What is your typical day?

[Peripheral2010]

What do you guys do in a typical day...
Clinic start/finish?
How many patients on your schedule in total?
Midlevels?
Are you in clinic or do you go to offsite areas and let the midlevels see follow ups?
One clinic site? Two? Three?
I’m just trying to see the way a practice can vary.... curious.
I’m NE area. 4.5 days a week, 30 patients a day. One location. One nurse practitioner. Do about 30-40 implants a year.

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[so55b]

Midwest. Hospital employee, 8-3:30pm ish, 5 days a week. 12-16 patients per day, last patient at 2:30pm. No midlevel for now but likely adding one in a year. Medical scribe support. One clinic site. 27 days vacations and holidays. I have sick days too but my salary is base + production so may not use my sick days.

Im a new pain doc, out of fellowship. Doing 2-3 stims and 1-2 kyphos a month for now but I envision numbers would go up.

 

[afob100]

East coast. Hospital employee. 3.5 days clinic. 1.5 days injections. 8a to 4p (1 hour lunch, usually spent answering pt messages). 18 clinic patients per day. ~20 injections per day. 2 clinic locations and separate ASC. 25 days vacation (5 are cme) plus 7 paid holidays.

 

[BobBarker]

Midwest. Hospital employee, 8-3:30pm ish, 5 days a week. 12-16 patients per day, last patient at 2:30pm. No midlevel for now but likely adding one in a year. Medical scribe support. One clinic site. 27 days vacations and holidays. I have sick days too but my salary is base + production so may not use my sick days.

Im a new pain doc, out of fellowship. Doing 2-3 stims and 1-2 kyphos a month for now but I envision numbers would go up.

Didn’t know I was writing your biography!


Roll in at 9:45 for 9:00 clinic in my mid series BMW. See my 3 patients that have been waiting on me, see 7 more by noon. Was hoping for about 5 no shows, but not today. Go to the hospital for lunch. Panini and sushi. Delicious as always. Get a plastic sack and fill it up with bottled drinks, hummus, sushi, and snacks for home. Run that home and play with the dog for an hour. Show up
at the hospital for 1:00 procedures at 1:30. Patient still not ready. Which is understandable since we only have 11 RN’s, 3 scrub techs, and 2 rad techs assigned to this area today. Knock out 6 procedures by 4:30. One was even a CESI! I could tell the staff was nervous since the other doc typically takes an hour on his. Total procedure time: 18 minutes, total web browsing time: a lot. Home by 5. Give hospital VP a ring on the way home and negotiate a nice monthly stipend for myself for medically supervising the PT department. That will cut into my web browsing time .01% but it will be worth it. Say hi to the wife and kids. But get suited up for an important meeting. The wife is so proud of me and she understands I have a lot of things going on. Off to Morton’s to hear about Zilretta. Home by 10. Bring my wife a dessert home that has melted into a puddle and she throws out. She has been doing keto for a year and I knew she wouldn’t eat it anyways but it is all about optics. Did notice 5 empty white claws in the trash outside that weren’t there at lunch, however. Rinse and repeat the next day. Probably take my lifted truck in tomorrow. The new MDT rep is supposed to swing by and I hear she is just out of college.

 

[Agast]

7:55 am: Stroll into clinic feeling pretty chipper. 25 patients plus 3 telemeds.
10:30 am: Start hating humanity. Browse SDN. Hatred intensifies.
12:14 pm: lunch while sending electronic refills. Mask off while I’m huddled next to my air purifier.
1:10 pm: Start afternoon clinic with an increasing amount of self-loathing
4:00 pm: Almost there...time to pay some bills and buy groceries online so that I feel like today was productive
5:30 pm: Everyone else is gone but now I feel guilty for being mad at my patients. Call the telemed patients, yes I know your “appointment” was at 4 pm but since you got to stay at home the office patients go first. Offer them the chance to do the next office visit in person, no takers. Walk to the staff room and stuff my pockets with chocolate before leaving.

