Q&A
Discussion on panel sizes and their impact on doctor workload
2:21:13
ยท
3 min
Council Member De La Rosa inquires about panel sizes and their impact on doctors' workloads. Doctors Adedeji and Goldstein provide insights into the challenges posed by increasing panel sizes and the 20-minute new visit policy.
- Panel sizes have increased from 1500 to 1750 patients per doctor
- The new system pushes doctors to reach full panel capacity, reducing time for revisits
- Doctors argue that the one-size-fits-all approach doesn't account for the complexity of H+H patients
- The increased workload is contributing to burnout and workforce shortages in primary care
Carmen N. De La Rosa
2:21:13
And how do they reconcile your panel with then now these 4 new patients that are added?
Adedayo Adedeji
2:21:21
Well, it just seems to be a shifting thing where you're told you only need 1200 patients, and then suddenly, the panel's 1400 patients.
2:21:27
And, frankly, I have no idea what the new panel is like now.
2:21:29
Okay.
2:21:30
It just keeps growing.
Carmen N. De La Rosa
2:21:31
Okay.
2:21:32
And then I my follow-up question was about the panels.
2:21:35
So, what are the numbers that what are those numbers for for the panels?
2:21:41
What do the panels look like?
2:21:42
And then I'd someone testified about a 30% absorption rate on the panels.
2:21:47
Can you, shed some more light into that?
Adedayo Adedeji
2:21:50
I'll say one quick thing about panel size.
2:21:52
It just seems like it's it almost seems to be almost like an obituary number that somebody in central office comes up with.
2:21:59
Nobody ever comes down to us and sits us down and says this is how we came up with this number.
2:22:04
Never.
2:22:05
The other decisions are just in fall from the sky and they were just meant to, like, figure it out somehow.
2:22:10
Okay.
Andrew Goldstein
2:22:12
Yeah.
2:22:12
I can provide a little bit more context on it.
2:22:14
So historically, H and H had a panel size for us of 1500 patients, and I believe in 2021, it increased to 17 50.
2:22:22
Mhmm.
2:22:23
But those panel sizes didn't matter if there was no system to make them actually felt.
2:22:29
So, currently, it's not just 20 minute new visits that's this policy that people call the 20 minute new visit policy.
2:22:36
It's actually, also a panel progression.
2:22:38
And so the number of new patient visits that you have per week or per month is set by how full you are on, the benchmark of 1750.
2:22:48
So if you're 50% full, you're gonna see a lot of new patients.
2:22:51
If you're 95% full, you're not gonna be seeing many new patients.
2:22:56
And so now we actually have a system to get everyone to 17 50.
2:22:59
So we've all been living, who knows, maybe at 1400 on average.
2:23:02
People have been practicing for decades, and they felt full based on how sick their patients are, how often they need to be seen how hard it is for them to get revisit access.
2:23:09
But now they're being told, you're actually losing revisit access.
2:23:13
You're gonna see more new patients in shorter visits, and you now have more patients who have less revisit access for you.
2:23:21
They're gonna write MyChart messages.
2:23:23
They're gonna show up at the front desk.
2:23:25
They're gonna call the clinic.
2:23:26
And then you, outside of those visits, have to provide care for them over the phone.
2:23:31
And so this is the struggle that a lot of us are facing that is driving a lot of the worsened burnout.
2:23:36
I'll just say one other thing.
Gale Brewer
2:23:37
Mhmm.
Andrew Goldstein
2:23:37
There are industry norms that our leadership has told us, about this.
2:23:41
We are well aware.
2:23:42
These industry norms are part of what have driven primary care workforce shortages nationwide.
2:23:48
This is corporate health care.
2:23:49
This is productivity cult.
2:23:51
You know, this is what's causing people to feel so burnt out and fried that they leave medicine earlier than they wanted to.
2:23:56
So many primary care doctors 40 years older than me have told me they left because it's awful now.
2:24:00
They remember when it was good.
2:24:02
We really don't need to do this.
2:24:03
We could be better, and I hope we could be.
2:24:06
But this one size fits all panel size is a really terrible metric.
2:24:10
Complexity scoring is one thing, but if the average still pushes us up 10, 20, 30%, it would be a really bad thing.
2:24:17
But our patients, we know from peers who have left the system that they've gone to work elsewhere that have 17, 52,000 patients on their panels, they're like, it's doable because those patients are so much less sick than they were at h and h and so much less complex socially.
2:24:32
So whatever the number is for us, we can't just reference some, you know, number in a vacuum.
2:24:36
It needs to be appropriate for our patients.
2:24:39
And we are reaching a breaking point.
2:24:40
So that should tell you that, you know, this is not the right number for our system.