Psychiatry patients seen per day

[notlucid]

Hi All

I am posting a thread to see how many patients are seen per day. I see 16 per 8 hour day in outpatient clinic. I work with ehr which slows me down or so I believe.I have colleagues who see 30 per day in 10 hours, that would be the most productive physician in our clinic.
It also depends on panel size too as if you see someone monthly then it is easier.

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[Bartelby]

Two thoughts: first, if this is limited to attending psychiatrists you might want to specify that. I'm guessing that you are not interested in how many patients a resident sees each day. Second, you might want a category of fewer than 10 for those who work part time or who have a therapy-intensive practice.

 

[notlucid]

I agree that the poll is for attending psychiatrists.I apologize for that.A clarification that one of the best clinicians that I trained under used to work 12 hours a day and see 40 more patients, so quality care can certainly be delivered while seeing a high no. of patients imho.

 

[wolfvgang22]

Severity of illness also matters a lot if you want to provide good care. If most all of your patients have serious mental illness like Schizophrenia, severe PTSD, Borderline, etc., it is difficult if not impossible to see 30 patients in 8 hours. If you are writing single prescriptions for only Citalopram 10mg or Adderall 10mg all day on less ill patients, short visits are easier to do. Also, support staff matters and can free up your time some.
I see many PTSD, chronic, severe patients with TBI and substance abuse that I inherited on multiple medications at the VA. 30 patients a day would be untenable for me.

 

[nexus73]

Inpatient here. 8-14 each day. Typically have multiple admits/discharges. Patients are obviously sick enough to be in the hospital. Days are closer to 5 hours of direct patient care. Staff meeting adds an hour. Family meetings and phone calls add time as well. Luckily we can still dictate.

 

[OldPsychDoc]

20 inpatient beds, 10 co-managed with a PA, so I'll usually only see admissions & discharges of that group--so 10 + 2-5 more on a typical day.

 

[Shikima]

Severity of illness also matters a lot if you want to provide good care. If most all of your patients have serious mental illness like Schizophrenia, severe PTSD, Borderline, etc., it is difficult if not impossible to see 30 patients in 8 hours. If you are writing single prescriptions for only Citalopram 10mg or Adderall 10mg all day on less ill patients, short visits are easier to do. Also, support staff matters and can free up your time some.
I see many PTSD, chronic, severe patients with TBI and substance abuse that I inherited on multiple medications at the VA. 30 patients a day would be untenable for me.

Agreed. A less complex day, I can see more, those with more problems requires more time and less ppl are seen that day.
This goes for intakes too. Less complicated, straight forward people with depression and anxiety, the intake can be completed in 30 mins. More complicated, the longer. It all balances out in the end because where you can make-up time, you will lose it in other circumstances. A much different beast compared to residency/fellowship.

 

[TexasPhysician]

I am building up a cash practice where new patients have 1.5 hour slots and follow-ups are 30 min.

I also round at an addiction center. As many of these patients are seen very frequently and well known, I see 16-40+ in a day. There isn't much to discuss when Prozac 20mg is working great and the last appointment was yesterday.

 

[Shikima]

I am building up a cash practice where new patients have 1.5 hour slots and follow-ups are 30 min.

I also round at an addiction center. As many of these patients are seen very frequently and well known, I see 16-40+ in a day. There isn't much to discuss when Prozac 20mg is working great and the last appointment was yesterday.

Bill those as 213?

 

[F0nzie]

100% outpatient. 90 for intakes, 60 for therapy, and 30 for med. 16 patients max. Average is 8-12 patients a day.

 

[sunlioness]

Outpatient. CMHC. 15 minute follow ups. 45 minute intakes if they've been seen in the system before. 60 min if they haven't. Eight hour days. Admin time is available, but not counted toward hours. Around mid twenties to thirty patients per day.

I don't find it sustainable.

My old job was thirty minute follow ups. Sixty minute intakes, limited to no more than 2/day and 8/week. Around 14 patients/day. That was doable.


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[SomeDoc]

Outpatient. CMHC. 15 minute follow ups. 45 minute intakes if they've been seen in the system before. 60 min if they haven't. Eight hour days. Admin time is available, but not counted toward hours. Around mid twenties to thirty patients per day.

I don't find it sustainable.

My old job was thirty minute follow ups. Sixty minute intakes, limited to no more than 2/day and 8/week. Around 14 patients/day. That was doable.


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Thank you for confirming this. I have been in talks with a CMHC and their setup is such that the psychiatrists has only 15 min for follow-up visits; that includes prior note review and documentation. I just don't see how this is enough time for a patient, especially if I am dealing with SMI populations.

 

[psych md jd]

100% forensic outpatient private practice. N~125. Follow-ups: 45 minutes [more if needed]. Intakes: 2 to 10 hours [more if needed]. I see about 40 patients per month.

No EHR, NO insurance, NO billing.

All patients are under court supervision, 100% C+S [or else]. 100% med compliant [or else].

 

[birchswing]

100% forensic outpatient private practice. N~125. Follow-ups: 45 minutes [more if needed]. Intakes: 2 to 10 hours [more if needed]. I see about 40 patients per month.

No EHR, NO insurance, NO billing.

All patients are under court supervision, 100% C+S [or else]. 100% med compliant [or else].

I think your set-up would lend itself to an interesting TV procedural. Except in the show you'd probably have to "bend" the rules. And there'd have to be some corrupt system you're up against. But the backdrop of a psychiatrist/lawyer meeting with people in the judicial system would be great.

