But, to answer your question, the average family doctor with an even mix of all of these in an average part of the country would earn from $120K-$140K seeing 25/day (that is my best guess). Perhaps that is a little high, but it is not far off.

The funny thing is, despite the fact that this is our reality, some don’t believe me. My experience is entirely practical. Reading your blog, you have nothing to worry about.

As far as appt types, the other thing we did was get rid of most of our appointment types. We have new peds, new adult, established peds, and established adults. That made things much easier and made the rest possible. It took some working with the EMR to make it happen.

(And I personally adore my primary care doc – can’t imagine getting by without him.)

Kidding aside, I cou’dnt agree with you more on the urgent care visits. I learned a lesson from my dentist on that one – see them just for the urgent issues, and have them come back for the annual. Most patients are exceedingly grateful to be seen on the day they call.

I do make an exception, however, for the patients I see out of network who pay cash for their visits. (about 20% of my practice at ths point). If I see them for an urgent problem, I will do whatever they need. I am their happy slave.

I see an average of 25 patients per day, 4.5 days per week. Plus I see an average of 15 walk-in clinic patients per week.

We use an EMR and use templates. We are mostly done with our notes at the end of each visit, but I usually have a few to follow-up on. We do not dicatation

We always limit the number of concerns for the work-in or walk-in visits (this is necessary). The routine visits have no such limit.
If they want to add on concerns to this type of visit (to “trick us” into doing a regular visit), we make them schedule a longer visit. The HPI and PMH are free text typed, while the rest is templated.

Honestly, the biggest thing for us was that our system was easily scaled up and the addition of more physicians did not add much incremental cost. This is when I saw the biggest gain in my income – when my relative overhead dropped, as most of my overhead is fixed and not variable.

How many patients do you see, on average, in a day?

How long is your workday?

Do you do your doumenting along the way or let it build up due to time constraints? What about patient calls, lab results, etc? (If it builds up, how much time spent after clinic hours finishing your work?)

Are you dictating? Using templates? Free type? How do you think other doctors would rate your notes? (concise, high signal/noise ratio, yet containing the “essence” of the visit and your thinking?)

How well are you able to stay “on schedule” in your practice? Do you aggressively limit how many patient concerns you will address on a given visit?

I think your model sounds ideal, but I suspect there are some devils in the above details, given my experience trying to carve out similar sanity in our practice.

Or maybe you’ve found nirvana.

We do enough of the quick visits that we don’t feel the need to rush the complex ones. In a sense, they subsidize the complex care we offer. Plus, they greatly increase loyalty in the patients we have. They love our practice because they can get seen.

AnnR hit the nail on the head in that we want the working people coming to our practice and try to make it easy for them. I think internists need to market themselves to the well and not just the sick. To do so, however, they need to adjust their schedules to that of the target market. The simple way to do this is to schedule a sick visit work-in for every complex patient visit. Then when you are waiting on labs, EKG’s, etc, you can go see the sick person. Plus, you have something to fall back on if the complex patient no-shows (which is far more likely than a same-day scheduled sick patient). With Medicare doing what they do, I don’t think internists can survive without doing this.

Again, for me about 70% of my schedule is pre-booked (not including walk-in hours), and the rest is same-day or walk-in visits.