underserved Posted October 26, 2012 Share Posted October 26, 2012 I'm a new grad PA. This FP clinic in a small town offered 85k, m-f 8 to 5pm "plus". I would work a Saturday every couple of months. The SP will train me but he will not be available onsite for consult after the training period. They say that I would see 30-40 patients per day. It would be myself and a nurse practitioner. I just think that the patient volume is high for a new grad. What do you guys think of this offer? Link to comment Share on other sites More sharing options...
mdebord Posted October 26, 2012 Share Posted October 26, 2012 Ruuunnnn!!! Link to comment Share on other sites More sharing options...
Doc Savage Posted October 26, 2012 Share Posted October 26, 2012 I think that patient volume is high for an established, seasoned PA... Do they mean 30-40 a day now or in 6-12 months when you are trained up a little more...? in any case... I would invest in a Z-Pak vending machine and a toradol dart gun... Link to comment Share on other sites More sharing options...
Just Steve Posted October 26, 2012 Share Posted October 26, 2012 Or is it that many split between you and the NP? Sure you can try it...but at what cost of quality? I'd ask to see their actual patient numbers for the past few months. May be a bit of pride/bragging in their numbers..see what it really is per provider. Link to comment Share on other sites More sharing options...
mdebord Posted October 26, 2012 Share Posted October 26, 2012 I only saw 18 patients today (light, esp for a Friday) but that included one new cancer diagnosis, two chest pain work-ups, one complicated hospital f/u, an uncontrolled diabetic, and one lady that didn't make it in but I spoke to on the phone about her renal failure and need to go to the ER. Each of those things take well over 30 min when you include the necessary chart reviews and documentation. It's also typical for even the sinus infections to have an additional problem/needed refill/etc. I can't even imagine 40.... Link to comment Share on other sites More sharing options...
treejay Posted October 27, 2012 Share Posted October 27, 2012 I only saw 18 patients today (light, esp for a Friday) but that included one new cancer diagnosis, two chest pain work-ups, one complicated hospital f/u, an uncontrolled diabetic, and one lady that didn't make it in but I spoke to on the phone about her renal failure and need to go to the ER. Each of those things take well over 30 min when you include the necessary chart reviews and documentation. It's also typical for even the sinus infections to have an additional problem/needed refill/etc. I can't even imagine 40.... So what about billing? Does the clinic the sees 35-40 patients a day bill the same as you charge your 18 patients, all else being equal? Link to comment Share on other sites More sharing options...
underserved Posted October 27, 2012 Author Share Posted October 27, 2012 I will get more information. It will be 30-40 patients per provider. Even after 6 months of training, I still think 30-40 is a bit much. I especially don't like the idea that I won't have an SP on site for consult; especially as a new PA. I'm surprise the NP is still there. Link to comment Share on other sites More sharing options...
primadonna22274 Posted October 27, 2012 Share Posted October 27, 2012 Way, way, way too many for any new grad and many seasoned PAs. You can bet the group cares about the bottom line more than about practicing good (safe!) medicine. Link to comment Share on other sites More sharing options...
underserved Posted October 27, 2012 Author Share Posted October 27, 2012 I agree Primadonna. Last week, I had a different FP Doc expecting me to see over 40 patients after a few months of training with her. But atleast she made it clear that she cared about the bottom line. Link to comment Share on other sites More sharing options...
KCMA79 Posted October 27, 2012 Share Posted October 27, 2012 That is too many patients to see per day and maintain any sort of quality. Sure, it can be done, I've done it a few times, but the quality of care you provide will suck. The place that offered this to you is a mill. Like someone else said, RUUUUUUN Link to comment Share on other sites More sharing options...
mdebord Posted October 27, 2012 Share Posted October 27, 2012 So what about billing? Does the clinic the sees 35-40 patients a day bill the same as you charge your 18 patients, all else being equal? I suppose it depends on the client population. Many of those patients that I mentioned were 99214 visits, and then of course we bill for procedures performed. However, that's part of my point. Everything can't always be squeezed into 15 minutes - you spend as much time on each patient as you have to. I suspect that seeing 30+ patients would require constant hurrying, then working long after 5 to finish notes. Link to comment Share on other sites More sharing options...
mdebord Posted October 27, 2012 Share Posted October 27, 2012 By the way, I didn't mention that I'm 8 months out. That's enough to feel reasonably comfortable, but I still frequently ask other providers for second opinions, double check drug dosing on Epocrates, figure out where we keep the XYZ or how to order the LMNOP. All of this will of course slow you down, but provide better care for your patients. Link to comment Share on other sites More sharing options...
Gordon, PA-C Posted October 27, 2012 Share Posted October 27, 2012 I suppose it depends on the client population. Many of those patients that I mentioned were 99214 visits, and then of course we bill for procedures performed. However, that's part of my point. Everything can't always be squeezed into 15 minutes - you spend as much time on each patient as you have to. I suspect that seeing 30+ patients would require constant hurrying, then working long after 5 to finish notes. Doesnt matter if all of them are truly level 4s or 5s you cant bill all of them like that. Insurance companies look at a snapshot of your current billing profile. If it doesnt look like a bell curve (e.g. 60% level 3s, 40% everthing else), then you are getting audited and they are going to block most of those level 4 claims, even if you document the crap out of them and they are legit. Link to comment Share on other sites More sharing options...