 

[doctorpilgrim]

When inpatient I see 12 patients a day, when outpatient 18 per day in 8 hours.
1. If private practice with control over support staff in an efficient system, with frequent follow up, the ability to see more patients depends on desire, comfort level, experience etc
2. If in a salaried job with no control over scheduling, inefficient system, large panel size, severe mental illness, more common in cmhc, then stress and burnout may result.

The problem is that early career psychiatrists can be taken advantage of by manipulative employers. In an ideal world these things would be common knowledge to ensure a good fit.

 

[SomeDoc]

100% forensic outpatient private practice. N~125. Follow-ups: 45 minutes [more if needed]. Intakes: 2 to 10 hours [more if needed]. I see about 40 patients per month.

No EHR, NO insurance, NO billing.

All patients are under court supervision, 100% C+S [or else]. 100% med compliant [or else].

Aside from a decompensation (this in itself may not be due to nonadherence), or through the use of meds that are depot/associated with serum levels, how do you confirm 100% adherence in your conditional release patients?

 

[Shikima]

Aside from a decompensation (this in itself may not be due to nonadherence), or through the use of meds that are depot/associated with serum levels, how do you confirm 100% adherence in your conditional release patients?

Ask. Or there are urine tests out there which will scan for all possible metabolites from psychotropics.

 

[psych md jd]

Judicial compulsion is a strong motivator. Not to mention random home inspections, pill counts, random serum levels, LAI's, polygraphy, and hair analysis.

 

[SoulinNeed]

I think what would be just as interesting is the number of the kinds of patients that you see. Anxiety? Depression? Schizo? Etc.

 

[hamstergang]

polygraphy

Are you saying that's good as a motivator or you actually trust its results?

 

[psych md jd]

Just another tool in the forensic toolbox.

 

[SomeDoc]

Judicial compulsion is a strong motivator. Not to mention random home inspections, pill counts, random serum levels, LAI's, polygraphy, and hair analysis.

Not to the individual who has no insight into their mental illness. I would be interested in how often hair analysis, and polygraphy for that matter are used. My guess is almost never, especially for polygraphy.

Pill counts? This reminds me of 100% adherence in a corrections facility where the inmate is taking their meds from the nurse, but flushing it down the toilet.

 

[SomeDoc]

I think what would be just as interesting is the number of the kinds of patients that you see. Anxiety? Depression? Schizo? Etc.

We're talking Bipolar I, schizophrenia, or unipolar depression, where psychosis is usually involved. Things get more complicated when you start getting into PTSD diagnosis territory, dissociative disorders, etc. among others.

Unlikely to see an anxiety disorder in such cases, and if one did, this would likely indicate that the district attorney, or the expert in the defendant's case, did not do their due diligence. Of course, there are exceptions.

 

[SoulinNeed]

We're talking Bipolar I, schizophrenia, or unipolar depression, where psychosis is usually involved. Things get more complicated when you start getting into PTSD diagnosis territory, dissociative disorders, etc. among others.

Unlikely to see an anxiety disorder in such cases, and if one did, this would likely indicate that the district attorney, or the expert in the defendant's case, did not do their due diligence. Of course, there are exceptions.

What kind of setting are we talking about here? Corrections?

 

[SomeDoc]

What kind of setting are we talking about here? Corrections?

Non-corrections outpatient forensic psychiatry; for individuals acquitted NGRI (not guilty by reason of insanity) and who transitioned from a state facility to less restrictive settings in the community like community integration homes or personal care homes.

 

[hamstergang]

Just another tool in the forensic toolbox.

But is it validated or reliable? My understanding was that it was basically pseudoscience.

 

[SomeDoc]

But is it validated or reliable? My understanding was that it was basically pseudoscience.

Polygraphy was previously inadmissable in court, based on the Frye Standard for evidence. This was superceded by the Daubert Standard, which now allows it on a nuanced, case-by-case basis. It is known to be variable in accuracy- not something you'd want to use in court without additional supporting data or collateral if you want to make a convincing case.

 

[psych md jd]

"Not to the individual who has no insight into their mental illness."
They usually don't make it to outpatient.

"My guess is almost never, especially for polygraphy."
A $25K/year bill for polygraphy is a lot of never.

"This reminds me of 100% adherence in a corrections facility where the inmate is taking their meds from the nurse, but flushing it down the toilet.
Based on my experience in jails and prisons, most inmates don't flush their meds, they sell them. Also, kind of difficult to have a therapeutic plasma level if the patient is non-compliant.

"My understanding was that it was basically pseudoscience"
Isn't the same said about psychoanalysis? I'm not interested in the "manifest" content of the test, but rather the "latent" content.

 

[SomeDoc]

"Not to the individual who has no insight into their mental illness."
They usually don't make it to outpatient.
Non-sequitur/irrelevant. Some do.

"My guess is almost never, especially for polygraphy."
A $25K/year bill for polygraphy is a lot of never.
Interesting, noted. Reliance must vary by jurisdiction.

"This reminds me of 100% adherence in a corrections facility where the inmate is taking their meds from the nurse, but flushing it down the toilet.
Based on my experience in jails and prisons, most inmates don't flush their meds, they sell them. Also, kind of difficult to have a therapeutic plasma level if the patient is non-compliant.
Non-sequitur/irrelevant. The point is that pill counts are not a fool-proof way to confirm "100% compliance."