Are 15 minute med management appointments that bad?

[BiscoDisco]

I know it's often attributed to poor care around here, but in reality are these short visits really that bad? From my experience 15 minutes is more than enough time to discuss the medications, side effects, and maybe one current social issue the patient is facing. Referral to a therapist would likely be warranted for many of these patients. The flip side to these short visits is more patients are going to be seen. Obviously from a personal economic perspective this is helpful. But from a general systems perspective, the wait times to get in with a psychiatrist is so high as it is. By getting more people seen, wouldn't we be able to help more people - many of whom may have otherwise gone unseen?

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[TexasPhysician]

Fairly common to do 15 min visits if referring all for therapy. I have no issues with it. The alternative is longer visits and refer stable patients back to PCP instead of keeping them.

 

[smalltownpsych]

As the person providing psychotherapy, I would prefer the 15 minute psychiatry visit and actually think that in early phases of treatment process more frequent brief follow ups probably make more sense than longer visits further apart. The last MD I worked with operated this way and it worked well. He applied the concept of titration to all aspects of the treatment including his time and therapy time along with environmental stress load. Brilliant concept that I apply every single day in my practice.

 

[Bartelby]

Interesting perspectives. I have not done 15-minute visits aside from issues like straightforward and highly stable ADHD, but I can see the point of the above posters. If you have highly stable patients who just need a quick check-in, that might be reasonable. I personally would be wary of such short visits for patients who need anything more than a few quick questions and a refill on medication though.

 

[calvnandhobbs68]

I think for adults, 15min can work with the right patient population. Problem with 15min appointments is that it really really depends on everyone showing up on time and everyone not having more than 15min worth of problems. Otherwise 5 minutes here, 5 minutes there, now you're a whole appointment behind, now this patient is pissed you're trying to shunt them out in 15min when they wanted to talk about how their co-worker made them feel depressed for another 10 minutes because you're their PSYCHIATRIST after all but you're already an appointment behind. I know people who do this kind of schedule and just run behind constantly....patients don't like it. Real 15 min visits are more like 10 min of patient contact time...so really scheduling 20min visits might keep you more on time.

In psychiatry, you just run a higher risk of patients you thought could be quick in and outs wanting to talk more too. Theoretically people "see their therapist" outside your appointments but like today I've already had 2 patients who haven't seen their therapist for like 2 months. So guess who gets to hear about all the life problems (i don't care cause I just bill a therapy add on code but I'd be running 30 minutes behind if these were supposed to be 15min check in).

Child/adolescent 15 minutes never realistically works and is absolutely substandard for anything less than a stable ADHD f/u.

 

[ObsequiousAplomb]

Most of the providers who see 4+ patients per hour say they are doing it to improve access to the community. Very rarely will they openly admit it's about money, since that sounds very greedy. They're both the same thing though. It's like most ethical arguments in medicine.

My answer to this question comes down to patient selection.

Some patients cannot tolerate a 30 minute or 60 minute visit and would be better served by more frequent 15 minute visits, as others have said.

Some patients, especially those who are truly stable, do not usually (but sometimes do) need more than 15 minutes. Sometimes those patients end up having a complication that extends the visit beyond 15 minutes, and as long as your system can handle that, then it's fine. Like splitting an hour of admin time into four 15 minute blocks spread out over the day to fill in the cracks. That way patients aren't sitting in the waiting room longer if one or two of the people who are usually straightforward take a little longer. Alternatively, you could take the policy of most PCPs and say patients need to show up 15 minutes early but expect to be in the waiting room up to an hour after the appointment time. Nothing angers me more in a day than feeling like I am cutting someone off while playing catch-up only for the next patient to no-show.

It's also important to be sure you have the general outline for those visits streamlined - reviewing all the PDMP reports for the day in the morning and briefly summarizing in the chart, same thing with lab orders being pre-written (Utox, lipids, whatever routine things you were definitely going to be doing) and results of recent tests reviewed and summarized. Not a bad idea to have some self-rating scales filled out too. At the very least it will show that you really were reviewing a bunch of data and justify that you really were providing 4 x 99214s and not just churning through. Without those scales and labs you would most likely be meeting 99214 criteria, it just makes it look better if audited or anyone else ever pokes their nose in your business. On the off chance someone just has one diagnosis, the labs, scales, and admin time will make sure most of those qualify as 99214.