 

[lobelsteve]

M-F.
555am alarm. But im already awake. Scrubs on, Coffee prep. Jura Giga W3. Jeep has heated seats and steering wheel. In at 6:45. Review pdmp for the day, answer yesterday’s messages and review labs, imaging. 20 patients from 7:30-11:10. Mix of new, follow-up, office procedures.
11:30-12:30 walking at local park and light lunch. 2.35 miles in nature, clears head for afternoon session. 1:00 to 3:30 12-16 patients. Same as am but less coffee. Jura C9 in office.
Friday afternoon is either ASC or OR. Max of 3 cases. Implants or kypho for those who need sedation. If no cases, it is a half day( doesn’t happen enough).
No weekends. No call. But available for those who do take call.

 

[paindoc007]

What do you guys do in a typical day...
Clinic start/finish?
How many patients on your schedule in total?
Midlevels?
Are you in clinic or do you go to offsite areas and let the midlevels see follow ups?
One clinic site? Two? Three?
I’m just trying to see the way a practice can vary.... curious.
I’m NE area. 4.5 days a week, 30 patients a day. One location. One nurse practitioner. Do about 30-40 implants a year.

Hospital employee. Start 8. End 430. Average 25-30 encounters a day. Usually half day procedures. One NP, helps me see patients, document notes (works kinda like a fellow, so I co-sign and bill all notes), and draws up meds/preps in asc while I dictating previous or signing consents in pre-op. I think around 25 scs trials/year.

 

[Peterluger]

How many dollar you make per year?

 

[Peripheral2010]

Didn’t know I was writing your biography!


Roll in at 9:45 for 9:00 clinic in my mid series BMW. See my 3 patients that have been waiting on me, see 7 more by noon. Was hoping for about 5 no shows, but not today. Go to the hospital for lunch. Panini and sushi. Delicious as always. Get a plastic sack and fill it up with bottled drinks, hummus, sushi, and snacks for home. Run that home and play with the dog for an hour. Show up
at the hospital for 1:00 procedures at 1:30. Patient still not ready. Which is understandable since we only have 11 RN’s, 3 scrub techs, and 2 rad techs assigned to this area today. Knock out 6 procedures by 4:30. One was even a CESI! I could tell the staff was nervous since the other doc typically takes an hour on his. Total procedure time: 18 minutes, total web browsing time: a lot. Home by 5. Give hospital VP a ring on the way home and negotiate a nice monthly stipend for myself for medically supervising the PT department. That will cut into my web browsing time .01% but it will be worth it. Say hi to the wife and kids. But get suited up for an important meeting. The wife is so proud of me and she understands I have a lot of things going on. Off to Morton’s to hear about Zilretta. Home by 10. Bring my wife a dessert home that has melted into a puddle and she throws out. She has been doing keto for a year and I knew she wouldn’t eat it anyways but it is all about optics. Did notice 5 empty white claws in the trash outside that weren’t there at lunch, however. Rinse and repeat the next day. Probably take my lifted truck in tomorrow. The new MDT rep is supposed to swing by and I hear she is just out of college.

Pineapple white claw is the best

 

[BobBarker]

Mango is the only one I like. Ruby Redbird is tasty and makes all the seltzers pointless if you compare nutritional labels.

 

[ateria radicularis magna]

How many dollar you make per year?

Lol

 

[drusso]

Private practice. M-F; see patients from 8-5pm...but I'm constantly working. Up at 5:00AM, pre-work/chart-prep, breakfast meeting, etc. Then clinic. After work, business meetings, business development, marketing, etc.

It's basically a 5-9 job...

 

[Laryngospasm]

That’s not sounding good

9-3.
See 15 or so before noon.
1 hour lunch— YouTube watching workout stuff or other
Afternoon 5-15 procedures.
Leave by 3 usually sometimes later if new nurses can’t check in orients fast enough.
No call, holidays, nights or weekends.

 

[lobelsteve]

9-3.
See 15 or so before noon.
1 hour lunch— YouTube watching workout stuff or other
Afternoon 5-15 procedures.
Leave by 3 usually sometimes later if new nurses can’t check in orients fast enough.
No call, holidays, nights or weekends.

Are orients harder to check in? Patients?

