r/FamilyMedicine • u/MrPBH MD • 14d ago
Absolutely based. Don't work for free.
/r/HealthInsurance/comments/1mr7o69/full_office_visit_copay_charged_for_mychart/53
u/Piffy_Biffy MD-PGY1 14d ago
My gut reaction here was that the doc should have just said schedule an appointment or go to ED if an emergency etc etc - but there might have been some clinic policies on that.
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u/Vegetable_Block9793 MD 14d ago
Doc did everything right and completed an e-visit and charged correct code for 5-10 mins of time. Patients insurance just sucks.
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u/John-on-gliding MD (verified) 14d ago
Yup. The doctor answered a question. I’m sure the patient clicked through some waiver explaining if they send a question they could be charged.
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u/Galactic-Equilibrium MD 14d ago
Correction. Patient just sucks. They wanted free crap. But got pissed when they got charged. If it is unsolicited questions( outside of what I asked for ), it should come as no surprise if they get billed.
That being said, I am in the “ make an appt or go to the ED” camp
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u/Vegetable_Block9793 MD 14d ago
I mean, they got charged $50 for 99421, kinda annoying, our org charges $25.
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u/John-on-gliding MD (verified) 13d ago
Yeah, but as with most patient complaints in healthcare, that's an issue with their insurance, not the doctor's office. Patients see doctor offices as the problem when they should call their employer and call their congressman.
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u/BlueLanternKitty billing & coding 13d ago
They could be counting it as a “procedure” code and not an E/M, which is what it really is (because you’re evaluating and managing the patient.) So the $50 is the patient responsibility and not a true copay.
Again, just a guess. But I’ve been doing billing reviews for a long time and payers do some weird stuff.
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u/RoarOfTheWorlds MD-PGY2 13d ago
I disagree. The reality is that not everyone reads every clinics fine print. The patient sent a message and in my opinion any decent clinic would've told them to come in or else it will be a telemedicine visit.
No one likes or expects to be charged for a message, just as much as we don't like doing free work just because it's a mychart message.
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u/John-on-gliding MD (verified) 13d ago
How was the clinic supposed to know the co-pay of an appropriately-billed 99421?
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u/Independent-Library6 layperson 13d ago
The patient never said the doctor did anything wrong. They're just unfamiliar with their insurance copay structure and thought a message would be less than a telemedicine visit.
You should get the stick or if your butt.
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u/Atticus413 PA 14d ago
Instead of "go to the ER," why not "try urgent care?"
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u/Silentnapper DO 13d ago
To elaborate further on the other reply you got:
If they aren't going to see you, the default recommendation should be a higher acuity of care because you give that type of response to complaints that you have not yet evaluated.
Sometimes urgent care is appropriate, for example a patient Friday no showed for suture removal and messaged if I could go to their house instead because they "have other shit to do" (don't get me started), I told them to go to urgent care.
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u/BlueLanternKitty billing & coding 13d ago
I’m sorry, I can’t hear you over the sound of that level of entitlement. Wow.
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u/EmotionalEmetic DO 13d ago
They wanted free crap. But got pissed when they got charged
"I will avoid using Mychart going forward!"
Oh no...
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u/sailorpaul other health professional 13d ago
I just charge a flat rate per month to all as an ongoing patient to cover that stuff
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u/Silentnapper DO 13d ago
Which is how some DPC clinics are run, basically insurance + a subscription fee to subsidize a smaller patient panel and more access to the doc.
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u/John-on-gliding MD (verified) 13d ago
basically insurance + a subscription fee to subsidize a smaller patient panel
Is that not concierge medicine?
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u/invenio78 MD 14d ago
Respectfully disagree. It was a simple medication question. Perfectly ok to address in a MyChart message. It was billed appropriately.
The amount charged is based on an insurance contract agreement. BTW- the cost would have been more with a visit as a 99213 is reimbursed higher than a 99421.
