Family med practice

[Guest copacetic]

hey has anyone ever seen any family med doctors run a regular appointment practice for say 8-3 and then from 3-8 run a drop in urgent care type thing out of the same office. that way you can see the complicated cases during the day and give each patient their due while seeing quick cases in the evening? is this reasonable or practical?

[thebouque]

Yeah they can have their regular office hours (that doesn't necessarily mean complicated cases though) during the day and do some walk in clinic at night.

[moo]

Yeah, that's how our clinic is run.

 

Appointments from 830-5, walk-in and urgent care from 5-8. As a PGY-5 resident, I mostly do walk-ins for the clinic, but I cheat and book some of my regular patients from 5-8. I tend to see 18-24 patients on average during this time, but can see up to 30 on busy nights. Of course, you can't have one doctor working all day as they would easily cap (50 patients in BC. After that the government pays 1/2 of your billings up to 65, after which they pay nothing). In Alberta though, some really hard working docs would do exactly as you describe, working from 8-8 at night, seeing 100 patients a day.

[moo]

Seriously? WTF is with this cap business? I know that if I find out my work is capped, I'm going to stop working when the cap hits, and try to move to a place without a cap. I don't work for free unless I want to.

 

Yeah it sucks. They instituted this in the early 2000s. The BCMA did nothing about it.

 

Despite the cap though, you can find ways to be creative. The cap only counts against routine office visits. So things like biopsies, shots, mole removals, WCB, ICBC, private pay, nursing homes, hospital visits, immigration medicals, drivers medicals etc. are not counted. This is how some family docs still end up billing way more than what you would bill under the "cap". I find I usually need to see about 55 to reach the cap, after which I'm so exhausted I don't want to see anymore. Plus, I only work about 3 hours on weekdays, about 6 hours on weekends, and if it's busy, it takes me about 5 hours to cap. So I never cap during weekdays and if I do on weekend, I look at it as a welcome break. Work five hours, bill about 1700 bucks and then still have an afternoon and evening to relax. It's nice to actually get a break sometimes, otherwise I'd just keep working. Just trying to put a positive spin on this.

[Guest tongtongcuty]

Hi Moo,

 

If you have exhausted your quota during the day time, but you plan to do some urgent walk-in clinic at night. How is it billed and at what rate?

 

Thanks

[Dino]

Yeah, that's how our clinic is run.

 

Appointments from 830-5, walk-in and urgent care from 5-8. As a PGY-5 resident, I mostly do walk-ins for the clinic, but I cheat and book some of my regular patients from 5-8. I tend to see 18-24 patients on average during this time, but can see up to 30 on busy nights. Of course, you can't have one doctor working all day as they would easily cap (50 patients in BC. After that the government pays 1/2 of your billings up to 65, after which they pay nothing). In Alberta though, some really hard working docs would do exactly as you describe, working from 8-8 at night, seeing 100 patients a day.

 

100 patients a day?

Forgive my ignorance, but is this true or were just using a figure of speech to make a point?

 

Thanks.

[thebouque]

How the hell does that make sense? Isn't this whole bull**** FP shortage based on a lack of routine office care? So they're saying there's a shortage of FP care but then limit the amount of care an FP can provide? How ridiculous!

 

I think that yes, taking a break is a good thing, but it should be decided by the practitioner, not the government.

 

I think part of the purpose of the cap is to force family physicians to do other duties than office work otherwise nobody would take calls at nursing homes etc.

[moo]

100 patients a day?

Forgive my ignorance, but is this true or were just using a figure of speech to make a point?

 

Thanks.

 

It's true. In residency, I worked with a rural doc who saw 100+ patients a day. He had really complicated patients too, booked patients in 3 minute intervals, and was a headache for me. But he knows each and every one of them well, so he doesn't need to go through their whole history when they visit. He even won family physician of the year from the CFPC one year. He's an example of where you don't need to spend a lot of time with each patient to provide excellent care; his patients loved him.

[moo]

Hi Moo,

 

If you have exhausted your quota during the day time, but you plan to do some urgent walk-in clinic at night. How is it billed and at what rate?

