The Sweet Spot

John Nelson, MD.

Editors’ note: This month we begin a new bimonthly column authored by John Nelson, MD. Dr. Nelson will cover practical, real-life topics and ideas for improving your practice in this space during the coming months.

Are you pretty sure your workload is in the sweet spot? That is, do you think you’re seeing the “right” number of patients? For most of us this isn’t an easy question to answer. My wife figured this out a long time ago. When she asked me “So how was it today?” at the end of the work day, I would nearly always answer “Too busy” or “Too slow.” On the rare occasion I enthusiastically said the day’s workload was “just right” she would nearly fall out of her chair. (Disclosure: Now the way I really answer her question most often is to say, “It was OK. How was your day?” I learned that the constant too busy/too slow answers are a downer and marital accord is served by other responses. I share this hoping you can benefit from my experience, but marital advice isn’t the point of this column.)

How you feel about your workload from day to day is terribly significant, but just how do you decide what the right workload is? More importantly, what can be done if you’re convinced you’re constantly working too hard or at an unsustainable pace?

This month I’ll offer thoughts for those who feel they’re seeing too many patients. In future installments of “Practice Management,” I’ll address those seemingly rare people who think their patient volume is too low.

Comparing Apples with Apples

If you think you’re seeing too many patients, you probably want to know the typical patient volume for hospitalists in practices similar to yours. So it is natural to turn to survey data, such as the SHM Compensation and Productivity Survey, which is published about every two years (results of the 2005-2006 are available to SHM members at

You might think about how your practice differs from the average practice in the survey to explain why your volume should be higher or lower. Then you might talk with individual hospitalists from other practices, and even the colleagues in your own practice. What is their patient volume and do they think it is too high, too low, or the elusive just right?

So by comparing your workload with external benchmarks, you know the real answer to whether your patient volume is too high or not. Right? Not so fast. Who says you are average and should feel comfortable working at the average pace? Isn’t it possible that the right patient volume for you is different than for others? I think data from other hospitalists serve only as a rough guideline and starting point for deciding about your own volume. Ideally you should have significant latitude to decide where the sweet spot is for yourself. Kudos if you’re in that situation now.

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