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u/JHoney1 MD-PGY1 14d ago
Not the cost to patient, it seems they have a flat copay amount.
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u/invenio78 MD 14d ago
How is the doctor supposed to know how much the copay for every visit type with every insurance is, where the pt stands in their deductible, or even if they have insurance, etc...? That's really the responsibility of the patient.
At the end of the day, the cost of care was less due to this being a 99421 than an in office visit. Unless you are advocating that the doctor should just offer professional advice for free, this was appropriate.
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u/JHoney1 MD-PGY1 14d ago
I agree, there is no way to know.
Your point about it would have cost more with a visit, my point was it wouldn’t have costed the patient any more.
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u/invenio78 MD 14d ago
When I say the "cost would have been more with a visit," I mean that the billable cost would have been more. The doctor actually got paid less with this MyChart message vs bringing the patient in for a visit to address. So you can't argue that the doctor was trying to "bill higher."
At the end of the day, the patient is always responsible for knowing their copays. The patient is complaining because they weren't familiar with their insurance plan. The doctor did nothing wrong here.
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u/Spartancarver MD 13d ago
lol the comments can’t figure out why they can’t get concierge-level access to their physician for free
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u/MrPBH MD 13d ago
That's the hidden subtext of this conversation that most people aren't talking about. This problem and many others go away when you have your own skin in the game and contract directly with a physician for medical services.
If we aren't going to commit to a government funded single payer system (Medicare for All), we really need to lean into the free market and go cash-pay for routine care and most elective procedures. The current quasi-socialized system is rife with rent-seeking middle men whose sole purpose is to skim profits which balloons costs and degrade quality.
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u/sgsduke layperson 13d ago
I am asking because I'm genuinely not sure of the answer if we do lean into the free market. I think i agree that the current system is a forked up middle ground that burns out doctors and bleeds most patients dry and makes insurance CEOs $$$.
From your perspective, if we were to lean toward cash-pay: What about those of us with chronic illness issues that require regular management and meds that are thousands of dollars out of pocket? What about the elderly? What about, like, giving birth?
I'm not saying we should be entitled to free health care / medication / long-term care / obstetrics! I just don't understand how we could get away from these barriers to big sections of the population. (Disabled, elderly, temporarily disabled like injury or pregnancy, impoverished).
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u/MrPBH MD 13d ago
It would require a government funded social safety net program. That's true of all markets, though. The government or some other regulatory body needs to step in to keep the market competitive and smooth over problems.
That's why I'd much prefer M4A (Medicare for All).
But in my hypothetical, the majority of the population would just pay out of pocket for routine care and use insurance for actual catastrophic health scenarios. So if you were insured when you got chronically ill, you'd be getting treatment paid by your insurer. If you weren't, then you'd fall into the government safety net. (Same if your insurer goes out of business.)
The costs of biologic drugs are a big problem for all health systems. In a perfect world, we'd have no patents and it would be easy to bring biosimilars to market. The current system offers patent protection for too long a period, resulting in stupidly high prices.
Make companies compete on price and efficiencies, rather than pulling dirty tricks to artificially create a monopoly.
Even if we gutted IP protections, biologic drugs are going to be pricier than small molecule drugs. It is just fundamentally hard and expensive to create custom antibodies from living cell lines. Plus every cell line is unique, so you can't have the same system of generics that we do for small molecule drugs.
That is unless you mandated that companies bank their cell lines in a library open to all manufacturers. Then you might see generic Rituximab like you see generic atorvastatin.
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u/Spartancarver MD 13d ago
Beautifully said.
I’m a hospitalist currently so I’m protected by the shift-based nature of my work and obviously have no real inbox to deal with.
The only way I would even consider going outpatient is with a system like you described where my volume of work directly correlates with my compensation and that includes being paid for responding to the inbox.
