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Vancouver Division of Family Practice
May 5th, 2017
The transition from residency to practice can be exciting and overwhelming. With the opportunity to establish a practice that suits you best, there are a lot of questions that can arise in the process. As a member organization of over a thousand GPs we get questions about all facets of practice. The most common one is, “How many patients should I have?”
In reality, the answer to this question is different for everyone. After thorough research and evaluation of several GP patient panels, the VDoFP derived a methodology to help physicians determine your optimal patient panel size specific to your situation.
Like patients, physicians are unique, and the way you practice will likely reflect that individuality. Many physicians say, “The average patient panel is around 1500 patients, so is that the number I should target?” Perhaps, but does that average reflect a full-time or part-time schedule? On aggregate, how complex are the patients? Finally, how long are the appointment slots? The truth is, there is no ‘one size fits all’ answer. The optimal patient panel size depends on two main factors: (1) your total available appointments and (2) your patients’ behavior.
In order to calculate available appointments, consider three variables that dictate your time…
- Patients per day – How many patients would you like to see in an average day? Be honest with yourself about how many patients you would see on a regular shift once you are settled in your practice. Think about what a typical and ideal day would look like, and how many patients you can comfortably see on those days. Some physicians comfortably see 40 patients in a day, while others see half of that. Some physicians work part-time in clinic and supplement their time in other settings. Think about designing your practice to suit your style and preferences.
We caution you from simply extrapolating your average booking length into the number of hours you work per day. Doing this may fail to capture the variability that comes from seeing your more complex patients, the ones who might require a bit longer appointment. You are better off looking back through the schedule at a few full days that you find are representative of how you would want to practice, and count how many patients you saw on those days. Looking at entire days will help to correct for some variability as some of those visits were likely shorter, and some were longer with more complexity.
- Days per month – Are you planning to work full-time or part-time? Are you working half days or full days? In a month where you don’t have any vacation, how many working days would you plan to be in clinic? To help you estimate this, consider the rule of thumb, which states that the average full-time work month consists of 21 to 22 working days.
- Vacation time per year – Consider the realistic amount of vacation you take, or would like to take, in a given year. Also, include time away from the clinic for CME events, conferences, and other personal and professional absences.
Ideally, you would want to also include your locum’s ability to cover your practice when you are away for your personal and professional absences. This would help to more accurately capture the availability of appointments throughout the year. The latter can be challenging, especially without a history of working with a locum(s). So, for this example, we will assume that for the time you are away, (a) you have locum coverage and (b) all of your patients will be seen at 100% locum efficiency.
These variables can be used to calculate your total number of available appointments, or in other words, your capacity. This number should be different for everyone. You can calculate an estimate value for this using the following equation:
Again, the above is a simplified version where the locum efficiency is 100% (not always true in real life). To keep it simple, you could use the calculation above. To include expected absences that will not be covered by a locum at 100% efficiency use the following equation.
The above will give you the approximate number of appointments you will have available to your patients over the course of the year. From here, you will need to identify at what rate those available visits are consumed. To do this you need to determine the average number of visits per year per patient by looking at your patient behavior.
For our purposes, patient behavior refers to the expected number of times a patient visits your office in a given year. Age is a reasonable indicator of the expected frequency of patient visits; not surprisingly elderly patients come in more often. Gender is also a good indicator, for whatever reason, males seem to have a lower number of visits per year than females. With an established panel, one can extract the average visit per year data for their patients either from his/her EMR or by reviewing their Doctors of BC mini practice profile. For physicians with a newly established, or yet unestablished practice, a good way to estimate patient behavior is to find a colleague or mentor with a practice that matches your anticipated future practice. For example, if you’re interested in obstetrics, find a physician whose panel is composed primarily of females and young families. Once you’ve identified a good proxy panel, you can use their EMR or mini practice profile information on average visits per patient per year as an estimate value for your calculations.
If physicians have access to a Doctors of BC Mini Profile, this provides a breakdown of patient demographics in Figure 6, and the frequency of patient visits by demographics in Figure 7. You can use these numbers to calculate the average patient visits per year for each category of patient. From here you can infer the average number of patient visits per year by dividing the total visits by the number of patients.
Just to drive the point home, elderly and complex patients may need to come visit you as often as once a month. On the contrary, young professionals in their 30’s may only visit you one to two times per year. These different types of patients will consume your total available visits at different rates and as such, the optimal size of your panel will fluctuate dependent on the relative proportions and types of patients that comprise it.
In order to complete your estimate for how many patients you should have in your panel, all we need to do is combine the two sections we’ve just discussed. Simply divide your total available appointments by the average number of patient visits per year.
Lastly, we encourage using this calculated value as something to work towards, but including a range or a buffer of 10-15% fewer patients will help to account for assumptions made, patient behavior, and changing preferences over time. These calculations are meant to help you start thinking about building your patient panel, and how many patients you may be able to take on. It is not meant to be a specific forecast of exactly how many patients are ideal for your practice.
Tips to avoid exhaustion early in career:
We’ve learned a few lessons from our work evaluating patient panels and helping physicians start-up new practices; keep the following tips in mind as you work through this process.
- Be honest with yourself about how you want to practice. Just because some of your colleagues want to and are able to see 50 patients per day, doesn’t mean this will be right for you. Try to find the volume you are comfortable with and use that for your estimates.
- It is easier to add patients to your patient panel than reduce your practice. Sometimes slowly ramping up can help you land on your optimal panel size more effectively.
- Make sure you allocate ample time for charting and administration. If you plan to practice in eight hour shifts, does that mean eight hours with patients or eight hours including all patient follow up and paperwork?
- Connect with your local Division of Family Practice to make sure you are aware of all the support and resources available to you as you transition into practice.
Contact the VDoFP at firstname.lastname@example.org if you have any questions or want support with calculating your optimal panel size.
The Vancouver Division of Family Practice (VDoFP) is a non-profit organization funded by the Doctors of BC and GPSC. We are a membership-based organization with over 1000 GP members across the City of Vancouver. One of our initiatives supports new to practice physicians as they transition into practice. This article is meant as a starting point for establishing the size of your practice. It is not meant to determine exactly how many patients you should take into your practice. This information can be a guide to help you determine a range, but each physician should build the type of practice they feel comfortable with.