40 in 8 hours is typical. Especially when your EMR and patient flow plan is solid.
Have your EMR autopopulate your diabetes tracking chart. Bill an A007 on all patients after you have the nurse take the BP, which counts as a physical exam system. Live in an area where you can bill a modifier for the location. Ensure your screening rates are high, get all the bonus diabetes codes, colon cancer screening etc. Have your nurse do all the vaccinations. Have your receptionist fill out all forms and bill for them. Do additional procedures like liquid nitro of AKs, joint injections etc.
Tons of ways to make money in family medicine if you have business savvy. Too often I see family doctors who have no idea what they are doing with regards to making money, using an incredibly inefficient EMR (aka nightingale), doing physical exams that have no diagnostic/prognostic value, doing procedures you can't bill for, referring out minor procedures, ignoring screening, meticulously filling out government forms, notes etc.
Every clinic I worked in did all the things you mention, yet were still seeing 25-30 patients a day only. Efficiency can only go so far in shortening patient visits.
Now, I'll agree that 40 in 8 hours is feasible under the right conditions, but far from ideal both for patients and even the physician's bottom line. Some visits are higher-paying but require more time. The typical annual physical has higher pay but requires a little bit more time than the standard visit (without defrauding the government). Likewise many of my preceptors would do inpatient care, home visits, or nursing home care into their day, all which pay reasonable well per unit of time, but involve seeing fewer patients in a day. Getting in 40 A007 billings is one thing, but any physician doing that is providing a rather restricted practice that may not be financially optimal.
Doing 40 patients in 8 hours means 12 minute visits and while some will be shorter, many will be longer. That leads to long wait times for patients and/or rushed care for those who come after the long visits in order to stay on schedule. Worse, there are some practitioners who stick religiously to their 12 minute appointments and those physicians absolutely miss things - they just don't realize they've missed something because they're out the door too quickly for it to come up. In each case, the physician may be providing technically adequate care, but not exactly patient-centered or comprehensive care. Running a clinic like a business doesn't have to mean improving your own income at the expense of patients, but it often happens that way.
And 40 in a day is nowhere near 60
MD Candidate 2017 - Schulich School of Medicine
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