Poll - Patients per hour

[Groove]

I'd also like to know:

1) Maximum pph where you personally feel that it's difficult to provide optimal care. (NOT the maximum # that you are personally capable of seeing.)

2) Admission rate.

For myself:

1) 3.0 but I really prefer to not exceed 2.5.

2) 25-40%

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[GeneralVeers]

My old job was 2.5 to 3.0 pts/hr. My new one is about 1.7 pts/hr. Life is much better now.

 

[Groove]

Nice. I'm taking a pay cut with the new job I'm taking and will be going from 2.5-3.0 to a group that averages 1.7 pph It sounds like heaven. It's a pay cut, mind you... but not a huge one.

 

[Apollyon]

Nice. I'm taking a pay cut with the new job I'm taking and will be going from 2.5-3.0 to a group that averages 1.7 pph It sounds like heaven. It's a pay cut, mind you... but not a huge one.

Back in 2006, when interviewing for a job, the group president said one guy was angling with him about this job versus another - the job for which I interviewed (and got) was 2.2 pph or less. The pres said the other job was $10K/year more - for 2.6 pph. 18% more patients for 6% more money? Yeah, no thanks.

I made $175K in 2011 seeing <1pph, nights, downtown Honolulu. I was single. It wasn't perfect (with a nurse with a personality disorder), but, boy howdy, it was close. Things were GOOD.

 

[EM2BE]

Back in 2006, when interviewing for a job, the group president said one guy was angling with him about this job versus another - the job for which I interviewed (and got) was 2.2 pph or less. The pres said the other job was $10K/year more - for 2.6 pph. 18% more patients for 6% more money? Yeah, no thanks.

I made $175K in 2011 seeing <1pph, nights, downtown Honolulu. I was single. It wasn't perfect (with a nurse with a personality disorder), but, boy howdy, it was close. Things were GOOD.

I am voting, but it's for my moonlighting job at this time. I don't know the admission rate at this point, but I have been seeing 2-2.5 pts/hr. Most of the time, there are quite a few sick people. I know I'm not super comfortable at this point doing this much when I have multiple really sick people at the same time. I have been able to handle it so far though. Thankfully it's double coverage during my shifts and the nursing staff has been great and helpful.

 

[usrael]

1.7 pts/hr. Fast-track staffed by PAs, so mostly higher acuity. Still feels easier than residency in terms of pts/hr. I enjoy being able to spend an extra few minutes with pts.
Admission rate just under 40% which will drop as I am further removed from training, though I suspect will end up around 30%.

 

[EvoDevo]

2.0 pph on a slow day with good PAs in fast track. Moderate acuity (seasonal, of course) and about a 10-15% admission rate.
3.1-3.5 pph on a brutal day (same PAs in FT), generally lower overall acuity and <10% admission rate.
1.7 - 2.0 with high acuity, high admission/transfer rates (20-30%)

 

[drguy22]

2.0 pph on a slow day with good PAs in fast track. Moderate acuity (seasonal, of course) and about a 10-15% admission rate.
3.1-3.5 pph on a brutal day (same PAs in FT), generally lower overall acuity and <10% admission rate.
1.7 - 2.0 with high acuity, high admission/transfer rates (20-30%)

I see on avg 2.5- 3 pts/hr on an avg. on a slow day its about 2/hr that include the PA's. If im alone i see about 2.5/hr

 

[RustedFox]

Back in 2006, when interviewing for a job, the group president said one guy was angling with him about this job versus another - the job for which I interviewed (and got) was 2.2 pph or less. The pres said the other job was $10K/year more - for 2.6 pph. 18% more patients for 6% more money? Yeah, no thanks.

I made $175K in 2011 seeing <1pph, nights, downtown Honolulu. I was single. It wasn't perfect (with a nurse with a personality disorder), but, boy howdy, it was close. Things were GOOD.

"Nurse with a personality disorder"

you mean... there are some that DON'T have personality disorders ?

Nyuk, nyuk. Mom and aunt are both nurses.

 

[Janders]

I just looked at the data from our last review (this past summer, which was reasonably busy).
I saw almost exactly 2.5/hr, averaged over 4 months. This number was exaggerated by the fact I have PA support during peak hours. However it also doesn't tell the entire story... the overnight only docs average 1.5/hr as we are small enough that overnights tend to have slow periods. So considering I work 30% overnights, which only see about 1.5 an hour, I must see closer to 3/hr during my day/eves to average 2.5 overall.

Our admission rate is about 17%, with an additional 3-4% transferred due to need for tertiary care, so basically similar to a 20% admit rate.

Personally, unless the acuity is horrible I think seen 2/hr of my own patients plus and additional 1.5/hr PA patients is a nice pace... not slow, but not hectic and pays the bills nicely.

 

[Rendar5]

I see 1.8-2.0 pph, not including PA coverage as we are not required to see all their patients. 20% admission rate with moderate acuity.

 

[Arcan57]

2.06 pph solo, 3.15 with midlevels (system regulations mean I end up seeing about 30% of their patients). Admit rate is right around 26%. Discomfort with volume is more a factor of how many active patients I have then patients evaluated per hour, which ends up usually being a function of how interested the nurses are in carrying out my orders in a timely fashion. I don't like to have more than 9 active patients, and feel my ability to re-assess and dispo in a timely fashion starts disappearing around 13-14 active patients.

