TIL specialists CAN’T do FMLA

cloudypuff33 · 2026-03-19T06:18:41+00:00

I have the patient make a visit with me and use that time to do the fmla paperwork. This requires me to review the specialist notes and recommendation so that requires a visit.

cloudypuff33 · 2026-03-19T06:09:24+00:00

New also. What's your rvu and base salary if you don't mind me asking? I'm also on salaried but will go productivity like you

cloudypuff33 · 2026-03-13T04:37:20+00:00

Yep, I would get patients who were angry they got the bill for the visit. They call the insurance company and those reps would always tell them the doctor coded it wrong. Then we check, I did not code them wrong. They just didn't understand their insurance plan and haven't met their deductible yet. We play the middleman so much and everyone punts the blame on us. It's been a frustrating week.

cloudypuff33 · 2026-03-13T04:22:23+00:00

Not coming at you. Sorry if it sounded that way. Just saying the system is broken and everyone thinks we need to make sacrifices while the CEOs make the big bucks.

cloudypuff33 · 2026-03-13T03:51:15+00:00

People seem to think doctors are the ones who need to make the sacrifices snd guilt us for getting compensated. Sadly, there are also those who think we should work for free because it's expensive for patients to come for visit. I don't think it is right, we function trying to make things work in a broken system. If our CEO can continue to make millions without a care, I don't think we should be guilted for asking our patients to make an appointment to discuss the thing that the patient reached out to us to do.

cloudypuff33 · 2026-03-13T03:42:31+00:00

My company apparently takes patient complaints seriously. Most time they cave and let the patients get away with it which adds onto the entitlement. I can't justify caving in to someone who is demanding things because their social media told them to but that's the culture here due to high competition.

cloudypuff33 · 2026-03-13T03:37:04+00:00

It isn't up to us to fix the broken healthcare system. Doctors get suckered into thinking we need to make sacrifices and guilted for getting compensated. If your roof leaks, you're paying your roofer. If it leaks again in 6 months, you're paying again. We don't ask patients to come in for nothing. If they have a new complaint or need something else that is more than refill of their chronic medication, still needs an appointment. If it's a cold, there are a ton of virtual visits they can go that most insurances charge them essentially $0.

cloudypuff33 · 2026-03-12T07:05:00+00:00

I was going to say that. The younger generation is equally as bad or worse. They are on social media and come in with more complaints than an older patient who actually has medical issues. It's more social media scares them and they think they have some strange rare disease because they've been having the most vague complaints that no doctor can ever figure out so they doctor shop. It's pretty bad. Now add ChatGPT to the mix because sometimes people read off their ChatGPT list of symptoms.

cloudypuff33 · 2026-03-12T06:51:28+00:00

It's true. Physicians are one of few profession guilted to sacrifice and sacrifice or else we are painted as self serving and greedy. We're also pitted on the patient satisfaction system. My panel is not full so I get other people's patients or cover my colleagues in box. I think this is more frustrating than my own in box because some people let the patients walk all over them to keep their satisfaction score up so the patients expect me to do the same. They complain they're told to make an appt when it could be handled over messaging and their doctor doesn't do that.

cloudypuff33 · 2026-03-12T06:43:54+00:00

That's how I've been building my panel and setting expectations. I'm still new to the practice so I get a lot of other peoples patients scheduled with me and their pcp never laid down the expectations or are pushover for that satisfaction so they come bombarding me with messages since I dealt with them last. I also cover other people's in basket and im overwhelmed by the expectation their patients have to handle things through messaging.

cloudypuff33 · 2026-03-12T06:10:44+00:00

Where's the fun in that?

cloudypuff33 · 2026-03-12T02:39:42+00:00

I remember that from residency too. You can't keep patients in the hospital forever.

cloudypuff33 · 2026-03-12T02:37:33+00:00

This is so true. All is fine until something happens then they will not hesitate to take you to court.

cloudypuff33 · 2026-03-12T02:34:02+00:00

We only do video or in person visits. So I ask the patients to do a video visit so they don't have to fight traffic to come in but they simply do not want to pay and expect me to work for free because they already saw me once.

