Internal vs Family - need advice

[d123123]

On 9/22/2017 at 9:34 PM, LittleDaisy said:

I think that you get paid more as an internist doing an inpatient geriatrician consult than a FM with + 1.  Again, a complete geriatrics consult requires 2-3 hours, compared to 45 min-1 hour for GIM consult. I don't think that a billing for a complete geri consult is much more lucrative than a GIM consult (400 $ for a comprehensive geri consult which takes 2-3 hours vs Comprehensive GIM consult 300 $ which takes 1-1.5 hours)

A lot of geriatricians doing in patient consults could only do maximum 2-4 inpatient comprehensive geriatrics consults per day, so it is less lucrative than doing 10-12 GIM & cardio & GI consults. That's why geriatrics is one of the lowest paid IM sub-specialty. People definitely don't go into geriatrics for money, if money is important to you, I definitely won't go into geri

At the end of day, it is up to you!

Looking over the OHIP schedule of benefits it seems like a complex GIM consult is 75 minutes. I don't know anything about billing yet but in the states an attending will bill based off complexity and even though a time usually corresponds to it, they're not bound by the quoted time. For example an attending will hill a consult as 70 minutes even if they only saw the patient for like 45. Is it the same in Canada or when it says 75 minutes for a complex GIM consult do you have to actually see the patient a full 75 minutes?

[LittleDaisy]

1 hour ago, d123123 said:

Looking over the OHIP schedule of benefits it seems like a complex GIM consult is 75 minutes. I don't know anything about billing yet but in the states an attending will bill based off complexity and even though a time usually corresponds to it, they're not bound by the quoted time. For example an attending will hill a consult as 70 minutes even if they only saw the patient for like 45. Is it the same in Canada or when it says 75 minutes for a complex GIM consult do you have to actually see the patient a full 75 minutes?

They definitely work around it, for example, your PGY3 in GIM clinic sees the patient for 30 minutes, review with you for 15 minutes, and then you see the patient with the PGY3 for 15-20 minutes, it adds to a total time of 75 minutes; as the PGY3 works under you, technically, you did spend 75 minutes for consulting on this complex patient. 

[d123123]

1 hour ago, LittleDaisy said:

They definitely work around it, for example, your PGY3 in GIM clinic sees the patient for 30 minutes, review with you for 15 minutes, and then you see the patient with the PGY3 for 15-20 minutes, it adds to a total time of 75 minutes; as the PGY3 works under you, technically, you did spend 75 minutes for consulting on this complex patient. 

So you're bound by the time to the minute here, not the complexity. And that means if you're not an academic you can only hill for the face to face time. 

[Snowmen]

9 minutes ago, d123123 said:

So you're bound by the time to the minute here, not the complexity. And that means if you're not an academic you can only hill for the face to face time. 

For some things like scoping, there are some limits to how many you are allowed to do in a day in Quebec. This would serve as an indirect incentive to actually "take your time" and there might be similar things in other provinces.

[d123123]

12 minutes ago, Snowmen said:

For some things like scoping, there are some limits to how many you are allowed to do in a day in Quebec. This would serve as an indirect incentive to actually "take your time" and there might be similar things in other provinces.

I don't know yet of a limit on consults per day. Honestly though while it would limit our income potential I wouldn't mind it. Internal medicine in the states is just a game about how many patients you can rush through without harming anyone that I don't mind that Canada forces you to take your time. It ends up being better medicine. What I kind of don't like though is say I was done with a patient in 65 minutes, I'd bill 175 for a general consult instead of 300 for a complex consult if I had kept them in the room for 10 minutes more. I guess you have to put the cutoff somewhere though. 

[LittleDaisy]

1 hour ago, d123123 said:

So you're bound by the time to the minute here, not the complexity. And that means if you're not an academic you can only hill for the face to face time. 

But if a patient is complex, you would spend around 60 minutes at least for a thorough old-schooled general internist. 

The ministry of health does sometimes audit physicians' billings, if you bill for 5-6 complex GIM consults > 75 minutes, eventually, it would cause you trouble. Moral of story , you should bill as reported. Just my two cents  

[Dikolator]

On 5/1/2018 at 5:54 PM, LittleDaisy said:

They definitely work around it, for example, your PGY3 in GIM clinic sees the patient for 30 minutes, review with you for 15 minutes, and then you see the patient with the PGY3 for 15-20 minutes, it adds to a total time of 75 minutes; as the PGY3 works under you, technically, you did spend 75 minutes for consulting on this complex patient. 

Someone at my centre was charged with fraud for something like this. 75min is for face to face time. The schedule of benefits makes it very clear.

[ArchEnemy]

6 hours ago, Dikolator said:

Someone at my centre was charged with fraud for something like this. 75min is for face to face time. The schedule of benefits makes it very clear.

Would the same apply for those in an academic centre?

[LittleDaisy]

14 hours ago, Dikolator said:

Someone at my centre was charged with fraud for something like this. 75min is for face to face time. The schedule of benefits makes it very clear.

Hummm...at academic centre, the staff physicians work round it. For example, if your resident assessed a patient after midnight for 2-3 hours, they would bill the after midnight billing code + complete consultation code > 75 minutes, and re-assessment codes; even though the staff never physically spent 2-3 hours face to face with patient (nor did the resident, as the majority of time was spent writing out the comprehensive admission notes) 

For academic centre GIM outpatient referrals, the staff never spent <<75 minutes>> face to face, but the time it takes a resident to assess the patient+ comes up with the plan, the staff to teach the resident around the case+ assess the patient, it definitely takes around 75 minutes. 

Also, in academic centres, the GIM get paid 30-40% less, because they pool money to fund people to be the PD or clinician scientist and clinician educator.