It's also worth noting that very, very few PCPs would be spending as long as 15 minutes with a stable patient that you refer back to them, and if they do spend 15 minutes then most of that was probably dedicated to addressing non-psychiatric topics.

If you don't want to refer back to PCP because you want them to stay with your office and intermittently be seen by you specifically, this would be an excellent use case for an NP or PA that you employ. Make sure you see them once a year or 6 months and let the NP or PA see them the other times. NP/PA just follows your preferred basic algorithm for the sessions between and the patient sees you if anything comes up / needs changed. This frees you up to see intakes and unstable patients. Depends whether you trust your employees more than the PCP to detect subtle signs of decompensation.

All this said, my general setup is 3 basic med management follow-ups an hour, 2 for meds and basic supportive or manualized therapy, 1 for dynamic work. I do have a few hours a week set aside for 15 minute appointments for my patients who require monthly med management appointments solely because I don't do longer than 30 day prescriptions of controlled substances. Stable ADHD means I see them once a month to make sure things are going well and there are no changes. I try to respect their time by making half of their visits virtual and keeping it short - they can book a longer appointment if they have a new problem to address.

 

[Alemo]

Ill take the contra position, of course its substandard. Can you imagine any scenario in which 15 minutes is equal to more time spent with the psychiatrist? Less is never more. It may be enough, but you dont know that before the patient starts talking.

I realize this implies some kind of residential treatment would be best (probably not true universally). “Long contact” treatment isn’t indicated for everyone, or even logistically feasible for most.

Anyway, the answer to the follow up question “how long is long enough” is unclear, but maybe bring back the days where it was sanctioned for the psychiatrist/physician to set their own appointment times. 15 min to cut hair will work on a ten tear old with a buzz cut, but not with a woman wanting a perm and highlights. It needs to vary according to demands of the situation and judgment of clinician.

Also, anytime there’s a financial incentive for the entrepreneur or insurance company to do something (because you went into psychiatry to make serious coin), you’ve got to take a step back. Is this good for the patient, or you? Its rarely coincidentally “both.”

 

[splik]

There is nothing wrong with seeing a pt for 15 minutes if that is what is clinically indicated.
There is something very wrong with a model where 15 minute visits is the norm and where the model is "med checks". We are not pharmacists. We should not be devaluing our work and skillset in this way.
I have certainly seen pts for 15 minutes or even 5 mins because there was nothing else to talk about. However most of my visits are closer to an hour and I see patients more frequently and can usually see patients within a week. In that sort of model I could see a patient for 5 minutes and it would be fine since I can see them the following week if needed etc.
Those settings where pts are stacked up in 15 minute back to back visits are often high volume settings where pts are seen q3 months. It is not possible to provide good care to pts in that model. If all of your patients are so stable that the default is this then you aren't expanding access to care since these patients could likely be seen in primary care. Having potentially complex patients, unstable patients, patients with psychosocial complexity and seeing them for 15mins a few times a year sounds awful.

Physician satisfaction tends to be low in these models of care. Patient satisfaction is low. Quality of care is low. If employed, the pay is usually not commensurate with the volume. Liability and risk of lawsuit is higher because your pt volume is higher, documentation is poorer, and chances of errors and patient suicides etc increases simply because you are carrying more patients.

I believe the duration of patient visits should ideally be individualized to clinical need and patient preference. Some patients may require 5 minutes, some 60 minutes. For the patient where it is not clear how much time is needed, 25-30minutes makes sense and is increasingly becoming the standard in psychiatry.

 

[Merovinge]

One issue w/ 15 min f/u is (compared to 30 min f/u) you have roughly twice the patient panel. This means twice as many phone calls, emergencies, letters, and refills. For the right practice than can deflect the lion's share of this from the physician it can work, but relies on having very good support staff than seems increasingly uncommon these days.

