Melissa Young, MD

My apologies for not blogging last week. I forgot all about it, to be honest. I was preoccupied. I was getting ready for my new associate to start.

We were able to learn most of what we needed to know before - it just wasn’t a pleasant learning experience. And after meeting with the new person, I have come up with the following dos and don’ts for any EMR trainer.

On a brighter note, I have found two motivated people to add to the staff (three if you count my new associate - I can’t wait until she starts!). I have a new medical assistant and a new part-time front-office person. They have both had their EMR training, and they didn’t leave screaming.

Was there a way to document the quit versus fire conversation? I typed up a description of the event as I recall it, but as she said, it's her word against mine. Should I lawyer up?

Some payers are now requiring that non-radiologists get certified or accredited to perform ultrasounds. Otherwise, guess what - they won’t pay.

Remember that old childhood rhyme? How much wood could a woodchuck chuck if a woodchuck could chuck wood? Well, here’s a new one. How many patients can a doc squeeze in if a doc could squeeze them in?

Wasn’t it about a month ago that I was carrying on about howI felt disrespected? Wasn’t it just a week or two ago that I said that life is good and that I shouldn’t complain? And now here I am with this week’s list of things that just plain irked me.

Ah, I remember the days when you could see a patient, write a brief note, write a prescription or order a test without having to undergo the third degree. Now, you need to write down the minutiae of what you do, make sure the proper ICD-9 codes are on every request, and be prepared to explain that yes, darn it, this med and that test are “medically necessary.”

I know I’ve used this blog to vent, to rant, to carry on. I’ve been accused to thinking I’m the center of the universe. And even though I am... :), I realize that life is good, and that the choices I have made have been sound ones.

It hasn’t even been a year. I can’t even really say my schedule is overwhelming. After all, I made it. But the day in, day out demands of solo private practice are starting to get to me.

I look forward to having a colleague in the office. And with the barrage of requests we get for new patient appointments, I’m sure my staff and those patients look forward to it too.

What ever happened to manners? To courtesy? Why do patients feel that our time is unimportant? That we should just sit there and take it when they yell? That they can call you at 11 p.m. to ask for a prescription? That they can not pay their share of their bill?

A couple of years ago, there was a survey of medical residents (or was it surgical residents?), 17 percent of whom admitted to laughing at or making fun of patients behind their backs. The other 83 percent are liars.

One of the reasons I wanted to go into solo practice was the independence. The ability to make the decisions, to call the shots, to make the policies. In short, to be the boss. Of course, with power comes responsibility.

While I still love the mental challenges of navigating the endocrine system, I have to admit there are many days that I ask myself why I do what I do. Between the non-medical part of medicine - the patients who think they are sick but aren’t, the prior auths, the record audits, the denial of payments, the phone calls, the faxes, and so on - there’s barely any time to be a “real” doctor.

I don’t expect primary-care physicians and other subspecialists to know all the nuances of diagnosing and treating endocrine disorders. After all, that’s my job, right? But quite frequently, I am puzzled, and sometimes appalled, by what patients tell me their doctors did or said.

It’s hard enough to see the people who are scheduled to be seen. What do you do with the unexpected patient?

A large imposing-looking man flashed his badge at me. Oh great. This can’t be good. He said he had papers for Dr. Young. Yes, unfortunately, that’s me. What was I supposed to do? He handed me the papers with the big word “SUBPOENA” on it. It made me very nervous. Uh-oh. Did I do something? Is someone suing me? Am I in trouble for that shiny stone my 5-year-old stuck in her pocket in a gift shop two years ago?

A large imposing-looking man flashed his badge at me. Oh great. This can’t be good. He said he had papers for Dr. Young. Yes, unfortunately, that’s me. What was I supposed to do? He handed me the papers with the big word “SUBPOENA” on it. It made me very nervous. Uh-oh. Did I do something? Is someone suing me? Am I in trouble for that shiny stone my 5-year-old stuck in her pocket in a gift shop two years ago?

I have a confession to make. I used to smoke. It does help me to relate to patients who have a hard time quitting, and I can honestly tell them that I do know how hard it is to quit.

My most precious resource of time is of limited quantity. And I can’t blame the pseudo-patients when apparently physicians don’t know when it is appropriate to refer either.

I think I tolerate a lot, but verbal abuse is not something I allow in my office. Would you have done the same?

I have recently realized that when patients Google me, the link to the blog pops up first. And apparently, my patients like reading it. It gives them insight as to who I am beyond the exam room.

I shouldn’t complain. Venturing out on my own has not been the financial disaster my former senior partner predicted despite the often miserable reimbursements. I have a steady stream of patients and the schedule is reasonably busy. After six months of practice, the current wait for a new patient is six weeks. For the coveted late afternoon slots, it’s about two months.

When patients call, it’s the voices of my administrative assistant and my medical assistant they hear first (ok, technically, they hear mine first because I’m on the phone message, but you know what I’m saying). The tone they set when they answer the phone, and the attitude they project is a reflection of the practice, and, in essence, of me.

As an endocrinologist, I do fingerstick blood glucose readings in the office. I use the same glucometer a patient might use at home, courtesy of one of the companies that leaves me sample meters and strips. I charge for the service, and am paid anywhere from nothing to about $10. Not a substantial amount, won’t change my bank account by much, and I’d probably do it even if wasn’t reimbursed since it takes a couple of seconds and it doesn’t cost me anything.

Hba1c machines are fairly easy to use, they don’t take up a lot of staff or physician time, and allegedly they are decently reimbursed by most albeit not all payers. The machine is free, but the consumables are not. So after expenses, net reimbursement is about $5.

A couple of weeks ago, a patient from my prior practice said that she Googled me to find my new location. She said that in addition to finding my new address, she also found my practice address, and an article about me that had been written while I was at my old office.

In previous posts, I wrote about my journey towards finding an EMR. I did lots of research. I read multiple articles online and in print. I looked at the surveys. I asked the experts. I had demos, online and live. I did site visits. And eventually, I made my choice.

When I ventured off on my own, and submitted my change of address and change of TIN to the insurance companies, I did so without really knowing what my contracted rates were and without knowing whether they would or had changed. Probably unwise on my part. But at the time, my only concern was being credentialed and getting paid something. Anything.