IM subspeciality with least amount of administrative work?

[nawrp11]

Hey guys,
Which subspeciality has the least amount of administrative work? Or is this something pervasive in the whole IM/medicine universe?

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[NewYorkDoctors]

Hey guys,
Which subspeciality has the least amount of administrative work? Or is this something pervasive in the whole IM/medicine universe?

what do you mean by administrative work?

are you a resident or fellow now? because in resident and fellow clinic, you get scutted out to do prior auths, disabiltiy paperwork, preemployment forms, Face to Face forms, etc... due to cost saving issues

once you're an attending you can see to it that you have staff to help you with these things.

all subspecialties have to do prior auths.
As an attending, you can get the online portals for PAs and your staff can be trained to click most of the things so you only need to upload your clinical note.

As PCP, you can just turf to the subspecialist to deal with the PAs if you do not work in a "Patient Centered medical home" set up with ancillary staff to do your own PAs. But as PCP you have to fill out all of those plans of care for geriatric patients who have home health aide care, are in assisted living, or are in a nursing home, etc...

all patients will call to leave call back tasks regardless of specialty.


basically i would like to think that if you did an IM subspecialty, then your "administrative work" will be more "meaningful." If that makes any sense...

 

[nawrp11]

what do you mean by administrative work?

are you a resident or fellow now? because in resident and fellow clinic, you get scutted out to do prior auths, disabiltiy paperwork, preemployment forms, Face to Face forms, etc... due to cost saving issues

once you're an attending you can see to it that you have staff to help you with these things.

all subspecialties have to do prior auths.
As an attending, you can get the online portals for PAs and your staff can be trained to click most of the things so you only need to upload your clinical note.

As PCP, you can just turf to the subspecialist to deal with the PAs if you do not work in a "Patient Centered medical home" set up with ancillary staff to do your own PAs. But as PCP you have to fill out all of those plans of care for geriatric patients who have home health aide care, are in assisted living, or are in a nursing home, etc...

all patients will call to leave call back tasks regardless of specialty.


basically i would like to think that if you did an IM subspecialty, then your "administrative work" will be more "meaningful." If that makes any sense...

Thanks

I'm a resident at the moment. By "administrative work" I basically refer to work that isnt using one's medical brain of taking hx, forming differentials and managing patients based on one's medical knowledge. So yea, prior auths disability paperwork discharge summaries etc
I have a feeling working with these kinds of things day in and day out will suck the joy out of my job real fast, so I'm wondering where theres the least of this...

 

[Gastrapathy]

The issue isn’t the specialty, it’s the practice. All that stuff can be handled by other people in a well run practice. The employed places that make the doctors do it know you’ll do it for free. It’s all about finding a good practice

 

[NewYorkDoctors]

Thanks

I'm a resident at the moment. By "administrative work" I basically refer to work that isnt using one's medical brain of taking hx, forming differentials and managing patients based on one's medical knowledge. So yea, prior auths disability paperwork discharge summaries etc
I have a feeling working with these kinds of things day in and day out will suck the joy out of my job real fast, so I'm wondering where theres the least of this...

paper work is forever.

if you ended up being a hospitalist in a hospital without PAs or residents, you would do your own discharge paperwork.
even if you were a hospitalist at a place with PA/NP/residents, you would stilll have to go over it with a fine tooth comb and also add your attending section as well.

I just look at this paperwork as a necessary burden.
A) no paperwork - no payment from insurance
B) keep track of what is going on meticulously so I do not have to store it in my brain. I refer to my own prior detailed note and willl know what happened and what to do.
C) document everything clearly and honestly in the event of a bad outcome so you protect yourself (assuming you did nothing wrong)

as a hospitalist , case management and social work does most of this for you. you just write your clinical notes and sign face to face sheets.
as a PCP, you will need to have this staff to do similar things for you.

as a subspecialist, case management and hospitalist helps you for inpatients. You just recommend what is needed and communicate.
as an outpatient, this will vary. If I need Nucala or Tezspire for asthma, I have to run a PA (my staff knows how to go to the online portals and upload my note). My staff also has to three way call with patients to call specialty pharmacy because I have very nonfunctional patients who refuse to do anything him/herself. if I need radiology, my staff does the online PA portal for CTs etc... you need staff to help you or else you will be burdened to no end if you did it yourself.
Cardiologists tell me they do a visit and EKG or EKG stress test on day 1, then have to get PA for everything such as the echo, the nuke, the holter, the carotid etc...
Oncologists have to get auth and order the chemo and immunotherapy.
etc...

but my take is as a subspecialist, doing this extra admin stuff is "meaningful." As PCP, trying to get "something the patient wants but doesn't need" is just mind numbing and soul draining.

