I don't believe that only doing income generating activities is the same as being efficient. Good patient care will require tasks like attending rounds, working collaboratively with social workers on psychosocial aspects of care, providing expert perspective to milieu staff on strategies for dealing with particularly difficult patients, talking to families, engaging with hospital structures such as pharmacy, compliance, legal, the ED, nursing leadership around ongoing strategies for quality improvement, reviewing recent literature to make sure you remain up to date on best practices, understanding local policy changes, completing commitment paperwork, responding to patient experience people, completing prior authorizations, and documenting in a way where your note carries the necessary information to support billing, inform the practice of subsequent providers and fully capture your formulation and work done versus just using a bunch of dot phrases. I am very efficient but also do a good job and I make good money but it is not 4 hours for 15 patients its more like 5 - 6 hours for 10 - 12 patients. I have no doubt that there are providers who see more patients in less time but if you were to achieve that by refusing to be comprehensive in the way described I wouldn't hire you on my team, and I would likely have no difficulty finding someone who was willing to do a more thorough job as income data supports that most people are ok making $350k for a full time (6 - 8 hours) inpatient job versus wanting to make more for a half day which is what you are proposing as a reasonable standard.