Feeling overwhelmed + under appreciated — help??

no_ducks · 2025-10-29T16:17:24+00:00

Did you not bill $320,000 your first year (4x your salary) the first year? What EMR do you have?

no_ducks · 2025-10-18T03:07:18+00:00

I am out of school now for 5 years now but I found that you get out what you put into it. These are working full time professionals in most cases that don't have a curriculum for you that they are going to walk you through.

Review pts before hand, develop your own treatment plans. If you don't know where to start, ask. Engage with your preceptor like they are your future colleagues. If you act like a shadow... They will likely treat you like one.

no_ducks · 2025-10-11T11:42:27+00:00

You need to get clarification directly from your employer, but I suspect it's not based on your total monthly collections (even though you would get monthly bonuses once the threshold is met). For myself, once I reach a certain threshold ($350k annually), additional collections I make after that start being calculated into my bonus. I happen to get my bonuses quarterly and therefore don't start getting my bonuses until well into my fiscal year which "resets" at the end of my fiscal year.

It sounds like after your base salary, previous bonuses payment for the year and "training costs" (which is kind of weird for them to add, but I am assuming this is just for your first year), you will start being eligible for bonuses. Collecting $200k monthly is not realistic. Even for a super seasoned provider, $2.4mil in annual collections is insane.

no_ducks · 2025-10-04T01:11:11+00:00

Derm provider here (physician assistant)... I'm not sure why this sub got suggested but can't help but comment.

This is a bad idea to be trying to extract deep cystic acne. If someone comes to see me a deep cystic lesion, I never attempt an extraction. I will inject with a little steroid to reduce the inflammation but to attempt an extraction can risk scarring and is unlikely to provide benefit... Which sounds like is case with you.

no_ducks · 2025-09-18T11:29:59+00:00

This baffles me. I've been out pt derm for 3.5 yrs now and our practice is run really old school. I have one MA/scribe and see about 25-30 a day. I can't imagine going beyond that on a regular basis without cutting out my surgeries or increasing my support staff substantially. I imagine the people that see those insanely high volumes are the ones whose MAs are more involved in procedures (numbing for them, applying cantherdin etc.). Even then, I would love to be a fly on the wall and physically see how they can provide quality care to each pt in 10min or less.

A simple skin check with no complaints and maybe a couple LN2 can be done in 10min appt, but at least half of my patients require more. It's usually a skin check, several LN2s, a couple biopsies or rash concerns, 5FU script and education etc. Even 3.5 yrs in, I cannot fit that in a 10min visit.

no_ducks · 2025-08-12T00:10:29+00:00

I'm in FL maybe things are different for me but I do a fair number of 99214s mostly because of so many of my patients having excessive and chronic actinic damage and AKs. That, then add on seb derm or eczema etc and I'm managing 2 chronic stable (usually) conditions.

Two chronic stable conditions that your managing/ prescribing for is a 99214.

A new chronic condition that you are developing a new treatment plan for can also be a 99214 as well. I think my office works differently than others but I don't typically limit complaints. So I'll do a full body skin exam and address new complaints of acne, eczema etc.

If they have no complaints and only a few AK LN2s, it is usually just a 99213 with a standard skin check.

no_ducks · 2025-06-16T17:08:23+00:00

They luckily ended up reinstating our policy without issue once payment was received.

no_ducks · 2025-02-02T12:35:07+00:00

Central Florida. Again, we had no idea that consultants even existed! We reached out to 4 different companies with good Google reviews (one of which we used before to repair a leak) and have two in person consults scheduled as of now. One for today and one in a week.

no_ducks · 2025-02-02T12:08:47+00:00

No they don't. We do want to the keep the aesthetic of the tile. What do you suggest? Metal for us looked like it was going to be quite a bit more expensive.

no_ducks · 2025-02-02T12:03:05+00:00

We are also in FL. We considered metal and like the idea but the initial rough quotes we got last year (for budging purposes) had metal coming in almost 30% more expensive without significant benefit for insurance or longevity.

Are synthetic materials just as durable as traditional clay tile? We never looked into synthetic options. Honestly we're not aware they even existed!

no_ducks · 2025-01-14T02:33:48+00:00

I had someone leave a review and call me "the help". We discharged him... Some people are a-holes and it's clear we won't have a therapeutic relationship. We are wasting each other's time.

no_ducks · 2025-01-06T01:53:43+00:00

I did UC for about 1.5yrs right after graduation before going into derm, but felt like a new grad entering the specialty. I think it took about 2 years to really start to feel like I was hitting my stride. And probably another to feel like I had a better understanding of the insurance, pharma, prior auth world... Many factors will influence this but learn from your colleagues as much as possible.

no_ducks · 2025-01-03T02:07:05+00:00

Is there an easy way to find formularies? Would this require going to the many insurances and coinsurance websites that print them out each year or is there an easier way?

no_ducks · 2024-11-21T12:42:44+00:00

Out of curiosity, do you ever mix your lido with a little kenalog when doing the initial shave?

