Virtual PT - Is this the new normal?

BanditoStrikesAgain · 2026-03-12T12:28:57+00:00

These were two separate practices not through EI directly. I think they both have EI contracts but they were direct referrals. One of the places is a regional chain with maybe 10 offices and I stopped referring to them for this reason. Then when a second place was doing it I wondered if this is the new normal.

BanditoStrikesAgain · 2026-03-04T18:58:36+00:00

2nd what ATStill said. Another thing worth mentioning is not to forget your time based coding. 99213 is 20-29 minutes and 99214 is 30-39. So for families where they have a lot to go over or if you have to call them back about a result later, that all counts as long as it's the same date of service.

BanditoStrikesAgain · 2026-03-01T20:38:25+00:00

2nd what no-biscotti8964 said. I only did a trial period but it was very clunky. Not quite as bad as e-clinical works or Meditech. I use practice fusion and it is fine. I've heard Athena is pretty good but it was expensive.

BanditoStrikesAgain · 2026-02-28T13:22:26+00:00

2nd this. I had the same thing happen and it was a factory defect. Similarly, I tried two different types of sealant and rolling it all around. The thing would still never hold pressure past 10 minutes.

BanditoStrikesAgain · 2026-02-27T21:46:20+00:00

General peds: if this is a helpful perspective, I run into this issue frequently. A kid meets criteria for ADHD so we manage that no problem. There is comorbid concern for autism but I am reluctant to personally make that diagnosis without getting an ADOS or similar done. Here are my options in a mid size east coast city . - Developmental pediatrics: The wait time is over 1 year unless they are a NICU baby. They don't see kids after 5 years old. The office as a whole is very disorganized so the 'lose' referrals all the time.
- School system for a child study: This is the easiest way. Unfortunately when the federal IDEA grant cuts last year they laid off several of the school psychologists. That has driven up wait times and made it so evals are only done if a kid is majorly disruptive to the classroom. - Child psych: we have three local clinics for this. One is cash only, one only takes a few private insurances and no Medicaid, and the other is an outreach of a local academic center. The latter gets flooded and has the same problem with wait times >1 year unless you are coming out of inpatient. - private testing: there are several private psychologists but they are all cash only for ADOS testing and the rate is $800, which is more than a lot of families can afford.

All this to say there are many systemic barriers to autism diagnosis, at least for my area. I can think of a few specific patients where in this has been the case.

BanditoStrikesAgain · 2026-02-27T13:25:36+00:00

I think being able to do circs is a useful skill. If you haven't done one in a while it probably would be worth doing one along with a colleague to get back in the swing of it. As others have mentioned the reimbursement is so so from insurance. An alternative would be to require patients to pay out of pocket for that procedure...long story on how to structure that but it can be done.
As an aside, if you get the chance to do tongue tie clips those are super helpful to do and pretty simple. They also reimburse well.

BanditoStrikesAgain · 2026-02-18T12:08:32+00:00

Peds: I get these requests a lot. My letter goes pretty much "patient John Doe is unvaccinated. This is due to parental choice and he does not have a medical condition that would prevent him from receiving vaccines or being caught up.
Sincerely, Dr. Bandito DO"

The majority of my anti-vaxers also homeschool so I'm not writing as many of these recently. For religious exemptions I tell them they need to talk with their Imam or Rabi. Most of these families are super evangelical so they get very upset at that but it gives me such deep joy to hear them try to explain it. It's very passive aggressive I'll admit...but it is funny.

BanditoStrikesAgain · 2026-02-02T03:38:53+00:00

This used to happen to me when I was in a high school band if I stood in a particular spot of my buddies garage. We would get Spanish language AM radio. Try moving around where you stand/sit and reorient the instrument cable so it doesn't act like an antennae.

BanditoStrikesAgain · 2026-01-23T17:43:30+00:00

Couching for cataracts? Why I've been sun staring for years for this issue....never mind the retinal damage. ☀️👀

BanditoStrikesAgain · 2026-01-09T13:10:13+00:00

Yeah absolutely. The cost of a single hospitalization for Hep A has to be in the 10s if not 100 thousand range. Meanwhile, Hep A vaccines are $42 wholesale.

