Comments on: A PCP’s patient panel

By: David E. Williams of the Health Business Blog

David E. Williams of the Health Business Blog — Mon, 09 Jul 2007 01:21:00 +0000

Anonymous said:

"David Williams has little understanding of modern medical practice, and the forces that impact upon it. I also resent his arrogant, ignorant comments about concierge practices."

Ouch! (I'm not perfect, but at least I sign my real name to my comments.)

I stand by what I wrote: it's awfully unlikely for a PCP to have 5000 patients, and it is possible to make a decent living with a more normal number.

Here's some data I shared with an FP commenter on the Health Business Blog:

According to the Medical Group Management Association’s Physician Compensation and Production Survey (2005 edition), the mean number of ambulatory encounters for a Family Practice Physician (w/o OB) is 4287 per year with a standard deviation of 1,568. The 75th percentile was 5,088 and 90th percentile 6,167. (The # of encounters for FPs who do OB is lower.)

According to the same source, mean compensation for FPs w/o OB was $170,059 with a standard deviation of $64,046. FPs in the 25th percentile made $129,662, those in the 75th made $196,645 and those in the 90th made $250,741. Those who did OB made a little more.

By: Anonymous

Anonymous — Mon, 09 Jul 2007 01:19:00 +0000

If performing services over the phone, such as treating UTI’s is an appropriate and routine part of primary care, then the docs can and should find a way to charge for that, whether a per service charge, or monthly charge to be available for that. As a patient, I prefer the first, as I virtually never call my doctor, but it is up to the docs to find what works for them.

One thing is clear, they have a right to charge for and get paid for their services whatever insurance companies and CMS says. Involuntary servitude is unconstitutional.

By: DDx:dx

DDx:dx — Mon, 09 Jul 2007 00:46:00 +0000

I agree with the empirical treatment. I do it over the phone after talking with the patient if the setting seems appropriate. But not three times in three months…Which I have seen.
Primary care shouldn’t be knee jerk anything. But if you want good care it requires some thought, some time, some communication.Some compensation?
(That is another topic…Hard to stay focused typing 10 WPM.)
My point is, that we have not upheld any significant measures of quality and assumed the certification tests with 90+% pass rate were adequate. And the market decides quality on their basis, which, given the nature of most things people seek medical care for in primary care are self limiting, thus they get better no matter what you do. And the ‘value’ of primary care gets diluted, when it should be undeniable.

By: Anonymous

Anonymous — Mon, 09 Jul 2007 00:42:00 +0000

David Williams has little understanding of modern medical practice, and the forces that impact upon it. I also resent his arrogant, ignorant comments about concierge practices.

By: Happyman

Happyman — Sun, 08 Jul 2007 23:37:00 +0000

no point whatsoever in getting a UA in that situation.

However, calling in a prescription without seeing the patient would give the patient the misconception that this non-reimbursable luxury will take place EVERY time in the future she has dysuria. Not to mention that if she has frequent symptoms, she needs a urine culture & perhaps some post-coital education for her & partner, & perhaps eventually a course of prolonged antibiotic prophylaxis and/or urology/urogyn referral.

By: Evan

Evan — Sun, 08 Jul 2007 22:01:00 +0000

DDX, just an aside. I am familiar with several recommendations that suggest an uncomplicated UTI with typical symptoms and no fever can be treated empirically.

Given that guideline … why get a UA in an uncomplicated patient with typical symptoms having her first UTI in years?

By: DDx:dx

DDx:dx — Sun, 08 Jul 2007 20:09:00 +0000

These comments relect the weakness of primary care. I am an FP and I was amazed to observe the range of care considered”acceptable” in the outpatient setting. From frequency of visits to treatments of common problems(UTI’s rx over phone, no UA,,, narcotic refills for years, MRI’s ordered without patient visit). And the patients love the doc and are sure he must be great because”he’s so busy’.
There ought to be an answer and infact there is. It’s just we want to do it OUR way. Cowboy up.http://poemd.blogspot.com/2007/02/primarily-careless.html

By: Anonymous

Anonymous — Sun, 08 Jul 2007 18:54:00 +0000

Actually, If you terminate your relationship with a patient with written notice, the time period can be as short as the time it takes another doctor to assume total care or at thirty days from notice. And seeing someone once terminated while on compulsory call, in the ED, for instance, does not automatically place that patient back in your census.

By: Anonymous

Anonymous — Sun, 08 Jul 2007 18:45:00 +0000

12:59:

Generally at three years from the last visit or at the time you transfer total care to another doctor at the patient's request or when the patient dies.

Three years is the period after which you can count a patient returning as a "new" patient to your practice, and charge their visit as a new patient visit, whether they have been in the care of someone else in that time or not.

By: Anonymous

Anonymous — Sun, 08 Jul 2007 17:59:00 +0000

Well…..yeah.

It depends on how you define “census”. There’s a lot of patients coming through my door, who I will never see again. The Japanese tourist, the scientist temporarily here on a research project, etc.

When is that person no longer your patient, for the purpose of counting him/her in the “census”?