Question
Does anyone have a estimate or rule-of-thumb to serve as a guide for number of patients seen per clinician? I work as a sole audiologist in a setting that has referrals from one ENT, but also many other physicians. I do diagnostics on all ages and my testing includes VNG's, ABR's, ECochG's, VEMP's, Posturography, OAE and hearing aids. I have no administrative help other than an individual that handles scheduling. As patient volume goes up I am struggling to keep up with the paperwork and all the other duties - since I do everything from copying, filing, and ordering supplies to performing tests and contacting insurance companies. The employer looks to increase fees and volume each year, but doesn't take into account that there can be a maximum volume that a clinician can handle, or even should handle before work quality starts deteriorating. Collections (not billing) is already about three times my compensation. Adding a second audiologist is on hold until a second ENT is hired. Does anyone have a feel for a case load number both with and without administrative help? I am willing to work hard, but feel there should be a reasonable expectation as to volume.
Answer
The work setting you describe sounds like one's worst nightmare.
It is difficult to comment on your exact setting, since I do not know what kind of agreement you worked out with the ENT. Are you a partner or an employee? Do you receive a salary (with or without benefits), a salary plus commission, or a percentage of the billed or collected revenue? Do you have paid vacation, holidays off, sick days, etc.? You see, many factors go into answering your question. If you are a partner, you are probably willing to work more hours and see more patients than if you're an hourly employee.
In a business, some of the factors that go into determining a person's caseload are:
- Salary
(Plus benefits) - Overhead
Equipment
Space (Audiologist & patient)
Shared space (waiting room, restrooms and other common areas)
Salaries of any support personnel (in your case none)
Office equipment & supplies
In our setting, the total of these factors is about $100,000/year/audiologist
Then, you have to determine how many days per year you're going to be available for work and how many hours per day you are willing to work.
In a fairly typical setting, you have the following:
Total full time work days/year 260 (2080 work hours)
Vacation days 10
Professional leave (continuing ed.) 5
Sick Days 5
National/State Holidays 7
Personal time (emergencies) 3
(Total non work time) 30 days
Total days available for work 230 days
Next you have to determine your actual billable time. In most settings, the actual billable time will average 6 hours out of every 8, due to cancellations, no shows, or other problems. So:
Available time = 230 days =1840 hrs/yr
Billable time/day = 6/8 =1380 hrs/yr
Now to break even, you have to consider the following:
Total costs/year $100,000
Billable hours/year 1380 hr.
Costs/billable hour $73
Now we need to consider the fact that in most settings that accept third party reimbursement, the reimbursement rate is only about 70% of the billable rate. So, we must increase the billable rate by 30% over the cost in order for the collectible to be equal to actual cost. So, billable must average $95/hour of patient contact time. These figures will not allow any profit margin, but will allow you to at least break even. Of course these figures need to be modified based on your circumstances, salary, benefits and all other items. You stated above that your billing is about three times your compensation. It is time for some support.
Now I know that to this point I have not directly answered your question regarding "a maximum volume that a clinician can handle, or even should handle before work quality starts deteriorating." The answer to that question is a little more difficult, because it depends on the staff member. However, with many years experience, working with a number of audiologists, you will have clinician burnout if you schedule them for more than 7 hours of direct patient contact per day, with a 5 day work week. Even with this schedule, they would have to be very efficient in completing reports (usually only summary reports) and other duties. They would then take care of the other duties like ordering supplies, etc. when a patient cancels or does not show.
You are being required to provide a wide variety of diagnostic tests, most of which requires preparation, integration and interpretation. With the pressure you have described, it is easy to let yourself function as a technician. Guard against that at all costs. You're a professional. Good Luck.
Dr. Don W. Worthington has been an audiologist for over 30 years. He is currently the Director of the Intermountain Hearing & Balance Center which is located in Salt Lake City, Utah. He loves the field of Audiology.