PTs: How many patients do you see an hour?

[PTNT]

I got to shadow my first PT at an outpatient clinic yesterday, and the one thing that stood out to me was how much multitasking she did. I had assumed PTs mostly worked 1-on-1, but she was typically handling 2-3 patients at a time, kinda running from one to the next. Is this common for all settings, or is it exclusive to smaller outpatient clinics?

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[DancerFutureDPT]

I used to work as an aide/tech at a company with many outpatient clinics throughout the Chicago area.

Our PTs would normally have 2 patients/hour (patients were scheduled in half hour increments). Normally the patient would come in and get an Ultrasound from an aide/tech, warmup on equipment, or get heat for the first 10 minutes or so, then PT would work 1-on-1 with them for a half hour, and then give them to an aide/tech to finish up exercises, get ice, etc. Most patients were there for an hour, maybe a little longer.

The only exception to the 2/hour rule was if it was the first appointment (a new evaluation)...then the PT would have a full hour blocked to have with the patient. The last patient before lunch or the last patient of the PT's day would also be a full hour of time. Of course that didn't mean the PTs still wouldn't have an aide take over partway through.

However, I worked at several different clinics this company owns, and they're all run somewhat independently. Some clinics are very strict - only 2 patients/hour, and only make exceptions in extreme circumstances. Other clinics would let certain PTs get overbooked, to where they would have patients coming in 2 at a time, or every 15 minutes. There were some nights where one PT would have 4-5 patients within an hour, which just got ridiculous for all of us trying to help out. The theory was customer satisfaction - they wanted to make sure patients could get in for appointments when it was convenient for them, even if other patients were already scheduled. That would annoy me as a patient, but most of these people were either older adults who didn't want to change their schedules, or kids with sports, club meetings, etc. Sometimes we'd have half of a school football team all in at the same time, so they didn't mind less 1-on-1 time with the PT.

But I've shadowed in some outpatient clinics that don't use PT techs, or only have one or two on staff...we usually had one tech per ever one or two therapists who were working on the schedule at that time. I think it really depends on the clinic, their mission/goals, and how many employees there are. When I was at the place where it was strictly 2 patients/hour, we rarely had to double up on patients as techs and could easily keep up with the PT patient turnover, and it worked well. Any more than that and it gets really disorganized. I liked it as a tech because I got to work more with patients instead of just doing laundry/changing tables. And I think the patients liked it because they got to be more social/interact with more people (especially the older patients). We never really had any patient complaints about not having enough time with the PTs when it was set up as 2/hour.

 

[PTNT]

Thanks Dancer, the 2 patient per hour rate seems a lot more sensible to me. I mean the PT I was shadowing was intelligent and capable, but she couldn't keep her on eye on everyone at the same time and I noticed some older patients were starting to slack on their exercise form, etc. I just feel like if you want to give quality care you need to be able to concentrate on one or max two people at a time.

Is it safe to assume that if I want a slower caseload as a PT, I would be able to find it? Or is this faster pace going to become the expected norm for profit's sake?

 

[rcheeley]

You can see as many or as little patients as you'd like to see, you just need to do your research, ask questions to employers, and find the right place for you. Typically at any place, you're going to be expected to see at minimal 1 patient per hour (if we're talking outpatient), so a minimal of 8 patients/day.

I work at a private practice outpatient ortho (PT owned) and I see on avg 12 patients/day. Now, that's on avg, so I may have some days I see 8, I may have some days I see 16+. However, I'm in charge of my schedule, so when I'm seeing 16+ patients per day, usually it is because the back end of my schedule I am seeing a bunch of middle/high school age kids coming for PFP, postural related back pain, ankle sprains, etc that I could manage in my sleep. We typically keep MC patients 1-on-1, evaluations are 1 hour, and then the rest if up to the PT.

Thanks Dancer, the 2 patient per hour rate seems a lot more sensible to me. I mean the PT I was shadowing was intelligent and capable, but she couldn't keep her on eye on everyone at the same time and I noticed some older patients were starting to slack on their exercise form, etc. I just feel like if you want to give quality care you need to be able to concentrate on one or max two people at a time.

Is it safe to assume that if I want a slower caseload as a PT, I would be able to find it? Or is this faster pace going to become the expected norm for profit's sake?

 

[PTNT]

You can see as many or as little patients as you'd like to see, you just need to do your research, ask questions to employers, and find the right place for you. Typically at any place, you're going to be expected to see at minimal 1 patient per hour (if we're talking outpatient), so a minimal of 8 patients/day.

I work at a private practice outpatient ortho (PT owned) and I see on avg 12 patients/day. Now, that's on avg, so I may have some days I see 8, I may have some days I see 16+. However, I'm in charge of my schedule, so when I'm seeing 16+ patients per day, usually it is because the back end of my schedule I am seeing a bunch of middle/high school age kids coming for PFP, postural related back pain, ankle sprains, etc that I could manage in my sleep. We typically keep MC patients 1-on-1, evaluations are 1 hour, and then the rest if up to the PT.

