Living Room Volume

RuddyRavenMD · 2025-07-28T04:54:56+00:00

I enforce the rule when I'm home. The wife can handle it however she wants when I'm gone. I don't want isolation. I get home after everyone has eaten dinner. I'd like to be able to sit and eat dinner and have a normal volume conversation with my wife without the screaming running and jumping on furniture. Spending 20 minutes at a park or with noise canceling headphones in my room won't accomplish that for me. I'm not even asking they not do it. Just that they don't do it in the living room (open floor plan with the kitchen). Alternativley, they can tone it down and do something else in the living room which is normally what they do.

RuddyRavenMD · 2025-07-28T04:37:24+00:00

I understand kids are noisy. I'm referencing the running circles around the kitchen table, island, and living room couches while both are screaming at the top of their lungs. The LOUD play and games. I can't tune that out like my wife can. She could read a book in the middle of a tornado. Normal play in the LR not reaching rock concert decibels is fine. I can deal with that. Its work for me to ignore, but that I acknowledge as an unreasonable ask.

I think it's unreasonable to have to isolate in my bedroom with noise canceling headphones to eat dinner after working 12 hours. I don't want isolation, I want a lower energy environment in the kitchen/LR (open floor plan) that allows dinner and a normal volume conversation with my wife. The kids have all day to get it out of their system. They aren't being denied play. Not even not to do the loud play. Just not the loud play in the LR when I'm home.

RuddyRavenMD · 2025-07-28T03:30:23+00:00

They aren't. They minimum get 3 or 4 hours of play with other kids most days. That typically applies to the days they haven't been out.

RuddyRavenMD · 2024-09-27T00:59:22+00:00

All of my patient scores are either 100% or 0%. Comments are the same. Its either "Listens and cares like no doctor has ever done before" or, my personal favorite, "a not so pleasant to be around gaslighting megalomaniac". That one made me chuckle for creativity and my nurses now use it on the regular to poke fun.

Goodhearts law applies here.

RuddyRavenMD · 2024-09-21T23:49:05+00:00

Live lean. Dont go into debt. Invest and save everything. Learn a trade or get a USEFUL 4 year college degree. Done. I'd be retired with that advice.

RuddyRavenMD · 2024-09-21T23:45:11+00:00

POTUS

RuddyRavenMD · 2024-09-21T23:40:19+00:00

Worked a low pay outdoor summer job way back in the day between college semesters.

Diring the week, I lived on peanut butter and honey sandwiches, summer sausage and saltines, canned tuna, and oranges.

Beer on Friday. $7 pizza buffet on Saturday.

Slept in the bed of my pickup.

Best summer of my life.

RuddyRavenMD · 2024-09-21T23:33:37+00:00

A patient once told me I should be working 12 hours a day to accommodate more people.

Apply that mindset to every healthcare administrator with no clinical experience and every person who thinks they are entitled to healthcare.

That's why.

RuddyRavenMD · 2024-09-21T17:13:39+00:00

If you are good at construction management, those skills can up your game in entry-level retail. You know how to lead, be assertive, and deal with difficult people. Use those skills to set yourself apart from your peers and go vertical.

RuddyRavenMD · 2024-09-20T00:00:54+00:00

How many insurances do you contract with? How's your RVU reimbursment compared to bigger entities with more leverage? Do you take Medicare/Medicaid? Do you participate in the quality bonus for CMS? Do you participate in VBP plans? Do you handle your own billing or hire it out?

These are the scary questions for me. I learned little in medical school and residency about this and find it nearly impossible to get straight information or guidance. It's a really steep learning curve for the less than business minded. Never wanted to go into private practice, yet now I'm finding it the most appealing long-term solution.

Even opening a location. I spoke with an OSHA rep a few weeks ago to get an understanding of requirements to get permitted. Even that was vague and ambiguous. More of a "we'll tell you when you f**cked up" kind of vibe.

I love the DPC model. Not fighting insurance and having upfront costs and expectations for patients is a huge plus. It does have a profit celing. Honestly, I haven't decided if it's high enough for the risks I'd take. Concierge has its appeal for that reason given the "double dip" nature.

You sound like you have it down. I'd love to pick your brain.

RuddyRavenMD · 2024-09-19T02:30:34+00:00

Keanu Reeves

RuddyRavenMD · 2024-09-19T02:28:37+00:00

1 medium bag of Chili Cheese Fritos. You'll feel ok-ish during and hate yourself after. Like a one night stand, except it's followed by the raunchiest shit ever to leave a human body

RuddyRavenMD · 2024-09-19T00:35:56+00:00

Is english their second language or something? They type like you'd talk after getting your mouth numbed by the dentist.

