Outpatient workload

[PsychPAinPA]

Those of you spending your days in outpatient clinics: how many patients do you see a day? How long do you have for appointments? How often do you stay late?

I recently switched specialties from psychiatry to general surgery about 4 months ago. I have a great mentor and feel like I am getting a handle on the new specialty. However, I feel overwhelmed by the work load. We are in a small town, so we basically are a GI and dermatology as well as surgery practice. A lot of our patients are complicated, and primary care does little to no workup prior to referral. Initial visits for a new problem are half an hour,  skin problems and follow ups are 15 minutes. I see between 15 and 20 patients a day. 

I do not have a nurse helping me, so I room my own patients, get vitals, and reconcile medications myself. There is a significant amount of paperwork for scheduling surgeries (lots of screen colonoscopies etc) in addition to just writing the notes. Also, the practice requires that I document last mammogram, colonoscopy etc on every patient. I can't just ask them, I have to scour their medical record from the local hospital for the report to add it to their chart in our EMR.  Also, I have to call patients and notify them of all test results, even if they are normal. This all takes an enormous amount of time, and I find myself consistently arriving about 2 hours early for work and then staying 2-3 hours after to do paperwork. I also round on patients at the hospital a few days a week prior to office hours. I am often working 12 hour days and feel drained. My employer seems disappointed by how overwhelmed I am, and doesn't seem to understand how I end up spending so much time on it.

Based on the above information, is my outpatient workload typical? Do I just need to work more efficiently? From what I have heard, 15-20 patients a day is a usual workload and I feel like a failure for being so overwhelmed. 

[sas5814]

Yes and no. You patient load is OK though maybe a bit heavy for your specialty. The rest is utter nonsense. You should have a nurse, MA, or office assistant rooming patients, documenting mammos etc. Not only is the practice wasting money by paying the high dollar help to do these things it is insulting to you as the PA. Does the surgeon do this? Does he/she have a nurse and/or a clerk? You don't need to answer. I already know.

I'd approach this from 2 directions. I'd start with the amount of money being wasted while you do office chores when you could be seeing patients. The other is simple respect for you an a provider.

[ventana]

you need to show them that the time savings for having an MA (you not spending countless hours a day doing something an MA can do) more then makes up with your efficiency and throughput....

 

period.. anything less then having your own dedicated MA (not just an MA of the day rotation) is just not fair, and is a huge hit on productivity....  and wears you down...

patients need to be roomed, vitals, hx done, all BS things like last colonoscopy or LMP all done by support staff NOT you 

you do medicine and leave the rest to someone else 

[PsychPAinPA]

Yeah, I think you guys are right. I need a nurse or MA to help with the paperwork, vitals, rooming etc. Now I need to convince my employer to hire a MA. The only nurse in the practice has her hands full with the doctor's patients.

Here is the trouble: I don't know how to convince them it is financially advantageous. Right now, I am salaried and not paid for overtime. I am working close to 60 hours a week and making 80k a year, doing secretarial work for free basically. It would cost them around 30k a year to hire an MA. Two prior PAs have left because they would not hire help. Right now I have a half hour per appointment, 15 minutes for post op visits and skin lesions, seeing 15-20 patients a day. They have told the past PAs they will hire an MA if they saw a patient every 15 minutes, around 30 daily. I feel like I will still be overwhelmed if I am seeing that many. Basically, I need them to just spend the money on me and hire somebody so I can work reasonable hours. The only way I can make it sound financially advantageous to the practice is if I point out the high cost of turnover, which would make it sound like I am threatening to quit. I don't want imply that in the interest of keeping good relations. 

Any suggestions?

[sas5814]

Do the math with real numbers. How much does a visit generate and how many visits can you do in a day if someone else is doing the simpler tasks.It won't take many more visits a day to make the numbers work.

However your comments are telling and it sounds like you will not be successful in convincing them. If they have already lost providers over this and failed to make any adjustments they are probably stuck in their ways.

A little basic math using the numbers you quoted suggests you are making about $27/hr. That's 48 60 hour weeks a year at 80k in pay. Now those numbers are rough but you'll have to really modify them to make it palatable.

me? I'd be looking for someplace to go. Over worked and underpaid and treated without respect. Bye Felicia.

[medic25]

3 hours ago, sas5814 said:

 

A little basic math using the numbers you quoted suggests you are making about $27/hr. That's 48 60 hour weeks a year at 80k in pay. Now those numbers are rough but you'll have to really modify them to make it palatable.

For some perspective, you're getting paid as a PA what our ED techs get paid.  Are you having these conversations with the surgeon or with an office manager?  might be worth going directly to the surgeon, and include in the discussion the estimated $100-200k it costs to lose, recruit and train a new APP.

[thinkertdm]

From a clinic perspective, any time you spend not seeing patients is not making money.  Period.  When you make a call to a patient, net income: zero.  Net loss: zero as well, because you are salaried and they aren't losing money.  However, you literally could have removed a lesion in that time: possible gain: 50$?  Just guessing, but the point is, the office manager should realize this.

From your perspective: you are a highly trained medical provider being paid crap wages a high school grad could do.  They are not going to budge, so cut bait and haul it out if there.

[rev ronin]

10 hours ago, PsychPAinPA said:

Right now, I am salaried and not paid for overtime.

Convert your salary to a pay rate, and work hourly with overtime paid.  Seriously--even if it's the $27 an hour you're actually making (gag), then they'll be able to save money by having a $15/hour person do the parts of the job that don't require a provider.  If they won't do that, quit, because it's not about money it's about their control.  Are you a slave?  No.  You are a nationally certified, state licensed medical professional.

I will take vitals when I want to take vitals.  I will room patients when I want to room patients.  Heck, I ran a urine dip tonight because my MA was more slammed than I was and it was the right thing to do. HOWEVER, clinic management doesn't ask me to do ANY of those things.  I mean, I suppose they could, but I would be getting paid to do the work that someone should be doing for 1/4th of my hourly pay rate.

Until it's their skin in the game, you lose.

Never take a salary, because then they get to argue how much busy work they can assign to you.  Insist on an hourly wage, because then everyone wins if they keep you working at the top of your license.

[ventana]

quit

move on

 

they are not going to get it

 

 

so get another job offer in hand, got to your current employer with all the #'s, ask them to hire an MA that is yours and yours alone

 

if not - hand them your resignation letter

 

 

 

(Disclaimer: I have had  bad week with over controlling non medical bosses and this might be influencing my posts)

[MT2PA]

Ventana may have had a bad week but I didn't and I still say quit.  You're underpaid and overworked and if your boss is disappointed that you're overwhelmed, he thinks the problem is you, not how the office runs.  I'd cut my losses.  Start working only reasonable hours, look for a new gig, and get out.

[Cideous]

Have another job in the bag before leaving this one.  (See "can't find a job in this market" thread...)

 

Just saying.

[sas5814]

^^This. Always. You can't eat pride.

[CAdamsPAC]

5 hours ago, sas5814 said:

^^This. Always. You can't eat pride.

Humble Pie and Crow have a  fowl taste to them!!