Patients per hour and notes

IPSIS: Formerly the Spine Intervention Society
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
K

Kkapa

Full Member
5+ Year Member
Joined
Mar 5, 2017
Messages
13
Reaction score
1
Members don't see this ad.
How many patients do you typically see per hour. I find most pain patients are complex and the appts take quite some time. I am able to see 3 to 4 per hour and stay on time however, I am unable to do my notes throughout the day which leaves a large amount of work at the end of the day.
 
I have been doing a lot better lately. I was bringing home two hours plus work and working through lunch. I am still working through lunch but mostly that is dealing with patient issues, not doing notes. I realized I was writing notes and then transcribing them later. Now I type during their visits. Has made a huge difference on the follow ups. I can’t do that really on the new ones. But I can type while looking at them and listening as they talk.
 
Dictate. If 10 min late for scheduled appt, rescheduled. I walk at lunch 2.3 mi for sanity. Not missing it unless new fx, new cancer, or my complication. Minimal computer interaction to save time. Nurses have imaging up and ready, last note up and ready. Paperwork in my hand before i walk in door.
 
I see between 18-25 per day depending on no shows. 30 min. new appts, 15 min f/u

I do a lot of dot phrases and auto-populated notes. I pretty much type my note before I see patient. Then add exam and quick A/P immediately after.

When I am examining and talking with patient I am not on computer but always seated directly in front of them so I can listen and look them in the eye. The old people esp like this- even if you only listen to them for 4 minutes it feels like 40 to them when they have your full attention and you're not typing as you go.

But to each their own, this is what works for me. I don't take work home but often look up next day's patients in the evening so I have a game plan. I work through lunch
 
I also walk over lunch when it's nice out. Typically review incoming consults over lunch and just do 20 minutes or so of tasks before going home. I dictate into epic with mmodal. I need to train my staff better like Steve's though.


Sent from my iPhone using SDN mobile
 
Do you like mmodal better than Dragon?
 
They're actually very similar although I do think mmodal gets more words correct. Dragon did better with names.


Sent from my iPhone using SDN mobile
 
I try to cap at 25 a day but often exceed due to add ons etc. 8-10 of these are procedures however. Usually I use the time in between procedures to catch up on previous days follow up notes if I am behind. Never take work home.
 
Ronin1 said:
try to cap at 25 a day but often exceed due to add ons etc. 8-10 of these are procedures however. Usually I use the time in between procedures to catch up on previous days follow up notes if I am behind. Never take work home.
Click to expand...

thats impressive! 25 per day is a really good number to hit, just u or do u have an NP?
 
The beginning of my week is lighter. I saw 13 today..10 yesterday morning then went to the asc to do procedures. I tend to get hit hard on Thursdays and Fridays. This Thursday seeing 38 and Friday seeing 21 just in the afternoon, 7 procedures am. No midlevels. Needlesss to say I end up catching up on notes into the following week..
 
i see about 21 patients per day, if everyone shows up. typically, there are 3-4 no shows.

i cant see much more because it typically takes 3-4 minutes to get Spanish/Nepali/Arabic/Canadian interpreter on, and using an interpreter really slows things down.
 
usually around 30/day. 12 or so injections, 18 or so clinic patients. (maybe 6-7 new patients in clinic and a couple for injections).

most ive seen is 40 in a day.

the ortho guys regularly see 50-60.

if you focus JUST on the spine, the way an ortho doc may see just the knees or just the hands, you can really increase the volume.

if you see your typical pain patients with a million complaints and psychosocial issues, it will halve your efficiency. sad to say, but true. what does drusso say? it is high-burnout, work that is not fairly compensated?

i use dragon, but i dont really like it. i think it slows me down vs. standard transcription

the key is to not let the patients talk all that much. when they start chit chatting about their neighbor's dog or their mother-in-law, it is time to pull the plug.

im not sure how much MORE i get paid by seeing a high volume, but the way i feel is that if i am physically present in the building, i might as well be busy. the day goes faster, and i feel like i accomplish something. when i am bored, all i do is poke around on SDN, which isnt good for anybody....
 
SSdoc33 said:
usually around 30/day. 12 or so injections, 18 or so clinic patients. (maybe 6-7 new patients in clinic and a couple for injections).

most ive seen is 40 in a day.

the ortho guys regularly see 50-60.

if you focus JUST on the spine, the way an ortho doc may see just the knees or just the hands, you can really increase the volume.

if you see your typical pain patients with a million complaints and psychosocial issues, it will halve your efficiency. sad to say, but true. what does drusso say? it is high-burnout, work that is not fairly compensated?

i use dragon, but i dont really like it. i think it slows me down vs. standard transcription

the key is to not let the patients talk all that much. when they start chit chatting about their neighbor's dog or their mother-in-law, it is time to pull the plug.

im not sure how much MORE i get paid by seeing a high volume, but the way i feel is that if i am physically present in the building, i might as well be busy. the day goes faster, and i feel like i accomplish something. when i am bored, all i do is poke around on SDN, which isnt good for anybody....
Click to expand...