Patient emergencies become much harder to address in 15 min blocks. Hospitalizing patients always takes time as does contacting the ED. Finding time to talk to other providers, therapists, etc becomes much harder with a more full schedule. My anecdotal experience is that calls back from psychiatrists occur in a timeliness proportional to their case panel. I recently spoke with a psychiatrist who's patient had been IP and then to my PHP/IOP and they had no idea if the patient was even there's by name until looking them up. I assure you when I did OP practice that any patient recently hospitalized I recognized by name despite my terrible memory for names.

Does all the above negate an increase in access? I think that would be a wonderful study to perform, but that realistically will never be done. I know I could not practice to the standard of care I hold myself to in a 4 patient per hour setup.

 

[calvnandhobbs68]

Patient emergencies become much harder to address in 15 min blocks. Hospitalizing patients always takes time as does contacting the ED. Finding time to talk to other providers, therapists, etc becomes much harder with a more full schedule. My anecdotal experience is that calls back from psychiatrists occur in a timeliness proportional to their case panel. I recently spoke with a psychiatrist who's patient had been IP and then to my PHP/IOP and they had no idea if the patient was even there's by name until looking them up. I assure you when I did OP practice that any patient recently hospitalized I recognized by name despite my terrible memory for names.

Exactly. I think the answer above where you build in a few 15-20min admin time blocks during the day would be the way to make this work because it inevitably comes up that a few times a week patients throw a curveball at you. That stable patient checks off SI on their PHQ-9 and tells you they thought about overdosing this week because they lost their job or they started cutting because school is so stressful this semester. This just realistically can't be addressed properly in a few minutes....you need a good 15 minutes alone to do a minimal safety plan and it's not standard of care to just go "oh man guess you should talk to your therapist about this".

 

[rjs2131]

I can't imagine having a 15-min appointment with a psychiatrist as the standard without a) being extremely burnt out or b) providing inadequate care for some patients.

A lot of this is very patient dependent but given the need to standardize things, I'd much rather err on the side of some patients not needing the full 30 min vs some patients needing more than 15 min (I could see this happening all the time) and being perpetually behind. That sounds terrible and not worth the increased revenue if you're working anywhere close to full-time.

 

[Marasmus1]

I know it's often attributed to poor care around here, but in reality are these short visits really that bad? From my experience 15 minutes is more than enough time to discuss the medications, side effects, and maybe one current social issue the patient is facing. Referral to a therapist would likely be warranted for many of these patients. The flip side to these short visits is more patients are going to be seen. Obviously from a personal economic perspective this is helpful. But from a general systems perspective, the wait times to get in with a psychiatrist is so high as it is. By getting more people seen, wouldn't we be able to help more people - many of whom may have otherwise gone unseen?

Discussing social issue does not make it disappear though. Honestly, I do not think 15 minutes med check every month is enough to cover many symptoms and co-morbidities for a conventional psychiatric patient, much more so for dysregulated patients.

Now, my opinion though is that no care many times (not all the time) is worse than a poor care or some care. So in community clinics I do understand the logic behind it. I guess I just dont want to be part of it personally.

 

[nexus73]

There is nothing wrong with seeing a pt for 15 minutes if that is what is clinically indicated.
There is something very wrong with a model where 15 minute visits is the norm and where the model is "med checks". We are not pharmacists. We should not be devaluing our work and skillset in this way.
I have certainly seen pts for 15 minutes or even 5 mins because there was nothing else to talk about. However most of my visits are closer to an hour and I see patients more frequently and can usually see patients within a week. In that sort of model I could see a patient for 5 minutes and it would be fine since I can see them the following week if needed etc.
Those settings where pts are stacked up in 15 minute back to back visits are often high volume settings where pts are seen q3 months. It is not possible to provide good care to pts in that model. If all of your patients are so stable that the default is this then you aren't expanding access to care since these patients could likely be seen in primary care. Having potentially complex patients, unstable patients, patients with psychosocial complexity and seeing them for 15mins a few times a year sounds awful.

