Is it legal to stop doing FMLA?

[FrustratedFamDoc]

Title says it all. I’m tired.

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[cj_cregg]

It may be legal, but it would also be a significant disservice to your patients who need it. How are you doing FMLA currently? Can you change your policy to make it less burdensome? e.g. require a 30 min office visit to complete the paperwork so you can charge for your time, and ensure you are not doing this stuff after hours?

 

[VA Hopeful Dr]

I almost never do them. I typically punt to the specialist in the area that is causing the need to miss that much work.

Otherwise, the above advice is the way to do it. Also, make the patient fill out everything they possibly can before the visit.

 

[5150man]

Agree. I have the patient fill out the majority. If they need more than a signature from me then they come in and I basically write what they tell me. I don’t spend much thought or effort on them.

 

[I_Cant_tell_you]

I just have them come in for a visit. If it's for "back pain" I document the back pain visit in my note and fill out the paperwork during the visit. If they need me to fill out extra stuff I have them come in. I never fill it out without a visit.

 

[Sardonix]

I am increasingly leaning toward dedicated visit for paperwork. Have a 1-2 pages that is completely filled out just needs my review and signature? I can add that on or do it after they drop it off.

Basically untouched requiring +5min of me standing there writing in BS or multiple spots for the patient to call back complaining they need a revision? Sounds like a service that I should be paid for.

That said, I am happy to do FMLA paperwork. But when they think they can just dump it on me as the 5th chief complaint as I exit the room my patience and likelihood of doing it go out the window.

 

[Ironheme]

I am increasingly leaning toward dedicated visit for paperwork. Have a 1-2 pages that is completely filled out just needs my review and signature? I can add that on or do it after they drop it off.

Basically untouched requiring +5min of me standing there writing in BS or multiple spots for the patient to call back complaining they need a revision? Sounds like a service that I should be paid for.

That said, I am happy to do FMLA paperwork. But when they think they can just dump it on me as the 5th chief complaint as I exit the room my patience and likelihood of doing it go out the window.

Agree with this.

Had a patient recently that wanted to drop off 'FMLA' paperwork - I said need visit. Came without paperwork, dropped it off later - okay, fine I can bite since visit had been done - but this added on time after work hours. 2 weeks later, requests another form - this time short term disability.

Sent him for disability eval at that point.

I think the disconnect is that patients think 'oh it's just a form that the doc can fill out in a couple minutes, no big deal' when for us we usually don't get dedicated time for this. I'm usually scrambling with it in between patients, during lunch - which I treat as a nice 'break,' when in reality is uninterrupted time for paperwork/charting/admin tasks.

Lol @ '5th chief complaint.' One of my least favorite things is if I've done all the work pre-charting and speed through 3 CC, and I think 'yes! finished early, so I can close the chart early/more time for charting' then patient thinks 'well great we have extra time to talk about my other chest pain, rectal bleeding, etc CC. Or when the acute visits, who know they only have 10 minutes with you say as you're leaving 'oh by the way, I had a few more questions about [unrelated CC].'

 

[Sardonix]

Agree with this.

Had a patient recently that wanted to drop off 'FMLA' paperwork - I said need visit. Came without paperwork, dropped it off later - okay, fine I can bite since visit had been done - but this added on time after work hours. 2 weeks later, requests another form - this time short term disability.

Sent him for disability eval at that point.

I think the disconnect is that patients think 'oh it's just a form that the doc can fill out in a couple minutes, no big deal' when for us we usually don't get dedicated time for this. I'm usually scrambling with it in between patients, during lunch - which I treat as a nice 'break,' when in reality is uninterrupted time for paperwork/charting/admin tasks.

Lol @ '5th chief complaint.' One of my least favorite things is if I've done all the work pre-charting and speed through 3 CC, and I think 'yes! finished early, so I can close the chart early/more time for charting' then patient thinks 'well great we have extra time to talk about my other chest pain, rectal bleeding, etc CC. Or when the acute visits, who know they only have 10 minutes with you say as you're leaving 'oh by the way, I had a few more questions about [unrelated CC].'

Also "No big deal just 1-2 min paperwork" adds up after so many patients requesting it.

Likewise, greatly enjoy the patient who comes in for a specific issue that you precharted for (don't ask me why I do this, sometimes precharting is indeed useful). Say the appt is specifically about BP med change. But they instantly demand we talk about something else for the entire appointment. Fine. Great, it's your party.

Without fail upon getting ready to leave: "But what about my BP med?"

 

[shaggybill]

This is good stuff. I've been working in physical therapy and rehab clinic and I get FMLA/short term disability paperwork requests multiple times per week. What information are you guys telling the patient to fill out beforehand? A lot of it is clinical, and most of the rest is determining how long they need to be out of work. 90% of my patients would take advantage of that and write themselves out 3 months for a back strain.

