Employed position rvu model

[liquidshadow22]

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What is the standard %of collections from rvu model that a psychiatrist could be offered in an outpatient employed practice? Lookin at jobs offering 55% of collections currently. Any thoughts?

 

[downwithDTB]

What is the standard %of collections from rvu model that a psychiatrist could be offered in an outpatient employed practice? Lookin at jobs offering 55% of collections currently. Any thoughts?

How can you be an RVU model and paid on collections? RVU means a flat rate per RVU whereas % collections = based on the actual contracts and money that comes in.

I have never heard of an super snotty academic institution in a big city offering a mere 55/45 split of collections. 60/40 is the worst I've ever heard and can imagine.

 

[liquidshadow22]

How can you be an RVU model and paid on collections? RVU means a flat rate per RVU whereas % collections = based on the actual contracts and money that comes in.

I have never heard of an super snotty academic institution in a big city offering a mere 55/45 split of collections. 60/40 is the worst I've ever heard and can imagine.

Thanks for the reply. They must have meant that I take home 60% of whatever I generate. Pts that are seen are Medicare, medicaid, and private insurance

 

[clausewitz2]

Thanks for the reply. They must have meant that I take home 60% of whatever I generate. Pts that are seen are Medicare, medicaid, and private insurance

No, if they are saying 55% of collections they mean you get 55% of what they get paid for your work. Push back on this, and if they won't budge, realize you are getting hosed if you take this job.

70/30 is much more typical in this neck of the woods and 80/20 is not unprecedented.

 

[liquidshadow22]

So you are saying that "55% rvu collection" means that they are likely paying me a lower rvu rate in comparison to what they actually collect from their insurance contracts and then taking are taking an additional 45% of what is generated for their overhead.

I just don't really know the lingo and what this phrase means exactly

 

[liquidshadow22]

I was told that if I am seeing pts full time I shoild make about 250 to 300k in their model. 30 min new, 15 min fu

 

[NickNaylor]

So you are saying that "55% rvu collection" means that they are likely paying me a lower rvu rate in comparison to what they actually collect from their insurance contracts and then taking are taking an additional 45% of what is generated for their overhead.

I just don't really know the lingo and what this phrase means exactly

Say an insurer pays your employer $100 for a certain type of visit (let's say a standard, new patient assessment). Under a collection-based arrangement, you will be paid whatever percentage of the money that is collected. In the example you provided, this means you would received $55 of that $100 while your employer would pocket the other $45.

In an RVU-based model, your productivity is divorced in a sense from the actual amont that is collected - you are simply paid a set amount per RVU that you generate, and your employer worries about the collections.

 

[liquidshadow22]

Thanks. Is it odd that a private outpatient clinic is using an rvu model instead of % collections?

 

[clausewitz2]

Thanks. Is it odd that a private outpatient clinic is using an rvu model instead of % collections?

You should probably ask them exactly what they mean because "% rvu collections" doesn't make a lot of sense. You can honestly say you are not familiar with this kind of phrasing and could they kindly clarify if it is a percentage based on the dollar amount collectes or a flat rate per rvu?

 

[Sushirolls]

wRVUs and % collections do not pair together. Never heard of it before, nor can I stretch my mind around it.

$55 per wRVU, okay, I could see them trying to offer that.

30min new, 15min follow up really is the part you should focus on. RUN. RUN AWAY FAST. Not a good job, do not look further, do not pass go, find something else. This is their way of saying they do not value you at all, and you are nothing more then a meat grinder and they just don't care about the quality of services you will deliver. RUN AWAY.

 

[clausewitz2]

wRVUs and % collections do not pair together. Never heard of it before, nor can I stretch my mind around it.

$55 per wRVU, okay, I could see them trying to offer that.

30min new, 15min follow up really is the part you should focus on. RUN. RUN AWAY FAST. Not a good job, do not look further, do not pass go, find something else. This is their way of saying they do not value you at all, and you are nothing more then a meat grinder and they just don't care about the quality of services you will deliver. RUN AWAY.

Oh, man, how did I miss the appointment times part? Maybe people who trained in South Asia and were routinely expected to see 50 people a day or whatever would be comfortable with this but there is no six figure sum you could pay me to take a job like that.

 

[calvnandhobbs68]

wRVUs and % collections do not pair together. Never heard of it before, nor can I stretch my mind around it.

