Relevancy of PM News

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HardRoadPaved said:
Just think this OP took the time out of their day to take a history, a photo then figure out how to send it to Barry Block. Then await a response then call the patient to tell them what they found out...
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This is 100% what’s wrong with this profession. Demonstrate your stupidity online instead of : 1) looking up the answer online, 2) referring to someone with an IQ > 80.
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NatCh said:
DEFINITELY needs a Lapiplasty and orthotics...
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See, this is why you aren’t making the BIG bucks. It’s obvious this patient needs laser ( for cash ) and needs some of those vitamins you should be selling at your front counter that cures everything. I would also make sure to perform vascular testing to make sure it’s not a vascular issue and sell them a UV shoe sanitizer which can be used for hands also! And if the patient is older, they also need some Mooron balance braces.

You’re obviously a slacker.
 
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ExperiencedDPM said:
See, this is why you aren’t making the BIG bucks. It’s obvious this patient needs laser ( for cash ) and needs some of those vitamins you should be selling at your front counter that cures everything. I would also make sure to perform vascular testing to make sure it’s not a vascular issue and sell them a UV shoe sanitizer which can be used for hands also! And if the patient is older, they also need some Mooron balance braces.

You’re obviously a slacker.
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I shall grow a mustache!
 
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Watch out for back surgeons
 
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I thought this was an interesting poll question. Note the number of respondents. In my opinion, I spend a TON of time on charting/FMLA forms/PAs, but it's no where near 40%.
 
Adam Smasher said:
View attachment 382039
I thought this was an interesting poll question. Note the number of respondents. In my opinion, I spend a TON of time on charting/FMLA forms/PAs, but it's no where near 40%.
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Well the fact they’re still calling it paperwork tells me a good portion of those polled aren’t quite keen on technology.

New patient notes aside you shouldn’t need to spend more than 1 minute on a patient note
 
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Adam Smasher said:
View attachment 382039
I thought this was an interesting poll question. Note the number of respondents. In my opinion, I spend a TON of time on charting/FMLA forms/PAs, but it's no where near 40%.
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I think that's not far off... 40%. It comes down to whether Rx writing, reading XR, doc notes, etc are considered "seeing patients" or "paperwork."

Most of my days are 30min prep read charts, morning 3.5hrs of 75/25% pts/notes, 30min finish morning notes, take lunch, afternoon 3hrs again 75/25%, 30-60min finish afternoon notes or various catch-up after patients leave. That's 5.7hr/day pts and 3.4-3.9hr/day notes... 38-41% notes and other non-f2f time.

The parts that make "paperwork" edge a lot higher are write up surgery, pre op orders, check test results, rx refills, pt work notes and forms, emails, practice admin (ordering, meetings, forms, payroll and benefits, marketing, whatever), billing cleanups. I'm up to 45-50% non pt time (non-f2f time) on avg.

...maybe AI notes will improve it someday. We can hope.
 
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Absolutely based response. She speaks for many of us
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Adam Smasher said:
View attachment 382039
I thought this was an interesting poll question. Note the number of respondents. In my opinion, I spend a TON of time on charting/FMLA forms/PAs, but it's no where near 40%.
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It’s pretty accurate for me. Even with help, but without scribes.

We use Epic. We’re trying to template as much as we can, but still a lot of staff messages, orders, note editing, PAs and work-related forms. Workman’s comp paperwork takes a lot of time too.

I saw a recent report that doctors even spend an average of 2 hours a day on vacation working and documentation requirements were the single greatest factor in burnout and career dissatisfaction.
 
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diabeticfootdr said:
It’s pretty accurate for me. Even with help, but without scribes.

We use Epic. We’re trying to template as much as we can, but still a lot of staff messages, orders, note editing, PAs and work-related forms. Workman’s comp paperwork takes a lot of time too.

I saw a recent report that doctors even spend an average of 2 hours a day on vacation working and documentation requirements were the single greatest factor in burnout and career dissatisfaction.
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Jeez if you’re spending 2 hours a day documenting on your vacation time to find a new job.

On vacation I don’t exist.
 
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Hybrocure said:
Well the fact they’re still calling it paperwork tells me a good portion of those polled aren’t quite keen on technology.

New patient notes aside you shouldn’t need to spend more than 1 minute on a patient note
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Is this a joke? you better be documenting better than that. The lawyers will destroy you in a medi-mal case. I use a ton of templates with extensive language to protect me but I am still fine tuning each note and it takes more than 1 minute to complete.
 
