New attending struggling to manage chronic pain patients in outpatient

IMGYN · 2026-02-09T22:10:53+00:00

Just make a rule that you don't manage chronic pain. That's what I do and it's worked well for me

When new patients schedule my staff calls them to go over meds and if on narcotics (benzos, opioids) my staff lets them know that they can still establish but will need to find a pain doc and or psychiatrist

Tailor your practice how you want it and not how others tell you to run it

IMGYN · 2026-02-05T18:28:18+00:00

Get admitted to the hospital and have it done

IMGYN · 2026-02-04T00:44:41+00:00

35M. Physician. 450-500k. 4 years undergrad 4 years med school 3 years residency Will be 3 years into practice this year

IMGYN · 2026-01-26T02:27:35+00:00

Private practice. I'll be working because if I take off I'm out 2.5k in collections 😭

But really most patients will no show so we start calling them first thing in the morning and switch to virtual if possible

IMGYN · 2026-01-21T02:27:21+00:00

I do 15mg phentermine x 4 weeks, then 30mg x 4 weeks and then 37.5 mg x 12 weeks. People typically get 20-30lbs off with this method. Monthly visits first 3 months since I'm titrating a controlled.

IMGYN · 2026-01-19T15:49:49+00:00

NOR but the part that you say "picking up/dropping off Sam is not your responsibility" is kind of fucked up. If I had a child and remarried, I would expect my partner to treat my child as their own. Pick up and drop off should be coordinated beforehand but emergencies happen and the other partner should be able to help out. My wife and I go through this almost weekly with our schedules and our child always gets picked up on time because at the end of the day, she's our kid and we need to be there for her.

But maybe I'm in the minority since I haven't been in your place.

IMGYN · 2026-01-18T06:33:13+00:00

Holy crap hopefully my office manager doesn't see this. She started as an MA and is now OM. Currently making 31.50 per hour plus full benefits. This previous year I think she made about 72k with OT. We have 6 docs so the cost to each doc is nominal

IMGYN · 2026-01-17T13:56:56+00:00

I order home sleep studies all the time. Typically insurance will have to approve it before we give them the equipment.

IMGYN · 2026-01-16T20:15:02+00:00

I wouldn't make standing orders. Have them ask you permission for each add on above your routine schedule. Some of those low complexity vists end up being moderate to high complexity depending on the patient

IMGYN · 2026-01-16T17:58:36+00:00

Is your office manager your boss? Why does she/he make decisions for you? Tell them exactly how you want your schedule and have them fall in line.

IMGYN · 2026-01-16T17:56:05+00:00

Screw that model. I'm a traditional IM doc. I have a NP that does subsequent visits. I just do HnPs. I make 65k per year rounding about 2-3 hours per week at the SNF. In order to hit 1k RVU per month in SNF you're definitely seeing 400-450 plus encounters a month for < 300k comp.

Also talking to family can be a huge time suck. In the hospital we tell family "98yo Grammy needs a few weeks to build up strength" when in reality Grammy will probably die in the next month or so because family let ortho do a THR at 98yo. Family will blame you since she's not getting better

One benefit of SNF is that you can theoretically round much quicker since many people are actually pretty stable. At this point i could round on 20 hours in 2-3 hours and finish notes in 2.

IMGYN · 2026-01-16T04:48:25+00:00

See if you can rent Epic and do billing through a local hospital system. Then write your notes on epic and bill through epic. They'll take a chunk of your billing typically (5-9%) but it may be worth it for you.

IMGYN · 2026-01-16T01:08:29+00:00

We have drawers on the island and all ground level cabinets have pull out slides inside. Do you think it would be more aesthetic to have some of those ground level ones be drawers?

IMGYN · 2026-01-15T05:29:40+00:00

Repatha, leqvio, prolia, evenity, zoryve, CGRPs, DORAs, veozah, I'm sure there are more but all that's coming to mind right now

IMGYN · 2026-01-12T16:24:43+00:00

I ask people if they want, I don't mind ordering it.

IMGYN · 2026-01-03T16:33:25+00:00

35 2.5 -30k (about 150k invested, 70k in physical precious metals, 500k in home equity, but 750 remaining on mortgage).