$55 per wRVU, okay, I could see them trying to offer that.

30min new, 15min follow up really is the part you should focus on. RUN. RUN AWAY FAST. Not a good job, do not look further, do not pass go, find something else. This is their way of saying they do not value you at all, and you are nothing more then a meat grinder and they just don't care about the quality of services you will deliver. RUN AWAY.

yeah wtf if you actually burned through 30min new intakes you’ll be collecting twice as much as that 250-300 they said you’ll be making. People get salaried in that range with 60min new/30min followup.

Patients that you can truly do 15min f/u on can probably be seen by primary care...

 

[Mass Effect]

30 min new, 15 min fu

This alone would make me turn down the job, but to each his own. IMO, this is pretty bad.

 

[Sushirolls]

Oh, man, how did I miss the appointment times part? Maybe people who trained in South Asia and were routinely expected to see 50 people a day or whatever would be comfortable with this but there is no six figure sum you could pay me to take a job like that.

Higher volume clinics with shorter appointment durations could be doable in the US if we didn't have to document certain metrics for insurance/billing, or for liability/lawyers. If I only needed to document for myself clinically, my notes we be just as short as what I've observed in another country.

 

[clausewitz2]

Higher volume clinics with shorter appointment durations could be doable in the US if we didn't have to document certain metrics for insurance/billing, or for liability/lawyers. If I only needed to document for myself clinically, my notes we be just as short as what I've observed in another country.

I actually think documentation is pretty much irrelevant to my desire to have more than 30 minutes for a new eval. I do not know how you could even pretend to be thorough doing that.

 

[psychapp121]

Higher volume clinics with shorter appointment durations could be doable in the US if we didn't have to document certain metrics for insurance/billing, or for liability/lawyers. If I only needed to document for myself clinically, my notes we be just as short as what I've observed in another country.

lawsuits are so rare and are paid by insurance not you so over the long term is not a reason to document well

 

[Sushirolls]

I actually think documentation is pretty much irrelevant to my desire to have more than 30 minutes for a new eval. I do not know how you could even pretend to be thorough doing that.

Yeah 30 Minutes is still too limited, but in general, I could shave off some time from my usual 90 min.

 

[Sushirolls]

lawsuits are so rare and are paid by insurance not you so over the long term is not a reason to document well

Taking that approach could then open up the issue of under documenting to the point where more concerning things like negligence gets tossed out there and then the insurance company opts to not defend you because you fell outside their scope of coverage.

 

[psychapp121]

Taking that approach could then open up the issue of under documenting to the point where more concerning things like negligence gets tossed out there and then the insurance company opts to not defend you because you fell outside their scope of coverage.

it’s a fine line but under documenting is probably cost effective in the long run..but obv not good clinical care

 

[Mass Effect]

Higher volume clinics with shorter appointment durations could be doable in the US if we didn't have to document certain metrics for insurance/billing, or for liability/lawyers. If I only needed to document for myself clinically, my notes we be just as short as what I've observed in another country.

Nah, high volume/short appt clinics are and always will be pill mills, in my book. Even the ones not prescribing controlled substances are practicing bad medicine and it has very little to do with documentation, imo.

 

[psychapp121]

Taking that approach could then open up the issue of under documenting to the point where more concerning things like negligence gets tossed out there and then the insurance company opts to not defend you because you fell outside their scope of coverage.

Is it actually a thing where your malpractice insurance or the hospitals insurance can choose to not defend you? Doesn’t seem legal..

 

[WisNeuro]

Is it actually a thing where your malpractice insurance or the hospitals insurance can choose to not defend you? Doesn’t seem legal..

In cases of negligence, they sure can.

 

[psychapp121]

In cases of negligence, they sure can.

what does that mean? Isn’t malpractice negligence?

 

[WisNeuro]

what does that mean? Isn’t malpractice negligence?

There's negligence, and then there's gross negligence. For example, someone can have a bad reaction to a medication that was reasonable prescribed, but the patient can still sue, because "Murrica." Or, a medication can be prescribed unreasonably, say, prescribing Xanax for anxiety and Benadryl and ambien for sleep in an 80 year old with cognitive difficulties and fall risk factors. When that person inevitably falls, or lights the house on fire due to a confusional episode, that family can also sue. In one of those cases, your legal representation has a very good argument that you are practicing outside of reasonable bounds and can conceivably try to justifiably throw you under the bus to limit their liability.

