about 15 patients/day and I am feeling overwhelmed by the amount of work I have. I write most of my notes write after seeing the patient, but usually by the end of the day I still have a couple things to finish on some notes. On top of that I have telephone encounters, labs, documents, and refill requests to review. I also like to prep my charts the day before so I know what I'm going to be seeing the next day. All of this amounts to being at work from about 7 AM (going in 1 hr early) to 5:30 PM and then doing about an hour of work at home. Lately I've been feeling like most of my life during the week is just work. I also don't think this situation is just because I'm new. The MD and PA I work with, both with 20 yrs of experience, do the same thing. It's making me feel burnt out from primary care and I've hardly just started. 

How much work do you do at home each day? What specialty are you in?

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zero - work in FP and see on average ~20 patients...of course it varies some, like today I saw 28.  It was h3!!, but in the door at 7:55am (start at 8am) and out the door with my desk 100% clear at 5:30pm (last patient scheduled 4:40 or maybe 4:50).  Usually I'm out the door between 5-5:15pm.

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37 minutes ago, mgriffiths said:

zero - work in FP and see on average ~20 patients...of course it varies some, like today I saw 28.  It was h3!!, but in the door at 7:55am (start at 8am) and out the door with my desk 100% clear at 5:30pm (last patient scheduled 4:40 or maybe 4:50).  Usually I'm out the door between 5-5:15pm.

Any tips for doing this? I feel like most of my day is spent just seeing patients and this leaves little time for labs, call back, documents, refills, etc. 

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Don't do any work at home.  Are you thinking "I'll just finish this at home"?  Because that might lead to you (maybe unconsciously) either working slower at work or actually putting it off until you get home- because you know you have a safety net, you slack off a bit and use your safety net as part or your work flow.

Aside from that, try tightening up your work flow.  Where are areas that are time wasters?

Are you using ancillary staff appropriately, to relay normal labs?  Do you have Ros check off sheets either in the waiting area or with the lpn?  

Do you dictate?  If you type, do you have a template you can use?  

Do you send out your own lab result letters?  

 

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zero. working from home is working for free unless you have X hrs of admin time/week built in to your schedule. If it is the last hr of my shift and I am behind on charts I only pick up people who are dying or very simple(UTI with + ua already done).

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44 minutes ago, EMEDPA said:

zero. working from home is working for free unless you have X hrs of admin time/week built in to your schedule. If it is the last hr of my shift and I am behind on charts I only pick up people who are dying or very simple(UTI with + ua already done).

You mean we can get paid for doing this!?

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I used to take work home like 7-10 charts but have found that if I do I spend hella more time trying to finish at home than if I stay after work. Today I was swamped! Messages were crazy (been crazy all week) and I'm covering another provider while he basks in Disneyland with his family lol.

I had 11 charts to finish. If I took that home it would probably take me a good 3 hours to finish. I stayed after work and finished all those charts answered all my messages and the one I'm covering's inbox and resulted out all my results and his in under 2 hours.

Now I'm home chillin' watching the warriors game and just had a wonderful dinner and cheesecake for dessert

I refuse to take work home.

Sent from my SAMSUNG-SM-G891A using Tapatalk

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45 minutes ago, thinkertdm said:

You mean we can get paid for doing this!?

some folks work it into their contracts.

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3 hours ago, Paigems said:

Any tips for doing this? I feel like most of my day is spent just seeing patients and this leaves little time for labs, call back, documents, refills, etc. 

1) A functioning EMR and using it to its peak potential.

2) An excellent MA

 

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Yes - taking work home all the time is a recipe for burnout 

At my institution there’s a big push for HCC coding for risk adjustment so we have the additional burden of “missed coding opportunities “ being monitored AND posted daily .

this is obviously causing even more documentation requirements / headaches 

yep - done with primary care and time to move on 

 

 

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14 hours ago, Paigems said:

Any tips for doing this? I feel like most of my day is spent just seeing patients and this leaves little time for labs, call back, documents, refills, etc. 

Our EMR is terrible compared to some of the ones I used while in PA school, but it allows for templates - I have many, I think at least twice the amount of the next provider in the practice.  I even invested the time to make some that I don't use that often, but it keeps me from having to search for buttons in the ROS and PE portions of the EMR (I hate point and click medicine).  My second biggest time saver.

I also have a TON of "auto-replace text" - I type three letters and the computer automatically inputs several sentences of information.  This is a wonderful thing that so many of my co-workers do not take advantage of...BY FAR MY BIGGEST TIME SAVER!!!!!

Beyond those two items, I almost never leave the room or allow the patient to leave until the chart is completed and closed.  If I leave the chart open it is because I am reminding myself about something.

My MA is awesome, which is the #1 reason I am sad to leave my current job, also why I have given her a portion of my bonus each time I have earned it.  This has made her the highest paid MA in the practice BY FAR and kept her from looking around for other positions just for a raise.   But, I also require quite a bit.  She takes care of 100% of all paperwork for me and then I sign.  She does prior auths, finds diagnosis codes when insurance companies are stupid (ALL THE FREAKING TIME!!!!), etc.  She calls patients with results, I only call if it is something serious, but usually if it is serious enough for me to call it means they really need an appointment so I don't call.

Now for the kicker...I feel that I am a compassionate provider and am more than happy to sit and talk with patients.  I have a personal relationship with many of them, knowing about their families, interests, jobs, etc. and they know about my family.  It is truly wonderful, but I also DO NOT just sit and talk forever.  When needed I keep the appointment on topic and focus on the topic at hand.  When a patient brings in a list of topics to discuss I make it clear that we can only do a few.  When a patient just continues to bring up issues, after the first 2-3 I tell them that our appointment is over and if they have further concerns they need to make another appointment.  The vast majority understand, they may not like it, but they understand.  Those that don't understand don't come back...fine by me.

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Zero.  No stress, default entries for the EMR and our limited SOP and their applicable PE’s.  No refills or patient calls since I’m not their PCP.  Last patient is thirty minutes before close and I’m usually done no later than 15” till, assuming there is that last slot patient.  37.5 hours/week full time.  I may check something from home with our cloud based EMR 1-2x/year, maybe.

Edited by GetMeOuttaThisMess

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Our healthcare system has the option for using vpn entry into the emr system via home laptop or cell phone. I have neither as I refuse to do any work at home. 

I typically do spend 30 minutes to 1 hour after my last patient in the office to finish charting, responding to calls, looking at results and refills which is unpaid work time unfortunately. I am suppose to work 8 pm to 4:30 pm. 1-2 days out of the week I am able to head home on time though which is a plus.  Your hours don't sound like outliers for primary care though to tell your the truth. I wonder if you are overcharting since this is your first year? Do you have a charting efficiency officer in your system to help and analyze your workflow and documentation?  

Templates and dot phrases or short cuts for long paragraphs towards documentation and prescriptions also help. My nurse also is a tremendous help with prior auths and making calls. I only call personally if the results are life altering such as need for hospitalizations or diagnosis of cancer. 

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I'm on zero as well. Didn't do it in FP. Not doing it in UC. Charting is part of work so it gets done on the clock.

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Even with 4 hours admin time built into my week, I used to do quite a bit. Then got smart with templates as well generally lowered my standards for notes. Then we got a new EMR and for my workflow to be smoother i either "prepped" the days charts the night before or went in 45 minutes early. It sucked but it kept my clinic running on time during the day. I was still using most or all of my admin time to complete notes for the week though or catch up on other paperworks.

Now I have a scribe and my new MA preps my charts for me. Costs me a bunch of $$ for the scribe but i am actually more productive because I have 4 more hours of clinic per week. 

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