Gordon, PA-C Posted October 27, 2012 Share Posted October 27, 2012 The only providers that can effectively see 40 patients in a day and actually do a good job are those that work in urgent care centers treating simple complaints. No way in hell can a primary care practice PCP pull that off unless they just dont give a damn about quality, OR they are using extended office hours (i.e. seeing 40 patients a day aint that bad if your office hours are 8 AM to 7 PM) Link to comment Share on other sites More sharing options...
mdebord Posted October 27, 2012 Share Posted October 27, 2012 That's not what I meant; believe me probably 75% of mine are level 3's. The point I was trying to illustrate is that even if you have only a few complicated patients thrown into the mix, it can very quickly derail a 30+ patient day. And furthermore, that I know to expect at least 3 of those in an average day of 24 patients. Double the patient load, and the OP could easily be looking at 6 or 7 such patients during the day. Something to consider. Link to comment Share on other sites More sharing options...
mdebord Posted October 27, 2012 Share Posted October 27, 2012 Okay Gordon, we're on the same page :;-D: Link to comment Share on other sites More sharing options...
underserved Posted October 27, 2012 Author Share Posted October 27, 2012 I appreciate y'alls input. It confirmed my thoughts. Thanks all!!!! Link to comment Share on other sites More sharing options...
tigerlily Posted October 27, 2012 Share Posted October 27, 2012 For those that see 30+ patients a day, do you address every concern during that visit? The reason I ask is because the providers I currently work for, do address every issue. For instance, a patient came in for "headaches". While doing her h&p, she brought up a desire to address a recent face rash; a "history" of depression, anxiety, lower back pain, and obesity. Absolutely everything was addressed by the provider, along with pertinent screening forms, labs, and referrals for all of the above. Along with all preventive measures. I'm just curious... Link to comment Share on other sites More sharing options...
physasst Posted October 27, 2012 Share Posted October 27, 2012 For those that see 30+ patients a day, do you address every concern during that visit? The reason I ask is because the providers I currently work for, do address every issue. For instance, a patient came in for "headaches". While doing her h&p, she brought up a desire to address a recent face rash; a "history" of depression, anxiety, lower back pain, and obesity. Absolutely everything was addressed by the provider, along with pertinent screening forms, labs, and referrals for all of the above. Along with all preventive measures. I'm just curious... I don't know how you could. My record was 54 patients in 12 hours in the ED. I literally spent 3-5 minutes with each patient. That was problem focused to the extreme. I don't know how you could address all concerns at a pace of 30+ per day. I NOW see about 6-8 patients per day..at the most 10 or 11 (IF I am feeling generous and add patients on)......and, if the 2 grants I have in submission are approved, and if the two international research meetings coming up work out, I could be practicing clinically less than 0.5....with even more funding in the works. Should be fun......But, I cannot imagine seeing 30+ patients per day again. I did that once.....won't do it again. Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 27, 2012 Moderator Share Posted October 27, 2012 seems silly to work so hard to get your license though PA school just to set yourself up to loose it at your first job.... seriously run fast in the other direction Might we worth a brief talk with the MD to identify that his expectation is unrealistic for ANY provider - but especially a new grad PA These doc's are looking ONLY at the $$$ and not anything else - they are merely business people that are only out to make $$$ off their practice and a new grad (or for that matter just about anyone) should run away! Link to comment Share on other sites More sharing options...
underserved Posted October 27, 2012 Author Share Posted October 27, 2012 I emailed the office manager declining the offer. I wrote that I did not want to compromise the quality of care of my future patients. And that seeing 30-40 patients per day is extreme for even the most experienced provider. Link to comment Share on other sites More sharing options...
underserved Posted October 27, 2012 Author Share Posted October 27, 2012 As ventana had stated, we worked way too hard to get our license; can't afford to get screwed on any job. Link to comment Share on other sites More sharing options...
CAdamsPAC Posted October 27, 2012 Share Posted October 27, 2012 I emailed the office manager declining the offer. I wrote that I did not want to compromise the quality of care of my future patients. And that seeing 30-40 patients per day is extreme for even the most experienced provider. A real good move. Link to comment Share on other sites More sharing options...
Hemegroup Posted October 27, 2012 Share Posted October 27, 2012 I can see 30-40 a day no problem, some very intense primary care cases included along with the usual urgent care procedures. two things make that possible ... excellent support staff and adequate time for charting, at least 30 minutes with possibly some spillover of 10 mins the next morning. i'm not a new grad anymore tho ... but i started seeing about 25 a day in my first position. and yes, i address everything. Link to comment Share on other sites More sharing options...
LESH Posted October 27, 2012 Share Posted October 27, 2012 A real good move. I agee with CA, Prima, and the others. Trust your gut it seems you have doubts, Try and get a gig with adequate supervision when starting out. Link to comment Share on other sites More sharing options...
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