Physician satisfaction tends to be low in these models of care. Patient satisfaction is low. Quality of care is low. If employed, the pay is usually not commensurate with the volume. Liability and risk of lawsuit is higher because your pt volume is higher, documentation is poorer, and chances of errors and patient suicides etc increases simply because you are carrying more patients.

I believe the duration of patient visits should ideally be individualized to clinical need and patient preference. Some patients may require 5 minutes, some 60 minutes. For the patient where it is not clear how much time is needed, 25-30minutes makes sense and is increasingly becoming the standard in psychiatry.

Plus, if you can justify seeing more patients to improve access but provide lower quality care, there is no liability protection. That's great you're trying to help the community, if some care is truly better than no care, but if something bad happens the lawyers will be circling.

I find it frustrating that we discuss crisis standards of care when hospital ICUs are being overrun, which does impart a level of liability protection. But psychiatry has basically been crisis standards for years and we get nothing.

 

[Candidate2017]

14 min, or less, can be enough (hence +90833). But unless you only have highly functional patients on one SSRI, it's not enough time to keep your clinic on schedule, check labs, finish notes, change scripts, send a worsening patient to the ER, etc.

However highly functional patients have no interest in taking time out of their lives to see a dispensing robot who runs late, asks the same questions, stares at a computer, and rushes them out. They quickly figure out it's more efficacious to get 4-6 months' worth of SSRI refills from their PCP (and retain a PhD therapist if needed). When they leave, who's left? Who else puts up with a 15 min cattle call? The low functioning patients desperate for a pill (stims and benzos) for each of life's problems.

Then you devolve into those docs who strike a quid pro quo deal: Don't ask don't tell, and I will refill your controlleds. Because if you actually pay attention, many stim/benzo patients will have funky stuff bubble up over time, whether comorbid depression and/or sub abuse and diversion (as is the case for 1/3 of stim patients). In the end, it's your call since psychiatry is gray and most clinical choices can be justified one way or the other, and the floor for standard of care is not difficult to meet.

Interestingly, I notice psychiatrists who are ok with 15 min med check clinics + turf to "therapist" usually trained at very prestigious places that emphasize "psychopharmacology" or trained at bottom of the barrel places.

 

[smalltownpsych]

Just to add that it is only going to be more effective to have briefer visits as a psychiatrist if you are having regular feedback from the one providing therapy and a certain amount of trust in them handling their part and bringing relevant issues to the psychiatrist. It also depends on the personality of the psychiatrist, I would imagine. Even as a psychotherapist I can be effective with briefer interventions at times and I am actually pretty good at 15 minute therapy, I just can't bill insurance for it.

edit to add: I would never schedule outpatient sessions like this and it has occurred mainly in the context of residential or inpatient settings.

 

[TexasPhysician]

One issue w/ 15 min f/u is (compared to 30 min f/u) you have roughly twice the patient panel. This means twice as many phone calls, emergencies, letters, and refills. For the right practice than can deflect the lion's share of this from the physician it can work, but relies on having very good support staff than seems increasingly uncommon these days.

Patient emergencies become much harder to address in 15 min blocks. Hospitalizing patients always takes time as does contacting the ED. Finding time to talk to other providers, therapists, etc becomes much harder with a more full schedule. My anecdotal experience is that calls back from psychiatrists occur in a timeliness proportional to their case panel. I recently spoke with a psychiatrist who's patient had been IP and then to my PHP/IOP and they had no idea if the patient was even there's by name until looking them up. I assure you when I did OP practice that any patient recently hospitalized I recognized by name despite my terrible memory for names.

Does all the above negate an increase in access? I think that would be a wonderful study to perform, but that realistically will never be done. I know I could not practice to the standard of care I hold myself to in a 4 patient per hour setup.

Many practices that do this will require letters and refills in appointments. More frequent visits for managing 1 change at a time and evaluate results. Emergencies are appointments or go to ER. Total patients are not usually 2x, maybe 1.5.

