Latest / The Ask Mike Reinold Show / How Many Patients Per Day Is Too Many and Setting You Up to Burn Out? - #AMR398

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How Many Patients Per Day Is Too Many and Setting You Up to Burn Out? - #AMR398 · The Ask Mike Reinold Show

• 0:50
  SPEAKER_01: On the substantial ask my crinal chill, we talk about how many patients a day is a good thing or a bad thing for you when you first get started in physical therapy.
• 0:59
  SPEAKER_01: The Ask My Cryp.
• 1:04
  SPEAKER_01: Helping people feel better, move better, better.
• 1:16
  SPEAKER_01: Before we get to the podcast, I wanted to make sure you knew about my free online course on the introduction to performance therapy and training.
• 1:24
  SPEAKER_01: If you want to learn how to get started optimizing and enhancing performance, this is the course for you.
• 1:29
  SPEAKER_01: Head to micrunnold.com slash performance to sign up today.
• 1:33
  SPEAKER_01: Welcome back, everybody, the latest episode of The Ask Mike Ronald Show.
• 1:35
  SPEAKER_01: I'm here at Champion PT and Performance, like physically in the PT room right now, and here answering your questions.
• 1:42
  SPEAKER_01: Anything you guys want to talk about, sports PT, career advice, performance things, anything you want to talk about, we're here for you.
• 1:48
  SPEAKER_01: Head to microna.com, click on that podcast link, and we will answer your questions.
• 1:53
  SPEAKER_01: Just like we've been doing for it's been over 10 years, right?
• 1:56
  SPEAKER_01: I think we we got a we have a number episode coming up that's cool too.
• 2:00
  SPEAKER_01: I don't remember which one, but maybe I don't even remember 400.
• 2:04
  SPEAKER_01: I don't know.
• 2:04
  SPEAKER_01: It's something cool is coming up.
• 2:06
  SPEAKER_01: But anyway, I'm joined here today with Dewesh Podell, Kevin Coughlin, um, Brendan Gates, and Lenny McRina.
• 2:13
  SPEAKER_01: For some reason, instead of just looking you guys in the eyes on Zoom and saying your name, I was reading them, which totally did decreased my momentum.
• 2:22
  SPEAKER_01: I don't know why, because Gates is like one word.
• 2:24
  SPEAKER_01: Anyway, so Len, who do we have for a student with us today?
• 2:29
  SPEAKER_01: Just have one student today.
• 2:30
  SPEAKER_02: One student, very unusual for uh a champion, but we we have more coming.
• 2:35
  SPEAKER_02: Um, we have Luke Alfonso from Creighton University.
• 2:38
  SPEAKER_02: Luke is flying solo, but trust me, my friend, there are others coming.
• 2:44
  SPEAKER_01: Well, it's gonna be it's gonna be hard to top Luke.
• 2:46
  SPEAKER_01: He's had an amazing how many weeks, Luke?
• 2:48
  SPEAKER_01: Three, four weeks you've been by yourself?
• 2:50
  SPEAKER_01: Is it three weeks, four weeks?
• 2:51
  SPEAKER_01: Week five.
• 2:52
  SPEAKER_01: Five?
• 2:54
  SPEAKER_01: He's flying solo, so he's getting everybody.
• 2:56
  SPEAKER_01: It's amazing.
• 2:57
  SPEAKER_01: You you found this, you know, you're like when Katie came to us for Christmas.
• 3:01
  SPEAKER_01: Right exactly.
• 3:02
  SPEAKER_01: Sorry, Katie.
• 3:03
  SPEAKER_01: Mary, if Mary, if you're listening, what's up, Katie's mom?
• 3:06
  SPEAKER_01: Luke, what what do we have for a question today, Luke?
• 3:10
  SPEAKER_00: Got a question from Rachel from Atlanta.
• 3:13
  SPEAKER_00: She says, I'm interviewing for my first job, and one clinic expects therapists to see 16 to 20 patients a day.
• 3:19
  SPEAKER_00: They say that's normal and that I'll learn faster because I'll see more cases.
