Which NPs don't deal with dozens of patient per day?

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Specializes in Med surg, cardiac, case management.

I've been advised to go on for my NP. I tend to agree that's a good decision, but I have a few hesitations.

One is that I know that many NPs deal with loads of patients, sometimes 30 or more per day. Which doesn't strike me as much of an improvement over my present med-surg position. While I interact well with people (and have lots of patience with them), I tend to prefer to deal with ideas. The idea of walking into a clinic with dozen of people waiting seems fairly exhausting, especially if they need extensive teaching about their conditions. Trying to explain things to my half dozen med-surg patients is pretty time-consuming and at times frustrating; I can only imagine what it would be like to have to do that with 5 times as many people per day.

I've been told that not all NPs deal with high patient loads, and I'm curious as to who those NPs are. I don't mind working hard or under difficult conditions...I do night shift at an inner-city charity hospital. But people can tire me out, and if I can limit the number I work with, or not work directly with the patients, that might be better.

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But people can tire me out, and if I can limit the number I work with, or not work directly with the patients, that might be better.

Well, if you don't want to work with patients then NP might not be good for you, unless you want to go into teaching..?

I work locums and today for example i've had 2 patients, and have 3 for the afternoon.. Personally that's a little to slow for me. I working in a Peds clinic.

The most i've seen is probably 30 in 8-12 hours. In the ER I would see about 30 over 12-13 hours without a break. But i was doing procedures, suturing, etc as well. I think 20-25/in 8 hour day is pretty normal and doable. Now for internal medicine or specialty it would probably be less in a good clinic.

Basically you choose where you work and how many patients you will see. I've interviewed for jobs that want me to see 50-100 pts/day, sorry that's not the kind of care I provide. I don't do drive through medicine. I think the clinics that do this type of care are not really "care-based" but rather money driven. I make an excellent income and have not had to provide subpar short-cutted care yet.

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Specializes in Med surg, cardiac, case management.
Well, if you don't want to work with patients then NP might not be good for you, unless you want to go into teaching..?

Naw, not much money in teaching. And that can be exhausting too! Just imagine lecturing in front of a big class for 3 to 4 hours...

I'm glad that there are practices where you aren't scheduling patients in 15 minute intervals. Don't think you can get much done that way

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I've been advised to go on for my NP. I tend to agree that's a good decision, but I have a few hesitations.

One is that I know that many NPs deal with loads of patients, sometimes 30 or more per day. Which doesn't strike me as much of an improvement over my present med-surg position. While I interact well with people (and have lots of patience with them), I tend to prefer to deal with ideas. The idea of walking into a clinic with dozen of people waiting seems fairly exhausting, especially if they need extensive teaching about their conditions. Trying to explain things to my half dozen med-surg patients is pretty time-consuming and at times frustrating; I can only imagine what it would be like to have to do that with 5 times as many people per day.

I've been told that not all NPs deal with high patient loads, and I'm curious as to who those NPs are. I don't mind working hard or under difficult conditions...I do night shift at an inner-city charity hospital. But people can tire me out, and if I can limit the number I work with, or not work directly with the patients, that might be better.

In the ICU we take 5-7 patients during the day. Evening and nights you split the management with the resident so you have two people taking care of up to 20 patients +/- admits. When I worked transplant it was similar 8-10 patients that you were primarily responsible for.

David Carpenter, PA-C

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Agree with Core0. I also work in the ICU and during the dayshift, the NP's only take up to 4 patients to pre-round on, present to the attending for AM rounds, perform procedures, write notes, and establish patient/family relationships with. The nightshift can be busy as you would have the entire unit to manage (up to 16 patients) but you have the ICU fellow as back-up and you have a call room to relax in when it's slow.

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Specializes in Nephrology, Cardiology, ER, ICU.

I work with chronically ill pts with renal disease and although I see a lot of folks - up to 60/day, they are the same pts.

I do dialysis rounding so don't have to room pts, take vitals, undress them, etc which makes my rounds very efficient, unless I'm travelling - lol.

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Specializes in Med surg, cardiac, case management.

I figured that acute care would probably see fewer patients than primary care.

Not sure I want to spend so much time in hospitals, though. I do enough of that now. ;)

I know it also varies on what specialty/sub-specialty you're part of, and the individual practices.

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But people can tire me out, and if I can limit the number I work with, or not work directly with the patients, that might be better.

Just a caution, a specialty practice that sees less patients/day is not necessarily easier than seeing many patients per day. You as a provider have more to get done during the visit. The patients are often medically complex and need a lot of teaching. If the patient or family is difficult you are with them for a long time trying to meet their needs... and it may still not be enough.

