Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 and it is somewhat reassuring to know I’m not the only one having a horrible week. First pt today mad at me because I didn’t authorize his diabetic shoes because there is nothing wrong with his feet; he just wants a new pair of shoes. “I won’t take off my shoes for the foot exam unless you sign my form!” Local rest home calling upset I won’t fill out paperwork to get extra, state paid for, Personal Care Aides for each of my patients already in their rest home for years; says they need assistance with their baths (? I guess they didn’t get bathed for the past few years?). Third pt of am wouldn’t even look at me and was furious b/c I didn’t automatically fill her bp meds last week (the pharmacy sent it three time!!); not seen here in nine months. Who knows what her creatinine is. Local health department wants notes and labs on ‘new diabetic’; problem is he doesn’t actually meet criteria for diabetes but since I told him to lose weight as his last glucose was a little elevated, he wants full DM education (but it’s free for your patient, doctor, the state pays for it- I guess appropriateness is optional.) End stage liver cancer patient wants referral to a nutritionist b/c he also has DM (a1C is 6.7) and doesn’t want to get complications of diabetes (really?). A new patient on disability for asthma and not even on inhaled steroids; I just use it once in a while, she says. All PFTs done were only mildly restrictive; must have had a good disability lawyer. Since when is undertreated asthma something to get lifelong disability for? This afternoon, previously well controlled diabetic with A1C of 14, out of meds, wouldn’t return for visit until her vision got blurry. I wouldn’t send in another refill after six months so waited months without meds before coming in; too busy to check sugars. Have had to discharge two patients this week for refusing to pay anything towards their balance in the past year. Panhandler comes into the office after lunch and tries to hit me up for ‘a few dollars’. I too work 2 extra jobs, med directing, just to pay the bills. I can’t keep the balance in the office checking account up. And my staff of three decided that they now want three weeks of vacation since they’ve worked here seven years. Have no idea how they think I can come up with nine weeks of pay for them to go on vacation. My head hurts. Tonya S. Little, MD tslittle@... From: [mailto: ] On Behalf Of magnetdoctor@... Sent: Thursday, August 09, 2012 5:50 PM To: Subject: Re: Forgiven rant I must jump in!. having a terrible week myself due to just these issues. Patients seem more demanding and less grateful every month. This week alone, had to fire someone who wouldn't be compliant with f/u for taper off Xanax ( I can't afford to even do a telephone visit!, my kids need to eat.... Yet driving new BMW, lives on local lake in newly refinanced house), and another that wants me to spend 15-30 min on phone with her rather than a visit, and do it for free, after she had TAHBSO for cancer, that I diagnosed and biopsed, because " I'm not going to pay just to talk to the doctor " ( she had hypoxia and sleep apnea post op and needs a sleep study). Meanwhile, my practice is underwater with debt, no bank will refi me and I make sure the staff is paid and bills are paid, but I work second IT job, seeing no patients, being a protocol monkey, and make more in the 20H wk than I have been able to pay myself for years!. Hate the second job, would like that 20h of free time!. Can't afford to not work it. See more patients every year, but make less due to insurance paying less. Have decided just yesterday, I'm done. Non-covered benefits fee, here I come. The ones who don't like it, here is the door!. Leave me with the ones who get it. And if they all leave, well I suspect at least half will be back after they have the 5 min appt but wait 1 month to get it, and only one issue please, and yes you have to be SEEN. Same rules, less access. If it doesn't work, well then at least I can say I tried, and I'll close up shop, and do the IT job FT. It would be more money than I have made in 12 years, and no call, no OT, unless I want, and tons of benefits. It's only a hassle now trying to do both. But of course the guilt is what keeps me going. I know I am good at what I do, I know this is the right way. But I can't take this any more, the disrespect, the constant grubbing for money, jumping through hoops and then having to justify to the patients. Was going to try to wait until after election, bring it on, if I did with the new Year in Jan. Screw that, I'm fed up. the letter goes out next in Sept, 3 month warning. Good luck I totally empathsize. Cote From: " Sharon McCoy " To: Sent: Thursday, August 9, 2012 10:12:49 AM Subject: Re: Forgiven rant Sorry Jean. Why do you think more PCP's are headed your way? Are they newly graduated residents that you inspired? Sharon On Thu, Aug 9, 2012 at 9:42 AM, Pratt wrote: Oh, Jean. You sound just like my husband!!! The only way he makes it through each day is to exercise. And the fact that he makes twice as much at his second job, working less than half the hours (not even giving direct patient care), shows how much the system is broken. Why is it that the front line docs aren't making more $$ than the ones lurking behind the scenes to make sure that the rules are being followed? Bureaucracy, plain and simple. Pratt On Aug 9, 2012, at 9:19 AM, wrote: I am sorry to whine I am sick of complaining I relaize I am well and have a job and live in a nice place. To be very honest I think I am going to stop talking to patients I am tired of making the effort I am going to get them in and out do my owrk They really do not WANT me to do refills at time of visit or solve problems they want to call and have me just do things when they want it call and get anythign at no charge anytime I mean who cares when I go home they say it is my job. and then sit and yak for 45minwhile here They cannot believe they have to come in when it has been a yr I am just really exhausted by explainng this all the time Since when did medicine become something you are expected to call in?? Visits are way too busy with all their needs and what I am supposed to do to put in the faxes and the labs to try to get consultant to answer me at all much less fax but still I must attach it to the chart and the er cannot just cannot understand why I will not get their machine that prints out daily so I that I can get up go to another machine to pull off a report to look and see who was admitted and then go find that then do something about it vs could we have a system where I am TOLD my patietns are admitted? on and on and on A l ocal person is touted for starting a million dollar nonprfoit about " quality " -sent to me yesterday by a hospital adminstrtor-when I doubt she has ever seen a patietn in her l ife- and she constantly lectures in the press about how doctors do not think in terms of systems alwasy yelling at us when we HAVE NO ACCESS to systems that cam make things go well and i t falls on our backs to either be compulsive and go broke and never go home or do a 15minvisit crappy job and leave at 5 pm rantrant whine whine I am so angry at al lthis crap What a stupid job. I f t here was a bus to come by to take my away I'd be on it. Noone should do this job without massive backup and financial support and superb systems Since tho e exist few places I frankly think this job sucks and do not any longer encourage anyone to do it On Thu, Aug 9, 2012 at 11:50 AM, Egly wrote: Hang in there it must get better. Administration of our practice is daily headache with new wrinkles to figure out crowding out old wrinkles till I have to relearn old wrinkles. (memory may be overtaxed). By the way just a side note, study of healthy 80% to 90% only spend $289 a year on healthcare so I still believe in the $1 per day to provide healthcare, but am just about to charge $10 per day for administration of healthcare. If only!!. From: Jean Antonucci To: Sent: Thursday, August 9, 2012 10:19 AM Subject: Re: Forgive my rant frankly I am stressed out of my own mind right now. The state apologized to me for being so bizarre in its rules for new hires(I got a part time RN) YOu have to file for unemployment taxes but cannot until the employee has earned 1500 or worked 20 weeks in a yr but when you file the quarterly taxes they want your Unemployment number Which the other agency will not give you becasue somehow someway I am supposed to remember this at 20 weeks or 1500 AND when I tried to file they changed my address to a town called Milo MAine 100 miles away and when I called they told me not to worry about it! BUT once you get TO 20 weeks you have TO PAY IT ALL ANYWAY fo r the whole yr not just for the 21-52 weeks so why not register to begin with??? I now do have my own personal state worker to email and she is keeping track of me She said the law was written by a blind lawyer(sarcasm) Then there's patietns who are all unhappy all of them and then there's more providers a re coming here(PCPs) I just do not htink we have the demand!! and Medicaid is cutting people off and there are letters daily about ACos and PMCh and so on.People are