Guest guest Posted August 9, 2012 Report Share Posted August 9, 2012 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!!. 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 themoy.thanks sorry. Bad bad spell here. 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 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 PhD Executive 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 -- MD ph fax http:/// Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 9, 2012 Report Share Posted August 9, 2012 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 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!!. 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 themoy.thanks sorry. Bad bad spell here. 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, 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 -- MD ph fax http:/// -- MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 9, 2012 Report Share Posted August 9, 2012 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 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 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!!. 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 themoy.thanks sorry. Bad bad spell here. 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, 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 9, 2012 Report Share Posted August 9, 2012 Sorry Jean.Why do you think more PCP's are headed your way? Are they newly graduated residents that you inspired? Sharon 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 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 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!!. 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 themoy.thanks sorry. Bad bad spell here. 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, 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 9, 2012 Report Share Posted August 9, 2012 hi jean. the only thing i can tell U is i forgive your rant and that i am reading your rant while i am out of town, having already spent an hour doing laps in a swimming pool that just has me and my mom in it with the kids playing wii about 2 miles away. facebooking while im at it, one day after ive done a photo shoot at the local botanical gardens (which i dont have at home) being massaged for free (trading for acupuncture sessions) DAILY 2 days at the outlet mall and a camera shop scoring camera bags (which i dont need) 50% off three dollars each....... BTW..... above is the truth.. but the real truth is i am reeducating myself and learning new skills so when the system implodes i am ready to pack up and go and set up shop elsewhere where my wares are peddled and not for free and will actually help people since there's no red tape and people truly are grateful cant wait to see you in person.. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 9, 2012 Report Share Posted August 9, 2012 I repeat, go spend some time in your garden. You need a vacation. When patient’s do nothing but annoy you, you need a break. When they call outside hours I listen briefly and then tell them they will need to schedule an appointment. Outside hours died out. You really shouldn’t be getting any unless emergencies, so stop letting people walk all over you. Your ER problem is stupid. Are you going to be taking care of them in the hospital? Or is this a courtesy notification. If you are seeing them in the hospital, they need to call. Tell them you don’t go to your office every day. Or you might be in your “other” office and faxing notification doesn’t work. You can’t be the only doctor with this issue. Go to your Chief of Staff if you need to or the Medical Stall Office liason saying it’s unacceptable and it needs to be done different. However, if this is just a courtesy notification and you won’t be rounding at the hospital then once a day you can walk all they way to the printer and get your reports. You will have to get over that one. Just because you have a good life, doesn’t mean that you aren’t allowed to get frustrated at times and vent. No apologies. Kathy SaradarianNJ PS: Someone who frequently vents! From: [mailto: ] On Behalf Of Sent: Thursday, August 09, 2012 12:19 PMTo: Subject: Re: Forgiven rant 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 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!!. To: Sent: Thursday, August 9, 2012 10:19 AMSubject: 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 themoy.thanks sorry. Bad bad spell here.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 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 -- MD ph fax http:/// -- MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 9, 2012 Report Share Posted August 9, 2012 I'm so sorry this has happened to you, and to so many of us. You have tried harder than I could ever have dreamed of doing. I don't know how or why you keep going, but it cannot be healthy. I slipped into a severe state of burnout last winter and spring, when I realized that my solo IMP is not going to work for me for the long-term. It started out with all the signs of being a great success, but eventually became clear to me that I am working MUCH TOO MUCH to make not enough money to meet my living expenses. I have been open nearly 4 years, now, and my income peaked in the second full year and has declined since then. I have wonderful patients and a long waiting list but cannot take on new patients because I cannot handle the administrative junk that comes with them. I do not want to become an employer and enter the administrative nightmare that you are dealing with, now, only to have to see even more patients to pay an employee. I cannot go cash-only or charge an adequate concierge fee in my location. So, I found myself desperately wanting to get out of medicine. Feeling trapped by my med school loans, I started reading the obituaries in the morning, hoping to find myself there, or at least taking