how many patients?

Sheri FNP-C · Mar 25, 2009

Wow...that is unbelievable. I am still a student, but in peds/obgyn we saw about 20ish in an 8 hour day (not including lunch). At my current internal medicine site we see 15-20 with the 1st patient at 7:30 and the last at 3:30. Elderly folks with multiple issues, 5 or more scripts needed to be rewritten, bps needing to be rechecked, listening to their heart, lungs, carotids, palpating pedal pulses and checking for edema cannot be seen and documented on in 15 minutes. That doesn't even include digging through all the notes from specialists that have come in since their last visit and addressing their long list of questions/concerns. We don't have EMR, so I bet that would speed up the documentation some.

I really think it takes time to provide quality care. I don't want to work at a "drive by" type facility where the provider was in with you such a short time that you don't remember seeing them! I think we became or are becoming NPs to provide quality care with a holistic approach including lots of teaching and primary prevention-which takes time. Wow...40...really?

core0 · Mar 25, 2009

Wow...that is unbelievable. I am still a student, but in peds/obgyn we saw about 20ish in an 8 hour day (not including lunch). At my current internal medicine site we see 15-20 with the 1st patient at 7:30 and the last at 3:30. Elderly folks with multiple issues, 5 or more scripts needed to be rewritten, bps needing to be rechecked, listening to their heart, lungs, carotids, palpating pedal pulses and checking for edema cannot be seen and documented on in 15 minutes. That doesn't even include digging through all the notes from specialists that have come in since their last visit and addressing their long list of questions/concerns. We don't have EMR, so I bet that would speed up the documentation some.
I really think it takes time to provide quality care. I don't want to work at a "drive by" type facility where the provider was in with you such a short time that you don't remember seeing them! I think we became or are becoming NPs to provide quality care with a holistic approach including lots of teaching and primary prevention-which takes time. Wow...40...really?

40 per day is on the upper end for FP but not unusual. Most places I've seen schedule every 15 minutes with 30 minutes for physicals. Add some walk ins and overbooks and 40 is not abnormal. These are for FP with fairly straight forward problems. If this is IM with complex older patients then its unrealistic. At one of the FP practices where I did my clinicals one of the physicians scheduled each hour as 5/10/15/10/15/5. The 5 minutes were supposed to be for level 2 visits with very simple complaints. They could be collapsed into another 10. He would routinely see 48 patients per day and stay mostly on time. It comes down to be firm with the patients and if they have issues that are more than you can take care of in one encounter telling them to come back. Not my cup of tea but one model.

While becoming NPs to provide provide quality primary care with a holistic approach may be an desireable goal, I suggest you look at reimbursement. The reason that primary care sets high encounter goals is that is generally the only way to pay the bills. There is a reason that physicians are fleeing primary care and the OP has discovered it.

David Carpenter, PA-C

JDCitizen · Mar 25, 2009

Wow!!! None of the practices I've been involved with made any of their providers see 40 in any given day. Over 30 is usually really busy for one provider. But I guess it's what you get used to doing.

I did hear from one NP her group required a patient every 12 minutes..... Sounds so much like cattle herding. Moooooooo!!!

Trauma Columnist · Mar 25, 2009

I do not work primary care but rather nephrology and I am expected to see 200 pts/week which works out to 40/day. I also usually see an additional 10 "sick" pts. However, these are chronic pts whom I see every week. Much of what I do is triage and stable pt care. And I do travel to two separate clinics.

However, it is definitely a "for profit" and "max billing" effort.

NPs4health · Mar 26, 2009

JD, what kind of practice do you work in? What age group are the patients? At our primary care practice we get a lot of strep, influenza, allergic rhinitis, hypertension, diabetes, pretty common stuff. We do get some crazy off the wall things, but mostly they get referred. And for full physicals we get about 15 minutes. There isn't much time for patient teaching though (likely because there's not billing code for patient teaching ha!)

I do feel like 40 is a lot, which is why I wondered how it is everywhere else.

kboyertcu · Mar 26, 2009

We see appx 25-30 a day. Chronic pain patients. They often change the subject but usually not much has changed.

JDCitizen · Mar 26, 2009

JD, what kind of practice do you work in? What age group are the patients? At our primary care practice we get a lot of strep, influenza, allergic rhinitis, hypertension, diabetes, pretty common stuff. We do get some crazy off the wall things, but mostly they get referred. And for full physicals we get about 15 minutes. There isn't much time for patient teaching though (likely because there's not billing code for patient teaching ha!)
I do feel like 40 is a lot, which is why I wondered how it is everywhere else.

