How many direct patient-facing clinical hours are normal for a full-time outpatient health psychology position?

[silverway]

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Hoping to hear what the range is for folks. If you can share the breakdown (individual vs group therapy vs admin time vs other etc.) and what feels doable vs overwhelming, even better. Thank you!

 

[borne_before]

In my clinic the expectation is 100% slot utilization, with 7 hours billed per day and an hour of admin work. So 35/week.

But that like rarely happens. Our contract has a .75 of that 35 productivity clause that’s never been enforced or looked at. They want us to hit basically 27 billable hours week with no shows and what not.

It’s pretty doable. But also do a ton of testing. But the 7 other providers I work with don’t really have issues.

 

[WisNeuro]

According to providers on Reddit, 12 hours is full-time, and you'll need at least 3 months of vacation a year for self-care to prevent burnout. Also, anything less than 200k for that level of work is exploitation in today's capitalistic hellscape.

 

[R. Matey]

According to providers on Reddit, 12 hours is full-time, and you'll need at least 3 months of vacation a year for self-care to prevent burnout. Also, anything less than 200k for that level of work is exploitation in today's capitalistic hellscape.

Those 12 hours are obviously spent doing the "real work" of somato-IFS/Jungian/Lacanian psychoanalysis rather than that gaslighting CBT.

 

[silverway]

In my clinic the expectation is 100% slot utilization, with 7 hours billed per day and an hour of admin work. So 35/week.

But that like rarely happens. Our contract has a .75 of that 35 productivity clause that’s never been enforced or looked at. They want us to hit basically 27 billable hours week with no shows and what not.

It’s pretty doable. But also do a ton of testing. But the 7 other providers I work with don’t really have issues.

Thanks for your answer! You might not be able to answer this, but do you think that split would be reasonable for someone seeing patients mainly in 30-minute slots, too? My impression is that since it would be double the number of sessions and notes per clinical hour, a bit more admin time might be needed.

I'm looking into a position that hasn't had someone in that specific role before, so I'm trying to gauge what expectations are reasonable and sustainable.

 

[borne_before]

Thanks for your answer! You might not be able to answer this, but do you think that split would be reasonable for someone seeing patients mainly in 30-minute slots, too? My impression is that since it would be double the number of sessions and notes per clinical hour, a bit more admin time might be needed.

I'm looking into a position that hasn't had someone in that specific role before, so I'm trying to gauge what expectations are reasonable and sustainable.

Ahh, then you can try to advocate for what you think is best.

Personally, I think the hour of therapy is sacrosanct.

I guarantee some bean counter in the organization wants 30 minutes sessions because they are "total" clinical number person.

This middle management bean counter can go to their boss and say "look, we went from X visits last month to X+280).

 

[quickpsych]

Hoping to hear what the range is for folks. If you can share the breakdown (individual vs group therapy vs admin time vs other etc.) and what feels doable vs overwhelming, even better. Thank you!

Depends on the specific setting.

If you're considering a "full time 40 hour a week" job in an outpatient clinic you're probably looking at anywhere from 25-35 billable hours a week. Sometimes little less, sometimes little more. I know someone who works in a outpatient clinic (non community mental health) and they have to average 38 a week which is absurd. I know someone else who works in a larger multi site clinic and their billable hours average is around 24 a week.

I spent a few years working in a community health center clinic (which tend to be , as far as I can tell from others on here, as bad as the VA in pushing volume over quality) and was expected to average around 35 hours of billable services a week. I was a bit fortunate in that I did some intakes and also ran groups in a partial hospitalization program that was part of the clinic so I usually had less one-one therapy sessions than most of the staff and this also meant my productivity was more easily reached (it was very rare to have an intake slot empty and groups were always running so my no show rate was low). I do miss the groups but don't miss the high volume and low pay. And I definitely don't miss how if they knew you had a no show they'd tell you to cover an extra intake or group. This was also before the deluge of paperwork and metrics was taking up more time.

I've also worked in settings where they'd take your lunch hour for meetings (admin) as much as they could and argue it was still lunch because you didn't have a patient in front of you. Some clinicians would purposely leave the building for their lunch break so they couldn't be found to be told to cover someone else's group or intake.