That's definitely encouraging, but I hope it's something that I can expect to be the case into the future. To me, it's a completely different job if you're dealing with multiple people at once.

 

[atstudent]

The company I work for has 6 locations. One location has 4 or 5 clinicians there on MWF. They see anywhere between 60-80 patients on those days. That's in a 10 or 12 hour a day. On Tuesday/Thursday there are two of them there and they see something like 25 in a day.

The location I work at normally will see about 25 with two clinicians MWF. If they see more than 12-13 per clinician in a day, they start freaking out.

 

[MinnDasota]

My last job, I saw 2 patients an hour (1 for evals). I also had the liberty to block off a full hour for patients that I felt needed the extra work/attention. Each PT also had his or her own aide.

Currently, I am only seeing 1 patient per hour, which is amazing, but there are times I feel like I just need a second away from my patients. Kinda miss having an aide sometimes!

I have interviewed at places that saw as many as 4 patients an hour which is ridiculous. Sounds like early burnout to me. I know PT's that thrive on the high volume, just not for me.

Oh, my focus is sports/orthopedics. Not sure how it is outside of this realm of PT.

 

[track11]

I'm really hoping to work somewhere with a 1 or 2 patient per hour ratio. When I was shadowing a therapist with a number of patients at a time, the patients would tell me they should only have to pay half of the cost of treatment since they were only getting half attention :/ I felt kinda bad for them!

 

[rcheeley]

I'm going to get way off topic here, and go on a soapbox, but this is leading to another issue....

So if they go see a physician, and that physician has 8-12 people scheduled within 1 hour, do they feel like they shouldn't have to pay but 1/8th to 1/12th the amount? Which in many cases, is the same co-pay/co-insurance amount as they might pay when they go see a PT. I've shadowed an ortho and a GP, and in most cases the patients were seen from anywhere for 1-10 minutes?

One of the biggest issues I see, as a PT and a clinic director, is patients coming in saying they can't afford PT, or they don't want it until they have x-rays, MRI, see an ortho or neuro they were referred to see by their PCP or GP. They often feel like, "how can you fix me if you dont know what's wrong" or that they much have an MRI done, which we know 1) does not fix them, 2) in many cases tells them nothing, and 3) doesn't change their treatment. However many of these patients are willing to go see a physician for 5 mins and without question pay whatever the cost to get a Rx to PT and told 'lets get some x-rays or an MRI to see what's going on." So then they pay for these imaging studies, they've paid for all the physician visits, they've paid for medicinal Rx's, and then finally they get sent to PT. Well then when they are told what it's going to cost for PT, they say "I can't afford it" whether its because they've already paid for everything else, or they just DON'T VALUE our services. Here it is, they've finally been sent to the person/s that are going to "fix them" and they don't value our services.

Run the numbers, look at the costs of physician visits, look at the cost of imaging studies such as x-rays, CT scans, MRIs, nerve conduction test, look at the cost of pain medications. In most cases, patients are going to get better w/ PT for musculoskeletal issues than any other treatment option with better long-term outcomes.

Prime example, a patient referred to me w/ CS radiculopathy. She called and told me she couldn't afford PT based on her insurance (high deductible, must pay OOP until met) and is suppose to have an MRI done so she's going to do this and doesn't want to come to PT. I ask her what her treatment has consisted of so far? Have you gotten any better? Does she know how much an MRI cost? Is her insurance going to pay for it? She responds with "Some pain pills, no they didn't help, I don't know how much an MRI cost, and I don't know if my insurance is going to pay for it."

So she's told me she can't afford PT, which based on what it would cost, would be about $100/visit she would owe, and would go towards her deductible. She doesn't have a clue what an MRI costs, or what her insurance will pay, because no one else cares (MD, RN, etc) about how much it costs her obviously and just told her to get it done. In my experience w/ CS radiculopathy, I could get her feeling better in 4-10 visits (or $400-1000). However, she's will to blindly pay whatever it costs for an MRI, which is going to do nothing in the sense of making her feel better, which most of us know on avg is about $2,000, and considering her insurance she is probably going to be responsible for most, if not all of this.

Best case scenario, she gets treated by a PT, she's feeling better in under $1,000 and she learned a "priceless" lession about what causes her pain, how to prevent it, and how to treat herself in the future if these symptoms return.

Worst case scenario, she gets treated by a PT, it doesn't work, the cost of PT has applied to her deductible, and she'll need some other intervention (which will require the MRI at that time) to solver her problem. $1000 for PT, $2000 for MRI, and then either injections, or surgery, to fix her problem, which in most cases she will have met her deductible by that point and she wouldn't have to pay anything else out of pocket.

