IPR Rounding, Weekends

[RangerBob]

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We've had recent variants of this topic recently, but I'd like to hear how you all handle weekends.

Our unit is going to be expanding soon. As of right now we don't have enough staff to cover weekday rounding when we expand, let alone weekend rounding. And we're a difficult to recruit area (it is a desirable place to live, but high COL and not many jobs for working spouses). Right now PM&R rounds daily/near daily, including weekends. Admits are 7d/week, generally during business hours. 24hr hospitalist coverage.

Do you round on all patients on weekends, or just ones who need attention (plus obviously see new admits within 24hrs)?

A doc I worked with prior had a gig I was jealous of--14 bed unit (ADC 13-14, which I think is a great balance of not too busy/not too boring and decent income). He covered M-F 8-5, IM provided after-hours call plus weekend call/admits--by which I mean remote orders and generally only saw patients if a rapid/code was called. They'd also put in basic orders for admits, but wouldn't see them. Weekend admits came Sunday, so the physiatrist could do H&P within 24hrs. The hospital also paid for a locums to cover about 4-6w vacation/year for him. Seemed like a good gig to me.

 

[Dansk2011]

At our hospital, when on for the weekend, we just do admits and see people that need to be seen. But can see everyone if we choose. We have hospitalist available if needed but we take all calls at least initially. Unit is within an acute hospital.

Sounds like a good gig. What happens if they can't find a locums for the time he wants off...say like the holidays?

 

[RangerBob]

At our hospital, when on for the weekend, we just do admits and see people that need to be seen. But can see everyone if we choose. We have hospitalist available if needed but we take all calls at least initially. Unit is within an acute hospital.

Sounds like a good gig. What happens if they can't find a locums for the time he wants off...say like the holidays?

Thanks for sharing your setup .

Well, this was years ago, but I believe it was all in his contract. As of the time I rotated there, the hospital had a reliable locums who could consistently cover for him and he had the days off (including Christmas) that he wanted. I can't be sure that setup is still working as flawlessly as it had been for the preceding years as I'm not in touch with the doc anymore.

 

[piviti]

We take turns doing weekends 1:3. Our main responsibility is seeing admits and a few patients who need attention. We do have internal medicine in house occasionally. We’ve been trying to get more internal medicine coverage over the weekend but it’s been tough.

Are you guys hiring?

 

[RangerBob]

We take turns doing weekends 1:3. Our main responsibility is seeing admits and a few patients who need attention. We do have internal medicine in house occasionally. We’ve been trying to get more internal medicine coverage over the weekend but it’s been tough.

Are you guys hiring?

We had to fight a long time to get IM coverage.

At some point yes we'll be recruiting more docs. But we're not yet at that phase. PM me in about six months or so though if you want to move!

 

[piviti]

Depends on where in California haha…near SF or LA or somewhere in between?

Also, does anyone hire mid levels to help with admissions and seeing patients who need attention? I know another physiatrist who hired a PA to help on the weekends and manages to see every patient.

On that note, what’s to prevent a physiatrist from hiring an internal medicine doctor or mid level to see their patient with them? It sounds like it wouldn’t be allowed but I don’t know if it’s explicitly stated somewhere.

 

[RangerBob]

Depends on where in California haha…near SF or LA or somewhere in between?

Also, does anyone hire mid levels to help with admissions and seeing patients who need attention? I know another physiatrist who hired a PA to help on the weekends and manages to see every patient.

On that note, what’s to prevent a physiatrist from hiring an internal medicine doctor or mid level to see their patient with them? It sounds like it wouldn’t be allowed but I don’t know if it’s explicitly stated somewhere.

I try to stay relatively anonymous here, so all I'll say is it's not the Central Valley. If you'd really like to know send me a PM

I guess don't know how helpful a midlevel would really be for an admission. If I recall the H&P has to be done by a physician. I could be wrong though. Still, I can prep and see a patient pretty efficiently, so I'm not sure what I'd gain from a midlevel who I have to staff the pt with. If they write the note then I still need to review it. Often it's just easier to do something myself...

Same for hiring the NP/PA to see patients with me on the weekend. I'm not really sure what I'm gaining. It seems like the main benefit would be if they see patients in lieu of me seeing the pt--unless after seeing the patient the PA/NP feels they need to be seen by a physician. I could see the merits of that.

As for hiring an internal medicine doc--there's a huge benefit. As a sole proprietor I wouldn't hire them (I would just consult them), but if you're the head of a group you could hire them and consult them on every patient for co-management (legal disclaimer--you may need to look into Stark laws and verify you actually can hire a physician you plan to consult on every patient). But in theory if you're hiring a doc, you're paying them less than they make you, so you'd make some profit there and the IM doc would save you a lot of time/hassle and provide better patient care.

Regardless, inpatient rehab patients usually have decent insurance coverage, so particularly in saturated areas it's often not hard to find internists who are willing to do consults/coverage for your patients for collections only

An NP or PA supervised by an IM doc could provide that same benefit with regards to patient care. But if they're an IM-PA/NP and billing as such, they need to be supervised by an IM physician, not PM&R.

 

[piviti]

I try to stay relatively anonymous here, so all I'll say is it's not the Central Valley. If you'd really like to know send me a PM

I guess don't know how helpful a midlevel would really be for an admission. If I recall the H&P has to be done by a physician. I could be wrong though. Still, I can prep and see a patient pretty efficiently, so I'm not sure what I'd gain from a midlevel who I have to staff the pt with. If they write the note then I still need to review it. Often it's just easier to do something myself...

Same for hiring the NP/PA to see patients with me on the weekend. I'm not really sure what I'm gaining. It seems like the main benefit would be if they see patients in lieu of me seeing the pt--unless after seeing the patient the PA/NP feels they need to be seen by a physician. I could see the merits of that.

As for hiring an internal medicine doc--there's a huge benefit. As a sole proprietor I wouldn't hire them (I would just consult them), but if you're the head of a group you could hire them and consult them on every patient for co-management (legal disclaimer--you may need to look into Stark laws and verify you actually can hire a physician you plan to consult on every patient). But in theory if you're hiring a doc, you're paying them less than they make you, so you'd make some profit there and the IM doc would save you a lot of time/hassle and provide better patient care.

Regardless, inpatient rehab patients usually have decent insurance coverage, so particularly in saturated areas it's often not hard to find internists who are willing to do consults/coverage for your patients for collections only

An NP or PA supervised by an IM doc could provide that same benefit with regards to patient care. But if they're an IM-PA/NP and billing as such, they need to be supervised by an IM physician, not PM&R.

Yeah, the attending I worked with did the H&Ps on the weekend but had help with orders, floor calls, and seeing follow ups on the weekend. I don’t think he would staff every patient.

I also looked into the Stark laws - looks like you can’t hire an IM doctor because that would be self referral.

Surprisingly we’ve had trouble getting IM coverage even though being in between two major cities.

 

[Momentum70]

ive worked at 2 large places and at both we took turns on weekends. We would admit all days but only round on the ones that were medically unstable. We sign out to each other which patients we actually need to see. Usually saturdays are worse than sundays as those unstable ones are typically more stable sunday and I can usually skip a few of them.

 

[lejeunesage]

When I work weekends, I see all the patients. But I don't have to. My colleagues don't always.

 

[Iamnew2]

When I work weekends, I see all the patients. But I don't have to. My colleagues don't always.

Same here. Except in rare occasions, I see all patients but we don't have to. Colleagues - some see all some don't.