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How do solo pediatricians see 30 kids daily AND finish notes AND have a life? hero image

How do solo pediatricians see 30 kids daily AND finish notes AND have a life?

Dr. Danni Steimberg's profile picture
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Question by a member of our Twofold community

“I am a solo pediatrician in a suburban clinic. I average about 30 patients a day from newborns to teens. Mix of sick visits, ADHD med checks, well child checks, sports physicals, vaccine visits, and a few procedures. I stay late most days finishing documentation and portal messages. I want clear, defensible notes with growth data, vaccines, counseling, and follow up captured, but I also want my evenings back. How can solo pediatricians keep this volume and still leave with notes done?”

Brief Answer

Treat documentation as part of the visit, not an afterthought. Use a tight pediatrics template that is problem oriented for sick visits and checklist based for well visits. Capture a 20 to 40 second in room summary or use an AI scribe, then finalize in a two to three minute micro block. Protect a short midday and end of day closure block. Keep notes focused on decision making, anticipatory guidance, orders, and return precautions. Most solo pediatricians who do this close charts same day even at 30 visits.

The Longer Answer

What good looks like in pediatrics

Use two core patterns and apply them consistently.

A. Sick visit, problem oriented

  • Reason for visit and duration
  • Focused history and exam positives and negatives
  • Data reviewed or tests ordered
  • Assessment and plan per problem
  • Home care, return precautions, school note if needed, follow up

B. Well visit, age based checklist

  • Interval history and concerns
  • Growth and vitals reviewed
  • Developmental and behavioral screens
  • Vaccines given or due, VIS discussed, consent documented
  • Anticipatory guidance topics personalized to age
  • Clearance for sports if applicable and follow up

Fast lane workflow for a 30 visit day

Think in three moves and repeat all day.

  1. In room capture
    During the last 30 to 45 seconds, speak a short clinical summary that covers problems, key findings, decisions, orders, and precautions. This becomes the draft backbone.
  2. Micro block finalize
    After every second or third patient, take two to three minutes to finalize those drafts. Sign and move on.
  3. Two closures
    Ten to fifteen minutes at lunch to finish morning charts. Fifteen to twenty minutes before leaving to close everything from the afternoon.

Minimum content that supports quality and coding

Section

Pediatric specifics to include

One line example

Reason for visit

Sick vs well and parent concern

Fever and cough for 3 days

Growth and vitals

Percentiles or flags if abnormalPercentiles or flags if abnormal

Weight 45th percentile, afebrile now

Focused exam

Pertinent positives and negatives

Clear lungs, mild pharyngeal erythema, no retractions

Data reviewed

Rapid tests, prior notes, imaging

Rapid strep negative, no prior asthma history

Assessment and plan

Decision with rationale and safety

Viral pharyngitis. Fluids, antipyretics. Return if breathing effort or dehydration

Vaccines and meds

Given, due, consent, VIS

Gave Hep A dose 2. VIS discussed. Tylenol weight based dose reviewed

Instructions and follow up

Parent friendly plan and timing

Phone check in 48 hours if persistent fever. Well visit in 6 months

Sample daily structure that solo pediatricians use

Block

What you do

Time target

Pre clinic huddle

Scan schedule, flag vaccines due and forms

10 minutes

Morning patients 1 to 10

In room summaries, micro finalize after every third patient

2 to 3 minutes per micro block

Midday closure

Finish remaining morning charts and top portal messages

15 minutes

Afternoon patients 11 to 30

Same pattern as morning

2 to 3 minutes per micro block

End of day closure

Finish all notes and sign forms

15 to 20 minutes

Pediatric shortcuts that save time without losing quality

  • Use weight based dosing macros for acetaminophen and ibuprofen so you never retype them
  • Pre load anticipatory guidance bullets by age and uncheck what you did not discuss
  • For ADHD med checks, keep a three line structure
    • Target symptoms and school function since last visit
    • Med dose, adherence, appetite, sleep, BP and pulse
    • Decision and follow up window
  • For sports physicals, attach clearance statement and list any restrictions in one line

Pitfalls that create late nights

  • Waiting until evening to write the first word of a note
  • Long narrative for simple viral syndromes rather than a short decision line and clear precautions
  • Well visit notes without growth percentiles, screens, or vaccine status
  • No protected closure blocks on the calendar

Tiny case example

Day with 32 visits. Two clusters of three sick visits each are summarized in room. Each cluster is closed in a five minute micro block. Lunch closure clears the morning. Afternoon repeats the pattern. End of day closure signs the remaining two notes. Charts are closed by departure and no weekend work is needed.

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Emily Alfe

Clinic Manager

3 weeks ago

ADHD med checks can sprawl, so I cap documentation to three focused lines even when extra concerns pop up.

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