Patients per Hour

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HoosierdaddyO

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How many patients are you all realistically seeing per hour. And what’s the context of you seeing them, ie with residents, or including ones you see with the PA. ESI 1-5 which percentage of those are high acuity. All the stats that talk about PPH are from the 1990s and Emergency medicine has changed incredibly. Tired of admin telling us we need to work harder and harder.

So what is the norm at your shop?

I’ll start I typical see 1.5 to 1.7 mostly ESI 2 and 3s in a community ER without any residents. Those numbers don’t include oversight of any PA.

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Community ER without a resident, APP, or scribes seeing 2.5-3 pph with a 30% admit rate seeing primarily ESI 2-3 with a few 4-5 sprinkled in. It’s a beating.
 
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Community ER without a resident, APP, or scribes seeing 2.5-3 pph with a 30% admit rate seeing primarily ESI 2-3 with a few 4-5 sprinkled in. It’s a beating.
Damn, you’re a beast. Do you mind sharing rough pay range? I’d imagine you’re doing quite well for yourself hustling that much. Also if you don’t mind, how long do you anticipate working in that kind of shop? As someone who jumped ship from EM really early, situations like yours really impress me.
 
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Damn, you’re a beast. Do you mind sharing rough pay range? I’d imagine you’re doing quite well for yourself hustling that much. Also if you don’t mind, how long do you anticipate working in that kind of shop? As someone who jumped ship from EM really early, situations like yours really impress me.
lol, not at all. I could make $100k more per year jumping ship to the USACS gig across town. I don’t want to get into our set up as it will be pretty obvious where I work for those that work in the region, but our contract is F’d which lead to a bunch of docs leaving to greener pastures which is part of the reason I’m seeing so many. I average around $240/hr only despite that volume. I’ve also cut down to 120hrs/mo.

Only reason I’m still with the job is because I can pick my schedule due to being in a leadership position and because switching jobs would compromise my well paying position with the medical school I work at, as well.
 
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3-4/hr with 1-2 midlevels
Admit rate depends on site 10-50%
If anyone has any of those job openings let me know
 
Community. 2.2-2.6PPH on average. 20% admission rate. 15% peds. Occasional rotating IM/PEDS/FM resident who's usually pretty worthless. (In their defense, they are interns and completely not interested in EM which is why I usually send them home early.)

The volume is higher than it used to be 10 years ago but acuity is much lower compared to our local tertiary care so it's pretty brainless work. I definitely don't feel as tired at the end of a shift compared to my old shifts with higher acuity.
 
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1.6-1.8 pph on average, much of this limited by the fact that patients never get in rooms and we practice a lot of WR medicine. Admit rate 20-30% range. No APPs or residents. Some days see 2-2.5pph if I mix in more low acuity stuff. Somehow it still feels miserable, can't imagine seeing 3pph.
 
Nocturnist, small city hospital, lots of good consultants but no residents/scribes. PA coverage part of the night. Usually see 2--2.5 pph, admit ~20%. Grossed $275/h + benefits as W-2 last year, mostly via our 25% night shift differential. Often stay an extra hour to chart, but that's paid prn.

I love my job. I can see so many patients because:

- my RNs are mostly experienced and they like me and tell me useful things, mostly because I don't waste their time by propagating subjective patient nonsense/my own anxieties
- our hospital system is very functional and most specialty clinics can see pts that I refer within a few days
- local hospitalists are GGG and they trust me because I don't waste their time by propagating my own anxieties
- it fulfills me to cut through BS and clear the waiting room, yet see most pts walk away grateful

Despite all the awesome, I can't sustain working nights for more than a few more years, and ER days don't interest me. So will probably go do something else eventually.
 