 

[Stagg737]

However highly functional patients have no interest in taking time out of their lives to see a dispensing robot who runs late, asks the same questions, stares at a computer, and rushes them out. They quickly figure out it's more efficacious to get 4-6 months' worth of SSRI refills from their PCP (and retain a PhD therapist if needed). When they leave, who's left? Who else puts up with a 15 min cattle call? The low functioning patients desperate for a pill (stims and benzos) for each of life's problems.

Just going to point out that I'm aware of several clinics that do exactly this (minus the running late part) and have high functioning patients for majority of their panel. Many of those patients are stable overall, but want the comfort of knowing they have a psychiatrist available if things go south. A lot of high functioning patients don't want to spend 30+ minutes with their doctor most of the time. They want to get in, get their meds refilled, and get out. One of those clinics I rotated through in med school and the patients were actually very appreciative of the model; and this was with a physician who did not prescribe benzos and only prescribed stimulants for patients who had completed a formal ADHD evaluation.

 

[TexasPhysician]

Does anyone do visits lasting <5 minutes? And seeing 35+ patients a day?

The people doing that don’t have time to post here. There is one psychiatrist I know that rounds on 2 inpatients in the morning. She then does outpatient clinic after. No appointment times. You show up and take a number at 8am. Whenever she arrives from rounding, clinic begins. Don’t expect length of time to be long, but she accepts a lot of plans. 5 min is quite possible.

Receiving her patients from inpatient is always an entertaining read.

 

[Alemo]

At some point it just becomes stupid. Why would someone who practices psychiatry like @TexasPhysician described even have gone into the field in the first place? If you wanted to churn and burn you should have gone into allergy or ophthalmology. The real money is in finance, bht that was like 5 exits ago bruh.

 

[calvnandhobbs68]

Yeah it certainly is a non-traditional practice style but in an area with high demand it could be appropriate. And to answer your question, ophthalmology is much more competitive than psych so not everyone can do that and allergy requires a rigorous internal medicine residency and is also competitive given limited number of fellowship positions. Regarding finance I agree.

Thanks for telling us what could or could not be appropriate practice med student.

Honestly if you don’t stop posting essentially asking about different ways you can make as much money as possible in psychiatry, I’m going to start flagging posts. You have nothing clinical to contribute and keep inquiring about how you can provide the ****tiest care for the most money.

 

[painballer27]

Thanks for telling us what could or could not be appropriate practice med student.

Honestly if you don’t stop posting essentially asking about different ways you can make as much money as possible in psychiatry, I’m going to start flagging posts. You have nothing clinical to contribute and keep inquiring about how you can provide the ****tiest care for the most money.

My apologies. I didn't mean to overstep any boundaries. It is certainly not my intention to ever provide poor care and I am sorry if my posts came off that way. I am done posting.

 

[clausewitz2]

Thanks for telling us what could or could not be appropriate practice med student.

Honestly if you don’t stop posting essentially asking about different ways you can make as much money as possible in psychiatry, I’m going to start flagging posts. You have nothing clinical to contribute and keep inquiring about how you can provide the ****tiest care for the most money.

I am guessing I am also not the only person the poster has DM'd specifically asking about how much money can potentially be made in psychiatry and whether it is a good specialty choice for making money without working too much.

 

[BiscoDisco]

I am guessing I am also not the only person the poster has DM'd specifically asking about how much money can potentially be made in psychiatry and whether it is a good specialty choice for making money without working too much.

Add me to the list

 

[allantois]

 

[allantois]

At some point it just becomes stupid. Why would someone who practices psychiatry like @TexasPhysician described even have gone into the field in the first place? If you wanted to churn and burn you should have gone into allergy or ophthalmology. The real money is in finance, bht that was like 5 exits ago bruh.

When I was a student there was a doc who would see over 100 patients a day. He's spend less than 5 mins with each and line everyone outside of his door. He was an FMG from India, who I am pretty sure had no passion for psychiatry or medicine other than making the most amount of money. I don't think he is the only one out there as I routinely get patients who complain to me about same experiences.. unfortunately it does seem to be common with FMGs from particular regions

 

[nexus73]

When I was a student there was a doc who would see over 100 patients a day. He's spend less than 5 mins with each and line everyone outside of his door. He was an FMG from India, who I am pretty sure had no passion for psychiatry or medicine other than making the most amount of money. I don't think he is the only one out there as I routinely get patients who complain to me about same experiences.. unfortunately it does seem to be common with FMGs from particular regions

i’ve heard this volume of patients can be typical in India. A combination of extreme physician shortage and essentially no malpractice risk. Patients line up around the block to see the doctor, hoping they can get in that day. Then the doctor sees them with the line stretching out the exam room door.