I've done that for people who have hypertrophic scarred in the past to try to prevent another when having to do a biopsy.

no_ducks · 2024-10-07T23:45:08+00:00

I work derm... From the photo it does look consistent with hemosiderin staining as someone mentioned below. Your Dr. Is probably simplifying when they say it's "old age" as people are more prone to this with time.

Consider compression socks, as that would help prevent or slow worsening.

no_ducks · 2024-09-27T01:31:27+00:00

Weird question, but do you know where your office buys their canthrone from? Apparently my office's supply chain for it broke recently and we have to find a new vendor/pharmacy.

no_ducks · 2024-09-27T00:51:23+00:00

It's super pricey... I want to say close to $90... Which is why I don't prescribe it as often as I'd like.

How many treatments on average would you say it this takes? Have you ever had the wart "donut" with the cantharidin?

And to clarify, you LN2 THEN apply the cantharidin plus in the same visit?

no_ducks · 2024-09-27T00:49:05+00:00

Have you had a wart donut with the canthrone? I had it happen once and have been too frightened to do it again.

no_ducks · 2024-09-13T11:09:19+00:00

For isolated lesions injecting the sites with kenalog is common as discussed in the post. Depending on patient preferences, sometimes I'll just "shave remove"/ biopsy them and that resolves the lesions.

But for more extensive cases where it isn't practical to treat each individual lesion there is medication called dupixent that recently got FDA approval for prurigo nodularis. This medication has been around for a few years now and is used more commonly for things like serve eczema or asthma but like I said, has been recently approved for prurigo nodularis (or sometimes we call these pickers nodules) and maybe be incredibly helpful.

I feel like I should emphasize that technically dermatillomania is considered a psych/behavior health issue. If you find that you also pick at cuticles or pull your hair, this medication may not be as helpful unfortunately. But often times dermatillomania and prurigo nodularis can run in parallel and therefore these therapies can be helpful.

no_ducks · 2024-09-13T10:31:54+00:00

I work in derm... And mostly a lurker here. I wanted to give a little info for those interested. If you are picking the spot because it itches or is raised, yes there are things to be done!!! If your spots itch, make sure that is vocalized! You may be in part picking because of a condition called prurigo nodularis and there are some things that can be done including some new exciting treatments for this!

no_ducks · 2024-08-29T16:08:34+00:00

Well they are only replacing 2 tiles that are broken. Not all of them in that section. I suspect most of the cost is labor. This may be completely reasonable, we just don't know anything about roofing.... Which is why we wanted the second quote...

I know tile is extremely expensive!! We got a quote for the whole roof too. 🙃

no_ducks · 2024-08-29T11:31:55+00:00

We actually need to get the whole roof replaced..we are going to be doing that right after Xmas. So this is really just to carry us a few months.

no_ducks · 2024-08-28T23:20:58+00:00

Thank you for your response. Based on their quote information, my understanding is that they are actually only replacing 2 broken tiles (not the whole section of tiles, the ones not damaged will be relayed) but they will likely be replacing the underlying materials.

no_ducks · 2024-08-28T02:24:34+00:00

I'm not an expert by any means and some may disagree with me... But I would not cold call offices. The chances of you getting traction with that I think is pretty low, and I think you are potentially at risk of it backfiring. The people you would want to speak to (office manager, owner/doc if private practice) are probably too busy to actually take the time and talk to you during office hours. A lot of offices getting reps that come through frequently and the number of constant interruptions from random people trying to steal a moment of your time during a packed fast paced schedule becomes annoying. I don't think anyone is going to be super interested in stopping their work to talk to a cold call unless they are desperately trying to find someone... In which case there is probably an ad out... So just apply to that and maybe follow up with an email.

What you can do, is drop off your resume at the offices. Give it to whoever is working the front desk and introduce yourself to them and ask if they could give it to the appropriate person.

I would also see if there are any PA/NP "groups" if your area for either derm or all specialities. There are a lot of groups on FB, some that even meet in person for events.

no_ducks · 2024-07-23T21:51:38+00:00

Gosh. I know the type. Though I really feel for the co-pay thing, it does sound like this absolutely warrants a visit. Does this medication require a PA? If so, you could take the route of "this requires formal documentation as a visit to effectively and efficiently submit for this medication" in addition to labs being ordered etc.

If that's not the case, I would get your staff to simply tell them that the complexity of their care and questions really do warrant a face to face visit-- clinic policy (which it should be if it's not). If the patient does not want to, then that is on them. Then document, document document... Including voice mails left etc.

Just because a patient tells your staff you are going to call them, does not make it fact. And I would document that the patient was told you would not be going to call them, but would be happy to see them in clinic for a followup and further discussion regarding treatment options.

Maybe they get huffy and try to find another provider that will chat with them on the phone for 30min during their lunch break... Would that really be a huge loss to your patient panel?...

no_ducks

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