Proportion of full skin checks to spot checks, new to return patients

[username456789]

I'm starting my first post-residency job soon and they're trying to figure out how to structure my schedule. Specifically, they want my input as to the number of full skin checks, problem focused lesion/spit checks, etc., as well as the proportion of new and return patients.

Taking into account billing, ease vs annoyance, and anything else, anyone have any guidance on what your preferred setup (within reason) would look like?

My compensation is mostly a very reasonable base salary, with a bonus that kicks in at ~40% of collections once I collect 2x base.

I'd love to find a way to set myself up for success from the beginning. On average I will probably be seeing ~4 patients an hour but this will vary somewhat based on appointment type and may increase with time. I'll be working in a fairly efficient/productive private practice with a couple docs and a couple PAs.

Thanks for any insight!

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[asmallchild]

I'm starting my first post-residency job soon and they're trying to figure out how to structure my schedule. Specifically, they want my input as to the number of full skin checks, problem focused lesion/spit checks, etc., as well as the proportion of new and return patients.

Taking into account billing, ease vs annoyance, and anything else, anyone have any guidance on what your preferred setup (within reason) would look like?

My compensation is mostly a very reasonable base salary, with a bonus that kicks in at ~40% of collections once I collect 2x base.

I'd love to find a way to set myself up for success from the beginning. On average I will probably be seeing ~4 patients an hour but this will vary somewhat based on appointment type and may increase with time. I'll be working in a fairly efficient/productive private practice with a couple docs and a couple PAs.

Thanks for any insight!

Depending on what type of practice you are joining, I would try and squeeze in as many patients as possible as it's typically slow to get off the ground for a new dermatologist. You can always pare down once you find your schedule full (I was able to rapidly build my own patient base by picking up all the patients the other docs didn't want to see: pediatrics, rashes, same day add-ons, etc etc)

Personally, I find full skin checks all day long tiresome but if you are looking to build up a surgical practice (or are feeding a Mohs surgeon), it is necessary. Problem focused lesion / spot checks go quicker but most practices will generally pressure you into convincing the patient to fully disrobe for a full check (one could argue it's better for the patient, it's definitely better for the practice from a billing and medicolegal viewpoint). Unless you are inheriting an outgoing dermatologist's patient base, most of your patients will probably be new so be sure to account for how long it takes for new patients to complete their paperwork. 4 new patients an hour isn't unreasonable but a lot of it depends on how the front staff handles new patient flow/paperwork.

I think your compensation and your schedule is pretty reasonable. I had a group once ask me to see 6 patients an hour for 9 hours. While that is doable if everyone coming in is established and here for spot checks, it will become rapidly draining if everyone is new and present for full skin checks.

If you have time between graduation and starting, it might be worth your while to shadow half a morning with the most efficient/productive docs in your group to see how they run their clinic and if you want to employ similar techniques.

 

[doctalaughs]

I personally find the spot and full exams easy as they are fairly predictable for time (even if you do several biopsies its easy to wrap up in 10 min). It's the bad dermatitis non-slam dunk rashes (ie not perioral derm, not contact or atopy etc) where they "want to know what is causing this" that can be difficult. Of course that also depends on the temperment of the patient partly.


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[sawtella]

Great idea for a thread as I'll be starting my first post-residency job as well. Would love to hear other people's thoughts.

On a somewhat related note, any advice on how to schedule your surgical (non-mohs) patients? Is it better to have a day(s) just for surgeries? or to mix it in with your regular clinic patients?

 

[asmallchild]

Great idea for a thread as I'll be starting my first post-residency job as well. Would love to hear other people's thoughts.

On a somewhat related note, any advice on how to schedule your surgical (non-mohs) patients? Is it better to have a day(s) just for surgeries? or to mix it in with your regular clinic patients?

I would probably go with what the other providers in your group are doing to make scheduling easier.

In general, I find mixing with regular clinic patients tends to provide more flexibility and fills your schedule quicker. However, this is if you are quick with your excisions (no more than 15 minutes/patient, something worth practicing in your final year if you have the chance) and if your staff is equipped to handle this (this means a front staff that is effective at getting patients in and out quickly and a clinical staff that can get the patient roomed and the trays set up quickly)

Some run a hybrid where they end/start the morning/afternoon with procedural slots to minimize the chaos that can occur if an excision runs late.

 

[werd]

Agree with some of the thoughts above. I'll tell you about my own schedule for comparison... I'm at a private practice and see about 20 patients per half day (6/hr), or do 7-8 excisions per half-day. My surgical time is generally separate from my "regular patient" time. When I started, I saw 4 pt's/hr with 2 new/hr and gradually worked up to 6 pt's/hr, 1 new/hr. Some of the other physicians in my group cap the number of skin checks per hour that can be scheduled, but personally I don't. I probably see 12-14 skin checks per half day and 6-8 for everything else. If you are thinking about billing, more skin checks generally brings in more productivity since those patients are more likely to have E/M plus procedure codes and it leads to more skin cancer diagnosis and treatment. Hopefully that helps.

 

[doctalaughs]

I would think all excisions together might be more efficient but I mix them into clinic because it breaks the day up and makes seeing 40 patients in a row less of a grind. I don't differentiate between new and follow-up patients because I don't think the time requirement really differs much (sometimes a return rash not responding to to 1st or 2nd line treatment can be far more time-consuming).

How do you guys gracefully limit the number of issues patients bring (ie skin check and by the way hair loss, onychomycosis and 2 cosmetic concerns)?


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[asmallchild]

I would think all excisions together might be more efficient but I mix them into clinic because it breaks the day up and makes seeing 40 patients in a row less of a grind. I don't differentiate between new and follow-up patients because I don't think the time requirement really differs much (sometimes a return rash not responding to to 1st or 2nd line treatment can be far more time-consuming).

How do you guys gracefully limit the number of issues patients bring (ie skin check and by the way hair loss, onychomycosis and 2 cosmetic concerns)?


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I unfortunately don't. Patients seem to like me much better than my partners because of this reason. Admittedly, I run a significantly less efficient clinic that way.

My partners actually have slots carved out for issues. You want a 10 minute emergency slot? It's a 1 issue visit. A standard 2o minute slot? 3 issues. Some providers are willing to carve out 30 min slots for patients with multiple issues. Most will make the patient come back over multiple visits if the list is really outrageously long.

Other providers within our office have their MA play bad cop before they even enter the room. e.g. The MA will room the patient, go through a brief history, have them undress, and then inform the patient that the doctor is running on time so pt can ask as many questions as they wish / doctor is running behind so they will be limited to x number of questions