Four an Hour is Three Too Many
Last Friday a former student of mine called. She is doing an outpatient affiliation now and is stressing out. She is having trouble keeping up. She has four patients every hour and is staying late to complete her notes. I told her not to worry. She knows her stuff. She should concentrate on learning what she needs to know and never has to do it again if she doesn't want to after she graduates.
That got me thinking. It's been a few years since I worked in an outpatient setting. And then it was a neuro clinic where patients were seen on a one-to-one basis with the therapist. I saw seven or eight patients each day and usually finished my notes on time.
Is four patients an hour, every hour, the new norm for outpatient? How do they charge for that? My understanding was you had to use the group charge if you saw more than one patient at a time. That clinic can't be making a profit if it only charges one group per patient, even multiplied by four an hour.
How are the therapists able to spend any one-on-one time with patients? The only way I could do that many patients at once was to have everyone doing something similar. Even if you had four knee patients at once, it would be difficult to watch each one perform each exercise. You couldn't individualize programs if everyone had to do the same thing.
When would there be time for hands-on stuff? Back when I did ortho/spine, I did a lot of manual therapy. That was one-on-one. I couldn't have done that and been able to supervise three additional patients. Even having tech help wouldn't make that much difference. All they can do is count reps and provide equipment.
I didn't ask but I assume at least some of these patients are following doctor or injury-specific protocols. Where is the clinical judgment in that? Yes, the evaluations require special tests and specific knowledge. But once the patient is on the protocol, all decision-making stops. Those protocols specify when and how much to progress, ROM, resistance, weight-bearing etc. Protocols are great for some things but they aren't very individualized.
I would go crazy within days if all I did was watch people exercise and maybe throw in a few modalities. With such emphasis on orthopedics in the APTA and literature, I can't believe all clinics practice that way. Why would so many clinicians feel the need to become specialized if they did? There would be no opportunity to use that knowledge.
I wonder how the patients feel about that set-up. When I finally get hurt from riding, I'm going to expect my therapist to spend time with me. I will expect explanations about why I'm doing what I'm doing, what I'm trying to achieve and feedback on performance. If I need help, I want someone there who knows what to do. I would expect all patients to feel the same way.
OK, outpatient ortho people. Tell me how you do it. Show me what I'm missing here. Surely this can't be the new standard of practice.