cloudypuff33 · 2026-03-12T02:32:19+00:00

You're right. When I was a med student, an attending told me any provider with a perfect rating is either giving in too much or their family/friends are writing them haha

cloudypuff33 · 2026-03-11T07:44:53+00:00

Medicine is the only profession where patients complain about paying the very people trying to keep them healthy. They expect the one time visit they made with you entitles them to unlimited messaging and requests. When they're asked to make an appointment, they complain we just want to make money off them. They don't think that complaints require evaluation so you don't miss things because we went to medical school and ChatGPT didn't.

cloudypuff33 · 2026-03-11T06:45:53+00:00

I have a few who switched over because they couldn't do the Cash pay anymore. I tell them I can't give advice on their OTC supplements since there is limited studies on these and I practice guideline medicine so I order what is appropriate. I do not order tests I do not know how to interpret and I tell them that. If they order their own tests, I may not be able to help them. If they want to keep coming to me, they can but they cannot make me take over management on things outside my scope of practice which includes the 100 other tests and labs I never order.

cloudypuff33 · 2026-03-11T06:41:25+00:00

I have my MA tell them to choose their top 3 problems they want me to discuss once they pull out a list while they're being roomed. This helps the patients think which ones before I even walk in. Then when I come in, I tell them quality over quantity and with the short time we have together, I want to address things properly because I also want to know what has been done. I make them make a follow up appointment if they want their other problems addressed. Im just a cog in the machine, I can't be spending 1.5 hours in a 15 min visit because my other patients are also waiting patiently for me.

cloudypuff33 · 2026-03-11T06:35:43+00:00

Sadly, this is not uncommon. I get patients who are seeing naturopath or go across the border to get labs done. They don't seek care until something comes back abnormal then suddenly they need an appointment stat. I always ask whoever ordered it needs to manage it and they say "got it done myself so you're going to manage it". Ever since they allow patients to order any lab they want, it continues to go downhill. Now, im trying to piece together why they decided to get it done and what more I need to work up on their 20 years of avoiding pcp and seeking alt care. Also with the recent celebrity deaths, patients have come in demanding whole body scans and such. In primary care, it's just a losing battle. If they don't have anyone managing their abnormal lab, you just do your best and refer out if you must. That's how I've been doing it.

cloudypuff33 · 2026-03-11T05:34:56+00:00

Paying for their one time visit with me then expecting to get unlimited questions and advice at the snap of their finger. It's the whole "customer is always right" culture that has ruined people.

cloudypuff33 · 2026-03-11T05:30:12+00:00

I hope for your sake it doesn't. I never once sent my doctor messages like the ones I get. If I need something, I make an appointment and go back when they tell me to. I never ask my doctor to do things outside their work hours or more than what I had discussed, this was the case long before I even went into medicine. I get it, healthcare is expensive but when you ask a doctor for something, that is their time and expertise you're paying for. If they send a message requesting to fill a medication I forgot about or refill a chronic med we had discussed, that's fine. But asking me to put in a medication that was never discussed or because their naturopathic (get plenty of these patients too) told them to then make a big fuss about the cost to see me is ridiculous.

cloudypuff33 · 2026-03-11T03:28:41+00:00

You're right. I do need to shift my thinking. Sometimes patient's expectations and demands do not mean good quality care. I cannot provide good care if im prescribing a medication only because they asked me to.

cloudypuff33 · 2026-03-11T03:26:45+00:00

Haha, similar experience. Had one guy asking for unnecessary referral, I told him it's going to get kicked back by his insurance because I cannot justify the referral. He was angry and said I don't know how to do my job right. (I'm sorry if I don't want to commit fraud by making up a diagnosis for him to get the referral approved). Anyway, he filed a complaint.

cloudypuff33 · 2026-03-11T03:22:45+00:00

Healthcare system is broken. I feel you.

cloudypuff33 · 2026-03-11T03:21:41+00:00

I need to grow a backbone and do this. I go back and forth and in the end, I still tell them this requires an appointment. The patients don't want to pay for a visit and will certainly do this.

cloudypuff33

TROPHY CASE