The Right-Sized Patient Panel: A Practical Way to Make Adjustments for Acuity and Complexity


Do you have the right number of patients on your panel? Here's a process and a spreadsheet for calculating and adjusting your panel based on actual patient behavior.

Fam Pract Manag. 2019 Nov-Dec;26(6):23-29.

Author disclosures: no relevant financial affiliations disclosed.

A foundational principle of family medicine is continuity of care — a personal, therapeutic relationship with your patients over time. Continuity matters because it results in lower costs, higher patient satisfaction, and enhanced clinical care and outcomes.13

Continuity depends on a clearly defined, right-sized patient panel. A right-sized panel allows the physician and associated care team to work to full capacity while meeting the panel's needs in terms of access, quality of care, and patient experience.24 A wrong-sized panel results in problems with continuity, quality, access, patient satisfaction, and physician burnout.45

This article explains how to achieve a right-sized patient panel starting with a proven method of panel attribution and then applying a practical method to adjust raw panel numbers for patient acuity and workload complexity based on actual patient behavior (see "How to right-size your panel"). Using the spreadsheet introduced in this article, physicians can objectively illustrate their workload and lay the foundation for discussion with their employer about right-sizing their patient panel.


  • A patient panel that is too large will result in problems related to continuity, quality, access, patient satisfaction, and physician burnout.

  • Increased patient acuity and increased amounts of nonvisit work are making panel sizes unmanageable for many physicians.

  • Patient panels must be accurately attributed and right-sized, with adjustments for acuity and workload complexity.

  • The spreadsheet model outlined in this article offers a tool for right-sizing your patient panel and demonstrating to employers why non-visit work should be included in the equation.


  1. Use the four-cut method to identify and attribute patients to each physician or other provider within a like category in the practice (e.g., primary care or a set of clinicians with a similar scope of practice who could provide coverage for one another).

  2. Complete the panel spreadsheet, which captures current panel and visit rate on the demand side and days worked and visits per day on the capacity side.

  3. Decide how you will measure nonvisit work (using weighted discrete events or EHR log-in time, for example) and adjust capacity (clinician visits per day) accordingly. This may require discussion within the organization.

  4. Derive the right-sized panel by dividing clinician visit capacity by the panel visit rate.

  5. Compare the current active panel and the right-sized panel to see whether you are over- or under-paneled.

  6. Identify opportunities to balance the panel equation by closing or opening to new patients, influencing the visit rate or length through greater efficiency, enhancing physician capacity through team support, or other strategies.67



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Rachel Weber is principal consultant of HealthcareIE, which specializes in using industrial engineering concepts to improve flow and reduce delays in the health care industry....

Dr. Murray, who practiced family medicine for 25 years, is owner of Mark Murray & Associates consulting company. He has long been an authority on access in health care and has written numerous published articles on the topic.

Author disclosures: no relevant financial affiliations disclosed.


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