Intern Outpatient Clinic question

[playingfrombehind]

More specifically I was just wondering the rate at which you see patients during your office sessions. For example are patients booked every 45 minutes for interns, every hour etc

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[JonMonkey]

I believe that this will be clinic dependent but my former program had interns seeing 4 patients per half day so roughly 1 per hour with the goal to get them up to 6ish by the end of the year. By the end of residency my program expected 3rd years to be seeing 12+ per half day.

 

[FrustratedFamDoc]

Our clinic, and I am assuming a large number of family practice clinic did have a large number of cancellations and no shows. From what I recall, I was typically booked around 6 patients per half day and saw maybe 3-4 of those. Initially, things mooved pretty slowly while getting familiar with patients, the EMR, preceptors and office staff. As things got more comfortable, the process moved much more efficiently. Typically, patients seen at the residency are more complex medically and socially than those seen in private practice.

 

[JustPlainBill]

Our clinic, and I am assuming a large number of family practice clinic did have a large number of cancellations and no shows. From what I recall, I was typically booked around 6 patients per half day and saw maybe 3-4 of those. Initially, things mooved pretty slowly while getting familiar with patients, the EMR, preceptors and office staff. As things got more comfortable, the process moved much more efficiently. Typically, patients seen at the residency are more complex medically and socially than those seen in private practice.

I wouldn't bet on that being the case -- I used to think that also but it really depends on where you practice and what your payor mix is --- we'd all like to have the 30 somethings with no issues that make life just a piece of cake -- but the reality is most of those people don't go to doctors so we wind up with the 40+'s who are starting to get hit with the diseases of aging --- and some just don't care about themselves and that goes across all socioeconomic groups --- I've seen more than one patient in private practice that were just as if not more complex than my county hospital residency patients but the strikes were against them as we do not have the resources of a teaching hospital available and they have to pay for everything -- case in point -- I was able to get compassionate bariatric surgery for a residency patient (didn't matter, they wound up returning to their old ways and were in the process of gaining it back when I left) -- in private practice, I've got several patients who need the surgery but can't afford the deductible/copay --

And yes, my goal is 30/day....

Intern year started with 4-6/4hours and by graduation we were expected to hit 12-16/4 hours.

 

[cabinbuilder]

In our residency clinic it was busy. As an Intern I saw 2-3 patients and hour. By 3rd year I saw 15-20 in a half day.

 

[SLC]

I started at 3 per half day, quickly (within 1-2 months) moved to 4, was at 6 by mid-year and ended the year at 6.

Now in second year I'm already at 10 some days depending on how many new patients/physicals I get (they get 30mins everyone else gets 15).

I think by end of 3rd year the goal is 12-15 per half day.

 

[FrustratedFamDoc]

I wouldn't bet on that being the case -- I used to think that also but it really depends on where you practice and what your payor mix is --- we'd all like to have the 30 somethings with no issues that make life just a piece of cake -- but the reality is most of those people don't go to doctors so we wind up with the 40+'s who are starting to get hit with the diseases of aging --- and some just don't care about themselves and that goes across all socioeconomic groups --- I've seen more than one patient in private practice that were just as if not more complex than my county hospital residency patients but the strikes were against them as we do not have the resources of a teaching hospital available and they have to pay for everything -- case in point -- I was able to get compassionate bariatric surgery for a residency patient (didn't matter, they wound up returning to their old ways and were in the process of gaining it back when I left) -- in private practice, I've got several patients who need the surgery but can't afford the deductible/copay --

And yes, my goal is 30/day....

Intern year started with 4-6/4hours and by graduation we were expected to hit 12-16/4 hours.

Oh, I definitely have some patients now that are far more complex than my residency patients, but it's not a full day of acute exacerbations of crappy life syndrome like residency was. Looking back, I'm glad I had it that way. You don't learn to manage the difficult/complex patients by seeing easy all day long. I'm fortunate to have an office contiguous to the hospital so I get a lot of hospital employees coming to see me.

The new patients that I know that I'm not going to have a good time with are the new patient (male) hospital follow up in their 50s/60s with no previous medical history. It's typically CVA/MI/horribly controlled DMII/smoker who really has no interest in changing their routine that wound them up in that situation in the first place. And they damn sure don't want to hear it from a 38 y/o sawbones like me.

 

[phialpharaider]

Hello,
I have a question concerning the ability of doctors to conduct a physical exam for the Dept. of Transportation. I've heard you have to take the DOT's course, pay a licensing fee, and take an exam every 5y in order to remain 'qualified' to conduct these exams. Is this true? For someone from a rural area, how is this okay or is there another side to it I'm not aware of? It seems ludicrous to me that doctors are expected to pay a fee and take an exam to be 'qualified' to conduct a basic physical exam on truck drivers and holders of a CDL license. Any thoughts/comments? Is there something I'm missing here?

 

[deleted87716]

https://www.fmcsa.dot.gov/medical/d...am-and-commercial-motor-vehicle-certification

That being said, I don't do 'em. The documentation requirements are too onerous, the exams are too time-consuming, and there's just too much liability. If chiropractors want to take the risk, then God bless 'em. 'Cause the jury certainly won't.

 

[DrMeowMeow]

I started out with 1 per hour so like 3 per half day. After 6 months I'm at one per half hour, but they'll adjust you to every half hour earlier if you're keeping up

 

[JustPlainBill]

And just to complete the circle, actually saw one of my former residency patients with a laundry list of problems and nonadherence issues they brought with them from residency. They've recently acquired medicare and were seeing someone else in the group but couldn't get in and landed on my schedule. They thought I had forgotten about them until I began reciting the problem list, adherence issues and seeking behaviors... it got real quiet, real fast in that exam room....

 

[FrustratedFamDoc]

And just to complete the circle, actually saw one of my former residency patients with a laundry list of problems and nonadherence issues they brought with them from residency. They've recently acquired medicare and were seeing someone else in the group but couldn't get in and landed on my schedule. They thought I had forgotten about them until I began reciting the problem list, adherence issues and seeking behaviors... it got real quiet, real fast in that exam room....

I'm in the same town that I did my residency in so I've had several find me after I graduated. Some have been quite pleasant as they were good patients. Some haven't. Matter of fact, just got done seeing one who was brave enough to establish with me in July of 2009 when I was fresh out of med school.

When my not so good ones realize that I'm not here to placate their generally poor health and enable their schedule medication problem, they usually find someone else.