Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 RE: 24/7 access -- is this realistic? All depends on degree. 1) Email for NONurgent contact-- I also use a Blackberry to keep up to date on pt's emails, esp if not near computer. 2) Office hours for regular, same day care whenever possible. 3) I've chosen NOT to do nursing home, or hospital work-- BUT I have chosen, and offer, and emphasize my responsiveness to pts after hours. Thus I'm able to provide access, and NOT burn out. Curiously, most pts don't call, and those that do, I know well, and call takes 5 min or so. I do USUALLY keep my computer database available for hx review. 4) Contrary to what some say, I DO employ an answering service. Not much money (about $60/month if minimal calls), but protection from pt insisting they called me, say, and having a bit of a buffer between me and pts after office hours is very helpful to "prevent" burnout issues. 5) Cell phone with high limit, nationally. I use this but adjusted time. Pagers in our area have become unreliable-- most use telephones. Just my thoughts... Dr Matt Levin FP, solo since Dec 2004 SOAPware user since 1997 Pittsburgh, PA 24/7 access i am concerned that as we promote this model, we don't fall into the trap of being all things and always available to our patients. i think 24/7 care/access leads to burnout, can promote inappropriate patient behavior, and can potentially delay urgent/emergent treatment, and result in increased liability. we do what we do in the office; if something happens that requires additional care outside of office hours, and is such that it can't wait, patients should go to urgent care or the emergency department, or call 911. that's why those services exist. we are not lone rangers. if there is a question about liability, the standard used, from what i've read, is the layman's perception and understanding of the situation. who's going to stake their license and malpractice insurance on their ability to diagnose over the telephone, other than to say, i think you need to be seen; go to urgent care or the hospital emergency department? when the patient says, i don't want to, it's too expensive, i just want you to reassure me, you're "it". good patient education, in the office, about potential complications and worsening symptoms, with the recommendation to either return during office hours, or to go to urgent care/emergency department/call 911 outside of office hours, is the responsible and appropriate thing to do. certainly, with certain patients, where one's knowledge of the patient can help to avoid expensive and needless additional work-up, it would be appropriate to be contacted, or to have that information available. circumstances will be different in different areas and with individual preference. nonetheless, i question what i perceive to be the underlying theme, that the system is screwed up, i do things the way they should be done, and i am the only one who can do my patients right. it's a setup for expectations which can't be met, and will ultimately lead to frustration, for us and for patients. LL Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously low rates. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 RE: 24/7 access -- is this realistic? All depends on degree. 1) Email for NONurgent contact-- I also use a Blackberry to keep up to date on pt's emails, esp if not near computer. 2) Office hours for regular, same day care whenever possible. 3) I've chosen NOT to do nursing home, or hospital work-- BUT I have chosen, and offer, and emphasize my responsiveness to pts after hours. Thus I'm able to provide access, and NOT burn out. Curiously, most pts don't call, and those that do, I know well, and call takes 5 min or so. I do USUALLY keep my computer database available for hx review. 4) Contrary to what some say, I DO employ an answering service. Not much money (about $60/month if minimal calls), but protection from pt insisting they called me, say, and having a bit of a buffer between me and pts after office hours is very helpful to "prevent" burnout issues. 5) Cell phone with high limit, nationally. I use this but adjusted time. Pagers in our area have become unreliable-- most use telephones. Just my thoughts... Dr Matt Levin FP, solo since Dec 2004 SOAPware user since 1997 Pittsburgh, PA 24/7 access i am concerned that as we promote this model, we don't fall into the trap of being all things and always available to our patients. i think 24/7 care/access leads to burnout, can promote inappropriate patient behavior, and can potentially delay urgent/emergent treatment, and result in increased liability. we do what we do in the office; if something happens that requires additional care outside of office hours, and is such that it can't wait, patients should go to urgent care or the emergency department, or call 911. that's why those services exist. we are not lone rangers. if there is a question about liability, the standard used, from what i've read, is the layman's perception and understanding of the situation. who's going to stake their license and malpractice insurance on their ability to diagnose over the telephone, other than to say, i think you need to be seen; go to urgent care or the hospital emergency department? when the patient says, i don't want to, it's too expensive, i just want you to reassure me, you're "it". good patient education, in the office, about potential complications and worsening symptoms, with the recommendation to either return during office hours, or to go to urgent care/emergency department/call 911 outside of office hours, is the responsible and appropriate thing to do. certainly, with certain patients, where one's knowledge of the patient can help to avoid expensive and needless additional work-up, it would be appropriate to be contacted, or to have that information available. circumstances will be different in different areas and with individual preference. nonetheless, i question what i perceive to be the underlying theme, that the system is screwed up, i do things the way they should be done, and i am the only one who can do my patients right. it's a setup for expectations which can't be met, and will ultimately lead to frustration, for us and for patients. LL Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously low rates. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 Two posts regarding 24/7 access. The first is a repost from Eads: X-Yahoo-Profile: meads1521 Mailing-List: list ; contact -owner Delivered-To: mailing list List-Unsubscribe: < mailto:-unsubscribe > Date: Fri, 4 Feb 2005 19:44:22 -0700 Subject: part time w/ open access Reply-To: Hi Stacey, I opened my part time (19 pt contact hours per week, 46 weeks a year) practice July 2003. I’m in the office a little M-F, with essentially a full day on Mon, then tapers down to 2 hours on Fridays. This has worked out very well for myself and my patients. Previously I was in a group working 2.5 days (pt contact time), and was not seeing pts 2 days out of the typical 5 day work week. My new practice’s hours work much better for continuity of care, accessibility, etc, with me being in the office M-F. I’ve been using open-access from the beginning, and it has worked out well. I can almost always see someone same day if requested, but sometimes have to defer a day or 2 for routine things like physicals or follow ups if pt wants to be seen at a certain time of day, etc. I have seen a few patients outside of my normal business hours (maybe 4 since I opened up). Most people understand that I want to be a Mommy too, and have not had any complaints. I am certain to mention my hours when people are checking out my practice, and have it in m y practice brochure. The accessibility is also enhanced by my phone and email care, which many people love. This can help reduce the strain on the schedule of face-to-face communication if it is not needed. I would probably bring in more money if I did not do this, but it works well for me. It may be difficult to do open access if you are not in the office M-F. A. Eads, M.D. At 08:26 PM 5/5/2006, you wrote: RE: 24/7 access -- is this realistic? All depends on degree. 1) Email for NONurgent contact-- I also use a Blackberry to keep up to date on pt's emails, esp if not near computer. 2) Office hours for regular, same day care whenever possible. 3) I've chosen NOT to do nursing home, or hospital work-- BUT I have chosen, and offer, and emphasize my responsiveness to pts after hours. Thus I'm able to provide access, and NOT burn out. Curiously, most pts don't call, and those that do, I know well, and call takes 5 min or so. I do USUALLY keep my computer database available for hx review. 4) Contrary to what some say, I DO employ an answering service. Not much money (about $60/month if minimal calls), but protection from pt insisting they called me, say, and having a bit of a buffer between me and pts after office hours is very helpful to " prevent " burnout issues. 5) Cell phone with high limit, nationally. I use this but adjusted time. Pagers in our area have become unreliable-- most use telephones. Just my thoughts... Dr Matt Levin FP, solo since Dec 2004 SOAPware user since 1997 Pittsburgh, PA 24/7 access i am concerned that as we promote this model, we don't fall into the trap of being all things and always available to our patients. i think 24/7 care/access leads to burnout, can promote inappropriate patient behavior, and can potentially delay urgent/emergent treatment, and result in increased liability. we do what we do in the office; if something happens that requires additional care outside of office hours, and is such that it can't wait, patients should go to urgent care or the emergency department, or call 911. that's why those services exist. we are not lone rangers. if there is a question about liability, the standard used, from what i've read, is the layman's perception and understanding of the situation. who's going to stake their license and malpractice insurance on their ability to diagnose over the telephone, other than to say, i think you need to be seen; go to urgent care or the hospital emergency department? when the patient says, i don't want to, it's too expensive, i just want you to reassure me, you're " it " . good patient education, in the office, about potential complications and worsening symptoms, with the recommendation to either return during office hours, or to go to urgent care/emergency department/call 911 outside of office hours, is the responsible and appropriate thing to do. certainly, with certain patients, where one's knowledge of the patient can help to avoid expensive and needless additional work-up, it would be appropriate to be contacted, or to have that information available. circumstances will be different in different areas and with individual preference. nonetheless, i question what i perceive to be the underlying theme, that the system is screwed up, i do things the way they should be done, and i am the only one who can do my patients right. it's a setup for expectations which can't be met, and will ultimately lead to frustration, for us and for patients. LL Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously low rates. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 I would like to get a better idea what people think about the right panel size. I am planning to work about 20 hours a week (of patient contact hours) and plan no staff. Almost all of the patients will be ones that I have been seeing at a bigger office run by the local hospital. What is everyone’s opinion on panel size? A special request for feedback from Eads, since her practice sounds very similar to mine. Kerry Graff Canandaigua. NY From: [mailto: ] On Behalf Of L. Gordon Sent: Saturday, May 06, 2006 9:42 AM To: Subject: Re: 24/7 access Two posts regarding 24/7 access. The first is a repost from Eads: X-Yahoo-Profile: meads1521 Mailing-List: list ; contact -owner Delivered-To: mailing list List-Unsubscribe: < mailto:-unsubscribe > Date: Fri, 4 Feb 2005 19:44:22 -0700 Subject: part time w/ open access Reply-To: Hi Stacey, I opened my part time (19 pt contact hours per week, 46 weeks a year) practice July 2003. Im in the office a little M-F, with essentially a full day on Mon, then tapers down to 2 hours on Fridays. This has worked out very well for myself and my patients. Previously I was in a group working 2.5 days (pt contact time), and was not seeing pts 2 days out of the typical 5 day work week. My new practices hours work much better for continuity of care, accessibility, etc, with me being in the office M-F. Ive been using open-access from the beginning, and it has worked out well. I can almost always see someone same day if requested, but sometimes have to defer a day or 2 for routine things like physicals or follow ups if pt wants to be seen at a certain time of day, etc. I have seen a few patients outside of my normal business hours (maybe 4 since I opened up). Most people understand that I want to be a Mommy too, and have not had any complaints. I am certain to mention my hours when people are checking out my practice, and have it in m y practice brochure. The accessibility is also enhanced by my phone and email care, which many people love. This can help reduce the strain on the schedule of face-to-face communication if it is not needed. I would probably bring in more money if I did not do this, but it works well for me. It may be difficult to do open access if you are not in the office M-F. A. Eads, M.D. At 08:26 PM 5/5/2006, you wrote: RE: 24/7 access -- is this realistic? All depends on degree. 