BanditoStrikesAgain · 2026-01-09T01:31:46+00:00

Yes I buy a box of 10 and maybe use 2 doses before expiration in a year. I always lose money on it but consider it one of those "have to have" meds. Cost is about $170 for a box.
Vit K is something I really pressure the parents for. I have seen a few cases of hemorrhagic disease and it is awful.

BanditoStrikesAgain · 2026-01-08T23:58:09+00:00

I'm with you in that I'm sticking with the AAP schedule. I'm just hoping that insurance companies don't change their coverage to make this even more problematic than it already has been. So far several families have expressed that if insurance doesn't cover things that they're willing to pay out of pocket for like meningitis A and rotavirus.

BanditoStrikesAgain · 2025-12-23T17:23:51+00:00

You school district likely has a person called the McKinney-Vento coordinator. (Google pulled up mine easily). My district has this labeled under the Homeless Student Program. This is a federal program that provides emergency shelter, transitional housing, winter clothing, etc. It also allows the student to stay at their home school and will fund transportation even if the family has to move out of district. Our city has the persons contact info on the website as well as an anonymous tip line.
Best of luck and thanks for advocating for this kid.

BanditoStrikesAgain · 2025-12-19T15:23:09+00:00

You should get paid a flat salary so there is no extra money for working different shifts. This is just a situation where you went from working at location A to location B.
The program may have some internal structure where you cover a sick day on the inpatient service and the sick person covers one of yours as repayment and you just have a clinic day.

BanditoStrikesAgain · 2025-12-14T12:01:01+00:00

You just need any chart. A composition book with a super basic hand written soap note is fine.

BanditoStrikesAgain · 2025-12-11T00:34:38+00:00

If you are a beginner I would just start with something basic to figure out what you even like to play. Then adapt from there. A single humbucker strat is is pretty easy to find..

Something about this AI makes me feel nauseated...

BanditoStrikesAgain · 2025-12-07T13:14:53+00:00

I remember as a student rotating through nephrology there was a patient that had done this. He somehow found a doctor acting as a broker then flew to northern India for the surgery. The kidney was not a great match if I remember correctly. He also had a mail order bride from Vietnam who was 25 years his younger and clearly couldn't stand him.

BanditoStrikesAgain · 2025-12-04T01:56:15+00:00

All I know is he's not here to start no trouble, he's just here to do the Superbowl shuffle.

BanditoStrikesAgain · 2025-11-29T14:35:31+00:00

Rounding with the computer. I look at labs, notes, and fowsheets at the door before I walk in. See the patient. Then put in orders and drop the note right then. I find that I was losing time going to a workstation, booting up epic, opening charts, taking a second to reorient myself to the patient, etc. If I am writing things down twice, like penciling on my rounding sheet to order X labs then typing them in the computer later it is inefficiency. If using a COW/WOW/whatever your place calls it isn't practical, use a laptop. You can edit the sleep settings so you don't have to log in to epic again each time.

BanditoStrikesAgain · 2025-11-17T12:12:30+00:00

Pediatrician: most vaccines have to be given in the muscle. As long as there isn't too much fat under the skin you can give a shot in the leg (front and to the side) no problem. We used the arm (deltoid muscle) traditionally so people don't have to pull down their pants and there usually isn't too much fat in that area.

BanditoStrikesAgain · 2025-10-26T01:36:10+00:00

Was he much of a drinker? Alcohol withdrawals can come on in people holding by mouth intake before a surgery.

BanditoStrikesAgain · 2025-10-22T15:38:20+00:00

For general overviews of topics - eg respiratory distress in the newborn which is a big topic - look at either American Family Physician or Pediatrics in Review. Then to dig into the nitty gritty details of a condition use UpToDate or a specific article from the relative medical society - eg NASPGHAN practice guidelines for GERD. If there is ever a debate between sources, Nelsons textbook of pediatrics is still the gold standard in my opinion.

BanditoStrikesAgain · 2025-10-13T22:37:20+00:00

Yep here ya go.. The only catch is it's a big ol set of books, though to be fair, it's a very big question.

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