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Putting It Into Practice
October 14, 2026 5 min read
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Key takeaways: The employed physician faces many challenges in terms of work-life balance. A recently retired physician offers tips for finding the right employer and optimizing workload. In this Putting It Into Practice column, Jonathan D. Leffert, MD, FACP, MACE, ECNU, talks with Yul D. Ejnes, MD, MACP, FRCP (Lon.), a recent retiree, about what employed physicians should know about the business of practicing medicine. Jonathan D. Leffert Leffert: From your perspective as a physician formerly in private practice and now recently retired from an employed position in a large practice, tell us about an optimal workload from the number of patients seen per day, the number of days per work and the protected time\u00a0allotted.
Ejnes: I prefer to frame \u201cworkload\u201d in terms of how many patients are taken care of in a day, which is more than the number seen per day. Focusing on office visits as a measure of productivity devalues the other important work that we do. That said, my schedule during the years after the pandemic was a good balance. When we reopened the office to in-person visits, it was with a \u201ctwo patients per hour\u201d rule to minimize foot traffic. As things quieted down, physicians were allowed to ramp up to pre-pandemic visit volume, but I liked the two-per-hour routine. For me, it meant 15 visits per day scheduled at the top and bottom of the hour. This did not mean 30-minute visits for everyone \u2014 if a visit was straightforward and took 10 minutes, I had time to take care of other things such as messages. If a patient needed more time, I could provide it without running late. If a patient came in late, I was often able to see them without blowing up the schedule. Prior to the pandemic, I was seeing 17 per day and a few years before that, as many as 22 per day. Things were much more rushed and there was less room for flexibility. What the \u201cright\u201d number is depends on your patient population, the practice\u2019s revenue and compensation model and your personal financial goals, as well as how much staff support you have so that you\u2019re not wasting visit time asking about the last eye exam or tracking down reports. Non-face-to-face time can be handled in many ways, some depending on the physician\u2019s work style. I liked having 30 to 60 minutes at the end of each half-day to take care of the portal and phone messages, refills that the pharmacy team couldn’t handle, and results. I worked 4 full days \u2014 plus a half day of \u201cadmin\u201d time, as it was misnamed \u2014 for working the in-basket and other patient care activities. That left me half a day free, which was nice for taking care of life matters on a weekday. Leffert: From the same perspective, tell us about the staffing required for a physician in practice. Ejnes: Some practices rely on medical assistants (MAs), others on nurses, some a combination of both. We used MAs primarily. At a minimum, each physician should have a dedicated MA, ideally two, since the MAs are very busy in team-based care models. It\u2019s more than just having someone do the work \u2014 that MA knows how you like things done and develops trusting relationships with your patients. If you have a say on how phone calls are handled, I would have that done in-office and not through a centralized call center. Leffert: What has your experience been regarding the turnover of physicians and how does turnover affect the practice? Ejnes: In many localities, including mine, most of the talk is about the recruitment problem. I believe the retention problem is more significant. My observation is that more physicians are leaving conventional practices for retainer-based practices (concierge, direct primary care, etc). There is also turnover related to relocation for the physician\u2019s or significant other\u2019s job or family issues, which is easier when the physician isn\u2019t also a partner in a practice. Regardless of the reason for the turnover, it is very disruptive to the practice, since most practices want to hold on to the patients, but the remaining clinicians are already maxed out as far as their schedules and panels go. Even if one is successful in recruiting new physicians, they are not able to absorb an entire mature practice the day they start work. I was fortunate in that when I retired, there were new hires and a few physicians who had room for more patients, so that every one of my patients had a new physician when I left. I\u2019ve had experiences where there was no one else and patients who had to be seen were seen by different clinicians with no continuity until a new physician became available. Leffert: What are the appropriate workload and support questions to ask the owner of the private practice group or an employed physicians\u2019 group prior to accepting a position as physician? Ejnes: Before getting into specifics, learning the philosophy and culture of the group is important. Large groups, regardless of ownership, often hire managers who live by what I call \u201cthe three -izes\u201d: standardize, centralize, optimize. That may work in a factory, but is not applicable to all aspects of a medical practice. With that in mind, prospective hires should ask to what extent can physicians customize their schedules and workflows. With respect to workload, asking about visits per day is important, but<\/p>\n","protected":false},"author":1,"featured_media":4021,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-4020","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/4020","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4020"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/4020\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/4021"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4020"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=4020"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=4020"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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