 

[geauxg8rs]

Are orients harder to check in? Patients?

We three kings of orient are...

to keep everyone in a festive spirit

 

[Laryngospasm]

Yes you have to watch the orients lol.. no that was patients

 

[clubdeac]

9-3.
See 15 or so before noon.
1 hour lunch— YouTube watching workout stuff or other
Afternoon 5-15 procedures.
Leave by 3 usually sometimes later if new nurses can’t check in orients fast enough.
No call, holidays, nights or weekends.

Dang you see 15 patients in 3 hours and then do 15 procedures in 2 hrs? Honestly how does one do 15 procedures in 2 hrs? You must have 2 c-arms otherwise you’re doing a procedure every 8 min. My staff are fast but no way can they flip a room in 3 min assuming you take 5 min for every procedure

 

[Laryngospasm]

Depends on the nurse I have. Unfortunately my best just left. I would typically have two people getting the patients check in and ready so she would often have a second patient in the room by the time I have finished my note on the first. 10 is usually the limit in two hours unless she was here. 15 would often push me to 4pm. But not unusual to do 5 and be out by 2. And honestly that’s not that great. I’ve seen people get more done for sure.

 

[ctts]

How is it possible to see so many patients in such little time and actually provide good care? I am not saying you don't...but I just cannot imagine how it is possible. And what is good care? To address the medical issue at hand without concern for patient education and satisfaction? I think when one sees so many patients, you have to sacrifice one for the other, usually the latter would be my guess. Or have you found a way to address both in a satisfactory way for both parties?

 

[BobBarker]

41 injections, lumbar trial, system revision, cervical trial, battery swap, Interstim explant. 7:30 - 4:00

 

[RoloTomassi]

41 injections, lumbar trial, system revision, cervical trial, battery swap, Interstim explant. 7:30 - 4:00

Well...that was emasculating

 

[painfree23]

41 injections, lumbar trial, system revision, cervical trial, battery swap, Interstim explant. 7:30 - 4:00

How many days a week look like this ??

 

[BobBarker]

1

 

[lobelsteve]

41 injections, lumbar trial, system revision, cervical trial, battery swap, Interstim explant. 7:30 - 4:00

2 rooms or it didn't happen.

 

[BobBarker]

1 room.

 

[lobelsteve]

Ouch. You must have great staff to move it along that quickly.

 

[buddababa]

41 injections, lumbar trial, system revision, cervical trial, battery swap, Interstim explant. 7:30 - 4:00

 

[Laryngospasm]

You do all your procedures on one day? Damn impressive efficiency.

 

[Ferrismonk]

My normal day:

I work from 8AM to roughly 4:30PM each day. We lunch from around 11:30ish to 1PM. Lunchtime will include finishing notes, putting out fires, reviewing new consults with case manager, etc.

We max out at 24 procedures per day, but often will do less if there are longer procedures scheduled. I also take OB anesthesia call roughly 4 times per month.

I could go faster, but lifestyle is also important.

 

[NJPAIN]

My normal day:

I work from 8AM to roughly 4:30PM each day. We lunch from around 11:30ish to 1PM. Lunchtime will include finishing notes, putting out fires, reviewing new consults with case manager, etc.

We max out at 24 procedures per day, but often will do less if there are longer procedures scheduled. I also take OB anesthesia call roughly 4 times per month.

I could go faster, but lifestyle is also important.

Kudos to you. Much to be said for taking your time to: thinking about what you are doing, make your patient feel like their not on an assembly line and have a relaxed atmosphere in the procedure room. I realize that time is money but this IS medicine not auto mechanics.

 

[Laryngospasm]

My normal day:

I work from 8AM to roughly 4:30PM each day. We lunch from around 11:30ish to 1PM. Lunchtime will include finishing notes, putting out fires, reviewing new consults with case manager, etc.







We max out at 24 procedures per day, but often will do less if there are longer procedures scheduled. I also take OB anesthesia call roughly 4 times per month.

I could go faster, but lifestyle is also important.

I can’t believe you still do ob call.. my least favorite thing about OR Anesthesia.

 

[Ferrismonk]

I can’t believe you still do ob call.. my least favorite thing about OR Anesthesia.

