Reply To: Clinic structure

  • Jennifer Toth

    October 26, 2021 at 4:21 pm

    Hi Danielle-

    I work at a small center- we have 5 physicians and I am the only NP/APP. We’re a combined clinic and infusion center in the same space. As our program has grown over the past couple of years, we have tried to implement structure to keep clinic organized and ensure that all the providers have protected time for academic/research/administrative/etc. work. That being said, everyone on our team is super flexible and willing to help each other out, so while this is generally how we do it on paper, it winds up being more fluid in practice. 

    Each physician has 1 day of week that is their primary assigned clinic day (with 2 of the physicians who see fewer patients “sharing” a day and one day as a “free for all”/primarily infusion day). If patients need to come in on another day than their primary doctor’s clinic day for whatever reason, it’s usually a conversation whether their primary MD will see them that day or the “doc of the day”/MD on call will see them. Same for sick visits, those are usually seen by the on-call person (we’re small enough that the MD on call covers inpatient and outpatient). Most of our docs see a mix of all diagnoses, so there aren’t formally specialty clinic days, although informally some tend to be more hematology-heavy or survivorship-focused, for example. As for me… well, I also see a little bit of everything 🙂 I have some primary patients who I follow and see whenever they come in  (with or without a tandem MD visit depending on situation) based on my interests and experience. There are also a few of the docs I work most closely with, and on their clinic days we’ll see some patients together and divide the rest of the list depending on who needs what. 

    When we are fully staffed with full-time nurses, we have a primary-nurse model, however we’ve mostly been staffed with travel and part time/PRN nurses recently, so we’ve had to move away from this. We have 2-3 nurses in clinic most days, so they decide between themselves how to divide up patients. Our clinic/infusion hours are 8am-5pm. Occasionally we have infusions that won’t finish by the time we close for whatever reason, and in those cases the patients will either go to the inpatient unit or one of the adult infusion centers (depending on age/situation) to finish.

    Hope this helps!

    Jennifer Toth, MSN, CPHON, CPNP-AC
    Nurse Practitioner
    Pediatric, Adolescent, and Young Adult Hematology/Oncology
    MedStar Georgetown University Hospital
    Washington, DC
    Original Message:
    Sent: 10-25-2021 08:56 PM
    From: Danielle Briggs
    Subject: Clinic structure

    Hi all,

    Our hospital has a growing practice for hematology/oncology. With an upcoming transition of providers, I am looking at how best to organize our daily structure of seeing patients, etc.

    I am wondering how small to medium sized facilities structure your clinics. Currently, we have 9 providers and multiple APP clinics for hematology, oncology, neuro-oncology and survivorship with set scheduled days. This is spread out amongst the week so not all providers have clinic at the same time due to increasingly limited space due to our growth.

    How do you structure who sees what patients on each level: nurse, APP and MD? Do your physicians only see oncology or hematology or do they see both? Does each physician have their own nurse? What are your clinic hours or infusion hours?

    Thank you in advance for your input.

    Danielle Briggs, MSN, RN, CPHON
    Haley Center for Children’s Cancer and Blood Disorders
    Arnold Palmer Medical Center
    Orlando, FL