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Hybrocure said:
Jeez if you’re spending 2 hours a day documenting on your vacation time to find a new job.

On vacation I don’t exist.
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How busy are you? Serious question. Every week I am behind 30-40 notes and spend my weekends catching up.

When I started my new hospital job and was doing 400 RVUs per month I would have every note done before I left the office.

At 800 RVUs per month I was doing work on the weekends but could get done after a Saturday

At 1100-1200 RVUs per month I am seriously behind. You need to document well in case you get sued. If you are doing complicated limb salvage cases or wound care you need to cover yourself.

If you are doing toenails, bunions and hammertoes then this is not overly complicated stuff and you should be breezing through these notes. Anybody doing complicated surgery or managing complicated patient day in and day out will be spending a lot more time documenting.
 
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Retrograde_Nail said:
How busy are you? Serious question. Every week I am behind 30-40 notes and spend my weekends catching up.

When I started my new hospital job and was doing 400 RVUs per month I would have every note done before I left the office.

At 800 RVUs per month I was doing work on the weekends but could get done after a Saturday

At 1100-1200 RVUs per month I am seriously behind. You need to document well in case you get sued. If you are doing complicated limb salvage cases or wound care you need to cover yourself.

If you are doing toenails, bunions and hammertoes then this is not overly complicated stuff and you should be breezing through these notes. Anybody doing complicated surgery or managing complicated patient day in and day out will be spending a lot more time documenting.
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I do basic stuff. Heel pain, foot pain, bunions, mild fractures. Follow up notes usually only differ in describing improving progress or new imaging.

I’m not as cool as you. But at the same time, I wager a lot of the PM News voter base also aren’t doing what you do. They likely fall into the toenails, bunions, hammertoes category given the results of previous polls.

No matter how busy you are during work, I just don’t understand typing notes on vacation time. Not routine days off mind you. I catch up on notes on the weekend like most of us. But if I’m taking a vacation week, I get that stuff squared away beforehand. Devoting 2 hours a day typing notes on vacation in Hawaii just sounds like a bad situation.
 
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Retrograde_Nail said:
Anybody doing complicated surgery or managing complicated patient day in and day out will be spending a lot more time documenting.
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Too bad we all get paid the same rate for a 992xx as long as you hit the bullet points.
 
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Retrograde_Nail said:
Is this a joke? you better be documenting better than that. The lawyers will destroy you in a medi-mal case. I use a ton of templates with extensive language to protect me but I am still fine tuning each note and it takes more than 1 minute to complete.
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Most routine followups are a breeze to document. I do spend more than 1 min embellishing unique findings, but not much. Nail care is a copy paste. Followup injections are templates. Boot/nightsplint are templates. Uncomplicated postops are templates.

The most tedious thing about charting is documenting the number and location of dystrophy nails/calluses on new pts. If it's a new msk complaint, there may be PE findings to document but that's not as banal for me.

Ulcer followups are a mixed bag, might look great (copy paste) might look horrendous (long note)

FMLA forms feel like an eternity to write but take only 5 min. They all only want to know the same thing, why is your pt out, when do they need to stop, when can they come back, your name, contact info, and signature. Your assistants can be trained at doing this other than the sig.

Unless you're managing gout, podiatry prescribing requires an infinitesimal time allowance.

So yeah I figured I'm at 25%/75%. Some of you are treating harder problems than I am so I understand why you are at your desk longer. Still doesn't excuse PM News respondents. Most podiatry just isn't that hard.🦞
 
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Retrograde_Nail said:
How busy are you? Serious question. Every week I am behind 30-40 notes and spend my weekends catching up.

When I started my new hospital job and was doing 400 RVUs per month I would have every note done before I left the office.

At 800 RVUs per month I was doing work on the weekends but could get done after a Saturday

At 1100-1200 RVUs per month I am seriously behind. You need to document well in case you get sued. If you are doing complicated limb salvage cases or wound care you need to cover yourself.

If you are doing toenails, bunions and hammertoes then this is not overly complicated stuff and you should be breezing through these notes. Anybody doing complicated surgery or managing complicated patient day in and day out will be spending a lot more time documenting.
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I hope they get you a PA and scribe so you can keep up with it and get to enjoy your weekend.
 
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Feeter said:
I hope they get you a PA and scribe so you can keep up with it and get to enjoy your weekend.
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I’ve requested an APP but I’m in a state where I can’t over see them so I’ll have to ask an MD to agree to it. Admin uses it as an excuse to not pay for one. It drives me crazy because I’ve already generated 1 million in charges 4 months into my 2nd year here. They can afford it.
 