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u/strainthebrain137 PhD 12d ago
There's already skin in the game by virtue of the fee-for-service system, even with insurance. If you pay physicians in direct proportion to the care they provide instead of paying them a salary, there are going to be incentives to cut appointments times short and opt for certain treatment options. These incentives act on either the providers directly if they are in private practice or indirectly if they work for an organization that sets certain "performance" targets.
You may say no self-respecting physician in private practice would be affected by this, but they're just people like anyone else, and there are vast shades of grey between outright medical fraud and behavioral tendencies that increase revenue. It's not hard to alter your behavior enough to make more money but not so much that you cross your own lines.
Ultimately, the only way patients are ever going to receive healthcare that they can be sure is honest is in a socialized system. I do think that having more private practices, particularly smaller ones as you seem to be imagining, would reduce these revenue-over-care tendencies, but it's still far from enough imo. Healthcare and the profit motive need to be decoupled.
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u/InvestingDoc MD 13d ago
I thought many of the comments were actually reasonable starting to recognize that physicians are getting squeezed and working for free via chart messages is coming to an end
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u/Zerkxes DO 13d ago
Absolutely agreed. I closed my inbox because my patients will generally try to ask for medications or other medical questions.
If it is a simple refill for non-controlled medications and they have been in-office the last 6 months, I just refill it.
If it is an overall question, controlled substance refill, or they have not been in-office over the last 6 months, it automatically becomes a televisit.
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u/Medium_Host1902 MD 13d ago
If 1% of a 1600 patient panel messaged me every work day, and it took 10 minutes each, that’s 2 hours and 40 minutes of extra work every day: not sustainable.
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u/Character-Ebb-7805 MD 13d ago
This is how you know most Americans don’t interact with lawyers on a regular basis
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u/Anon_bunn other health professional 13d ago
It’s a problem if medical practices aren’t clearly communicating policies and expectations with patients. This gleeful response is gross. This is a person trying to care for their health and navigate a complex system while dealing with budget constraints. This patient was likely told to use MyChart or was inadvertently directed to the portal through an email/website and then used it.
As an aside, it’s not at all hard to set up “helper text” so that a patient sees as soon as they try to send a message that they may be billed for that message.
Of course, some patients don’t listen and don’t pay attention to policies. I’m not talking about them. Engaged patients should not be surprised by billing and confused about policies. That’s a admin failure and an expectation setting failure.
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u/Nearby-County7333 other health professional 12d ago
THANK YOU. i keep explaining this. the reactions have me unnerved.
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u/MrPBH MD 13d ago
The problem is that the conditions to bill for a MyChart message are complicated and vary between the different insurance companies. Creating a helper text warning would be difficult to implement, unless it is a universal disclaimer that pops up with every message like "you may be charged a co-pay for sending a message." Patients would still complain because they don't understand their insurance policy.
The whole system is irredeemably rotten and I hope against hope that we will someday have universal, tax-funded, single payer healthcare for all Americans. We are currently spending enough money to fund such a system--we just lack the political will to implement it.
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u/Anon_bunn other health professional 13d ago
I completely agree! Thanks for the response. I think the universal helper text would still add value, although you’re right, it may result in frustrated patients.
Irredeemably rotten indeed.
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u/John-on-gliding MD (verified) 13d ago
It’s a problem if medical practices aren’t clearly communicating policies and expectations with patients.
The patient almost certainly clicked on a waiver disclosing the cost. This issue has everything to do with the co-pay their insurance assigned to them. It has nothing to do with the practice.
That’s a admin failure and an expectation setting failure.
No. It's an insurance failure. This insurance charged the co-pay.