• 3:24
  SPEAKER_00: At what point does a high caseload become bad for the therapist and the patient?
• 3:29
  SPEAKER_01: Awesome.
• 3:30
  SPEAKER_01: Rachel, uh man, that is probably gosh, I'd hate to say the number one question because we do get a lot of like questions, but in terms of like questions that I think the current state of physical therapy students and new grads or even early career professionals are kind of asking is this exact question.
• 3:47
  SPEAKER_01: Um, and it's funny, you know, Lenny and I, you know, I guess we date ourselves, we'd be like, wow, 16 a day, that sounds like a breeze.
• 3:53
  SPEAKER_01: That was a more that was a morning.
• 3:56
  SPEAKER_01: That was a morning.
• 3:58
  SPEAKER_01: But um uh, you know, I I think this is like when we're when we've been talking to our PT students lately, and you know, you guys, the PTs, everybody here takes students.
• 4:06
  SPEAKER_01: Um, I I think this is like the number one thing that they're they're thinking about and they're asking about.
• 4:11
  SPEAKER_01: Like you can tell Rachel like asked that in her interview, like how many they see.
• 4:15
  SPEAKER_01: Um, and yeah, I mean, I think she like phrased this really well.
• 4:18
  SPEAKER_01: And she phrased it on the pessimistic side, which is okay.
• 4:21
  SPEAKER_01: Like, when does it become bad for both her and the patient, which is a very valid question?
• 4:26
  SPEAKER_01: Um, but you know, I you know, I think their employer phrased it from the optimistic side, right?
• 4:31
  SPEAKER_01: Like that it'll be beneficial for her to get some experience and stuff.
• 4:34
  SPEAKER_01: So gosh, I wonder where the the fine line exists.
• 4:40
  SPEAKER_01: So, Len, do you want to start off with a historical perspective?
• 4:43
  SPEAKER_01: That's what we that's what we can say.
• 4:45
  SPEAKER_01: Well, just like like what like what are your thoughts as an old person?
• 4:49
  SPEAKER_01: Sorry.
• 4:49
  SPEAKER_01: And then um, I'd love to hear from Kevin and Brendan just kind of what their like you know current thoughts are, you know, as middle career professionals.
• 4:58
  SPEAKER_01: Like I know you guys probably were fessing that, but Len, why don't you why don't you kick it off?
• 5:02
  SPEAKER_01: What do you think?
• 5:03
  SPEAKER_02: Back when I was treating King Tut, um he was difficult to know.
• 5:07
  SPEAKER_02: I mean, yeah, I mean, this was my honestly, I'm not even exaggerating.
• 5:10
  SPEAKER_02: That was our morning, right?
• 5:11
  SPEAKER_02: Like we would treat 30 to 40 sometimes in a day.
• 5:15
  SPEAKER_02: And trust me, it was not easy.
• 5:16
  SPEAKER_02: But I got my notes done and I felt like I gave really good care.
• 5:19
  SPEAKER_02: I never felt like it was bad care.
• 5:22
  SPEAKER_02: I had a good uh helper, my athletic trainers were all like they knew me, they knew our systems, and we just we just went at it.
• 5:30
  SPEAKER_02: And the notes got done.
• 5:31
  SPEAKER_02: Everything was on uh electronic, like a tablet or um a laptop thing that we got, and we we we got it done.
• 5:38
  SPEAKER_02: Now I get it, not it's not for everybody, and I thrived in it, and I still to this day I catch my eyes wandering because now we're one-on-one, so my mind is just like I'm looking for others, I'm looking at other stuff because I the one-on-one is great.
• 5:51
  SPEAKER_02: Trust me, my patients and I we have a blast, but you know, I'm used to the the fast four, six, eight at a time going, and it's just um I know it's not ideal, and it's probably there's a legality side of it too, that I think is where you know there's a gray area, but it's not for everybody, and you gotta figure out you're gonna last six months, a year, two years.
• 6:09
  SPEAKER_02: I did it for 12, and um it was only because we we opened up in Boston the champion um that I left.
