how consults are split in your practice

[PRAD_ONC]

Long time lurker, new attending radonc in private practice.

How do people in multi-physician practices split new consults? ... specifically, what do you do if a consult is not directed to any specific physician? is the consult assigned to the first available slot? Do you split them 50/50 (if 2 docs) and wait until a slot is open for each physician?

Lastly, what percent of consults in multiphysician practices are not directed?

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[medgator]

Depends on the practice model. If eat what you kill, consults are referred to a specific physician usually

If an equal partnership group, consults are generally divided up equally to keep everyone productive. Doesn't always work as some patients /referring MDs may prefer a specific physician.

If no specific physician listed, usually we will schedule based on patient preference for schedule and who is in the office on that day

 

[domestique]

Our practice is built in a kind of academic way with ~2 disease sites preferences for each MD in practice. So it's essentially a "triage system" for each disease site with physicians having consult spots filled based on this disease site preference list. Since we have disease specific tumor boards for all sites, this allows the five of us to split coverage of these, to develop a deeper expertise in those areas, and to have responsibility for opening trials corresponding to these sites. This has built a tremendous respect among referrings and produced a host of other benefits locally. Final pay is roughly the same among all MDs.

 

[thaddeus]

We are a hippie liberal coastal practice, and split all NPs equally. Our front office ensures that patients are divided relatively evenly between the physicians. We are too small to specialize as domestique discussed. Our annual RVUs are typically within a few percent of each other. It works well, as well all have strong relationships with our referring docs, and prevents a feeling of competition within our group. Some may argue that we have travelled down the road to socialism, but so far we have avoided bread lines and eating gruel in the gulags. And our patient satisfaction is very high.

 

[RadRadRad]

I would guess less than half are referred to specific md
Scheduler tries to divide evenly otherwise

 

[Irradi8or]

I'm in a large socialist practice where all partners make the same (split the pot evenly). If a patient is referred to one of us, we try to schedule with that specific physician, but if there's a time delay in getting to that physician, we give the patient or referring physician's office the option to schedule with one of our physicians at that site. Naturally, some referring physicians prefer one physician or another, and it takes time for our newer hires to get into some of the referral streams.

 

[seper]

I'm at at practice where productivity affects pay, so there is some tensions between physicians, and front desk often gets a lot of complaints about who gets to see what.

 

[dogjam]

We are transitioning to a model where all the docs are more mindful of their wRVUs. Not straight productivity, but we need to maintain a certain wRVU threshold to maintain our salary. So we're trying to figure out the fairest way to distribute consults.

We're leaning towards having consults for which a specific MD was requested go to that MD (obviously), and then having the remaining pool of general/no-specific-physician-requested consults distributed equally in a rotational fashion. Thus, if you are requested more often, then your volume grows (as opposed to having your requested consult count as your turn in the rotation).

 

[PRAD_ONC]

We are transitioning to a model where all the docs are more mindful of their wRVUs. Not straight productivity, but we need to maintain a certain wRVU threshold to maintain our salary. So we're trying to figure out the fairest way to distribute consults.

We're leaning towards having consults for which a specific MD was requested go to that MD (obviously), and then having the remaining pool of general/no-specific-physician-requested consults distributed equally in a rotational fashion. Thus, if you are requested more often, then your volume grows (as opposed to having your requested consult count as your turn in the rotation).

kind've getting into the weeds a little bit, but how do you deal with a long wait time for patients ... i.e. when one of the physicians is on vacation or maternity leave?

 

[medgator]

kind've getting into the weeds a little bit, but how do you deal with a long wait time for patients ... i.e. when one of the physicians is on vacation or maternity leave?

Where I am, If pt or referring requests a sooner appt, they see someone else in the practice when the requested MD won't be available. We all treat everything.

 

[Mandelin Rain]

Make sure you hire really good, like-minded people. Split the patients evenly. Split the money evenly. Avoid resentment, competition, and envy.

Works really well for us.

 

[dogjam]

Where I am, If pt or referring requests a sooner appt, they see someone else in the practice when the requested MD won't be available. We all treat everything.

Same here. Our goal is to offer an appointment within 1 week if non-urgent, and within 2 days if there's any urgency (often we will do same-day if urgent). If the rotation doesn't allow for that, then we break the rotation (and even it up later on).

Make sure you hire really good, like-minded people. Split the patients evenly. Split the money evenly. Avoid resentment, competition, and envy.

I agree--this would be optimal. Unfortunately in our institution we are all judged individually, based on our individual wRVUs, with respect to our individual (and different) salaries.