needing huge long visits with thier worries and complexties I am off today and just plowed through about 20 faxes everyone demanding I do this or that for them oy. thanks sorry. Bad bad spell here. On Thu, Aug 9, 2012 at 10:56 AM, wrote: Please keep sharing....helps reduce stress.........alcohol is nice too...........not enough $ or time to go to camp in the west coast this year!!! :-( M in Western PA From: " Dr. Izquierdo-Porrera MD PhD " To: Sent: Thursday, August 9, 2012 10:34:20 AM Subject: Forgive my rant I just came to a realization that I wanted to share with you. In land the Medicaid office is full of people that are benignly incompetent (i.e. not necessarily hard working but occasionally try and are nice to talk to you) vs the Medicare contractor (Novitas Solutions) that suffers from a severe case of negligent incompetence (nasty and useless). I need to keep my rant short so I cannot go into the details of how I am in my third submission to become a medicare provider but I will be happy to share a bottle of wine and my fun stories during camp. By the way the State Medicaid office recognizes my voice and knows me by my first name. That should tell you something… Izquierdo-Porrera MD PhD Executive Director & Co-founder Care for Your Health, Inc Phone Fax http://www.care4yourhealth.org/ " Don't ever let injustice go by unchallenged. " Help us make our community healthy -> http://www.care4yourhealth.org/wanttohelp.php <image003.jpg> -- MD 115 Mt Blue Circle Farmington ME 04938 ph fax http:/// -- MD 115 Mt Blue Circle Farmington ME 04938 ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 I hear each and everyone of you!!!!! and I have reached my breaking point. made decision to close my practice. My accountant and my husband staged an intervention with me! Pointed out that I am working a second job to keep my office open without a clear vision of what exactly could change to make it profitable.Have tried cutting expenses........... I do not even have 1 FTE on staff right now. Am doing my own billing.Am doing cash based weight loss as well as regular primary care.Have not been paid by Medicare since Nov 2011...I have hired that problem out to a professional? biller.Am getting letter from specialist in town that say it is my responsibility to let my patients known when their scheduled appointments is AND if my patient does not show up, cancels or reschedules more than once, I cannot refer there the patient again....so I guess I should now hire staff to make sure my patients show up their offices??? Yes because i am the one making so much $$$$.Blue Shield will contemplate paying me for a visit with a patient I dx'd with a vertebral fracture AFTER I submit and they review all of my notes, labs and rad studies related to this visit...seriously???? Let me pay someone to pull all that info together and fax it to you.All local radiology companies expect me to do a pre-auth for all the studies THEY will make money on.....yes let me pay someone to for that too!!!Exhausted and done!Dannielle Dannielle Harwood, MD Please keep sharing....helps reduce stress.........alcohol is nice too...........not enough $ or time to go to camp in the west coast this year!!! :-( M in Western PA From: "Dr. Izquierdo-Porrera MD PhD" To: Sent: Thursday, August 9, 2012 10:34:20 AM Subject: Forgive my rant I just came to a realization that I wanted to share with you. In land the Medicaid office is full of people that are benignly incompetent (i.e. not necessarily hard working but occasionally try and are nice to talk to you) vs the Medicare contractor (Novitas Solutions) that suffers from a severe case of negligent incompetence (nasty and useless). I need to keep my rant short so I cannot go into the details of how I am in my third submission to become a medicare provider but I will be happy to share a bottle of wine and my fun stories during camp. By the way the State Medicaid office recognizes my voice and knows me by my first name. That should tell you something… Izquierdo-Porrera MD PhD Executive Director & Co-founder Care for Your Health, Inc Phone Fax http://www.care4yourhealth.org/ "Don't ever let injustice go by unchallenged." Help us make our community healthy -> http://www.care4yourhealth.org/wanttohelp.php <image003.jpg> -- MD 115 Mt Blue Circle ph fax http:/// -- MD 115 Mt Blue Circle ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 All these posts about doctors quitting are very disheartening. Kathy Saradarian, MDNJ From: [mailto: ] On Behalf Of Dannielle HarwoodSent: Thursday, August 09, 2012 9:28 PMTo: Subject: RE: Bad week everywhere? I hear each and everyone of you!!!!! and I have reached my breaking point. made decision to close my practice. My accountant and my husband staged an intervention with me! Pointed out that I am working a second job to keep my office open without a clear vision of what exactly could change to make it profitable.Have tried cutting expenses........... I do not even have 1 FTE on staff right now. Am doing my own billing.Am doing cash based weight loss as well as regular primary care.Have not been paid by Medicare since Nov 2011...I have hired that problem out to a professional? biller.Am getting letter from specialist in town that say it is my responsibility to let my patients known when their scheduled appointments is AND if my patient does not show up, cancels or reschedules more than once, I cannot refer there the patient again....so I guess I should now hire staff to make sure my patients show up their offices??? Yes because i am the one making so much $$$$.Blue Shield will contemplate paying me for a visit with a patient I dx'd with a vertebral fracture AFTER I submit and they review all of my notes, labs and rad studies related to this visit...seriously???? Let me pay someone to pull all that info together and fax it to you.All local radiology companies expect me to do a pre-auth for all the studies THEY will make money on.....yes let me pay someone to for that too!!!Exhausted and done!Dannielle Dannielle Harwood, MDPlease keep sharing....helps reduce stress.........alcohol is nice too...........not enough $ or time to go to camp in the west coast this year!!! :-( M in Western PATo: Sent: Thursday, August 9, 2012 10:34:20 AMSubject: Forgive my rant I just came to a realization that I wanted to share with you. In land the Medicaid office is full of people that are benignly incompetent (i.e. not necessarily hard working but occasionally try and are nice to talk to you) vs the Medicare contractor (Novitas Solutions) that suffers from a severe case of negligent incompetence (nasty and useless). I need to keep my rant short so I cannot go into the details of how I am in my third submission to become a medicare provider but I will be happy to share a bottle of wine and my fun stories during camp. By the way the State Medicaid office recognizes my voice and knows me by my first name. That should tell you something… Izquierdo-Porrera MD PhDExecutive Director & Co-founderCare for Your Health, IncPhone Fax http://www.care4yourhealth.org/ " Don't ever let injustice go by unchallenged. " Help us make our community healthy -> http://www.care4yourhealth.org/wanttohelp.php <image003.jpg> -- MD ph fax http:/// -- MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 Cash only.Fire patients that are non compliant.And marry rich to pay the bills! All these posts about doctors quitting are very disheartening. Kathy Saradarian, MD NJ From: [mailto: ] On Behalf Of Dannielle Harwood Sent: Thursday, August 09, 2012 9:28 PMTo: Subject: RE: Bad week everywhere? I hear each and everyone of you!!!!! and I have reached my breaking point. made decision to close my practice. My accountant and my husband staged an intervention with me! Pointed out that I am working a second job to keep my office open without a clear vision of what exactly could change to make it profitable. Have tried cutting expenses........... I do not even have 1 FTE on staff right now. Am doing my own billing.Am doing cash based weight loss as well as regular primary care.Have not been paid by Medicare since Nov 2011...I have hired that problem out to a professional? biller. Am getting letter from specialist in town that say it is my responsibility to let my patients known when their scheduled appointments is AND if my patient does not show up, cancels or reschedules more than once, I cannot refer there the patient again....so I guess I should now hire staff to make sure my patients show up their offices??? Yes because i am the one making so much $$$$. Blue Shield will contemplate paying me for a visit with a patient I dx'd with a vertebral fracture AFTER I submit and they review all of my notes, labs and rad studies related to this visit...seriously???? Let me pay someone to pull all that info together and fax it to you. All local radiology companies expect me to do a pre-auth for all the studies THEY will make money on.....yes let me pay someone to for that too!!!Exhausted and done!Dannielle Dannielle Harwood, MD Please keep sharing....helps reduce stress.........alcohol is nice too...........not enough $ or time to go to camp in the west coast this year!!! :-( M in Western PA To: Sent: Thursday, August 9, 2012 10:34:20 AMSubject: Forgive