 

[TooMuchResearch]

2.06 pph solo, 3.15 with midlevels (system regulations mean I end up seeing about 30% of their patients). Admit rate is right around 26%. Discomfort with volume is more a factor of how many active patients I have then patients evaluated per hour, which ends up usually being a function of how interested the nurses are in carrying out my orders in a timely fashion. I don't like to have more than 9 active patients, and feel my ability to re-assess and dispo in a timely fashion starts disappearing around 13-14 active patients.

Not to derail at all, but how far into your career were you when you a) really started to hit your peak efficiency and b) had worked enough to be able to assess your efficiency like you did in that post?

 

[gman33]

I've found that my ability to see patients is greatly tied into support staff.
I work at multiple hospitals in my residency.
When looking for a job, any tips on how to assess what is a reasonable number of pph?
3 pph may be reasonable at place that has triage based orders (CP already has lab drawn and ordered), and good support for procedures.
2 pph maybe impossible if nothing ever gets done unless you do it yourself.

 

[Pinner Doc]

1.7 pts/hr. Fast-track staffed by PAs, so mostly higher acuity. Still feels easier than residency in terms of pts/hr. I enjoy being able to spend an extra few minutes with pts.
Admission rate just under 40% which will drop as I am further removed from training, though I suspect will end up around 30%.

I just heard a bit about this from my director at our yearly review because my admit rate was 21%, compared to the group average, somewhere around 15-20%. I'm 2-ish years out of residency. I'd say we have some fairly sick folks at our community ED. I just feel like, in my case, we're splitting hairs.

 

[Pinner Doc]

I'd say that I'm about 1.5-2 pph. We have a fast track with a PA. On any given shift, the ED is divided up among 3 providers, so I only have 7 functional rooms per shift. Half the time, about two of them are used up by psych boarders or floor admits who sit in the department for hours. And if *I* end up admitting a patient? Forget about it. There goes that room for the majority of the shift, while they wait for a bed upstairs, too.

Did I mention we're RVU-based?

At night we are single coverage for half the shift (the last swing shift doctor stops taking patients around 1:30. Then, the whole department (25 ish rooms) is yours to fill. I think the most I've seen is 22 pts in an 8 hour shift.

 

[Janders]

The most is 22 in 8 hours? And you are RVU based? Doesn't sound necessarily optimum...

 

[Pinner Doc]

The most is 22 in 8 hours? And you are RVU based? Doesn't sound necessarily optimum...

Agreed. Am actually in process of transitioning to a dept with straight up hourly pay.

 

[walkermd]

I'm at a busy urban academic center, non-fast track 4-5 pts/hr, fast-track (with 1 PA so staffing 50% primarily) 5-7 pts/hr. Admission rate 25-40%. This is VERY busy, my max for feeling "safe".

What do other folks in academia do?

 

[The White Coat Investor]

I'm one of those two guys at the bottom. We were averaging 1.3, but now we're 1.2. Personally, I wouldn't want to see more than 2 per hour on average. That's 16 in an 8 hour shift. That's enough with a decent payor mix. We admit something like 12%.

 

[e30ftw]

Since I started PGY-2 I've averaged 2.0 patients per hour with around a 40% admit rate. If I could find a job working at the same level of efficiency as an attending that would be awesome. At my program attendings still see around 40% of patients by themselves so most complicated/critical patients go to residents. Saw 26 in 10 hours one busy night and came close to losing it.

My dream job as an attending is a well-staffed equal-or-less-than 2 pph w/ ~20% admit.

 

[doctorFred]

i will usually see 20 patients in an 8 hr shift. when it's busy, and i cross the 24 mark/3pph, it starts to feel unsafe. admission rate probably around 40%.

 

[Janders]

I think a lot depends on PA / midlevel support, not just acuity. I just looked, and over the past 3 shifts I've seen 2.7/hr. Two shifts felt pretty slow, one was pretty busy (70% admit rate!).

However, once you break it down I was actually seeing 2/hr of my own, and 0.75/hr of PA oversight... which takes about 5 minutes max.

I get pretty bored when I an <1.5/hr. Which is fine if I need to catch up on the internet, or have some admin work to do at 0330... but I wouldn't want to permanently work somewhere seeing 1-1.5/hr.

 

[med2UCC]

The average where I work is 2.2/hr. I average somewhere between 2.2-2.5, depending on the mix of shifts I work and how log jammed the ED is. i tend to work a lot of evening and weekend shifts and on these we get slowed down by the complete lack of space to see patients. I've worked recent shifts where, in our 28 bed ED (+2 if you count the trauma/resus bay) we've had 18 admitted patients waiting for beds and at most one stretcher to work out of because the rest are all occupied by patients on telemetry waiting for test results. Kind of slows you down.
M

 

[pagemmapants]

It goes without saying that it really depends on the acuity mix. My shops are single MD/DO coverage with 1 or 2 PAs depending on the time of day and the day of the week. My group considers adding PA coverage when we get above an average of 3 pph in an hour period. A "comfortable" rate is 1.5-2.5 for me; occasionally in our "crazy" location we get up to 3-5 pph but it's really spiky and a lot of those are psych medical clearance which take minimal time (hooray for mobile psych teams) or pain zombies. In contrast sometimes on overnights I (what?!) actually sleep a couple hours. I'm not sure what my admission rate is but it *feels* like about 20% at one shop and about 30% at the other (if you include psych admits).