 

Thanks

 

If you see 50 during the day, you can only see 15 more at 1/2 the rate. Any more, the government does not pay you. Physicals are counted at 2.17 times for the purposes of the cap (as you get paid 2.17 times the regular visit rate).

 

Walk in clinic visits are counted the same as regular visits for the purposes of the cap.

 

I think BC is the only province that has this though. Again, even when I hit the cap, I need to see 55-60 patients in total (as some do not count toward the cap) before I say stop... I'm too tired to continue usually anyway. Thus, I can't see how anyone can see 100 a day. I suppose if I worked 10 hours straight, I could hit it, with my rate of 10 patients per hour, but I think I would be so brain dead, you wouldn't want to see me.

[leviathan]

I thought physical exams / 'checkups' weren't covered by MSP? Or is there some workaround to that?

[moo]

They are covered if the patient has a medical condition, e.g., hypertension.

[ghost dog]

If you see 50 during the day, you can only see 15 more at 1/2 the rate. Any more, the government does not pay you. Physicals are counted at 2.17 times for the purposes of the cap (as you get paid 2.17 times the regular visit rate).

 

Walk in clinic visits are counted the same as regular visits for the purposes of the cap.

 

I think BC is the only province that has this though. Again, even when I hit the cap, I need to see 55-60 patients in total (as some do not count toward the cap) before I say stop... I'm too tired to continue usually anyway. Thus, I can't see how anyone can see 100 a day. I suppose if I worked 10 hours straight, I could hit it, with my rate of 10 patients per hour, but I think I would be so brain dead, you wouldn't want to see me.

 

Ontario doesn't have a cap.

 

However, I was under the impression that this cap was more theoretical than a practical one. Specifically, when the cap was in place I believe it was in the neighborhood of around $400,000 - that's a lot of visits.

 

Moo, if you are a PGY-5, how do you bill - aren't you under a resident's salary? Different for community med?

[moo]

Ontario doesn't have a cap.

 

However, I was under the impression that this cap was more theoretical than a practical one. Specifically, when the cap was in place I believe it was in the neighborhood of around $400,000 - that's a lot of visits.

 

Moo, if you are a PGY-5, how do you bill - aren't you under a resident's salary? Different for community med?

 

If you work 365 days a year, see 50 patients a day, at 30 bucks each, you will bill 547500. Average of about 1500 a day. Some docs still bill more than this (on MSP alone). When you see 50 patients though, you usually will bill about 1700, because of all the extra stuff (sick notes, WCB, etc.) The most I've ever billed in one day was like 3100, seeing about 55 patients, with hospital work, chronic disease fees, forms, etc.

 

Of course, some visits are worth more than 30 bucks each (older people above the age of 50;) that still counts as one visit.

 

I have my residency salary which takes care of my mortgage. My wife does not work.

 

And then I have my medical corporation for which I am FFS.

[ghost dog]

I have my residency salary which takes care of my mortgage. My wife does not work.

 

And then I have my medical corporation for which I am FFS.

 

Interesting, I didn't know this.

 

I knew a few peeps who were in comm medicine who transferred into family medicine.

[rmorelan]

Interesting, I didn't know this.

 

I knew a few peeps who were in comm medicine who transferred into family medicine.

 

Yeah, let's see if I remember this - moo already has a FM residency so is able to practise FFS under that, and is also a resident so gets salary with that (could be wrong on that though - although in any case I have seen that a few times with people doing extra training in other areas).

[ghost dog]

If you work 365 days a year, see 50 patients a day, at 30 bucks each, you will bill 547500. Average of about 1500 a day. Some docs still bill more than this (on MSP alone). When you see 50 patients though, you usually will bill about 1700, because of all the extra stuff (sick notes, WCB, etc.) The most I've ever billed in one day was like 3100, seeing about 55 patients, with hospital work, chronic disease fees, forms, etc.

 

Of course, some visits are worth more than 30 bucks each (older people above the age of 50;) that still counts as one visit.

 

I have my residency salary which takes care of my mortgage. My wife does not work.