my rant I just came to a realization that I wanted to share with you. In land the Medicaid office is full of people that are benignly incompetent (i.e. not necessarily hard working but occasionally try and are nice to talk to you) vs the Medicare contractor (Novitas Solutions) that suffers from a severe case of negligent incompetence (nasty and useless). I need to keep my rant short so I cannot go into the details of how I am in my third submission to become a medicare provider but I will be happy to share a bottle of wine and my fun stories during camp. By the way the State Medicaid office recognizes my voice and knows me by my first name. That should tell you something… Izquierdo-Porrera MD PhD Executive Director & Co-founderCare for Your Health, Inc Phone Fax http://www.care4yourhealth.org/ " Don't ever let injustice go by unchallenged. " Help us make our community healthy -> http://www.care4yourhealth.org/wanttohelp.php <image003.jpg> -- MD ph fax http:/// -- MD ph fax -- Graham Chiuhttp://www.compkarori.co.nz:8090/Synapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 le,My heart goes out to you. What are you going to do next? SharonSharon McCoy MDRenaissance Family Medicine 10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com I hear each and everyone of you!!!!! and I have reached my breaking point. made decision to close my practice. My accountant and my husband staged an intervention with me! Pointed out that I am working a second job to keep my office open without a clear vision of what exactly could change to make it profitable. Have tried cutting expenses........... I do not even have 1 FTE on staff right now. Am doing my own billing.Am doing cash based weight loss as well as regular primary care.Have not been paid by Medicare since Nov 2011...I have hired that problem out to a professional? biller. Am getting letter from specialist in town that say it is my responsibility to let my patients known when their scheduled appointments is AND if my patient does not show up, cancels or reschedules more than once, I cannot refer there the patient again....so I guess I should now hire staff to make sure my patients show up their offices??? Yes because i am the one making so much $$$$.Blue Shield will contemplate paying me for a visit with a patient I dx'd with a vertebral fracture AFTER I submit and they review all of my notes, labs and rad studies related to this visit...seriously???? Let me pay someone to pull all that info together and fax it to you. All local radiology companies expect me to do a pre-auth for all the studies THEY will make money on.....yes let me pay someone to for that too!!!Exhausted and done!Dannielle Dannielle Harwood, MD Please keep sharing....helps reduce stress.........alcohol is nice too...........not enough $ or time to go to camp in the west coast this year!!! :-( M in Western PA From: " Dr. Izquierdo-Porrera MD PhD " To: Sent: Thursday, August 9, 2012 10:34:20 AM Subject: Forgive my rant I just came to a realization that I wanted to share with you. In land the Medicaid office is full of people that are benignly incompetent (i.e. not necessarily hard working but occasionally try and are nice to talk to you) vs the Medicare contractor (Novitas Solutions) that suffers from a severe case of negligent incompetence (nasty and useless). I need to keep my rant short so I cannot go into the details of how I am in my third submission to become a medicare provider but I will be happy to share a bottle of wine and my fun stories during camp. By the way the State Medicaid office recognizes my voice and knows me by my first name. That should tell you something… Izquierdo-Porrera MD PhD Executive Director & Co-founder Care for Your Health, Inc Phone Fax http://www.care4yourhealth.org/ " Don't ever let injustice go by unchallenged. " Help us make our community healthy -> http://www.care4yourhealth.org/wanttohelp.php <image003.jpg> -- MD 115 Mt Blue Circle ph fax http:/// -- MD 115 Mt Blue Circle ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 Ouch!I am very sorry to hear many are having tough times.I think about my current job, and while there are many things I don't like...I don't have the same struggles as those on this list that made the leap to have their own practice. I have tremendous respect for those that made the leap, even if its not going the way you want. There has to be something said for having the guts to try! Way more than me! I wish there was more that can be done to help. IMP hired virtual assistants? ACOs? Begging for grants from the Gates Foundation (I'm out in Seattle..)...imp grants to start practices...or keep them going? Getting voice recognition software so she doesn't have to type? I don't know how well Dragon Naturally speaking handles cursing though...might be a good week to train for that! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 It makes me sad to read about the struggles you all are going through. It wasn't that long ago that I was in a sinking boat trying to IMP in a toxic environment. I wish what you do was rewarded appropriately! Three years ago I gave up the ghost and took a hospitalist job. My income immediately jumped to FIVE TIMES what I had been making, plus benefits like a pension and health insurance...they even pay part of my cell phone bill and give me free meals at the hospital. I won't say things are perfect because there are still struggles. But still, it is SO much better here. I recently lost my temper at my computer, and a few minutes later realized that it was the FIRST time in three years that I have been angry. For the previous seven years it seems I was constantly angry, but since moving here to take this job, I am thankful every day for all my many blessings. I had to give up my IMP dream, throw away a lot of STUFF, leave behind patients that I love, and live two hours away from my husband...but it has been SO worth it!! If anyone has any interest in joining me here in the outskirts of heaven, I'd be tickled to tell you all about it. WE would LOVE to add to our team, and the pay is good, the cost of living way less than just about anywhere else in the lower 48, and we don't even really have drought here..it has been raining at least one day out of each of the last four weeks. Our corn is hit, but nothing like in other places...we will get at least 70 %, and our second cutting of hay will be ready next week. And there is room for more PCPs here as well...some of our local docs are in their 90's and still practicing...They can't last much longer. And only 2 local docs are taking new patients. I discharge people with follow up appointments 2 hours away because it's the best I can find for them. Best wishes to you all, whatever you decide is right for you. Annie le, My heart goes out to you. What are you going to do next? Sharon Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com I hear each and everyone of you!!!!! and I have reached my breaking point. made decision to close my practice. My accountant and my husband staged an intervention with me! Pointed out that I am working a second job to keep my office open without a clear vision of what exactly could change to make it profitable. Have tried cutting expenses........... I do not even have 1 FTE on staff right now. Am doing my own billing.Am doing cash based weight loss as well as regular primary care.Have not been paid by Medicare since Nov 2011...I have hired that problem out to a professional? biller. Am getting letter from specialist in town that say it is my responsibility to let my patients known when their scheduled appointments is AND if my patient does not show up, cancels or reschedules more than once, I cannot refer there the patient again....so I guess I should now hire staff to make sure my patients show up their offices??? Yes because i am the one making so much $$$$. Blue Shield will contemplate paying me for a visit with a patient I dx'd with a vertebral fracture AFTER I submit and they review all of my notes, labs and rad studies related to this visit...seriously???? Let me pay someone to pull all that info together and fax it to you. All local radiology companies expect me to do a pre-auth for all the studies THEY will make money on.....yes let me pay someone to for that too!!!Exhausted and done!Dannielle Dannielle Harwood, MD Please keep sharing....helps reduce stress.........alcohol is nice too...........not enough $ or time to go to camp in the west coast this year!!! :-( M in Western PA To: Sent: Thursday, August 9, 2012 10:34:20 AM Subject: Forgive my rant I just came to a realization that I wanted to share with you. In land the Medicaid office is full of people that are benignly incompetent (i.e. not necessarily hard working but occasionally try and are nice to talk to you) vs the Medicare contractor (Novitas Solutions) that suffers from a severe case of negligent incompetence (nasty and useless). I need to keep my rant short so I cannot go into the details of how I am in my third submission to become a medicare provider but I will be happy to share a bottle of wine and my fun stories during camp. By the way the State Medicaid office recognizes my voice and knows me by my first name. That should tell you something… Izquierdo-Porrera