Physician Leadership recently asked, “How many patients can a primary care physician treat?” According to their findings:
“Not as many as required — but delegation can lessen the workload.”
As of 2019, the average primary physician may treat 2,500 — or more — patients. They also share criteria used by Duke University’s studies that to “deliver all the recommended preventive, chronic and acute care services needed by 3,000 patients with a typical U.S. age and disease distribution, a doctor would have to work 17 hours a day — seven days a week, all year, without a break.”
Technological advances have contributed to a decrease in patient panels with ranges from 1,800 to 2,000, although most physicians feel that it “needs to drop more.” To complicate the issue more, the National Library of Medicine (NIH) released an article concluding that from the “physician perspective, overtreatment is common.”
The reasons cited for overtreatment were:
- 84.7% have a fear of malpractice
- 59.-% feel pressure from their patients
- 38.2% have difficulty accessing prior medical records.
To make matters worse, the U.S. physician shortage is only going to get worse. We could see a shortage of “54,100 to 139,000 physicians by 2033.” The anticipated shortfall is predicted to include both primary and specialty-care fields.
But why does the United States have so few doctors? The Atlantic took a deep dive into how we got here, and the answer starts in the late 20th century. From 1980 to 2005, medical schools began to restrict class sizes in response to medical groups’ assertions that we had an “oversupply of physicians.”
The results from that initial decision meant that the number of medical school graduates “basically flatlined” while the population grew by 60 million people. Add on the debt load after at least nine years of schooling, and we find ourselves with a disproportionate number of specialists and fewer primary care physicians.
How Many Patients Are Too Many?
Really, there’s no one-size-fits-all answer to this question. The ideal patient panel size roughly depends on the following:
- How many appointments you have available
- How much care your patients require
To further break down the number, you’ll want to consider how many patients you can realistically see in a given day and how many days you plan to work each month. Don’t forget to calculate how many days you will need for professional absences (CME events, conferences, etc.), plus how much vacation you’ll want to take.
When it comes to patient care requirements, taking a realistic look at the type of patients who come to see you is important in determining whether you’re seeing too many patients. The elderly and patients with complex medical issues will take up more time per visit and come to see you more often, adding to the amount of time you’ll spend caring for them.
As a measure of self-care, make sure you are honest with yourself in calculating how much time you want to spend at work. Make sure you realistically allocate enough time for charting and administration, as that will also inform how large your patient panel can be and how many patients are too many for you.
Across the pond, The British Medical Association (BMA) says that physicians “are working at unsafe levels and are at risk of burnout.” That’s obviously not unique to Great Britain, as the number of American doctors experiencing burnout has never been higher.
The Association suggested that in an effort to reverse this finding, family doctors see only between 25 to 35 patients each day for “routine appointments” and a maximum of 15 patients with “complex needs.” Apparently, the proposal has “sparked a furious debate in the medical community.”
What To Do When You’re Too Busy
If you find yourself in the position of a full (over overly full) patient panel and you’re too busy to stretch another inch, there are ways to manage your workload and leverage the opportunity.
ROI Corporation put a positive spin on the issue of too many patients. “It’s an unfortunate side effect of being successful…[and] is a luxury and opportunity.”
Viewed from the perspective of supply and demand, you can test the theory of scarcity for yourself. The theory of scarcity — a limited supply of anything — says that it “immediately supports the increase in demand for your service.”
If that is true in your practice, you’ve just been presented with the opportunity to raise your fees. This is a common strategy employed by many professionals.
And if you’re wondering about the ethics of raising rates in medical practice, I’m not suggesting that you violate the fundamental ethical principles in healthcare. The values of “beneficence, justice, autonomy, and non-maleficence” should trump all else. Still, within these principles, there is certainly room to grow the financial success of your practice without sacrificing yourself to burnout.
Here are three main ways to help you run a more physician business when you’re fully booked and you find yourself too busy:
- Manage your schedule
- Manage your systems
- Hire and delegate
- Bring on a partner
Manage Patient Panel Schedules
For busy doctors, managing patient panels can become quite hectic. Manual appointment scheduling systems may have worked at one point, but they’re no longer effective in meeting the needs of a busy practice. Investing in a robust scheduling system is key to helping manage your clinic’s appointments and patient load.
Good scheduling ensures that there are no overlapping appointments, as well as no-shows or late arrivals. Long waiting times in clinics are a major concern for patients and can lead to unhappy patients and poor experiences.
Effectively managing queues and scheduling systems can help manage walk-in and booked appointments, reduce patient waiting time, and reduce patient complaints. Scheduling systems also allow for better management of time and resources and lead to more efficiency in patient care. It allows for better communication between the staff so that everyone knows when patients are coming in, who has seen who last, and what treatments were performed.
This means fewer mistakes and oversights, leading to improved outcomes for everyone involved. In addition, these systems provide physicians and other staff members with access to patient medical records from any location or device, making sure all relevant information is available when making decisions about patient treatment plans. Also, investing in an appropriate scheduling system reduces paperwork overhead, ensuring all relevant patient visit information is accurately recorded without needing manual input.
