Moving the meat, efficient charting, good patient care

[ewokka]

Question answered. Thanks boardingdoc

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[BoardingDoc]

I apologize in advance as this is going to be a very disjointed question

My first job is on the horizon as I am PGY3 looking to sign early. Prospective job at a level 2 trauma center in the north east that is rather faced paced. The "fast" guys see ~3patient/hr in fast track area and 2 in higher acuity area and are rewarded accordingly as it is an RVU based system with base rate of $205 for those that can't average more than ~x5 RVU/hr (@$40/RVU). Director says most docs average 6RVU/hr ($240/hr) They do offer scribes for free.

I average ~2patients per hour currently as a PGY 3 at a level 1 ~110,000 visits/yr. This # includes pure peds ED shifts, "fast-track"/low acuity pod shifts, and high acuity shifts (admission rates close to 40%). No doubt the number is skewed especially given that we try to avoid picking up in the last hour of the shift to avoid hand offs. On my evaluations my patient per hour metrics is typically "above average." Will this translate to practice or do things change drastically once out? I just dont want to sign on at this busy shop and not be able to keep up and make good $.

I feel pretty confident that I can see more per hour but dont want to sacrifice patient care or note quality. Notes should be easier with a scribe. I moonlight and will read notes from older docs and notice sometimes there nearly nothing when it comes to MDM and ED course. Just a diagnosis and ordered medications etc... Is this acceptable for lower acuity patients that require minimal testing or when you have a low suspicion for badness? Is this what allows some docs to see patients faster? How does one provide good patient care, document adequately, and still move the meat? Good charting does improve reimbursment after all so there has to be a balance. Someone please weigh in. Once again sorry. I know this is a mess

You may want to edit your post. I've read it twice and I still don't know what your main question is. To take a stab at it though...

"On my evaluations my patient per hour metrics is typically "above average." Will this translate to practice or do things change drastically once out?"
In general, you will be faster as an attending as you don't need to staff patients anymore.

"Just a diagnosis and ordered medications etc... Is this acceptable for lower acuity patients that require minimal testing or when you have a low suspicion for badness? "
I don't know what you're asking here. Are you asking if you can write minimalistic charts? Sure, you just need to be sure you're billing appropriately and writing a defensible chart.

"How does one provide good patient care, document adequately, and still move the meat? "
Practice, practice, practice. If it were as simple as saying "the magic trick is X" there wouldn't be a million threads on this very topic every year.

As a random tip in your case, this post seems to indicate that you're not good at coming up with efficient strategies on the fly (train of thought post with no clear overarching question). I'd work a few attending shifts, and when you're at home, come up with a strategy for charting more efficiently. Come up with SPECIFIC STEPS to take. If you try to figure it out mid-shift, I suspect it will end poorly.

 

[ewokka]

I appreciate the response but wouldn't necessarily judge my abilities from a blog post. I 100% agree that my paragraph-word-vomit-question was pretty pathetic but I think that was simply a reflection of hopping on this site that has helped guide me to this point in my career with excitement as all my preparation has finally allowed me to see some light following a stellar interview.

I like your recommendation in your last paragraph and think that is a great strategy. Thanks

 

[Hamhock]

Your strategy at the start will seem silly in two years.

That doesn't mean you shouldn't have a strategy. It just means that you must let go at some point.

HH

 

[Old_Mil]

Prospective job at a level 2 trauma center in the north east that is rather faced paced. The "fast" guys see ~3patient/hr in fast track area and 2 in higher acuity area and are rewarded accordingly as it is an RVU based system with base rate of $205 for those that can't average more than ~x5 RVU/hr (@$40/RVU). Director says most docs average 6RVU/hr ($240/hr)

240 an hour to see 2-3pph in the tax and malpractice heavy northeast?

That doesn't sound like a particularly good deal.