 

[dl2dp2]

Is it actually a thing where your malpractice insurance or the hospitals insurance can choose to not defend you? Doesn’t seem legal..

Depends on how the contract is written. Generally, insurance companies don't defend you if you are practicing outside of your scope, or that you commit a crime, etc. However, if there are disagreements you can always sue your insurance company and force them to defend you for breach of contract for "specific performance". It's sort of like when you buy a house with deposit and contract signed, and your seller decides to not sell, you can either give up and get your deposit back, or sue to make the transaction occur anyway--which will cost you.

In civil procedures, there's not a matter of strict "illegality". Things can always be stalled, and if you feel that a harm is done, you can initiate an action, which then has its own consequent procedure and costs associated. There's never a limit to any action as long as there's enough money to make a fuss, which is why large organizations have legal departments that handle daily actions and dispuates. OTOH, the worst that could happen financially is that you personally is to go bankrupt, and even that's very rare. In fact, it's rare for personal assets to be touched in malpractice suits.

 

[psychapp121]

There's negligence, and then there's gross negligence. For example, someone can have a bad reaction to a medication that was reasonable prescribed, but the patient can still sue, because "Murrica." Or, a medication can be prescribed unreasonably, say, prescribing Xanax for anxiety and Benadryl and ambien for sleep in an 80 year old with cognitive difficulties and fall risk factors. When that person inevitably falls, or lights the house on fire due to a confusional episode, that family can also sue. In one of those cases, your legal representation has a very good argument that you are practicing outside of reasonable bounds and can conceivably try to justifiably throw you under the bus to limit their liability.

that Is very dumb..because they could argue anything is gross negligence and always try to get out of it..what if I had to prescribe those things because nothing else worked..medicine is nuanced unless it’s like obviously a crime or something crazy they shouldn’t be able to get out of it otherwise why tf am I paying for malpractice insurance

 

[WisNeuro]

that Is very dumb..because they could argue anything is gross negligence and always try to get out of it..what if I had to prescribe those things because nothing else worked..medicine is nuanced unless it’s like obviously a crime or something crazy they shouldn’t be able to get out of it otherwise why tf am I paying for malpractice insurance

If you prescribe that kind of regimen, to that kind if patient, you deserve to be thrown under the bus. Malpractice should not function to shield the truly incompetent. It exists to protect against the more frivolous stuff

 

[downwithDTB]

that Is very dumb..because they could argue anything is gross negligence and always try to get out of it..what if I had to prescribe those things because nothing else worked..medicine is nuanced unless it’s like obviously a crime or something crazy they shouldn’t be able to get out of it otherwise why tf am I paying for malpractice insurance

You can argue that anything is anything. That's why we have judges. Physicians are very very rarely successfully sued for gross negligence, "a conscious, voluntary act or omission in reckless disregard of a legal duty and of the consequences to another party."

I'd love to see some actual cases where a physician was sued for doing something that they could find someone else who does it (i.e. not z drug is 80s, but propofol at home), they kept medical records with a dx (insomnia) and plan (Rx) and successfully dissavowed by the insurance company.

Correct me if I'm wrong, but not representing you would actually be a massive risk for the insurance company: if the claim of gross negligence is unfounded but negligence is founded, they would not be absolved of their liability for your actions. If the alleged action is completely, obviously very, very bad (sex with psychotic patient) and there is zero chance of just regular negligence, maybe they would run...

Out of curiosity, if an insurance company refused to defend you, and you settled to your policy max with both parties agreeing negligence, I imagine the insurance company would have a heck of a time getting out of paying out, can anyone confirm this?

 

[dl2dp2]

Out of curiosity, if an insurance company refused to defend you, and you settled to your policy max with both parties agreeing negligence, I imagine the insurance company would have a heck of a time getting out of paying out, can anyone confirm this?

This is very rare for several reasons: 1) medmal is relatively competitive with lots of players so they want happy customers. 2) customers are typically institutions, and believe you me if megacorp hospital WILL pursue breach of contract and specific performance if they feel that their bottomline is infringed upon, especially as megacorp hospital is typically named in such lawsuits from plaintiff. This sets the tone for this business such that medmal insurance companies rarely drop clients.

