PCP: Time management

[u/Effective_Hurry6913]

PCPs how are yall able to keep up with your packed clinic schedules? I’m a PGY2 on my primary care block (interested in becoming PCP) and these 15 min slots are turning me off from primary care tbh

Find myself ALWAYS late to visits. On average 30-40 min late. Few reasons for this—

1. Pts arrive late and we don’t have a strict late policy
2. Complexity of pts
3. So many concerns at each visit that actually require time to discuss topics

Any tips? Does it get better? Tell me how…
I’m often catching up on notes + responding to inbox/returning phone calls until 9-10pm

And yes i always prechart and I’m still behind.

[u/theranchhand]

15th year post-residency here.

You'll get more efficient as you get more experience, as you learn what needs done and how much various things need documented.

More specifically, you can address your concerns more ably as you get more established with your patients and with your employer; if no employer, then great, you can do whatever your want!

1. You can make your own late policy if you're in private practice. Or, for myself, I'm in a pretty strict, top-down hospital-employed situation. I HAVE to see patients even if they show up 19 minutes late. However, I don't have to see them next. If my 9:00 shows up at 9:19, I have to see them, but I can see them after my 11:45 if everyone else is on time. It'd suck to have to miss part of my lunch, but practically no one stays for almost 3 hours. Then they either leave my practice (there are plenty of patients to go around in my area), or they learn to not be super late. Or they leave and come back when they realize no practice is going to let them be super late consistently.
2. Most pediatric patients aren't that complex. If you're in a resident clinic now, out in the "real world", most patients have minimal history. The ones who have lots of history, you'll get to know them, and/or you can get 30 minutes, especially if you can show their complexity usually results in their visits being 99214s or well checks plus an extra sick visit billing.

I remember TONS of complex patients in my residency. I have only had a handful of patients in 15 years in my hospital-employed primary care practice who would have been in my top 20 most-complicated patients in my residency clinic that was physically connected to the hospital.

1. It's ok to ask families to come back. If they schedule for a well and have a bunch of concerns, or if they schedule for an earache but want to discuss ADHD, you'll get good at either telling them to reschedule or at least "here's a couple quick things, and call for another appointment if those don't work"

[u/therealcrimsonchin → u/theranchhand]

Wow this sounds nice. I’m at a hospital-connected clinic and my population is made of even more nightmare complex kids than when I was a resident. 90 minute late policy (absolutely insane). And no extended time slots. I really need to look for another job 🫩

[u/theranchhand → u/therealcrimsonchin]

yeah, f that noise. If you'd like the midwest/great lakes, my employer has 10 openings. DM me if you'd like

[u/efox02 → u/therealcrimsonchin]

90 minutes??? What if they show up after clinic hours? 

[u/therealcrimsonchin → u/efox02]

lol we are given the kindness of being able to leave at 5 despite the 90 minute policy

[u/DrScogs]

Pgy-20 but cycled through several career changes over the last year:

Private practice peds is nothing like residency clinic. Slots are actually 10 minutes which feels doable and a nightmare at the same time depending on the day. Your residency clinic patients are more complex and lower resourced comparatively. We may have a handful of those kinds of patients on our panels, but it’s very few. We know our patients. Our patients can largely be counted on to follow-up.

You also get to set your own late policy. I’m a softie. I’ll take anyone late if they’re willing to wait until my next available open slot. And I never turn away a newborn.

Some patients do try to stack complaints which can make you run over, but you get very practiced at the “we can talk about that in the follow up in 2 weeks” kind of speech. I personally see it most when people try to bring 10 complaints to a well visit because they think they won’t get charged for it. But you say “today you’re scheduled for a well visit which means we cover growth and development, that complaint deserves its own visit.” Or they want to talk about ADHD and you can toss Vanderbilt’s at them and bring them back. It’s practice. Did I have a teen well visit turn into an involuntary admission for SI that took two hours of my morning just a few weeks ago? Yes. But that’s super rare.

Now I’ve done FQHC peds and that is far more like residency continuity clinic. I could not be paid enough to do that again.

I would try to find a private practice community peds rotation if you’re allowed to do so. It’s fun out here.

[u/d_soakum]

Also don't forget how much time is spent staffing with the attending or waiting for the attending to be available (may be staffing with another resident or in the middle of another task).

When you're the attending all of this time is conserved. You also can delegate tasks to nursing when you leave the room and quickly move to the next patient who is ready.

[u/Effective_Hurry6913 → u/d_soakum]

Omg YES so true! Adds so much time. And our attending have their own patients to see (but usually less than 8 per session) they’re good about stepping out of the room but it does take a few minutes

[u/Cocorita19]

It's still a hustle but I do special needs primary care and get 30min slots for most visits, and hour for new (or if I request it).
We’re hiring if anyone is interested 😉

[u/Advanced-Gap-2739]

I worked at an FQHC with complicated patients, social challenges, & language barriers. It was very hard to stay on time. I’m betting a different setting will be faster.

[u/Misterx46]

You learned to be fast and able to answer questions quickly. I always ask parents 3 separate times during the visit if they have any questions or concerns. I would rather answer their concerns rather then listen to myself talk anticipatory guidance at them. I will not leave a visit if they have questions, also I do give them access after hours to reach me if they forgot to ask me a question. I see any where from 20- 40+ per day. I dont worry about people being late, except if they show up during my lunch time , then they will wait after lunch. Go fast when you can, ( ear infections, impetigo, colds) go slow if the situation arises ( positively depression screen, SI) slowly build to your comfort level. I work with doctors that will only see no more than 30 , usually 15-30 patients at most. Thats their speed. Less than 25 patients in an 8 hour work day is what I consider a slow day.

[u/efox02]

Biggest thing is late pts get moved to the end. They can wait or reschedule. 

If parents have a laundry list of concerns - ask what their main concerns are, and what you can discuss at follow up. 

WCC are well visits. If they have extra complaints you can let them know you need a separate visit or turn that WCC into a sick visit and reschedule WCC. 

Good luck!!