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Probably 1.25-1.75 patients per hour with maybe 15-20% admit rate for all comers but maybe 30% for those seen by the physicians
 
-1.6-1.8ish/hr when it’s slow
2.2ish/hr when busy. 2.9/hr is my all-time max at mothership and that was a bad time overnight with like 70% admitted. ESI 1-2’s at mothership. 3’s and the occasional 4 at other community sites as well. Mothership admit rate >50%, community and freestanding sites 20-30%.
-Pay is around 330/hr.
-Standard population + a lot of complex, sick old ppl. APP’s see low acuity and my numbers aren’t accounting for what they see. No residents (well, the rare FM or IM that probably only make me slower).
 
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1.5 PPH.

You'd think it'd be good but leadership sucks, nurses weak and nothing moves.
 
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PA presents ~1.5 patients an hour similar to how a resident would.
I primaried 2.25 - 2.75 pph on my own in addition on average last year. It seems to be going up this year.
Acuity is very high. I don't know what our admission rate is, but people are sick.
At the end of every shift I feel somewhere between slightly and extremely fried.
I am paid extremely well though. Easily top 1% comp for EM on an hourly basis (not counting FSED owners)
 
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I'm pulling up the rear at about 4-5 pph with one midlevel split between two attendings

the pay is below average

@Tenk can confirm via numerous screenshots this isn't an exaggeration

boluses of 10-15 pph have happened at any time from beginning, mid and end of shift

I rarely contribute to these topics because I see people talking about seeing 2 pph and making 250/hr complaining about how busy they are and how unsafe they feel and I want to cry via fetal position

Definitely practicing at the speed of malpractice

gotten very good at highly concise notes. After seeing what people sue for it seems people are gonna sue no matter what if they want to so spending hours defensively charting isn't gonna make life a guaranteed easy path

EDIT: Not an urgent care. moderate/high acuity. I feel double sad whenever an arrest comes in: someone has died and when I come out of that room I'll have 5ish new patients assigned
 
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Busy urban community ER. The docs in my group probably average 1.6pph. I know this with near certainty because we receive a 'report card' after every shift showing everyone's pph, admit rate, etc.

For those of you claiming to see 3 - 4+ pph... why? You're either full of it or just need to leave, full stop.
 
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I can tell you both individual and group averages where I work.

Last month was our busiest in patients/per day, but the volume has been similar/building for a year.

We saw 110/day, and have 32hr of physician coverage, so INCLUDING PA patients the overall group average all days all times of day was 3.44pt/hr.

Now we have 22hr/day of overlapped PA coverage, they seen a fair number of patients and do present them all to us, and also handle the majority of simple procedures (lacs/abscess) so the actually MD primary rate is closely to 2-2.5/hr, and you are free to not handle mild procedures.

In that we are eat-what-we-kill and love each other dearly, on extra high volume days people do tend to stay late and see more patients (and make more money) so we honestly probably function more like 36hr of MD coverage / day, driving averages a bit below what I posted above.

My own personal opinion is these are about as high as you want to push your mean pt/hr before you increase coverage. Obviously that is a complex equation, and when stacks of patients are left in the WR d/t hospital flow and capacity, and you have an undersized or under resourced ED, just adding ED MD hours may be a way to "waste money" and not actually meaningfully impact flow/patients seen. If we actually sustain volumes of 110/day and have the ability to see them with LWBS rates 3% or less, I think we will up coverage in some fashion.

That was of course our busiest month; data from a representative quarter last year shows--
3pt per hour overall group average (includes PA patients)
2.2pt per hour overall group average MD Primary patients only

Our mean admission rate over the past year is about 19-20%, but being a smaller hospital we do have a significant xfer rate of about 5-6% basically all of which are admissions at tertiary centers.

CC billing rate is roughly 8-9% (though we have a couple of people I feel under-bill; for the more "typical" billers the rate is 12%).

My own numbers tend to be about 10% higher that group average, by math this usually is just kissing 1SD from the mean.

We are eat-what-you-kill, so are reasonably compensated for pushing hard. That said, we've had a marked increase in volume since 2019 (say >10% growth) with markedly more difficult working conditions. The overhead has also increased markedly (insurance costs!), not to mention inflation. So the feeling is the last growth in volume/work has not given the feeling of commiserate pay increase one may expect. This is a much bigger discussion on medicare and insurance reimbursement rates, networks, etc.
 
