Contact Hours

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PeaJay

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I am reviewing my patient volumes and comparing to industry data. There is data for average patient volume, but I cannot find any data on average patient contact hours.

If you don’t mind sharing, what is your clinic patient contact hours per week?

I am 8-4pm with a 1 hour lunch 4 days a week. The fifth day is my OR block/office time. So 28 hours of patient contact for me.

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I am reviewing my patient volumes and comparing to industry data. There is data for average patient volume, but I cannot find any data on average patient contact hours.

If you don’t mind sharing, what is your clinic patient contact hours per week?

I am 8-4pm with a 1 hour lunch 4 days a week. The fifth day is my OR block/office time. So 28 hours of patient contact for me.
Last job I was 8-5 M-Th with Friday Surgery.

New job is 830 - 430 M-Th with Friday surgery.

If I get busy again like I was in my last position I am going to ask for another 1/2 day OR.

Edit I have a 1hr lunch in current and last job.
 
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8:30-5 M-W, 1 hour lunch
Thursday, OR day, 7:30- varies. Average probably 1pm but I was done by 11am today
Off Friday

So 22.5 contact hours in clinic per week
 
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8:30-5 M-W, 1 hour lunch
Thursday, OR day, 7:30- varies. Average probably 1pm but I was done by 11am today
Off Friday

So 22.5 contact hours in clinic per week
Awesome schedule.

Loss of a day generating clinic wRVU would be expensive (for me) but I am slightly envious.
 
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7am to 3:30pm TWTh, OR Monday and Friday, usually 3 cases each day, sometimes less, sometimes none so I may open it for clinic. 1.5 hour lunch (11:30-1pm). Off every other Friday.
 
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My clinic schedule is 8am - 5pm MWTF with an hour lunch break from noon-1pm. Tuesday is my surgery day. If no cases then I enjoy the day off or do some admin stuff but never clinic.

Also for the AM my last patient is scheduled at 11am and for the PM my last patient is scheduled at 4pm.

So most days in the AM I am done a little after 11am (or 11:30am if running behind) so I get more than an hour lunch break since my PM clinic starts at 1pm. Same for PM, I am done seeing my last patient a little after 4pm. We close at 5pm so my staffs have about an hour to prep charts for next day.
 
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3 day clinic 1 day OR is pretty common west coast and mountain west. More progressive in schedules and 4 days work 1 day off/maybe some admin
 
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I do 5 days clinic 8-5 with an hour lunch. Try not to do more than 4 patients per hour; 1-2 planned OR days a month. With the remaining time, I s***post this field on SDN
 
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8-4:30 on MTW, lunch 12-1:30 with block surgery time Thursday AM and then PM clinic until 4:30. Friday is just morning clinic with afternoon off. Usually I run across the street to see a few inpatients in the hospital during lunch break and to grab free lunch from the hospital. If I'm lucky I'll have about 30 minutes left to sit in my car and relax/nap.
 
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Mon, Tues and Thurs 8-4 in clinic with 1 hour
Wed OR starts at 8 30am due to grand rounds
Friday OR 7 30 to noon
Friday afternoon is "admin time"

So roughly 34 hours pt contact hours but this changes a lot when I am on call and is unpredictable. Call is now 1 week every two months.
 
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No four day work week when you are basically straight %...

5 days office: first four 8a-5p, Friday 8a-3p all with 1hr lunch.
1 day every other week OR block time (becomes office pts day or afternoon if few or no cases)
No call whatsoever... my choice if I want to come in for rare bona fide surgical emergencies.
...so roughly 34 hrs/wk of office pts (38 one week, 30 the next)... a bit over 40hr avg if you count OR early 0630 pre-op days as "contact hours."

I'm not sure what setup hours or patient volume would matter much, though... collections/RVU is usually the language spoken by PPs, hospitals, groups, anyone. Take home pay (esp per hour) is obviously the language employees speak.
 
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1st approx 10 yrs in practice:
M-Th 8a-4p
Fridays OR
Office hours after OR most fridays

Years approx 10-20 in practice:
Mondays mornings OR
Monday 1-4p ofc hrs
Tues-thur 8a-4p
Fri 8a-noon - pm OR if needed for add ons

Last approx 15 years in practice:
Monday morning OR
Off Monday afternoon
Tues&thur 9a-4p
Wed 8-noon
Off Fridays

I have found to love Monday mornings in the OR. It allows you to deal with MOST complications tue-thur vs. dealing with them all weekend from operating on Fridays. Plus Mondays are typically more "slow" vs. Fridays with respect to OR volume.

Hope everyone has a great weekend!
 
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I'm not sure what setup hours or patient volume would matter much, though... collections/RVU is usually the language spoken by PPs, hospitals, groups, anyone. Take home pay (esp per hour) is obviously the language employees speak.

I am truly salaried. Production has a strong correlation with compensation, but is not directly linked.