It only makes sense to me you'd go with the option that is 1) going to cost you less, and 2) is probably needed in the 1st place just to prevent you needing PT services "post invasive" treatment.

We fix people, and we fix people CHEAPLY!! PT is considerably a very cost effective treatment option, even when it is ineffective. By ineffective I mean we didn't make that person feel better. However, what we have done, that goes unnoticed, is we've educated this person on what probably led them to where they are, we've educated them on how to prevent this in the future, and we've, to some extent, "conditioned" them to be better prepared for whatever other treatment they will receive in order to get the best outcomes.

The sad thing, is I constantly see PTs discounting our services. When we fix people, are we asking for more money? No, we send them on w/ life lessons so they don't have to come back to see us. When they are treated by a physician, whether it's through medication, injections, surgery, and that doesn't work, do they ask for a discount? No. If you can't afford surgery, what happens, you go to Pain Management, and if you can't afford that, you're sent to PT - and we're suppose to discount services because we are BEGGING for any business we can get.

I could go on FOREVER about this, but I'll quit babbling, sorry for taking up your time, but if you read it then I guess you were interested. Maybe there will be a thread about this later to discuss.

Back to the original topic...

You stated the patient should only have to pay for 1/2 the cost of treatment...why? Okay maybe they had to wait a little longer for the therapist, because yeah, his/her schedule is over-booked, but you know what, there might be a good reason this PTs schedule is this busy, because maybe they are a good PT. If that's the case, then this patient needs to just wait, just like they do when they go to see their PCP, Ortho, or Neuro, when they're waiting in the lobby, and then in the room, and then after the physician leaves.

I'm really hoping to work somewhere with a 1 or 2 patient per hour ratio. When I was shadowing a therapist with a number of patients at a time, the patients would tell me they should only have to pay half of the cost of treatment since they were only getting half attention :/ I felt kinda bad for them!

 

[track11]

You stated the patient should only have to pay for 1/2 the cost of treatment...why? Okay maybe they had to wait a little longer for the therapist, because yeah, his/her schedule is over-booked, but you know what, there might be a good reason this PTs schedule is this busy, because maybe they are a good PT. If that's the case, then this patient needs to just wait, just like they do when they go to see their PCP, Ortho, or Neuro, when they're waiting in the lobby, and then in the room, and then after the physician leaves.

I didn't state that as my opinion. That's what patients told me while I was shadowing. I start school in June, so I definitely am no expert on how patients should be charged. But I read your post and can see your point. From my observation, though, it seemed patients felt like they were being herded through or not given enough attention when their PT was helping a number of other patients at the same time. This is why they half-jokingly would say something like, "So I only have to pay for half of this, right?"

 

[jesspt]

I didn't state that as my opinion. That's what patients told me while I was shadowing. I start school in June, so I definitely am no expert on how patients should be charged. But I read your post and can see your point. From my observation, though, it seemed patients felt like they were being herded through or not given enough attention when their PT was helping a number of other patients at the same time. This is why they half-jokingly would say something like, "So I only have to pay for half of this, right?"

.A lot of this type of dissatisfaction can be dealt with prior to scheduling a patient for a time slot that you know in advance is going to be busy. Let them know up front that you're happy to see them at the time that is most convenient for them, but that the the treatment gym tends to be packed at this time of day. This way, they won't be surprised to see so many other bodies in the clinic. Also, empower the patient to ascertain whether or not the treatment they received was beneficial - I give my patients "assignments" if you will. I need them to determine if, after today's treatment, they are able to run further, sit at their computer longer, etc. Then I explain the plan for the next session if they come back with improved symptoms, or if their symptoms have been unchanged. Then, I try to follow that plan the next session. That way, they feel they accomplished what we needed to accomplish, even if the treatment area is busy and I didn't spend as much one-on-one time with them.
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[dlizzy]

The two places I observed were very different regarding how many patients seen per hour. The one place was the health center at my undergrad school, and the PTs saw between 2 and 4 patients per hour, and would leave us interns to finish exercises with a patient while they went to tend to someone else.

The other place is an outpatient PT facility and is known for its "one-on-one" therapy. Each PT sees one patient per hour, and they each have their own private treatment room. There is a gym attached to the building so the patients can do exercises that the treatment rooms are too small for, and the gym is also open to the public to join. I really like this kind of physical therapy because the PTs really get to know their patients. The only downside is they obviously make a lot less money, seeing only 8 patients per day. After I pay off most of my loans I would love to get a job at a facility similar to this.

Like someone above said, how many patients seen per hour depends on the clinic and its own mission.

