clinic volume

[JelloIsJigglin]

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Tried to search forums but maybe I'm typing in wrong keywords.

Just curious what you guys consider respectable clinic volume.
My august 2021 numbers are 4 new patients and 20 f/u per clinic day ; 22 procedures per procedure day

 

[drusso]

Tried to search forums but maybe I'm typing in wrong keywords.

Just curious what you guys consider respectable clinic volume.
My august 2021 numbers are 4 new patients and 20 f/u per clinic day ; 22 procedures per procedure day

Are you part-time or full-time?

 

[JelloIsJigglin]

Are you part-time or full-time?

full time in private practice.
My days are random.
Wednesdays and Fridays are my heaviest and I typically see 30-35 patients with about 3 or 4 new.
Monday , Tuesdays I typically experience a ton of no shows unfortunately (different clinic locations).
Thursdays, volume is slowly rising as it is a new expansion clinic in new territory so I'm working on building our name out.

I've been at this practice for a year now and I'm asking management to show me my numbers to give me a sense of how i've done and where I should realistically and reasonably be.

 

[afob100]

I see about 18-19 per day - about 10 new, rest follow up. Hospital employed.

 

[SSdoc33]

You are seeing too many follow ups. The new patients are your lifeblood and will feed your injection volume. The NUMBER of patients you are seeing is about right

 

[afob100]

How do you guys see 30-35 patients (especially if more than half are new?).

I spend 20 min per patient (new or f/u) with 7 patient care hours (=20 patients per day).

 

[BobBarker]

That is too long for a follow up. New patients should take a lot longer than a follow up.

 

[callmeanesthesia]

Seems like a lot of follow ups, especially for only one year in practice. Are you doing a lot of med management?
My appointments are 15 minute follow up and 30 new. 7:30-4:00, hour break for lunch.

 

[DOctorJay]

How frequently are you bringing your follow ups back in? Is everyone 4 or 8 week follow up?

 

[Ducttape]

for quality care, 15 minutes is really not enough.

but for financial care, 15 minutes is probably the right amount of time.

a respectable clinic volume is the one where neither you nor the administrators are feeling overly stressed over it, and are both happy with pace. (a lot depends on your clinic make up)


the way hospital admins keep track is by looking at your wRVUs. you should be able to get that number monthly.

 

[nopain1234]

100+ injections per week is very solid

 

[pmrmd]

Your practice numbers can be fine. It depends on how you operate. I see patients in follow-up visits that have new complaints and move from cervical to lumbar to peripheral joint and so on. All injections or procedure of some kind.

 

[jsammi245]

I am curious about this as well. I just started as a new attending and I see about 30 patients a day (sometimes more). Maybe 3-4 new but have acquired a lot of follow up patients (basically new to me). Procedure days are separate. It seems like I barely have adequate time for my patients. When you are seeing this many patients are you repeating an adequate physical exam? I always like doing a physical exam to make sure if things are still the same or if I am missing anything new. Also, when I try to wean down opioid medications it takes a lot of time too. Its just hard to develop a good relationship with them especially when I try to explain multidisciplinary approaches to their treatment.

 

[Sooshi]

My current impression is that 20 patients per day is about the limit to what you can reasonably do in a day while actually providing some quality care and using your noodle a bit here and there.

 

[SSdoc33]

I am curious about this as well. I just started as a new attending and I see about 30 patients a day (sometimes more). Maybe 3-4 new but have acquired a lot of follow up patients (basically new to me). Procedure days are separate. It seems like I barely have adequate time for my patients. When you are seeing this many patients are you repeating an adequate physical exam? I always like doing a physical exam to make sure if things are still the same or if I am missing anything new. Also, when I try to wean down opioid medications it takes a lot of time too. Its just hard to develop a good relationship with them especially when I try to explain multidisciplinary approaches to their treatment.

here is your answer. you will get more efficient when you learn what you don't need to do. example: you don't need to do a full exam for most injection follow-ups.

also, if you let patients talk, they will discuss their cat from 1982. focused questions only. that whole "open-ended" question nonsense that was taught in medical school is for the birds

 

[buddababa]

I am curious about this as well. I just started as a new attending and I see about 30 patients a day (sometimes more). Maybe 3-4 new but have acquired a lot of follow up patients (basically new to me). Procedure days are separate. It seems like I barely have adequate time for my patients. When you are seeing this many patients are you repeating an adequate physical exam? I always like doing a physical exam to make sure if things are still the same or if I am missing anything new. Also, when I try to wean down opioid medications it takes a lot of time too. Its just hard to develop a good relationship with them especially when I try to explain multidisciplinary approaches to their treatment.