Salary = (production + patient volume + community involvement + population health + scholarly endeavors + resident/student involvement) multiplied by some conversion factor

The service line is a team. Podiatry offloads lower revenue procedures from ortho. Non-op and clinic heavy providers offload surgically focused pods of non-operative maladies. This allows everyone to be more efficient, but concentrates some lower producing aliments in certain clinics. This is where patient volume can be used a measure of productivity (albeit not a replacement for wRVU).

Having a feel of average clinic contact hours can help develop an average pace. You want to know how to control all the variables (including clinic contact hours) to better position yourself for slow sustained growth. Sustained growth is key when it comes to salaried positions.
 
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Last approx 15 years in practice:
Monday morning OR
Off Monday afternoon
Tues&thur 9a-4p
Wed 8-noon
Off Fridays
I love that schedule. In residency there were a few that did some variation of that. Great work life balance.

My first few years out:
M-Th 830-4 with 1 hour lunch. OR was before clinic as needed about 1 a week.

Now:
I average 4.5 days a week (off every other Friday) and about 2-3 surgeries a week still before clinic with the same hours.
I would love to get back to the every Friday off but its hard to say no to people wanting to get in and to turn down those wRVUs.
 
I love that schedule. In residency there were a few that did some variation of that. Great work life balance...
I agree with DPM Tooth (for once) that early week surgery is good so any complications, questions, bled through bandage, etc come in later in the work week, not the weekend. Complications should be rare on elective surgery if technique and pre-op visit were good, but those issues still happen.

Mondays are nuts, though. There is good reason they are always the least popular and least busy days at any hospital or ASC. To say they're a top choice day is taking what's available and then saying you wanted that all along. The surgery staff are dragging, patients or staff are more likely to arrive late, patients sometimes forget altogether (just like in clinic, since they were called and reminded days prior), and Mondays are a rough enough day even when you don't start extra early. Also, in PP, your staff are usually going to slack and pretend to be busy when you're out of office regardless, but doubly so on a Monday... they will find ways to "work from home" or generally do nothing.

I think Tue and Wed are the prime days to do surgery, and they're relatively available at a lot of facilities. A lot of Ortho, Gen, other MDs like Thu and Fri the best, so those are likely to be blocked out by one surgeon or another at most places. Both, esp Fridays, have the obvious downside of patients calling or having issues on the weekend. That's no a huge issue for Urology, Vasc, Ortho, etc who have PAs and partners on call, but for most DPMs, it's not ideal. Fridays are a good day to just finish office early if you're on productivity pay or take off if you are employed/FI and you can finesse that.
 
8:20-5:00 with 1 hour lunch on T/W/Th. Friday surgery.
 
Having every Monday off is nice because while just about everyone else is dreading going into work on Monday, I'm not.
 
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I feel like everywhere I have been Friday is the main podiatry day in the OR?
Our biggest cases in residency were always on a friday
I operate on friday
Every other DPM in the hospital is there operating on a friday.
It was hard for me to get block time any time other than Friday at my last and current job.
 
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esp Fridays, have the obvious downside of patients calling or having issues on the weekend. That's no a huge issue for Urology, Vasc, Ortho, etc who have PAs and partners on call, but for most DPMs, it's not ideal. Fridays are a good day to just finish office early if you're on productivity pay or take off if you are employed/FI and you can finesse that.
OTOH, Friday surgery is nice for patients who have to take time off from their work, since it's two extra days immediately post-op for which they don't need to use their PTO.

Edit: And, it's nice to have their initial post-op recovery happen on a weekend if their spouse (or other caregiver) can be home to help them without needing to burn their PTO.
 
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I feel like everywhere I have been Friday is the main podiatry day in the OR?
Our biggest cases in residency were always on a friday
I operate on friday
Every other DPM in the hospital is there operating on a friday.
It was hard for me to get block time any time other than Friday at my last and current job.

That's been the same experience for me. I always figured that it was because we got the leftovers.
 
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OTOH, Friday surgery is nice for patients who have to take time off from their work, since it's two extra days immediately post-op for which they don't need to use their PTO.
I feel like everywhere I have been Friday is the main podiatry day in the OR?
Our biggest cases in residency were always on a friday
I operate on friday
Every other DPM in the hospital is there operating on a friday.
It was hard for me to get block time any time other than Friday at my last and current job.
Yeah, Fridays are definitely the "podiatry day" in over half the hospitals I've ever seen or been on staff at. We had a lot of Fridays in residency where we'd have to send just a student to some forefoot cases or leave them uncovered.
Whether that's because it's what's left from what other surgeons choose for blocks or because that's what DPMs want, I'm not sure. Either way, M and F are always the times most easily available, the mid week Tu W Th morning blocks are usually much tougher to get - Thu seems to be most popular. I have targeted Tuesdays at some places with success.

...That is a good point of how Friday surgery gives people a couple more days off to weather the early anesthesia and Rx meds so they can go back to work with fewer sick days burnt up. It seems everyone has 800 sick days built up and wants to take 6 months off for a neuroma, or they have almost none and would go back to work a few hours after RRA surgery if they could. 😋
 
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Hey Feli I also agree.....tues/wed are the ideal OR days but the specialties that have block time (eye/GI/plastics) those days seem to never give up those slots. You are right, Monday mornings normally people are draggin' in pre-op/OR....when you get old Monday mornings are no different than any other day though. :)
 
I have Friday as surgery day because that's when block time was available. Sometimes they'll slip in a quick dental case ahead of me at 7:30am so they can get in and out without being "to follow" and honestly I don't mind since I don't love having to leave home at 6:45am for a 7:30 case.
 