MD PhD Executive Director & Co-founder Care for Your Health, Inc Phone Fax http://www.care4yourhealth.org/ " Don't ever let injustice go by unchallenged. " Help us make our community healthy -> http://www.care4yourhealth.org/wanttohelp.php <image003.jpg> -- MD ph fax http:/// -- MD ph fax -- Annie Skaggssville, KY Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 Hello everyone,My name is Fred Klemmer. I am an acupuncturist, not a MD, though I own a holistic healing center and am in the process of creating a multidisciplinary group practice (legal in WA state) that includes physicians.I found out about the IMP movement a while back at a conference with Patch and ever since I have been inspired by what folks associated with IMP have been doing. You are heroes - real everyday heroes, which are the kind of heroes we need most, especially in times like this.I come from a family of physicians. I learned about healing from my mother who for many years was the doctor for the Hansens Disease program in Hawaii. She modernized their treatment but she also gave deeply from her heart. Where now are the physicians like her? Some of them are right here on this listserve.You may have to wait longer than you would like to receive the appreciation and compensation you all deserve, but it might not be as long as you might think. Things are starting to change. The current situation is unsustainable and so change will happen. And no matter how difficult it may seem, and no matter how much it may seem at times like the change is going in the wrong direction, I for one am certain that you are on the right side of history. So thank you for being my everyday heroes as I also try to do my small part in creating a better healthcare system from the inside out. If anyone wants to move to WA state and join me in doing this together, let me know.Yours in gratitude,Fred Klemmer LAcOwner and Founder, Heart of Wellness PSCcell: http://heartofwellness.org"Be the change you wish to see in the world." -- GandhiNote: Email messages cannot be guaranteed to be secure or error-free. Neither Heart of Wellness nor any of its associates, employees or tenants accept liability for any interception, error or omission in this message arising as a result of email transmission. This communication, including any attachments, may contain confidential information and is intended only for the individual or entity to which it is addressed. Any review, dissemination, or copying of this communication by anyone other than the intended recipient is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and delete and destroy all copies of the original message. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 Fred and others: Thank you all for your support. I am posting a link to Dike Drummond's article about physicians venting about how bad our situations are. I am NOT doing this because I think it is wrong for us to vent here. Heaven knows I've done enough of it. I am actually GLAD that we are airing our problems, because I think it is unfair to pretend that everyone is doing fine, while others struggle in isolation and wannabees are out there planning to open IMPs of their own. Anyway, the article challenges us to do less venting and more changing. Also, read some of his other articles listed along the right-hand side. I found them helpful. Again, no financial ties...http://www.thehappymd.com/stop-being-a-victim-of-your-medical-career/...S\ harlene > > Hello everyone, > > My name is Fred Klemmer. I am an acupuncturist, not a MD, though I own a holistic healing center and am in the process of creating a multidisciplinary group practice (legal in WA state) that includes physicians. > > I found out about the IMP movement a while back at a conference with Patch and ever since I have been inspired by what folks associated with IMP have been doing. You are heroes - real everyday heroes, which are the kind of heroes we need most, especially in times like this. > > I come from a family of physicians. I learned about healing from my mother who for many years was the doctor for the Hansens Disease program in Hawaii. She modernized their treatment but she also gave deeply from her heart. Where now are the physicians like her? Some of them are right here on this listserve. > > You may have to wait longer than you would like to receive the appreciation and compensation you all deserve, but it might not be as long as you might think. Things are starting to change. The current situation is unsustainable and so change will happen. And no matter how difficult it may seem, and no matter how much it may seem at times like the change is going in the wrong direction, I for one am certain that you are on the right side of history. > > So thank you for being my everyday heroes as I also try to do my small part in creating a better healthcare system from the inside out. If anyone wants to move to WA state and join me in doing this together, let me know. > > Yours in gratitude, > > Fred Klemmer LAc > Owner and Founder, Heart of Wellness PSC > cell: > > http://heartofwellness.org > > " Be the change you wish to see in the world. " -- Gandhi > > Note: Email messages cannot be guaranteed to be secure or error-free. Neither Heart of Wellness nor any of its associates, employees or tenants accept liability for any interception, error or omission in this message arising as a result of email transmission. This communication, including any attachments, may contain confidential information and is intended only for the individual or entity to which it is addressed. Any review, dissemination, or copying of this communication by anyone other than the intended recipient is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and delete and destroy all copies of the original message. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 Sorry. The link didn't come through clearly. It is http://www.thehappymd.com/stop-being-a-victim-of-your-medical-career/ > > > > Hello everyone, > > > > My name is Fred Klemmer. I am an acupuncturist, not a MD, though I own a holistic healing center and am in the process of creating a multidisciplinary group practice (legal in WA state) that includes physicians. > > > > I found out about the IMP movement a while back at a conference with Patch and ever since I have been inspired by what folks associated with IMP have been doing. You are heroes - real everyday heroes, which are the kind of heroes we need most, especially in times like this. > > > > I come from a family of physicians. I learned about healing from my mother who for many years was the doctor for the Hansens Disease program in Hawaii. She modernized their treatment but she also gave deeply from her heart. Where now are the physicians like her? Some of them are right here on this listserve. > > > > You may have to wait longer than you would like to receive the appreciation and compensation you all deserve, but it might not be as long as you might think. Things are starting to change. The current situation is unsustainable and so change will happen. And no matter how difficult it may seem, and no matter how much it may seem at times like the change is going in the wrong direction, I for one am certain that you are on the right side of history. > > > > So thank you for being my everyday heroes as I also try to do my small part in creating a better healthcare system from the inside out. If anyone wants to move to WA state and join me in doing this together, let me know. > > > > Yours in gratitude, > > > > Fred Klemmer LAc > > Owner and Founder, Heart of Wellness PSC > > cell: > > > > http://heartofwellness.org > > > > " Be the change you wish to see in the world. " -- Gandhi > > > > Note: Email messages cannot be guaranteed to be secure or error-free. Neither Heart of Wellness nor any of its associates, employees or tenants accept liability for any interception, error or omission in this message arising as a result of email transmission. This communication, including any attachments, may contain confidential information and is intended only for the individual or entity to which it is addressed. Any review, dissemination, or copying of this communication by anyone other than the intended recipient is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and delete and destroy all copies of the original message. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 Thanks, Annie. It's good to know that there may still be some light on the other side! Maybe the wisdom we have gained here will help us make better choices.