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u/Good_Bottle_7757 other health professional 13d ago
I really hope that every medical office removes the ability for patients to message their physician. Being surprised billed is wrong but that’s on administration for allowing the messaging then decide to start billing without really telling a patient. And what counts as something billable or not billable? It just has to end. To add though, it would never occur to me that physicians aren’t getting paid to answer calls, messages, whatever. In my mind, you get paid a salary to work x amount of hours, some of that time with patients, some of it taking care of admin work. What I read here though, that isn’t the case. Hence the doctors need to see more patients to make more money and burn out and give less than amazing care due to time. And this due to contracts signed by the true owners of the health care facility? Just my simplified way of looking at it and I am beginning to look for privately owned small practices in the hopes maybe it is better? Smh, probably not.
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u/Different-Bill7499 MD 13d ago
Ask any of these people who chafe at paying for MyChart message capability if they’d expect an attorney to work for free, and they’d probably say ‘of course not’
We have done a terrible job as a profession of letting people walk on us.
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u/SkylarkV layperson 11d ago
Health care administrators: "Use MyHealth." Patient: uses MyHealth. Doctors:"Stop abusing MyHealth." Patient: "Screw it, I'll Google." Problem solved?
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u/Hot_Inflation_8197 other health professional 13d ago
So if a patient messages you to follow up on a prior authorization that they haven’t heard back on, cuz their pharmacy says they contacted you but actually did not, still the same?
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u/msjammies73 PhD 14d ago
I truly don’t understand why doctors push more and more for this “fee per minute” model of payment.
Every field that works this way is universally distrusted and considered corrupt (think lawyers and mechanics).
Patients hate it and it erodes the relationship. Physicians should be pushing for panel sizes that allow a certain amount of follow up per visit and a few questions a year. As a professional scientist, I’m paid a salary that covers me providing my expertise to many different people throughout the day and over the year. I don’t bill for every new thought or idea I have.
Physicians should be paid well. Really really well. But this direction of per minute billing is moving medicine in the wrong direction.
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u/HeparinBridge DO-PGY2 14d ago
Physicians have been pushing for smaller panel sizes for decades, but nobody cares what doctors want, and it cuts into profits. If the public wants any of this to change they need to mobilize political will in favor of primary care, instead of voting for politicians who cut Medicare/Medicaid.
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u/Kindly_Coffee_9389 MD 14d ago
"Physicians should be pushing for panel sizes that allow a certain amount of follow up per visit and a few questions a year."
Shortage of primary care providers + hospital systems' drive to maximize profit = gl with that.
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u/msjammies73 PhD 13d ago edited 13d ago
I couldn’t agree more. But I don’t understand why so many physicians complain about not being able to bill For things, when the real problem is that corporate greed is killing you. It seems like pitting patients and doctors against each other works to divide us while insurance companies and management companies and laughing their asses off while cashing their checks.
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u/Negative_Way8350 RN 14d ago
You're also not carrying the liability of hundreds of patients who try to use you as a shortcut to free medical care.
Because that really is FREE care. In other countries it may be subsidized, or here a visit is paid through insurance.
But 30+ messages demanding medication "questions" is a lot of completely free care unless the physician bills.
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u/XZ2Compact DO 14d ago
Are you providing that expertise to 20-30 people in person and an additional 30+ people through messages every day?
Shit wears you down. I'm not saying you're wrong, I'm just saying that's where this is coming from for most of us.
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u/msjammies73 PhD 13d ago
I hardly know any physicians who aren’t burned out and at/past their breaking point. The system doesn’t work for you and it’s increasingly untenable for patients as well. That’s sort of my point.
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u/msjammies73 PhD 13d ago
That I 1000 percent believe and support. If the message is that it’s too Much to manage or just unsafe, I think people can get behind it. But I believe the messaging is currently very focused on patients being greedy and wanting free care. That is very harmful for both groups.
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u/Intelligent-Grab-501 MD 14d ago
I am so burnt out. These people think we’re being greedy af whereas I doubt even 1% of these people will survive our workload
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u/youre-stupid-69 MD 14d ago
“Expertise” that is becoming more commoditized thanks to ChatGPT. Why should you get to charge patients exorbitant amounts for this “expertise” they can get for free elsewhere?