 

[Ironheme]

This is good stuff. I've been working in physical therapy and rehab clinic and I get FMLA/short term disability paperwork requests multiple times per week. What information are you guys telling the patient to fill out beforehand? A lot of it is clinical, and most of the rest is determining how long they need to be out of work. 90% of my patients would take advantage of that and write themselves out 3 months for a back strain.

I don't usually have this problem with FMLA - it protects their job, not their wage. Most of my patients that ask for this want to get back to work asap so they can earn $.

The disability is a different story. That one I will send over to OT to assess their lifting/standing/etc.

I remember one case I had a parent bring in their 16 year old and wanted long term disability. When I asked why - they told me that their child had leg pain when standing while working at McDonald's by the end of the day........ So they felt their child could not do any job that required anything more than minimal physical activity. (Child's BMI was > 99% for their age).

 

[5150man]

This is good stuff. I've been working in physical therapy and rehab clinic and I get FMLA/short term disability paperwork requests multiple times per week. What information are you guys telling the patient to fill out beforehand? A lot of it is clinical, and most of the rest is determining how long they need to be out of work. 90% of my patients would take advantage of that and write themselves out 3 months for a back strain.

I don't usually have this problem with FMLA - it protects their job, not their wage. Most of my patients that ask for this want to get back to work asap so they can earn $.

The disability is a different story. That one I will send over to OT to assess their lifting/standing/etc.

I remember one case I had a parent bring in their 16 year old and wanted long term disability. When I asked why - they told me that their child had leg pain when standing while working at McDonald's by the end of the day........ So they felt their child could not do any job that required anything more than minimal physical activity. (Child's BMI was > 99% for their age).

Agree. FMLA is: what is their problem? How long has it been going on? Are they pregnant? When did you see them? What tests have been done? What dates did they miss? Continuous block or intermittent time?
The patient fills all that out and I sign it. If the employer wants to push paperwork on me because they don’t want to deal with their crappy employee who misses 2 weeks every month for diarrhea/anxiety/runny nose/etc then I’ll send worthless paperwork right back at them. I’m not wasting my time putting thought into their paperwork.

If you’re talking disability then that’s a whole nother level of pain. I’ll try to push them off to a disability specialist unless I actually think they are disabled.

 

[HemeOncHopeful19]

I don't usually have this problem with FMLA - it protects their job, not their wage. Most of my patients that ask for this want to get back to work asap so they can earn $.

The disability is a different story. That one I will send over to OT to assess their lifting/standing/etc.

Many states are implementing paid FMLA - not nearly the majority but I do think it’s inevitable.

 

[shaggybill]

I don't usually have this problem with FMLA - it protects their job, not their wage. Most of my patients that ask for this want to get back to work asap so they can earn $.

Working in a PT and Rehab clinic, I see a lot of personal injury cases. I'm pretty sure their lawsuits attempt to recover any lost wages due to being out of work secondary to their "physical and emotional injuries and pain." A decently high number of these cases like to milk the system. Fortunately, there are enough of those who do actually want to return to work and be productive members of society to make me not lose my mind.

I try not to judge, but man it's hard not to sometimes with some of these requests and obviously fake complaints.

 

[Itachi87]

They're a drag to fill out. At my new job we have a dedicated staff member that helps us fill out these FMLA paperwork so it makes it more tolerable.

 

[goldsummer]

I don't usually have this problem with FMLA - it protects their job, not their wage. Most of my patients that ask for this want to get back to work asap so they can earn $.

The disability is a different story. That one I will send over to OT to assess their lifting/standing/etc.

I remember one case I had a parent bring in their 16 year old and wanted long term disability. When I asked why - they told me that their child had leg pain when standing while working at McDonald's by the end of the day........ So they felt their child could not do any job that required anything more than minimal physical activity. (Child's BMI was > 99% for their age).

Wow...
My fav disability request was a healthy 30 yr old female who wanted disability cause she felt tired. Long story short, I just handed the papers back to her and said you dont qualify for disability. This made her mad and she left before the MA Discharged her. I thought i wouldnt see her again, but she has been back to see me multiple times. and no mention of feeling tired.

 

[Marcus Brody]

I have a copy made and the patient fills out one copy, I transfer what I deem appropriate/accurate (names of other providers they've seen, hospitalization dates, etc) to the other copy. Maybe I'm paranoid but I don't like patients' handwriting on their own disability forms.

I asked chatGPT about refusing FMLA/disability forms or charging for them a few months ago and it said it would be iffy legally. I semi-jokingly asked if I could charge $1000/page for any paperwork whatsoever at my solo practice.

The determination of which types/sources of paperwork are legally mandatory for a patient's primary care physician to complete can vary by state and specific legal requirements. However, some common examples of legally mandatory paperwork that primary care physicians may be required to complete include medical record requests for other providers, disability forms, and workers' compensation forms.