I'm pulling up the rear at about 4-5 pph with one midlevel split between two attendings

the pay is below average

@Tenk can confirm via numerous screenshots this isn't an exaggeration

boluses of 10-15 pph have happened at any time from beginning, mid and end of shift

I rarely contribute to these topics because I see people talking about seeing 2 pph and making 250/hr complaining about how busy they are and how unsafe they feel and I want to cry via fetal position

Definitely practicing at the speed of malpractice

gotten very good at highly concise notes. After seeing what people sue for it seems people are gonna sue no matter what if they want to so spending hours defensively charting isn't gonna make life a guaranteed easy path

EDIT: Not an urgent care. moderate/high acuity. I feel double sad whenever an arrest comes in: someone has died and when I come out of that room I'll have 5ish new patients assigned

This is just stupid.
 
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2.15pph solo; 2.88 including APP patients.

I'm about average for my group.
 
People with high volumes greater than 2.2 pph, are you including any time spent documenting after the shift is technically over? What’s your typical shift length? Are you counting patients you see during the last hour of your shift that you sign out?

2.5 pph working an 8 hour shift staying 30-60 mins over for documentation/cleanup and signing out 5 of them is a lot different than working a 12 hour shift and finishing everything on time. The former is quite busy, the latter seems impossible.
 
about 1.6pph at main shop (25% admit), closer to 2pph at the lower acuity (5-10% admit rate) shop. ~$340/hr in 2023 including 401k match/profit share.
 
People with high volumes greater than 2.2 pph, are you including any time spent documenting after the shift is technically over? What’s your typical shift length? Are you counting patients you see during the last hour of your shift that you sign out?

2.5 pph working an 8 hour shift staying 30-60 mins over for documentation/cleanup and signing out 5 of them is a lot different than working a 12 hour shift and finishing everything on time. The former is quite busy, the latter seems impossible.
I work 8 or 9 hour shifts. My 2.25-2.75 pph = patients I saw primarily that day / shift length. Unless the department is completely exploding, and doing so in a way where my staying late will meaningfully help (e.g. there's 10 waiting to be seen), I'm usually out the door around 30 min after my shift ends. I generally sign out nothing or 1 or 2 patients which have very clear cut dispos (e.g. suspect kidney stone. CT pending. DC is written as if it's a stone.) Again, unless the dept is exploding, I won't usually pick up someone in the last hour of my shift that I can't dispo within 90 minutes as handing it off to the next doc isn't exactly doing them a favor.
 
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How many patients per hour do they expect me to see?

This question comes up often.

The answer is always the same. The answer is “More.”
 
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Reminder: This is SDN. We all got a 42 MCAT, a 270 Step 1, and see 2.8 PPH.

Source: My colleagues and I see 1.6-1.8 PPH in a group full of younger hungry docs (PAs siphon off the easiest stuff). We work our butts off, but usually leave on time or close to it with notes done.
 
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Reminder: This is SDN. We all got a 42 MCAT, a 270 Step 1, and see 2.8 PPH.

Vast spectrum of individual and system functionality.

Suffice to say some folks are in good spots and some folks are not.

Generally reasonable to synthesize the anecdote and say fewer folks are in good spots than before, and the good spots aren't quite as good as they once were ....
 
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I'm pulling up the rear at about 4-5 pph with one midlevel split between two attendings

the pay is below average

@Tenk can confirm via numerous screenshots this isn't an exaggeration

boluses of 10-15 pph have happened at any time from beginning, mid and end of shift

I rarely contribute to these topics because I see people talking about seeing 2 pph and making 250/hr complaining about how busy they are and how unsafe they feel and I want to cry via fetal position

Definitely practicing at the speed of malpractice

gotten very good at highly concise notes. After seeing what people sue for it seems people are gonna sue no matter what if they want to so spending hours defensively charting isn't gonna make life a guaranteed easy path