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u/Not_So_Rare_Earths MD (verified) 13d ago
You get what you pay for -- or at least, it's rare to get more than what you paid for*.
I loved Star Trek Voyager, and it's pretty obvious that ChatGPT isn't The Doctor. It's wrong about so, so many things -- and it really irks me that it's now automatically at the top of every search engine.
But if a patient comes in with a HyperTolphnemia because GPT erroneously advised 5000% the daily recommended maximum of Tolphno supplements, we can fix that too. Although I won't hold my breath waiting for the programmers to be sued for medical malpractice.
*Exceptions: Wikipedia, Khan Academy, and extremely generous physicians who suffer the slings and arrows of the daily MyChart barrage for free.
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u/DarkestLion MD 13d ago
I'm all for people asking AI. Less liability on me. I get to practice medicine. May even see some zebras
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u/Normal_Dot7758 RN 13d ago
Doctors don’t rank much better than lawyers on the list of most trusted professions. There are good and bad aspects of all reimbursement models.
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u/PopeChaChaStix DO 13d ago
I'd wonder though what your work hours are. As a PCP we see patients 8-5 but the patient requests and inbox messages can take the rest of your day until bed and your weekends unless you have some boundary.
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u/msjammies73 PhD 13d ago
I’m not arguing that you should be working more. That’s my whole point. Billing for each interaction doesn’t solve the problem that you are being buried in work.
I work hard, but the physicians in my family work much more grueling schedules than I do. I’m burned out, but they are utterly depleted. This billing model doesn’t fix that and just makes doctors and patients trust each other less.
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u/PopeChaChaStix DO 13d ago
System doesn't work. Also, read the rest of your comments which clarify a lot but I responded only to your first comment before reading.
But, without system change, charging does reduce inbox messages and that helps my brain. I don't charge, but ive had a big lack of support staff lately so messages are not getting directed to me in a timely manner and several pts have left my care out of frustration...which, helps.
I've also been somewhat forced to start telling pts that inbox is not a good way to reach me right now, they need appts or phone visits. Some more left which helps.
I guess charging or telling pts "this won't work for you" both improve my quality of life
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u/Moist-Barber MD 14d ago
lol this represents a fundamental misunderstanding of how physicians are paid.
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u/msjammies73 PhD 13d ago
I understand exactly how physicians are paid. I’m arguing that the system is flawed and broken. And the messaging around it from doctors is eroding medicine.
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u/youre-stupid-69 MD 14d ago
This. Many if not all white-collar professionals are salaried and don’t get overtime, so in essence work “for free”. Why should FM physicians have it any different? Replying to patient portal messages is just a part of the job. Suck it up or go work somewhere else.
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u/celestialceleriac NP 12d ago
But why is working "for free" okay to begin with? I can understand in occasional, urgent situations, sure. But otherwise, that's just toxic.
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u/Different-Bill7499 MD 13d ago
Does your attorney work for free?
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u/msjammies73 PhD 13d ago
Of course not. No one should Work for free. But pushing for the billing model of lawyers shouldn’t be what your efforts go towards. It’s a crappy model and not conducive to promoting health.
Plenty of professions don’t bill ala cart. Does your kids teacher bill you when you email to ask about a grade? Does your pharmacist charge you more for a prescription if they had to call your insurance company 5 times? Do I charge my company extra if the FDA suddenly has an emergency request for data because a patient in a phase 1 trial went into liver failure over the weekend?
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u/Different-Bill7499 MD 13d ago
The amount of daily messages we get through the EHR is staggering. The average physician working in a primary care clinic gets 49.3 messages a day. This is on top of 22-25 face to face clinic encounters a day. I haven’t even mentioned phone calls or test results that need review.
The message system is abused and it’s hard to explain unless you’re working in the shit.