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Retrograde_Nail said:
I’ve requested an APP but I’m in a state where I can’t over see them so I’ll have to ask an MD to agree to it. Admin uses it as an excuse to not pay for one. It drives me crazy because I’ve already generated 1 million in charges 4 months into my 2nd year here. They can afford it.
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That is impressive volume.

In the past I've used contribution margins and operational margin as an argument to advocate and get a scribe or APP. Someone in finance in your devision can calculate that and throw that number at management whenever you are asking for support staff. Obviously how effective you'll be with it is entirely dependent on the culture of the place you work at.
 
Hybrocure said:
...I wager a lot of the PM News voter base also aren’t doing what you do. They likely fall into the toenails, bunions, hammertoes category given the results of previous polls.

No matter how busy you are during work, I just don’t understand typing notes on vacation time. Not routine days off mind you. I catch up on notes on the weekend like most of us. But if I’m taking a vacation week, I get that stuff squared away beforehand. Devoting 2 hours a day typing notes on vacation in Hawaii just sounds like a bad situation.
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It's just hard to get away from it. It's a no-win situation to leave the office.
Even if it's paid time off or you just do forefoot, you are still doing surgery, wounds, injuries, and other stuff.
The longer you are on vaca and the more you ignore email/EMR, the further behind you get. No way around it.

Even a 4 or 5 day weekend turns into a handful of phone msgs, email msgs, a few Rx refills, PT and DME sign-offs... maybe doozies like a hospital renew application or FMLA forms, bills, employee issue, whatever.

It's less common in private office vs system docs, but 41% of PP docs ("independent") and 85% of health system-based providers stated feeling“somewhat burned out” to “extremely burned out.” That would make sense for docs that can largely control their workflow vs ones who largely cannot.

...The thing I truly don't get is how docs try to cut to part time work (esp solo or retaining owner decisions).
You still pay full time malpractice, hospital dues, rent, etc etc. The paperwork doesn't take days off.
That part-time thing makes no sense to me (maybe locums or house calls... but not clinic). You still have constant inflow of paperwork.
 
Feli said:
It's just hard to get away from it. It's a no-win situation to leave the office.
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I schedule a late start my first day back from vacation, 15-30 min delay for every day out. This way you can empty your inbox and get started with first patients later in the day. Good news: if you've been away for a week, that's one week you weren't doing the things that generate paperwork (that is, patient care), so your inbox might be a little lighter for the week ahead.
 
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Hybrocure said:
I do basic stuff. Heel pain, foot pain, bunions, mild fractures. Follow up notes usually only differ in describing improving progress or new imaging.

I’m not as cool as you. But at the same time, I wager a lot of the PM News voter base also aren’t doing what you do. They likely fall into the toenails, bunions, hammertoes category given the results of previous polls.

No matter how busy you are during work, I just don’t understand typing notes on vacation time. Not routine days off mind you. I catch up on notes on the weekend like most of us. But if I’m taking a vacation week, I get that stuff squared away beforehand. Devoting 2 hours a day typing notes on vacation in Hawaii just sounds like a bad situation.
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I don't work while on vacation either. I don't take work-related phone calls, text messages, and I don't open emails. You'll burn out and get grouchy if you do those things.
 
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Feli said:
You still pay full time malpractice,
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If anyone else is in this situation, check with your malpractice carrier for a part-time reduction. I use the Doctors Company and only need half-time coverage (50% discount).
 
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Retrograde_Nail said:
I’ve requested an APP but I’m in a state where I can’t over see them so I’ll have to ask an MD to agree to it. Admin uses it as an excuse to not pay for one. It drives me crazy because I’ve already generated 1 million in charges 4 months into my 2nd year here. They can afford it.
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Damn them. They can afford it WTH.
 
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NatCh said:
If anyone else is in this situation, check with your malpractice carrier for a part-time reduction. I use the Doctors Company and only need half-time coverage (50% discount).
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I have ahead part time through doctors company as well.
 
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8C94CD67-ABCD-45E9-8320-909D8098AB8D.jpeg


Ortho vs Taco Bell whereas we are still battling with Panda Express and Buccees
 
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Hybrocure said:
View attachment 382632

Ortho vs Taco Bell whereas we are still battling with Panda Express and Buccees
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www.medpagetoday.com

Orthopedic Surgeons on Track to Earn Less Than Taco Bell Workers

If current trends continue, patients are in big trouble
www.medpagetoday.com www.medpagetoday.com

That third order polynomial model must really think poorly of medicare.