It's not so bad. Mostly epidurals on healthy happy people and directing CRNAs for our sections. I work at a high-risk place, but still not bad.

I also do per-diem main OR anesthesia. God I hate that. Intubating 350 pound people with an EF of 10% and CKD4 is not my idea of fun.

 

[Dr. Ice]

My normal day:

I work from 8AM to roughly 4:30PM each day. We lunch from around 11:30ish to 1PM. Lunchtime will include finishing notes, putting out fires, reviewing new consults with case manager, etc.

We max out at 24 procedures per day, but often will do less if there are longer procedures scheduled. I also take OB anesthesia call roughly 4 times per month.

I could go faster, but lifestyle is also important.

How many days a week are you doing 24/day?

I thought I was high volume, but I guess 30 procedures/week isn’t??

 

[Taus]

41 injections, lumbar trial, system revision, cervical trial, battery swap, Interstim explant. 7:30 - 4:00

41 injections, lumbar trial, system revision, cervical trial, battery swap, Interstim explant. 7:30 - 4:00

Woah…. What is staffing like to do this?

>26/27 of anything is a really hectic day for me in office fluoro even if mainly bread and butter injections. I’m generally about 25. Granted ~1/3 of mine are direct injection referrals so they usually have lots of Qs and a longer discussion about consent. Also plenty of old ladies in pain who take forever getting on/ off table. Or the young tattooed tough guy who screams and nearly vagals with the local. If all I had to do was walk in room and inject and walk out I can prob do 40. One staff member checks them in, gets vitals, helps them complete checklists and other paperwork, then does post op vitals, snacks, checkout. Xray tech is only other person in room with me unless I have a resident or fellow rotating. Xray tech and I both help patient get on table, position patient, then she helps me draw and I prep. We then often both help patient get off table. As I get busier consistently, ie booking beyond 25ish, I’m thinking I should request another MA in room. I’d really like to be able to just walk in room, draw up, inject and walk out and start talking to next patient.

my 2nd procedure day/week is in ASC and about 20-22 procedures with mix of injections (higher percent cervical), 3-6 rf, about 1 scs trial/month. All I have to do in room is walk in and do procedure, but the pre-op paperwork takes a bit and a fair amount of direct injection referrals that take some more time with pre-op conversation, consent, mri review

 

[Laryngospasm]

We’ve been over this before. I think over 75procedures a week is fairly high volume. I do about 10-15a day usually in 2-3 hours.

 

[BobBarker]

I do all of my fluoro injections in a single day per week at my hospital job, rarely will I run over and do an injection at lunch for a patient in a bind.

I probably do 10 blind or US guided procedure in clinic a week.

I have a procedure room. There are two RN’s, a rad tech, a scrub tech, and me. I prep, I drape, I help get the patients on and off the table. The rad tech cleans the Oakworks and puts the new sheet down. About half get light sedation.

out of the room there is an armada of nurses and scrub techs. Reminder, this is a tiny hospital so they wouldn’t be doing anything if I wasn’t working. So lots of help getting the patients ready.

we have patient B Waiting outiside
While patient A is getting her injection. I never leave the room.

About half the time they have a 2nd crna for the bigger cases and they flip rooms for me. We can do the big cases very, very quickly if that is the case. I might do 35 injections and 8 big cases if there are a lot of kyphos. Always done by 5. Usually 4.

 

[Ferrismonk]

How many days a week are you doing 24/day?

I thought I was high volume, but I guess 30 procedures/week isn’t??

Each week is different, but in general I work 3 pain days and one 24-hour anesthesia call per week. I currently work in an office where NPs see most of the returning patients, so I spend more time in the procedure suite than in the office side.

We schedule 15 minute slots for routine injections. That's 5 minutes injecting, 10 minutes on/off/to/from/cleaning time. RFA gets 2 slots, or 30 min, for unilateral and 3 slots, or 45 min, for bilateral. SCS trial gets 4 slots, or one hour.

If I do all simple injections, I can fit in 24. For example, if I do 4 bilateral RFs, I can fit in 12 other simple injections for a total 16. Keep in mind this is in a HOPD, so there are inefficiencies.

