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  • Lordosis Lordosis 
    Participant
    Status: Physician
    Posts: 1672
    Joined: 02/11/2019
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    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!

    “Never let your sense of morals prevent you from doing what is right.”

    #220681 Reply
    Avatar StateOfMyHead 
    Participant
    Status: Advanced Practice Provider
    Posts: 114
    Joined: 01/01/2019

    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.

    #220690 Reply
    Lordosis Lordosis 
    Participant
    Status: Physician
    Posts: 1672
    Joined: 02/11/2019

    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.

    Click to expand…

    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.

    “Never let your sense of morals prevent you from doing what is right.”

    #220693 Reply
    Liked by StateOfMyHead
    Avatar Kamban 
    Participant
    Status: Physician
    Posts: 2423
    Joined: 08/01/2016

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

    #220694 Reply
    Liked by Hank, ENT Doc
    ENT Doc ENT Doc 
    Participant
    Status: Physician
    Posts: 3459
    Joined: 01/14/2017

    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.

    #220700 Reply
    Liked by Kamban
    Lordosis Lordosis 
    Participant
    Status: Physician
    Posts: 1672
    Joined: 02/11/2019

    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 🙁

     

    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!

    “Never let your sense of morals prevent you from doing what is right.”

    #220712 Reply
    Avatar SValleyMD 
    Participant
    Status: Physician
    Posts: 454
    Joined: 05/12/2016

    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.

    #220722 Reply
    Liked by Zaphod
    ACN ACN 
    Moderator
    Status: Physician
    Posts: 616
    Joined: 01/08/2016

    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.

    If you're ever having a bad day, just remember in 1976 Ronald Wayne sold his 10% stake in Apple for $2,300.

    #220726 Reply
    ENT Doc ENT Doc 
    Participant
    Status: Physician
    Posts: 3459
    Joined: 01/14/2017

    “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.

    #220728 Reply
    Liked by HandFellow, Zaphod
    Avatar Kamban 
    Participant
    Status: Physician
    Posts: 2423
    Joined: 08/01/2016
    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…

    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.

    #220742 Reply
    Liked by StarTrekDoc
    Lordosis Lordosis 
    Participant
    Status: Physician
    Posts: 1672
    Joined: 02/11/2019

    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!

     

    “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.

    “Never let your sense of morals prevent you from doing what is right.”

    #220757 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 193
    Joined: 01/02/2018

    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 ass-backwards.

     

    ENT Doc ENT Doc 
    Participant
    Status: Physician
    Posts: 3459
    Joined: 01/14/2017

    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.

    #220768 Reply
    Avatar StarTrekDoc 
    Participant
    Status: Physician
    Posts: 1966
    Joined: 01/15/2017

    @ 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.

     

    #220771 Reply
    Avatar StarTrekDoc 
    Participant
    Status: Physician
    Posts: 1966
    Joined: 01/15/2017

    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?

    #220772 Reply
    Liked by ENT Doc

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