 

[nexus73]

If you prescribe that kind of regimen, to that kind if patient, you deserve to be thrown under the bus. Malpractice should not function to shield the truly incompetent. It exists to protect against the more frivolous stuff

I think the problem is the definition of incompetent practice or frivolous lawsuits is not absolute. You may disagree with ambien in an 80 year old, but there may be rare cases where it is reasonable to try. (Maybe I'm misreading and you're saying Xanax AND benadryl AND ambien, and not just one of these three...but even so...there again may be the rare case where this combination is what finally gets an 80 year old patient with dementia stable enough to go home...though I'd agree it's not first line).

 

[WisNeuro]

I think the problem is the definition of incompetent practice or frivolous lawsuits is not absolute. You may disagree with ambien in an 80 year old, but there may be rare cases where it is reasonable to try. (Maybe I'm misreading and you're saying Xanax AND benadryl AND ambien, and not just one of these three...but even so...there again may be the rare case where this combination is what finally gets an 80 year old patient with dementia stable enough to go home...though I'd agree it's not first line).

Unfortunately, that was not a hypothetical case. Xanax was for mild anxiety, of which the family and patient denied significant anxiety on clinical interview, as for the sleeping issue, pt has a short period of having trouble falling asleep, but with napping, was sleeping about 18 hours a day. Moderate dementia before the regimen, had sustained several falls, one with hospitalization following the addition of these meds. I am not kind to prescribers in such situations, and clearly outline the inappropriateness of that med regimen in the situation, with appropriate literature.

I will agree that there are likely weird cases where a questionable regimen is called for. That is the exception, not the rule. Usually it's simply lazy and/or incompetent prescribers who are not asking the right, or any question prior to making decisions.

 

[Mass Effect]

I have a problem with non-prescribers outlining inappropriateness of certain medications given by prescribers. Maybe that's just me.

As for the above regimen, I wasn't there and while it does sound questionable, patients also lie all the time. What was conveyed as "mild anxiety" to you could very well have been debilitating anxiety to a prescriber. Sleeping 18 hours could have been conveyed as going 3 days without sleep, triggering destabilization in a patient with dementia. Just because the patient says so after the fact doesn't mean that's what happened.

 

[clausewitz2]

I have a problem with non-prescribers outlining inappropriateness of certain medications given by prescribers. Maybe that's just me.

As for the above regimen, I wasn't there and while it does sound questionable, patients also lie all the time. What was conveyed as "mild anxiety" to you could very well have been debilitating anxiety to a prescriber. Sleeping 18 hours could have been conveyed as going 3 days without sleep, triggering destabilization in a patient with dementia. Just because the patient says so after the fact doesn't mean that's what happened.

Especially after bad stuff already happened to Grandma/Gramps! Is it more likely after liberal application of the retrospectoscope that they are going to say
A) things were so bad before those meds, we were desperate, they did what they could but unfortunately our relief came at the cost of our loved one's health

B)That f*king quack did this for no reason, it's not our fault.

Because we rotate in so many different settings in my program I frequently get to hear people recount things I supposedly told them without them realizing I was the one who told them that. So rarely is there a tight mapping between what was said (and documented!) at the time and their later recall.

 

[WisNeuro]

I have a problem with non-prescribers outlining inappropriateness of certain medications given by prescribers. Maybe that's just me.

As for the above regimen, I wasn't there and while it does sound questionable, patients also lie all the time. What was conveyed as "mild anxiety" to you could very well have been debilitating anxiety to a prescriber. Sleeping 18 hours could have been conveyed as going 3 days without sleep, triggering destabilization in a patient with dementia. Just because the patient says so after the fact doesn't mean that's what happened.

We all deal with insecurities in our own way I guess 🙂

As for the patient example, corroborated by several family members as well as consistent with the EMR documentation. Justify with whatever fantasy you want, this is not an uncommon example.

 

[Mass Effect]

We all deal with insecurities in our own way I guess 🙂

Please, spare me. Ugh.

 

[WisNeuro]

Please, spare me. Ugh.

👍

 

[clausewitz2]

We all deal with insecurities in our own way I guess 🙂

As for the patient example, corroborated by several family members as well as consistent with the EMR documentation. Justify with whatever fantasy you want, this is not an uncommon example.

I am willing to accept plenty of people get inappropriate benzos and anticholinergics and psychiatrists prescribe them but the idea that psychiatrists are apparently chasing down people who don't complain of any meaningful anxiety to shove benzo prescriptions in their hands is more of a fantasy.