1) Email for NONurgent contact-- I also use a Blackberry to keep up to date on pt's emails, esp if not near computer. 2) Office hours for regular, same day care whenever possible. 3) I've chosen NOT to do nursing home, or hospital work-- BUT I have chosen, and offer, and emphasize my responsiveness to pts after hours. Thus I'm able to provide access, and NOT burn out. Curiously, most pts don't call, and those that do, I know well, and call takes 5 min or so. I do USUALLY keep my computer database available for hx review. 4) Contrary to what some say, I DO employ an answering service. Not much money (about $60/month if minimal calls), but protection from pt insisting they called me, say, and having a bit of a buffer between me and pts after office hours is very helpful to " prevent " burnout issues. 5) Cell phone with high limit, nationally. I use this but adjusted time. Pagers in our area have become unreliable-- most use telephones. Just my thoughts... Dr Matt Levin FP, solo since Dec 2004 SOAPware user since 1997 Pittsburgh, PA 24/7 access i am concerned that as we promote this model, we don't fall into the trap of being all things and always available to our patients. i think 24/7 care/access leads to burnout, can promote inappropriate patient behavior, and can potentially delay urgent/emergent treatment, and result in increased liability. we do what we do in the office; if something happens that requires additional care outside of office hours, and is such that it can't wait, patients should go to urgent care or the emergency department, or call 911. that's why those services exist. we are not lone rangers. if there is a question about liability, the standard used, from what i've read, is the layman's perception and understanding of the situation. who's going to stake their license and malpractice insurance on their ability to diagnose over the telephone, other than to say, i think you need to be seen; go to urgent care or the hospital emergency department? when the patient says, i don't want to, it's too expensive, i just want you to reassure me, you're " it " . good patient education, in the office, about potential complications and worsening symptoms, with the recommendation to either return during office hours, or to go to urgent care/emergency department/call 911 outside of office hours, is the responsible and appropriate thing to do. certainly, with certain patients, where one's knowledge of the patient can help to avoid expensive and needless additional work-up, it would be appropriate to be contacted, or to have that information available. circumstances will be different in different areas and with individual preference. nonetheless, i question what i perceive to be the underlying theme, that the system is screwed up, i do things the way they should be done, and i am the only one who can do my patients right. it's a setup for expectations which can't be met, and will ultimately lead to frustration, for us and for patients. LL Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously low rates. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 Speaking of not doing inpatient (hospital) work, do many of you have patients that complain and/or transfer out of the practice because of that one issue? I've had a few " old tomers " that just do not get that I don't do hospital work & have left the practice because of it. I guess it just goes back to the notion that you absolutely will not please every patient & sometimes it just not a good match. > > > Date: 2006/05/05 Fri PM 08:26:50 EDT > To: < > > Subject: Re: 24/7 access > > RE: 24/7 access -- is this realistic? > > All depends on degree. > 1) Email for NONurgent contact-- I also use a Blackberry to keep up to date on pt's emails, esp if not near computer. > 2) Office hours for regular, same day care whenever possible. > 3) I've chosen NOT to do nursing home, or hospital work-- BUT I have chosen, and offer, and emphasize my responsiveness to pts after hours. Thus I'm able to provide access, and NOT burn out. > > Curiously, most pts don't call, and those that do, I know well, and call takes 5 min or so. I do USUALLY keep my computer database available for hx review. > > 4) Contrary to what some say, I DO employ an answering service. Not much money (about $60/month if minimal calls), but protection from pt insisting they called me, say, and having a bit of a buffer between me and pts after office hours is very helpful to " prevent " burnout issues. > 5) Cell phone with high limit, nationally. I use this but adjusted time. Pagers in our area have become unreliable-- most use telephones. > > Just my thoughts... > > Dr Matt Levin > FP, solo since Dec 2004 > SOAPware user since 1997 > Pittsburgh, PA > 24/7 access > > > i am concerned that as we promote this model, we don't fall into the trap of being all things and always available to our patients. > i think 24/7 care/access leads to burnout, can promote inappropriate patient behavior, and can potentially delay urgent/emergent treatment, and result in increased liability. > we do what we do in the office; if something happens that requires additional care outside of office hours, and is such that it can't wait, patients should go to urgent care or the emergency department, or call 911. that's why those services exist. > we are not lone rangers. > if there is a question about liability, the standard used, from what i've read, is the layman's perception and understanding of the situation. > who's going to stake their license and malpractice insurance on their ability to diagnose over the telephone, other than to say, i think you need to be seen; go to urgent care or the hospital emergency department? when the patient says, i don't want to, it's too expensive, i just want you to reassure me, you're " it " . > good patient education, in the office, about potential complications and worsening symptoms, with the recommendation to either return during office hours, or to go to urgent care/emergency department/call 911 outside of office hours, is the responsible and appropriate thing to do. > certainly, with certain patients, where one's knowledge of the patient can help to avoid expensive and needless additional work-up, it would be appropriate to be contacted, or to have that information available. circumstances will be different in different areas and with individual preference. > nonetheless, i question what i perceive to be the underlying theme, that the system is screwed up, i do things the way they should be done, and i am the only one who can do my patients right. it's a setup for expectations which can't be met, and will ultimately lead to frustration, for us and for patients. > > LL > > > ------------------------------------------------------------------------------ > Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously low rates. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 I would guess between 400-500 active patients. However, a lot depends on your style of medicine (ex.how soon do you follow up HTN and diabetic patients), how many HMO type insurances you have (i.e. how many referrals need to be put through) and if you are doing your own billing (which either takes time or costs money). You will have a good feel for how busy your schedule is as you reach this number and be able to decide whether to shut down to new patients or keep taking more in. part time w/ open access Reply-To: Hi Stacey, I opened my part time (19 pt contact hours per week, 46 weeks a year) practice July 2003. Im in the office a little M-F, with essentially a full day on Mon, then tapers down to 2 hours on Fridays. This has worked out very well for myself and my patients. Previously I was in a group working 2.5 days (pt contact time), and was not seeing pts 2 days out of the typical 5 day work week. My new practices hours work much better for continuity of care, accessibility, etc, with me being in the office M-F. Ive been using open-access from the beginning, and it has worked out well. I can almost always see someone same day if requested, but sometimes have to defer a day or 2 for routine things like physicals or follow ups if pt wants to be seen at a certain time of day, etc. I have seen a few patients outside of my normal business hours (maybe 4 since I opened up). Most people understand that I want to be a Mommy too, and have not had any complaints. I am certain to mention my hours when people are checking out my practice, and have it in m y practice brochure. The accessibility is also enhanced by my phone and email care, which many people love. This can help reduce the strain on the schedule of face-to-face communication if it is not needed. I would probably bring in more money if I did not do this, but it works well for me. It may be difficult to do open access if you are not in the office M-F. A. Eads, M.D. At 08:26 PM 5/5/2006, you wrote: RE: 24/7 access -- is this realistic? All depends on degree. 1) Email for NONurgent contact-- I also use a Blackberry to keep up to date on pt's emails, esp if not near computer. 2) Office hours for regular, same day care whenever possible. 3) I've chosen NOT to do nursing home, or hospital work-- BUT I have chosen, and offer, and emphasize my responsiveness to pts after hours. Thus I'm able to provide access, and NOT burn out. Curiously, most pts don't call, and those that do, I know well, and call takes 5 min or so. I do USUALLY keep my computer database available for hx review. 4) Contrary to what some say, I DO employ an answering service. Not much money (about $60/month if minimal calls), but protection from pt insisting they called me, say, and having a bit of a buffer between me and pts after office hours is very helpful to " prevent " burnout issues. 5) Cell phone with high limit, nationally. I use this but adjusted time. Pagers in our area have become unreliable-- most use telephones. Just my thoughts... Dr Matt Levin FP, solo since Dec 2004 SOAPware user since 1997 Pittsburgh, PA 24/7 access i am concerned that as we promote this model, we don't fall into the trap of being all things and always available to our patients. i think 24/7 care/access leads to burnout, can promote inappropriate patient behavior, and can potentially delay urgent/emergent treatment, and result in increased liability. we do what we do in the office; if something happens that requires additional care outside of office hours, and is such that it can't wait, patients should go to urgent care or the emergency department, or call 911. that's why those services exist. we are not lone rangers. if there is a question about liability, the standard used, from what i've read, is the layman's perception and understanding of the situation. who's going to stake their license and malpractice insurance on their ability to diagnose over the telephone, other than to say, i think you need to be seen; go to urgent care or the hospital emergency department? when the patient says, i don't want to, it's too expensive, i just want you to reassure me, you're " it " . good patient education, in the office, about potential complications and worsening symptoms, with the recommendation to either return during office hours, or to go to urgent care/emergency department/call 911 outside of office hours, is the responsible and appropriate thing to do. certainly, with certain patients, where one's knowledge of the patient can help to avoid expensive and needless additional work-up, it would be appropriate to be contacted, or to have that information available. circumstances will be different in different areas and with individual preference. nonetheless, i question what i perceive to be the underlying theme, that the system is screwed up, i do things the way they should be done, and i am the only one who can do my patients right. it's a setup for expectations which can't be met, and will ultimately lead to frustration, for us and for patients. LL Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously low rates. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 Yes, I have had a couple of patients not come back after their initial “interview” simply because I don’t admit. The unfortunate part is I generally agree with them. They are better off if they can find someone who can establish a good dr/patient relationship, follow them closely in both the outpatient and inpatient settings and have the skills to figure out how to make both aspects of their practice balance with a family life. The problem is that I have not figured out a way of doing this, and in general I would say no other doctor in the area has been able to do it all that well either. Something always seems to suffer. I am interested in those who have managed to make inpatient and outpatient work together. How do you do it? Is call a nightmare? Re: 24/7 access > > RE: 24/7 access -- is this realistic? > > All depends on degree. > 1) Email for NONurgent contact-- I also use a Blackberry to keep up to date on pt's emails, esp if not near computer. > 2) Office hours for regular, same day care whenever possible. > 3) I've chosen NOT to do nursing home, or hospital work-- BUT I have chosen, and offer, and emphasize my responsiveness to pts after hours. Thus I'm able to provide access, and NOT burn out. > > Curiously, most pts don't call, and those that do, I know well, and call takes 5 min or so. I do USUALLY keep my computer database available for hx review. > > 4) Contrary to what some say, I DO employ an answering service. Not much money (about $60/month if minimal calls), but protection from pt insisting they called me, say, and having a bit of a buffer between me and pts after office hours is very helpful to " prevent " burnout issues. > 5) Cell phone with high limit, nationally. I use this but adjusted time. Pagers in our area have become unreliable-- most use telephones. > > Just my thoughts... > > Dr Matt Levin > FP, solo since Dec 2004 > SOAPware user since 1997 > Pittsburgh, PA > 24/7 access > > > i am concerned that as we promote this model, we don't fall into the trap of being all things and always available to our patients. > i think 24/7 care/access leads to burnout, can promote inappropriate patient behavior, and can potentially delay urgent/emergent treatment, and result in increased liability. > we do what we do in the office; if something happens that requires additional care outside of office hours, and is such that it can't wait, patients should go to urgent care or the emergency department, or call 911. that's why those services exist. > we are not lone rangers. > if there is a question about liability, the standard used, from what i've read, is the layman's perception and understanding of the situation. > who's going to stake their license and malpractice insurance on their ability to diagnose over the telephone, other than to say, i think you need to be seen; go to urgent care or the hospital emergency department? when the patient says, i don't want to, it's too expensive, i just want you to reassure me, you're " it " . > good patient education, in the office, about potential complications and worsening symptoms, with the recommendation to either return during office hours, or to go to urgent care/emergency department/call 911 outside of office hours, is the responsible and appropriate thing to do. > certainly, with certain patients, where one's knowledge of the patient can help to avoid expensive and needless additional work-up, it would be appropriate to be contacted, or to have that information available. circumstances will be different in different areas and with individual preference. > nonetheless, i question what i perceive to be the underlying theme, that the system is screwed up, i do things the way they should be done, and i am the only one who can do my patients right. it's a setup for expectations which can't be met, and will ultimately lead to frustration, for us and for patients. > > LL > > > ------------------------------------------------------------------------------ > Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously low rates. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 It depends on you proximity to hospital. For us it is right next door. It does add to your call load at night because a hospital staff does not care what time of day or night they call for some very stupid stuff. I have not had a patient in hospital for 2 weeks now. Usually will have a census or one or two. It will add about 15 percent billings to practice with minimal overhead. It fits the LOVE style. Brent > > Yes, I have had a couple of patients not come back after their initial > " interview " simply because I don't admit. The unfortunate part is I > generally agree with them. They are better off if they can find someone > who can establish a good dr/patient relationship, follow them closely in > both the outpatient and inpatient settings and have the skills to figure > out how to make both aspects of their practice balance with a family > life. The problem is that I have not figured out a way of doing this, > and in general I would say no other doctor in the area has been able to > do it all that well either. Something always seems to suffer. I am > interested in those who have managed to make inpatient and outpatient > work together. How do you do it? Is call a nightmare? > > Re: 24/7 access > > > > RE: 24/7 access -- is this realistic? > > > > All depends on degree. > > 1) Email for NONurgent contact-- I also use a Blackberry to keep up to > date on pt's emails, esp if not near computer. > > 2) Office hours for regular, same day care whenever possible. > > 3) I've chosen NOT to do nursing home, or hospital work-- BUT I have > chosen, and offer, and emphasize my responsiveness to pts after hours. > Thus I'm able to provide access, and NOT burn out. > > > > Curiously, most pts don't call, and those that do, I know well, and > call takes 5 min or so. I do USUALLY keep my computer database > available for hx review. > > > > 4) Contrary to what some say, I DO employ an answering service. Not > much money (about $60/month if minimal calls), but protection from pt > insisting they called me, say, and having a bit of a buffer between me > and pts after office hours is very helpful to " prevent " burnout issues. > > 5) Cell phone with high limit, nationally. I use this but adjusted > time. Pagers in our area have become unreliable-- most use telephones. > > > > Just my thoughts... > > > > Dr Matt Levin > > FP, solo since Dec 2004 > > SOAPware user since 1997 > > Pittsburgh, PA > > 24/7 access > > > > > > i am concerned that as we promote this model, we don't fall into the > trap of being all things and always available to our patients. > > i think 24/7 care/access leads to burnout, can promote inappropriate > patient behavior, and can potentially delay urgent/emergent treatment, > and result in increased liability. > > we do what we do in the office; if something happens that requires > additional care outside of office hours, and is such that it can't wait, > patients should go to urgent care or the emergency department, or call > 911. that's why those services exist. > > we are not lone rangers. > > if there is a question about liability, the standard used, from what > i've read, is the layman's perception and understanding of the > situation. > > who's going to stake their license and malpractice insurance on > their ability to diagnose over the telephone, other than to say, i think > you need to be seen; go to urgent care or the hospital emergency > department? when the patient says, i don't want to, it's too expensive, > i just want you to reassure me, you're " it " . > > good patient education, in the office, about potential complications > and worsening symptoms, with the recommendation to either return during > office hours, or to go to urgent care/emergency department/call 911 > outside of office hours, is the responsible and appropriate thing to do. > > certainly, with certain patients, where one's knowledge of the > patient can help to avoid expensive and needless additional work- up, it > would be appropriate to be contacted, or to have that information > available. circumstances will be different in different areas and with > individual preference. > > nonetheless, i question what i perceive to be the underlying theme, > that the system is screwed up, i do things the way they should be done, > and i am the only one who can do my patients right. it's a setup for > expectations which can't be met, and will ultimately lead to > frustration, for us and for patients. > > > > LL > > > > > > > -------------------------------------------------------------------- ---- > ------ > > Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously low > rates. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 In my first 6 months of practice, I had seven admissions (many, if I consider the number of patients I have... but I have a couple of sick ones like metastatic cancer, end stage CHF...). The hospital I admit at is wonderful, no bogus calls (like colace at midnight), nice nurses, relaxed and prompt consultants...I love it. > It depends on you proximity to hospital. For us it is right next > door. It does add to your call load at night because a hospital > staff does not care what time of day or night they call for some very > stupid stuff. I have not had a patient in hospital for 2 weeks now. > Usually will have a census or one or two. It will add about 15 > percent billings to practice with minimal overhead. It fits the LOVE > style. > Brent > >> >> Yes, I have had a couple of patients not come back after their > initial >> " interview " simply because I don't admit. The unfortunate part is I >> generally agree with them. They are better off if they can find > someone >> who can establish a good dr/patient relationship, follow them > closely in >> both the outpatient and inpatient settings and have the skills to > figure >> out how to make both aspects of their practice balance with a family >> life. The problem is that I have not figured out a way of doing > this, >> and in general I would say no other doctor in the area has been > able to >> do it all that well either. Something always seems to suffer. I am >> interested in those who have managed to make inpatient and > outpatient >> work together. How do you do it? Is call a nightmare? >> >> Re: 24/7 access >>> >>> RE: 24/7 access -- is this realistic? >>> >>> All depends on degree. >>> 1) Email for NONurgent contact-- I also use a Blackberry to keep > up to >> date on pt's emails, esp if not near computer. >>> 2) Office hours for regular, same day care whenever possible. >>> 3) I've chosen NOT to do nursing home, or hospital work-- BUT I > have >> chosen, and offer, and emphasize my responsiveness to pts after > hours. >> Thus I'm able to provide access, and NOT burn out. >>> >>> Curiously, most pts don't call, and those that do, I know well, > and >> call takes 5 min or so. I do USUALLY keep my computer database >> available for hx review. >>> >>> 4) Contrary to what some say, I DO employ an answering service. > Not >> much money (about $60/month if minimal calls), but protection from > pt >> insisting they called me, say, and having a bit of a buffer between > me >> and pts after office hours is very helpful to " prevent " burnout > issues. >>> 5) Cell phone with high limit, nationally. I use this but > adjusted >> time. Pagers in our area have become unreliable-- most use > telephones. >>> >>> Just my thoughts... >>> >>> Dr Matt Levin >>> FP, solo since Dec 2004 >>> SOAPware user since 1997 >>> Pittsburgh, PA >>> 24/7 access >>> >>> >>> i am concerned that as we promote this model, we don't fall > into the >> trap of being all things and always available to our patients. >>> i think 24/7 care/access leads to burnout, can promote > inappropriate >> patient behavior, and can potentially delay urgent/emergent > treatment, >> and result in increased liability. >>> we do what we do in the office; if something happens that > requires >> additional care outside of office hours, and is such that it can't > wait, >> patients should go to urgent care or the emergency department, or > call >> 911. that's why those services exist. >>> we are not lone rangers. >>> if there is a question about liability, the standard used, from > what >> i've read, is the layman's perception and understanding of the >> situation. >>> who's going to stake their license and malpractice insurance on >> their ability to diagnose over the telephone, other than to say, i > think >> you need to be seen; go to urgent care or the hospital emergency >> department? when the patient says, i don't want to, it's too > expensive, >> i just want you to reassure me, you're " it " . >>> good patient education, in the office, about potential > complications >> and worsening symptoms, with the recommendation to either return > during >> office hours, or to go to urgent care/emergency department/call 911 >> outside of office hours, is the responsible and appropriate thing > to do. >>> certainly, with certain patients, where one's knowledge of the >> patient can help to avoid expensive and needless additional work- > up, it >> would be appropriate to be contacted, or to have that information >> available. circumstances will be different in different areas and > with >> individual preference. >>> nonetheless, i question what i perceive to be the underlying > theme, >> that the system is screwed up, i do things the way they should be > done, >> and i am the only one who can do my patients right. it's a setup > for >> expectations which can't be met, and will ultimately lead to >> frustration, for us and for patients. >>> >>> LL >>> >>> >>> >> -------------------------------------------------------------------- > ---- >> ------ >>> Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously > low >> rates. >>> >>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 In my first 6 months of practice, I had seven admissions (many, if I consider the number of patients I have... but I have a couple of sick ones like metastatic cancer, end stage CHF...). The hospital I admit at is wonderful, no bogus calls (like colace at midnight), nice nurses, relaxed and prompt consultants...I love it. > It depends on you proximity to hospital. For us it is right next > door. It does add to your call load at night because a hospital > staff does not care what time of day or night they call for some very > stupid stuff. I have not had a patient in hospital for 2 weeks now. > Usually will have a census or one or two. It will add about 15 > percent billings to practice with minimal overhead. It fits the LOVE > style. > Brent > >> >> Yes, I have had a couple of patients not come back after their > initial >> " interview " simply because I don't admit. The unfortunate part is I >> generally agree with them. They are better off if they can find > someone >> who can establish a good dr/patient relationship, follow them > closely in >> both the outpatient and inpatient settings and have the skills to > figure >> out how to make both aspects of their practice balance with a family >> life. The problem is that I have not figured out a way of doing > this, >> and in general I would say no other doctor in the area has been > able to >> do it all that well either. Something always seems to suffer. I am >> interested in those who have managed to make inpatient and > outpatient >> work together. How do you do it? Is call a nightmare? >> >> Re: 24/7 access >>> >>> RE: 24/7 access -- is this realistic? >>> >>> All depends on degree. >>> 1) Email for NONurgent contact-- I also use a Blackberry to keep > up to >> date on pt's emails, esp if not near computer. >>> 2) Office hours for regular, same day care whenever possible. >>> 3) I've chosen NOT to do nursing home, or hospital work-- BUT I > have >> chosen, and offer, and emphasize my responsiveness to pts after > hours. >> Thus I'm able to provide access, and NOT burn out. >>> >>> Curiously, most pts don't call, and those that do, I know well, > and >> call takes 5 min or so. I do USUALLY keep my computer database >> available for hx review. >>> >>> 4) Contrary to what some say, I DO employ an answering service. > Not >> much money (about $60/month if minimal calls), but protection from > pt >> insisting they called me, say, and having a bit of a buffer between > me >> and pts after office hours is very helpful to " prevent " burnout > issues. >>> 5) Cell phone with high limit, nationally. I use this but > adjusted >> time. Pagers in our area have become unreliable-- most use > telephones. >>> >>> Just my thoughts... >>> >>> Dr Matt Levin >>> FP, solo since Dec 2004 >>> SOAPware user since 1997 >>> Pittsburgh, PA >>> 24/7 access >>> >>> >>> i am concerned that as we promote this model, we don't fall > into the >> trap of being all things and always available to our patients. >>> i think 24/7 care/access leads to burnout, can promote > inappropriate >> patient behavior, and can potentially delay urgent/emergent > treatment, >> and result in increased liability. >>> we do what we do in the office; if something happens that > requires >> additional care outside of office hours, and is such that it can't > wait, >> patients should go to urgent care or the emergency department, or > call >> 911. that's why those services exist. >>> we are not lone rangers. >>> if there is a question about liability, the standard used, from > what >> i've read, is the layman's perception and understanding of the >> situation. >>> who's going to stake their license and malpractice insurance on >> their ability to diagnose over the telephone, other than to say, i > think >> you need to be seen; go to urgent care or the hospital emergency >> department? when the patient says, i don't want to, it's too > expensive, >> i just want you to reassure me, you're " it " . >>> good patient education, in the office, about potential > complications >> and worsening symptoms, with the recommendation to either return > during >> office hours, or to go to urgent care/emergency department/call 911 >> outside of office hours, is the responsible and appropriate thing > to do. >>> certainly, with certain patients, where one's knowledge of the >> patient can help to avoid expensive and needless additional work- > up, it >> would be appropriate to be contacted, or to have that information >> available. circumstances will be different in different areas and > with >> individual preference. >>> nonetheless, i question what i perceive to be the underlying > theme, >> that the system is screwed up, i do things the way they should be > done, >> and i am the only one who can do my patients right. it's a setup > for >> expectations which can't be met, and will ultimately lead to >> frustration, for us and for patients. >>> >>> LL >>> >>> >>> >> -------------------------------------------------------------------- > ---- >> ------ >>> Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously > low >> rates. >>> >>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2006 Report Share Posted May 7, 2006 RE Hospital follow up. If solo in your " LOVE " model, how can you provide 24/7 access, you always available, AND hospital? Do you share call with someone, and if you do, then don't you have to care for their pts too when you're on call? Maybe I'm missing something... Dr Matt Levin 24/7 access > > > > > > i am concerned that as we promote this model, we don't fall into the > trap of being all things and always available to our patients. > > i think 24/7 care/access leads to burnout, can promote inappropriate > patient behavior, and can potentially delay urgent/emergent treatment, > and result in increased liability. > > we do what we do in the office; if something happens that requires > additional care outside of office hours, and is such that it can't wait, > patients should go to urgent care or the emergency department, or call > 911. that's why those services exist. > > we are not lone rangers. > > if there is a question about liability, the standard used, from what > i've read, is the layman's perception and understanding of the > situation. > > who's going to stake their license and malpractice insurance on > their ability to diagnose over the telephone, other than to say, i think > you need to be seen; go to urgent care or the hospital emergency > department? when the patient says, i don't want to, it's too expensive, > i just want you to reassure me, you're " it " . > > good patient education, in the office, about potential complications > and worsening symptoms, with the recommendation to either return during > office hours, or to go to urgent care/emergency department/call 911 > outside of office hours, is the responsible and appropriate thing to do. > > certainly, with certain patients, where one's knowledge of the > patient can help to avoid expensive and needless additional work- up, it > would be appropriate to be contacted, or to have that information > available. circumstances will be different in different areas and with > individual preference. > > nonetheless, i question what i perceive to be the underlying theme, > that the system is screwed up, i do things the way they should be done, > and i am the only one who can do my patients right. it's a setup for > expectations which can't be met, and will ultimately lead to > frustration, for us and for patients. > > > > LL > > > > > > > -------------------------------------------------------------------- ---- > ------ > > Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously low > rates. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2006 Report Share Posted May 8, 2006 To me, the amount of extra reimbursement gained from an occasional hospital patient is outweighed by the inordinate amount of time involved (traveling, charting, after hrs calls, etc). It would only be worth it to me if I had 2-4 pt's in every day. > > > Date: 2006/05/06 Sat PM 03:35:56 EDT > To: > Subject: Re: 24/7 access > > It depends on you proximity to hospital. For us it is right next > door. It does add to your call load at night because a hospital > staff does not care what time of day or night they call for some very > stupid stuff. I have not had a patient in hospital for 2 weeks now. > Usually will have a census or one or two. It will add about 15 > percent billings to practice with minimal overhead. It fits the LOVE > style. > Brent > > > > > Yes, I have had a couple of patients not come back after their > initial > > " interview " simply because I don't admit. The unfortunate part is I > > generally agree with them. They are better off if they can find > someone > > who can establish a good dr/patient relationship, follow them > closely in > > both the outpatient and inpatient settings and have the skills to > figure > > out how to make both aspects of their practice balance with a family > > life. The problem is that I have not figured out a way of doing > this, > > and in general I would say no other doctor in the area has been > able to > > do it all that well either. Something always seems to suffer. I am > > interested in those who have managed to make inpatient and > outpatient > > work together. How do you do it? Is call a nightmare? > > > > Re: 24/7 access > > > > > > RE: 24/7 access -- is this realistic? > > > > > > All depends on degree. > > > 1) Email for NONurgent contact-- I also use a Blackberry to keep > up to > > date on pt's emails, esp if not near computer. > > > 2) Office hours for regular, same day care whenever possible. > > > 3) I've chosen NOT to do nursing home, or hospital work-- BUT I > have > > chosen, and offer, and emphasize my responsiveness to pts after > hours. > > Thus I'm able to provide access, and NOT burn out. > > > > > > Curiously, most pts don't call, and those that do, I know well, > and > > call takes 5 min or so. I do USUALLY keep my computer database > > available for hx review. > > > > > > 4) Contrary to what some say, I DO employ an answering service. > Not > > much money (about $60/month if minimal calls), but protection from > pt > > insisting they called me, say, and having a bit of a buffer between > me > > and pts after office hours is very helpful to " prevent " burnout > issues. > > > 5) Cell phone with high limit, nationally. I use this but > adjusted > > time. Pagers in our area have become unreliable-- most use > telephones. > > > > > > Just my thoughts... > > > > > > Dr Matt Levin > > > FP, solo since Dec 2004 > > > SOAPware user since 1997 > > > Pittsburgh, PA > > > 24/7 access > > > > > > > > > i am concerned that as we promote this model, we don't fall > into the > > trap of being all things and always available to our patients. > > > i think 24/7 care/access leads to