 

[MinnDasota]

The other place is an outpatient PT facility and is known for its "one-on-one" therapy. Each PT sees one patient per hour, and they each have their own private treatment room. There is a gym attached to the building so the patients can do exercises that the treatment rooms are too small for, and the gym is also open to the public to join. I really like this kind of physical therapy because the PTs really get to know their patients. The only downside is they obviously make a lot less money, seeing only 8 patients per day. After I pay off most of my loans I would love to get a job at a facility similar to this.

I am actually getting paid quite a bit more with one-on-one vs 2 patients/hour. Really depends on how the practice is set up (in network vs out of network vs self pay). Fortunately I work in an area where many are willing to pay for one-on-one PT services. Unfortunately, this is not possible in most parts of the country though.

 

[donnabrenton]

Two patients per hour..

 

[Akiramay]

Just finished my first week of an outpatient clinical experience, and we see patients every 30-45 min. So 1-2 patients an hour. There is occasionally some overlap during the last few minutes with trying to wrap up one session and start another, but it's not much.

 

[alinak]

You can't decide how many patient in 1 hr. It depends on patient. If patient is very serious then we have give them more time than normal patient.

 

[SingingPT]

I currently work for a Private Clinic as an Aide as I am applying to PT schools. Our clinic has up to 3 therapists, 2 aides (sometimes 3), and a 4 pt/hr rule. That means at some points we have 12 patients in at once. It's an absolute madhouse! Couple that with the fact that most of them speak little to no English, and it sometimes is incredibly frustrating. I have been told though, over and over and over, that patients don't mind waiting in the treatment area, but they despise waiting in the waiting room. I don't know why this is, personally, the waiting room is more appealing to me than a small white-walled room.
Other times, my favorite time to work, it's just me and one PT working up to 4 pts/hr. That is actually fun. Usually, he manually treats while I set them on heat or exercise, and we rotate. We've been doing it for a while so it's clockwork. The only time it gets bad is if it's an evaluation, which takes over half an hour of his time. That's when it gets ugly. But, generally, it's never too much, especially if we can communicate to our patients! Hahaha.
As a personal note, something that I don't understand is a patient's philosophy of the "too much time" thing. I see this everyday. I understand that they have a life outside of PT, but these people who always leave early are always the ones we see come back again and again. I exercise everyday, this exercise we have them do is only 3x a week, for about 30 minutes. It's also exercise that allows them to feel better. I routinely have patients tell me that they only want manual/manipulation and E-stim, and they will be fine. No. No. And, NO. It's funny, they always say they aren't getting enough attention when we are busy, but when I give them undivided attention, they complain that I am making them do too much exercise. Bottom line, patients are funny. As much as they drive me crazy, I can't see myself doing anything else for a living. I literally am addicted to the thrill of having to help a large amount of patients in the most efficient way possible. Long live PT!

 

[darkangel77]

Depends on the setting and how many patients you're willing to see. My first clinical experience was in a veteran's hospital, where it was combined inpatient/outpatient. I saw as little as 1 patient in an hour, to 6 at once, since not everybody strictly follows their schedule. But we were scheduled for 3-4 patients/hour.

My second clinic was in a nursing home, where the PTAs saw 2-3 patients an hour and the PTs saw 1-2 in an hour, including the students.

My friend, who recently finished an outpatient affiliation, said she saw an upward of about 4-5 an hour, and described outpatient rehab as a "revolving door" of patients.

 

[NewDPT31]

Hey all I just graduated this Spring and started a new job with a company that has 10+ clinics in a big metro area. While I was told I would start slow and have a mentor, my first week I was left in charge of a clinic(everyone else went on vacation) and had 15pts with 1 aide. They book patients every 15 minutes(sometimes even double book every 15!) and I will routinely have 4-6 patients at the same time with 1 aide(who is also helping the PTA when she is there). After a short time, this has caused a riff between me and management because of the lack of personalized care. We have a moderate cancellation rate due to the population(mostly state funded) so there will be "slow" days with each therapist only having 10 and some days 25 each. There have been a few saturdays where its me(a PT) and an aide for the four hours we are open...It's not uncommon to have 14-18 patients show up in that time span(including 2-3 evals) and have the aide mainly do secretarial work. Evals get 30 mins, but they double book them with follow ups, and on weekdays(8 hours) i'll see 4-6 evals. I'm coming to a point where, after only a few months, of burnout with the process, company and patient population. I just don't think its the right fit for a new grad, like they made it sound during the interview process. It has led to a lot of personal stress because I don't believe in the efficacy of my treatments because I just don't have the time for more than 10 minutes with the patient. Suggestions? Normal? Abnormal?
Thanks!

 

[jblil]

I just don't think its the right fit for a new grad, like they made it sound during the interview process.

How can the patients get adequate care in such a setting? I don't blame you for looking to jump ship, I would have done so right away. Can you please PM me the name of the clinic/chain, so I can avoid them? Thanks.