Overloaded with Patients? How to Spot an Overcrowded Schedule

As a physician, you work hard. You do your best to take care of your patients, to have a positive impact in their lives. The more patients you see, the more lives are changed. How do you determine when there are too many patients on your schedule? Your definition of too many may be just right for another doctor.

Let us explore some signs that your schedule is overbooked and what you can do about it.

Are you always behind schedule? As a hematologist oncologist, I can see four benign hematology patients in an hour, but for more complicated oncology patients, it may take me 30 minutes or more to see one patient. If you are spending most of your days behind schedule, it may be a sign that you have more patients than you can handle in that period of time.

Are you working extra hours, hours which are not recognized by monetary compensation or your institution but only recognized by you and your family? While you are feeling rushed and doing your best in hopes of not falling too behind, you sacrifice yourself by having unfinished charts and a full load of in-basket tasks to tackle after you see your last patient. Break? What break? Forget about having any breaks during the day. As much as you want a little lunch time, you are ploughing through with writing up some charts. Any administrative duties are done after hours. Your day seems to never end, and this happens over and over again.

Do you find yourself having difficulty in fully engaging with patients? During a patient encounter, you are physically there. You try your best to listen to what your patient is saying, but you are distracted by how the clock is ticking, by how many more minutes you are behind, by how you want to finish the encounter and move on. Connecting with your patient seems to be something too luxurious for you to experience.

Are you feeling uneasy, anxious, stressed or overwhelmed regarding work most of the time? When your schedule is overcrowded, it is easy to feel emotionally exhausted. You may be drained before even starting your day. You are losing joy and passion in your work. All you can think of is how crazy your schedule is and how it should be decreased. The quality of your care is likely affected because it is difficult for you to fully commit to providing the best care possible.

It is important to recognize your schedule is overcrowded. You can then choose to do something about it. Other people’s schedules serve as reference points. You are you, and you will change over time. I used to think 25 patients were too many for me to care for in a day. Now, I think that same patient load is manageable.

Deep dive into your schedule. Keep a log of how much time you spend with each patient. The more patients you observe, the more data points you have for a more representative average. If you spend on average 20 minutes with each patient and there are 4 patients scheduled in an hour, your schedule is overbooked. Overbooking once or twice in a day is probably not causing a  significant change, but if you are overbooked every hour, that causes a big impact.

Examine how many extra hours you work a day. After seeing your last patient, how much time does it take for you to finish your charts, to call back the patients and to complete the in-basket tasks? Or do you still have incomplete charts and tasks from days ago?

When you notice that your schedule is overcrowded, see if it is possible to adjust your schedule. If you are the owner of your own practice, that is probably easier to do. If you are employed by an institution which focuses on RVUs, it may be more difficult to adjust your patient load. Talk to your administration. Discuss the situation. There is always something you can negotiate. With a decreased patient load, your compensation may be affected. You get to decide what is more important.

Reflect on your individual work. Is there room to increase your efficiency? Are you taking full advantage of the technology you have? Do you know your electronic health record system inside out? Are you streamlining the workflow? Is there room for more delegation?

Ask for help. Ask a colleague who is efficient, seeing about the same number of patients as you are and is leaving work on time with everything done. What is the secret? What are you missing? Consult a mentor or a coach, especially a coach who has gone through what you are going through.

An overcrowded schedule affects both you and your patients negatively. You constantly feel rushed, cannot fully connect with your patients and spend extra hours to finish all your work. Your patient care may be compromised. Recognize the signs of an overcrowded schedule. Evaluate your work situation and see if you can adjust your schedule. Do not hesitate to raise your concerns to the administration. Ask for help from your peers, a mentor or a coach. Explore ways to be more efficient. You are always changing. A schedule that is overcrowded for you now may be just right for you in the future. Ultimately, the most important thing is to take care of yourself and to provide the best care possible to your patients.