• 6:16
  SPEAKER_02: Otherwise, I'd probably still be grinding doing that, and I had a great time.
• 6:19
  SPEAKER_02: So it's not for everybody.
• 6:20
  SPEAKER_02: My I think my personality was okay with it.
• 6:22
  SPEAKER_02: I could I hand I handled that that fast-paced, um, and I just learned a ton.
• 6:27
  SPEAKER_02: And we had great doctors.
• 6:28
  SPEAKER_02: I had access to the doctors, and I made sure that I carved that out as part of my career was to get to the doctors and be able to talk to them as much as I could, and I used that to be able to speak.
• 6:38
  SPEAKER_02: So I think it's it was that and the patient experiences that got me to where I was able to get to to do national speaking and to and to write papers and to publish research.
• 6:49
  SPEAKER_02: So it's all what you want to make of it.
• 6:50
  SPEAKER_02: And if you do get, you find yourself getting uh, you know, I guess burnt out or tired from it, then you move on.
• 6:56
  SPEAKER_02: But I think you you just take the if you are considering it still, um you take the the 16 to 20 a day and you take the experiences and you're gonna have a huge amount of mental um experiences that you can uh tie you know tap into when you're off on your own and you have a good uh practice going on your own somewhere, hopefully locally, where all those patients will want to see you.
• 7:16
  SPEAKER_02: And now you have a good base of patients to start with uh when you have your own experiences and you're on your own.
• 7:21
  SPEAKER_02: So hopefully that makes sense.
• 7:22
  SPEAKER_02: You know, it's it's just you're building that mental database of experiences that's gonna be huge for you when you're two, three, five, ten years out, twenty years out, like us, you know.
• 7:32
  SPEAKER_01: Yeah, and you know, to give you to make sure people understand what Lenny's saying here too.
• 7:36
  SPEAKER_01: Like he mentioned like we we had partners in that system.
• 7:38
  SPEAKER_01: So it's basically two clinicians, you know, treating, you know, like that many people.
• 7:43
  SPEAKER_01: So if you actually divide it by half, it's not like astronomical, like crazy, like, you know, like like to think about.
• 7:49
  SPEAKER_01: It's just two people working together and knocking it out, which I don't think that model's as popular as it used to be either, right?
• 7:55
  SPEAKER_01: But like when a P a PT and a PTA or an athletic trainer, depending on the state you're in, kind of like tackling a schedule together.
• 8:02
  SPEAKER_01: I mean, you you can make a lot of damage that way because there's there's some downtime between things.
• 8:06
  SPEAKER_01: There's times for you to like hop back and forth between people, like you know, it's it's not necessarily you know the right thing.
• 8:12
  SPEAKER_01: But gosh, you know, let Lenny said something that I think is the most important thing to take out of this, right?
• 8:17
  SPEAKER_01: You know, for you to become good at anything in the world, it's about repetitions, right?
• 8:23
  SPEAKER_01: So that I think this is the first thing I'm gonna say.
• 8:25
  SPEAKER_01: If you work in a place that sees 16 patients a day versus a place that sees eight patients a day, I can almost guarantee you you'll get twice as good at your profession in half the time.
• 8:38
  SPEAKER_01: It's just math, it's just the way it works.
• 8:40
  SPEAKER_01: Like you won't be stumped when like somebody comes in because you've seen it a few times already earlier in your career.
• 8:45
  SPEAKER_01: So I think that's like like some of the some of the benefits type things, you know.
• 8:50
  SPEAKER_01: Like from the employer, like the other thing I just would just tell you guys too, like the new grads and stuff here, it depends on where you are, right?
• 8:57
  SPEAKER_01: If you're in New York City, right?
• 8:58
  SPEAKER_01: Yeah, gosh, the rent's expensive, right?
• 9:01
  SPEAKER_01: So, like like employers aren't doing this because like they want to get rich off you, they're doing it because that's the model that they need to do to make their clinic successful, right?
• 9:12
  SPEAKER_01: So keep that in mind too.
