Sounds like clock work with minimal patient-physician interaction. How much time do you guys actually spend with each patients? As a patient or refferring physician, this may/would raise a red flag.
Those referring must be happy with me because my numbers just keep going up. When I first started I did my own preops, postops, and fracture care followups however much of that is wasted time. I go over everything with patients so that they fully understand but cast techs do casts and braces better than I do. The PA's can do H&P's, write orders, refill Rx just as well as I can. Every new patient sees me, not the PA. They see the less complicated fracture care followups, not all of them. Referring docs care about 2 things: seeing their patients ASAP and making them better (especially when they or others have not been able to do so). We all need these PA's and others helping us be more efficient so we can see more patients, not to make more money but because the demand keeps increasing. Patients are willing to accept a long waiting list for surgery but not to be initially seen.
This is important info. As a student or resident, you are used to changing dressings, casting, splinting, crutch training, taking H&Ps, etc for each patient. Sometimes you even position and develop your own x-rays, put on VACs, etc.
It's important that you learn how to do those things since you might do them occasionally as an attending, but the main reason for doing them is so that you can eventually train your assistants on those tasks. When you enter practice, you need to realize which services take actually doctor's skill, which services a midlevel provider can do, which a RN can do, and which a med asst can do. You have to realize that each member of the clinic/rounding team has a different educational level, different skill set, and different patient care capabilities/limitations.
When it comes down to it, the medical world is based on rank, not unlike a military system. Attending docs write down or verbally give other team members "orders" for a reason (they're not called "suggestions," now are they?), and there is a hierarchy of the team members due to different levels of training. One of our program's alumni, who works in a group which does a high volume of surgery, likes to jokingly call the lower level skills and patient cares "NOB that nurses and PAs take care of" (NOB = non-operative bulls***). He's sorta kidding around, but sorta serious at the same time. In order to run an efficient business, you have to realize which cares demand which level of skill and therefore what each member's typical job duties are... ie for pod:
-Attending docs: surgery (incl sharp wound debridements), most initial evals of pts (formulation of diagnosis and care plan), ordering and eval of medical imaging or other tests, prescribing most Rx, major bedside or office procedures (ie fracture reduction, office surgery), etc (and any thing below)
-Residents, PAs, or NPs: assisting in surgery, H&Ps, initial prelim diagnosis and plan (to be discussed with attending for definitive plan), most follow-up visits or post-op rounding notes and orders, casting/splinting, prescribing some basic Rx or refill Rx, some simple and non-consented office or bedside procedures (lac repair, injects, or derm lesions), etc (and anything below)
-RNs: IV access and prepping/giving meds, bandage changes, wound VACs and some wound cares if certified, initial medical history taking, blood draws, assisting with complex patient hygene/grooming (and anything below)
-Med/Nurse/Pod Assistants or Techs: taking vitals, taking XRs, crutch training, restocking clinic supplies, cleaning instruments, assisting with patient positioning or basic hygene/grooming, bandage breakdown or basic bandaging, assisting above providers in any higher level clinic cares, etc
You can imagine how an attending doc who did all of his own dressing changes, casting, vital sign taking, etc is just not being efficient at all. Sure, if you're brand new to practice, you only have 10pts per day, and you don't want to pay for assistants you don't need, then you were trained on how to do those things yourself. Still, it's not a great habit to get into since patients may begin to "expect" the doc himself to do those things in the future. Once the docs are busy enough that they would have to see fewer patients per day to do the lower level cares, then there's absolutely no reason they should be doing that stuff. It's simply inefficient for a doc who can bring the office ~$200+/hr to be doing things a ~$35/hr PA or a ~$25/hr nurse could do... much less doing tasks that a $10/hr med asst has been trained to do.
In an efficient office's first patient visit, the med asst would take vitals, the nurse or PA would do the history, doc would see the pt and come up with a plan, med asst may take XR, doc would read XR, and then the PA would cast or inject the pt... or maybe the med asst or nurse would bandage the patient. For a follow up visit after a surgery the doc did, it might be the med asst taking the bandage down, PA evaluating the incision, RN removing stitches, and med asst re-bandaging. If the doc did it all himself every step of the way, he's just wasting his time (and the practice is hemorrhaging money).
It's not "dumping" the tasks on anyone, it's just a matter of efficiency. Would you see an army captain or general cleaning the rifles, training new recruits, pitching the tents for the camp, or cooking in the mess hall? Doubtful... the higher ups know how to do those things, but the army is efficient. The higher ranked members are probably busy making the battle plans and interpreting intel while the privates, maybe corporals, do the more basic things that the unit requires to run efficiently.