burnout, can promote > inappropriate > > patient behavior, and can potentially delay urgent/emergent > treatment, > > and result in increased liability. > > > we do what we do in the office; if something happens that > requires > > additional care outside of office hours, and is such that it can't > wait, > > patients should go to urgent care or the emergency department, or > call > > 911. that's why those services exist. > > > we are not lone rangers. > > > if there is a question about liability, the standard used, from > what > > i've read, is the layman's perception and understanding of the > > situation. > > > who's going to stake their license and malpractice insurance on > > their ability to diagnose over the telephone, other than to say, i > think > > you need to be seen; go to urgent care or the hospital emergency > > department? when the patient says, i don't want to, it's too > expensive, > > i just want you to reassure me, you're " it " . > > > good patient education, in the office, about potential > complications > > and worsening symptoms, with the recommendation to either return > during > > office hours, or to go to urgent care/emergency department/call 911 > > outside of office hours, is the responsible and appropriate thing > to do. > > > certainly, with certain patients, where one's knowledge of the > > patient can help to avoid expensive and needless additional work- > up, it > > would be appropriate to be contacted, or to have that information > > available. circumstances will be different in different areas and > with > > individual preference. > > > nonetheless, i question what i perceive to be the underlying > theme, > > that the system is screwed up, i do things the way they should be > done, > > and i am the only one who can do my patients right. it's a setup > for > > expectations which can't be met, and will ultimately lead to > > frustration, for us and for patients. > > > > > > LL > > > > > > > > > > > -------------------------------------------------------------------- > ---- > > ------ > > > Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously > low > > rates. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2006 Report Share Posted May 8, 2006 To me, the amount of extra reimbursement gained from an occasional hospital patient is outweighed by the inordinate amount of time involved (traveling, charting, after hrs calls, etc). It would only be worth it to me if I had 2-4 pt's in every day. > > > Date: 2006/05/06 Sat PM 03:35:56 EDT > To: > Subject: Re: 24/7 access > > It depends on you proximity to hospital. For us it is right next > door. It does add to your call load at night because a hospital > staff does not care what time of day or night they call for some very > stupid stuff. I have not had a patient in hospital for 2 weeks now. > Usually will have a census or one or two. It will add about 15 > percent billings to practice with minimal overhead. It fits the LOVE > style. > Brent > > > > > Yes, I have had a couple of patients not come back after their > initial > > " interview " simply because I don't admit. The unfortunate part is I > > generally agree with them. They are better off if they can find > someone > > who can establish a good dr/patient relationship, follow them > closely in > > both the outpatient and inpatient settings and have the skills to > figure > > out how to make both aspects of their practice balance with a family > > life. The problem is that I have not figured out a way of doing > this, > > and in general I would say no other doctor in the area has been > able to > > do it all that well either. Something always seems to suffer. I am > > interested in those who have managed to make inpatient and > outpatient > > work together. How do you do it? Is call a nightmare? > > > > Re: 24/7 access > > > > > > RE: 24/7 access -- is this realistic? > > > > > > All depends on degree. > > > 1) Email for NONurgent contact-- I also use a Blackberry to keep > up to > > date on pt's emails, esp if not near computer. > > > 2) Office hours for regular, same day care whenever possible. > > > 3) I've chosen NOT to do nursing home, or hospital work-- BUT I > have > > chosen, and offer, and emphasize my responsiveness to pts after > hours. > > Thus I'm able to provide access, and NOT burn out. > > > > > > Curiously, most pts don't call, and those that do, I know well, > and > > call takes 5 min or so. I do USUALLY keep my computer database > > available for hx review. > > > > > > 4) Contrary to what some say, I DO employ an answering service. > Not > > much money (about $60/month if minimal calls), but protection from > pt > > insisting they called me, say, and having a bit of a buffer between > me > > and pts after office hours is very helpful to " prevent " burnout > issues. > > > 5) Cell phone with high limit, nationally. I use this but > adjusted > > time. Pagers in our area have become unreliable-- most use > telephones. > > > > > > Just my thoughts... > > > > > > Dr Matt Levin > > > FP, solo since Dec 2004 > > > SOAPware user since 1997 > > > Pittsburgh, PA > > > 24/7 access > > > > > > > > > i am concerned that as we promote this model, we don't fall > into the > > trap of being all things and always available to our patients. > > > i think 24/7 care/access leads to burnout, can promote > inappropriate > > patient behavior, and can potentially delay urgent/emergent > treatment, > > and result in increased liability. > > > we do what we do in the office; if something happens that > requires > > additional care outside of office hours, and is such that it can't > wait, > > patients should go to urgent care or the emergency department, or > call > > 911. that's why those services exist. > > > we are not lone rangers. > > > if there is a question about liability, the standard used, from > what > > i've read, is the layman's perception and understanding of the > > situation. > > > who's going to stake their license and malpractice insurance on > > their ability to diagnose over the telephone, other than to say, i > think > > you need to be seen; go to urgent care or the hospital emergency > > department? when the patient says, i don't want to, it's too > expensive, > > i just want you to reassure me, you're " it " . > > > good patient education, in the office, about potential > complications > > and worsening symptoms, with the recommendation to either return > during > > office hours, or to go to urgent care/emergency department/call 911 > > outside of office hours, is the responsible and appropriate thing > to do. > > > certainly, with certain patients, where one's knowledge of the > > patient can help to avoid expensive and needless additional work- > up, it > > would be appropriate to be contacted, or to have that information > > available. circumstances will be different in different areas and > with > > individual preference. > > > nonetheless, i question what i perceive to be the underlying > theme, > > that the system is screwed up, i do things the way they should be > done, > > and i am the only one who can do my patients right. it's a setup > for > > expectations which can't be met, and will ultimately lead to > > frustration, for us and for patients. > > > > > > LL > > > > > > > > > > > -------------------------------------------------------------------- > ---- > > ------ > > > Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously > low > > rates. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2006 Report Share Posted May 8, 2006 To me, the amount of extra reimbursement gained from an occasional hospital patient is outweighed by the inordinate amount of time involved (traveling, charting, after hrs calls, etc). It would only be worth it to me if I had 2-4 pt's in every day. > > > Date: 2006/05/06 Sat PM 03:35:56 EDT > To: > Subject: Re: 24/7 access > > It depends on you proximity to hospital. For us it is right next > door. It does add to your call load at night because a hospital > staff does not care what time of day or night they call for some very > stupid stuff. I have not had a patient in hospital for 2 weeks now. > Usually will have a census or one or two. It will add about 15 > percent billings to practice with minimal overhead. It fits the LOVE > style. > Brent > > > > > Yes, I have had a couple of patients not come back after their > initial > > " interview " simply because I don't admit. The unfortunate part is I > > generally agree with them. They are better off if they can find > someone > > who can establish a good dr/patient relationship, follow them > closely in > > both the outpatient and inpatient settings and have the skills to > figure > > out how to make both aspects of their practice balance with a family > > life. The problem is that I have not figured out a way of doing > this, > > and in general I would say no other doctor in the area has been > able to > > do it all that well either. Something always seems to suffer. I am > > interested in those who have managed to make inpatient and > outpatient > > work together. How do you do it? Is call a nightmare? > > > > Re: 24/7 access > > > > > > RE: 24/7 access -- is this realistic? > > > > > > All depends on degree. > > > 1) Email for NONurgent contact-- I also use a Blackberry to keep > up to > > date on pt's emails, esp if not near computer. > > > 2) Office hours for regular, same day care whenever possible. > > > 3) I've chosen NOT to do nursing home, or hospital work-- BUT I > have > > chosen, and offer, and emphasize my responsiveness to pts after > hours. > > Thus I'm able to provide access, and NOT burn out. > > > > > > Curiously, most pts don't call, and those that do, I know well, > and > > call takes 5 min or so. I do USUALLY keep my computer database > > available for hx review. > > > > > > 4) Contrary to what some say, I DO employ an answering service. > Not > > much money (about $60/month if minimal calls), but protection from > pt > > insisting they called me, say, and having a bit of a buffer between > me > > and pts after office hours is very helpful to " prevent " burnout > issues. > > > 5) Cell phone with high limit, nationally. I use this but > adjusted > > time. Pagers in our area have become unreliable-- most use > telephones. > > > > > > Just my thoughts... > > > > > > Dr Matt Levin > > > FP, solo since Dec 2004 > > > SOAPware user since 1997 > > > Pittsburgh, PA > > > 24/7 access > > > > > > > > > i am concerned that as we promote this model, we don't fall > into the > > trap of being all things and always available to our patients. > > > i think 24/7 care/access leads to burnout, can promote > inappropriate > > patient behavior, and can potentially delay urgent/emergent > treatment, > > and result in increased liability. > > > we do what we do in the office; if something happens that > requires > > additional care outside of office hours, and is such that it can't > wait, > > patients should go to urgent care or the emergency department, or > call > > 911. that's why those services exist. > > > we are not lone rangers. > > > if there is a question about liability, the standard used, from > what > > i've read, is the layman's perception and understanding of the > > situation. > > > who's going to stake their license and malpractice insurance on > > their ability to diagnose over the telephone, other than to say, i > think > > you need to be seen; go to urgent care or the hospital emergency > > department? when the patient says, i don't want to, it's too > expensive, > > i just want you to reassure me, you're " it " . > > > good patient education, in the office, about potential > complications > > and worsening symptoms, with the recommendation to either return > during > > office hours, or to go to urgent care/emergency department/call 911 > > outside of office hours, is the responsible and appropriate thing > to do. > > > certainly, with certain patients, where one's knowledge of the > > patient can help to avoid expensive and needless additional work- > up, it > > would be appropriate to be contacted, or to have that information > > available. circumstances will be different in different areas and > with > > individual preference. > > > nonetheless, i question what i perceive to be the underlying > theme, > > that the system is screwed up, i do things the way they should be > done, > > and i am the only one who can do my patients right. it's a setup > for > > expectations which can't be met, and will ultimately lead to > > frustration, for us and for patients. > > > > > > LL > > > > > > > > > > > -------------------------------------------------------------------- > ---- > > ------ > > > Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously > low > > rates. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2006 Report Share Posted May 8, 2006 But how do you take vacation? What if you want to drive an hour away from the hospital & you get called? > > > Date: 2006/05/06 Sat PM 05:19:06 EDT > To: > Subject: Re: 24/7 access > > In my first 6 months of practice, I had seven admissions (many, if I > consider the number of patients I have... but I have a couple of sick > ones like metastatic cancer, end stage CHF...). The hospital I admit at > is wonderful, no bogus calls (like colace at midnight), nice nurses, > relaxed and prompt consultants...I love it. > > > > It depends on you proximity to hospital. For us it is right next > > door. It does add to your call load at night because a hospital > > staff does not care what time of day or night they call for some very > > stupid stuff. I have not had a patient in hospital for 2 weeks now. > > Usually will have a census or one or two. It will add about 15 > > percent billings to practice with minimal overhead. It fits the LOVE > > style. > > Brent > > > >> > >> Yes, I have had a couple of patients not come back after their > > initial > >> " interview " simply because I don't admit. The unfortunate part is I > >> generally agree with them. They are better off if they can find > > someone > >> who can establish a good dr/patient relationship, follow them > > closely in > >> both the outpatient and inpatient settings and have the skills to > > figure > >> out how to make both aspects of their practice balance with a family > >> life. The problem is that I have not figured out a way of doing > > this, > >> and in general I would say no other doctor in the area has been > > able to > >> do it all that well either. Something always seems to suffer. I am > >> interested in those who have managed to make inpatient and > > outpatient > >> work together. How do you do it? Is call a nightmare? > >> > >> Re: 24/7 access > >>> > >>> RE: 24/7 access -- is this realistic? > >>> > >>> All depends on degree. > >>> 1) Email for NONurgent contact-- I also use a Blackberry to keep > > up to > >> date on pt's emails, esp if not near computer. > >>> 2) Office hours for regular, same day care whenever possible. > >>> 3) I've chosen NOT to do nursing home, or hospital work-- BUT I > > have > >> chosen, and offer, and emphasize my responsiveness to pts after > > hours. > >> Thus I'm able to provide access, and NOT burn out. > >>> > >>> Curiously, most pts don't call, and those that do, I know well, > > and > >> call takes 5 min or so. I do USUALLY keep my computer database > >> available for hx review. > >>> > >>> 4) Contrary to what some say, I DO employ an answering service. > > Not > >> much money (about $60/month if minimal calls), but protection from > > pt > >> insisting they called me, say, and having a bit of a buffer between > > me > >> and pts after office hours is very helpful to " prevent " burnout > > issues. > >>> 5) Cell phone with high limit, nationally. I use this but > > adjusted > >> time. Pagers in our area have become unreliable-- most use > > telephones. > >>> > >>> Just my thoughts... > >>> > >>> Dr Matt Levin > >>> FP, solo since Dec 2004 > >>> SOAPware user since 1997 > >>> Pittsburgh, PA > >>> 24/7 access > >>> > >>> > >>> i am concerned that as we promote this model, we don't fall > > into the > >> trap of being all things and always available to our patients. > >>> i think 24/7 care/access leads to burnout, can promote > > inappropriate > >> patient behavior, and can potentially delay urgent/emergent > > treatment, > >> and result in increased liability. > >>> we do what we do in the office; if something happens that > > requires > >> additional care outside of office hours, and is such that it can't > > wait, > >> patients should go to urgent care or the emergency department, or > > call > >> 911. that's why those services exist. > >>> we are not lone rangers. > >>> if there is a question about liability, the standard used, from > > what > >> i've read, is the layman's perception and understanding of the > >> situation. > >>> who's going to stake their license and malpractice insurance on > >> their ability to diagnose over the telephone, other than to say, i > > think > >> you need to be seen; go to urgent care or the hospital emergency > >> department? when the patient says, i don't want to, it's too > > expensive, > >> i just want you to reassure me, you're " it " . > >>> good patient education, in the office, about potential > > complications > >> and worsening symptoms, with the recommendation to either return > > during > >> office hours, or to go to urgent care/emergency department/call 911 > >> outside of office hours, is the responsible and appropriate thing > > to do. > >>> certainly, with certain patients, where one's knowledge of the > >> patient can help to avoid expensive and needless additional work- > > up, it > >> would be appropriate to be contacted, or to have that information > >> available. circumstances will be different in different areas and > > with > >> individual preference. > >>> nonetheless, i question what i perceive to be the underlying > > theme, > >> that the system is screwed up, i do things the way they should be > > done, > >> and i am the only one who can do my patients right. it's a setup > > for > >> expectations which can't be met, and will ultimately lead to > >> frustration, for us and for patients. > >>> > >>> LL > >>> > >>> > >>> > >> -------------------------------------------------------------------- > > ---- > >> ------ > >>> Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously > > low > >> rates. > >>> > >>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2006 Report Share Posted May 8, 2006 But how do you take vacation? What if you want to drive an hour away from the hospital & you get called? > > > Date: 2006/05/06 Sat PM 05:19:06 EDT > To: > Subject: Re: 24/7 access > > In my first 6 months of practice, I had seven admissions (many, if I > consider the number of patients I have... but I have a couple of sick > ones like metastatic cancer, end stage CHF...). The hospital I admit at > is wonderful, no bogus calls (like colace at midnight), nice nurses, > relaxed and prompt consultants...I love it. > > > > It depends on you proximity to hospital. For us it is right next > > door. It does add to your call load at night because a hospital > > staff does not care what time of day or night they call for some very > > stupid stuff. I have not had a patient in hospital for 2 weeks now. > > Usually will have a census or one or two. It will add about 15 > > percent billings to practice with minimal overhead. It fits the LOVE > > style. > > Brent > > > >> > >> Yes, I have had a couple of patients not come back after their > > initial > >> " interview " simply because I don't admit. The unfortunate part is I > >> generally agree with them. They are better off if they can find > > someone > >> who can establish a good dr/patient relationship, follow them > > closely in > >> both the outpatient and inpatient settings and have the skills to > > figure > >> out how to make both aspects of their practice balance with a family > >> life. The problem is that I have not figured out a way of doing > > this, > >> and in general I would say no other doctor in the area has been > > able to > >> do it all that well either. Something always seems to suffer. I am > >> interested in those who have managed to make inpatient and > > outpatient > >> work together. How do you do it? Is call a nightmare? > >> > >> Re: 24/7 access > >>> > >>> RE: 24/7 access -- is this realistic? > >>> > >>> All depends on degree. > >>> 1) Email for NONurgent contact-- I also use a Blackberry to keep > > up to > >> date on pt's emails, esp if not near computer. > >>> 2) Office hours for regular, same day care whenever possible. > >>> 3) I've chosen NOT to do nursing home, or hospital work-- BUT I > > have > >> chosen, and offer, and emphasize my responsiveness to pts after > > hours. > >> Thus I'm able to provide access, and NOT burn out. > >>> > >>> Curiously, most pts don't call, and those that do, I know well, > > and > >> call takes 5 min or so. I do USUALLY keep my computer database > >> available for hx review. > >>> > >>> 4) Contrary to what some say, I DO employ an answering service. > > Not > >> much money (about $60/month if minimal calls), but protection from > > pt > >> insisting they called me, say, and having a bit of a buffer between > > me > >> and pts after office hours is very helpful to " prevent " burnout > > issues. > >>> 5) Cell phone with high limit, nationally. I use this but > > adjusted > >> time. Pagers in our area have become unreliable-- most use > > telephones. > >>> > >>> Just my thoughts... > >>> > >>> Dr Matt Levin > >>> FP, solo since Dec 2004 > >>> SOAPware user since 1997 > >>> Pittsburgh, PA > >>> 24/7 access > >>> > >>> > >>> i am concerned that as we promote this model, we don't fall > > into the > >> trap of being all things and always available to our patients. > >>> i think 24/7 care/access leads to burnout, can promote > > inappropriate > >> patient behavior, and can potentially delay urgent/emergent > > treatment, > >> and result in increased liability. > >>> we do what we do in the office; if something happens that > > requires > >> additional care outside of office hours, and is such that it can't > > wait, > >> patients should go to urgent care or the emergency department, or > > call > >> 911. that's why those services exist. > >>> we are not lone rangers. > >>> if there is a question about liability, the standard used, from > > what > >> i've read, is the layman's perception and understanding of the > >> situation. > >>> who's going to stake their license and malpractice insurance on > >> their ability to diagnose over the telephone, other than to say, i > > think > >> you need to be seen; go to urgent care or the hospital emergency > >> department? when the patient says, i don't want to, it's too > > expensive, > >> i just want you to reassure me, you're " it " . > >>> good patient education, in the office, about potential > > complications > >> and worsening symptoms, with the recommendation to either return > > during > >> office hours, or to go to urgent care/emergency department/call 911 > >> outside of office hours, is the responsible and appropriate thing > > to do. > >>> certainly, with certain patients, where one's knowledge of the > >> patient can help to avoid expensive and needless additional work- > > up, it > >> would be appropriate to be contacted, or to have that information > >> available. circumstances will be different in different areas and > > with > >> individual preference. > >>> nonetheless, i question what i perceive to be the underlying > > theme, > >> that the system is screwed up, i do things the way they should be > > done, > >> and i am the only one who can do my patients right. it's a setup > > for > >> expectations which can't be met, and will ultimately lead to > >> frustration, for us and for patients. > >>> > >>> LL > >>> > >>> > >>> > >> -------------------------------------------------------------------- > > ---- > >> ------ > >>> Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously > > low > >> rates. > >>> > >>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2006 Report Share Posted May 8, 2006 I live one hour away from the hospital. Even if I would live ten minutes away, if the patient codes I will not be there on time. I have a friend (also internist) who accepted to cover if I go on vacation. She has also a small practice. When I was working in my previous job I used to cover for 3 physicians and two nurse practitioners who did not take their calls. I had to go overnight at the hospital, maybe five times in one year. let's face it : I can't do an angiogram, I can't do emergency surgery, the ER physician intubates and I don't deliver babies. So, what's left ? The occasional abdominal pain of uncertain etiology (if I don't trust the ER guy) and the chest pain-EKG can be faxed and cardiologist called if patient needs angiogram. And after some years of heavy hospital practice (like mine) you get that " feeling " (I don't know how to call it) when you are needed ASAP and when you are not. The hospital where I admit my patients has a call list : in 6 months I was on call once. > But how do you take vacation? What if you want to drive an hour away > from the hospital & you get called? > > >> >> >> Date: 