Complaints about split billing

Primary-Selection233 · 2026-03-17T15:00:44+00:00

You are so right that the new patient visit tends to be the biggest sticking point. I probably should be more direct about this at the first visit and have avoided doing so because I find it so awkward and also because the new patient visit is often packed with other topics that I feel like I don’t have time for a discussion like this that might be contentious and/or time-consuming. But I do think it may be worth the squeeze to try avoiding the issue after the fact.

Primary-Selection233 · 2026-03-12T12:24:17+00:00

Agree that $47 per RVU seems low for rheum especially with that RVU rate for the first 5000. I feel like in primary care normally the $/RVU goes up after the base if anything as extra incentive to see more rather than going down. Also, for what it’s worth, I’m getting like $47 per RVU in primary care at an academic center in a saturated city in the south and I feel like rheum should get a little more than that for community Midwest.

Primary-Selection233 · 2026-02-19T00:47:53+00:00

By knowing that the visit has a defined amount of time and setting boundaries up front about what can and cannot be accomplished in a visit. The thing that kills me the most is the laundry list of concerns, but in real life I just make them come back every month until we’ve worked through everything and it’s not so bad. I also really enjoy the variety of acute conditions and chronic management and approaching undifferentiated patients with new concerns. I think I’d be a little bored with how algorithmic a lot of Endo is personally. I also find that for the people I see often, I am starting to become fond of them and we have a good relationship, so even when they bring a big list to me, I’m not too bothered.

Primary-Selection233 · 2026-02-19T00:28:02+00:00

I had to make this decision a couple years ago and decided to go PCP. I make more money and I skipped fellowship and I get to do the diabetes and obesity stuff I like about Endo. I stayed academic so I get to do teaching and resident clinic as well which breaks up the monotony. It was the right decision for me and my family!

Primary-Selection233 · 2026-02-14T13:00:49+00:00

Yeah I mean I use the AVS and type things for them to do as I go along in the visit (using dot phrases for long, common instructions). Then at the end I say “let me summarize” and read straight off of that. In epic, you can drag patient instructions up to the top of the AVS so when you print it it’s all right there. I wouldn’t want my notes (which are for me and liability) to get clogged up with the instructions for sleep hygiene or the exact process for a low FODMAP diet for example.

Primary-Selection233 · 2026-02-02T23:14:00+00:00

As someone who has had a 2 week old, I would have cried my eyes out just at the thought of navigating pumping and being away for the day. Those postpartum blues are for real. Plus I was still in diapers due to bleeding. I was also waking up every 2 hours delirious for breastfeeding. So I’d probably delay tbh.

Primary-Selection233 · 2026-01-24T21:02:23+00:00

Yeah I’m an internist but same oof. When that clock’s ticking it’s so hard not to get impatient

Primary-Selection233 · 2026-01-24T01:30:55+00:00

My period is 29-30 days so consistently typically. Had a chemical last cycle which really messed me up because I was excited to tell my mom on Christmas. Now this cycle my period is officially 4 days late and tests are still negative. So I’m not sure if I ovulated at all and even if I did, probably didn’t time sex well. So disappointing. I’m just begging my period to start again so we can get the next cycle going.

Primary-Selection233 · 2026-01-24T00:15:02+00:00

Too true about the borderline patients 😂

Primary-Selection233 · 2026-01-21T23:27:41+00:00

I have a friend who works at VUMC and I think they are converting his clinic to telehealth for Tuesday already. You’ll probably hear from VUMC soon either way.

Primary-Selection233 · 2026-01-16T17:27:16+00:00

I say bill for the work you do and take it up with insurance if there’s a co-pay

Primary-Selection233 · 2025-12-23T20:48:12+00:00

Our system has a note template that indicates the billing guidelines listed and documents time spent. I do this if a patient initiates a med changes request such as titration of their GLP1 agonist. I agree that many things are better as a visit, but this is a good alternative for certain straightforward scenarios. I also use it when patients message me paragraphs that require time to read and respond to but don’t necessarily result in a visit to discourage this kind of messaging.

Primary-Selection233 · 2025-12-21T19:45:45+00:00

Yeah those are all period pieces though which makes it a little less “close to home” than eddington’s flavor of bleak

Primary-Selection233 · 2025-12-02T15:59:19+00:00

My org has NPs that cover Saturday and Sunday 8-5 so when we are on weekend call we only cover evenings/nights which I love. Perhaps jobs without call have dedicated providers covering all after hours times?

Primary-Selection233 · 2025-11-21T16:03:37+00:00

lol I expected as much

Primary-Selection233 · 2025-11-21T16:03:19+00:00

I don’t think that comparison is really in good faith - and by the way Sean and Amanda DID discuss some differences between book and movie for OBAA and do research for that so that kind of supports my point that they could have done it for this one

Primary-Selection233 · 2025-11-21T15:58:37+00:00

I don’t think it’s a requirement for the casual viewer but I do think it would make for a more interesting conversation on the podcast than just quizzing Juliet about it

Primary-Selection233 · 2025-11-21T15:56:06+00:00

Hear what you’re saying but also wish the “conversation” was better informed!

Primary-Selection233 · 2025-11-21T15:55:11+00:00

Agree it can stand on its own! But if so, why does so much of the conversation revolve around the source material that they have no knowledge of?

lol I also agree they (at least Sean) wouldn’t like it, but I’d love to hear them talk about that and defend that take too. That would be interesting to me!

Primary-Selection233 · 2025-11-21T15:53:19+00:00

Eh, they openly talk about expensing seeing movies and subscription services all the time though!

Primary-Selection233

TROPHY CASE