EDIT: Not an urgent care. moderate/high acuity. I feel double sad whenever an arrest comes in: someone has died and when I come out of that room I'll have 5ish new patients assigned
I kind of disagree on your malpractice statement. My first lawsuit was significantly more difficult to defend because of my lack in documentation. Little things like that can actually make or break the case as it is being read many times by a physician hired by the plaintiff. If they don't understand why you are doing what you are doing, they might say the case has merit whereas if you are clear and precise in your thinking....they may say it doesn't have merit. The case getting taken or dropped is entirely in the hands of the physician reviewing your note. My second case had meticulous defensive documentation and I can say with almost complete certainty that it got dropped because of that whereas if my documentation had been less than solid...it would have been pursued. I'm a huge believer in defensive documentation (after my first case). I've also become a huge believer in the philosophy that the less you order (as long as it is appropriate), the harder it is to prove that a test you didn't order...would have been abnormal had you ordered it at the time of the patient encounter.
 
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I kind of disagree on your malpractice statement. My first lawsuit was significantly more difficult to defend because of my lack in documentation. Little things like that can actually make or break the case as it is being read many times by a physician hired by the plaintiff. If they don't understand why you are doing what you are doing, they might say the case has merit whereas if you are clear and precise in your thinking....they may say it doesn't have merit. The case getting taken or dropped is entirely in the hands of the physician reviewing your note. My second case had meticulous defensive documentation and I can say with almost complete certainty that it got dropped because of that whereas if my documentation had been less than solid...it would have been pursued. I'm a huge believer in defensive documentation (after my first case). I've also become a huge believer in the philosophy that the less you order (as long as it is appropriate), the harder it is to prove that a test you didn't order...would have been abnormal had you ordered it at the time of the patient encounter.

I was sued for not doing a thing that I did and documented that I did.

The "expert" still signed off against me.

Documentation don't mean ****.
 
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I kind of disagree on your malpractice statement. My first lawsuit was significantly more difficult to defend because of my lack in documentation. Little things like that can actually make or break the case as it is being read many times by a physician hired by the plaintiff. If they don't understand why you are doing what you are doing, they might say the case has merit whereas if you are clear and precise in your thinking....they may say it doesn't have merit. The case getting taken or dropped is entirely in the hands of the physician reviewing your note. My second case had meticulous defensive documentation and I can say with almost complete certainty that it got dropped because of that whereas if my documentation had been less than solid...it would have been pursued. I'm a huge believer in defensive documentation (after my first case). I've also become a huge believer in the philosophy that the less you order (as long as it is appropriate), the harder it is to prove that a test you didn't order...would have been abnormal had you ordered it at the time of the patient encounter.

The alternative based off of volume I see is to stay over and chart 2-3 hours a day

I dunno man

I see your point

But I need you to see mine
 
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I'm pulling up the rear at about 4-5 pph with one midlevel split between two attendings

the pay is below average

@Tenk can confirm via numerous screenshots this isn't an exaggeration

boluses of 10-15 pph have happened at any time from beginning, mid and end of shift

I rarely contribute to these topics because I see people talking about seeing 2 pph and making 250/hr complaining about how busy they are and how unsafe they feel and I want to cry via fetal position

Definitely practicing at the speed of malpractice

gotten very good at highly concise notes. After seeing what people sue for it seems people are gonna sue no matter what if they want to so spending hours defensively charting isn't gonna make life a guaranteed easy path

EDIT: Not an urgent care. moderate/high acuity. I feel double sad whenever an arrest comes in: someone has died and when I come out of that room I'll have 5ish new patients assigned
Wtf that's insane.

At our big house we see 1.5 pph or less not counting PA patients and we only write notes on ones the PA requests we see or our rules require us to see. High average acuity and we have frequent discussions about adding more hours (I'm against it currently).

We get busier at the smaller hospitals but acuity is on average lower.

The slow rural shifts seem to be getting busier over time.
 