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u/msjammies73 PhD 13d ago
That’s an insane number and I can see how the resentment and anger would built quickly. But I would argue that being able to bill for each of those doesn’t save you from drowning under the weight of it all.
The problem is the workload and the number of people trying to profit off your labor.
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14d ago
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u/Tiny_Rat layperson 13d ago
I mean, the stipend is literally less than you'd earn mixing cocktails for a degree that takes on average 50% longer than yours, and even top salaries in STEM are far lower than an MDs, but go off....
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13d ago
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u/Tiny_Rat layperson 13d ago
A PhD is also spending their 20s and 30s on hold while they do their PhD and postdoc for poverty wages. And then afterwards scientists continue to earn 100+k a year less than you. Are you seriously trying to argue that scientists are wealthier than doctors? Wtf are you smoking?
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13d ago edited 13d ago
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u/msjammies73 PhD 13d ago
Please look at what incomes many PhDs make with their degrees compared to MDs. We spend our 20s and 30s not buying houses or contributing to 401ks either.
You’re still a resident, so the debt is drowning you. But lifetime earrings of MDs blow away the vast majority of PhDs.
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u/slwhite1 PharmD 13d ago
Well, why are you still arguing? Looks like you got the last word. Maybe you should chill.
Also like to point out that you started the struggling Olympics. You basically said his opinion was worthless because he has less debt (which isn’t true), he pointed out that the pay discrepancies are not as different as you seem to think, and on it went. You want to call it the struggle Olympics, fine, but you DID start it, not sure why you’re calling it out here at the end.
The hypocrisy really does rankle sometimes.
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13d ago
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u/Tiny_Rat layperson 13d ago
I do, in fact, hold a PhD, I just dont have flair on this sub since I mainly browse on mobile.
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u/pizzystrizzy PhD 12d ago
My wife and I are tenured professors. Many of our friends are attending physicians, and I don't know a single one that isn't significantly more wealthy than we are, despite the extra debt that they initially had to pay off.
Not complaining -- I love my life and career -- but the idea that the lack of early debt compensates for lifetime salaries equivalent to residents is risible.
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u/msjammies73 PhD 13d ago
My earning potential is well below yours which is why we get stipends. We would never ever get out of debt with the salaries most of us make.
And again, I am not in any way arguing you shouldn’t be paid extremely well. It’s absolutely not about the money that you absolutely deserve. It’s about this idea that patients are at fault for wanting to communicate with their physicians and wanting to bill ala carte. It’s doing medicine a disservice.
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u/LongevityBroTX social work 14d ago
Ok but be real, a MyChart message is not the same as an actual visit. Don't be greedy.
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u/invenio78 MD 14d ago
OP in that thread says they billed him a 99421. That seems to be the appropriate code for the MyChart message.
I don't see anything about being greedy. You bill for the service that you provide. The insurance contract determines the cost, not the doctor.
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u/Agitated_Degree_3621 MD 14d ago
If you say that then you have no idea how long some of the messages get. I’ve had a patient write me their whole weeks history about how sick they were, why they missed work, ask for antibiotics and a work note. Tell me why i should do all that for free?
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u/John-on-gliding MD (verified) 14d ago
I once had a patient run into a character limit I didn’t realize existed, so she send me a google doc link!
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u/IamTalking other health professional 14d ago
You should have a nurse triaging those and never even have to look at them
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u/Agitated_Degree_3621 MD 13d ago
I did they were bad. Office didn’t hire RNs they hired MAs who just were awful.
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u/PopeChaChaStix DO 13d ago
Lol. Then there's that. No one paying to retain good staff and it just piles back on us. I've been writing, signing, faxing my own letters lately due to no staff.
The whole system is bad. Not even sure where to start. Maybe with the nation's massive debt.
Complicated by the fact that we all actually want to help the patients under the weight of it.
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u/Intelligent-Fuel-641 layperson 14d ago
I wouldn't expect you to do that for free, but is there a gray area? Full copay for someone who writes a Russian novel as opposed to someone who just writes a one-sentence question?
