New patients

[Lordosis]

How long does it take to get a new patient into your office? How may new patients do you see a day?

 

I am a family physician.  I see 1 new patient a day and I am booked out for 6 months.

Very few PCPs accepting new patients in my area.

It is a good problem to have but I feel for the patients who have to wait.

 

I have colleagues who do not take new patients but also cannot handle their load.  Acutes are seen by PA or sent to urgent care.  Physicals and follow up appointments are booked out months in advance.  I see the financial incentive to running this way but I know I would not want that of my Physician.

 

Anyone with similar issues?

Comments/suggestions appreciated!

[StateOfMyHead]

One of the easiest modifiable factors to increase the number of patients seen that is also cheap to rectify, if an issue at your practice, is reducing no-shows.

[Lordosis]

StateOfMyHead wrote:

One of the easiest modifiable factors to increase the number of patients seen that is also cheap to rectify, if an issue at your practice, is reducing no-shows.

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I completely agree.  Our institution has a 3 strike policy and 1 strike for new patients.  I am one of the few docs who adheres to it.  My no show numbers are only slightly lower then other docs but I attribute that to being one of the few seeing new patients.   They tend to have a higher rate.

[Kamban]

Also, cut out insurances that pay poorly. Or take long to process claims, delay it purposefully, deny it and so on. Or do both.

[ENT Doc]

Sounds like you need to hire some physician extenders and let them see the routine follow up or mundane new. That 6 months and only one new patient both seem like they need to be addressed.

[Lordosis]

Kamban wrote:

Also, cut out insurances that pay poorly. Or take long to process claims, delay it purposefully, deny it and so on. Or do both.

Click to expand...

Great idea but not allowed to do that

 

ENT Doc wrote:

Sounds like you need to hire some physician extenders and let them see the routine follow up or mundane new. That 6 months and only one new patient both seem like they need to be addressed.

Click to expand...

I agree that would help me financially and allow me to churn more patients a day but I prefer to see my own patients.  I also hate the idea to give the easy just to a PA and keep the complex.  Sounds like a recipe for disaster.

We try to work in more new patients where we can but I am usually seeing a few more patients then I want on typical days.  Anymore and it will start to impact my lifestyle in a negative way.  I would rather not stay later or do work at home.   I hate to have to post here less

 

I am employed so my options are somewhat limited.

 

Thanks for the comments!

[SValleyMD]

4-7 new pts a day

But as a specialist new pts drive my practice and bring in 3-10x (or more) when incorporating downstream testing so I have very little desire to see follow ups (unless active issues) who usually are a complete waste of time and mainly done to appease pts and pcps.

[ACN]

56 patient slots per day. 20 new, 36 fu available.

Typically 40 patients scheduled with about 15 new.. Depending on how much call I took.

[ENT Doc]

“I also hate the idea to give the easy just to a PA and keep the complex. Sounds like a recipe for disaster.“

No, this is a recipe for efficiency. You want to match the level of ability to provide care with the level being demanded. Don’t need a sledgehammer for every nail. Why would this be a disaster? Everyone is doing this.

[Kamban]

ACN wrote:

56 patient slots per day. 20 new, 36 fu available. Typically 40 patients scheduled with about 15 new.. Depending on how much call I took.

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You must be a superman to see 40 patents with 15 new ones.:-)

I just see 15 patients a day, max. Usually see 0-3 new patients /day, average of 1.

[Lordosis]

ACN wrote:

56 patient slots per day. 20 new, 36 fu available.

Typically 40 patients scheduled with about 15 new.. Depending on how much call I took.

Click to expand...

All I can say is Holy Cow!

 

ENT Doc wrote:

“I also hate the idea to give the easy just to a PA and keep the complex. Sounds like a recipe for disaster.“

No, this is a recipe for efficiency. You want to match the level of ability to provide care with the level being demanded. Don’t need a sledgehammer for every nail. Why would this be a disaster? Everyone is doing this.

Click to expand...

I do not get reimbursed for the work the midlevels do.  So under my contract I would get more complex patients with no increase in pay.  If I was a practice owner or they gave me a slice of the midlevel work I supervise then I completely agree.

Also call me old fashioned but when I am sick and go to my doc I want to see my doc.  I have a bunch of patients who feel the same way.  I aim to please because once people do not care about seeing docs any longer us in primary care are screwed.

[Dusn]

I agree with your philosophy Lordosis.    Although the reality of most of the physician practices that I've been to as a patient is the exact opposite:   the physician is seeing me for routine yearly visits that could be handled by a midlevel and when I actually have an issue and need to be seen acutely, they have me seeing the midlevel because the physicians are all booked.  Unfortunately, when I have an acute issue is the time when I really need to be seeing the physician.   It's completely ******************-backwards.

 

[ENT Doc]

Understood the employment restrictions. However, this is a win/win IMO. It should behoove all parties to have mid levels around. I would negotiate something different in a new future contract that allows for more flexibility on your part and an ability to have the cost of a NP direct expensed to you. That way you get to have oversight of exactly who you want them to see. Otherwise you’ll continue seeing one patient a day while the competition adapts and can offer earlier times to be seen. Just a thought. Philosophically I agree with your sentiments re: seeing a doctor. But the explosion of NPs/PAs and expansion of practice are things no one is going to change. You adapt...or not.

[StarTrekDoc]

@ Lordosis - you have a traditional access balance problem.  Sounds like over pannelled and under staffed.  All acutes going elsewhere anyways since 6 months wait.

What the heck do you do for post hospitalization?

Not really panel management at all unless you count only chronic disease management into that equation.

 

[StarTrekDoc]

New panels:  3/session - 6 per day  ;  Established -  1/session if standard attrition;  if overpanelleed-  CLOSED;   if nearing capacity - 1-2 news per session

Access is measured by 3rd Next Available follow up.  If extending past 2 weeks, we start looking on the why -- panel too big?  bringing in too much? extended vacations?