Money matters and incentives matter. My opinion is you should get at least $100 per patient you see alone and about $50 for every MLP chart you sign. If you make less than that you are being screwed by your employer. I would count resident charts as seen alone.

So if yuo are seeing 4-5 pph as mentioned you better be making top line dough. i know it varies but if you are hourly why see more than 2.2 pph.. or 1,8 pph and sign the MLP notes. just a different approach to the pph talk. I personally dont mind working hard as long as i get paid for it.
 
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Speaking of MLP notes... With all the 2024 CMS changes, has anyone experienced any cosignatory changes at their gigs? For instance, where I work...MLPs see their own patients and prior to this year they are all sent to me to co-sign. The encounter is then billed under my NPI by my CMG. It's also a hospital bylaw requirement, I believe. This year, the pt encounters are not being presented to us yet the charts are still getting sent to sign. In my state, I think only 20-30% pt encounters are actually supposed to be reviewed by the supervising physician which technically would be whoever signed for their privileges at the hospital (usually FMD). I asked CMG brass if there was going to be any change to our cosign requirements but nobody has gotten back to me yet. Anybody else noticed any changes this year?
 
Why don't you like days?
So many reasons. The main one is that I feel like I can win at night, usually. I think most humans need to feel like they are winning in order to be happy.

I come in, I just had a good nap, I'm pumped. WR has 35 in it at 10pm. A few have been there since AM. Well then me lads and lasses, hoist ho and we'll clear 'er by 2am yarharhar!!!1 I run around like a psychotic busboy writing work notes and discharging patients who have been there 10 hours and fistbumping my crew. All the burned-out day people trickle away, and we stop feeling powerless and listening to each other whine and get down to just getting 'er done. WIth luck, my narrative will hold (sure it's mostly LWBS IknowIknow), and we will clear the WR by 2--3am. Then the RNs will chill and maybe even start gossiping about each other in between tending to their broken hospitalist boarders, and I will finish my notes. And then life is beautiful.

Never had a day shift like that. The system is broken, I see it. But at night, here, we often still have capacity, and things still feel pretty nice for now.

No idea whether it will last, so trying to make hay while the sun shines. And so even if I loved days, would make no sense to switch to them now, for a 20% pay cut plus all the other personal/family/schedule drawbacks.

(Also forgot to mention that 1/3 of my shifts are at a critical access place where I see 1pph and then just sleep or play BG3 for 4--5 hours. :))
 
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So many reasons. The main one is that I feel like I can win at night, usually. I think most humans need to feel like they are winning in order to be happy.

I come in, I just had a good nap, I'm pumped. WR has 35 in it at 10pm. A few have been there since AM. Well then me lads and lasses, hoist ho and we'll clear 'er by 2am yarharhar!!!1 I run around like a psychotic busboy writing work notes and discharging patients who have been there 10 hours and fistbumping my crew. All the burned-out day people trickle away, and we stop feeling powerless and listening to each other whine and get down to just getting 'er done. WIth luck, my narrative will hold (sure it's mostly LWBS IknowIknow), and we will clear the WR by 2--3am. Then the RNs will chill and maybe even start gossiping about each other in between tending to their broken hospitalist boarders, and I will finish my notes. And then life is beautiful.

Never had a day shift like that. The system is broken, I see it. But at night, here, we often still have capacity, and things still feel pretty nice for now.

No idea whether it will last, so trying to make hay while the sun shines. And so even if I loved days, would make no sense to switch to them now, for a 20% pay cut plus all the other personal/family/schedule drawbacks.

(Also forgot to mention that 1/3 of my shifts are at a critical access place where I see 1pph and then just sleep or play BG3 for 4--5 hours. :))

Hell yeah BG3!

Currently playing Elden Ring but BG3 might be my next big one.
 
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BG3 keeps crashing on me on XSX. It's gotten so frustrating and I'm not even that far in the game. In their defense, I'm using a beta OS as part of the xbox insider program.

