Patient Volume

[thefootfixer]

In terms of volume, is there any logical reason why a practitioner would want to see 50-60 patients per day?? I understand revenue etc but with that high of a number, they’re likely mostly nail patients, what’s the reasoning behind that???

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[deleted1138023]

who can see 50 nail patients a day?

 

[air bud]

who can see 50 nail patients a day?

Depends on how many students are at the VA that month

 

[thefootfixer]

Private practice guys….

 

[thefootfixer]

And gals

 

[PlainsPod]

That’s ridiculous. I am in private practice. 24 is my magic number. I have almost entirely phased out nail care.

 

[thefootfixer]

That’s ridiculous. I am in private practice. 24 is my magic number. I have almost entirely phased out nail care.

How it should be!

What would you say to docs who believe RFC is truly the foundation of ANY PP? Just having people come in q 2 months, churn em and burn em style??

 

[thefootfixer]

That’s ridiculous. I am in private practice. 24 is my magic number. I have almost entirely phased out nail care.

And how did u exactly phase it out while maintaining revenue for overhead salaries etc

 

[NatCh]

50-60 per day? No thanks.

I’ve phased out nail care too. Eventually your schedule fills up enough with other chief complaints. I’d rather see one new patient with an ingrown toenail than ten patients with tinea ungium [edit: who are there for only Q8 toenail debridement].

 

[NatCh]

What would you say to docs who believe RFC is truly the foundation of ANY PP? Just having people come in q 2 months, churn em and burn em style??

“Can I have a stack of your business cards?”

 

[Shiyuan]

Had a doc in residency see 80 pts on his once-a-week “nail care” day. Insane.

 

[NatCh]

Had a doc in residency see 80 pts on his once-a-week “nail care” day. Insane.

How in the royal F...

 

[GreenHousePub]

Max for me is usually 40. An average day I typically see 35.

 

[Shiyuan]

That’s ridiculous. I am in private practice. 24 is my magic number. I have almost entirely phased out nail care.

Samesies. 20-24 is good. Enough time to care for the patient and be comprehensive.

 

[Pronation]

Max for me is usually 40. An average day I typically see 35.

This is my flow but I recognize this would be brutal without the support staff which includes an MA, a FT nurse, shared cast tech, and a shared scribe for 1.5 clinic days.

 

[PlainsPod]

And how did u exactly phase it out while maintaining revenue for overhead salaries etc

By having enough demand for virtually every other pathology we treat

 

[wakaflocka88]

My max is 27. My MA is very efficient and usually has the room set up before hand if there’s an ingrown nail consult or post op sutures etc etc. Treat the staff well and your clinic will be more efficient.

 

[Pronation]

Treat the staff well and your clinic will be more efficient.

Can’t stress this enough. Small talk, lots of gift cards, results in big ROI

 

[619]

My typical day is 15-20. Holiday week it can go up to 24. My sweet spot is 20. I could easily fill up my clinic to 40+ but half of them will be nails. Most of my nails I don't schedule. I just tell them to call back in 3 months. Most call back 4-5 months later. I like to keep my schedule open for same day/same week acute pathologies. I love my school teachers, fire fighters, police officers, ware house workers, office workers, all blue workers etc. These folks have busy lives and when they call around for a doctor, they want to get in same week or following week max.

My practice is next to a level 2 trauma hospital so naturally there are other pods around which I don't mind. 2-3 big super groups have offices less than 0.5 mile radius from me and a few other solo docs are about a mile away. I am the newest in town but there is work for everyone. The county is currently in the top 3 fastest growing in the whole state. Other folks are booked out for weeks/month so I capture the patients calling around trying to get in same week.

I always said increased patient volume does not mean more revenue or collections. I will let the other pods keep the nails and I want to focus on acute MSK pathologies, heel pain, ingrown, warts, etc. I will be pissed if my schedule next week or 2 already has 30 nail patients scheduled. Right now I have about 10 follow-ups/new each day for next week but when next week rolls around it will already grow to 15-20. Half of my volume a day are new patients. You just have to walk in faith.

 

[NatCh]

I like to keep my schedule open for same day/same week acute pathologies.

This is key. I make room for add-ons every day. If someone has an ingrown toenail they don't want to be told that the next available appointment is in six weeks.