 

[WisNeuro]

I am willing to accept plenty of people get inappropriate benzos and anticholinergics and psychiatrists prescribe them but the idea that psychiatrists are apparently chasing down people who don't complain of any meaningful anxiety to shove benzo prescriptions in their hands is more of a fantasy.

Hyperbolic language aside, I think we all know that maintenance benzos are given out pretty freely, and for pretty minor things. We all know who the candy men/women are in our organizations and communities.

 

[clausewitz2]

Hyperbolic language aside, I think we all know that maintenance benzos are given out pretty freely, and for pretty minor things. We all know who the candy men/women are in our organizations and communities.

There are pill mills and benzo/stimulant factories for sure, no one is denying that. But the practice environment and culture surrounding me (and probably a lot of posters here) is pretty well converted to pharmacological Calvinism and prescribing new maintenance benzos is heresy. I think dogmatic refusal to use these molecules is a mistake but is waaaaaay more the norm. A lot of others posting here seem to have had the same experience. This makes me think there are two likely major possibilities:

1) your geographic area is a bastion of benzo dead-enders whose valium can only be wrenched from their cold dead hands

2) your clinical population is heavily enriched for people on inappropriate substances seriously impacting their cognition and function

Personally I think #2 is most likely but we have had that argument before. A schematic:

Us: "maybe the people you see aren't typical of general adult psychiatry outpatients because 99% of our patients have never even spoken to a neuropsychologist."

You: "Nah"

This seems like a prima facie true statement, honestly, and I have no idea why you think it's not plausible. I am willing to be persuaded.

 

[WisNeuro]

The several geographic areas I have trained and worked in, along with the variety of clinics that I have served make #1 and #2 very unlikely. I'm just curious as to why you find this unlikely given the state of prescribing in this country. There is a ton of research out there about the increase in prescribing within this class. Granted, primary care has shown the largest increase, but it's sizable all around, relatively speaking. Willfully ignore it if you want, doesn't change the facts of the situation.

 

[clausewitz2]

The several geographic areas I have trained and worked in, along with the variety of clinics that I have served make #1 and #2 very unlikely. I'm just curious as to why you find this unlikely given the state of prescribing in this country. There is a ton of research out there about the increase in prescribing within this class. Granted, primary care has shown the largest increase, but it's sizable all around, relatively speaking. Willfully ignore it if you want, doesn't change the facts of the situation.

Do you have any names of papers or links to this research with prescribers broken down by specialty that tracks whether the person writing it initiated the script v. continuing them?

I get you have been in two different areas, but we have psychiatrists from all over the US here, many of whom have worked in at least two different geographic areas, and we are all pretty much always in agreement that the sentiment has turned solidly against benzos. No offense, but I think the anecdotal experience of at least a dozen people actually seeing unselected adult psychiatric outpatients for their job for years trumps the anecdotes of one person who is psychiatry adjacent and works in a role in which you are dramatically more likely to encounter people on medications that might have noticeable negative cognitive impacts.

You have never really addressed that point beyond "nuh-uh", but I would be very interested to know how your referral process works, as you have asserted that you are not likely to be referred people based on concerns about cognitive functioning. Since that's how it works around here, I would love to hear how it works in your neck of the woods.

So no, I don't know that maintenance benzos are common because in my city psychiatrists who are willing to start benzos on anything other than a one-off basis are kind of an endangered species.

 

[clausewitz2]

We all deal with insecurities in our own way I guess 🙂

As for the patient example, corroborated by several family members as well as consistent with the EMR documentation. Justify with whatever fantasy you want, this is not an uncommon example.

I propose this: if you want to talk about the insecurities of some psychiatrists as the reason we don't accept what you're asserting, we get to talk about the narcissistic injury and seething resentment of some psychologists towards people who they realistically have 15 IQ points on and who think maybe 1/3 as much about each patient but still get paid twice as much and to whom in many contexts they will be professionally subordinate to forever.

Or maybe just stick to the content of arguments instead of tying our conversants to psychopathology? Yes, let's do that.

 

[downwithDTB]

This conversation derailed... the point that you could be abandoned by your malpractice ins if you're likely to be successfully sued for gross negligence was offered with a clear example of stupid medicine. Moral of the story:
1) document at least the minimum amount legally required by your state
2) don't Rx controlled substances to people who clearly shouldn't have them
3) don't do something really stupid like give propofol at home, sleep with your patient or tell your patient with a fever and mouth sores who started lamictal two weeks ago to follow up in two weeks.

