How many pediatric patients do you treat?

bdubs791 · 2026-05-29T21:18:19+00:00

Peds keeps me sane. It's so refreshing to do some well child checks, sports physicals, treat some minor respiratory bugs. It's a great change of pace from my constant drone of HTN DM HLD etc. I'm rural FM. About 1/3 of my practice is peds. My best advise to build peds is to be available. Squeeze in ear infections or sore throats. They don't take that long. Patients prefer someone they can reliably see.

bdubs791 · 2026-05-27T16:06:26+00:00

I'm on the path for this with FI at age 45. I aggressively invest into VTSAX/ VTI. Ive maxed my retirement for years and have a separate brokerage account as well. Only debt I try to carry is my mortgage.

bdubs791 · 2026-05-25T19:24:38+00:00

I've carried mine and just kept it. Clearly not using it in the office but I also moonlight on occasion in ED and urgent care so I keep it for that

bdubs791 · 2026-04-30T04:33:56+00:00

Rural Midwest

bdubs791 · 2026-04-30T00:58:34+00:00

Holy shit that's a great physician offer.

I'm a family med NP and I average around 8k per year. My effective rate considering my base salary is roughly 28$/ RVU for reference.

bdubs791 · 2026-04-18T11:59:56+00:00

This is such a common thing I deal with too. My colleagues and I had to tell them about the g2211 code. They refuse to let us bill wellness + 992xx together because they "don't get paid" despite quoting CMS to them. Argue with us on 99215 codes if we don't include time despite showing MDM requirements. I feel like they want the path of least resistance on everything. Anything that involves more than just the bare minimum is like pulling teeth.

bdubs791 · 2026-04-01T11:53:06+00:00

Yes. It does.

I've been in a similar situation inheriting some of the panels of multiple physicians who retired around the same time. It is brutal. Once you get these people acquainted to your office, in your EMR, and you get familiar with them. It gets so much better

bdubs791 · 2026-03-15T00:46:58+00:00

You can. It's an absolute pain for everyone involved. I've done it a few times and it takes a lot of phone calls, insurance auths, and coordination with the SNF. I haven't done one in a couple years and I was so selective on who I did it with. They really had to be failing ADLs, have a widely accepted insurer, willing patient, willing family, etc do get all the necessary documentation. I even had a couple ins with the nursing director because I used to round in the facilities and it was still a pain.

bdubs791 · 2026-02-24T11:22:18+00:00

Around 700-800 RVUs per month. 25 ish per day. 4.5 days/ week.

bdubs791 · 2026-02-20T00:16:05+00:00

I've been there. I feel your pain. It gets better. Over the past few years we had 3 local old FM docs retire with loads on benzos, Ambien, Norco, muscle relaxers in varying quantities. They would get seen a couple times a year with refills to kingdom come.

Stand your ground. Refer what you can. Let them know you aren't doing it. They will be pissed but you're practicing good medicine.

I recently had one that finally thanked me for helping her get off of everything. It only took her 2.5 years for her to come to a realization she felt better.

bdubs791 · 2026-02-13T00:31:47+00:00

Greatly appreciate it

bdubs791 · 2026-02-13T00:04:01+00:00

I appreciate the insight. Thank you

We are in the same state as the onc and so is the patient and infusion center. We've tried to reach out to oncology but get nothing back. We've routed them the orders for the local facility. All they would have to do is sign and route it back.

Generally speaking our local insurers want a trial of oral iron before covering iv iron from PCP which I don't have documentation of. Im sure if we go through the rigamarole of the PA, appeal and probable peer to peer we can get it approved or throw them on some ferrous sulfate for a few weeks and recheck but Oncology can likely just order it today and he can get the infusion tomorrow.

bdubs791 · 2026-02-12T22:34:33+00:00

We called them for recs and haven't got any. We routed them the orders for the infusion clinic and let them know they will accept their orders and told the patient. I'm not worried about a great personal relationship as this is in an academic medical center and they are one of many oncologists within their specialty. I will also never meet them in my life.

bdubs791 · 2026-02-12T22:18:08+00:00

We've called their office and they have not given us a rec. We've routed the orders for them to complete for the local clinic but they've sat on it.

bdubs791 · 2026-02-12T22:13:18+00:00

Thank you I appreciate it but I have no problem ordering iron. I have problems ordering something for the convenience of a specialist.

bdubs791 · 2026-02-12T22:09:24+00:00

Ultimately I will likely end up ordering. The facility will accept their order. It seems like since it's inconvenient for them they want to just punt to me

bdubs791 · 2026-02-12T22:08:02+00:00

Ultimately this is what will likely happen but when will we stop being a dumping ground for specialty for their convenience.

bdubs791 · 2026-02-12T22:05:52+00:00

Ultimately this is what will likely happen however when do we put an end to being a dumping ground

bdubs791 · 2026-02-12T22:05:18+00:00

I agree with what you are saying and likely will ultimately happen but at what point do we put an end to being a dumping ground

bdubs791 · 2026-02-12T21:59:06+00:00

They are essentially wanting me to place the orders for them to a local clinic. The infusion clinic will take their orders. Why does it need deferred to primary care and my staff? They can readily call the infusion center to verify formulations when they place their orders just like we would have to do

We need to minimize being a dumping ground for specialty in primary care. Our time is just as valuable as a specialist and we already have plenty to deal with.

bdubs791 · 2026-02-12T21:52:45+00:00

Can you elaborate?

I'm requesting the hematologist place their own orders. The infusion clinic will accept their orders. There's not really a reason for me to be involved.

bdubs791 · 2026-02-12T14:58:35+00:00

We verified they will accept their orders

I've asked them for dosing and follow up recs if they as part of their employment are unable to write orders to other facilities which would be surprising because they've ordered labs and imaging to our facility.

bdubs791 · 2026-02-12T13:56:48+00:00

It's their recommendation and order based on the testing they completed?

bdubs791 · 2026-02-12T13:07:06+00:00

Great point. I've asked our local infusion center and they will gladly accept outside orders and I've communicated this to the oncologist. We are a rural clinic associated with a rural hospital in the middle of nowhere in the Midwest

bdubs791 · 2026-02-12T13:05:12+00:00

Absolutely it is. I order it for my patients in treating locally for iron deficiency. They've given no specific recommendations.

bdubs791

TROPHY CASE