General Pediatrics / Practice Volume

[oracle2]

The general pediatricians I've shadowed have expressed dissatisfaction with the sheer volume of patients they have to see to keep their doors open. That it's easy to get off schedule, makes challenging or unique diagnoses more stressful because they don't have time to spend with their patients, etc. It seems like it might be easy to "miss" something when you have to see a patient in under 10 minutes. One referenced a recent lawsuit in Maryland resulting in a 7million dollar verdict against a pediatrician for missing a heart defect, which from looking at the article seemed pretty easy to miss since the child had very few symptoms. What awful luck. Another encouraged his daughter, a pediatric resident, to specialize in neonatology to avoid this.

Anyway, I'm feeling discouraged about my potential career choice, since general peds was always my primary interest. Do you agree with these sentiments?

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[Markbright]

I believe for every 1 discouraging story there are 10 great stories. I've read that Pediatricians are known to have the highest rates of job/career satisfaction. Some of the problems (patient time) you describe do exist and hopefully health care reforms may fix this.

 

[Socrates25]

The general pediatricians I've shadowed have expressed dissatisfaction with the sheer volume of patients they have to see to keep their doors open. That it's easy to get off schedule, makes challenging or unique diagnoses more stressful because they don't have time to spend with their patients, etc. It seems like it might be easy to "miss" something when you have to see a patient in under 10 minutes. One referenced a recent lawsuit in Maryland resulting in a 7million dollar verdict against a pediatrician for missing a heart defect, which from looking at the article seemed pretty easy to miss since the child had very few symptoms. What awful luck. Another encouraged his daughter, a pediatric resident, to specialize in neonatology to avoid this.

Anyway, I'm feeling discouraged about my potential career choice, since general peds was always my primary interest. Do you agree with these sentiments?

Ummm, liability in subspecialties, ESPECIALLY critical care subspecialties like NICU and PICU, is higher than general peds. I believe that general peds actually has much lower liability than most other areas of medicine.

If you set up a clinic with private insurance in a generally low cost area, I think its pretty easy to keep the doors open. Not so much on Medicaid, the current increased reimbursement levels notwithstanding. I worked with a general peds guy who sees 10 to 15 patients per day, sick visits are 20 minutes, well child checks are 40 mins. His average reimbursement per visit is about $150 to $200. He has 1 front desk person and 1 nursing assistant. Even with all the clinic bills and utilities he still makes about $180k per year, which isnt bad at all for general peds. I'd rather make 180k seeing 15 patients per day rather than 280k seeing 50 patients a day. Once your patient volume gets above a certain threshold, your practice costs go up geometrically, because the volume of staff required to handle that patient load sucks up a lot of resources. 1 front desk person can easily handle the phone load of a 15 patient per day practice, but if it gets higher than that, then you need 2 front desk people, 2 nurses, etc. Eventually it gets large enough and you have to hire an office manager to deal with all of that staff.

Here's the deal - in order to make that setup work you need to think like a business owner. That means if your front desk person aint cutting it, you dont have an office manager fire them, YOU have to fire them. It also requires a lot of after office hours to manage the books and deal with business regulation issues. It can be done, but arent going to make that work by putting in standard 8 to 5 office hours type work.

 

[Postictal Raiden]

Ummm, liability in subspecialties, ESPECIALLY critical care subspecialties like NICU and PICU, is higher than general peds. I believe that general peds actually has much lower liability than most other areas of medicine.

If you set up a clinic with private insurance in a generally low cost area, I think its pretty easy to keep the doors open. Not so much on Medicaid, the current increased reimbursement levels notwithstanding. I worked with a general peds guy who sees 10 to 15 patients per day, sick visits are 20 minutes, well child checks are 40 mins. His average reimbursement per visit is about $150 to $200. He has 1 front desk person and 1 nursing assistant. Even with all the clinic bills and utilities he still makes about $180k per year, which isnt bad at all for general peds. I'd rather make 180k seeing 15 patients per day rather than 280k seeing 50 patients a day. Once your patient volume gets above a certain threshold, your practice costs go up geometrically, because the volume of staff required to handle that patient load sucks up a lot of resources. 1 front desk person can easily handle the phone load of a 15 patient per day practice, but if it gets higher than that, then you need 2 front desk people, 2 nurses, etc. Eventually it gets large enough and you have to hire an office manager to deal with all of that staff.

Here's the deal - in order to make that setup work you need to think like a business owner. That means if your front desk person aint cutting it, you dont have an office manager fire them, YOU have to fire them. It also requires a lot of after office hours to manage the books and deal with business regulation issues. It can be done, but arent going to make that work by putting in standard 8 to 5 office hours type work.

Just out of curiosity, how much does Medicaid reimburse for new/established visits?

Thanks