 

And then I have my medical corporation for which I am FFS.

 

Why not see patients 12 hours a day , 365 days / year ? You could be a gazillionaire (he says while holding pinky finger thusly ) LOL. Serenity now.

 

This is not a realistic rep of most family MDs practices. This is more representative of a walk in clinic; yes, you can see 50 patients / day via this model.

 

Most family docs see about 25-30 pts / day.

 

Walk in clinics get to be a bit boring after awhile; also burn out is a factor. Most docs will take a walk in shift 1-2 days / week. But every day? That's a bit much.

 

pt: "Doc I've had this cough for the past 2 weeks."

 

Me: "Well, it seems like a viral infection (acute bronchitis). Antibiotics won't help."

 

pt: "The last doc gave me antibiotics and it cleared up a few days later (pause). Can't you just give me a script for antibiotics?"

 

Rinse and repeat (x at least 5-10 times per walk in shift). Not exactly rewarding medicine, although $$.

 

You also get a lot of drug seekers in the walk in.

[moo]

Moo, how are you able to work so much independently during your residency?

 

Not hard. Just be organized and never procrastinate

[moo]

Why not see patients 12 hours a day , 365 days / year ? You could be a gazillionaire (he says while holding pinky finger thusly ) LOL. Serenity now.

 

This is not a realistic rep of most family MDs practices. This is more representative of a walk in clinic; yes, you can see 50 patients / day via this model.

 

Most family docs see about 25-30 pts / day.

 

Walk in clinics get to be a bit boring after awhile; also burn out is a factor. Most docs will take a walk in shift 1-2 days / week. But every day? That's a bit much.

 

pt: "Doc I've had this cough for the past 2 weeks."

 

Me: "Well, it seems like a viral infection (acute bronchitis). Antibiotics won't help."

 

pt: "The last doc gave me antibiotics and it cleared up a few days later (pause). Can't you just give me a script for antibiotics?"

 

Rinse and repeat (x at least 5-10 times per walk in shift). Not exactly rewarding medicine, although $$.

 

You also get a lot of drug seekers in the walk in.

 

Yeah walk-in is exactly like that. I do have my own patients which I book in between. And also that's why I do public health. It gives me a break from all the routine-ness of walk-in clinic and even family medicine.

[coastalslacker]

Moo, how are you able to work so much independently during your residency?

 

Depends on what you're doing your residency in.

 

I think if people in the business world looked at how residents are paid they would be incredulous - pay based on years of service, not how much work people are actually required to do. Anyways, so it goes - ain't changing soon.

[A-Stark]

Depends on what you're doing your residency in.

 

I think if people in the business world looked at how residents are paid they would be incredulous - pay based on years of service, not how much work people are actually required to do. Anyways, so it goes - ain't changing soon.

 

True, though my fairly young preceptor was stunned yesterday that first-year residents make at least $50k. He said that PGY5s made about that much "in his day" and he started out making $30k.

[justletmein]

True, though my fairly young preceptor was stunned yesterday that first-year residents make at least $50k. He said that PGY5s made about that much "in his day" and he started out making $30k.

 

He probably did his residency in Quebec. lol.

[moo]

True, though my fairly young preceptor was stunned yesterday that first-year residents make at least $50k. He said that PGY5s made about that much "in his day" and he started out making $30k.

 

How young is your preceptor? In 2006, I was making 48K in Alberta in my first year of residency.

[aaronjw]

Depends on what you're doing your residency in.

 

I think if people in the business world looked at how residents are paid they would be incredulous - pay based on years of service, not how much work people are actually required to do. Anyways, so it goes - ain't changing soon.

 

pay in the business world isn't necessarily based on "how much work people are required to do" so much as it's based on A) your responsibilities to the organization and/or value to the company - what having you there means to the bottom line.

[thebouque]

pay in the business world isn't necessarily based on "how much work people are required to do" so much as it's based on A) your responsibilities to the organization and/or value to the company - what having you there means to the bottom line.

 

C) luck

 

 

 

10 char

[aaronjw]

C) luck

 

 

 

10 char

 

translation: networking lol