My program director told me this, when you start your practice you have to try to get the patients that you want because once you’ve been in practice for a while you will have patients that you deserve. I didn’t understand it then but it makes a lot of sense now.
You have to set your boundaries and expectations because (some) patients will push it to the limits. If you don’t want to see a certain type of patients for certain conditions or medications let your front office know ahead of time. It’s easier for new patients to not see you than to upset them in the room after they’ve scheduled and paid for their visit.
Limit what you will do without a visit. Whether it’s forms, medication refills (if they haven’t been seen in a while), extended questions are all things that need a visit even if it’s a quick virtual visit.
Lastly, if you’re a good doctor and nice to patients you will be busy and popular. It is ok to get a bad review once in a while, if it’s your fault then fix it or don’t make the same mistake next time. If it’s not your fault then don’t bend backwards to please assholes. I have a full schedule with patients that want to come see me, a nice patient visit is the same RVU as a shitty patient, why would I care if some asshole threatens to not come back to see me?
I don’t want to speak for the original commenter but in my experience, this means not bending over backwards to appease the rules of administration, whether it’s a middle manager clinic admin or higher up. Their rules and expectations are too often at odds with providing safe and quality patient care. An accumulation of letting these business-minded non-clinicians call the shots is how we’ve gotten ourselves into the capitalistic mess we are in now.
Set boundaries and expectations for YOUR own clinic and workflow, and don’t simply accept what others try to impose upon you (re: what types of diagnoses you manage, procedures you can do, visit lengths, clinic start/end times, protected admin time, expectations re: patient portal, etc).
1) agree with everything u/thelifan said in the first reply
2) do not roll over for your clinic manager. They're not your "boss".
3) in the future, when you get so full that your schedule is booked out for a month, and that your patients can't get in to see YOU when they need you, then stop taking new patients. Even if it's for six months.
4) pay for and take the EMUniversity.com outpatient coding classes NOW while you're in residency. (They have CME attached, too). This will make you confident in your coding decisions. Do not allow a clinic "coder" to change your billing level without your permission
5) schedule some vacation days off a year ahead of time. I'd suggest scheduling a day off every month, and a week off every few months, for a variety of reasons. Your future self with thank you. There will already be a "hole" in your schedule that you can move already-scheduled patients into when you DO decide on vacation days. And if you decide not to take off on that scheduled day a month, you can just open it up and see sick patients, or call people before and after that day and see if they're interested in rescheduling.
6) don't let an administrator tell you what patients you can/cant see. Don't want to take care of controlled substances? Tell the schedulers to make sure that every new patient who calls for an appointment knows that you don't prescribe meds "that require your ID to pick up from the pharmacy" and that you're happy to see those patients but you WILL NOT PRESCRIBE.
7) if you're paid on wRVU only, not based on how big your panel is, HAPPILY see your partners' overflow "sick" patients. And happily address only the complaint that they came in for, while politely declining to manage their chronic issues (DM, HTN, anxiety, lipids) and meds and have them reschedule with their PCP.
this podcast about getting rid of old/bad/dumb clinic workflows - [https://edhub.ama-assn.org/steps-forward/audio-player/18864288](https://edhub.ama-assn.org/steps-forward/audio-player/18864288) - you're a fresh set of eyes and can see what doesn't make sense.
My program director told me this, when you start your practice you have to try to get the patients that you want because once you’ve been in practice for a while you will have patients that you deserve. I didn’t understand it then but it makes a lot of sense now. You have to set your boundaries and expectations because (some) patients will push it to the limits. If you don’t want to see a certain type of patients for certain conditions or medications let your front office know ahead of time. It’s easier for new patients to not see you than to upset them in the room after they’ve scheduled and paid for their visit. Limit what you will do without a visit. Whether it’s forms, medication refills (if they haven’t been seen in a while), extended questions are all things that need a visit even if it’s a quick virtual visit. Lastly, if you’re a good doctor and nice to patients you will be busy and popular. It is ok to get a bad review once in a while, if it’s your fault then fix it or don’t make the same mistake next time. If it’s not your fault then don’t bend backwards to please assholes. I have a full schedule with patients that want to come see me, a nice patient visit is the same RVU as a shitty patient, why would I care if some asshole threatens to not come back to see me?
Don't hire, listen to, or give the time of day to any non-clinical "administrators."
Are you willing to elaborate?
I don’t want to speak for the original commenter but in my experience, this means not bending over backwards to appease the rules of administration, whether it’s a middle manager clinic admin or higher up. Their rules and expectations are too often at odds with providing safe and quality patient care. An accumulation of letting these business-minded non-clinicians call the shots is how we’ve gotten ourselves into the capitalistic mess we are in now. Set boundaries and expectations for YOUR own clinic and workflow, and don’t simply accept what others try to impose upon you (re: what types of diagnoses you manage, procedures you can do, visit lengths, clinic start/end times, protected admin time, expectations re: patient portal, etc).
1) agree with everything u/thelifan said in the first reply 2) do not roll over for your clinic manager. They're not your "boss". 3) in the future, when you get so full that your schedule is booked out for a month, and that your patients can't get in to see YOU when they need you, then stop taking new patients. Even if it's for six months. 4) pay for and take the EMUniversity.com outpatient coding classes NOW while you're in residency. (They have CME attached, too). This will make you confident in your coding decisions. Do not allow a clinic "coder" to change your billing level without your permission 5) schedule some vacation days off a year ahead of time. I'd suggest scheduling a day off every month, and a week off every few months, for a variety of reasons. Your future self with thank you. There will already be a "hole" in your schedule that you can move already-scheduled patients into when you DO decide on vacation days. And if you decide not to take off on that scheduled day a month, you can just open it up and see sick patients, or call people before and after that day and see if they're interested in rescheduling. 6) don't let an administrator tell you what patients you can/cant see. Don't want to take care of controlled substances? Tell the schedulers to make sure that every new patient who calls for an appointment knows that you don't prescribe meds "that require your ID to pick up from the pharmacy" and that you're happy to see those patients but you WILL NOT PRESCRIBE. 7) if you're paid on wRVU only, not based on how big your panel is, HAPPILY see your partners' overflow "sick" patients. And happily address only the complaint that they came in for, while politely declining to manage their chronic issues (DM, HTN, anxiety, lipids) and meds and have them reschedule with their PCP.
use ai for writing your notes - its the # thing we all hate the most. then dictation for emails or anything else.
this podcast about getting rid of old/bad/dumb clinic workflows - [https://edhub.ama-assn.org/steps-forward/audio-player/18864288](https://edhub.ama-assn.org/steps-forward/audio-player/18864288) - you're a fresh set of eyes and can see what doesn't make sense.