---Sharlene > >> > >> Please keep sharing....helps reduce stress.........alcohol is nice > >> too...........not enough $ or time to go to camp in the west coast this > >> year!!! :-( > >> > >> > >> > >> M in Western PA > >> > >> *From: * " Dr. Izquierdo-Porrera MD PhD " < > >> aizquierdo@... > >> > > >> *To: * <http://mc/compose?to=@\ yahoogroups.com> > >> *Sent: *Thursday, August 9, 2012 10:34:20 AM > >> *Subject: * Forgive my rant > >> > >> > >> > >> > >> > >> I just came to a realization that I wanted to share with you. In land > >> the Medicaid office is full of people that are benignly incompetent (i.e. > >> not necessarily hard working but occasionally try and are nice to talk to > >> you) vs the Medicare contractor (Novitas Solutions) that suffers from a > >> severe case of negligent incompetence (nasty and useless). > >> > >> > >> > >> I need to keep my rant short so I cannot go into the details of how I am > >> in my third submission to become a medicare provider but I will be happy to > >> share a bottle of wine and my fun stories during camp. > >> > >> > >> > >> By the way the State Medicaid office recognizes my voice and knows me by > >> my first name. That should tell you something… > >> > >> > >> > >> Izquierdo-Porrera MD PhD > >> > >> Executive Director & Co-founder > >> > >> Care for Your Health, Inc > >> > >> Phone > >> > >> Fax > >> > >> http://www.care4yourhealth.org/ > >> > >> * * > >> > >> * " Don't ever let injustice go by unchallenged. " * > >> > >> > >> > >> Help us make our community healthy -> > >> http://www.care4yourhealth.org/wanttohelp.php > >> > >> > >> > >> <image003.jpg> > >> > >> > >> > >> > >> > >> > >> -- > >> > >> > >> > >> MD > >> > >> > >> ph fax > >> http:/// > >> > >> > >> > >> > >> > >> > >> -- > >> > >> > >> > >> MD > >> > >> > >> ph fax > >> > >> > >> > >> > >> > > > > > > > > -- > Annie Skaggs > sville, KY > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 So good to hear from you again , and to know there is life outside of IMP/solo practice. I can't move, but probably some can so that is good to know. Not sure I could ever go back to working for a hospital, even working from home, doing IT job where I really don't have to deal with the superstructure of bosses etc, (at least in person) still chafes me. Glad most days I have the second job, but it is killing me, as it is apparently so many others on this list. Hoping the retainer, partial concierge thing will save me, but contemplated full bankruptcy earlier this year, and may still do, but husband opposed as the practice is the ONLY thing pulling us under. If this doesn't work, will go to IT FT, and give up real medicine, keep doing Botox/Filler in a single room, as that would pay for itself well. But in the current high Overhead practice it isn't. Good luck to all, and Gordon, can't you do something on the govt level to show them that solo doctors are going to be leaving practice en mass soon if something isn't done. We are all the examples here. CCote To: Sent: Thursday, August 9, 2012 11:29:01 PMSubject: Re: Bad week everywhere? It makes me sad to read about the struggles you all are going through. It wasn't that long ago that I was in a sinking boat trying to IMP in a toxic environment. I wish what you do was rewarded appropriately! Three years ago I gave up the ghost and took a hospitalist job. My income immediately jumped to FIVE TIMES what I had been making, plus benefits like a pension and health insurance...they even pay part of my cell phone bill and give me free meals at the hospital. I won't say things are perfect because there are still struggles. But still, it is SO much better here. I recently lost my temper at my computer, and a few minutes later realized that it was the FIRST time in three years that I have been angry. For the previous seven years it seems I was constantly angry, but since moving here to take this job, I am thankful every day for all my many blessings. I had to give up my IMP dream, throw away a lot of STUFF, leave behind patients that I love, and live two hours away from my husband...but it has been SO worth it!! If anyone has any interest in joining me here in the outskirts of heaven, I'd be tickled to tell you all about it. WE would LOVE to add to our team, and the pay is good, the cost of living way less than just about anywhere else in the lower 48, and we don't even really have drought here..it has been raining at least one day out of each of the last four weeks. Our corn is hit, but nothing like in other places...we will get at least 70 %, and our second cutting of hay will be ready next week. And there is room for more PCPs here as well...some of our local docs are in their 90's and still practicing...They can't last much longer. And only 2 local docs are taking new patients. I discharge people with follow up appointments 2 hours away because it's the best I can find for them. Best wishes to you all, whatever you decide is right for you. Annie le, My heart goes out to you. What are you going to do next? Sharon Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com I hear each and everyone of you!!!!! and I have reached my breaking point. made decision to close my practice. My accountant and my husband staged an intervention with me! Pointed out that I am working a second job to keep my office open without a clear vision of what exactly could change to make it profitable.Have tried cutting expenses........... I do not even have 1 FTE on staff right now. Am doing my own billing.Am doing cash based weight loss as well as regular primary care.Have not been paid by Medicare since Nov 2011...I have hired that problem out to a professional? biller.Am getting letter from specialist in town that say it is my responsibility to let my patients known when their scheduled appointments is AND if my patient does not show up, cancels or reschedules more than once, I cannot refer there the patient again....so I guess I should now hire staff to make sure my patients show up their offices??? Yes because i am the one making so much $$$$.Blue Shield will contemplate paying me for a visit with a patient I dx'd with a vertebral fracture AFTER I submit and they review all of my notes, labs and rad studies related to this visit...seriously???? Let me pay someone to pull all that info together and fax it to you.All local radiology companies expect me to do a pre-auth for all the studies THEY will make money on.....yes let me pay someone to for that too!!!Exhausted and done!Dannielle Dannielle Harwood, MD Please keep sharing....helps reduce stress.........alcohol is nice too...........not enough $ or time to go to camp in the west coast this year!!! :-( M in Western PA To: Sent: Thursday, August 9, 2012 10:34:20 AMSubject: Forgive my rant I just came to a realization that I wanted to share with you. In land the Medicaid office is full of people that are benignly incompetent (i.e. not necessarily hard working but occasionally try and are nice to talk to you) vs the Medicare contractor (Novitas Solutions) that suffers from a severe case of negligent incompetence (nasty and useless). I need to keep my rant short so I cannot go into the details of how I am in my third submission to become a medicare provider but I will be happy to share a bottle of wine and my fun stories during camp. By the way the State Medicaid office recognizes my voice and knows me by my first name. That should tell you something… Izquierdo-Porrera MD PhD Executive Director & Co-founder Care for Your Health, Inc Phone Fax http://www.care4yourhealth.org/ "Don't ever let injustice go by unchallenged." Help us make our community healthy -> http://www.care4yourhealth.org/wanttohelp.php <image003.jpg> -- MD ph fax http:/// -- MD ph fax -- Annie Skaggssville, KY Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 I commiserate with all of the bad-week folks. My well-being has taken a hit from some of these pressures, too. Not so much my patients -- I have a pretty good group and have agreed to take on some of their lack of self-responsibility in exchange for my NCBF. But the demands of payers, pharmacies, ancillary providers, government, etc. are stacking up to the point that I'm concerned that the end of the small practice as coming sooner and sooner. My catharsis yesterday, though, was some survey outfit paying me $65 to spend 15 minutes telling them what I thought of a couple of payers. I could do that all day! Haresch www.onefamilydoctor.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 is this something we'll be talking about at camp? Seems like such an important topic.The demands on the primary care doctor, whether in small practice or in group, are pretty intense, and they seem to be getting more so. I've often found myself thinking that primary care doctors need to find some way of advocating for decent working conditions. Does anyone know if there are any groups advocating for our working conditions? I feel that whenever they talk about increasing the number of primary care docs, they talk about med school loan forgiveness, which would help but really is not nearly enough. -- Kernisan, MD MPHGeriatrics I commiserate with all of the bad-week folks. My well-being has taken a hit from some of these pressures, too. Not so much my patients -- I have a pretty good group and have agreed to take on some of their lack of self-responsibility in exchange for my NCBF. But the demands of payers, pharmacies, ancillary providers, government, etc. are stacking up to the point that I'm concerned that the end of the small practice as coming sooner and sooner. My catharsis yesterday, though, was some survey outfit paying me $65 to spend 15 minutes telling them what I thought of a couple of payers. I could do that all day! Haresch www.onefamilydoctor.com ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 I don't know. I have many such moments, but its only getting better. I mean my ability to say that these are things I won't do.. I have- insurance companies 3rd party data massagers calling for records, - paperwork needing to be done ASAP.