To be real, many clinics will tell you your admin time is on you to figure out (i.e. if a no show comes and they don't make you cover something else, do your notes then) and will try to fill every hour of every work shift with a billable service.

TLDR: 25-35 hours of billable work per week is the range and most will skew to the higher end.

 

[Sanman]

Thanks for your answer! You might not be able to answer this, but do you think that split would be reasonable for someone seeing patients mainly in 30-minute slots, too? My impression is that since it would be double the number of sessions and notes per clinical hour, a bit more admin time might be needed.

I'm looking into a position that hasn't had someone in that specific role before, so I'm trying to gauge what expectations are reasonable and sustainable.

Is this hospital based? Are there other duties? Do they expect you to have room for warm hand-offs from a PCP? Are you limited to only 30 min sessions? Are intakes 30 min or 60 min?

 

[silverway]

Is this hospital based? Are there other duties? Do they expect you to have room for warm hand-offs from a PCP? Are you limited to only 30 min sessions? Are intakes 30 min or 60 min?

Outpatient clinic. I don't know the answer to most of those, yet. 60 minutes for intake.

 

[oliversacks4thewin]

Unfortunately, this is a difficult question to answer as there is so much variability dependent on the structure of the setting. For example, is this an AMC that builds research into performance metrics? Then you can typically "buy-out" patient facing time for a grant, if you have secured one. Is there an expectation for teaching/supervising/community outreach?

Is it standard practice to have contracts built with admin time at this location? You said Health Psychology, so I am assuming that it needs to fit following structures. What type of behavioral health consultation structure is the clinic? multidisciplinary clinic setting? co-located care in a family med clinic? consultation model? What are you supposed to target treatment/assessment towards? Treating/assessing medication adherence issues is vastly different than treating/assessing functional symptoms, which is markedly different from pre-operational evaluations... I would say it's important to learn much more about the site. All of these factors radically change the number of patient-facing hours.

 

[bcliff]

100% clinical is 32 billable hours per week in my academic medical setting... and I don't think anyone in my department is 100% clinical.

 

[WisNeuro]

100% clinical is 32 billable hours per week in my academic medical setting... and I don't think anyone in my department is 100% clinical.

28-32 billables was the mark last I was in a hospital setting. We also had training responsibilities.

 

[AcronymAllergy]

The expectation at my last hospital was 90% of your time (excluding lunch) booked in face-to-face patient care, so basically 32 hours. There were exceptions for neuropsych to allow report writing time to count toward this as well.

 

[WisNeuro]

The expectation at my last hospital was 90% of your time (excluding lunch) booked in face-to-face patient care, so basically 32 hours. There were exceptions for neuropsych to allow report writing time to count toward this as well.

As it should, them's billable!

 

[borne_before]

As it should, them's billable!

Hence a benefit of being a tester! I only do about 15 face to face hours a week I recon.

 

[AcronymAllergy]

As it should, them's billable!

Indeed. Although apparently, trying to convince some VA administrators that a neuropsychologist needs non-face-to-face time to write a report, rather than just breezing through it while the patient's in the room for the eval, was a gargantuan task.

 

[WisNeuro]

Indeed. Although apparently, trying to convince some VA administrators that a neuropsychologist needs non-face-to-face time to write a report, rather than just breezing through it while the patient's in the room for the eval, was a gargantuan task.

Midlevel managers are not known for their ability to understand nuanced situations. ""That's not what the cells on my spreadsheet tell me!"

 

[Sanman]

Midlevel managers are not known for their ability to understand nuanced situations. ""That's not what the cells on my spreadsheet tell me!"

Had a medical director ask why neuropsychs were not seeing 7 pts per day at one point.

 

[WisNeuro]

Had a medical director ask why neuropsychs were not seeing 7 pts per day at one point.

Yup, why it's important to have people in leadership who have actually done the work at some point. I have definitely had to correct glaring inaccuracies many times along the way.

 

[AcronymAllergy]

Yup, why it's important to have people in leadership who have actually done the work at some point. I have definitely had to correct glaring inaccuracies many times along the way.

Or at least people in leadership who are willing to listen to the providers about what they do.

 

[WisNeuro]

Or at least people in leadership who are willing to listen to the providers about what they do.

