Not Enough Patients...

[hebel]

I'm in a bit of a weird situation. I've been working full-time W2 for a FQHC for the past year, and my patient volume remains shockingly low. Most days I'm seeing 6 or less follow-ups, with about 2 new patients per week on average.

I tend to retain the patients I see, with a low no-show rate. I'm one of 2 psychiatrists at this clinic. I actually wanted to work part-time for them initially, but they insisted I agree to full-time.

In some ways this is quite the (chill) gig, but I'm worried that the low volume might lead to me being fired. Has anyone heard of a situation similar to this before?

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[comp1]

Fired? This is a pretty impressive humble brag all around. "My patients just get well so fast that I can't keep my schedule full!" There's probably some sort of mismanagement in terms of scheduling or outreach that will be rectified eventually. But no...physicians do not get fired for this from FQHCs. I'm not sure what the problem is exactly, but if you really want to know what is going on, talk to the clinic manager. I'm guessing, however, you probably don't really want to bring attention to this.

 

[hebel]

Fired? This is a pretty impressive humble brag all around.

Oh gosh, I didn't want want it to come across that way! I'm anxious about this situation, not happy lol. I mentioned the stability part because a patient going from every 3-6 weeks at the beginning of treatment to every 3-6 months numerically affects how "full" my follow-up schedule is (e.g. 3 visits v 1 visit in a 3 month period). I also mentioned retention to clarify that it wasn't a patient retention problem.

I do not at all think this is from me getting people "better" so fast. These intake numbers just seem crazy low to me. After reading it back, I'm actually going to just delete that sentence though 😆.

 

[Sushirolls]

Say nothing. Do nothing.
Keep on truckin'

Covid, people were fired.
Places replacing psychiatrists for ARNPs, get fired. Keeping a token Med Dir MD/DO around.
Bad Big Box shops that have too much Admin and only look at spread sheet, fire whole psych departments.

 

[the5thelement]

I'm in a bit of a weird situation. I've been working full-time W2 for a FQHC for the past year, and my patient volume remains shockingly low. Most days I'm seeing 6 or less follow-ups, with about 2 new patients per week on average.

I tend to retain the patients I see, with a low no-show rate. I'm one of 2 psychiatrists at this clinic. I actually wanted to work part-time for them initially, but they insisted I agree to full-time.

In some ways this is quite the (chill) gig, but I'm worried that the low volume might lead to me being fired. Has anyone heard of a situation similar to this befor

What about the other psychiatrist , whats their caseload like?

 

[hebel]

What about the other psychiatrist , whats their caseload like?

Case load is probably about 85% full. He's been here about 2 years and inherited a large portion of his panel from a previous psychiatrist, which helped a lot with their initial case load growth.

 

[Celexa]

Case load is probably about 85% full. He's been here about 2 years and inherited a large portion of his panel from a previous psychiatrist, which helped a lot with their initial case load growth.

I agree with everyone above who says this isn't your problem if you don't want it to be. It's not your job to generate referrals.

But these are the things I wonder from what you describe. There are two reasons (not mutually exclusive) why referrals (or inpatient consults) are low, other than administrative incompetence (ie, referrals going down a black hole and the patient not ever being scheduled).

1. The referring docs don't know what to refer to you or don't know how to refer.

2. The results of the referrals were persistently unhelpful and/troubling (the previous psych was a candy man or a *****, etc) and so they stop referring except when they have absolutely no choice.

If the reason is 2) the referrals will pick up via natural feedback as the pcps notice the referrals are resulting in positive change.

If 1), you can learn a great deal by chatting up your pcp colleagues and/or spending a few hours in clinic with them. Many (most? The vast majority?) of other types of doctors have a very limited understanding of the full spectrum of what a well trained psychiatrist can offer, due to a combination of getting a VERY skewed perspective on the field in medical school on inpatient units and also the generally poor average level of care in general.

 

[J ROD]

I am more surprised the other psychiatrist is not bitching and making you take some patients.

 

[bashir]

Keep doing what you're doing. Enjoy the slow period while it lasts. Like celexa said,f you want, use some of the extra time to get to know your colleagues which will increase referrals and probably improve your job satisfaction there. Or if you're thinking that the place is so mismanaged you don't want to get too attached, then use the time to do whatever you want that will prepare you well for the next gig.

 

[clozareal]

This sounds like my goal before I decided PP. To work at a FQHC or medi-cal clinic where the volume is low, collect good salary, and get PSLF. Some of my colleagues are working seeing 5 patients per week and getting paid $300k per year.

There's not enough hours in the day for all I want to do. I'd love to have a job like yours.

I do know of one person whose contract wasn't renewed because they were telehealth during the pandemic and saw maybe 4 patients per day at the most at a FQHC. Came in maybe once every other month for half a day. Never came to any staff meetings.

I also know psychiatrists who were doing great work, busting their assess off, and then fired to be replaced by NPs.

 

[comp1]

Just so new graduates don't get the wrong idea...county clinics are generally MACHINES. What people above are describing is not normal. They are much more likely to be burn out factories than cushy. Trust that we are not overfunding our safety net programs in the US.

 

[Celexa]

Just so new graduates don't get the wrong idea...county clinics are generally MACHINES. What people above are describing is not normal. They are much more likely to be burn out factories than cushy. Trust that we are not overfunding our safety net programs in the US.

Yeah I have a friend at a FQHC and she filled almost immediately. That's why I wondered above if there is something specific to this places history that is making the pcps not refer very often.

 

[annoyedpsychiatrist]

I'm in a bit of a weird situation. I've been working full-time W2 for a FQHC for the past year, and my patient volume remains shockingly low. Most days I'm seeing 6 or less follow-ups, with about 2 new patients per week on average.

I tend to retain the patients I see, with a low no-show rate. I'm one of 2 psychiatrists at this clinic. I actually wanted to work part-time for them initially, but they insisted I agree to full-time.

In some ways this is quite the (chill) gig, but I'm worried that the low volume might lead to me being fired. Has anyone heard of a situation similar to this before?

When I started my job here i was constantly in fear that my volume wasnt enough and that i would get fired as a result. Private clinics focus on RVU and volume while other community or hospital systems dont necessarily see psychiatrists as money makers and they make their money through other means such as grants, donations, etc. The psychiatry part is just a necessary service is all.

you cant control the volume, as youre not scheduling the patients. if they fire you and hire someone else then they will just have the same problem with the next provider. If theyre insisting you work full time then it seems unlikely they want to fire you, and I would wager they expected this to be the outcome and arent entirely shocked by your volume.

 

[clozareal]

Just so new graduates don't get the wrong idea...county clinics are generally MACHINES. What people above are describing is not normal. They are much more likely to be burn out factories than cushy. Trust that we are not overfunding our safety net programs in the US.

Yes this is more typical. Seeing 4-6 patients per hour, sometimes double booked, in medi-cal clinics seems to be more the norm.

 

[hippopotamusoath]

Personally, I get nervous when my schedule is too light. I think I'm a terrible psychiatrist and no one wants to see me. BUT, I also get nervous when my schedule is too full. I feel over-worked and exploited, and I get irritable that my patients are so helpless that they need to come back so often.

There's a small window where I have the exact right amount of patients, but it's like flying a small aircraft through a slot canyon--a little to the right or left, and it's a disaster again.

I think what I'm saying is, lots of us are a little neurotic about this kind of stuff. Just relax, do good work, and enjoy what is probably a short period of your professional life when you're able to have a little breathing room.