- Blue shield asking me for hospital records ( I billed the patient, who promptly called the hositpal and got the records and faxed it to them)-declined to make an appointment who no showed for their first appointment , with no calls or explanations- am not leaving myself open to that again -I don't deal with any 3rd party that has a phone tree, I call/email the patient and clarify the issueI am getting ever more comfortable saying this is the way I do things, your priorities will just have to wait... You guys gave me the courage to not have to be nice all the time, I have had patients return to me after cussing me out....There are so many tools that make overhead lower every year.. Sharing assistants virtually is a great idea- eg my assistant who is here an hour extra with little to do can also do copay posting on kareo, document loading in PF or anybody else remotely I expect next year as medi-cal payments go up, there will be more higher reimbursement patients seekingWhere as, working as a hospitalist in a nearby hospital ( not much fun- I see the real moral distress in working in a system with little support) I am not sure what I am trying to say.. but I was pleased with how fritcionless some days are getting to be( granted I don't have loan obligations, and a CURRENTLY well employed spouse) Sangeetha is this something we'll be talking about at camp? Seems like such an important topic.The demands on the primary care doctor, whether in small practice or in group, are pretty intense, and they seem to be getting more so. I've often found myself thinking that primary care doctors need to find some way of advocating for decent working conditions. Does anyone know if there are any groups advocating for our working conditions? I feel that whenever they talk about increasing the number of primary care docs, they talk about med school loan forgiveness, which would help but really is not nearly enough. -- Kernisan, MD MPHGeriatrics I commiserate with all of the bad-week folks. My well-being has taken a hit from some of these pressures, too. Not so much my patients -- I have a pretty good group and have agreed to take on some of their lack of self-responsibility in exchange for my NCBF. But the demands of payers, pharmacies, ancillary providers, government, etc. are stacking up to the point that I'm concerned that the end of the small practice as coming sooner and sooner. My catharsis yesterday, though, was some survey outfit paying me $65 to spend 15 minutes telling them what I thought of a couple of payers. I could do that all day! Haresch www.onefamilydoctor.com ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 Sangeetha,I hope neither the spouse nor the job goes away in the near future (the way you all cap'd CURRENTLY) . Would be interested in " buying " a little virtual assistant time from you....let's talk. Sharon Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com I don't know. I have many such moments, but its only getting better. I mean my ability to say that these are things I won't do.. I have- insurance companies 3rd party data massagers calling for records, - paperwork needing to be done ASAP.- Blue shield asking me for hospital records ( I billed the patient, who promptly called the hositpal and got the records and faxed it to them)-declined to make an appointment who no showed for their first appointment , with no calls or explanations- am not leaving myself open to that again -I don't deal with any 3rd party that has a phone tree, I call/email the patient and clarify the issueI am getting ever more comfortable saying this is the way I do things, your priorities will just have to wait... You guys gave me the courage to not have to be nice all the time, I have had patients return to me after cussing me out....There are so many tools that make overhead lower every year.. Sharing assistants virtually is a great idea- eg my assistant who is here an hour extra with little to do can also do copay posting on kareo, document loading in PF or anybody else remotely I expect next year as medi-cal payments go up, there will be more higher reimbursement patients seekingWhere as, working as a hospitalist in a nearby hospital ( not much fun- I see the real moral distress in working in a system with little support) I am not sure what I am trying to say.. but I was pleased with how fritcionless some days are getting to be( granted I don't have loan obligations, and a CURRENTLY well employed spouse) Sangeetha is this something we'll be talking about at camp? Seems like such an important topic.The demands on the primary care doctor, whether in small practice or in group, are pretty intense, and they seem to be getting more so. I've often found myself thinking that primary care doctors need to find some way of advocating for decent working conditions. Does anyone know if there are any groups advocating for our working conditions? I feel that whenever they talk about increasing the number of primary care docs, they talk about med school loan forgiveness, which would help but really is not nearly enough. -- Kernisan, MD MPHGeriatrics I commiserate with all of the bad-week folks. My well-being has taken a hit from some of these pressures, too. Not so much my patients -- I have a pretty good group and have agreed to take on some of their lack of self-responsibility in exchange for my NCBF. But the demands of payers, pharmacies, ancillary providers, government, etc. are stacking up to the point that I'm concerned that the end of the small practice as coming sooner and sooner. My catharsis yesterday, though, was some survey outfit paying me $65 to spend 15 minutes telling them what I thought of a couple of payers. I could do that all day! Haresch www.onefamilydoctor.com ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 IMp does not have to stand for immensely poor. Private solo practice is tough, especially if you play by a third parties rules. If you truly want to make a better go at it, start removing yourself one by one from third party contracts and offer your services for cash up front. Try offering a low priced retainer for the year. Being an imP and allowing third parties and entitled patients to ruin your product just does not work. Steve stown > <blockquote> > > > > > > > Please keep sharing....helps reduce stress.........alcohol is nice too...........not enough $ or time to go to camp in the west coast this year!!!  :-( > > >  > > > > > M in Western PA > > From: " Dr. Izquierdo-Porrera MD PhD " < aizquierdo@... > > To: > Sent: Thursday, August 9, 2012 10:34:20 AM > Subject: Forgive my rant > > > > >  > > > > > > > > > I just came to a realization that I wanted to share with you. In land the Medicaid office is full of people that are benignly incompetent (i.e. not necessarily hard working but occasionally try and are nice to talk to you) vs the Medicare contractor (Novitas Solutions) that suffers from a severe case of negligent incompetence (nasty and useless). > > >  > > > I need to keep my rant short so I cannot go into the details of how I am in my third submission to become a medicare provider but I will be happy to share a bottle of wine and my fun stories during camp. > > >  > > > By the way the State Medicaid office recognizes my voice and knows me by my first name. That should tell you something… > > >  > > > Izquierdo-Porrera MD PhD > > > Executive Director & Co-founder > > > Care for Your Health, Inc > > > Phone > > > Fax > > > http://www.care4yourhealth.org/ > > >  > > > " Don't ever let injustice go by unchallenged. " > > >  > > > Help us make our community healthy -> http://www.care4yourhealth.org/wanttohelp.php > > >  > > > <image003.jpg> > > >  > > > > > > > > -- > > > >    MD >    >    > ph   fax > http:/// > >  > </blockquote> > > > > > > > -- > > > >    MD >    >    > ph   fax > > </blockquote> > > >  > > </blockquote> > > > > > </blockquote> > > > > > > > > </blockquote> > > > > -- > Annie Skaggs > sville, KY > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 haha he's been thru a few startups ( not in one now), so CURRENTLY employed is ALWAYS goodSangeetha Sangeetha,I hope neither the spouse nor the job goes away in the near future (the way you all cap'd CURRENTLY) . Would be interested in " buying " a little virtual assistant time from you....let's talk. Sharon Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com I don't know. I have many such moments, but its only getting better. I mean my ability to say that these are things I won't do.. I have- insurance companies 3rd party data massagers calling for records, - paperwork needing to be done ASAP.