Schedule Template

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Starting as attending in July. Employer is asking how I want my schedule template to look. What is a reasonable time to allow for new, return, procedure slots? How long did you keep your initial template after first starting (I.e. did you make your slots shorter over time)? Thanks for any input.

I'm starting in July too. Until I get used to the EMR system there, I'm gonna take 30 minutes for new patients, 15 minutes for re-visits, 1-hour for most EMGs, and 15 minutes for each procedure. Should be able to decrease the clinic times after the first month. Having patients wait is one of my biggest pet peeves.

I started with 30 minute f/u and 60 min consults. I quickly dropped that to 15min f/u 30 min new. I knew I could do them that fast but wanted to give myself some time to get used to the work flow etc. Plus it made my schedule look less empty at first

I do 15min procedures with 40 min for rf (30 if only doing one side) and discos and usually 60 min for vertebro. SCS I give myself 60 min for trial 90 for implant at our asc and add 30 minutes to those times at the big house

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45min for initials
f/u is 20min

ESI/MBB/SIj---all 20min
(takes me less than 15min to actually do, more like 10...but i have 'padding' in there just in case something goes wrong and so that sometimes I can finish the note right afterwards or see the next patient).

Kypho-60min

SCS trials--60min

implant ----send to surgeon

generic advice: for a fresh young kid right out of training schedule longer clinic visits. Rightly or wrongly patients will accuse you of being too young, too fast, too new, not caring enough, not listening too them, etc. It's a no win scenario, but if you don't rush them or yourself you'll sleep better at night

i would book 60 mins for news and 30 mins for f/us for the first 2-3 months....

you will get a quick reputation around town as being "thorough", patients love a "listener"

plus honestly, most novice private practice docs aren't busy enough to justify shorter visits... once you are consistently packed w/ that schedule then you can change those time slots...

but y ou have to explain to the new practice your rationale --- you don't want them to think you are lazy.

I'd schedule more than 30new/15 fu when you first start. Even if as a graduating fellow, you're convinced you're the bomb, things are different on your own, the first month you'll be getting used to the computer and establishing how you explain things and how you approach things.

Don't forget you may want to look up a thing or two, now that your safety blanket is gone and its your ass on the line if when things go wrong.....

Unless you've just got drove of patient's waiting for you on day one I'd start with at least 40new/20fu or 60/30

Plus as tenesma said, you'll get a good rep those first few months that way.

Originally Posted by Tenesma

i would book 60 mins for news and 30 mins for f/us for the first 2-3 months....

you will get a quick reputation around town as being "thorough", patients love a "listener"

plus honestly, most novice private practice docs aren't busy enough to justify shorter visits... once you are consistently packed w/ that schedule then you can change those time slots...

but y ou have to explain to the new practice your rationale --- you don't want them to think you are lazy.

1+

Be efficient later on, be nice now. When I get rushed I worry and become a bit*h. Don't do that.

Will you be using an EMR you're unfamiliar with? Don't forget to factor this in to the argument for extra time early on.

I personally think doctors should doctor and secretaries should do clerical work. If your practice doesn't allow transcription get Dragon (not the overpriced medical version) and a handheld microphone (my Philips speechmike II is awesome - eBay $75), dictate into word, make clerical staff paste into the Electronic Mistake Record.

Originally Posted by Tenesma

i would book 60 mins for news and 30 mins for f/us for the first 2-3 months....

you will get a quick reputation around town as being "thorough", patients love a "listener"

plus honestly, most novice private practice docs aren't busy enough to justify shorter visits... once you are consistently packed w/ that schedule then you can change those time slots...

but y ou have to explain to the new practice your rationale --- you don't want them to think you are lazy.

2+
Better to err on the side of the patient than the side of the $.
After a few months, if you feel you can provide superior care with less time and meet a need, then go for it. Besides, it never hurts to leave some room for improvement.

Originally Posted by hyperalgesia

2+
Better to err on the side of the patient than the side of the $.
After a few months, if you feel you can provide superior care with less time and meet a need, then go for it. Besides, it never hurts to leave some room for improvement.

ah yes, the "don't set the bar too high" philosophy. words to live by. not only does it work on reality TV shows where contestants get eliminated each week, but also in medicine. if you give the "perception" of improvement a lot of times it is as good as actual improvement. if you are purely based on dollars collected, then disregard everything above except the TV reference.

the feedback that I got a lot when i started my practice and when i had competition in town --- was that I took my time, was thorough and listened to all of their problems --- as compared to the competition who would spend 5 minutes on the consult and 1 minute on a f/u... this worked really well in my favor and I also had the luxury of time at that point in my career.

Originally Posted by Tenesma

the feedback that I got a lot when i started my practice and when i had competition in town --- was that I took my time, was thorough and listened to all of their problems --- as compared to the competition who would spend 5 minutes on the consult and 1 minute on a f/u... this worked really well in my favor and I also had the luxury of time at that point in my career.

I get the impression that a lot ( most ? ) of the ORTHO peeps rush their consults, although I guess they can get away with this. In pain medicine , I would imagine that we would be less likely to be able to do so, as we are more dependent on patiients returning and maintaing that doctor patient relationship I've heard so much about.

As for me, I spend:

1. Usually 60 mins on a new patient / consult. I try to be an "active listener" ( whatever the hell that means - I think I've been married too long ).

2. 10 -15 minutes med visit.

3. 20 minutes procedure.

If you have a good admin staff, you'll find that they will adjust your schedule accordingly ( i.e. your secretary will get to know how long you take with the above patients over time ). NOTE for the newbies : the importance of hiring a good administrator can not be over emphasized. They are the face of your practice.

I do 30-40 for new's, 10-30 for fu's, 20-40 for procedures.

I agree that in the beginning 60 new, 30 fu, prob 30 for b and b inj's, more for RF.

As you train the staff and get used to the EMR this will change.

There is a lot to be said for being known as the 'thorough' doc who listens. The PCPs will hear about this and respect you. Pts will also 'like' you and that buys you a lot of useful equity.

I keep fluoro and clinic seperate b/c I like to get 'in the zone' for procedures and not deal with clinic related drama at that time.

Could not agree more about being the new grad and the challanges you face in the eyes of patients.
You are already going to get the scrutiny of appearing young and having the questions about "how long have you been doing this?"
When you can balance that with getting patients to say "geez doc that is the first time a doc has actually explained what is wrong with me." or "thank you for spending the time with me.". "all my pcp does is rush me out the door and never even touches me"
That is when you start getting spouses and neighbors and friends as patients. Then you can go quicker as you become more efficient in your own way. Either through better/more staff, technology, or other. Good luck, it is such an exciting time once you are finally out on your own!

I have wide-screen monitors in each exam room and go over the imaging w/ anatomic models for each consultation.... this usually helps blow away the patients... i have had patients start crying stating that they have had pain for (example) 8 years, had 2 spine surgeries, and this was the first time anybody showed them their pictures.... w/ all that extra time you will have, make sure you maximize your performance

Originally Posted by Tenesma

I have wide-screen monitors in each exam room and go over the imaging w/ anatomic models for each consultation.... this usually helps blow away the patients... i have had patients start crying stating that they have had pain for (example) 8 years, had 2 spine surgeries, and this was the first time anybody showed them their pictures.... w/ all that extra time you will have, make sure you maximize your performance

I've gotta get that ipad playa !

All my students have one - it looks like da bomb.