I wish I had time like that to game at night. The last time I did that was during one of the D4 betas and I brought my XSS to work and had a few hours of downtime with no patients and played. Nights like that are rare though these days. I can remember moonlighting at this gig 10 years ago and would get 4 hours uninterrupted sleep. Not any more.
 
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Speaking of MLP notes... With all the 2024 CMS changes, has anyone experienced any cosignatory changes at their gigs? For instance, where I work...MLPs see their own patients and prior to this year they are all sent to me to co-sign. The encounter is then billed under my NPI by my CMG. It's also a hospital bylaw requirement, I believe. This year, the pt encounters are not being presented to us yet the charts are still getting sent to sign. In my state, I think only 20-30% pt encounters are actually supposed to be reviewed by the supervising physician which technically would be whoever signed for their privileges at the hospital (usually FMD). I asked CMG brass if there was going to be any change to our cosign requirements but nobody has gotten back to me yet. Anybody else noticed any changes this year?
There aren't any midlevel attestation changes in 2024 to my knowledge. The proposed rule where only "time spent" can be used to assign either the MD or the NP/PA as the biller has been pushed back again until at least 2025.

Some MD still needs to sign all the NP/PA charts in order to capture 100% instead of 85% of those bills. Who that person is varies wildly from site to site. If no MD even had the case presented to them, I argue that the site director can sign those charts. The idea that you would need to sign a chart for a patient that you had literally no involvement with is insane to me.
 
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The idea that you would need to sign a chart for a patient that you had literally no involvement with is insane to me.

Routinely happens where I'm at. Multiple CMGs over the years, various hospitals in the city so it's not one hospital system bylaw or one particular CMG's practice. It definitely chaps my hide. I feel the same...that the FMD should sign all of those. After all, they are usually listed as the "supervising physician" on credentialing paperwork for the APC.
 
Routinely happens where I'm at. Multiple CMGs over the years, various hospitals in the city so it's not one hospital system bylaw or one particular CMG's practice. It definitely chaps my hide. I feel the same...that the FMD should sign all of those. After all, they are usually listed as the "supervising physician" on credentialing paperwork for the APC.
How some lawyer hasn't used this to go after a CMG is crazy to me.

Patient seen by PLP. Patient has bad outcome. Doc gets sued as usual. Doc explains that their job description literally involves signing the chart of patients whom they had no involvement with whatsoever. Lawyer decides to go for some real money and sue the CMG for creating definitionally unsafe practice patterns for their patient. For f***'s sake, they could do this as a class-action lawsuit. I'm not one to support lawyers in general, but I don't think this would be a terrible thing to happen.
 
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There are 4 primary ways to make money in EM:

1) See more patients. More patients per hour.
2) Make money off of MLPs or other employed physicians.
3) Own a FSED and collect facility fees.
4) Earn non-clinical revenue through administrative or other responsibilities.

#1 is the the most equitable and common way to increase compensation.

At my group we strive for more PPH as that is the best way for us to increase compensation. We are limited though by flow and hospital inefficiency, as well as volume and acuity fluctuation.

I average 2.1 pph. Occasionally I’ll see around 3 pph, which is great. Sometimes I’ll even have surges of 6+/hour. Anything over 3 pph at decent acuity over a sustained time period is fairly draining, although certainly compensates well. Rarer times of slower paced shifts are nice for the change of pace, but the decreased compensation hurts.

The paradox of EM is correct. We only want emergencies, but the volume and worried well is what makes the money.

I think ~2 pph is both sustainable and compensates reasonably. This should at least average to $150/patient and $300/hour after expenses. Those working for employers/CMGs will make less than this with income skimmed off the top and perhaps forced to see more patients than desired for uncompensated white collar labor. Those in private groups will make more than this and receive higher income particularly if can increase pph numbers.
 
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I see anywhere from 0.3-1.5 pph nowadays depending on boarders. As I write this I have seen one new patient in two hours. The rest is sign out. I make $250/hr + benefits as a dysfunctional ER hospitalist.
 