Manage Your Systems
Creating systems and processes to streamline how you work can help you make the most of your limited time. Another way to save mental resources is to stay on top of current evidence-based practices.
The field of medicine is ever-changing, and staying up to date can help doctors diagnose and treat more effectively. A great way to do this is to create a system for potential treatments that follows evidence-based practice. That way, you can ensure that each patient receives the most up-to-date care.
The first step in setting up an office system is to get organized. Designate one person in the office to handle all scheduling duties, such as creating and maintaining appointment calendars, entering patient data, tracking office hours, and organizing patient records. This will help to ensure that everyone in the office is on the same page and that there are no gaps in patient care.
Additionally, many doctors find success when bringing on a partner to help manage their busy schedules. Having two medical professionals present allows for collaboration and extra help when managing crowded appointment calendars.
Similarly, medical assistants or other medical personnel can handle administrative tasks or serve as receptionists while the doctor focuses on taking care of their patients. Lastly, hiring locum tenens physicians or nurse practitioners can provide extra support as needed.
Make sure to provide feedback to your staff so they can continue to improve and adapt their systems. Regularly scheduled meetings with your staff can help to identify any issues and come up with solutions quickly and efficiently.
Hire and Delegate
Having too many patients in queues and limited time for each patient can lead to unsatisfied patients, loss of revenue, and even a negative reputation. To avoid these consequences, doctors with fully booked practices should consider hiring nurse practitioners and other mid-level health providers to help expand their healthcare provider staff and provide adequate patient care.
However, hiring mid-level health providers should be based on careful assessment and financial projections. This is because the hiring process requires resources and time that must be invested in order to ensure success.
In addition, physicians should not perform tasks that don’t require an M.D., such as administrative tasks, but instead delegate them to staff and pay well for skills and performance. A highly skilled back-office person can increase patient flow and enhance patient communications, which will save the doctor’s time and help them manage their schedule more effectively.
Delegating tasks also increases efficiency by allowing employees to specialize in specific roles and focus their efforts solely on those specific activities.
Utilizing technology tools can also play a key role in streamlining operations and automating various processes. For instance, automated scheduling tools allow physicians to easily manage appointment requests from multiple channels (such as email or SMS) and speed up booking processes. Medical practice management software can also simplify billing, track lab results, enable efficient communication between staff members, and much more.
Bring on a Partner
When running a practice that is overly booked, it can be helpful to bring on a partner. In a well-organized and well-managed group, clinic management can be improved, and you’ll also find greater negotiating power with health plans and insurance.
By performing similar tasks collectively, the efficiency of the practice is increased. For example, groups of patients can be pre-screened for COVID-19 or influenza vaccine visits, allowing multiple physicians to conduct visits quickly and easily.
Adding a partner to your practice also allows for greater leverage with economies of scale. With two or more physicians providing services, you can better serve more patients than one physician alone.
You can share overhead expenses, leverage skillsets, and divide patient panels. And, if one of the partners is away, the other partner can step in and keep the practice running smoothly.
All of this can lead to improved patient care and satisfaction. It can also help alleviate the stress of having an overbooked schedule.
Moreover, you could create an environment where both doctors communicate openly and work collaboratively. This will lead to a smoother transition when transferring patients between each other. An added bonus of bringing on a partner is gaining their unique knowledge and perspectives, which could lead to new ideas and strategies within your practice. Ultimately, having an extra pair of hands and a fresh perspective could make all the difference when dealing with an overwhelmed schedule.
Back to Raising Your Rates
Raising your rates can be a great way to free up your time and reduce stress while still being able to provide quality care to your existing patients. Do some research into the current market rate and determine an appropriate amount to charge while still providing a good customer experience.
The first step in raising your rates is to determine the current market rate for services similar to yours. This can be done by researching the rates of other medical professionals in your area or even across the country.
It’s important to remember that the amount you charge for your services shouldn’t be too extreme – if you’re charging too much above the market rate, potential customers may be put off from using your services.
When raising your rates, it’s also important to ensure that your services are worth the cost. Make sure that the customer experience is smooth and professional – look into having a booking system or receptionist on hand to handle incoming appointments and keep customers updated on any changes or delays.
As usual, this topic runs right in my sweet spot for helping physicians create highly profitable 6- and 7-figure businesses.
When I graduated from my residency, I walked into my first patient’s room, wrote my prescription, and walked out. Sad. I felt like there had to be more. I ran so hard, for so long to get… here?
I knew there had to be more, so I started a private practice one year after residency while pregnant. Unfortunately, what I realized is that if you hang the shingle, they won’t come.
So, I got to work on mastering business skills; I learned how to hire, fire, market, and lead. And my practice grew — a lot!
Money was good, life was good, everything was good. But I realized that doctoring alone wouldn’t cut it in the future. I needed something else.
So, after considering several options, I started coaching other doctors who wanted more, just like I had. Fast forward to today, and I’m the founder of EntreMD, the host of The EntreMD podcast, a regular contributor to Forbes, and have a 7-figure business.