2006/05/06 Sat PM 05:19:06 EDT >> To: >> Subject: Re: 24/7 access >> >> In my first 6 months of practice, I had seven admissions (many, if I >> consider the number of patients I have... but I have a couple of sick >> ones like metastatic cancer, end stage CHF...). The hospital I admit >> at >> is wonderful, no bogus calls (like colace at midnight), nice nurses, >> relaxed and prompt consultants...I love it. >> >> >>> It depends on you proximity to hospital. For us it is right next >>> door. It does add to your call load at night because a hospital >>> staff does not care what time of day or night they call for some very >>> stupid stuff. I have not had a patient in hospital for 2 weeks now. >>> Usually will have a census or one or two. It will add about 15 >>> percent billings to practice with minimal overhead. It fits the LOVE >>> style. >>> Brent >>> >>>> >>>> Yes, I have had a couple of patients not come back after their >>> initial >>>> " interview " simply because I don't admit. The unfortunate part is I >>>> generally agree with them. They are better off if they can find >>> someone >>>> who can establish a good dr/patient relationship, follow them >>> closely in >>>> both the outpatient and inpatient settings and have the skills to >>> figure >>>> out how to make both aspects of their practice balance with a family >>>> life. The problem is that I have not figured out a way of doing >>> this, >>>> and in general I would say no other doctor in the area has been >>> able to >>>> do it all that well either. Something always seems to suffer. I am >>>> interested in those who have managed to make inpatient and >>> outpatient >>>> work together. How do you do it? Is call a nightmare? >>>> >>>> Re: 24/7 access >>>>> >>>>> RE: 24/7 access -- is this realistic? >>>>> >>>>> All depends on degree. >>>>> 1) Email for NONurgent contact-- I also use a Blackberry to keep >>> up to >>>> date on pt's emails, esp if not near computer. >>>>> 2) Office hours for regular, same day care whenever possible. >>>>> 3) I've chosen NOT to do nursing home, or hospital work-- BUT I >>> have >>>> chosen, and offer, and emphasize my responsiveness to pts after >>> hours. >>>> Thus I'm able to provide access, and NOT burn out. >>>>> >>>>> Curiously, most pts don't call, and those that do, I know well, >>> and >>>> call takes 5 min or so. I do USUALLY keep my computer database >>>> available for hx review. >>>>> >>>>> 4) Contrary to what some say, I DO employ an answering service. >>> Not >>>> much money (about $60/month if minimal calls), but protection from >>> pt >>>> insisting they called me, say, and having a bit of a buffer between >>> me >>>> and pts after office hours is very helpful to " prevent " burnout >>> issues. >>>>> 5) Cell phone with high limit, nationally. I use this but >>> adjusted >>>> time. Pagers in our area have become unreliable-- most use >>> telephones. >>>>> >>>>> Just my thoughts... >>>>> >>>>> Dr Matt Levin >>>>> FP, solo since Dec 2004 >>>>> SOAPware user since 1997 >>>>> Pittsburgh, PA >>>>> 24/7 access >>>>> >>>>> >>>>> i am concerned that as we promote this model, we don't fall >>> into the >>>> trap of being all things and always available to our patients. >>>>> i think 24/7 care/access leads to burnout, can promote >>> inappropriate >>>> patient behavior, and can potentially delay urgent/emergent >>> treatment, >>>> and result in increased liability. >>>>> we do what we do in the office; if something happens that >>> requires >>>> additional care outside of office hours, and is such that it can't >>> wait, >>>> patients should go to urgent care or the emergency department, or >>> call >>>> 911. that's why those services exist. >>>>> we are not lone rangers. >>>>> if there is a question about liability, the standard used, from >>> what >>>> i've read, is the layman's perception and understanding of the >>>> situation. >>>>> who's going to stake their license and malpractice insurance on >>>> their ability to diagnose over the telephone, other than to say, i >>> think >>>> you need to be seen; go to urgent care or the hospital emergency >>>> department? when the patient says, i don't want to, it's too >>> expensive, >>>> i just want you to reassure me, you're " it " . >>>>> good patient education, in the office, about potential >>> complications >>>> and worsening symptoms, with the recommendation to either return >>> during >>>> office hours, or to go to urgent care/emergency department/call 911 >>>> outside of office hours, is the responsible and appropriate thing >>> to do. >>>>> certainly, with certain patients, where one's knowledge of the >>>> patient can help to avoid expensive and needless additional work- >>> up, it >>>> would be appropriate to be contacted, or to have that information >>>> available. circumstances will be different in different areas and >>> with >>>> individual preference. >>>>> nonetheless, i question what i perceive to be the underlying >>> theme, >>>> that the system is screwed up, i do things the way they should be >>> done, >>>> and i am the only one who can do my patients right. it's a setup >>> for >>>> expectations which can't be met, and will ultimately lead to >>>> frustration, for us and for patients. >>>>> >>>>> LL >>>>> >>>>> >>>>> >>>> -------------------------------------------------------------------- >>> ---- >>>> ------ >>>>> Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously >>> low >>>> rates. >>>>> >>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 9, 2006 Report Share Posted May 9, 2006 Kerry, I have 19 pt contact hrs/week, total ~ 30 hrs doing office work on average. Most of my appts are 1 hr long – I like to spend a lot of time discussing my pts chronic illnesses/working on self-management, answering their questions, etc. I initially thought I’d have only a couple of 1 hr appts/day, and speculated 37 visits/week and panel size of 700. Now, at least half of my appts are 1 hr long, and my panel is 400 (have gradually whittled down) to keep it manageable and personable. If you are inclined to see people for the traditional 15 minutes, I would suspect you could handle a larger panel size. I have a MA that works with me, and I do the billing. I would suggest shutting off the flood gates when you reach ~ 90% full capacity (ie full schedule),so you can leave a trickle for the family members of current pts, etc, and not get overwhelmed. Hope that helps. A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 From: [mailto: ] On Behalf Of Graffs Sent: Saturday, May 06, 2006 10:47 AM To: Subject: RE: 24/7 access I would like to get a better idea what people think about the right panel size. I am planning to work about 20 hours a week (of patient contact hours) and plan no staff. Almost all of the patients will be ones that I have been seeing at a bigger office run by the local hospital. What is everyone’s opinion on panel size? A special request for feedback from Eads, since her practice sounds very similar to mine. Kerry Graff Canandaigua. NY From: [mailto: ] On Behalf Of L. Gordon Sent: Saturday, May 06, 2006 9:42 AM To: Subject: Re: 24/7 access Two posts regarding 24/7 access. The first is a repost from Eads: X-Yahoo-Profile: meads1521 Mailing-List: list ; contact -owner Delivered-To: mailing list List-Unsubscribe: < mailto:-unsubscribe > Date: Fri, 4 Feb 2005 19:44:22 -0700 Subject: part time w/ open access Reply-To: Hi Stacey, I opened my part time (19 pt contact hours per week, 46 weeks a year) practice July 2003. Im in the office a little M-F, with essentially a full day on Mon, then tapers down to 2 hours on Fridays. This has worked out very well for myself and my patients. Previously I was in a group working 2.5 days (pt contact time), and was not seeing pts 2 days out of the typical 5 day work week. My new practices hours work much better for continuity of care, accessibility, etc, with me being in the office M-F. Ive been using open-access from the beginning, and it has worked out well. I can almost always see someone same day if requested, but sometimes have to defer a day or 2 for routine things like physicals or follow ups if pt wants to be seen at a certain time of day, etc. I have seen a few patients outside of my normal business hours (maybe 4 since I opened up). Most people understand that I want to be a Mommy too, and have not had any complaints. I am certain to mention my hours when people are checking out my practice, and have it in m y practice brochure. The accessibility is also enhanced by my phone and email care, which many people love. This can help reduce the strain on the schedule of face-to-face communication if it is not needed. I would probably bring in more money if I did not do this, but it works well for me. It may be difficult to do open access if you are not in the office M-F. A. Eads, M.D. At 08:26 PM 5/5/2006, you wrote: RE: 24/7 access -- is this realistic? All depends on degree. 1) Email for NONurgent contact-- I also use a Blackberry to keep up to date on pt's emails, esp if not near computer. 2) Office hours for regular, same day care whenever possible. 3) I've chosen NOT to do nursing home, or hospital work-- BUT I have chosen, and offer, and emphasize my responsiveness to pts after hours. Thus I'm able to provide access, and NOT burn out. Curiously, most pts don't call, and those that do, I know well, and call takes 5 min or so. I do USUALLY keep my computer database available for hx review. 4) Contrary to what some say, I DO employ an answering service. Not much money (about $60/month if minimal calls), but protection from pt insisting they called me, say, and having a bit of a buffer between me and pts after office hours is very helpful to " prevent " burnout issues. 5) Cell phone with high limit, nationally. I use this but adjusted time. Pagers in our area have become unreliable-- most use telephones. Just my thoughts... Dr Matt Levin FP, solo since Dec 2004 SOAPware user since 1997 Pittsburgh, PA 24/7 access i am concerned that as we promote this model, we don't fall into the trap of being all things and always available to our patients. i think 24/7 care/access leads to burnout, can promote inappropriate patient behavior, and can potentially delay urgent/emergent treatment, and result in increased liability. we do what we do in the office; if something happens that requires additional care outside of office hours, and is such that it can't wait, patients should go to urgent care or the emergency department, or call 911. that's why those services exist. we are not lone rangers. if there is a question about liability, the standard used, from what i've read, is the layman's perception and understanding of the situation. who's going to stake their license and malpractice insurance on their ability to diagnose over the telephone, other than to say, i think you need to be seen; go to urgent care or the hospital emergency department? when the patient says, i don't want to, it's too expensive, i just want you to reassure me, you're " it " . good patient education, in the office, about potential complications and worsening symptoms, with the recommendation to either return during office hours, or to go to urgent care/emergency department/call 911 outside of office hours, is the responsible and appropriate thing to do. certainly, with certain patients, where one's knowledge of the patient can help to avoid expensive and needless additional work-up, it would be appropriate to be contacted, or to have that information available. circumstances will be different in different areas and with individual preference. nonetheless, i question what i perceive to be the underlying theme, that the system is screwed up, i do things the way they should be done, and i am the only one who can do my patients right. it's a setup for expectations which can't be met, and will ultimately lead to frustration, for us and for patients. LL Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously low rates. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 9, 2006 Report Share Posted May 9, 2006 Kerry, I have 19 pt contact hrs/week, total ~ 30 hrs doing office work on average. Most of my appts are 1 hr long – I like to spend a lot of time discussing my pts chronic illnesses/working on self-management, answering their questions, etc. I initially thought I’d have only a couple of 1 hr appts/day, and speculated 37 visits/week and panel size of 700. Now, at least half of my appts are 1 hr long, and my panel is 400 (have gradually whittled down) to keep it manageable and personable. If you are inclined to see people for the traditional 15 minutes, I would suspect you could handle a larger panel size. I have a MA that works with me, and I do the billing. I would suggest shutting off the flood gates when you reach ~ 90% full capacity (ie full schedule),so you can leave a trickle for the family members of current pts, etc, and not get overwhelmed. Hope that helps. A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 From: [mailto: ] On Behalf Of Graffs Sent: Saturday, May 06, 2006 10:47 AM To: Subject: RE: 24/7 access I would like to get a better idea what people think about the right panel size. I am planning to work about 20 hours a week (of patient contact hours) and plan no staff. Almost all of the patients will be ones that I have been seeing at a bigger office run by the local hospital. What is everyone’s opinion on panel size? A special request for feedback from Eads, since her practice sounds very similar to mine. Kerry Graff Canandaigua. NY From: [mailto: ] On Behalf Of L. Gordon Sent: Saturday, May 06, 2006 9:42 AM To: Subject: Re: 24/7 access Two posts regarding 24/7 access. The first is a repost from Eads: X-Yahoo-Profile: meads1521 Mailing-List: list ; contact -owner Delivered-To: mailing list List-Unsubscribe: < mailto:-unsubscribe > Date: Fri, 4 Feb 2005 19:44:22 -0700 Subject: part time w/ open access Reply-To: Hi Stacey, I opened my part time (19 pt contact hours per week, 46 weeks a year) practice July 2003. Im in the office a little M-F, with essentially a full day on Mon, then tapers down to 2 hours on Fridays. This has worked out very well for myself and my patients. Previously I was in a group working 2.5 days (pt contact time), and was not seeing pts 2 days out of the typical 5 day work week. My new practices hours work much better for continuity of care, accessibility, etc, with me being in the office M-F. Ive been using open-access from the beginning, and it has worked out well. I can almost always see someone same day if requested, but sometimes have to defer a day or 2 for routine things like physicals or follow ups if pt wants to be seen at a certain time of day, etc. I have seen a few patients outside of my normal business hours (maybe 4 since I opened up). Most people understand that I want to be a Mommy too, and have not had any complaints. I am certain to mention my hours when people are checking out my practice, and have it in m y practice brochure. The accessibility is also enhanced by my phone and email care, which many people love. This can help reduce the strain on the schedule of face-to-face communication if it is not needed. I would probably bring in more money if I did not do this, but it works well for me. It may be difficult to do open access if you are not in the office M-F. A. Eads, M.D. At 08:26 PM 5/5/2006, you wrote: RE: 24/7 access -- is this realistic? All depends on degree. 1) Email for NONurgent contact-- I also use a Blackberry to keep up to date on pt's emails, esp if not near computer. 2) Office hours for regular, same day care whenever possible. 3) I've chosen NOT to do nursing home, or hospital work-- BUT I have chosen, and offer, and emphasize my responsiveness to pts after hours. Thus I'm able to provide access, and NOT burn out. Curiously, most pts don't call, and those that do, I know well, and call takes 5 min or so. I do USUALLY keep my computer database available for hx review. 4) Contrary to what some say, I DO employ an answering service. Not much money (about $60/month if minimal calls), but protection from pt insisting they called me, say, and having a bit of a buffer between me and pts after office hours is very helpful to " prevent " burnout issues. 5) Cell phone with high limit, nationally. I use this but adjusted time. Pagers in our area have become unreliable-- most use telephones. Just my thoughts... Dr Matt Levin FP, solo since Dec 2004 SOAPware user since 1997 Pittsburgh, PA 24/7 access i am concerned that as we promote this model, we don't fall into the trap of being all things and always available to our patients. i think 24/7 care/access leads to burnout, can promote inappropriate patient behavior, and can potentially delay urgent/emergent treatment, and result in increased liability. we do what we do in the office; if something happens that requires additional care outside of office hours, and is such that it can't wait, patients should go to urgent care or the emergency department, or call 911. that's why those services exist. we are not lone rangers. if there is a question about liability, the standard used, from what i've read, is the layman's perception and understanding of the situation. who's going to stake their license and malpractice insurance on their ability to diagnose over the telephone, other than to say, i think you need to be seen; go to urgent care or the hospital emergency department? when the patient says, i don't want to, it's too expensive, i just want you to reassure me, you're " it " . good patient education, in the office, about potential complications and worsening symptoms, with the recommendation to either return during office hours, or to go to urgent care/emergency department/call 911 outside of office hours, is the responsible and appropriate thing to do. certainly, with certain patients, where one's knowledge of the patient can help to avoid expensive and needless additional work-up, it would be appropriate to be contacted, or to have that information available. circumstances will be different in different areas and with individual preference. nonetheless, i question what i perceive to be the underlying theme, that the system is screwed up, i do things the way they should be done, and i am the only one who can do my patients right. it's a setup for expectations which can't be met, and will ultimately lead to frustration, for us and for patients. 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Guest guest Posted May 9, 2006 Report Share Posted May 9, 2006 Thanks, ! Kerry Graff From: [mailto: ] On Behalf Of Eads Sent: Monday, May 08, 2006 10:15 PM To: Subject: RE: 24/7 access Kerry, I have 19 pt contact hrs/week, total ~ 30 hrs doing office work on average. Most of my appts are 1 hr long – I like to spend a lot of time discussing my pts chronic illnesses/working on self-management, answering their questions, etc. I initially thought I’d have only a couple of 1 hr appts/day, and speculated 37 visits/week and panel size of 700. Now, at least half of my appts are 1 hr long, and my panel is 400 (have gradually whittled down) to keep it manageable and personable. If you are inclined to see people for the traditional 15 minutes, I would suspect you could handle a larger panel size. I have a MA that works with me, and I do the billing. I would suggest shutting off the flood gates when you reach ~ 90% full capacity (ie full schedule),so you can leave a trickle for the family members of current pts, etc, and not get overwhelmed. Hope that helps. A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 From: [mailto: ] On Behalf Of Graffs Sent: Saturday, May 06, 2006 10:47 AM To: Subject: RE: 24/7 access I would like to get a better idea what people think about the right panel size. I am planning to work about 20 hours a week (of patient contact hours) and plan no staff. Almost all of the patients will be ones that I have been seeing at a bigger office run by the local hospital. What is everyone’s opinion on panel size? A special request for feedback from Eads, since her practice sounds very similar to mine. Kerry Graff Canandaigua. NY From: [mailto: ] On Behalf Of L. Gordon Sent: Saturday, May 06, 2006 9:42 AM To: Subject: Re: 24/7 access Two posts regarding 24/7 access. The first is a repost from Eads: X-Yahoo-Profile: meads1521 Mailing-List: list ; contact -owner Delivered-To: mailing list List-Unsubscribe: < mailto:-unsubscribe > Date: Fri, 4 Feb 2005 19:44:22 -0700 Subject: part time w/ open access Reply-To: Hi Stacey, I opened my part time (19 pt contact hours per week, 46 weeks a year) practice July 2003. Im in the office a little M-F, with essentially a full day on Mon, then tapers down to 2 hours on Fridays. This has worked out very well for myself and my patients. Previously I was in a group working 2.5 days (pt contact time), and was not seeing pts 2 days out of the typical 5 day work week. My new practices hours work much better for continuity of care, accessibility, etc, with me being in the office M-F. Ive been using open-access from the beginning, and it has worked out well. I can almost always see someone same day if requested, but sometimes have to defer a day or 2 for routine things like physicals or follow ups if pt wants to be seen at a certain time of day, etc. I have seen a few patients outside of my normal business hours (maybe 4 since I opened up). Most people understand that I want to be a Mommy too, and have not had any complaints. I am certain to mention my hours when people are checking out my practice, and have it in m y practice brochure. The accessibility is also enhanced by my phone and email care, which many people love. This can help reduce the strain on the schedule of face-to-face communication if it is not needed. I would probably bring in more money if I did not do this, but it works well for me. It may be difficult to do open access if you are not in the office M-F. A. Eads, M.D. At 08:26 PM 5/5/2006, you wrote: RE: 24/7 access -- is this realistic? All depends on degree. 1) Email for NONurgent contact-- I also use a Blackberry to keep up to date on pt's emails, esp if not near computer. 2) Office hours for regular, same day care whenever possible. 3) I've chosen NOT to do nursing home, or hospital work-- BUT I have chosen, and offer, and emphasize my responsiveness to pts after hours. Thus I'm able to provide access, and NOT burn out. Curiously, most pts don't call, and those that do, I know well, and call takes 5 min or so. I do USUALLY keep my computer database available for hx review. 4) Contrary to what some say, I DO employ an answering service. Not much money (about $60/month if minimal calls), but protection from pt insisting they called me, say, and having a bit of a buffer between me and pts after office hours is very helpful to " prevent " burnout issues. 5) Cell phone with high limit, nationally. I use this but adjusted time. Pagers in our area have become unreliable-- most use telephones. Just my thoughts... Dr Matt Levin FP, solo since Dec 2004 SOAPware user since 1997 Pittsburgh, PA 24/7 access i am concerned that as we promote this model, we don't fall into the trap of being all things and always available to our patients. i think 24/7 care/access leads to burnout, can promote inappropriate patient behavior, and can potentially delay urgent/emergent treatment, and result in increased liability. we do what we do in the office; if something happens that requires additional care outside of office hours, and is such that it can't wait, patients should go to urgent care or the emergency department, or call 911. that's why those services exist. we are not lone rangers. if there is a question about liability, the standard used, from what i've read, is the layman's perception and understanding of the situation. who's going to stake their license and malpractice insurance on their ability to diagnose over the telephone, other than to say, i think you need to be seen; go to urgent care or the hospital emergency department? when the patient says, i don't want to, it's too expensive, i just want you to reassure me, you're " it " . good patient education, in the office, about potential complications and worsening symptoms, with the recommendation to either return during office hours, or to go to urgent care/emergency department/call 911 outside of office hours, is the responsible and appropriate thing to do. certainly, with certain patients, where one's knowledge of the patient can help to avoid expensive and needless additional work-up, it would be appropriate to be contacted, or to have that information available. circumstances will be different in different areas and with individual preference. nonetheless, i question what i perceive to be the underlying theme, that the system is screwed up, i do things the way they should be done, and i am the only one who can do my patients right. it's a setup for expectations which can't be met, and will ultimately lead to frustration, for us and for patients. LL Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously low rates. Quote Link to comment Share on other sites More sharing options...
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