Wednesday, December 3, 2008

The Slow Down

Its happening again. I'm entering my second year of practive in my new location. And strangely....unexpectedly...I'm finding myself not very busy. In fact if I look back at my schedule I was busier six months ago then today. This really worries me. Surely I have more patients now then I had six months ago. In fact I usually see at least one new patient every day if not 2-3. So what gives?

At first I thought maybe its just the economic slow down. Maybe people don't want to pay their copays. I guess thats possible. But at least 50 percent of my patient population is medicare. They don't have copays. Then I thought maybe people are leaving me. That I am being ineffective. But we haven't recieved any record transfer forms. In fact a number of patients have moved considerable distances but still come back in town to see me.

Now that I think about it the same thing happened in my last practice. Coming out of residency I joined an internal medicine group that I stayed at for five years. Over time I accumulated about 2000 patients and was one of the busiest doctors in the office. But the truth is....the same thing happened there also. 2-3 years into it my numbers went down. My hospital census plummeted to one patient a week (after maybe having 2-3 patients in the hospital on a given day).

So what to make of all this? Previously I made up for low numbers by covering the other docs in the office. Although I saw more patients then any of them, I also would see most of their overflow. There were 5 more senior doctors in the same office who provided a steady stream of acute visits.

In my current practice there is only one physician more senior then I. So I really don't get much overflow. I still see my partners patients in the hospital...this keeps me a little busy. And for the first time in my life I am going to nursing homes and have taken on a medical directorship.

Maybe my patients just aren't that sick. I guess thats possible...but I have a huge medicare population. In fact....occasionally I have days where I see 4-5 patients in the office on the same day who are in their nineties. One of my biggest referal sources is the local nephrology group...so I have more then average number of dialysis patients.

I guess in my heart of hearts my hope is that I am slowing down because I am taking good care of people. Because I am catching disease earlier, treating it more aggressively, and keeping them out of the hospital. Becuase I am getting my dying patients enrolled in hospice so they can die at home.

In other words....I think my patients are needing me less and less each day. Gratifying...but bad for the bottom line.

But who knows...I could be wrong....maybe I am just pissing people off and they are leaving me!

3 comments:

tracy said...

I highly doubt you are "pissing people off"...i'd come see you...if i could! :)

Matthew said...

Remember, correlation and causality are two different things. While you see the same trend in the same time period of each practice, that's a correlation. There is no evidence to prove causality.

I spoke with a hospital market analyst/consultant friend early this year at a conference. He told me to be prepared to see slow downs in physician network visits and a rise in admissions through the emergency rooms. People will forgo primary care, letting their conditions worsen to the point where emergency care is needed.

In my mind people probably associate Doctors visits with costs whether they pay a co-pay or not.

I'm curious. I in a beauty salon while my girlfriend got her hair cut, on her way out the receptionist asked, "would you like to go ahead and schedule your next visit ahead of time?" I thought this was brilliant, not only are they providing convenient scheduling, but it in a way locks them in to a return visit.

Why can't physician offices do this as well? Especially given the case of those harder to manage chronic diseases like CHF and diabetes.

When I started working at this hospital I'm at now, I got strep throat within the first 2 weeks. I went to one of our physicians across the street for a new patient visit as I was new to the area. On the way out they should have hit me up for a wellness visit, it's something I know I should do but never actually do. As a new employee I had the benefit dollars to do it, but ended up letting the go to waste

Anonymous said...

Actually, you could be. If you're as arrogant in person as you are on your blog you probably are.