Good luck finding that unicorn in a big healthcare system these days.

 

[smalltownpsych]

When I worked in a healthcare setting, my compensation was based on productivity and was basically 60% of what was billed. Came out to about 150k per year and this was about ten years ago so prior to recent inflation. I scheduled 40 hours a week and would sometimes see patients during my lunch hour. Had about 80% show rate and would use the no shows to do paperwork or grab a bite to eat. Department meetings were once a month and used a lunch hour. The key to me is that if my pay is based on how hard and efficiently I work, then I will do it. I do respond to behavioral reinforcement.

 

[AcronymAllergy]

When I worked in a healthcare setting, my compensation was based on productivity and was basically 60% of what was billed. Came out to about 150k per year and this was about ten years ago so prior to recent inflation. I scheduled 40 hours a week and would sometimes see patients during my lunch hour. Had about 80% show rate and would use the no shows to do paperwork or grab a bite to eat. Department meetings were once a month and used a lunch hour. The key to me is that if my pay is based on how hard and efficiently I work, then I will do it. I do respond to behavioral reinforcement.

Sadly, given what insurance-based MH reimbursement rates have been doing in the interim, the rate probably wouldn't have increased much from then to now.

But I agree--if there are going to be productivity expectations, assuming compensation isn't tied directly to productivity, then I think there should also be productivity-based incentives/bonuses.

 

[Sanman]

When I worked in a healthcare setting, my compensation was based on productivity and was basically 60% of what was billed. Came out to about 150k per year and this was about ten years ago so prior to recent inflation. I scheduled 40 hours a week and would sometimes see patients during my lunch hour. Had about 80% show rate and would use the no shows to do paperwork or grab a bite to eat. Department meetings were once a month and used a lunch hour. The key to me is that if my pay is based on how hard and efficiently I work, then I will do it. I do respond to behavioral reinforcement.

Sadly, given what insurance-based MH reimbursement rates have been doing in the interim, the rate probably wouldn't have increased much from then to now.

But I agree--if there are going to be productivity expectations, assuming compensation isn't tied directly to productivity, then I think there should also be productivity-based incentives/bonuses.

I think this spends on the model you are using. For outpatient clinic work, a productivity model is useful. For something like PC-MHI where warm handoffs and emergency availability is needed, a productivity model is less useful. This boils down to whether you are structuring the position for a value-based care or fee for service model. My job works more on a flat salary value based care model. My goal there is to usually work smarter and reduce unnecessary headaches.

 

[AcronymAllergy]

I think this spends on the model you are using. For outpatient clinic work, a productivity model is useful. For something like PC-MHI where warm handoffs and emergency availability is needed, a productivity model is less useful. This boils down to whether you are structuring the position for a value-based care or fee for service model. My job works more on a flat salary value based care model. My goal there is to usually work smarter and reduce unnecessary headaches.

Also agreed. I think there are some positions and services that are expected to be a net loss to the company, but that still provide value. Having productivity benchmarks and incentive other than raw RVUs/billables is important for fairness in those types of positions, although you've got me as to what some of those benchmarks and incentives might be. Maybe things like patient encounters, etc.

Plus, I believe there's research to support that at least some of those types of services still provide a net financial gain (or at least less of a loss), such as by reducing costs elsewhere, encouraging patients to come to the facility, etc.

But again we see why viewing healthcare solely through the lens of profit can be problematic.

 

[Sanman]

Also agreed. I think there are some positions and services that are expected to be a net loss to the company, but that still provide value. Having productivity benchmarks and incentive other than raw RVUs/billables is important for fairness in those types of positions, although you've got me as to what some of those benchmarks and incentives might be. Maybe things like patient encounters, etc.

Plus, I believe there's research to support that at least some of those types of services still provide a net financial gain (or at least less of a loss), such as by reducing costs elsewhere, encouraging patients to come to the facility, etc.

But again we see why viewing healthcare solely through the lens of profit can be problematic.

The measurement of value-based care is very difficult on an individual level, which is the problem. You can't really measure a hospitalization that is avoided or a disease process that has not worsened but could have unless you compare it to those not receiving the care. Part of the ongoing headaches in participating in the model. However, people in business offices feel the need to justify their existence.