If you are private practice outpatient and seeing all your own patients in office with 3 days office, 2 days procedures, I expect you should be doing between 20-25 procedures a day or 40-50 per week to be considered close to "high volume".

 

[JelloIsJigglin]

I work 3.5 to 4 clinic days a week. 1 to 1.5 days of procedures. Clinic 8-5 with 1 hour lunch. I see anywhere from 22 to 35 patients depending on clinic location and no show rate. New patients range from 4 to 7.

Procedure mornings are 7 to 12. I do 15 to 22 bread and butter procedures. Everything is "supposed" to be scheduled 15 minutes other than 30 minutes for RFA and 60 minutes for scs trial.

Can I ask you guys your specific in office steps? Im wondering how our system can be efficient. Patients check in, get IV, come to room, sedation nurse and fluoro tech help patient on bed, fluoro tech helps prep, nurse gets vitals and gives sedation while I draw up meds and set up trays and needles. Finish procedure. Then recovery staff gets patient while fluoro tech and nurse turnover room and I drink coffee.

 

[drusso]

I work 3.5 to 4 clinic days a week. 1 to 1.5 days of procedures. Clinic 8-5 with 1 hour lunch. I see anywhere from 22 to 35 patients depending on clinic location and no show rate. New patients range from 4 to 7.

Procedure mornings are 7 to 12. I do 15 to 22 bread and butter procedures. Everything is "supposed" to be scheduled 15 minutes other than 30 minutes for RFA and 60 minutes for scs trial.

Can I ask you guys your specific in office steps? Im wondering how our system can be efficient. Patients check in, get IV, come to room, sedation nurse and fluoro tech help patient on bed, fluoro tech helps prep, nurse gets vitals and gives sedation while I draw up meds and set up trays and needles. Finish procedure. Then recovery staff gets patient while fluoro tech and nurse turnover room and I drink coffee.

Are you still checking sensory stim on your RFA's?

 

[painfree23]

I work 3.5 to 4 clinic days a week. 1 to 1.5 days of procedures. Clinic 8-5 with 1 hour lunch. I see anywhere from 22 to 35 patients depending on clinic location and no show rate. New patients range from 4 to 7.

Procedure mornings are 7 to 12. I do 15 to 22 bread and butter procedures. Everything is "supposed" to be scheduled 15 minutes other than 30 minutes for RFA and 60 minutes for scs trial.

Can I ask you guys your specific in office steps? Im wondering how our system can be efficient. Patients check in, get IV, come to room, sedation nurse and fluoro tech help patient on bed, fluoro tech helps prep, nurse gets vitals and gives sedation while I draw up meds and set up trays and needles. Finish procedure. Then recovery staff gets patient while fluoro tech and nurse turnover room and I drink coffee.

Stop using iv sedation. If ur patient needs 6mg iv midaz for her mbnb, she’s got more issues than axial low back pain

 

[Laryngospasm]

Not doing sedation saves tons of time

 

[JelloIsJigglin]

Not doing sedation saves tons of time

yes i would typically agree. But for me:
- once the RN gets vitals immediately upon patient laying on table, she provides the mild sedation. At this time I'm drawing up my own injectate medications. By the time I'm finished drawing up all the syringes and bending all my needles, usually sufficient time has passed for sedation to work its way in and so I begin.

So for me, during the procedure, I'm not sure how much time I'd be saving if I didn't use any sedation at all.

No I do not test sensory for RFA. I check multiplanar views and motor only.

Thank you all for your suggestions.

 

[painfree23]

yes i would typically agree. But for me:
- once the RN gets vitals immediately upon patient laying on table, she provides the mild sedation. At this time I'm drawing up my own injectate medications. By the time I'm finished drawing up all the syringes and bending all my needles, usually sufficient time has passed for sedation to work its way in and so I begin.

So for me, during the procedure, I'm not sure how much time I'd be saving if I didn't use any sedation at all.

No I do not test sensory for RFA. I check multiplanar views and motor only.

Thank you all for your suggestions.

