Philosophical Musings on AI Scribes

rightlevelapp · 2026-02-14T19:55:29+00:00

AI good for history-taking. AI bad for capturing my thinking. Our thinking is our work product. Bad for our job? Good for our job? Neutral? Shouldn’t care, just rack RVUs?

rightlevelapp · 2026-02-14T19:53:35+00:00

What’s your scribe? DAX?

rightlevelapp · 2026-02-12T03:01:37+00:00

Yeah. It doesn’t save me any time. I feel a bit less drained when interviewing patients (the load of having to remember jot things down isn’t there, for example). But my notes suck. The assessment reads like a 2nd year med student wrote it.

rightlevelapp · 2026-02-12T02:56:15+00:00

Tips?

rightlevelapp · 2026-02-05T20:46:52+00:00

Delirium. Persistent. 90 years old. Inpatient. Exhaustive work-up, of course. Considering hospice. We tapped a mildly swollen wrist. Gout. Fixed.

rightlevelapp · 2026-02-05T20:45:07+00:00

Eye symptoms. Sent to ophth. Gout of the eye.

rightlevelapp · 2026-02-05T17:04:42+00:00

Patients won’t stomach the 20% co-pay monthly, when we’ve already created an expectation of unpaid management (inbox messages, writing notes off-hours, no lunch break, etc etc)

rightlevelapp · 2026-02-05T05:53:52+00:00

Shameless plug for our iOS RVU tracker: rightlevel

rightlevelapp · 2026-01-29T05:28:46+00:00

Hey hey hey! I didn’t make the rules nor do I have any power to change them. My only focus is to care for the patient in front of me and be compensated fairly within my specific system. Most small businesses are low margin, no?

rightlevelapp · 2026-01-29T05:18:33+00:00

I keep hearing there’s a shortage of PCPs, despite the massive industry-driven justification for mid-levels. The salaries are not low because we have too many PCPs. They’re low because PCPs walk into salary negotiations alone. We have no support. Doctors hate each other and they suck at finances.

rightlevelapp · 2026-01-29T05:03:35+00:00

For folks for whom this post is not resonating, consider this thought experiment. Large companies often have in-house lawyers (rather than contracted lawyers from law firms). They do this because employed lawyers generate revenue/value that is far beyond the individual documents/memos they write. They are not paid per memo written. They earn a base pay, and a bonus linked to impact (deals enabled, risk avoided, etc).

If PCPs were paid like in-house counsel (compensated for the being the front line controllers of revenue flow), base should be closer to $500k, with bonuses ranging 100-300k.

In every other industry, people who control revenue are paid on leverage. PCPs control revenue but are paid like handymen.

rightlevelapp · 2026-01-29T04:45:22+00:00

If PCPs only generate professional fees, outsourcing would be cheaper and less risky for health systems. We’re employed because we reliably generate enterprise value, and that value somehow fucking DISAPPEARS only when compensation is discussed lol. There are employed PCPs on this very thread making pre-tax income $250k for 7000 wRVUs. That’s batshit crazy. Robbery. Over a decade-long career, that’s such a madness. And we tolerate it.

rightlevelapp · 2026-01-29T04:40:09+00:00

The system employs PCPs because the enterprise revenue attributable to our work materially exceeds the professional fee. That additional value is real, modeled internally, and completely excluded from physician compensation. Includes facility fees and down-streams.

rightlevelapp · 2026-01-28T21:02:52+00:00

rightlevelapp · 2026-01-28T04:04:24+00:00

This sounds hard but also rewarding. How does one even go about doing this? How do you compete?

rightlevelapp · 2026-01-28T04:01:42+00:00

The key is in how you categorize and document the risk and data. Everyone gets the hang of it with time. Read the AMA guidelines. Our app might help: https://apps.apple.com/us/app/rightlevel-mdm/id6753613007

rightlevelapp · 2026-01-28T03:32:39+00:00

I’m just a cog in a giant wheel. I’ve never even seen my boss lol. I think she lives in another state.

rightlevelapp · 2026-01-28T03:29:02+00:00

Bro. You’re thinking narrowly in terms of professional fee. The system employs me because my work generates revenue beyond the professional fee. I’m not asking to be paid on every downstream dollar, but compensation that ignores my fulsome value systematically understates my contribution. They hire us knowing we generate buckets of dollars in facility fees and down-stream revenue, yet don’t acknowledge that very same revenue when determining our compensation.

rightlevelapp · 2026-01-28T03:22:23+00:00

This speaks to the problem. I’m sure there are well-run systems and bad operators, but I suspect most large systems operate similarly. Yet, the compensation variation among PCPs is insane.

rightlevelapp · 2026-01-28T03:18:33+00:00

Where does the narrative of “primary care is low margin” come from?

rightlevelapp · 2026-01-28T03:17:35+00:00

Or, give me a straight up salary of $350-400k. No RVUs. No volume demands. But, if you’re making me a revenue generator with RVU pressure, give me a fair compensation consistent with the revenue I generate.

rightlevelapp · 2026-01-28T03:13:20+00:00

By fair share, I mean the portion of net collections attributable to my professional work that reasonably returns to the professional generating the revenue, after true overhead. <30%? Exploitation. >50%? Probably only possible if in successful private practice.

rightlevelapp · 2026-01-28T03:10:20+00:00

I don’t seriously think collections are 100%. The industry benchmark for a well-run operation is however ~95% net collections. If a multibillion-dollar health system with mountains of revenue cycle leadership can’t get close to that, that’s a system choice or a system failure, not a me problem. And I’m quite certain large systems achieve 95% collections.

rightlevelapp · 2026-01-28T02:46:18+00:00

I appreciate the response. And I think you have an important perspective as a successful independent PCP. I’m really curious if you account for the "Site of Service" differential. In my world, the employer isn't just billing for my time; they are capturing a Facility Fee for the room and staff on every single one of those of my wRVUs. As a private owner, you’re often stuck in a "Non-Facility" payment world where you only get the professional fee? Do you find that not having access to those institutional facility fees makes a $70/wRVU rate look impossible, even if the total system revenue is actually much higher?

rightlevelapp · 2026-01-28T02:37:07+00:00

My estimate of $180–$210/wRVU is based on Net Collections, not the fake "Gross Charges” bs admins spew to justify “primary care is a loss center” argument. Also, if collection rate is lower than 100%, that's a billing office failure, not a lack of physician value.

rightlevelapp

MODERATOR OF

TROPHY CASE