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I see anywhere from 0.3-1.5 pph nowadays depending on boarders. As I write this I have seen one new patient in two hours. The rest is sign out. I make $250/hr + benefits as a dysfunctional ER hospitalist.

Do your partners/other people in your group also see this few? How is this sustainable for your group or hospital?

I would be in my director's office looking to find ways to "increase my productivity" if I were seeing this few, and not going out to the WR to practice WR medicine and dispo easy quick ones.
 
Do your partners/other people in your group also see this few? How is this sustainable for your group or hospital?

I would be in my director's office looking to find ways to "increase my productivity" if I were seeing this few, and not going out to the WR to practice WR medicine and dispo easy quick ones.
Yes. We’ve been doing this for like 2 years. There’s no beds in our state so more complicated things board. We are a critical access hospital with 25 inpatient beds and 21 ed beds.
 
Yes. We’ve been doing this for like 2 years. There’s no beds in our state so more complicated things board. We are a critical access hospital with 25 inpatient beds and 21 ed beds.
Critical access means “gubment” $$.

The other way to make more money for an sdg. Get better contracts and document better.
 
Critical access hospital:

Average is 1.3 pph. Used to be 1.1 but a sister critical access closed and daily average volume jumped from 28 to 33.

Average is brought down by night shifts where you usually see less than 1 pph.

Day shift you are usually seeing around 18-20 in 12 hours. Very busy day shifts you end up seeing low 30s sometimes.
 
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2.5 per hour. Including midlevels (we have to staff all of them). I don't see patients for the last hour of my shift (we have overlap) and try not to pick up new complicated patients when we have another doc coming in <30 minutes, just very simple stuff.

Still see 20+ patients in 8 hours (2.5+ PPH).
 
Critical access means “gubment” $$.

The other way to make more money for an sdg. Get better contracts and document better.
Correct. It’s a lot of money too. But I’m an employee without any rvu incentive so I don’t really care when we are boarding and nothing moves.
 
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Correct. It’s a lot of money too. But I’m an employee without any rvu incentive so I don’t really care when we are boarding and nothing moves.
Makes sense. Other than location (to me) sounds reasonable.
 
So many reasons. The main one is that I feel like I can win at night, usually. I think most humans need to feel like they are winning in order to be happy.

I come in, I just had a good nap, I'm pumped. WR has 35 in it at 10pm. A few have been there since AM. Well then me lads and lasses, hoist ho and we'll clear 'er by 2am yarharhar!!!1 I run around like a psychotic busboy writing work notes and discharging patients who have been there 10 hours and fistbumping my crew. All the burned-out day people trickle away, and we stop feeling powerless and listening to each other whine and get down to just getting 'er done. WIth luck, my narrative will hold (sure it's mostly LWBS IknowIknow), and we will clear the WR by 2--3am. Then the RNs will chill and maybe even start gossiping about each other in between tending to their broken hospitalist boarders, and I will finish my notes. And then life is beautiful.

Never had a day shift like that. The system is broken, I see it. But at night, here, we often still have capacity, and things still feel pretty nice for now.

No idea whether it will last, so trying to make hay while the sun shines. And so even if I loved days, would make no sense to switch to them now, for a 20% pay cut plus all the other personal/family/schedule drawbacks.

(Also forgot to mention that 1/3 of my shifts are at a critical access place where I see 1pph and then just sleep or play BG3 for 4--5 hours. :))
Also a nocturnist and also have levels of winning

Level 1 - one page of active pt by 0600
Level 2 - one page active by the time the midlevel leaves(2-3am) (this is currently my benchmark - I can get there most of the time if I try and someone is drawing labs for the WR patients)
Level 3 - one page active by midnight
Level 10 - no active pt at 0600 (then I can leave ~2h early - once every other month - glorious)

Bonus round : How many transfers from our auto accept freestanding can I put in the hallway?
(The fake r/o subdural comes to mind - yep it was in 9H 🤣)

I enjoy it more when I can WIN. And there’s no winning on day shift.
 
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