Hospitalists should limit the number of patients they see

I was talking to a fellow physician and he inquired, “how many patients do you see in a day?” I said, “maybe around 20.”

He smirked and replied, “20 only! I can see around 40 in a day and still have time to hit some balls.” There is something fishy here at Smallville.

A few years ago I used to work for this company. I had no option but to see a huge number of patients. Sometimes my census would be around 40 or so. I remember one day that I got 26 new admissions. I took care of them all along with the patients who were already on my list. By the end of the day I was a tad confused. When nurses would call it would take me a moment to recall a patient. I would have to think twice so that I don’t confuse a chest painer with a GI bleeder.

You can see a lot of patients, but I think it is not fair to the patient. It is just not about billing. You cannot provide adequate care when you are breezing through your list. The goal is not just to see them but to make the right decisions. One way to see them would be to call 20 thousand consults and let other doctors make decisions for you, or you can try to see them like you should and spend your whole day and night seeing them all.

The devil is in the details. If you are detail oriented and if you have a good system in place, then you decrease your chance of error. Believe me, it is going to happen. You will make an error (Murphy’s Law), but the difference is the gravity of error.

So what is the magic number? Various factors play a role when you consider the right number of patients to see. If you have mid-level support or you have residents, than you can probably see more, but that is not the case for most of us. I think 15-20 patients per day is a fair number in a 12 hours shift in a hospital setting.

I read  this article sometime ago at Today’s Hospitalist, it nicely breaks down various situations versus patient census accordingly.

I call these doctors Super Doctors: “Look! It’s a bird. It’s a plane. No, it is a Super Doctor!” No patient can really identify what breezed through them. But just remember it takes only one piece of kryptonite to bring down the mighty.

S. Irfan Ali is a hospitalist who blogs at Human Factor in Medicine and Life.

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  • solo fp

    At my hospital, thankfully the hospitalists see the unassigned ER patients. 2/3-3/4 of these are Medicaid or Self Pay/no pay. The only way to break even is to see a lot of them daily. In residency my record on surgery was 27 patients in 24 hours of weekend rounds, and primary care inpatient record was a list of 29 patients with 9 admissions in 24 hours. This was more time consuming as we had resident rounds and attending rounds, along with separate private attending calls to make. In the real world, 30 patients a day on average, either outpatient or inpatient, is a lot easier than in residency.

  • Fam Med Doc

    I’m not a hospitalist, so I will not speculate on the specific number patients that can safely be seen, but I agree with the authors overall concern. There is a limit on the number of patients one can see and at the same time provide good care. My biggest concern is the patient education required that is potentially being missed when one is seeing so many patients- it simply is not being done. Then the very reason why the patient landed in the hospital isn’t addressed. It’s not just ordering the right test. It’s explaining to the patient (and family) why that test is needed. I see this in the outpatient setting too. I hear doctors who report seeing 35 primary care patients a day in an 8 hr day. I’m in disbelief that GOOD primary care can see 35 pts in an 8 hrs. I can do 23 follow up patients in a day, some of them quite complex mixed in with a few easy ones, & still be done in 8 hrs with prob another 30 min of admin (charting & phone calls) left to do after.

    Patients aren’t like cars where you just slip in the new part & it works just as new. The doctor needs to spend time establishing rapport, educating, & convincing the pt of the necessary issues. That takes time. Alot.

    But I guess that’s why I’m financially struggling in primary care- I take time with my patients but really don’t get paid for it.