 

[PeaJay]

15-20 is my sweet spot. I have recently switched fully away from nail and callus care. I could probably do more, but the quality of my notes would suffer. About 75% of my patients read/review my note within 24 hours, so I don’t want them reading poorly composed notes.

 

[Feli]

It all depends on support and physical space.
I could see 50+ with enough well-trained MAs and rooms. I had plenty of residency attendings who averaged around that number.

As has been discussed, the trap is high staff + high volume ... versus low overhead/staff + low volume. High volume then falls apart if staff level/training does or if you lose your scribe(s). You are obviously doing very little aside from invasive procedures and major diagnostics in high volume (MAs cast, disp DME, cut nails, do all setups for procedures, etc etc). It is certainly not impossible, though... many docs - DPM or others - do it every day.

... I settle for more around 30-40 with some room for ER or new pts that have a time-sensitive issue. I just don't have consistent success with decent notes - esp for surgery and ER new pts - if I go higher; my views might change after done with ABFAS. The pt volume is always in flux with my staff quality/volume. The demand is there... and you can always yo-yo your daily volume a bit by making f/u a bit longer or shorter out.

 

[NatCh]

About 75% of my patients read/review my note within 24 hours, so I don’t want them reading poorly composed notes.

I think this is important too. There's the art of the progress note in which you accurately cover the medical facts without potentially offending either the patient or the referring doctor. If a PCP sends you a patient and they've already tried treating the patient then they probably won't feel good if your note makes it sound like they failed because they did something wrong, or because they didn't do something right. You have to have some tact. I've read plenty of notes from other providers that made me face palm.

"54 year-old non-compliant, sedentary, male fat bastard has heel pain..." No bueno.

"Despite the appropriate and timely treatment from Dr. So-and-so, the patient continues to have pain..." Mas bueno.

 

[air bud]

I think this is important too. There's the art of the progress note in which you accurately cover the medical facts without potentially offending either the patient or the referring doctor. If a PCP sends you a patient and they've already tried treating the patient then they probably won't feel good if your note makes it sound like they failed because they did something wrong, or because they didn't do something right. You have to have some tact. I've read plenty of notes from other providers that made me face palm.

"54 year-old non-compliant, sedentary, male fat bastard has heel pain..." No bueno.

"Despite the appropriate and timely treatment from Dr. So-and-so, the patient continues to have pain..." Mas bueno.

Will need to take this into consideration. Now using Epic for the first time and need to remember other people can see my notes and will also be higher likelihood of patients reading notes.

 

[AttackNME]

For private practice folks its nice to be able to see high volume in short amount of time, can do this if you have a streamlined practice with efficient MAs. The benefit is if you need to see 100 patients a week to hit your desired revenue goals, and you're able to squeeze that into 3 days (33 patients a day) then you can have 1 day for OR, 3 days for clinic, and 1 weekday off every week.

Another example is if you can see 60 a day for example all your quick postop and f/u visits, and put your 40 new and some f/u pts into 1.5 clinic days, thats 2.5 clinic days a week to see 100 patients, then you have time for 1.5 days of surgery and 1 day off. Or 2.5 clinic days a week and 2.5 weekdays off. It's not for everybody and not everybody can handle that. Those ass kickin days will keep you past 7pm just doing notes but some attendings can do that so they have the rest of the week off for routine family time or vacations

 

[PeaJay]

Will need to take this into consideration. Now using Epic for the first time and need to remember other people can see my notes and will also be higher likelihood of patients reading notes.

This is a huge consideration with efficiency. There is a large disconnect between providers that use EPIC with some patient connectivity platform versus PP docs.

You are held accountable for the notes not only by insurance/billing, but also the patients. This can limit patient volume as templated notes can be troublesome unless you are very regimented in your discussions with patients. When your patients can consistently review the records they will question templated phrases. For example if you have a standard plan for plantar fasciitis that says you explained xyz, you will be held accountable as patients will call you out.

 

[NatCh]

While I'm dicating my note I imagine that I'm the patient reading it at some point in the future. These days you can also expect that they might post it on their social media too. I usually say something complimentary within the note, both about the patient and about the referring provider's care if they've already tried managing the problem.

 

[PlainsPod]

While I'm dicating my note I imagine that I'm the patient reading it at some point in the future. These days you can also expect that they might post it on their social media too. I usually say something complimentary within the note, both about the patient and about the referring provider's care if they've already tried managing the problem.