- Blue shield asking me for hospital records ( I billed the patient, who promptly called the hositpal and got the records and faxed it to them)-declined to make an appointment who no showed for their first appointment , with no calls or explanations- am not leaving myself open to that again -I don't deal with any 3rd party that has a phone tree, I call/email the patient and clarify the issueI am getting ever more comfortable saying this is the way I do things, your priorities will just have to wait... You guys gave me the courage to not have to be nice all the time, I have had patients return to me after cussing me out....There are so many tools that make overhead lower every year.. Sharing assistants virtually is a great idea- eg my assistant who is here an hour extra with little to do can also do copay posting on kareo, document loading in PF or anybody else remotely I expect next year as medi-cal payments go up, there will be more higher reimbursement patients seekingWhere as, working as a hospitalist in a nearby hospital ( not much fun- I see the real moral distress in working in a system with little support) I am not sure what I am trying to say.. but I was pleased with how fritcionless some days are getting to be( granted I don't have loan obligations, and a CURRENTLY well employed spouse) Sangeetha is this something we'll be talking about at camp? Seems like such an important topic.The demands on the primary care doctor, whether in small practice or in group, are pretty intense, and they seem to be getting more so. I've often found myself thinking that primary care doctors need to find some way of advocating for decent working conditions. Does anyone know if there are any groups advocating for our working conditions? I feel that whenever they talk about increasing the number of primary care docs, they talk about med school loan forgiveness, which would help but really is not nearly enough. -- Kernisan, MD MPHGeriatrics I commiserate with all of the bad-week folks. My well-being has taken a hit from some of these pressures, too. Not so much my patients -- I have a pretty good group and have agreed to take on some of their lack of self-responsibility in exchange for my NCBF. But the demands of payers, pharmacies, ancillary providers, government, etc. are stacking up to the point that I'm concerned that the end of the small practice as coming sooner and sooner. My catharsis yesterday, though, was some survey outfit paying me $65 to spend 15 minutes telling them what I thought of a couple of payers. I could do that all day! Haresch www.onefamilydoctor.com ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 Good, Sangeetha :)Sharon haha he's been thru a few startups ( not in one now), so CURRENTLY employed is ALWAYS goodSangeetha Sangeetha,I hope neither the spouse nor the job goes away in the near future (the way you all cap'd CURRENTLY) . Would be interested in " buying " a little virtual assistant time from you....let's talk. Sharon Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com I don't know. I have many such moments, but its only getting better. I mean my ability to say that these are things I won't do.. I have- insurance companies 3rd party data massagers calling for records, - paperwork needing to be done ASAP.- Blue shield asking me for hospital records ( I billed the patient, who promptly called the hositpal and got the records and faxed it to them)-declined to make an appointment who no showed for their first appointment , with no calls or explanations- am not leaving myself open to that again -I don't deal with any 3rd party that has a phone tree, I call/email the patient and clarify the issueI am getting ever more comfortable saying this is the way I do things, your priorities will just have to wait... You guys gave me the courage to not have to be nice all the time, I have had patients return to me after cussing me out....There are so many tools that make overhead lower every year.. Sharing assistants virtually is a great idea- eg my assistant who is here an hour extra with little to do can also do copay posting on kareo, document loading in PF or anybody else remotely I expect next year as medi-cal payments go up, there will be more higher reimbursement patients seekingWhere as, working as a hospitalist in a nearby hospital ( not much fun- I see the real moral distress in working in a system with little support) I am not sure what I am trying to say.. but I was pleased with how fritcionless some days are getting to be( granted I don't have loan obligations, and a CURRENTLY well employed spouse) Sangeetha is this something we'll be talking about at camp? Seems like such an important topic.The demands on the primary care doctor, whether in small practice or in group, are pretty intense, and they seem to be getting more so. I've often found myself thinking that primary care doctors need to find some way of advocating for decent working conditions. Does anyone know if there are any groups advocating for our working conditions? I feel that whenever they talk about increasing the number of primary care docs, they talk about med school loan forgiveness, which would help but really is not nearly enough. -- Kernisan, MD MPHGeriatrics I commiserate with all of the bad-week folks. My well-being has taken a hit from some of these pressures, too. Not so much my patients -- I have a pretty good group and have agreed to take on some of their lack of self-responsibility in exchange for my NCBF. But the demands of payers, pharmacies, ancillary providers, government, etc. are stacking up to the point that I'm concerned that the end of the small practice as coming sooner and sooner. My catharsis yesterday, though, was some survey outfit paying me $65 to spend 15 minutes telling them what I thought of a couple of payers. I could do that all day! Haresch www.onefamilydoctor.com ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2012 Report Share Posted August 11, 2012 Yes Sharon, I have IDEAS! Will write to you. Good, Sangeetha :)Sharon haha he's been thru a few startups ( not in one now), so CURRENTLY employed is ALWAYS goodSangeetha Sangeetha,I hope neither the spouse nor the job goes away in the near future (the way you all cap'd CURRENTLY) . Would be interested in " buying " a little virtual assistant time from you....let's talk. Sharon Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com I don't know. I have many such moments, but its only getting better. I mean my ability to say that these are things I won't do.. I have- insurance companies 3rd party data massagers calling for records, - paperwork needing to be done ASAP.- Blue shield asking me for hospital records ( I billed the patient, who promptly called the hositpal and got the records and faxed it to them)-declined to make an appointment who no showed for their first appointment , with no calls or explanations- am not leaving myself open to that again -I don't deal with any 3rd party that has a phone tree, I call/email the patient and clarify the issueI am getting ever more comfortable saying this is the way I do things, your priorities will just have to wait... You guys gave me the courage to not have to be nice all the time, I have had patients return to me after cussing me out....There are so many tools that make overhead lower every year.. Sharing assistants virtually is a great idea- eg my assistant who is here an hour extra with little to do can also do copay posting on kareo, document loading in PF or anybody else remotely I expect next year as medi-cal payments go up, there will be more higher reimbursement patients seekingWhere as, working as a hospitalist in a nearby hospital ( not much fun- I see the real moral distress in working in a system with little support) I am not sure what I am trying to say.. but I was pleased with how fritcionless some days are getting to be( granted I don't have loan obligations, and a CURRENTLY well employed spouse) Sangeetha is this something we'll be talking about at camp? Seems like such an important topic.The demands on the primary care doctor, whether in small practice or in group, are pretty intense, and they seem to be getting more so. I've often found myself thinking that primary care doctors need to find some way of advocating for decent working conditions. Does anyone know if there are any groups advocating for our working conditions? I feel that whenever they talk about increasing the number of primary care docs, they talk about med school loan forgiveness, which would help but really is not nearly enough. -- Kernisan, MD MPHGeriatrics I commiserate with all of the bad-week folks. My well-being has taken a hit from some of these pressures, too. Not so much my patients -- I have a pretty good group and have agreed to take on some of their lack of self-responsibility in exchange for my NCBF. But the demands of payers, pharmacies, ancillary providers, government, etc. are stacking up to the point that I'm concerned that the end of the small practice as coming sooner and sooner. My catharsis yesterday, though, was some survey outfit paying me $65 to spend 15 minutes telling them what I thought of a couple of payers. I could do that all day! Haresch www.onefamilydoctor.com ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2012 Report Share Posted August 11, 2012 This is truly depressing to hear. We found last year to be a tough go, but have seen a significant upturn this year. No idea why but living in a resort area, people seem to be willing to spend more money all of a sudden. So far we have had the best year since 2007, and see no end. Many tourists, but lots of the usual locals. We do run a very cost practice and can make due with 10-12 patients a day, cover our costs at 5 a