Advice For new primary care attending

[guitarguy23]

Hi all,

Recently finished my IM residency and have taken a 100% outpatient IM position with a good group. Does anyone have any general advice they wish they knew when starting their first post residency job? Mainly ways of getting efficient and comfortable with billing etc. My job is the standard salary based followed by productivity model. Kind of nervous so any advice would be great! Thanks.

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[Sushirolls]

Learn the business side of things as much as possible, billing, CPT codes, reimbursement, what all the staff in office are doing, etc. So in ~2 years if you realize you are completely unhappy, you can go open your private practice.

 

[jdh71]

I would leave this page open on my web browser

It's one of the free pages you can find over at E/M university, after a few months you'll basically have the coding levels down for what you did for the visit and then you'll be that much faster not only at figuring out your bill but also at coming up with the amount of documentation you *actually* need for the visit to get where you can maximally get (appropriately). Sometimes remembering in that you only need to add in the labs that you looked at anyway will be enough to bump you up a level will make putting together the note that much quicker. The same for if you clearly aren't going to hit a level four or even a three based on what you have available to you, you can quickly knock out the note and move the eff on or maybe get a cup of coffee. Sometimes a quick level three in the middle of an otherwise busy day is nice and if you can recognize it quick, you can then make use of that time.

 

[gutonc]

Knowing when to cut your losses and just bill a 99213 is huge. I can legitimately bill 99214+ for >80% of my patients. I will easily take the 0.5 wRVU hit for 10% or so of those just to be able to put them to bed and move on.

I don't think you should ever (or at least, very rarely) be billing <99213.

If you're well trained in outpatient procedures, and have the support for it, get as many of those as you (legitimately) can.

 

[jdh71]

Knowing when to cut your losses and just bill a 99213 is huge. I can legitimately bill 99214+ for >80% of my patients. I will easily take the 0.5 wRVU hit for 10% or so of those just to be able to put them to bed and move on.

I don't think you should ever (or at least, very rarely) be billing <99213.

If you're well trained in outpatient procedures, and have the support for it, get as many of those as you (legitimately) can.

Sometimes I'm like, "Oh you had a cough and it's gone now, and there is no other issue?? Come back to see me PRN." Yes. Short note time, 99212, go get coffee.

 

[gutonc]

Sometimes I'm like, "Oh you had a cough and it's gone now, and there is no other issue?? Come back to see me PRN." Yes. Short note time, 99212, go get coffee.

Yeah...but if you listen to heart lungs and have them open their mouth, you've got enough of an exam for a 99213.

Just sayin'.

 

[jdh71]

Yeah...but if you listen to heart lungs and have them open their mouth, you've got enough of an exam for a 99213.

Just sayin'.

But then I have to listen to their heart and lungs and have them open their mouth . . .

 

[guitarguy23]

Lol “attending problems”

 

[guitarguy23]

But then I have to listen to their heart and lungs and have them open their mouth . . .

Lol “attending problems”

 

[FrustratedFamDoc]

Establishing boundaries and expectations up front with patients. " I can help with you with x,y,z but you can do more to help yourself than I ever can." Don't go down the rabbit hole of trying to solve their social issues. It's a never ending hole and you really won't like where it goes.

 

[DrSnips]

But then I have to listen to their heart and lungs and have them open their mouth . . .

Or you could notice from across the room that there is no JVD and that there is normal chest wall excursion during breathing and that they appear to have good dentition when they were speaking. Only need one exam finding for each system, no one ever said it had to involve touching the patient.

 

[jdh71]

Or you could notice from across the room that there is no JVD and that there is normal chest wall excursion during breathing and that they appear to have good dentition when they were speaking. Only need one exam finding for each system, no one ever said it had to involve touching the patient.

Ok

 

[sdoctor7]

What is the pay difference between primary care IM track vs categorical IM track after residency is completed ?

 

[gutonc]

What is the pay difference between primary care IM track vs categorical IM track after residency is completed ?

There should be no difference for the same job at the same place.

 

[UnderservedPC]

Sounds like you are considering primary care track/programs vs categorical. My advice would be to focus more on what each individual track or program offers in terms of the skills and training you would need to perform well when you become an attending. I know that sounds obvious, but not all primary care tracks/programs are created equal. Some just give you more outpatient time without much additional dedicated primary care teaching. I would suggest looking for programs that teach you broad based skills like interview techniques, musculoskeletal, dermatology, chronic disease management, population health, etc. Some categorical programs may have this but it would be less likely. If you leave Residency feeling confident and knowing that you are a well prepared primary care clinician, you will easily find the job you love that pays well. I am a primary care program grad and everything I do clinically is built upon that strong foundation I got in residency.

Hope that helps, happy to answer any other questions you may have.