Whats the average outpatient load in psychiatry?

[annoyedpsychiatrist]

How many people are you guys typically carrying at once in the outpatient setting?

---

Members don't see this ad.

 

[hamstergang]

I started feeling quite busy/full at 50 patients per day per week worked. Some caveats: child/adolescent, hospital-based practice so some time taken up by meetings and committees, patients not scheduling regularly and so taking up more of my time outside of appointments than they should, I'm slow at writing notes.

 

[ObsequiousAplomb]

I started feeling quite busy/full at 50 patients per day per week worked. Some caveats: child/adolescent, hospital-based practice so some time taken up by meetings and committees, patients not scheduling regularly and so taking up more of my time outside of appointments than they should, I'm slow at writing notes.

Can you please clarify "per day per week worked"?

I imagine you mean 4 days per week x 50 patients = 200 patients if working M-R? So average followup time being 8 weeks would mean 6 patients per day?

 

[FlowRate]

I'll have data to answer the question of "active" caseload in a few weeks. The data I have now is basically all unique patients I've seen in the past 2.5 years minus any patients who switched to a different psychiatrist within our system. (Patients where I'm listed as their psychiatrist on their epic care team.) That number is about 700. I do not feel overwhelmed or unduly burdened. And I'm 0.8 clinical FTE which, in our system, means 24 patient-facing hours per week. 8 hours for patient care administration--forms, calling therapists, controlled refills, replying to patient messages, etc.--built in to the 0.8 clinical FTE and 8 hours for 0.2 FTE department/clinic administration.

 

[Bartelby]

I don't have much experience working in large-system outpatient practice. Something I have always wondered with numbers like the above (700 patients) is how you approach care with a panel of that size. Doing some quick math, if you only do follow-ups (zero intakes) you have:

48 follow-up slots per week (24 patient care hours, 30 mins per follow-up)
700 patients

700 / 48 = 14.6 weeks between patients, if everyone is being seen regularly at the exact same frequency.

In my experience, many outpatients need to be seen more often (anywhere from every 1-4 weeks when not stable). Anyone being seen at that high frequency obviously throws the numbers off quite a bit in terms of how often everyone else can be seen.

So are there a lot of patients who are on your list who are actually inactive, as in you don't see them in a typical year? Or do you tend to see some people only once or twice per year, and anyone needing frequent follow-up (such as every week for a time) refer to a higher level of care like IOP? I often see what seem like high numbers to me thrown around for outpatient panel sizes, but find myself wondering if (for instance) many patients can bee seen once per year, why not hand them back off to the PCP?


In terms of my own thoughts for a "full" outpatient private practice panel, I think in terms of how often I am comfortable seeing people. I would feel very uncomfortable with doing an intake but, for instance, not being able to see them for follow-up until a month or two has passed. If we assume people average out to being seen around every three weeks, and assume 24 patient hours, that works out to something like:

48 follow-up slots per week
Q3 week follow-up (on average)

3 weeks between patients x 48 available slots per week = around 144 patients to be "full." In a productivity-based system (like PP), this also works out fine. You get just as much workload credit seeing a 30-min followup who was seen two weeks ago as you do for seeing a 30-min follow up that needs to be spaced out to every three months.

 

[hamstergang]

Can you please clarify "per day per week worked"?

I imagine you mean 4 days per week x 50 patients = 200 patients

Yes, you understood correctly.

 

[FlowRate]

I don't have much experience working in large-system outpatient practice. Something I have always wondered with numbers like the above (700 patients) is how you approach care with a panel of that size. Doing some quick math, if you only do follow-ups (zero intakes) you have:

48 follow-up slots per week (24 patient care hours, 30 mins per follow-up)
700 patients

700 / 48 = 14.6 weeks between patients, if everyone is being seen regularly at the exact same frequency.

In my experience, many outpatients need to be seen more often (anywhere from every 1-4 weeks when not stable). Anyone being seen at that high frequency obviously throws the numbers off quite a bit in terms of how often everyone else can be seen.

So are there a lot of patients who are on your list who are actually inactive, as in you don't see them in a typical year? Or do you tend to see some people only once or twice per year, and anyone needing frequent follow-up (such as every week for a time) refer to a higher level of care like IOP? I often see what seem like high numbers to me thrown around for outpatient panel sizes, but find myself wondering if (for instance) many patients can bee seen once per year, why not hand them back off to the PCP?


In terms of my own thoughts for a "full" outpatient private practice panel, I think in terms of how often I am comfortable seeing people. I would feel very uncomfortable with doing an intake but, for instance, not being able to see them for follow-up until a month or two has passed. If we assume people average out to being seen around every three weeks, and assume 24 patient hours, that works out to something like:

48 follow-up slots per week
Q3 week follow-up (on average)

3 weeks between patients x 48 available slots per week = around 144 patients to be "full." In a productivity-based system (like PP), this also works out fine. You get just as much workload credit seeing a 30-min followup who was seen two weeks ago as you do for seeing a 30-min follow up that needs to be spaced out to every three months.

700 patients is everyone I've seen in the past 2.5 years who hasn't transferred to another psychiatrist in our system. It doesn't exclude patient attrition (moving, loss of insurance, seeing an outside NP for the Rx they wanted that I didn't give them) or returned to PCP (I'd estimate roughly 40 patients, despite trying.) I'm working on getting data for our department that's intended to clarify actual "active" panel size, typical return rates, etc. at the moment so I will have a better idea of that in a few weeks.

I have very few patients who I've felt needed to be seen more frequently than every 3 weeks. Pretty much none who I need to see weekly--if they're that acute then we're looking at IOP or PHP. For the rare truly subacute (active but not needing hospital/PHP LOC psychosis and mania) cases I do see them about every 2-4 weeks.

I generally follow-up with patients 6 weeks after most med changes. If there's a potential reason to gather data or consider making a change sooner than that, I typically ask the pt to either send me an update or have an RN call. Once things are stable, I usually do 3-6mo, 6-12mo, then try to repatriate to PCP unless there's a specific reason not to.

I generally have a few open appointments each week between advance cancellations, held urgent slots, and low pt demand for the dedicated face-to-face slots, so I am usually able to get pts in if they need to see me within the week.

 

[calvnandhobbs68]

I mean even for my regular private insurance based outpatient practice which has been around for a little over a year (not within a large system) I currently have:

361 "active" outpatients (so I've seen them some time in the last <6 months)
20 patients who have been discharged for various reasons
82 "inactive" patients (which captures a bunch of stuff but basically are patients I haven't actually discharged but either never followed back up, sent back to their PCP but said they could follow back up if their PCP wanted so I didn't want to officially "discharge" them, patients I haven't seen for >6 months)

This is with 32 patient contact hours a week with 30min f/u and 90 min split intakes. So basically have had about 100 patients over the past year who have either officially left, fallen off the map or sent back to their PCP.

 

[surfguy84]

I mean even for my regular private insurance based outpatient practice which has been around for a little over a year (not within a large system) I currently have:

361 "active" outpatients (so I've seen them some time in the last <6 months)
20 patients who have been discharged for various reasons
82 "inactive" patients (which captures a bunch of stuff but basically are patients I haven't actually discharged but either never followed back up, sent back to their PCP but said they could follow back up if their PCP wanted so I didn't want to officially "discharge" them, patients I haven't seen for >6 months)

This is with 32 patient contact hours a week with 30min f/u and 90 min split intakes. So basically have had about 100 patients over the past year who have either officially left, fallen off the map or sent back to their PCP.

Wow thats great to hear you filled 32 patient hours in just a year. Do you take all insurances or just top payors in your area?