Seeing more patients = striking a nerve. Apparently, many physicians didn’t like the recent advice of a practice management consultant:

. . . His assertion that a doctor may miss the mark because he talks too much or is a daydreamer or perfectionist is also incredible. Besides treating my patients’ immediate illnesses successfully, nothing gives me greater pleasure than to be part of their personal lives. Undoubtedly, the more time you can spend with a patient leads to greater patient and physician satisfaction, and better care. . .

. . . Six thousand annual patient encounters translate to three patients per hour, or 20 minutes per visit, if a physician works a 40-hour week for 50 weeks. . . . It’s outrageous to recommend this volume of encounters to any physician doing quality primary care work. . . .

. . . Unless you have a practice management consultant who can say more than “see more patients,” please don’t waste my time with the same old advice. After all, I’m too busy seeing more patients so I can pay the rent . . .

Unfortunately in primary care, we don’t have much choice. Reimbursement favors procedures. With the lack of procedures in primary care, the only option is to see more patients. The ideal of changing the reimbursement system or finding “new advice” is not going to happen. So, these physicians will eventually be forced kicking and screaming into becoming high-efficiency physicians – or they will be out of business. And you can’t practice good medicine if you’re out of business. That is primary care in America.

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  • dr john

    Sometimes the right answer is to see fewer patients — not more.
    For example, my HMO patients have, on average, a $15 co-pay. Four of these patients an hour yields $60.
    But the average overhead for a primary care doctor is about $150 per hour.
    The theoretical best economic plan is to collect the monthly capitation, but avoid seeing these patients in the office.
    (But that would be wrong …)

  • Anonymous

    Dr John : you are talking about capitation ? Don’t take any and cut your office staff. Look at insurances that generate the most overhead (I call them “expensive”) and cut them from your practice. We tend to look only at reimbursement but this is wrong. We have to look at how much overhead an insurance generates and compare it to the reimbursement. I don’t even bother accepting medicaid and capitation and keep HMOs to a minimum.