comfort that other folks my age sometimes die. (And no, I am not actively suicidal.) This is NOT how we should be feeling in one of the most valuable of all professions! Anyway, I found my way to The Happy MD website of Dike Drummond, who is a former family doc who burned out and left medicine. He counsels docs experiencing burnout, as well as other entrepreneurs. If you register on his website, he will send you all sorts of interesting, supportive, free articles and videos, as well as offer you a free, 1-hour telephone session, which I found very cathartic. You can schedule more phone sessions, for a fee, if you want to. He will teach you that you deserve MUCH better from life. I also got in on a 6-week pilot of a " Balance and Boundaries " webinar he was putting together for physicians, which taught skills necessary to reclaim our lives when it seems that medicine is consuming every minute of our day and every ounce of our strength. I thought it was great, and I highly recommend it if you ever see the final product advertised. Anyway, all those experiences led me to the revelation that I can't keep doing what I'm doing and expect to get different results, especially with the handwriting on the wall that there is going to be less and less concern about us " inefficient " small, independent practices, who can't possibly be expected to give high-quality, cost-effective care. I recently interviewed for a job with a VA outpatient clinic, where they will give me 30-minute patient visits, a nice salary with benefits, and (you won't believe this) 140 days off per year!!! If I get the job, I know it will not be a bed of roses and I will not like the loss of autonomy, but I am going to try desperately to make it work until I retire in 10 years. So, I hope there is a VA clinic near you, because you sound like you might be burned out, too. BTW, I have no financial ties with Dike Drummond, but I think he is offering a valuable service that a lot of us desperately need.---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: * > > *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 > > > > [image: Care_your_health.jpg] > > > > > > > > > > > > -- > > > > > > > > MD > > > > > > ph fax > > http:/// > > > > > > > > > -- > > > > MD > > > ph fax > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 9, 2012 Report Share Posted August 9, 2012 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 To: Sent: Thursday, August 9, 2012 10:12:49 AMSubject: 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 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 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 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!!. To: Sent: Thursday, August 9, 2012 10:19 AMSubject: 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 themoy.thanks sorry. Bad bad spell here. 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 It does no service to anyone to work in a burned-out, frustrated frame of mind: not you, not your patients, not society. Don't feel guilty about putting an end to that. All the best.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 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 To: Sent: Thursday, August 9, 2012 10:12:49 AMSubject: 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 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 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 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!!. To: Sent: Thursday, August 9, 2012 10:19 AMSubject: 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 themoy.thanks sorry. Bad bad spell here. 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2012 Report Share Posted August 10, 2012 I repeat, go spend some time in your garden. You need a vacation. When patient’s do nothing but annoy you, you need a break. When they call outside hours I listen briefly and then tell them they will need to schedule an appointment. Outside hours died out. You really shouldn’t be getting any unless emergencies, so stop letting people walk all over you. Your ER problem is stupid. Are you going to be taking care of them in the hospital? Or is this a courtesy notification. If you are seeing them in the hospital, they need to call. Tell them you don’t go to your office every day. Or you might be in your “other” office and faxing notification doesn’t work. You can’t be the only doctor with this issue. Go to your Chief of Staff if you need to or the Medical Stall Office liason saying it’s unacceptable and it needs to be done different. However, if this is just a courtesy notification and you won’t be rounding at the hospital then once a day you can walk all they way to the printer and get your reports. You will have to get over that one. Just because you have a good life, doesn’t mean that you aren’t allowed to get frustrated at times and vent. No apologies. Kathy SaradarianNJ PS: Someone who frequently vents! From: [mailto: ] On Behalf Of Sent: Thursday, August 09, 2012 12:19 PMTo: Subject: Re: Forgiven rant 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 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!!. To: Sent: Thursday, August 9, 2012 10:19 AMSubject: 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 themoy.thanks sorry. Bad bad spell here.