You do in office injections? Also what do u do about the patient with fibro that has a million records to review?
 
painfree23 said:
You do in office injections? Also what do u do about the patient with fibro that has a million records to review?
Click to expand...

no, i dont do in-office injections.

i try not to see the fibro patients, and if i do, i try to focus on their spine and see if i can help. but yeah, they take more time and hand-holding. if your schedule is filled with these patients, you've got a problem.
 
For those who are able to finish your notes so quickly. Do you guys prescribe opioids? Now that there is more scrutiny on this I find my time for doing notes has substantially increased
 
yup, templated information for a lot of the discussion as well as PDMP review, opioid agreement, urine tests, and risks associated with opioid medications.
 
Just wondering if you guys use medical scribes to improve efficiency. It seems like they would be cost effective if they allowed you to see even 1-2 more patients a day.
 
I also do 30 min, new and 15 min for follow ups on clinic days. I usually will try to cap it out at 23 or so per day (maybe, max 25ish, if it's a week before or after a vacation, playing catch-up). I could do more, but more than that just feels like a grind. I do my charts as I go and never leave any open when I leave for the day. In fact, I rarely move to the next patient before finishing my chart.

Procedure days have a totally different set up.

I don't use a scribe but I know some who do, docs who are not efficient at charting, and it seems to work for them. Personally, I like to document myself, since a medical chart is a legal document, and if I had a scribe, I'd probably spend too much time double checking their work, to justify having a scribe.
 
20 min new, 10 min follow up.

I have an hour lunch and I see around...28 or so per day. I could do more but I start at 8AM and don't feel like starting earlier.

Complex pain pts with a million problems don't fly in my clinic. I can't help those ppl so either I don't see them, or if they sneak into my clinic I'm taking over that pt interaction so they can't sabotage my clinic.
 
I saw 23 this pm by myself. No midlevel. It’s tough. I’m def getting burnt out. I practice in a high cost of living state (NJ) where pain docs have notoriously reaped the benefits of being out of network and seeing 10 patients a day making 3-4x what I make for the same or quite honestly very substandard work. That is apparently coming to an end soon. Those who oppose it threaten “mass exodus” of providers from the state which I think is rather humorous..as if it’s so easy to just pick up and leave from somewhere that you have roots in. Needless to say I would love to see these out of network docs have to try to change their entire practice style just to survive here. If I had any advice for new and upcoming docs..it would be to stay far away from the northeast unless you have some passion for academic medicine....
 
I had 28 scheduled this morning. It will be down to 23 if my remaining three patients all show. Usually around 19 pts if seeing my max of 6 NIV, closer to 23-26 if more FUV. 40 minute new, 20 minute follow up. I use those times because our scheduling software only work in 10 minute blocks and 10 minutes seemed too short, although what I usually end up doing is double booking the 20 minute follow ups. That also helps with the inevitable no-shows. See pts M, T, Th in office, W, F all day procedures. Two rooms on Fridays.

Do my notes immediately after seeing pt - I'm also in the camp of "refuse to take work home". One hour lunch and often walk over to the hospital during that time for free meal and networking at the doctor's lounge.
 
drrosenrosen said:
I had 28 scheduled this morning. It will be down to 23 if my remaining three patients all show. Usually around 19 pts if seeing my max of 6 NIV, closer to 23-26 if more FUV. 40 minute new, 20 minute follow up. I use those times because our scheduling software only work in 10 minute blocks and 10 minutes seemed too short, although what I usually end up doing is double booking the 20 minute follow ups. That also helps with the inevitable no-shows. See pts M, T, Th in office, W, F all day procedures. Two rooms on Fridays.

Do my notes immediately after seeing pt - I'm also in the camp of "refuse to take work home". One hour lunch and often walk over to the hospital during that time for free meal and networking at the doctor's lounge.
Click to expand...

How many of these follow ups are refills?
 
painfree23 said:
How many of these follow ups are refills?
Click to expand...
Very few. I have almost no chronic opioid patients. My former partner had about 70. Most of those are now being seen by NP who has the express goal of making sure all patients are at or below CDC guidelines, or else tapered off. I review every one of her notes, and she doesn't see patients when I'm not in the office.
 
drrosenrosen said:
Very few. I have almost no chronic opioid patients. My former partner had about 70. Most of those are now being seen by NP who has the express goal of making sure all patients are at or below CDC guidelines, or else tapered off. I review every one of her notes, and she doesn't see patients when I'm not in the office.
Click to expand...
Wow that's awesome. You must have an excellent referral base. Congrats.
 
You must log in or register to reply here.

Similar threads

LineEmTubeEm
New patients and follow-ups
Replies
4
Views
855
callmeanesthesia
C
C
Perc SCS in patients with FBSS?
2
Replies
53
Views
4K
Orin
O
D
wRvu per year
2
Replies
94
Views
7K
BobBarker
BobBarker
lobelsteve
Running the patients
Replies
35
Views
2K
hyperalgesia
hyperalgesia
bedrock
Company takes money from docs AND patients
Replies
1
Views
664
TheLoneWolf
TheLoneWolf
Top