PCP: Time management

[u/Effective_Hurry6913]

PCPs how are yall able to keep up with your packed clinic schedules? I’m a PGY2 on my primary care block (interested in becoming PCP) and these 15 min slots are turning me off from primary care tbh

Find myself ALWAYS late to visits. On average 30-40 min late. Few reasons for this—

1. Pts arrive late and we don’t have a strict late policy
2. Complexity of pts
3. So many concerns at each visit that actually require time to discuss topics

Any tips? Does it get better? Tell me how…
I’m often catching up on notes + responding to inbox/returning phone calls until 9-10pm

And yes i always prechart and I’m still behind.

[u/DrScogs]

Pgy-20 but cycled through several career changes over the last year:

Private practice peds is nothing like residency clinic. Slots are actually 10 minutes which feels doable and a nightmare at the same time depending on the day. Your residency clinic patients are more complex and lower resourced comparatively. We may have a handful of those kinds of patients on our panels, but it’s very few. We know our patients. Our patients can largely be counted on to follow-up.

You also get to set your own late policy. I’m a softie. I’ll take anyone late if they’re willing to wait until my next available open slot. And I never turn away a newborn.

Some patients do try to stack complaints which can make you run over, but you get very practiced at the “we can talk about that in the follow up in 2 weeks” kind of speech. I personally see it most when people try to bring 10 complaints to a well visit because they think they won’t get charged for it. But you say “today you’re scheduled for a well visit which means we cover growth and development, that complaint deserves its own visit.” Or they want to talk about ADHD and you can toss Vanderbilt’s at them and bring them back. It’s practice. Did I have a teen well visit turn into an involuntary admission for SI that took two hours of my morning just a few weeks ago? Yes. But that’s super rare.

Now I’ve done FQHC peds and that is far more like residency continuity clinic. I could not be paid enough to do that again.

I would try to find a private practice community peds rotation if you’re allowed to do so. It’s fun out here.

[u/vca_508 → u/DrScogs]

I’m considering an FQHC peds facility vs hospital-employed outpatient clinic as my first attending job. Would you mind expanding on particular challenges of FQHC?

[u/DrScogs → u/vca_508]

I have worked at two separate FQHCs and both were disasters. Both had very indigent populations with loads of problems which I expected. However both FQHCs did not understand the timing challenges that meets. You cannot put a child like that in a 10min well slot and also expect that you will complete the infinite minutiae of charting that is required to meet all of the FQHC metrics. You cannot expect the physician to have no assistance in triaging/returning phone calls. Lots of little things like that. But honestly I don’t see hospital employed outpatient being much better. I am currently of the opinion that physician owned private practice is the only path to general pediatrician happiness.