 

[BiscoDisco]

When I was a student there was a doc who would see over 100 patients a day. He's spend less than 5 mins with each and line everyone outside of his door. He was an FMG from India, who I am pretty sure had no passion for psychiatry or medicine other than making the most amount of money. I don't think he is the only one out there as I routinely get patients who complain to me about same experiences.. unfortunately it does seem to be common with FMGs from particular regions

Lol that would be like 10M a year.

 

[allantois]

Lol that would be like 10M a year.

It was like a medicaid practice or $55 per app cash

 

[Merovinge]

I am guessing I am also not the only person the poster has DM'd specifically asking about how much money can potentially be made in psychiatry and whether it is a good specialty choice for making money without working too much.

Haha, I feel special to have gotten the same DM. First time getting a mass DM on SDN, I have arrived!

 

[allantois]

The people doing that don’t have time to post here. There is one psychiatrist I know that rounds on 2 inpatients in the morning. She then does outpatient clinic after. No appointment times. You show up and take a number at 8am. Whenever she arrives from rounding, clinic begins. Don’t expect length of time to be long, but she accepts a lot of plans. 5 min is quite possible.

Receiving her patients from inpatient is always an entertaining read.

One of my professors called these ppl whor**. She would routinely testify against them in court as well, but most seem to never get into any legal trouble

 

[jbomba]

One of my professors called these ppl whor**. She would routinely testify against them in court as well, but most seem to never get into any legal trouble

Seems like a bit of a biased witness..

 

[lockian]

I am able to get some patients done in 15 minutes or less and for some I need all 30 minutes. Some people are also not good at describing their experience so you have to ask clarifying questions. Psychiatry is like a box of chocolates, you never know what you're going to get.

 

[lockian]

Also, a patient may be stable for years and then arrive in crisis or having decompensated hard. And then what are you going to do in 15 minutes?

 

[Liquid8]

Like many others, I just find 15 minute appointments too rushed and too prone to having my schedule disrupted due to having patients that are unexpectedly late, complex or both. More usually it is patients arriving 10-15 minutes late for half hour appointments – under those circumstances they will probably still get at least 20 minutes even if I go overtime, and over the course of a day I can catch up on this with a few minutes per review.

The problem with shorter duration appointments is that these patients who would otherwise have just been late will instead end up missing their appointments completely, generating a whole lot of demands for followup calls/scripts etc. Also, time gets magnified to the point where it can get hard to wrap things up early even when this is a possibility (patients complaining about not getting their allocated time), and running late by 5 minutes is acceptable for 30 or 60 minute slots but becomes more obvious when it’s only a 15 minute one.

Most of my colleagues see patients at 30 or 60 minute appointments. One of the guys who does a lot of ADHD work does have some 15 minute slots in the mix, but even in his case it’s only for a couple of hours a day and he’s quite picky about selecting patients who he knows are straightforward. Stable patients with a new crisis isn’t exclusive to non-ADHD patients as they usually have other psychiatric comorbidities that require monitoring too.

For shorter time slots than that, I don’t know anyone running that kind of outpatient practice. However, some of the big inpatient admitters carry 10-15 patient caseloads and end up running conveyor belt style systems. Essentially they work their outpatient sessions to 5pm, then before they arrive on the ward they get the ward nurses to find and line up their inpatients outside an interview room and they might take 60-90 minutes to get through their entire caseload. This approach isn’t always favoured by patients – they typically complain to patients looked after by other psychiatrists who spend more time with their inpatients.

