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To my Emergency Medicine colleagues, I was just wondering what the requirements are at your facility regarding patients per hour you are required to see?  Does management take patient acuity into account?  How about Urgent Care?  Anyone ever get reprimanded, written up, or terminated for not seeing enough patients (not being productive enough)?

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12 hours ago, SickEKMan said:

To my Emergency Medicine colleagues, I was just wondering what the requirements are at your facility regarding patients per hour you are required to see?  Does management take patient acuity into account?  How about Urgent Care?  Anyone ever get reprimanded, written up, or terminated for not seeing enough patients (not being productive enough)?

Happens all the time in corporate UC's.  It's really the luck of the draw.  I can see 40 sinus infections with virtually no wait time, but throw in 3 lacs, and I&D and a few X-Rays and things grind to a halt.  That's when the high school center managers loose their shite.

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I lost a full-time gig in a busy private urgent care earlier this year due to my productivity not being up to par, plus some other issues at a company level, not personal.    In-office X-ray capability, basic in-house labs, ability to give IV fluids / meds with relatively quick access to CT / MRI / more complex labs available often on a same-day basis, so we saw a lot of complex patients in addition to the typical urgent care smorgasbord.  I worked with top notch providers but could not get my hustle factor to where it needed to be.  Speed and efficiency absolutely count.  I'm getting ready to turn 61 and feeling burned out on it all, so I am thinking it is time for a career change. 

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On 3/5/2020 at 10:05 AM, Cideous said:

Happens all the time in corporate UC's.  It's really the luck of the draw.  I can see 40 sinus infections with virtually no wait time, but throw in 3 lacs, and I&D and a few X-Rays and things grind to a halt.  That's when the high school center managers loose their shite.

We have this same conversation in our office staff meetings almost every month.   The corporate admins think that if a person is scheduled for a "cough" that is a ten min appointment because that should be "simple".   And every meeting I ask them - why is that simple?  Is the cough due to a viral URI, allergies, GERD/reflux, asthma out of control, atrial fib, lung mass, COPD exacerbation, or runs of SVT - among MANY other more serious conditions that cause a "simple cough".     Ugh.    

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Private UC with a couple of locations. No productivity "requirements." The only time I have seen someone canned for lack of productivity was so blatantly obvious they didn't pull their weight it was getting to the point no one wanted to work with them. We have slower and faster providers, but for the most part everyone keeps the meat moving the best they can. Boss totally gets that some patients simply require more time than others. General attitude is "be quick but don't hurry." If you have to chart at the end of the day and stay late then you get paid for that. Not ideal, but at least it is paid.

The more I learn about corporate UC, the happier I am in my position. 

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I've often heard productivity numbers of ~2.2 pts/hour for an ED PA bandied about.  However, my personal opinion is that those numbers are only attainable if there are a fair number of quick patients, whether lower acuity or just ones that don't need much time.  I usually hit about 1.7 pts/hour, with (patients + procedures + 30 minute increments of critical care time) of 2/hour.

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I stopped working at places that want me to move the meat several years ago in favor of places that want me to practice good medicine. If you are consistently seeing more than 2 pts/hr with mixed acuity and procedures, you are probably missing stuff, doing crappy work, and writing bad notes. not worth it for a few more dollar in bonus money. 

I can work hard, but get paid the same amount if I see zero patients in 24 hours or 21. 

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On 3/4/2020 at 7:20 PM, SickEKMan said:

To my Emergency Medicine colleagues, I was just wondering what the requirements are at your facility regarding patients per hour you are required to see?  Does management take patient acuity into account?  How about Urgent Care?  Anyone ever get reprimanded, written up, or terminated for not seeing enough patients (not being productive enough)?

I work in the ER. Been a PA for 4.5 years. 

There’s no “requirement.” We have slower PAs and faster ones. The docs love us all equally - we all do a good job. But nursing staff and hospital admin? They like the fast ones. The speed of the providers does get brought up in meetings. We do hear complaints sometimes. But really, no one has been threatened to be fired for not being fast enough unless they were realllllly slow (I.e. one patient per hour slow). We’ve actually had more issues with providers (not PAs... NPs specifically... just being honest) who were way too fast and careless and ended up with bad outcomes.

I work at one hospital where the patients are mostly old and medically complex. Sometimes takes fifteen minutes just to get a damn history! Usually these patients are admits or involve complex discharge processes (calling multiple specialists, involving the PCP, calling family, etc). At that hospital I am honestly busy at 1.5 patients an hour. At our other hospital we have more lower acuity patients. In the main ED, where I see a mix, I usually see 1.5-1.75 an hour. In the fast track I can easily see a little over two an hour and be good.

Downside of being slow is we won’t hit our productivity target. We have a minimum target of RVUs we need to hit and beyond that we take in an extra 25 bucks an RVU. RVUs and patients per hour don’t necessarily correlate but on average, to hit the target and start making RVUs, it is around 1.5 patients an hour. 

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My experience was that I was able to hit 6.5-7 RVU/hour, but I was working pretty hard to get there.  If you've got an RVU model, picking up procedures is the way to go, especially I&D's and injections: trigger point and nerve block.  They are relatively quick vs laceration repairs and foreign body removals.

For example: RVU's for ED visit levels:

Level 1 ED Visit: 0.60
Level 2 ED Visit: 1.17
Level 3 ED Visit: 1.75
Level 4 ED Visit: 3.32
Level 5 ED Visit: 4.89
Critical Care:
1st 30-74 min: 4.5
Each addt’l 30 min 2.25
 
Vs. RVU's for some simple procedures:

.Trigger point: 0.66 (0.75 if 3 or more)

Occipital nerve block: 0.94

Dental block: 1.11
Sphenopalatine ganglion block: 1.36
Sciatic nerve block: 1.48
 
So, it's pretty easy to double or in some cases triple your RVU's for your dental pain, neck pain, migraine, and back pain patients - all while giving them faster relief than with other modalities.
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