• 9:13
  SPEAKER_01: It's not always like a greed thing, sometimes it's a location thing.
• 9:16
  SPEAKER_01: So if you choose to work in Manhattan or you choose to work in downtown Chicago, that might change things.
• 9:23
  SPEAKER_01: So it it also goes back down to your preference and where do you want to live?
• 9:26
  SPEAKER_01: So but um, but Kevin, Brendan, I'd love to hear from one of you guys who wants to start off, maybe Kev.
• 9:31
  SPEAKER_01: Um, like what do you what do you think about this concept from your perspective?
• 9:36
  SPEAKER_04: Yeah, I think um what I would wonder about with the uh clinician asking is like what other benefits does the company you're working for offer you?
• 9:46
  SPEAKER_04: Like is is everything else really good, but you're a little overwhelmed with the number of patient visits?
• 9:51
  SPEAKER_04: Uh, because sometimes you got to do that kind of calculus on your own.
• 9:54
  SPEAKER_04: And you're you're not if you're an early career professional, you're not always gonna get everything you want in one job.
• 10:00
  SPEAKER_04: And there might have to be some sacrifices.
• 10:02
  SPEAKER_04: So if your dream scenario is treating end uh eight to ten people a day, uh, but you want good continuing education and good mentorship from your coworkers and you know, time to do documentation during the workday, and you have all those other things uh lined up, but it's just the patient visits, sometimes there is some give and take there, and you you have to be willing to sacrifice on that.
• 10:24
  SPEAKER_04: Um, the other thing I'd say, and I think Lenny mentioned this, is in terms of you know the burnout specifically, I think some people's personalities can just handle it really well.
• 10:33
  SPEAKER_04: They do well in a high stress environment or they do well with a lot of things going on.
• 10:38
  SPEAKER_04: Uh, some people don't.
• 10:39
  SPEAKER_04: And if if you're gonna be the clinician who's always thinking that the grass is greener somewhere else and that, you know, you're you can't stop fixating on the fact that, like, oh, you know, I think my my boss is trying to get rich off me.
• 10:50
  SPEAKER_04: You know, they're the whole system, the healthcare system stinks, I'm seeing too many people, you're just kind of ruminating on that.
• 10:56
  SPEAKER_04: You you either have to change your mindset or look for a different uh position, I think.
• 11:02
  SPEAKER_04: So it's it's probably not for everybody, but I think if you're in that environment, uh you can make the most of it.
• 11:07
  SPEAKER_04: Cause I think what both of you said is so true.
• 11:09
  SPEAKER_04: Like the more repetitions you get early on, even if you know this is only like a five to 10 year plan and then you want to go somewhere with a lower uh patient caseload, that's totally fine.
• 11:20
  SPEAKER_04: And then you have all those repetitions you built up early on.
• 11:23
  SPEAKER_04: So, you know, it's it's one of those things.
• 11:25
  SPEAKER_04: I don't think there's a right or wrong answer.
• 11:27
  SPEAKER_04: It really depends on how you look at it and what else you're getting out of the job and what your long-term goal is.
• 11:33
  SPEAKER_04: Uh, but I I do think for a lot of people, it's probably a good thing in the long term.
• 11:38
  SPEAKER_04: Um, if you can look for the benefits in it, uh there's probably some there.
• 11:43
  SPEAKER_01: Yeah, and you got you got to be happy, right?
• 11:45
  SPEAKER_01: And I I think in our profession, right, the majority of our profession, like we're look, we're not the highest paid profession.
• 11:50
  SPEAKER_01: Everybody knows that going in.
• 11:51
  SPEAKER_01: Like you can make more money in a different profession.
• 11:53
  SPEAKER_01: But I think the satisfaction level and like like do people enjoy their job?
• 11:57
  SPEAKER_01: Do they enjoy going to work every day is very high in our profession, you know, hopefully because you know, you chose it because based on your personality.
• 12:04
  SPEAKER_01: So if you're in a position where you just can't stand your job, like it's not matching your personality.