 

[Prehealth1011]

Thanks

I'm a resident at the moment. By "administrative work" I basically refer to work that isnt using one's medical brain of taking hx, forming differentials and managing patients based on one's medical knowledge. So yea, prior auths disability paperwork discharge summaries etc
I have a feeling working with these kinds of things day in and day out will suck the joy out of my job real fast, so I'm wondering where theres the least of this...

Pulm crit?

 

[gutonc]

Thanks

I'm a resident at the moment. By "administrative work" I basically refer to work that isnt using one's medical brain of taking hx, forming differentials and managing patients based on one's medical knowledge. So yea, prior auths disability paperwork discharge summaries etc
I have a feeling working with these kinds of things day in and day out will suck the joy out of my job real fast, so I'm wondering where theres the least of this...

I'm an oncologist and maybe spend 10-15 min a week on that stuff, including P2P calls. For literally everything else, if there's actual paperwork to be completed, I put the patient's name and DOB on the top if it's not already there, sign/date the bottom and hand it off to people who aren't paid $275/hr.

 

[dozitgetchahi]

I'm an oncologist and maybe spend 10-15 min a week on that stuff, including P2P calls. For literally everything else, if there's actual paperwork to be completed, I put the patient's name and DOB on the top if it's not already there, sign/date the bottom and hand it off to people who aren't paid $275/hr.

Exactly.

As a PP rheumatologist, I see the patients, write the notes, and do my portion of the in basket stuff. Everything else is handled by staff.

OP: GME really sucks for this stuff. I did a ton of paperwork and actual “scut work” while training (in rheum fellowship they actually made us schedule patient appointments, chase down patients who missed their appointments, harass the schedulers into actually doing their jobs and scheduling imaging and other studies, schedule each infusion personally etc etc) - so much of that stuff was just a total waste of time, and not educational. In the real world, most of this stuff has been handled by staff - it varies a bit from place to place as to how good they are, but at least at my current job I can hire as many as I need.

 

[nawrp11]

Thanks guys!

 

[NewYorkDoctors]

ironically nephrology has relatively little paperwork.
besides your physician progress notes, most other paperwork is all automatically done by case management at the hospitals or HD centers.
for any procedures (IR or vascular surgery), you just refer to the respectively to deal with the PAs for those procedures.

HD , CRRT, and plasmapheresis orders are in the EMR these days.

For ESA agents for on HD patients it is part of the ESRD Bundle in the HD center.

For ESA agents in CKD patients, that's a PA and coordinating with specialty pharmacy.
Since nephrology does not do any in office procedures, there are no PA burdens in the office.

if you're at a super academic center and you control the infusion center, you might have to work with the specialty pharmacy to get PA and all those things

in the community you can can just order and refer to an infusion center (besides the hospital ones there are also independent chemo infusion centers and transfusion centers you can send an order to with your clinical notes and they will take care of the buy and bill)

nephrology usuallyj ust orders CXR, KUB, and renal bladder U/S- none of which needs PA
occassionally you might order a CT Urogram for hematuria workup. but those PAs are easy enough and instant approval based on hematuria alone.
anything more complex like a lasix renal nuclear medicine scan .... defer to urology as outpatient to deal with.

renal biopsies do not usually need PAs and can be scheduled asap. again in the community just refer to IR to deal with those paperworks.


so yeah... do nephrology (lol) if you want less paperwork

 

[collegestud2013]

Hey guys,
Which subspeciality has the least amount of administrative work? Or is this something pervasive in the whole IM/medicine universe?

Likely any subspecialty hospitalist position at a hospital where they're not the primary admitting service (ie they are consulting, and the patients are admitted under a IM/FM hospitalists). For example, there are a share of ID, cardiology, neurology, nephrology hospitalist jobs with no outpatient responsibilities. They only write consult and progress notes and defer anything non-urgent to their outpatient colleagues. This is probably the best you can get to doing the most actual high-level decision making, unless you do a specialty with no direct patient contact like radiology or pathology. IM/FM hospitalist will have a bit more since they are usually the primary admitting service but most of it is handled by a case manager or social worker. There's an occasional insurance P2P to be done, or transfer form to be signed, but the amount is usually still less than outpatient.

Just about any outpatient specialty, whether it is general IM or a subspecialty, will have their share of paperwork like prior auths, P2Ps, disability, and answering patient portal messages. As others have mentioned, it a well staffed clinic, most of it can be handled by ancillary staff by some still requiring the physician to get involved.