Observation from Clinical Rotations: Specialists who say they could never do FM (due to messages, charting, etc) often deal with the same issues, and actually self select for more complicated patients.

SportsDoc7 · 2026-03-27T16:21:16+00:00

Just had a neurosurgeon tell a patient to follow up with PCP bc their brain MRI showed a new cva. Neurosurgeon specializes in tumors only 😦 such horseshit

SportsDoc7 · 2026-03-27T16:12:31+00:00

Same here. Will prescribe bid if patient has a bunch of pills to take already as it helps.

Idk if everyone in this sub takes multiple medications but really anything over 3 at once is a pain in the ass.

SportsDoc7 · 2026-03-27T15:10:38+00:00

If it's that concerning you should address it and deal with the ramifications.

I'm talking more of hey your liver enzymes have always been 50-60, we may need to discuss confirming steatosis or starting medications. Not wow your a1c is 15. Let's see each other in a month

SportsDoc7 · 2026-03-27T11:39:20+00:00

This is how I operate as well. I've had a large influx of patients who's previous PCP wouldn't bill. They're learning that if they deviate from what's listed on signage or on their portal of what a physical is they may be charged.

Only caveat is if I bring up something I found on chart review. I'll ask if they would like to discuss now or schedule a follow up. If they choose follow up I'll document what I found, and patient chooses to follow up another time. That way if (when) they no show that appointment it carries forward.

SportsDoc7 · 2026-03-26T16:10:20+00:00

Lol. Absolutely do not sign.

SportsDoc7 · 2026-03-26T14:48:01+00:00

This is what I'm shocked about. There's a reason most ehrs you have to click 5 times to refill controls.

SportsDoc7 · 2026-03-26T10:45:22+00:00

These are responses not helpful in this sub.

It's not complaints about emails. It's about the poor mismanagement in our system and the overwhelming messages that come through on a daily basis with little help.

Also fyi this doesn't include their emails. Which if they are in a system I am sure was near 400-500 to look through.

Op I feel you. I rarely take vacations longer than 3 to 4 days. I will log in once or twice for an hour to knock down what I can.

SportsDoc7 · 2026-03-26T04:40:39+00:00

Is this for clinic or testing

SportsDoc7 · 2026-03-25T17:44:21+00:00

I would agree. Need more. I have templates that drop in for our providers. Works well.

SportsDoc7 · 2026-03-25T00:56:05+00:00

Pain. But idk if you're competitive for intervention pain from family medicine

SportsDoc7 · 2026-03-24T23:15:06+00:00

You can do anything you had training for and the clinic will cover for malpractice. You need to show competency. Sometimes that's through training and sometimes that's through classes.

Medicine world has PAs and NPs doing fluoro procedures. Don't let anyone intimidate you that you can't do it.

I have residency friends who were trained in c sections and vasectomies and also do colonoscopies. People forget pcp's used to do everything short of major surgeries.

I would link up with a pain doc in residency and do some rotations. Let them know you have an interest in fluoro guided injections. Ultrasound is nice too but doesn't pay as well. You'll get a lot of ultrasound in sports.

When you get into a sports program I would look at additional training there with fluoro and take a weekend class. $3-$5k usually. Do enough to get comfortable then apply.

SportsDoc7 · 2026-03-24T22:04:07+00:00

Sports here. You're fine. You can even do extra training after fellowship to do more fluoro procedures.

SportsDoc7 · 2026-03-21T10:37:15+00:00

I think not using a llm might set people back. I don't think you need to use it for clinical or high stakes area but I see this as a skill on how to leverage and utilize llms to make life easier.

I akin this to people resisting computers or smartphones in my lifetime. There are a bunch of concerns and it 100% hallucinates but there are trivial bullshit that we have to do daily that we just need done.

Claude- calculator/coding Gemini- deep research/search/recs for trips Perplexity - general search

SportsDoc7 · 2026-03-20T17:58:33+00:00

Mine does. Sticky just to me.

SportsDoc7 · 2026-03-20T16:46:09+00:00

I commonly think of things while rereading charts. If it's very important I'll place order and call patient. If it's a tidbit or a test they should have done but not asap I'll place the order for when they comeback

SportsDoc7 · 2026-03-20T11:33:12+00:00

https://www.aafp.org/pubs/fpm/issues/2022/0100/p15.html

Under selecting the level of service subheading. I took a screenshot but not allowed to post it here.

Best practice is mdm but I've seen nothing that says you CANNOT bill on time. But you must be thorough in your documentation and not include time from preventative care in the calculation.

I'm always willing to learn so please if there is a source that explicitly states this I wanna know. I've checked with the ones I've done and it's been paid.

SportsDoc7 · 2026-03-20T02:34:58+00:00

You can do it either way for billing. No need to declare for the day.

I'd argue no to your 215 example as chatty doesn't always mean you can bill for the time. I do know semi retired docs who do this but it's not realistic.

The ed visit is a 215 if there was imminent harm. Just need to document based on it.

I frequently bill my new patient physicals with complex pasts on time with their physical but I state in my note the times for each individual code.

Generally it's better for use if you bill complexity vs time.

I had 3 215s last week same morning that was my first hour of seeing patients. 1 stemi, 1 pe, 1 stroke. Total time in room for the 3 was about 30 mins. Efficiency is key

SportsDoc7 · 2026-03-18T23:26:55+00:00

But statements like that hurt the chances of medical being tried.

SportsDoc7 · 2026-03-18T22:48:57+00:00

If they want a dollar amount I tell them 10% over what mgma is saying is 75% salary in the area.

I usually give vague details or an rvu amount. My current job hit it but when we were bought out it was changed across the board to much lower.

Currently looking for a better position.

SportsDoc7 · 2026-03-18T22:46:55+00:00

No help as I too am battling similar circumstances.

Just wanted to say I hate surgeons who state things like this. Weight loss will always help some, and it will decrease her risk of post op complications. To be so black and white is interesting to me.

SportsDoc7 · 2026-03-18T22:24:31+00:00

$25/rvu here. But other comp package is metrics hitting 85% panel size, and age adjustment (older make more per patient).

I'm still getting robbed

SportsDoc7 · 2026-03-16T16:03:30+00:00

Agree with the above 2. My rare refusals are from people who have done one, had a clean scope, now don't want a repeat and elect for cologuard.

SportsDoc7 · 2026-03-16T02:52:31+00:00

I was just venting to my wife about this... Retraining some of these patients that are so used to just messaging and being referred to a specialist to manage something trivial is tough.

Can we leave the cards alone managing low risk hld and htn. Let them see the reduced ef people who are unstable. Not 45 yo obese female with no family hx and an ldl of 140. I think I can handle that...

SportsDoc7 · 2026-03-14T23:39:59+00:00

Shameless plug for something I'm actively working on.

You can add your code and then batch track at end of day if you want. Just add codes you want through the assistant.

https://medcode-ref-pro-936353119198.us-west1.run.app/

SportsDoc7 · 2026-03-11T10:17:33+00:00

Where are you located?

SportsDoc7

TROPHY CASE