Serious question so please don't get mad at me for asking.
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u/Jek1001 DO 14d ago
It is a good question. For me, it depends on what is being asked. However, if you are in one way or another asking me to make a medical decision about one’s health, then it should be a charge with a proper evaluation.
Medication refill for a condition we have already discussed? No big deal, I’ll send the medication if I think it is appropriate.
Requesting antibiotics for something? Work note? Refill of medication for a condition we have not discussed previously? No, the patient needs to present to the clinic for a proper evaluation. There are situations in which this can be the exception. That’s not what we are discussing.
If a person went to a lawyer, engineer, dentist, CPA, they would all charge for their services, I don’t see why we should be any different. In addition, it is considered fraud to over bill for services; it is also fraud to under bill for services.
I don’t mind doing things for free, or for charity. But the shear volume of messages I get on top of a full day of clinic (20+ patients), asking for basically a free evaluation, with all the risk and liability is to much, and frankly not safe for anyone involved.
In short, yes there are some grey areas, but it is for the physician to decide because, at the end of the day it is their name on the bottle/form/document/etc. and everything that comes with it, including the bill.
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u/Agitated_Degree_3621 MD 13d ago
Yes one liners are fine. Ppl who don’t abuse the system are fine. But it’s a small population that just abuse the system and ruin it for everyone, but such is life.
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u/Yuv_Kokr DO 13d ago
Its more about time, if it takes 5-10 minutes, its billable under most insurances. Sometimes a one liner will be pretty complicated take 15 minutes to take care of. When we only get an hour a day to finish charting, respond to messages, and prepare for the next days patients, time is in super short supply.
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u/Nearby-County7333 other health professional 13d ago
you should have a nurse that looks through the messages for you. why are you not doing that?
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u/Agitated_Degree_3621 MD 13d ago
Bc nurses are not free labor, they have to call pts with results, room patients, give vaccines, do EKG’s. A novel slows down everyone’s workflow.
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u/Nearby-County7333 other health professional 13d ago
the nurse would be paid for it, as they would respond during working hours. if a ‘novel’ is sent then you don’t respond. or set up an automated response system. you guys are making yourselves victims when you really shouldn’t be. it’s not that complicated of an issue don’t wanna do free labor? then DON’T. nurses don’t have to either. literally most places have a nurse that responds to patient concerns via phone calls as well as messages. if you’re in this position then you need to address it with your office.
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u/Not_So_Rare_Earths MD (verified) 13d ago
There's the very much not-rare edge case of Residency, where at least in my program there was no such nurse, and residents were responsible for addressing every single result (with a formal chart note and a letter, MyChart message, or documented call to the patient) of every single test, every prescription refill, and every MyChart message. Even with efficient macros that's a bare minimum 0.5-3 minutes per normal result, and more for abnormals. Not to mention prior auths and peer to peers. Even on inpatient hospital rotations where you're responsible for that on top of already working 6A-6P for 12 days straight, then a 2 day "Golden Weekend" and repeat (or go onto nights). And, while it's not the Suffering Olympics, FM is still generally one of the "lighter" residencies.
But even outside of that unique hamster wheel in a hellfire, "don't respond" is NEVER an option.
Your patient metaphorically wrote you a Dickens novel but buried 700 words in were "my chest hurts and I can't breathe". When they die of MI and you don't have documentation of advising emergent medical care, I guarantee their survivors' lawyer won't say, "nah, it's cool, it's frankly an unrealistic expectation for their PCP to parse all that". And if they literally send you a Dickens novel, you're probably spending time coordinating care with the local inpatient psych care. And still coming out underwater despite answering messages while in the phone tree.