Other paperwork sources, such as school or camp physical forms, may not be legally mandatory for a patient's primary care physician to complete but may be requested by patients or their families for convenience or insurance purposes.

It may be legally permissible to charge a fee for completing non-mandatory paperwork sources, but the fee should be reasonable and proportional to the amount of work required to complete the paperwork. Charging an exorbitant fee for paperwork completion could potentially be considered price gouging or an unfair business practice, which could lead to legal or reputational consequences for the physician.

Bottom line seems to be, if they're your patient, unless you can push it off on a specialist (unfair professionally imo), you're stuck with it.

 

[geauxg8rs]

Agree with this.

Had a patient recently that wanted to drop off 'FMLA' paperwork - I said need visit. Came without paperwork, dropped it off later - okay, fine I can bite since visit had been done - but this added on time after work hours. 2 weeks later, requests another form - this time short term disability.

Sent him for disability eval at that point.

I think the disconnect is that patients think 'oh it's just a form that the doc can fill out in a couple minutes, no big deal' when for us we usually don't get dedicated time for this. I'm usually scrambling with it in between patients, during lunch - which I treat as a nice 'break,' when in reality is uninterrupted time for paperwork/charting/admin tasks.

Lol @ '5th chief complaint.' One of my least favorite things is if I've done all the work pre-charting and speed through 3 CC, and I think 'yes! finished early, so I can close the chart early/more time for charting' then patient thinks 'well great we have extra time to talk about my other chest pain, rectal bleeding, etc CC. Or when the acute visits, who know they only have 10 minutes with you say as you're leaving 'oh by the way, I had a few more questions about [unrelated CC].'

Patients think it is a form that docs “must” fill out. Fixed it for you.

Like all we do all day is full out their forms and sit on the phone for peer to peers. Which patients also think we must do. It is actually a favor to do either

 

[Lee Ik-jun MD]

These kind of paper work is why everyone is Burnt out in primary care. I still sign them but I make it a visit and discuss it with the patient on why he's using FMLA

 

[VA Hopeful Dr]

These kind of paper work is why everyone is Burnt out in primary care. I still sign them but I make it a visit and discuss it with the patient on why he's using FMLA

Bingo. FMLA paperwork bothers me way less if I'm getting paid for it.

 

[VenusinFurs]

Idk about legal but like if you are a doctor because you want to help people stay healthy, job loss due to a temporary disability likely will have health consequences for the patient. I think setting boundaries that a dedicated visit is needed, charging a nominal fee if allowed, setting expectations for timeline to completion are all appropriate, but to just refuse to do it is in my mind kind of antithetical to what family doctors are supposed to do? In residency they teach us all this fuzzy doo doo about the biopsychosocial model and caring for the whole patient, we have family in our speciality name, we are kind of supposed to care about our patients lives.

 

[Homo sapien]

Idk about legal but like if you are a doctor because you want to help people stay healthy, job loss due to a temporary disability likely will have health consequences for the patient. I think setting boundaries that a dedicated visit is needed, charging a nominal fee if allowed, setting expectations for timeline to completion are all appropriate, but to just refuse to do it is in my mind kind of antithetical to what family doctors are supposed to do? In residency they teach us all this fuzzy doo doo about the biopsychosocial model and caring for the whole patient, we have family in our speciality name, we are kind of supposed to care about our patients lives.

Who cares about doctors' lives

 

[VenusinFurs]

Who cares about doctors' lives

Yeah so apply some basic empathy here. Yes, as a doctor you are given many challenges that others may not have. But imagine if you got very sick and needed time off or had some other reason such as maternity to need fmla and the doctor you saw refused to do fmla paperwork for you. You at least have job security built in by having that medical degree and license. You have willingly chosen those additional challenges, there are other options for your life you can take. Do you really think you are valued less than a migrant laborer or a fast food employee? I’m not saying doctors aren’t dehumanized and devalued, I’m saying everyone is and as doctors we actually sort of have a lot of advantages and opportunities others don’t have. It’s important to keep a sense of perspective when you are miserable at work, and if work is untenable for you it’s important to set boundaries. But don’t take it out on the patient.

 

[HemeOncHopeful19]

Yeah so apply some basic empathy here. Yes, as a doctor you are given many challenges that others may not have. But imagine if you got very sick and needed time off or had some other reason such as maternity to need fmla and the doctor you saw refused to do fmla paperwork for you. You at least have job security built in by having that medical degree and license. You have willingly chosen those additional challenges, there are other options for your life you can take. Do you really think you are valued less than a migrant laborer or a fast food employee? I’m not saying doctors aren’t dehumanized and devalued, I’m saying everyone is and as doctors we actually sort of have a lot of advantages and opportunities others don’t have. It’s important to keep a sense of perspective when you are miserable at work, and if work is untenable for you it’s important to set boundaries. But don’t take it out on the patient.