30 patients a day imo, is quite a lot unless you're working long hours. There should be a fine balance in providing excellent care, but also not burning out, making enough money and not looking at each patient as an rvu.
But then again, big difference between which model you're employed, the expectation of the employer, hopd based etc. So, there really isn't a right answer, just my 2 cents.

 

[JelloIsJigglin]

for quality care, 15 minutes is really not enough.

but for financial care, 15 minutes is probably the right amount of time.

a respectable clinic volume is the one where neither you nor the administrators are feeling overly stressed over it, and are both happy with pace. (a lot depends on your clinic make up)


the way hospital admins keep track is by looking at your wRVUs. you should be able to get that number monthly.

so I feel i'm very efficient during the patient visit and i have gotten really good at developing rapport, providing quality care or at least take the time to explain thought process and decision making.

my 1 year review has come up. Obviously I feel most comfortable with the standard 20 f/u (15 min) and 6 new (30min) on an 8 hour work day with 1 hour lunch (8-5). However there is the never ending "pressure", whether real or not, about volume and productivity. I have walked into this practice that is high volume and currently in expansion phase. I do see a lot of established follow-ups but there is also an eye-opening pile of referral packets waiting to be seen.
First, solid volume would be around 26-30 with 6 news, yes?
Second, should i ask my schedule to be more around 8-10new with 10-14 follow-ups instead?
I want to be a valuable asset but don't want to kill myself or compromise patient care. There are some MDs in the area who "see" 40 patients with 10 to 15 news but I have a good sense of what those encounters are actually like...

 

[SSdoc33]

so I feel i'm very efficient during the patient visit and i have gotten really good at developing rapport, providing quality care or at least take the time to explain thought process and decision making.

my 1 year review has come up. Obviously I feel most comfortable with the standard 20 f/u (15 min) and 6 new (30min) on an 8 hour work day with 1 hour lunch (8-5). However there is the never ending "pressure", whether real or not, about volume and productivity. I have walked into this practice that is high volume and currently in expansion phase. I do see a lot of established follow-ups but there is also an eye-opening pile of referral packets waiting to be seen.
First, solid volume would be around 26-30 with 6 news, yes?
Second, should i ask my schedule to be more around 8-10new with 10-14 follow-ups instead?
I want to be a valuable asset but don't want to kill myself or compromise patient care. There are some MDs in the area who "see" 40 patients with 10 to 15 news but I have a good sense of what those encounters are actually like...

if you dont get paid for your extra volume, you will feel resentful and burnt out. if you get the $$ for the work, it will feel more fair..... at least for a while

 

[JelloIsJigglin]

if you dont get paid for your extra volume, you will feel resentful and burnt out. if you get the $$ for the work, it will feel more fair..... at least for a while

fair enough. it's ultimately a personal decision. i do get paid on productivity which is fair. i just wanted to get a sense what others do to see where I stand.

 

[RoloTomassi]

The biggest factor in efficiency is time wasted on non face to face things--EMR, orders, scripts, pulling up images, calls, P2P. If you can get that down to a minimum, then streamline your face to face (exam while taking history, cut them off when they go on tangents, etc) you'd be surprised how many quality visits you can do and not feel rushed. A lot of that rushed feeling happens because you are frantically getting things done between face to face encounters.

 

[Ferrismonk]

What is an appropriate number is completely dependent on what your goals are. My last job had 20min new patient appointments and 10min followups. Completely doable if you streamline the office and outsource all things that the physician isn't required to do personally. Generic med refill physical exams can be done from the door. I often charted or caught up on patients during lunch and stayed after to catch up on misc paperwork/UDS/patient portal/etc.

That being said, I did not enjoy this pace and am now much happier with a max 24 patient per day schedule and often take a 1.5 hour lunch and still get out at 4. My kids also like knowing I exist.

 

[Dr. Ice]

7a-1p or 1p to 7p Monday-Friday. Thanks to Covid and my group doesn’t want to go back to full day schedule. No lunch..I probably see 25 in that time with the help of a PA, mix of new and follow ups. 3 clinic days, 2 procedure days. Private practice. I’m probably 75-80% productivity as compared to pre-covid. My kid probably sees me too much...