• 12:10
  SPEAKER_01: I I agree with Kevin 100%.
• 12:11
  SPEAKER_01: You gotta move, right?
• 12:13
  SPEAKER_01: Because you know, life's too short, you know.
• 12:15
  SPEAKER_01: So find an environment that's that's good for you, and and I think that'll be huge.
• 12:19
  SPEAKER_01: But uh, Brendan, what do you think?
• 12:21
  SPEAKER_01: What are your thoughts?
• 12:22
  SPEAKER_03: Yeah, I think I see both sides of the question.
• 12:25
  SPEAKER_03: Um, for uh, you know, the employer to say that you'll learn a lot faster because you'll see more cases.
• 12:32
  SPEAKER_03: I I totally agree.
• 12:34
  SPEAKER_03: Uh and I think at one point I was the PT worried about having too high of a caseload in my first job out of school.
• 12:40
  SPEAKER_03: Um but uh I took it, you know, I was in a higher volume clinic at first, and it felt super overwhelming.
• 12:48
  SPEAKER_03: Um and I felt a little guilty sometimes because I felt like I was almost learning through trial and error a little bit with some people I wasn't as comfortable with.
• 12:55
  SPEAKER_03: Um but now looking back on that, like I would not trade that first yeah.
• 13:00
  SPEAKER_03: I thought it was super valuable to get me to our now in a lower volume clinic in our one-in-one care.
• 13:05
  SPEAKER_03: That's you know, much as closer to like maybe six to eight people a day, or 15 to 20.
• 13:10
  SPEAKER_03: Um, but I think that there is value to having the high volume clinic right out of school and getting those reps, like you guys have said.
• 13:17
  SPEAKER_03: Um I certainly think that we need to keep patient care a priority.
• 13:22
  SPEAKER_03: And if that starts to drop based on the personality, you know, if you're overwhelmed, you can't program or prep as much as you want to, um, then it might be worth you know looking to a place that has maybe 40 minute treatments rather than 30 or something like that.
• 13:35
  SPEAKER_03: You know, there is, I think, a sweet spot between what we do and like the really high volume clinics.
• 13:39
  SPEAKER_03: Um, and I think part of that is based on the clinician.
• 13:43
  SPEAKER_03: Um, I do think another valuable thing that I know you've talked about, Mike, is the higher volume places will have to kind of force you to develop a system so that you can really streamline things and your way of thinking and reasoning.
• 13:56
  SPEAKER_03: So um, I almost think that like you know, getting tossed in and figuring out as you go uh can be really valuable for a lot of people.
• 14:03
  SPEAKER_03: So uh I I definitely think there's a sweet spot, but I think there's value to a higher volume clinic.
• 14:09
  SPEAKER_01: Yeah, love it.
• 14:10
  SPEAKER_01: I mean, that makes sense.
• 14:11
  SPEAKER_01: Um, you know, uh to me, I think I'll end the episode with this.
• 14:14
  SPEAKER_01: And I'm gonna I'm gonna I'm gonna hit this question from a different perspective, I think, is okay, you're in that situation.
• 14:21
  SPEAKER_01: What is some advice I would give you to handle that situation as best as you can?
• 14:26
  SPEAKER_01: Because you're right, there is some you know hesitations.
• 14:28
  SPEAKER_01: But I will say when some of our students say, like, hey, I'm, you know, my first job's gonna be one-on-one, you know, and they have like two, three, four patients a day for a while.
• 14:37
  SPEAKER_01: Like, I I don't think that's ideal for them.
• 14:40
  SPEAKER_01: I would rather you be on the other side of that, to be honest with you.
• 14:43
  SPEAKER_01: You're you're gonna you're gonna have a hard time, you know, getting your reps in.
• 14:46
  SPEAKER_01: And like Brendan said, sometimes you feel like you're you're experimenting on people, and sometimes that's real, and oftentimes it isn't, right?
• 14:54
  SPEAKER_01: It's just your lack of self-confidence because you don't have the reps, right?
• 14:57
  SPEAKER_01: Um, but you know, you're well prepared for it.