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 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 -- 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 Myria,I have all patient messages that cannot be answered with a simple yes or no by staff transferred to my voicemail/ transcribed and delivered to me. patients are informed, it may be 24 hrs before I return the call. When I call back, the conversations are much smoother because I am better prepared. I usually call back in a couple of hours but on rough days it gives me more room.... Sangeetha My heart goes out to all who are struggling. le, be well. Jeanne, you have been my idol and I just wonder what can I say or do that will help. I love Kathy's, Matt's and Sharlene's advice. The patients are getting more and more demanding -- and I'm getting tighter with the boundaries -- sending out no show fees, demanding that patients make choices rather than keep trying to blame me. But I too have been angry and resentful the past month so I'm trying to go back to the serenity prayer -- fix what I can and let go what is not my responsibility and try very, very hard not to get entangled in patient's helplessness and expecting rescue which is co-dependency not teamwork. Thank you to all who shared as I thought it was me. When I get this burned out (and I am not in the red[except taxes] and have paid and unpaid help so I count my blessings) I know I need to do a better job of holding my boundaries. I'm fearful I'll never have a good balance but I will never go back to working for someone else. I will work on efficiency. To me doing chart audits isn't efficient. I ignore them and some of them do go away. The others who persist I tell the requesters once -- tell me what you need --- I'll pull HgbA1C or immunizations, etc but I do not send 1-2 years of charts or charts I sent you last year. For DME junk (see previous posts) I have to make a paper form and quickly fill it out and fax it the old way. (I find flipping through computer pages much harder than flipping through paper!) I've just started setting my phone alarm to go off 10 minutes before end of visit. My home visits may be the first to bite the dust as they are simply too complex and I spend 1-2x the visit time doing the chart and referrals and VNA orders (I've yet to figure out how to get paid for that.) My part time nurse and I are wondering if patients are less long winded if they HAVE to leave a message so we can then make them focus when we call them back. That may backfire as I consider Gordon's lessons of patients are less demanding if responded to quickly. But what I'll do for myself may not be what others need. These ideas don't address the emotional drain and the constant demeaning that flogs primary care. Political change is a must. Patients are sicker and sicker: physically and mentally/emotionally and we have to fight for prolonged visits and don't have anywhere near a fair rate. One of my patients noted the local mechanic gets more per hour than I do! I will go under if Medicare gets cut. I'm glad those who have left have found other niches. I hope together we can find ways to keep IMP alive. God Bless Us, Every One. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2012 Report Share Posted August 11, 2012 What a concept! Thanks for sharing. I will certainly consider some form of this. To: Sent: Friday, August 10, 2012 11:44 PM Subject: Re: forgiven rant Myria,I have all patient messages that cannot be answered with a simple yes or no by staff transferred to my voicemail/ transcribed and delivered to me. patients are informed, it may be 24 hrs before I return the call. When I call back, the conversations are much smoother because I am better prepared. I usually call back in a couple of hours but on rough days it gives me more room.... Sangeetha My heart goes out to all who are struggling. le, be well. Jeanne, you have been my idol and I just wonder what can I say or do that will help. I love Kathy's, Matt's and Sharlene's advice. The patients are getting more and more demanding -- and I'm getting tighter with the boundaries -- sending out no show fees, demanding that patients make choices rather than keep trying to blame me. But I too have been angry and resentful the past month so I'm trying to go back to the serenity prayer -- fix what I can and let go what is not my responsibility and try very, very hard not to get entangled in patient's helplessness and expecting rescue which is co-dependency not teamwork. Thank you to all who shared as I thought it was me. When I get this burned out (and I am not in the red[except taxes] and have paid and unpaid help so I count my blessings) I know I need to do a better job of holding my boundaries. I'm fearful I'll never have a good balance but I will never go back to working for someone else. I will work on efficiency. To me doing chart audits isn't efficient. I ignore them and some of them do go away. The others who persist I tell the requesters once -- tell me what you need --- I'll pull HgbA1C or immunizations, etc but I do not send 1-2 years of charts or charts I sent you last year. For DME junk (see previous posts) I have to make a paper form and quickly fill it out and fax it the old way. (I find flipping through computer pages much harder than flipping through paper!) I've just started setting my phone alarm to go off 10 minutes before end of visit. My home visits may be the first to bite the dust as they are simply too complex and I spend 1-2x the visit time doing the chart and referrals and VNA orders (I've yet to figure out how to get paid for that.) My part time nurse and I are wondering if patients are less long winded if they HAVE to leave a message so we can then make them focus when we call them back. That may backfire as I consider Gordon's lessons of patients are less demanding if responded to quickly. But what I'll do for myself may not be what others need. These ideas don't address the emotional drain and the constant demeaning that flogs primary care. Political change is a must. Patients are sicker and sicker: physically and mentally/emotionally and we have to fight for prolonged visits and don't have anywhere near a fair rate. One of my patients noted the local mechanic gets more per hour than I do! I will go under if Medicare gets cut. I'm glad those who have left have found other niches. I hope together we can find ways to keep IMP alive. God Bless Us, Every One. Quote Link to comment Share on other sites More sharing options...
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