Another thing to consider everyone, if your program has a good relationship with ortho - try to schedule the "big podiatry OR day" on a day when ortho is slow for the residents. Besides add-ons from the weekend, Mondays are very slow for ortho at our hospital. This allows the residents on ortho to help cover podiatry on non ortho days (multiple dpm attendings in ORs here @ same time) and vise versa on fridays (ortho day here).

I know "other rotations" are important, but knife time (primary scrub) with podiatry/orthopedics is the most single important experience (in my opinion) in the podiatry residency (behind office pre-op/post op work ups and follow ups). The more screws/pins the residents throw while "practicing" allows them to perfect their skills, minimizing complications.
 
Yeah, Fridays are definitely the "podiatry day" in over half the hospitals I've ever seen or been on staff at. We had a lot of Fridays in residency where we'd have to send just a student to some forefoot cases or leave them uncovered.
Whether that's because it's what's left from what other surgeons choose for blocks or because that's what DPMs want, I'm not sure. Either way, M and F are always the times most easily available, the mid week Tu W Th morning blocks are usually much tougher to get - Thu seems to be most popular. I have targeted Tuesdays at some places with success.

...That is a good point of how Friday surgery gives people a couple more days off to weather the early anesthesia and Rx meds so they can go back to work with fewer sick days burnt up. It seems everyone has 800 sick days built up and wants to take 6 months off for a neuroma, or they have almost none and would go back to work a few hours after RRA surgery if they could. 😋
The Friday thing definitely started started because that is when block time and slots for those with no block time were easier to obtain.

At this point it has been going on so long that it may have actually evolved a bit to where some podiatrists think this is a desirable time (even though no other specialties particularly want it) so they can do surgery then start their weekend early with no pm clinic.
 
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Another thing to consider everyone, if your program has a good relationship with ortho - try to schedule the "big podiatry OR day" on a day when ortho is slow for the residents. Besides add-ons from the weekend, Mondays are very slow for ortho at our hospital. This allows the residents on ortho to help cover podiatry on non ortho days (multiple dpm attendings in ORs here @ same time) and vise versa on fridays (ortho day here).

I know "other rotations" are important, but knife time (primary scrub) with podiatry/orthopedics is the most single important experience (in my opinion) in the podiatry residency (behind office pre-op/post op work ups and follow ups). The more screws/pins the residents throw while "practicing" allows them to perfect their skills, minimizing complications.
Are we talking about residencies or practice? I don’t have a program, residents, or any relationship with orthopedics.
 
My preferred ASC has begun adding "outpatient total knee". They aim to do these starting at like 7am. If I understand correctly they do a max of 2 and there's a small chance the patient spends the night overnight for 24 hours although the goal is to go home. The end result of this is my surgery center has a greater intensity in the mornings and they are essentially desperate to start these without complication which I think pushes everyone off a little. In general I try to live with a spirit of gratitude towards my center - they really never give me grief, the staff are good to excellent, I've had 1 case cancelled (*legitimately needed more work-up and then died while trying to reschedule claiming they had no issues) in 3 years, and no one gives me grief about hardware.

Apparently though, this new total knee game may be causing some trouble in paradise amongst the orthos. They put in place some sort of quality qualification system - you have to have done a certain number of knees, I guess have a very controlled surgery time, and have a specific complication rate. Not everyone qualified and some of the people who didn't apparently are complaining claiming they aren't getting the attention they need etc.

Meanwhile I just do my lumps and bumps and go home when I'm done.
 
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Apparently though, this new total knee game may be causing some trouble in paradise amongst the orthos. They put in place some sort of quality qualification system - you have to have done a certain number of knees, I guess have a very controlled surgery time, and have a specific complication rate. Not everyone qualified and some of the people who didn't apparently are complaining claiming they aren't getting the attention they need etc.

This has bee in place for a while in my region.

There are “centers of excellence” that have certain volumes and meet certain metrics. The centers run on a strict formula that dictates inpatient versus outpatient totals. They also receive certain preferential treatment when it comes to reimbursement if I remember correctly.

Runs real smooth.
 
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the mid week Tu W Th morning blocks are usually much tougher to get

I definitely love my Wednesday block time.

It works out well. Perfect to add cases from the weekend as well as get any pain calls or strike through taken care of before weeks end.
 
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I'm in academic practice with a 75-25 clinical-admin contract.

Monday: clinic 9-3, lunch 12-1
Tuesday: clinic 9-12, OR add-ons in the afternoon if needed
Wednesday: clinic 8-3, lunch 12-1
Thursday: admin time (teaching, workshops, lectures, charts etc)
Friday: OR block time full day, 7:30 start
 
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