• 14:59
  SPEAKER_01: But I I'm I'm gonna I'm gonna give you the uh give you the the answer to this as advice.
• 15:04
  SPEAKER_01: And the first one for me was definitely gonna be systems, like Brendan said.
• 15:07
  SPEAKER_01: You get really good at systems, right?
• 15:09
  SPEAKER_01: Luke and I talked about this yesterday in the clinic, systems, right?
• 15:12
  SPEAKER_01: So you know, we're gonna do, you know, you know, uh almost like an a la carte of like a few different like micro recipes that you put together so that way you know like it's it's in sync.
• 15:22
  SPEAKER_01: So systems is number one.
• 15:23
  SPEAKER_01: Two is like if you can change your schedule, I would, you know, book people every 30 minutes, not two people at the top of the hour, if you can, if you have to treat 16 people, right?
• 15:33
  SPEAKER_01: These this is the advice we talk about this a lot in my CPS program in our community because people are trying to implement this.
• 15:39
  SPEAKER_01: Every 30 minutes, you can do a bunch of hands-on stuff and then kind of give them some guided, like thyrex-based things that you can monitor while you're working on the next person, and it's a good community environment.
• 15:49
  SPEAKER_01: Uh, but the third one on that is based on schedules.
• 15:52
  SPEAKER_01: I would actually say my biggest advice is if you can control your schedule, control it.
• 15:57
  SPEAKER_01: Meaning, like, do not let a front desk person schedule on your schedule for you.
• 16:02
  SPEAKER_01: There's nothing more disruptive than putting like an ACL post-op evaluation in the middle of two complicated patients that need your hands-on a time.
• 16:12
  SPEAKER_01: You know your patients better than anybody else.
• 16:14
  SPEAKER_01: So try to control your schedule as best as you can.
• 16:16
  SPEAKER_01: Even if you send the people out and tell them to go schedule at the front desk at specific times, but make sure that you are putting the right people at the right time.
• 16:24
  SPEAKER_01: And in that case, though, it gets a lot easier, right?
• 16:26
  SPEAKER_01: I say this with Lenny all the time.
• 16:28
  SPEAKER_01: It would be so disruptive for me to have six Tommy Johns in a row and then throw an ACL in the middle of that.
• 16:33
  SPEAKER_01: That would just destroy the flow of my day, right?
• 16:36
  SPEAKER_01: Like, even though that sounds cool, like it would just, yeah.
• 16:39
  SPEAKER_01: Well, you put that on your cell phone.
• 16:42
  SPEAKER_01: But um, but that's my biggest one.
• 16:44
  SPEAKER_01: And then the last one, I say this to everybody, is I do all my notes before I go to work, right?
• 16:50
  SPEAKER_01: I'm fresh, I got a cup of coffee.
• 16:51
  SPEAKER_01: It takes me 10, 15 minutes to bust through all my notes, and I go into that day prepared.
• 16:56
  SPEAKER_01: I know exactly what I'm gonna do with everybody, right?
• 16:59
  SPEAKER_01: And sure, at the end of the day, you tweak a couple of things, but you go in there prepared and ready to attack the day.
• 17:04
  SPEAKER_01: It doesn't matter how many people, right?
• 17:05
  SPEAKER_01: And again, Luke and I, we you know, we do go this every day.
• 17:08
  SPEAKER_01: I'm in, I I kind of send them a list of the game plan for the day.
• 17:11
  SPEAKER_01: So for me, that's my biggest piece of advice because sometimes you can't control this.
• 17:14
  SPEAKER_01: So, how do we make it as best as possible?
• 17:17
  SPEAKER_01: Uh, Rachel, I think that's a question a lot of people are gonna have.
• 17:19
  SPEAKER_01: So, thank you for submitting that.
• 17:20
  SPEAKER_01: If you have a question like that, head to micronot.com, click on that podcast link and ask away.
• 17:25
  SPEAKER_01: And thank you so much.
• 17:26
  SPEAKER_01: We will see you on the next episode.