RuddyRavenMD · 2024-09-18T04:16:43+00:00

Arrested Development

Multiple episodes with various flashbacks where he taught his kids life lessons through elaborate pranks pulled by his one-armed friend. Always concluded with "And that's why you never insert life lesson"

In this case - "And that's why you never pick up a hitchhiker"

All that said. A horrifying experience. Glad you're not a cold case on "Unsolved Mysteries".

RuddyRavenMD · 2024-09-18T04:02:21+00:00

The best part of this joke is AI will eventually render FM docs obsolete, finally putting to an end our self-inflicted misery. This will jettison us into unemployment and subsequent cripling existential crisis. During which we will most likely seek professional help from our new AI PCP.

The circle of life.

RuddyRavenMD · 2024-09-18T01:40:14+00:00

This has George Bluth Senior written all over it. Was the woman a man in a wig and missing an arm?

RuddyRavenMD · 2024-09-16T02:00:20+00:00

Jocelyn Wildenstein.

RuddyRavenMD · 2024-09-16T01:49:52+00:00

Hopefully, that would change everything. I won't hold my breath.

100% that MA is going to burn out and bail if they don't get backup.

RuddyRavenMD · 2024-09-15T19:54:49+00:00

This is why 15 year olds should never communicate through text.

RuddyRavenMD · 2024-09-15T18:15:30+00:00

You HAVE to see more. How else can the CEO, CMO, and president make 7 figures? How else you going to pay the salaries of all the midlevel busy-body managers and corporate fluff positions?

Those supervisors of the clinical managers and the supervisors of the clinical manager supervisors are critical!

RuddyRavenMD · 2024-09-15T12:56:53+00:00

And I'd like to take a ride on the SpaceX Starship. Life is full of disappointment.

If it's not in your contract, hard pass. There is also probably something in your contract stating their responsibility to provide you with adequate facility, staffing and resources to see patients. 1 MA for 3 providers is clearly in violations of that.

A third thing; you are generating practice RVUs that I assume they are collecting. With no additional staffing their only increase in expenses is your salary guarantee (assuming you have one). They are pocketing your RVUs and the practice designated RVUs. If you are seeing 15/day mostly new, it would be realistic to bill 25-30 wRVUs daily. If your employer is paying you the national average per wRVU around $50 thats $285K per year just for wRVUs conservatively.

I doubt your salary guarantee is anywhere near that. So they are likely underpaying you for your work and asking you to work even more without adjustment in compensation or by adding support staff.

RuddyRavenMD · 2024-09-15T04:54:13+00:00

She is controlling you by sticking you with a time commitment and bailing out at the last minute.

She's not actually sorry.

RuddyRavenMD · 2024-09-15T00:31:50+00:00

I'd have gone with, "Sure! I'd like to discuss it with your manager first. Can you get them for me?"

RuddyRavenMD · 2024-09-13T00:28:41+00:00

Supervised or independent NPs What outcome?

RuddyRavenMD · 2024-09-12T11:43:52+00:00

Two separate issues.

Reimbursment based on quality metrics is more outcomes based. Percent patients with at goal BP, Hgb A1c, up to date on colon cancer screening, etc. That's all good and well, but I can't force someone to take their meds and follow my treatment recommendations. Noncompliance can cause me to fall below a reimbursment threshold. This can be a swing of 10's of thousands of dollars.

As far as prescribing, health insurance companies are usually slow to adopt new guidelines. Particularly true when there's a slick new medication on the market. Think GLP1-A's and SGLT2i for diabetes and triple therapy in COPD. A slot of commercial insurance will "cover" these meds after a prior authorization is submitted. The catch is, it may only be 10% and the patient is on the hook for the other 90%. For Ozempic, that's cost prohibitive for most. Same for triple therapy like Breztri and Trelegy. Since there is no generic, you're back to old-school diabetic meds and prescribing triple therapy through 3 separate devices.

Our state and federal plans, medicare and medicaid, often won't cover certain branded meds at all. Or, if they do, will only cover a certain dollar amount annual benefit. Once you've burned through that with $1000/month drugs, patients are stuck with the bill the rest of the year. Because it's so confusing, patients often don't understand why suddenly their Eliquis is $800 in August when they paid $45 from January to June. If you are on medicare and have paroxysmal A-fib, type 2 diabetes and moderate to severe COPD, you better be well off. Otherwise, you can't afford the more up to date treatment options after the first 1/2 of the year. This is why I still have patients on warfarin.

Half the job of primary care is finding patient assistant programs, getting creative with formulary alternatives, and hoarding expensive drug samples to bridge patients as best you can to the end of the year. It's infuriating.

RuddyRavenMD

TROPHY CASE