It's less patients, but it can be a lot more intense. These intense encounters can "tire you out" just as much as seeing many patients who are generally healthy.

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Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.

I know I keep talking about my job - but I do truly love it! I work in the short-procedure unit and help out in pre-admissions testing for the anesthesia group specifically, so all I am doing is H&Ps on patients coming in for elective surgery, ordering the appropriate labs, EKGs and X-rays. In short-procedure, I just do the H&P and the testing ordering (if they were not seen in PAT) and the anesthesiologist reviews the results since their surgery is that day. When I help out in PAT, I get the results and then follow-up with the PCP or order a pre-op med. clearance on a patient if their results/history are significant enough to warrant it. While there are some days I will see about 15 patients, it's usually not that bad since I don't do much teaching (I just explain which type of anesthesia might be utilized, which meds they need to stop, etc. before surgery) and anything out of the ordinary is referred back to their PCP.

It is a great position that I was lucky enough to stumble across in my job search.

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Specializes in Med surg, cardiac, case management.
Just a caution, a specialty practice that sees less patients/day is not necessarily easier than seeing many patients per day. You as a provider have more to get done during the visit. The patients are often medically complex and need a lot of teaching. If the patient or family is difficult you are with them for a long time trying to meet their needs... and it may still not be enough.

It's less patients, but it can be a lot more intense. These intense encounters can "tire you out" just as much as seeing many patients who are generally healthy.

That's a good point, I hadn't considered that specifically.

Although I have wondered if it wouldn't be better to see more healthy patients. My med-surg floor is high acuity, with many nursing home patients, and it gets tiring.

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Depends on if you work with a population that has (typically) multiple meds to manage and who require lots of teaching. Primary care (Internal Med, Family, Peds) can require lots of patient/parent teaching. Dermatology might not require as intense teaching and the exam is usually more straightforward. Endocrinology would involve LOADS of patient teaching, lab reviews, etc.

Is there a particular population you know you enjoy working with (females, geriatrics, teenagers) already? If so, you might want to expand on your existing preference. Likewise, is there a population you know you DON'T want to work with (for me, that's kids and their parents...) and you can begin the elimination process that way?

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That's a good point, I hadn't considered that specifically.

Although I have wondered if it wouldn't be better to see more healthy patients. My med-surg floor is high acuity, with many nursing home patients, and it gets tiring.

In the end its going to be about the money. You don't get paid as much for healthy patients as for sick patients. You get paid more for procedures than for taking care of patients.

For example yesterday in a 13 hour shift I:

Admitted and stabilized one patient (120 minutes CCM time).

Took care of three critical care patients (55, 65, and 90 minutes of CCM time)

Transferred one patient (HV3 30 minutes)

Took care of two patients awaiting transfer HV3 35 minute, and HV2 20 minutes)

Admitted one non-critical care patient NP3 60 minutes.

I also did two art lines and one central line (120 minutes total)

So my total billed time was 595 minutes (or about 10 hours). This was a medium busy day. I took care of eight patients (although I never had more than seven at one time (our max). That still leaves 3 hours of down time for lunch, billing and doing a little reading.

For the billing. I'm going to do this in RVUs (revenue value units) to compare them.

The critical care time is 4.5 RVU for the first 74 minutes and 2.25 for every 30 minutes after that

So the first patient is 4.5+(2.25x2) the second is 4.5 the third is 4.5 and the last is 4.5+2.25 so I have a total of 24.75 RVUs

The HV3 is worth 2 RVU and the HV2 is worth 1.39 The new patient is 3.86 So a total of 9.25 RVU for the non-critical care patients.

Finally the procedures are worth 1.15 for the art line plus .3 for US. The central line is 2.5 RVU

So procedures are 5.4 RVU

My totals for ten hours are 39.4. Now to put this in perspective to get the same number follow up visits (easy Follow up level 2) at 1.39 per I would have to see 28 patients in that same period of time.

For E/M time for Medicare we get around $50 per RVU. For procedures its around $75 per RVU. So the E/M portion was around $1700 and the procedures were $405 for a total of around $2100 or around $210/hr of productive time.

Also notice that the CCM time 330 min E/M time 265 min the CCM time is worth around double the E/M time on an RVU basis. The procedure time is worth even more (the current numbers are skewed by one art line that took 1 hour 15 minutes).

Also consider that there is essentially no physical plant cost for inpatient. We have a couple of billers and a few support people compared to the mass of people that it takes to run a primary care office (4-6 per provider).

If you want to make any reasonable amount of money as an outpatient its either going to be lots of volume or lots of complexity. On the inpatient side its much easier to make decent money (and bring in lots of money) by seeing a few patients.

David Carpenter, PA-C

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