Managing Your Caseload As a New Grad
Erin M. King, PT, DPT
Congratulations! You just finished the onboarding process for your first job as a newly licensed, fresh PT. Your nametag is done and you can introduce yourself to patients as Doctor Whateveryournameis. It feels amazing to be able to sign off on your notes without a clinical instructor critiquing every word, post your own charges, and … oh, what’s that? A case manager needs an update on her client’s progress in therapy? A physician is on the phone and wants to know why his post-op patient isn’t progressing like he should be? Your patient’s equipment vendor needs MORE documentation in support of why the equipment requested is medically necessary? There are 4 voicemails from patients who need questions answered? Oh, and all of your notes still need to be written after a full day of treating patients? Welcome, fresh PT! This is caseload management. Hopefully you were exposed to many of these elements of caseload management as a student, but taking over all of these components with your own caseload can sometimes feel like a lot, even for veteran clinicians. The key to caseload management is developing a system that works for you and your practice setting.
I currently work in outpatient neurological rehab, but as a new grad, I spent two years working in a busy outpatient orthopedic clinic. I was seeing 2-3 patients per hour, working 11-hour shifts. Even with doing my best to keep up with documentation during sessions, I worked through lunch every day, and typically still had 10-12 notes to write at the end of the day. Add in keeping track of progress note due dates, plan of care updates, insurance rules in regards to charges allowed, and it would not take long for my head to start to spin. How did I keep it all straight? For me, embracing the technology available to me was critical. I had electronic sticky notes on my desktop with specific insurance rules, I used my Outlook calendar to remind me of when patients had post-op follow ups with progress notes needed, and thankfully the EMR I used automatically told me when a progress note was due. Now, what about all of that extra stuff I mentioned above? Calling physicians, case managers, or patients can be time consuming. This is where utilizing cancellations is crucial. Sometimes it’s easy to slack off if you get some open time during the day, or be so focused on getting your notes done that the next time you are free, physicians and case managers are no longer available (because apparently other professions don’t work past 5pm). Unfortunately, your notes aren’t going away, so managing your time wisely can be very beneficial to checking items off your to-do list.
Having experience in both outpatient ortho, and outpatient neuro, I will say, figuring out how to manage a neuro caseload, even with 2 years of clinical experience was a whole new ball game. The needs some of these patients have are astronomical. Spending seemingly endless time on hold with a physicians office due to blood pressure issues, talking with case managers about return to work after a concussion, playing phone tag with equipment vendors because my four page letter of medical necessity was apparently not good enough for an insurance company, emailing or talking with my patient’s OT, SLP, recreation therapist, social worker, and orthotist throughout their plan of care to ensure all bases are being covered… how do you possibly balance it all? Again – timing is key. Prioritize the things that have to be done today, things that have to be done by the end of the week, and things that could maybe wait a week because you don’t see that patient again for 10 days. Next, begin to come to terms with knowing that certain settings will not allow you to simply work a 40-hour week. I love my job because I love my patient population. Managing this caseload well will inevitably involve “overtime,” some weeks more than others. When things get really chaotic, paper to-do lists help me sort it all out. Collaborating with colleagues who have been at this longer than I have helps to navigate the unknowns of orthotic adjustments and equipment evaluations (who knew shower chairs could be SO complicated?). Trial and error is so important in many aspects of life, and figuring out your system for caseload management is no different. Be patient with yourself. You are just getting started in a career that I love dearly, and the highs and lows along the way will be plentiful. Embrace it.
Caseload Management in Summary
- Organization – electronic or old school paper lists. Do what works for you!
- Timing – make a plan for the day, week, and know what is okay to have on the back burner.
- Collaboration – don’t be afraid to ask questions! It’s okay to admit when you don’t know what you’re doing.
- Trial and error – be patient with yourself and the development of your system.
Do you have any tips for other new grads? What have you found works well for you?