If the RN can help u draw ur meds and prep..it will be faster

 

[JelloIsJigglin]

If the RN can help u draw ur meds and prep..it will be faster

my rad tech helps me prep the patient under observation.

i feel like i draw up meds faster myself with one handed glove technique. (plus it frees up my RN to do whatever she needs to do, such as charting, or giving sedation, or helping prep with rad tech).

seems i'm not missing any major strategies though.

ok thank you all!

 

[NY172]

What is the compensation for some the the gigs being described here?

 

[Ferrismonk]

What is the compensation for some the the gigs being described here?

Eat what you kill.

 

[bedrock]

7:55 am: Stroll into clinic feeling pretty chipper. 25 patients plus 3 telemeds.
10:30 am: Start hating humanity. Browse SDN. Hatred intensifies.
12:14 pm: lunch while sending electronic refills. Mask off while I’m huddled next to my air purifier.
1:10 pm: Start afternoon clinic with an increasing amount of self-loathing
4:00 pm: Almost there...time to pay some bills and buy groceries online so that I feel like today was productive
5:30 pm: Everyone else is gone but now I feel guilty for being mad at my patients. Call the telemed patients, yes I know your “appointment” was at 4 pm but since you got to stay at home the office patients go first. Offer them the chance to do the next office visit in person, no takers. Walk to the staff room and stuff my pockets with chocolate before leaving.

damn, I do love the humor in many of your posts

 

[bedrock]

41 injections, lumbar trial, system revision, cervical trial, battery swap, Interstim explant. 7:30 - 4:00

2 rooms or it didn't happen.

Not doing sedation saves tons of time

Bob barker puts most of us to shame, doing all that in one room. Agree that sedation is a time suck in one room, but not really if running two rooms.

I have modified my schedule this year so I that I only do 4.5 days of procedure per month, but I maximize my time those days. I run two ASC rooms one full day, 8am-5pm, 3 out of 4 weeks per month, so 3 of these room flipping ASC days/month. I do mainly injections on these days, maybe 1-2 RFA, but I try to limit it to 95% injections. I average 40-42 injections on those two room days, about 40-50% of cases get IV sedation, but I write the sedation orders ahead of time, so they've already had the meds on board for 4 minutes by the time I walk in the room and so I don't waste time messing around with sedation other than maybe adding one extra dose, but this doesn't delay the procedure. My other room is 15 feet away.

I also do 1.5 days per month of ASC procedures that are performed in a single room that day. This includes all larger procedures such as stim trials, implants, and ablations. Far fewer procedures per day but still move reasonably quickly, but I don't require as much staff on these cases, and these cases don't benefit as much from room flipping as do injection cases.

Adds up to approximately 125 injections, 20 ablations, and 2 stims/month accomplished in 4.5 days of procedure time/month

 

[painfree23]

Bob barker puts most of us to shame, doing all that in one room. Agree that sedation is a time suck in one room, but not really if running two rooms.

I have modified my schedule this year so I that I only do 4.5 days of procedure per month, but I maximize my time those days. I run two ASC rooms one full day, 8am-5pm, 3 out of 4 weeks per month, so 3 of these room flipping ASC days/month. I do mainly injections on these days, maybe 1-2 RFA, but I try to limit it to 95% injections. I average 40-42 injections on those two room days, about 40-50% of cases get IV sedation, but I write the sedation orders ahead of time, so they've already had the meds on board for 4 minutes by the time I walk in the room and so I don't waste time messing around with sedation other than maybe adding one extra dose, but this doesn't delay the procedure. My other room is 15 feet away.

I also do 1.5 days per month of ASC procedures that are performed in a single room that day. This includes all larger procedures such as stim trials, implants, and ablations. Far fewer procedures per day but still move reasonably quickly, but I don't require as much staff on these cases, and these cases don't benefit as much from room flipping as do injection cases.

Adds up to approximately 125 injections, 20 ablations, and 2 stims/month accomplished in 4.5 days of procedure time/month

Are these all spine “injections”? Or joints too?

 

[DODOCSS]

Are these all spine “injections”? Or joints too?

Usual mix obviously