If you follow 1-3, you're gonna be defended.

 

[calvnandhobbs68]

Hyperbolic language aside, I think we all know that maintenance benzos are given out pretty freely, and for pretty minor things. We all know who the candy men/women are in our organizations and communities.

PCPs are far and away the largest prescribers of benzos (along with all psychiatric drugs in general). At least when someone goes to see psychiatry they’re getting more than a 10 minute “I’m anxious”-> “K here’s 60 Klonopin”.

yeah there’s inappropriate prescribing by psychiatrists but if you’re looking for the most bang for your buck, PCPs are it.

Since the original point was that this would be an example case that a malpractice insurers would decline to represent you...I would disagree with that as did others above. the case above isn’t even really a good case. As was mentioned before, you could feasibly give some reasoning for each of those medications. They probably aren’t great reasons but they on the surface have some logic. But there have been physicians who have done straight up criminal acts who were still represented by malpractice carriers for the malpractice section of their case.

 

[clausewitz2]

PCPs are far and away the largest prescribers of benzos (along with all psychiatric drugs in general). At least when someone goes to see psychiatry they’re getting more than a 10 minute “I’m anxious”-> “K here’s 60 Klonopin”.

yeah there’s inappropriate prescribing by psychiatrists but if you’re looking for the most bang for your buck, PCPs are it.

And the PCP starts getting cold feet when the dose gets out of control and sends them to a psychiatrist, who very reasonably does not want to begin their therapeutic relationship by yanking away the one thing this person perceives as the only thing holding them together and allowing them any quality of life.

It doesn't matter if they're wrong, that's not what you lead with.

 

[WisNeuro]

I propose this: if you want to talk about the insecurities of some psychiatrists as the reason we don't accept what you're asserting, we get to talk about the narcissistic injury and seething resentment of some psychologists towards people who they realistically have 15 IQ points on and who think maybe 1/3 as much about each patient but still get paid twice as much and to whom in many contexts they will be professionally subordinate to forever.

Or maybe just stick to the content of arguments instead of tying our conversants to psychopathology? Yes, let's do that.

Ohh, testy, a little more ad hominy than you usually go for, kind of disappointed in you there. I appreciate you proving my earlier point, though.

 

[psychapp121]

Ohh, testy, a little more ad hominy than you usually go for, kind of disappointed in you there. I appreciate you proving my earlier point, though.

Im not sure why you’re still arguing when you have a variety of academic and community psychiatrists telling you that the above medication regimen does not necessarily constitute malpractice and certainly doesn’t constitute gross negligence..but you’re still arguing when you’re not even a psychiatrist I don’t understand

 

[clausewitz2]

Ohh, testy, a little more ad hominy than you usually go for, kind of disappointed in you there. I appreciate you proving my earlier point, though.

Dude. You are the guy who made the conversation about asserting we are just compensating for our insecurities. You don't get to pretend you are the purely rational Vulcan in this situation when you do that.

I note you still haven't responded to any substantive questions or points in response, in this thread or any of the others in which you have made the same assertions. I have to assume it's because you have no answer apart from vague insinuations.

Cue "you can assume whatever you want" non-response in 5...4...3...

 

[WisNeuro]

Dude. You are the guy who made the conversation about asserting we are just compensating for our insecurities. You don't get to pretend you are the purely rational Vulcan in this situation when you do that.

I note you still haven't responded to any substantive questions or points in response, in this thread or any of the others in which you have made the same assertions. I have to assume it's because you have no answer apart from vague insinuations.

Cue "you can assume whatever you want" non-response in 5...4...3...

Live long and prosper man. But seriously, if you want to have a good faith discussion about benzo prescribing, I'm here. We can start a journal club on the subject, plenty out there.

 

[clausewitz2]

Live long and prosper man. But seriously, if you want to have a good faith discussion about benzo prescribing, I'm here. We can start a journal club on the subject, plenty out there.

I would love to see some of the studies you mention about prescribing patterns, in all seriousness. Lay it on me, I read fast.

Perhaps you can also accept the overwhelming evidence that physicians trained in the last decade have all had repeated exposure to things like the Beers Criteria, as evidenced by medical school and residency curriculums nationwide?