 

[DesertDoc16]

I’m a pain doc in a big Ortho practice. I see ~22 pts in clinic/day….. 30 min New, 15 min f/u. 2.5 clinic days/week

22-25 procedures/day in the injection suite (includes SCS trials- 2/week)

8-5 M-F, no call, no weekends

~1,000 wRVU/month

I keep 50% of collections

 

[PAINISGOOD]

I’m a pain doc in a big Ortho practice. I see ~22 pts in clinic/day….. 30 min New, 15 min f/u. 2.5 clinic days/week

22-25 procedures/day in the injection suite (includes SCS trials- 2/week)

8-5 M-F, no call, no weekends

~1,000 wRVU/month

I keep 50% of collections

You keep 50% of collections after getting paid on wRVU? I'm confused. What's your CF?

 

[DesertDoc16]

No, I was just giving my wRVU for reference. It is easier to compare apples to apples when looking at wRVUs.

I don’t get paid on RVU, I just keep 50% collections

 

[JelloIsJigglin]

What is an appropriate number is completely dependent on what your goals are. My last job had 20min new patient appointments and 10min followups. Completely doable if you streamline the office and outsource all things that the physician isn't required to do personally. Generic med refill physical exams can be done from the door. I often charted or caught up on patients during lunch and stayed after to catch up on misc paperwork/UDS/patient portal/etc.

That being said, I did not enjoy this pace and am now much happier with a max 24 patient per day schedule and often take a 1.5 hour lunch and still get out at 4. My kids also like knowing I exist.

what were your daily numbers when you were at that last job?
i seem to be comfortable seeing 5-6 news and 20 patient follow-ups . i've seen 3-4 new patients with 28 f/us before which keeps me busy but i'm not breaking my back.

i'd like to see if i can pick up more volume without losing quality of care; but before I run my mouth I want to open the flood gates with caution.
fortunately the administrators at my practice aren't pressuring me in any way, which i'm thankful for; but i do want to see if can be of more service to the growth of this practice.

 

[plasma.]

New fellow here, interesting discussion everyone! I'm impressed by the volume you are all seeing.

Would anyone mind sharing their template or a couple consultation letters (without patient data of course!) they have for typical patients? Low Back Pain, Neck Pain etc? I am finding that the notes are keeping my efficiency down significantly.

 

[kstarm]

New fellow here, interesting discussion everyone! I'm impressed by the volume you are all seeing.

Would anyone mind sharing their template or a couple consultation letters (without patient data of course!) they have for typical patients? Low Back Pain, Neck Pain etc? I am finding that the notes are keeping my efficiency down significantly.

With the new billing rules your documentation should be a lot less onerous. I would recommend creating your own templates and continuing to modify them as you figure out how you practice though realize you are at the mercy of your attendings for what they might require. I essentially have 3 new patient templates (back pain, neck pain, other). I refer to my notes frequently for specific things and like those things in specific places to make them easy to find. Also there are scribe options (probably not as a fellow), which if you have a good one will make a significant difference in your charting time. Keep focused on the big picture of learning pain management. The charting gets easier as you feel more confident about what is essential, your plans, and next steps if plan A doesn't work.

 

[plasma.]

With the new billing rules your documentation should be a lot less onerous. I would recommend creating your own templates and continuing to modify them as you figure out how you practice though realize you are at the mercy of your attendings for what they might require. I essentially have 3 new patient templates (back pain, neck pain, other). I refer to my notes frequently for specific things and like those things in specific places to make them easy to find. Also there are scribe options (probably not as a fellow), which if you have a good one will make a significant difference in your charting time. Keep focused on the big picture of learning pain management. The charting gets easier as you feel more confident about what is essential, your plans, and next steps if plan A doesn't work.

Excellent advice kstarm! I only have one template right now but I think separating them will be helpful. I'll try that next week. To be honest so much of my time is spent getting their PMHx, previous therapies, imaging etc. Our clinic isn't very optimized and I often have to navigate multiple programs / EMRs so I imagine after fellowship I can speed up quite a few things.

 

[Espn123]

I’m a pain doc in a big Ortho practice. I see ~22 pts in clinic/day….. 30 min New, 15 min f/u. 2.5 clinic days/week

22-25 procedures/day in the injection suite (includes SCS trials- 2/week)

8-5 M-F, no call, no weekends

~1,000 wRVU/month

I keep 50% of collections

This is similar to me