lemonlove

2+ Year Member
Feb 4, 2016
40
1
I am seriously hating 3rd year. My attendings keep on telling me that I am spending way too much time with the patient's talking to them and getting to know them. They are constantly telling me that I won't survive in the real world where I'll have to see at least 20 patient's a day. I honestly felt happier doing inpatient and seeing 10-12 patients everyday. I didn't do much therapy, but it felt more enjoyable.

What is the real outpatient world like and how much time do you spend to see the patient, do your note etc?

One thing, I cannot multi-task, I cannot do the note while I'm talking to the patient. Nor can I call the pharmacy.
 

wannabie

7+ Year Member
Nov 28, 2011
165
82
Status
Fellow [Any Field]
I am seriously hating 3rd year. My attendings keep on telling me that I am spending way too much time with the patient's talking to them and getting to know them. They are constantly telling me that I won't survive in the real world where I'll have to see at least 20 patient's a day. I honestly felt happier doing inpatient and seeing 10-12 patients everyday. I didn't do much therapy, but it felt more enjoyable.

What is the real outpatient world like and how much time do you spend to see the patient, do your note etc?

One thing, I cannot multi-task, I cannot do the note while I'm talking to the patient. Nor can I call the pharmacy.
I'm also a third year resident starting outpatient. We're seeing eight to fourteen patients a day. It's hard in the beginning because we're learning a new EMR and template. Every patient we see is a new patient and we have to work to verify history and diagnoses--and most of the patients I inherit are unstable. I'm able to stay afloat when I type while talking to a patient. The template takes a while to get through because they're making us reconcile medications and medical history, but I think I could see myself seeing three patients an hour after residency.

Please remind yourself that it gets easier as your skills develop and that you will likely be able to handle twenty patients a day when they're patients you know well.

But I totally understand where you're coming from. I prefer inpatient at this time but for other reasons!
 

Shikima

10+ Year Member
Oct 15, 2006
4,529
2,650
Status
Attending Physician
After a while, you'll get much faster. Especially if you work in a single system where EMR won't change and can learn to operate it more efficiently.
 
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keifernny2

5+ Year Member
Aug 26, 2013
262
163
Status
Attending Physician
You don't have to see 20 pts per day in the real world unless you want to.

A good way to find out how to manage is to ask them outright how they manage to see 20 per day, and if you can, start using their note template.

Make sure that you identify, document, and discuss with attending all the pt liabilities that could put yourself and these attendings at legal risk now and in the future, e.g. Suicidality, child abuse, driving while impaired, threats of violence against others. If there isn't time for these things, ask if the patient can be booked for a double length appt next week so that this can be done and documented appropriately. In your didactics, if it hasn't happened already, it may be a good idea to request that the hospital attorney come in and give a presentation about malpractice and what to document to reduce risk.


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splik

Professional Cat at Large
10+ Year Member
Nov 30, 2009
3,794
5,242
Status
Attending Physician
I am seriously hating 3rd year. My attendings keep on telling me that I am spending way too much time with the patient's talking to them and getting to know them. They are constantly telling me that I won't survive in the real world where I'll have to see at least 20 patient's a day. I honestly felt happier doing inpatient and seeing 10-12 patients everyday. I didn't do much therapy, but it felt more enjoyable.

What is the real outpatient world like and how much time do you spend to see the patient, do your note etc?
My thoughts:
1. your attendings dont sound very supportive (and i highly doubt they are seeing 20+ pts themselves). You have just started third year - it is a steep learning curve, and you are supposed to be slow(er)! You are supposed to be learning and shouldn't have anywhere near the patient load of someone in practice.
2. If you don't like outpatient - that's great! Most psychiatrists hate inpatient, or even working in the ER. There are plenty of inpatient jobs there that tend to be much cushier than outpatient and pay a lot better.
3. You can see as many or as few patients as you want once you graduate. BTW the standard nowadays is 60mins news, and 30 mins for follow ups. If you are doing 15 min visits, then you're a sucker. Most people would regard 2 news a day as standard.
4.As you fill your panel, get to know your patients, and stabilize them it gets a lot easier and quicker.
4. You can do what you like once you're out in practice. I don't do much outpatient work but I like spending lots of time doing evaluations. For forensic cases I sometimes spend 7-10 hours doing an eval and get paid on an hourly basis. Even for clinical evals I like to spend 2hrs.
 

Bartelby

10+ Year Member
Mar 15, 2007
1,317
624
Status
Attending Physician
One hour intakes, 30 minutes for followups has become pretty standard for employed positions. You should be able to find a job that allows for at least that much time pretty much anywhere. In the right private practice setting, you can take as long as you believe is necessary.
 

st2205

Attending
10+ Year Member
Oct 29, 2006
1,835
1,115
Status
Attending Physician
This is rich. I'd assume your attending(s) is (are) generating jack **** in billing on their own and depend heavily on you and your 14 patients per day to reach their quotas and fill out their paycheck, while perhaps seeing a small portion of patients on the side (nowhere close to 20), and bitch to you about not being able to survive in the "real world" that they've probably never stepped foot in.

You don't have to see 20 patients a day unless you have a strong desire to do CMH. 12-14 is fine. And it gets easier when you're not always checking out to someone who spends time lecturing about nonsense like how you're not going to make it in the real world.
 

Shikima

10+ Year Member
Oct 15, 2006
4,529
2,650
Status
Attending Physician
This is rich. I'd assume your attending(s) is (are) generating jack **** in billing on their own and depend heavily on you and your 14 patients per day to reach their quotas and fill out their paycheck, while perhaps seeing a small portion of patients on the side (nowhere close to 20), and bitch to you about not being able to survive in the "real world" that they've probably never stepped foot in.

You don't have to see 20 patients a day unless you have a strong desire to do CMH. 12-14 is fine. And it gets easier when you're not always checking out to someone who spends time lecturing about nonsense like how you're not going to make it in the real world.
This is correct for employed positions. Aside from cash only PP, the other side of the coin would be for most ins based PP wanting to see as many as they can. Coding also matters.
 
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