| February 1, 2008
According to this consultant, it’s 30 to 35 patients. That’s a recipe for conveyor-belt medicine.
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Hate to say it, but we already see between 50 and 100 patients per day per physician. 30 to 35 patients would hardly pay the rent.
Anon: What kind of doctor are you? My mouth is hanging open. 50-100 patents a day between how many doctors? The idea of seeing 30 is over the top for Internal Medicine. Maybe you can do it in a peds office where the nurse is giving injections but I can’t fathom what kind of care you are rendering.
You probably spend 1-2 min with patient, with the RN or PA doing most of the work.
Please tell me you don’t do surgery…
I prefer to see 20-30 a day but the number depends completely on what type of visits. Anybody can whip through respiratory acutes, throwing z-packs at viral illnesses (c’mon, admit it-we all do it). What is challenging, and time consuming, is chronic care, ie diabetes, copd, etc. Ironically, that is where money is lost, although it is also where “quality” measures are focused. If the quality police really cared about quality, why don’t they just reimburse primary care better? Quality measures are like Miranda rights, they can, and will be, be used against us.
I read the Medical Economics article and was aghast at how out of touch the consultants were. Actually, that whole magazine is ridiculous and useless.
Anybody who sees more than 4 patients an hour is either a genius, lazy (by “punting” everything to specialists), or sloppy. And there are not many geniuses around; actually geniuses in medicine tend to be slow and inefficient.
The whole topic underscores why we cannot succeed as primary care doctors; if we increase volume, quality suffers. However, we need to increase volume to improve our bottom line. Something has to give.
Underpaid in Upstate New York
Unless you are a psychiatrist, it is usually unnecessary to spend more than 5-10 minutes of face time per patient for a routine exam. Busier physicians may employ a team, consisting of an ancillary provider, scribe, triage nurses, front desk staff, and phlebotomy/laboratory staff. The triage nurses gather initial information and move patients between rooms. The nurse practitioner or PA works to the limit of their ability and the physician may or may not need to see the patient. The physician works solely at the level to which he or she is trained; a scribe is used for presciptions, documentation, and “go-fers”. This makes sense, as in reality most physicians are too bogged down with work that can be delegated or is not revenue producing, scut as we used to call it. Please keep in mind that you have to have a very popular, accessible, and high volume practice to make this work.
I saw 125 on friday and was finished at 4 pm.
This is why I choose my doctors wisely. I feel fortunate to have found practitioners who are extremely caring. I am a professor at a medical school and so I am aware of the demands placed on doctors, but, really, 100 patients in one day? I saw my GP on Friday for a suspected fracture and was with her for 45 minutes.
“I saw my GP on Friday for a suspected fracture and was with her for 45 minutes.”
Umm…What could take 45 minutes to evaluate re: a suspected fracture? How many patients behind you were really pissed off and walked out or chewed your GP’s head off when they were finally seen? Or perhaps you and your GP are wise and this is a concierge practice. If so, my apologies. If not, you better buy that GP one nice gift, especially if you were seen “insurance only”!
I didn’t keep her for 45 minutes, and so I doubt that there were patients immediately behind me. I think, honestly, that it went into her lunch hour. Again, I certainly don’t expect this level of care and am extremely appreciative (and believe me, I let her know that). I have a chronic condition which I see a specialist for, but she checked in on that to see how she could be a support. Again, I didn’t bring this up. She is an extremely competent and caring doctor and is very well-respected. She is a physician primarily because she believes that people require and deserve quality care. And care, as we all know it, comes in different shapes and forms. She chooses to work with under-served and immigrant communities, working for a surgery connected to the state’s major public hospital.
I do think that she must extend herself beyond human limits. I know her socially and have some sense of how much she gives, and not just to me.
I thanked her profusely both when I saw her and afterwards. But I should say that her checking in on the other issue was supremely helpful and touching, and I suspect that that sort of care has sets of effects which are not always immediately measurable, yet they are important, at least to me.
Although I agree 45 minutes is a little excessive for a suspected fracture, but I just do not believe you guys see 50-100 a day without commiting at least a few of the following offenses:
1) overprescribing antibiotics; it is easier to write for a z pack than take time to explain to a patient why it is not needed2) ignoring psychologic issues, ie depression/anxiety, that frustratingly do take time3) not providing informed consent, ie explaining side effects of medications, for example4) poor documentation, putting yourselves at medicolegal risk5) lack of encouraging preventative care, ie colonoscopies
I am sure that there are other items to add to the list.
You guys who see patients that quickly are simply “mills” that undermine the dignity and importance of primary care.
When friends and family ask me what they look for in a doctor, I advise them to inquire how often patients are scheduled. Any doctor who sees patients more frequently than every 15 minutes is either a genius or sloppy, and there are not many geniuses around.
Underpaid in New York
You might SEE 50 patients a day, but you are not going to ATTEND 50 patients a day.
If you are seeing that many patients and think you are practicing medicine, you are kidding yourself–you are only pretending to practice medicine. You aren’t even paying enough attention to know how much you are missing and how many bad outcomes you are leaving in your wake. Your patients are coming to you for your standardized mindless script–when they want real medical care they go to someone else and you never know because you never take a history anyway and are in and out so fast that if they try to tell you, they are talking to our back as it goes out the door.
Those of you who practice like that can rant about the bureaurocrats and manage care all you want–YOU are the ones who have in fact already sold out to the dollar, lock stock, and barrel. You may or may not be mature enough to be honest with yourself about it. You may or may not be moral enough to feel guilty about it. Either way, you are not a physician–just a person with a license who pretends to be one.
This is why it is morally imperative that physicians set their own fees. There is ALWAYS someone whore enough to give less service for more volume and take a lower fee–even if it means faking it. There must free fee setting so that quality medicine can survive.
The anon who said he sees 50-100 patients a day never identified his specialty. This # is impossible for a good primary care physician, but 50/day can be done by other specialties- orthopedists on non-op days, dermatologists, etc.
I beg to differ. It is the elitist dinosaurs that somehow believe that providing better care equates proportionately to M.D. face-time spent, and that patients/insurance companies and/or taxpayers should compensate them double, triple, or more than their more efficient counterparts for that extra time. In the past, it was necessary to spend much more time with patients as history and physical diagnosis were the mainstays of delivering proper care. Specialists were much more of a rarity, and the scope of medical diseases managed by the internist was much broader than today. In the modern era, diagnostic and laboratory testing is the gold standard; the physical exam has diminished in significance and modern physicians quite frankly are probably not as good at physical examination as their obsolete predecessors. With expensive diagnostic testing minimized, fewer referrals to consultants, fewer medication options for every malady encountered, and fewer therapeutic/laser/surgical modalities available, more of the health care dollar could go directly to the doctor. No more.
I would love to spend at least 20-25 minutes per patient face time, chat about family, friends, and the weather, but my fee, laboratory testing, and their medication bill could easily be $500 or more. Simply put, this is patently unaffordable for the average patient for a routine visit to the family practitioner they might visit 2 to 4 times per year (a patient making 30k per year might be spending 5% of their gross income on me alone! Dream on.)
This is not to berate or diminish concierge practices. Just accept them for the luxury that they are.
As for surgical procedures, you are generally wisest to go to a moderate to high volume and efficient surgeon. Interestingly, higher volume surgeons are often faster and have lower complication rates than their slower counterparts who probably consider themselves underpaid rather than inefficient. Isn’t that interesting?
I will assume that those seeing 100 patients a day are not seeing people with Cadillac plans but those on medicare and medicaid.
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