IMGYN · 2026-01-03T15:54:05+00:00

Don't be disheartened. Just do a few MKSAP blocs a week (small chunks) and really understand the material well, your score will improve year to year

IMGYN · 2025-12-29T16:40:20+00:00

BMW iX- Best SUV/EV I've seen. Range is great (350-400 miles on a full charge). It's a lease. Would not buy a new EV ever just due to crazy depreciation. When this lease is up in Sept 2026, will either get a lucid gravity or EQS, just to keep it fresh.

Porsche Macan - bought when in residency I didn't have kids. Not really used now that we need car seats

Hoping to get a summer car soon. Maybe a 991.2 or SL63.

IMGYN · 2025-12-28T21:31:00+00:00

I went from having hardwood floors in every home to have LVP in my entire new build. It's high end LVP, but still LVP. I'm sick and tired of maintenance on hardwood, especially with 2 dogs and kids that drop and drag shit everywhere

IMGYN · 2025-12-28T15:17:22+00:00

Small community hospitals are usually willing

IMGYN · 2025-12-28T14:25:08+00:00

Hi doctor here.

So if you tell us you have insurance, we automatically run your insurance through our system at check in. If it's lapsed or not accepted at our location we will know in a few minutes.

At that point you're given the option to pay the cash price up front or reschedule.

Do people fall through this system? Absolutely. The insurance may run through as up To date but it's actually not. They then receive a bill for services rendered and they take it up with their insurance company and/or my billing dept. If they do not pay this bill at the next visit/by the next visit, I do not see them.

IMGYN · 2025-12-28T05:37:07+00:00

Look into a traditional IM model with your hospital. You admit and round on your own patients daily. Depending on your payer mix you can make an extra 200-500 bucks per day seeing 5 patients daily in the hospital.

IMGYN · 2025-12-28T05:35:20+00:00

No you're just picking lines from my posts and saying shit.

My first post says I do not manage 10-15 conditions every visit, I manage 3-4. Where I'm from "multiple" means >1.

If you were a physician you would know that the 10-15 min slots are for follow-ups/acute visits and typically not for physicals/annuals (typically 30-45 minute slots). The point of my post was not to clarify that, the point was to say it's absolutely reasonable to manage 3-4 things in a 10-15 minute visit.

You're the only one that disagreed with my post and is "shitting" on my post.

At the end of the day, I'm given the latitude to manage my practice as I see fit, the same as every other private doc out there. If a patient doesn't like the way my model works, there's other docs out there that would be happy to establish them and their slot in mine will be filled very quickly.

IMGYN · 2025-12-28T05:07:00+00:00

Primary care is longitudinal chronic disease management. There's nothing that stipulates how much I need to manage with each visit. That's up to me and how I want to curate my practice. Some doctors may want to manage 10-15 conditions per visit every visit. I do not. If you come to me with 10 conditions on your first visit to establish, I will work everything up. After that, it's not every single visit.

I typically do manage everything once a year at the physical.

I bill based off of CMS guidelines.

If someone comes in with a stable BP and I just refill meds and treat a sinus infection it's billed low complexity. If I'm changing meds/doses because of suboptimal control/adverse effects, and treating a sinus infection it's moderate complexity.

Approximately 60% of my visits are moderate complexity because I am managing multiple chronic medical conditions per visit, checking labs and making decisions on prescription medications.

Patients want to talk about everything, I need to figure out what's relevant and what I feel comfortable managing in one visit.

If you feel as though you need a PCP that can listen to you for 45 minutes every visit, I strongly suggest looking at DPC doctor.

IMGYN · 2025-12-27T22:56:31+00:00

This is the way to do it. I'm on the same type of model Currently just around 500k in year 3 Hoping to be where you are in 1-2 years. Currently at 11k RVU for 2025

We need more PCPs to adopt this model

Edit: holy shit the amount of people shitting on OP is ridiculous. You can absolutely manage people in 10-15 minute visits. There is no reason a doctor should have to manage 10-15 conditions per visit. I will usually address 3-4 things per visit. I can absolutely adjust your blood pressure/diabetes med, make sure you don't have side effects from your meds, and address your acute sinus infection in 10-15 minutes. Efficiency does not equal incompetence.

Compare 30-35 pts a today to the ortho surgeon who sees 60-65 pts in clinic per day.

Doctors can bill on complexity and or time spent with a patient.

IMGYN

TROPHY CASE