I do the same unless their previous treatment was from The Good Feet Store….then I go scorched earth.

 

[heybrother]

While I'm dicating my note I imagine that I'm the patient reading it at some point in the future. These days you can also expect that they might post it on their social media too. I usually say something complimentary within the note, both about the patient and about the referring provider's care if they've already tried managing the problem.

The number one place I have to "modulate" notes is referrals from wound healing centers.

 

[NatCh]

The number one place I have to "modulate" notes is referrals from wound healing centers.

"After having TEN. Weeks. Of. HBOT. And grafts they're still not any better, SMH."

 

[wakaflocka88]

Oh lord, EPIC. love it and hate it. Patients love reading my notes and sending me messages if there’s an error. Doctor, you’d didn’t tell me about stretching exercises. Doctor I’m not overweight (despite chart documenting BMI of 40). It’s amazing how outside of medicine, humans refuse to accept the concept and fact of aging and bodily degeneration especially when it’s come to the MSK system. One time I kept writing “he” when the patient demanded I use “she” and I would get increasingly angrier messages each time I forgot to do that in my note.

 

[AttackNME]

Not a podiatrist but have been working under three for about 2 years now as sole MA. Wondering what your staff composition is like vs the patient load?

There is a particular surgeon i work with that primarily sees postops, very little nail care, about 30 patients/day. Just curious to learn more about other pod practices

If i'm single booked, that's 4 an hour, then 1 MA. If i'm double booked, ~6 an hour, then 2 MA

 

[ExperiencedDPM]

I often see 25 patients by lunch and another load like that after lunch. I despise the load, but apparently I’m a popular fellow. I often pray for a RFC so I don’t have to think for a few minutes.

I see very few if any RFC patients. It has to be a well oiled machine. And I have assistants who make my day smoother.

Here’s the formula:

1) Have trained staff booking appts who know how to book. So they can book a few post ops back to back and not back to back new patients. (One staff member was out and some scheduling was delegated to other staff and I went ape sh-t when they scheduled me 17 new patients in a row).

2). I meet with my staff prior to hours and look over the schedule. We know who is having a dressing change, an injection, an x-ray, etc. So we prepare ahead of time.

3). I bounce from room to room to room. Numb up room one, remove sutures in room 2, check my post op in room 3 and have the staff take an X-ray and go back to room one and do my small procedure and go to room 4 to check on an urgent patient and keep bouncing around.

You must have good staff and they must be able to keep up. I move in high gear and my office assistants threaten to quit if I ever drink coffee.

Ideally, I’d like 30 daily and soon I will slow down as I did a few years ago until I ramped back up.

Bought a new road bike and when it warms up it’s time to chill and wind down.

 

[msuDPM]

This is a huge consideration with efficiency. There is a large disconnect between providers that use EPIC with some patient connectivity platform versus PP docs.

You are held accountable for the notes not only by insurance/billing, but also the patients. This can limit patient volume as templated notes can be troublesome unless you are very regimented in your discussions with patients. When your patients can consistently review the records they will question templated phrases. For example if you have a standard plan for plantar fasciitis that says you explained xyz, you will be held accountable as patients will call you out.

I'm so repetitious in how I talk to patients/how I describe a condition that I annoy myself. At least partially due to this reason.

 

[DYK343]

After about 25 I feel like a robot and I feel that im not giving the care I should.
Some days I would walk in and see 35-40 on my schedule at my last job. Those days were awful.
I did very little routine care.

I had residency attendings regularly seeing 50+ a day. It can be done. But its not for me.

 

[Redsting]

Samesies. 20-24 is good. Enough time to care for the patient and be comprehensive.

The occasional day I have that many in a morning I go cross eyed.
Usually I am with you, 24 is right for me. I don't know how seeing 50 a day is good for anyone, besides financially.

After about 25 I feel like a robot and I feel that im not giving the care I should.

Yes. That exactly describes it. I feel like a robot and zone myself out when talking.

I do see RFC. Some of it is cause I haven't figured out how to say "no". Some of it is I like having a couple on my schedule to incase I am running behind I can catch up and not think. I have capped it per day so its not like I am having full days of RFC.