day, but have been at 18-22. I guess, location, location location means something in medicine also. The real issue for all of us, is the individual mental stress, and the unfortunate drive to employment by the larger entities. I still believe the IMP model is the best and most efficient, but without the right reimbursment models, it is really hard to survive with any practice model. Perhaps the CPC grant/demontration project will show that a serious effort to retool to a capitated reimbursment is one way for all of us to do better. From: [ ] On Behalf Of Kathy Saradarian [qualityfp@...] Sent: Thursday, August 09, 2012 8:44 PM To: Subject: RE: Bad week everywhere? All these posts about doctors quitting are very disheartening. Kathy Saradarian, MD NJ From: [mailto: ] On Behalf Of Dannielle Harwood Sent: Thursday, August 09, 2012 9:28 PM To: Subject: RE: Bad week everywhere? I hear each and everyone of you!!!!! and I have reached my breaking point. made decision to close my practice. My accountant and my husband staged an intervention with me! Pointed out that I am working a second job to keep my office open without a clear vision of what exactly could change to make it profitable. Have tried cutting expenses........... I do not even have 1 FTE on staff right now. Am doing my own billing. Am doing cash based weight loss as well as regular primary care. Have not been paid by Medicare since Nov 2011...I have hired that problem out to a professional? biller. Am getting letter from specialist in town that say it is my responsibility to let my patients known when their scheduled appointments is AND if my patient does not show up, cancels or reschedules more than once, I cannot refer there the patient again....so I guess I should now hire staff to make sure my patients show up their offices??? Yes because i am the one making so much $$$$. Blue Shield will contemplate paying me for a visit with a patient I dx'd with a vertebral fracture AFTER I submit and they review all of my notes, labs and rad studies related to this visit...seriously???? Let me pay someone to pull all that info together and fax it to you. All local radiology companies expect me to do a pre-auth for all the studies THEY will make money on.....yes let me pay someone to for that too!!! Exhausted and done! Dannielle Dannielle Harwood, MD Please keep sharing....helps reduce stress.........alcohol is nice too...........not enough $ or time to go to camp in the west coast this year!!! :-( M in Western PA To: Sent: Thursday, August 9, 2012 10:34:20 AM Subject: Forgive my rant I just came to a realization that I wanted to share with you. In land the Medicaid office is full of people that are benignly incompetent (i.e. not necessarily hard working but occasionally try and are nice to talk to you) vs the Medicare contractor (Novitas Solutions) that suffers from a severe case of negligent incompetence (nasty and useless). I need to keep my rant short so I cannot go into the details of how I am in my third submission to become a medicare provider but I will be happy to share a bottle of wine and my fun stories during camp. By the way the State Medicaid office recognizes my voice and knows me by my first name. That should tell you something… Izquierdo-Porrera MD PhD Executive Director & Co-founder Care for Your Health, Inc Phone Fax http://www.care4yourhealth.org/ " Don't ever let injustice go by unchallenged. " Help us make our community healthy -> http://www.care4yourhealth.org/wanttohelp.php <image003.jpg> -- MD ph fax http:/// -- MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2012 Report Share Posted August 11, 2012 Bad clinical week! Bad HIV diagnosis to break, and events before and after Rapid death from breast cancer metatstatic to brain (3 weeks after discovery) Gadzillions of worried sick and worried well people. Last night, at work until 11PM, last patient at 9PM, r/o DVT Before that new anisocoria (did you guys know that abnormal pupillary dilation can be mediated by a cervical process?), probably some sort of atypical migraine bizarre variant Before that every slot taken by sad people, worried people, funny teens and kids with poison ivy, very old people who take a lot of time. Even when the finances are OK the work is hard. Saw 50+ people this week which is lot for me. On top of that the new AC PM is not quite working all the way through yet (though when it does IT WILL BE GREAT) My head is crawling with PEOPLE and I am going to go out to dinner tonight and stare thoughtfully into my soup. Quietly and for long time and without uttering a single word, maybe for the whole rest of the evening. I might humbly suggest that some of you will want to do the same :-) Lynn Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2012 Report Share Posted August 11, 2012 Amen Lynn.What an impressively hard week. Hang in there. Your patients are lucky to have you. Sharon Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com Bad clinical week! Bad HIV diagnosis to break, and events before and after Rapid death from breast cancer metatstatic to brain (3 weeks after discovery) Gadzillions of worried sick and worried well people. Last night, at work until 11PM, last patient at 9PM, r/o DVT Before that new anisocoria (did you guys know that abnormal pupillary dilation can be mediated by a cervical process?), probably some sort of atypical migraine bizarre variant Before that every slot taken by sad people, worried people, funny teens and kids with poison ivy, very old people who take a lot of time. Even when the finances are OK the work is hard. Saw 50+ people this week which is lot for me. On top of that the new AC PM is not quite working all the way through yet (though when it does IT WILL BE GREAT) My head is crawling with PEOPLE and I am going to go out to dinner tonight and stare thoughtfully into my soup. Quietly and for long time and without uttering a single word, maybe for the whole rest of the evening. I might humbly suggest that some of you will want to do the same :-) Lynn Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2012 Report Share Posted August 11, 2012 Did you mention AC PM--as in Amazing Charts Patient Management? They've been promising PM for a long time?!? RE: Bad week everywhere? Bad clinical week! Bad HIV diagnosis to break, and events before and after Rapid death from breast cancer metatstatic to brain (3 weeks after discovery) Gadzillions of worried sick and worried well people. Last night, at work until 11PM, last patient at 9PM, r/o DVT Before that new anisocoria (did you guys know that abnormal pupillary dilation can be mediated by a cervical process?), probably some sort of atypical migraine bizarre variant Before that every slot taken by sad people, worried people, funny teens and kids with poison ivy, very old people who take a lot of time. Even when the finances are OK the work is hard. Saw 50+ people this week which is lot for me. On top of that the new AC PM is not quite working all the way through yet (though when it does IT WILL BE GREAT) My head is crawling with PEOPLE and I am going to go out to dinner tonight and stare thoughtfully into my soup. Quietly and for long time and without uttering a single word, maybe for the whole rest of the evening. I might humbly suggest that some of you will want to do the same :-) Lynn Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2012 Report Share Posted August 11, 2012 Thank you Sharon!I think one of my biggest issues was that I really let my patients walk all over me and it burned me out.I have a part time position as the medical director and onsite physician for Sierra Nevada Brewery here in Chico.Will see where this goes. I followed Graham's advice and married well so I am not financially stressed which is a big plus.How is Irvine?? How many patients are you caring for right now?Dannielle Please keep sharing....helps reduce stress.........alcohol is nice too...........not enough $ or time to go to camp in the west coast this year!!! :-( M in Western PA From: "Dr. Izquierdo-Porrera MD PhD" To: Sent: Thursday, August 9, 2012 10:34:20 AM Subject: Forgive my rant I just came to a realization that I wanted to share with you. In land the Medicaid office is full of people that are benignly incompetent (i.e. not necessarily hard working but occasionally try and are nice to talk to you) vs the Medicare contractor (Novitas Solutions) that suffers from a severe case of negligent incompetence (nasty and useless). I need to keep my rant short so I cannot go into the details of how I am in my third submission to become a medicare provider but I will be happy to share a bottle of wine and my fun stories during camp. By the way the State Medicaid office recognizes my voice and knows me by my first name. That should tell you something… Izquierdo-Porrera MD PhD Executive Director & Co-founder Care for Your Health, Inc Phone Fax http://www.care4yourhealth.org/ "Don't ever let injustice go by unchallenged." Help us make our community healthy -> http://www.care4yourhealth.org/wanttohelp.php <image003.jpg> -- MD 115 Mt Blue Circle ph fax http:/// -- MD 115 Mt Blue Circle ph fax Quote Link to comment Share on other sites More sharing options...
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