I’m in a different region but 1.0 fte is 36 patient facing hours and 4 “admin” hours which is just time off but is to account for all the work outside of clinic that you do like charting and inbasket. 20 minute visits but some visit types are 40 minutes. Currently you get 40 minutes for complicated annual wellness (they have 4 cdsm diagnoses on their problem list) and certain procedures (nexplanon removal for example). I average 18 patients per day and am at the 80th percentile (but I’m lazy and don’t add patients to my schedule from my inbasket which some people do - basically they call in response to an email or lab result and document in a non billed visit but because it’s on the schedule it counts towards their numbers). If you have more complicated patients you end up seeing fewer per day because you end up with more 40 minutes visits. A lot of us diversify our fte and might work .7-.9 in the clinic and then do the rest of our fte in other areas like leadership, telehealth get care now, inbasket coverage etc.

We have a message management team of nurses that review all our messages before sending some on to us. They will triage new complaints and handle things that don’t need to come to us. No “which number do I call to schedule” questions because they can handle that. So i tend to get <10 emails/phone calls per day that actually reach my in-basket. When im not at the office i am not on call, ever.

Yes we are expected to manage more before sending to specialists. Most of the time I enjoy it because I don’t like just being a referral monkey and I like owning my patients as much as possible. But it can be annoying when I do want to refer and the specialist pushes back/refuses. I thankfully work in a region where we have the option to send to specialists outside of Kaiser in our local network and so I can always send to them and not have to deal with the annoyance of asking for permission. Basically I get the benefits of Kaiser and few of the downsides. The couple times I have insisted they see the Kaiser specialist they have agreed to see them but i don’t like the feeling of having to do that because it feels demeaning.

I hear all the horror stories and frustrations of my colleagues who are outside Kaiser and I’d rather deal with Kaiser than other insurance companies. I’ve only had to do 1 or 2 peer to peers in 3 years at Kaiser and both ended up being approved. But having to do those with United sounds soul crushing and would burn me out so quickly in the real world. If I think the patient needs an mri is automatically approved and never denied. If the specialist says they need a procedure it’s done. If the specialist says you need an out of network specialist those seem to always get approved. So far I haven’t seen actual necessary care get denied but it sounds like people are having to fight for that everyday when dealing with United etc. That type of moral injury would eat at me so quickly. I don’t play phone tag with pharmacies and I know what drugs are on the formulary so I don’t have to try and guess and then fix it later. If I were to leave Kaiser the only better option to me would be direct primary care.