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u/Nearby-County7333 other health professional 13d ago
okay, no response is not allowed, understood. then this wouldn’t apply. what i said otherwise still stands. physicians of their own practice or shared practice should not be having this issue. residents don’t have as much authority as an actual physician, which you know. you are still working under someone. so yeah, there’s not much you can do then. talk to the patients and let them know what the mychart is for at every appointment. follow a letter system where u can get quick responses back, like the dentist’s office for example. if it’s unavoidable, then work on improving it. you and insurance are not players on the same team.
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u/Agitated_Degree_3621 MD 12d ago
Clearly you don’t work in healthcare. Not responding to messages is not an option. Nurses are paid, they have their jobs and it does not include responding to novels from patients that take away care from other patients. Your attitude is a reason why physicians suffer such high rates of burnout. But you do you.
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u/Nearby-County7333 other health professional 12d ago
okay, not an option, fine. then set up an automated response system. talk to your office about it. set up a system where the patient replies in letters, like the dentist’s office. you guys don’t want to find solutions, just complain. you must live in a bubble if you think something like this hasn’t been dealt with before. do you think nurses never interact with patients via phone call or mychart?? it’s common practice for nurses to be the middleman between the patient and doctor. they answer calls and respond to my chart questions. should patients send novels? no. if it’s an issue, address it with every patient and tell them not to. sorry but if it takes my ‘attitude’ to cause you to burnout, then maybe you didn’t have realistic expectations.
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u/Agitated_Degree_3621 MD 12d ago
The solution is charging the patient and limiting the messages behind a paywall. Just like OP said.
Also automated response is stupid bc if they send in an actual medical emergency then we’ll miss it. But you wouldn’t know what being in healthcare is actually like so I won’t be able to explain much more to you. Have a good one.
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u/Nearby-County7333 other health professional 12d ago edited 11d ago
you would actually CHECK AFTER the automated response, or, like a messaging system, see what letter they respond with that corresponds to an emergency. these are actually implemented in REAL HEALTHCARE OFFICES. have u literally never called any medical office in your life? it’s fine to not want to work for free but the actual disregard that several of you show for patients is extremely concerning. disregarding my healthcare experience just because i’m arguing with you is childish.
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u/Agitated_Degree_3621 MD 11d ago
I have more than you bc your solution still required reading the novel, so is not actually doing anything. Big brain you got there, have a good one you’ll be ignored moving forward. Adios.
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u/MrPBH MD 13d ago
An honest to god RN draws a salary of at least $60K a year and thus costs a clinic about $100-120K to employ (an employee typically costs 2x their salary when accounting for employment insurance, healthcare, retirement funding, and taxes). Realistically, in today's economy, you're looking at an $80K salary to attract and retain a BSN.
That's a huge cost for a clinic to shoulder, just to respond to MyChart messages. At a large clinic, it might take an employee working their entire FTE just to manage the inbox. You have to justify that role financially.
They deserve to get paid too, right?
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u/Nearby-County7333 other health professional 13d ago
the nurse would be paid for it, as they would respond during working hours. how often do you respond to mychart messages off the clock? set up an automated response system. you guys are making yourselves victims when you really shouldn’t be. it’s not that complicated of an issue don’t wanna do free labor? then DON’T. nurses don’t have to either. literally most places have a nurse that responds to patient concerns via phone calls as well as messages. if you’re in this position then you need to address it with your office.
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u/PopeChaChaStix DO 13d ago
They for sure do. Must he possible...I know that my salary is less than 5% of my billing amounts each year. Who knows what actually gets paid out though. Anyway, seems like they could afford a nurse.
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u/Catscoffeepanipuri M1 13d ago
If my doctor has to take the time to open my chart read the last appointment history and decide what to do, idgaf how they bill it. They did the work, and they deserve to be compensated.
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u/DrSwol MD 14d ago
Honestly it’s less about getting paid, moreso putting a bottleneck on how many patients abuse MyChart messages.
If I even charged patients $5 for a message, it would cut down on my inbox by a remarkable amount…