 

[smalltownpsych]

I also just remembered that the doc I worked with in a residential setting was scheduling the patients for 30 minute slots. It is just that most of the time he would only spend about 15 to 20 minutes face to face with patient. I sat in on a couple of his sessions with patients of mine and it was pretty comprehensive and not rushed at all. Occasionally he could squeeze in extra patients or a brief consult with therapist or other staff because of the flex time. I highly doubt that trying to schedule and hold to 15 minute sessions all day would work well at all.

 

[nexus73]

I also just remembered that the doc I worked with in a residential setting was scheduling the patients for 30 minute slots. It is just that most of the time he would only spend about 15 to 20 minutes face to face with patient. I sat in on a couple of his sessions with patients of mine and it was pretty comprehensive and not rushed at all. Occasionally he could squeeze in extra patients or a brief consult with therapist or other staff because of the flex time. I highly doubt that trying to schedule and hold to 15 minute sessions all day would work well at all.

agreed. some patients need 7 minutes, some need 34 minutes. can’t predict. can’t send a suicidal patient out because they hit the 15 minute endpoint.

 

[Bartelby]

I also just remembered that the doc I worked with in a residential setting was scheduling the patients for 30 minute slots. It is just that most of the time he would only spend about 15 to 20 minutes face to face with patient. I sat in on a couple of his sessions with patients of mine and it was pretty comprehensive and not rushed at all. Occasionally he could squeeze in extra patients or a brief consult with therapist or other staff because of the flex time. I highly doubt that trying to schedule and hold to 15 minute sessions all day would work well at all.

And if you take 20 minutes with a patient it gives you 10 minutes to chart, review charted updates, place orders, and as you mention squeeze in talking with therapists, urgent questions etc. It's just such a more pleasant way to practice than being constantly behind and having adequate time only when things go exactly as expected.

 

[Candidate2017]

Just going to point out that I'm aware of several clinics that do exactly this (minus the running late part) and have high functioning patients for majority of their panel. Many of those patients are stable overall, but want the comfort of knowing they have a psychiatrist available if things go south. A lot of high functioning patients don't want to spend 30+ minutes with their doctor most of the time. They want to get in, get their meds refilled, and get out. One of those clinics I rotated through in med school and the patients were actually very appreciative of the model; and this was with a physician who did not prescribe benzos and only prescribed stimulants for patients who had completed a formal ADHD evaluation.

I can see the utility of reserving one half to one day a week for 15 min refill slots for well established patients with a long history of stability. I'd call it Fiesta Fridays... Everything good? Scripts are in, same time in 3 months? Bye, have a good weekend!

I like it in theory. Maybe I will get there one day. But 3 per hr billed at 99214+90833 is all the rage in my area. So many choices.

 

[Bartelby]

But 3 per hr billed at 99214+90833 is all the rage in my area. So many choices.

This is why we can't have nice things! (In other words, how long until this behavior leads to cracking down on therapy add ons for those of us who are actually doing over 16 mins of real therapy at each meeting?)

 

[deleted1100659]

A lot of private clinics are doing 15 min med checks. My issue with that is its 4 patients each hour of clinic time. Certainly some will be late, so hopefully theres a solid late policy place and people who do arrive on time. Also it would be hard having any time at all for patient messages/issues unless you have good support staff. I have all 20 min follow ups with high acuity patients which is not near enough time tbh. For that reason, if a patient has questions I usually require appt unless its a med refill or something of the sort. Logistically just seems very difficult if 15 min f/u all you're doing unless you have a very reliable patient population.

 

[whopper]

There's a zone where you get as much time as you need. Most of the time it's between 10-45 minutes. It's like like a bell curve. Most will fit nicely within 30 minutes. Some will for 15 but this is a smaller amount.

15 minutes IMHO works well on patients where they're fine, all significant issues that you treat are in remission and it's really mostly just a refill meeting. This is going to be the majority of your patients once you've stabilized them. The problems being even in this selective group on occasion and often times unannounced some patients will relapse. They scheduled for 15 minutes but it's really not a 15 minute meeting and they won't take the hint when you tell them 15 minutes is up. Another problem is that even if you can get 4 patients in an hour and they're all doing well this is not a comfortable work pace to keep up all day long.