I work 80% full time seeing patients, the rest being various administrative and teaching responsibilities. The average American goes to the doctor 2.3 times per year (yeah, lots of you never go to the doctor but there are a special few who go like 20 times a year, so it averages out). Doing some math, my practice should be full at about 1600 patients, a number I surpassed like 6 months into my career (you know, primary care shortage). However, thanks to the magic of cost sharing, under insurance, and general lack of concern for their health problems on the part of my patients, I can't keep my schedule full at 1600 patients; periodically I have to open the practice back up to new patients, agonizing over the decision each time. There are currently about 2300 people who consider me their primary care physician.
In July of this year, as we were looking at empty schedules and rising expenses, we had to bite the bullet and open up again. Though I like not losing money and laying off employees, I still protested hard. Not that I mind being busy, what I mind is being exposed to the circulating pool of crazies.
"What do you mean by 'circulating pool of crazies,' Dr. Sour Puss" my nurse asked.
"There's this population of patients, chronic patients with unfixable problems who burn out their doctors pretty quickly and once it's clear that doctor cannot help them, they jump to the next doctor-victim" I said. Because they go to the doctor a lot, and because they are always looking for a new doctor, they represent a disproportionate amount of the new patients calling to schedule an appointment. Just ask any doctor who just recently hung out his or her shingle.
"You're just being negative like always, you need to relax."
"Oh really, you don't believe me, eh?"
There's a white board in my office and we've been keeping a track. Here is the current tally as of today.
Since July 19, 2008
Number of new patients, establishing care: 44
Number of new patients with a pain complaint requiring narcotics of > 3 months' duration: 23
Number of new patients with very severe uncompensated mental illness: 9