 

[NatCh]

I'm so repetitious in how I talk to patients/how I describe a condition that I annoy myself. At least partially due to this reason.

Have you guys ever noticed how some retail or service industry workers have a "retail voice" or "service voice" where you can tell that they're pretty much on autopilot? I've caught myself using "doctor voice" before and yeah, it's annoying. It's so robotic. Blehhh.

 

[HardRoadPaved]

Then again how can you really make certain conditions cool. Nail fungus is just nail fungus. Do your script and get out.

No I don't care how it all started in 1983 at the carnival.

 

[heybrother]

Then again how can you really make certain conditions cool. Nail fungus is just nail fungus. Do your script and get out.

No I don't care how it all started in 1983 at the carnival.

This.

That said - the ideal fungus encounter goes something closer to this.

Hi. Yes, your nail is probably fungal but the nurse says you'd like me to permanently remove the nail. Is that correct?

 

[Pronation]

This.

That said - the ideal fungus encounter goes something closer to this.

Hi. Yes, your nail is probably fungal but the nurse says you'd like me to permanently remove the nail. Is that correct?

With all due disrespect, if you had advanced training such as myself then you would instead offer them total toenail replacement surgery.

 

[heybrother]

With all due disrespect, if you had advanced training such as myself then you would instead offer them total toenail replacement surgery.

Sadly my residency was only RRA and not RRA/TTR. I've tried attending some weekend courses but cadavers only get you so far and the learning curve is steep.

 

[air bud]

Sadly my residency was only RRA and not RRA/TTR. I've tried attending some weekend courses but cadavers only get you so far and the learning curve is steep.

I agree. Cadaver Tars are just like the real thing and gave me the confidence to do complex multiplanar deformity correction. But cadaver TTRs just don't work the same. Have done maybe a 5 or so labs with the top TTR surgeons out there, many on the ABPM lecture circuit as we well as @Pronation (even more insightful and thoughtful in person). Thinking of taking a year off and doing a fellowship. They have a few taught by MDs in Europe. 2 in Albania and 1 Estonia.

 

[CutsWithFury]

I agree. Cadaver Tars are just like the real thing and gave me the confidence to do complex multiplanar deformity correction. But cadaver TTRs just don't work the same. Have done maybe a 5 or so labs with the top TTR surgeons out there, many on the ABPM lecture circuit as we well as @Pronation (even more insightful and thoughtful in person). Thinking of taking a year off and doing a fellowship. They have a few taught by MDs in Europe. 2 in Albania and 1 Estonia.

How will you identify after completing this rigorous training?


Fellowship trained foot, ankle, toenail reconstructive orthoplastic nerve surgeon?

………..
………
…..
….
..
.

Still a podiatrist

 

[ExperiencedDPM]

You mean NONE of you are certified Keralac technicians? How do expect to be successful. Jeez.

 

[pod squad]

Volume question for PP guys/gals out there: assuming a good payer mix (no Medicaid, relatively little Medicare) and minimal RFC, what kind of gross revenue would one anticipate generating seeing ~100 patients per week? Mostly sports med/ingrown nail/foot pain type patients, a few wounds. Not counting any surgical revenue for the sake of this hypothetical...

 

[NatCh]

Volume question for PP guys/gals out there: assuming a good payer mix (no Medicaid, relatively little Medicare) and minimal RFC, what kind of gross revenue would one anticipate generating seeing ~100 patients per week? Mostly sports med/ingrown nail/foot pain type patients, a few wounds. Not counting any surgical revenue for the sake of this hypothetical...

There are so many variables but I think an average of $150 collected per patient isn't unreasonable. Therefore, you can hope to make roughly $1 billion dollars per year (at least that's what I always hope for).

 

[air bud]

There are so many variables but I think an average of $150 collected per patient isn't unreasonable. Therefore, you can hope to make roughly $1 billion dollars per year (at least that's what I always hope for).

Okay now what about putting a graft on everything can you please revise your estimate

 

[NatCh]

Okay now what about putting a graft on everything can you please revise your estimate

$1B and a half!

 

[ExperiencedDPM]

There are so many variables but I think an average of $150 collected per patient isn't unreasonable. Therefore, you can hope to make roughly $1 billion dollars per year (at least that's what I always hope for).

Rumor has it you go through almost a billion dollars worth of tires on that mountain bike.