Patient should be able to submit their own records for FMLA.

Why does the doctor need to fill out separate paperwork in addition to their already documented visits for their HR department? We don’t work for our patient’s employers. Should we able to bill their HR dept for our time?

 

[VA Hopeful Dr]

Patient should be able to submit their own records for FMLA.

Why does the doctor need to fill out separate paperwork in addition to their already documented visits for their HR department? We don’t work for our patient’s employers. Should we able to bill their HR dept for our time?

Why are you filling it out anyway? This is one of the things we have MAs/Nurses for. I sign it, put in a return to work date, then they do literally everything else.

 

[VenusinFurs]

Patient should be able to submit their own records for FMLA.

Why does the doctor need to fill out separate paperwork in addition to their already documented visits for their HR department? We don’t work for our patient’s employers. Should we able to bill their HR dept for our time?

The patient note is full of information HR doesn’t need to know and generally does not address the actual matter HR is concerned with, the length of absence. Unless you put how long you expect the patient to be out in your notes, which I typically don’t, but it does not change the fact the patient has a right to privacy and FMLA is a federal act meaning the forms used are standard and full of redundancy and there’s no getting around that. You can try to lobby congress and see if they can change the process. Good luck with that.

 

[dozitgetchahi]

Patient should be able to submit their own records for FMLA.

Why does the doctor need to fill out separate paperwork in addition to their already documented visits for their HR department? We don’t work for our patient’s employers. Should we able to bill their HR dept for our time?

Look, the big thing is that I think doctors should basically be able to send their notes *only* and have that count for FMLA. And the questions they ask are stupid. How many days do you think the pt will need off in the next year? Who the hell knows? Is this disease expected to flare? Hopefully not, if we’re controlling it? “Is the disease pregnancy?” Since when is pregnancy a disease? And on and on.

 

[HemeOncHopeful19]

Look, the big thing is that I think doctors should basically be able to send their notes *only* and have that count for FMLA. And the questions they ask are stupid. How many days do you think the pt will need off in the next year? Who the hell knows? Is this disease expected to flare? Hopefully not, if we’re controlling it? “Is the disease pregnancy?” Since when is pregnancy a disease? And on and on.

Yep and then you always get back questions from the HR department who can’t even understand what the FMLA form says (not the part I wrote, but the pre-printed FMLA form part) for “clarification”

 

[Ironheme]

Why are you filling it out anyway? This is one of the things we have MAs/Nurses for. I sign it, put in a return to work date, then they do literally everything else.

Think I need to steal your nurses.......

 

[finalpsychyear]

100 bucks a pop makes it tolerable. Everyone pays yearly for it and it works well for me to not ever do uncompensated work.

 

[Eysteve228]

Think I need to steal your nurses.......

They are spot on though. At least where I'm working which is a hospital employed gig, averaging about 30 patients a day my expectation is anything like fmla, disability etc is handled by staff with use of my documentation of the visit to guide them and nothing more than a signature from me. If this wasn't the case I'd either avoid FMLA/disability forms in 99% of circumstances (per OP, legal, at least in the state I practice) or if corporate expected it of me I'd seek employment elsewhere rather quickly. As you mentioned earlier though it is generally to protect their job rather than wages and the system is bogus. Outside of the ridiculous requests and outliers, for most it is a beneficial service we can provide for their livelihood albeit it's ridiculous bureaucratic nonsense akin to prior auths.

Private practice is of course a different story and certainly agree with those who charge for it.

 

[DOswag]

They are spot on though. At least where I'm working which is a hospital employed gig, averaging about 30 patients a day my expectation is anything like fmla, disability etc is handled by staff with use of my documentation of the visit to guide them and nothing more than a signature from me. If this wasn't the case I'd either avoid FMLA/disability forms in 99% of circumstances (per OP, legal, at least in the state I practice) or if corporate expected it of me I'd seek employment elsewhere rather quickly. As you mentioned earlier though it is generally to protect their job rather than wages and the system is bogus. Outside of the ridiculous requests and outliers, for most it is a beneficial service we can provide for their livelihood albeit it's ridiculous bureaucratic nonsense akin to prior auths.

Private practice is of course a different story and certainly agree with those who charge for it.

Im an outpatient psychiatrist and I get FMLA requests quite frequently as well. We have staff do like 99% of it based off my documentation. Every once in a while they'll just ask me how I want something phrased but for the most part, the patient fills out whatever they are supposed to, our staff fills out the rest, I review quick and sign. If I didn't have admin staff to do this it'd be much more of a burden.

 

[brianmartin]

Simple, require a visit to fill it out. If it's a valid request it will only take 5-10 minutes to interview and sign. Never take on burdensome paperwork in your off time just because you think you "should".