Probably a little more than you asked for:

Neighborhood Health Clinic maybe 30 but usually 20's (whatever walks through the door)

Prison clinic 20-30s have hit the 40s more than a few times (adult male ages teens to 80's with conditions that makes me happy that at least one of the two doctors I work with is always willing to teach, help and we bounce ideas off each other) When I say clinic I have an office, I also do 99% of the emergencies and if the patient is coming back from a consult I see them so a schedule of 10 can end up being 35.. The plus here I can tell the nurse at almost anytime to clear my schedule. The negative is its prison medicine: Defensive health care and wading through those gaming the system to care for the truly sick (this kind of practice can only be imagined by those who have gone through it or who are doing it). My clinic actual covers the things like you mentioned like strep, influenza, allergic rhinitis, hypertension, diabetes but add HIV, hepatitis, MRSA, etc., etc, plus since I am also ordering test and consults it gets way deeper almost every day.

Hospital: Adults all ages, all floors except OB and rarely the ER (this is like being a RN sometimes it depends what doctor you are on with is how you get to work) Usually in a 8-10 hour shift around 25 patients. Why rarely the ER: I just hate the ER at this particular facility.

JDCitizen · Mar 26, 2009

We see appx 25-30 a day. Chronic pain patients. They often change the subject but usually not much has changed.

Oh my chronic pain patients! How do you do it day in and day out?

emtneel · Mar 26, 2009

I only see about 5-16 pts in 10 hours.. sometimes it gets pretty boring..And when I have "more" patients it is usually all at once, so I see 10-12 pts in 2-3 hours, then nothing for 6 hours, then maybe 2-4 more..

I work night shift, which is why the patient ratio is low.

I work at a College walk-in/urgent care type clinic. Mostly minor acute, lots of cold/flu/gastro.. but I do get to do some cooler stuff/procedures. I love suturing and procedures so i get to do that sometimes, and I can take my time and not be rushed (most of the time) I usually spend more time with the patients then i would actually need to because i have the time.. I am able to do a TON of teaching.. (not sure how much is actually retained..)

I'm a fairly new grad, just been in outpatient/walk-in type setting since Jan and LOVE it, I can probably see 3-4 pts an hour easily depending on what the problem is. If its colds/flu i could/can go faster.

I work alone as the solo provider, with a RN and a CMA so i do have to look stuff up a lot which takes more time, but I am learning probably more than i would be if I just asked another provider.

I LOVE this type of setting and am not sure if i will be able to do tradional Family Practice and rush visits.. I like having time, if i need it, and i like not knowing what is going to come in the door.

JDCitizen · Mar 26, 2009

I only see about 5-16 pts in 10 hours.. sometimes it gets pretty boring..And when I have "more" patients it is usually all at once, so I see 10-12 pts in 2-3 hours, then nothing for 6 hours, then maybe 2-4 more..
I work night shift, which is why the patient ratio is low.
I work at a College walk-in/urgent care type clinic. Mostly minor acute, lots of cold/flu/gastro.. but I do get to do some cooler stuff/procedures. I love suturing and procedures so i get to do that sometimes, and I can take my time and not be rushed (most of the time) I usually spend more time with the patients then i would actually need to because i have the time.. I am able to do a TON of teaching.. (not sure how much is actually retained..)
I'm a fairly new grad, just been in outpatient/walk-in type setting since Jan and LOVE it, I can probably see 3-4 pts an hour easily depending on what the problem is. If its colds/flu i could/can go faster.
I work alone as the solo provider, with a RN and a CMA so i do have to look stuff up a lot which takes more time, but I am learning probably more than i would be if I just asked another provider.
I LOVE this type of setting and am not sure if i will be able to do tradional Family Practice and rush visits.. I like having time, if i need it, and i like not knowing what is going to come in the door.

Even though I have other providers around me most of the time I still look things up it just seems to stick with me better. I also use goggle images: Nothing like showing your patient what they have on another person to reinforce diagnosis and treatment. 100% of the time I keep a dermatology book on my desk. Serving the undeserved populations usually the education levels are lower and comorbidities higher. Anything I can use that breaks my teaching and diagnosis into concrete examples helps.

Trauma Columnist · Mar 26, 2009

Great ideas.