Here is total hemi arthroplasty data- 27130
2007 Medicare Reimbursement $1,473.02
Adjusted for inflation $2,244.41

2023 Medicare Reimbursement $1,375.53

Net change: $868.88 or 38.8% drop

Avg yearly change ~2.5% or you can plug it into a 'third order polynomial model'

So by 2030 can expect payments to be worth about 44.7% of that in 2007.

So 1003.25 / 440 minute reported case time = $137 / hr

Taco bell worker has a long way to go to get there
 
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HardRoadPaved said:
www.medpagetoday.com

Orthopedic Surgeons on Track to Earn Less Than Taco Bell Workers

If current trends continue, patients are in big trouble
www.medpagetoday.com www.medpagetoday.com

That third order polynomial model must really think poorly of medicare.


Here is total hemi arthroplasty data- 27130
2007 Medicare Reimbursement $1,473.02
Adjusted for inflation $2,244.41

2023 Medicare Reimbursement $1,375.53

Net change: $868.88 or 38.8% drop

Avg yearly change ~2.5% or you can plug it into a 'third order polynomial model'

So by 2030 can expect payments to be worth about 44.7% of that in 2007.

So 1003.25 / 440 minute reported case time = $137 / hr

Taco bell worker has a long way to go to get there
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Ortho psy op infiltrating PM News confirmed
 
Ortho will be fine.

You could sometimes get the impression from this forum that surgery doesn't pay anything. Good commercial insurance can reimburse quite nicely. If I could operate 4 days a week on good commercial insurance I'd die, but my wife wouldn't have to remarry.
 
heybrother said:
Ortho will be fine.

You could sometimes get the impression from this forum that surgery doesn't pay anything. Good commercial insurance can reimburse quite nicely. If I could operate 4 days a week on good commercial insurance I'd die, but my wife wouldn't have to remarry.
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How many podiatrists are at ortho jobs getting funneled high paying insurances though? A lot of podiatry ortho jobs are dealing with Medicare and Medicaid
 
We may be talking about separate things here. I'm not in an ortho group. No one funnels me cases. But I didn't do anything to get my best surgical contract. My practice, my IPA, and another IPA have the exact same rates. Its the most common commercial insurance in the state.
 
HardRoadPaved said:
www.medpagetoday.com

Orthopedic Surgeons on Track to Earn Less Than Taco Bell Workers

If current trends continue, patients are in big trouble
www.medpagetoday.com www.medpagetoday.com

That third order polynomial model must really think poorly of medicare.


Here is total hemi arthroplasty data- 27130
2007 Medicare Reimbursement $1,473.02
Adjusted for inflation $2,244.41

2023 Medicare Reimbursement $1,375.53

Net change: $868.88 or 38.8% drop

Avg yearly change ~2.5% or you can plug it into a 'third order polynomial model'

So by 2030 can expect payments to be worth about 44.7% of that in 2007.

So 1003.25 / 440 minute reported case time = $137 / hr

Taco bell worker has a long way to go to get there
Click to expand...

The AAOS is so dramatic. You’d think a majority of orthopedic surgeons were women…

There will never be a point in time where an orthopedic surgeons “hourly” compensation for a joint replacement is less than what anyone at Taco Bell makes. They had to play around with the numbers heavily just to try to make the claim that their compensation is in line with what nurses and dentists make.
 
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Let’s get back to PM News basics. The genius Elliot Udell discusses pickle ball injuries and recommends warming up before and after you play. How do you warm up after you play? He said it’s important so you don’t TWIST a muscle. WTF is a twisted muscle?

Idiots.
 
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ExperiencedDPM said:
Let’s get back to PM News basics. The genius Elliot Udell discusses pickle ball injuries and recommends warming up before and after you play. How do you warm up after you play? He said it’s important so you don’t TWIST a muscle. WTF is a twisted muscle?

Idiots.
Click to expand...
Muscle twists only happen in pickle ball.
 
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ExperiencedDPM said:
Let’s get back to PM News basics. The genius Elliot Udell discusses pickle ball injuries and recommends warming up before and after you play. How do you warm up after you play? He said it’s important so you don’t TWIST a muscle. WTF is a twisted muscle?

Idiots.
Click to expand...
I believe Dr. Richie beat you to it on this one 😅
 
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I still like how when I google PM News the first result is always a Nigerian news outlet
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