Saturday, January 19, 2008

6 Months

The Bean is six whole months old today, and I find myself feeling as though I have blinked and missed it! He is growing up so very fast. With CindyLou, I remember always looking forward to the next big milestone...I couldn't wait for her to smile, sit, crawl, walk, etc. With Bean, I find myself feeling the opposite, he is hitting milestones and *I'm* not ready for it yet. I suppose it is because I have hindsight from watching CindyLou, knowing how fast she is growing up (and she tells us every day), coupled with the fact that Bean is, in all likelihood, our last baby. Whatever it is, I'm not ready.

Bean is such a happy baby, though. He loves to play, he is starting to clap his hands, and he really loves singing (lucky for him!) He weighs a little over 15 lbs., which, I know, is still pretty small compared to most kiddos. He is starting to eat "real" food, too. So far we have tried (and liked) rice cereal, sweet potatoes, and applesauce. Teething has been in full force for a few weeks, now, there is much drool and chewing involved, but no visible teeth yet. Bean has nearly mastered the tripod sit, but still hasn't shown much interest in rolling a lot (he's done it once or twice) or trying to crawl. He loves the exersaucer and still hates sleeping in his own bed (the record thus far is 4-5 hours). We are still nursing/pumping, and I don't see him giving that up any time soon...quite the boob man. He does something that I have never seen a baby do in my life; he scratches the living daylights out of his teeny head, sometimes drawing blood. We've tried baby oil, bathing more and less frequently, hypo-allergenic soap, lotioning him (head included) within an inch of his life, and of course, keeping a hat on his head and his nails as short as possible. He still goes after his scalp with both hands and digs as if it kills him. Anyone else have this problem? Our pediatrician has not been overly helpful in this arena.

Today is the first day I have had off of call since 12/30/07 (last year! Ha!) It goes without saying that our house has transitioned from utter disarray (the "normal" state of being) to uncontrolled chaos. It makes my brain hurt, and Mr. Whoo and I have been up and working since early this morning. Laundry, folded but not put away, had been residing upon our bedroom floor for far too long; so, I took it upon myself to finally place the clothes in their proper homes. Whilst putting the Bean's laundry away, I realized how many outfits in his drawers were clothes that he has outgrown. I pulled sweet baby onesie after sleeper after teeny booties and hats out to place in storage bins and just had to sigh. I know that if we do our jobs as parents correctly, our children will grow, leave us, and one day begin the cycle anew, having children of their own, but no one told me how it makes your heart ache, just a little.

We are planning to take the kids out to a movie this afternoon, so I've not a lot of time to post individual responses to all of your wonderfully helpful comments to my previous post, but I will, I promise. You are all the best, and I really appreciate every person's input. I had a bad feeling about going in to a situation like this to begin with (spouse being the office manager) but felt, at the time, that the good aspects outweighed the bad. My contract is coming up in about a year and a half, so I am taking some steps now, as suggested. More on that in the comment section, maybe later tonight. Again, I cannot thank you all enough, your feedback keeps me sane! I hope that you are having a wonderful winter weekend!

Sunday, January 06, 2008

So ya say you wanna Resolution, weellll you know...

we all wanna change the world. Happy New Year, everyone! I am fervently attempting to keep up all resolutions, at least until the end of the month, ha! Some are going well:

-drink more wine, check! I'm liking Syrah, right now.
-blog more, check!
-play more/make friends, check! I got a DS for Christmas, and I am addicted to Brain Age and Zelda already. Today I went on a play date with CindyLou and got to chat with her playmate's mother for the afternoon. Woo!
-tell manager where to stick it, check! (Um, well, sort of...more on that later.)

Some are not going so well:

-take less call. Well, OtherDoc is on vacation for the week, so I am taking call for him. I actually have had call all weekend by myself with the kids, as Mr. Whoo was out of town in a wedding. Luckily it has been the "q" word...shhh don't tell anyone!
-lose weight/cook real meals. HA! That is all.
-be an understanding physician. I'm just being bitter, I guess, but I am O-V-E-R the calls for pain meds. I got a call from a pregnant person requesting meds for a migraine, and, as this was a legit request, I phoned the pharmacy. The pharmacy informed me that this particular patient had 2 different narcotic scripts filled in the last week from different physicians, so I opted not to call in the third script. I guess that's what I get for giving someone the benefit of the doubt!

As for telling my office manager where to get off, please allow me to elaborate. (Beware, a long, practice-related rant follows, likely supremely boring for most, but for my fellow OBs/physicians in practice, I'd love some feedback.) I know that I am still yet a novice, in my toddlerhood of practice, if you will. I will be the first to admit that I know very little about the "business" of medicine. I accepted a hospital-employed position for this very reason. Even though I am an employee, and get a paycheck regardless of the revenue I generate (in theory); I still need to generate enough to cover my expenses in order to "earn my keep," so to speak. When I first started out, I (naively, I admit), trusted that my office manager would assist me with any coding/billing of charts and/or surgeries in order to get paid the maximum amount for the work that I was doing. In residency, I had a cursory overview of coding, and I know a little, but I need to take a coding course (in my spare time, of course).

My office manager, however, had no such interest in making certain that I was billing to capacity, since she was too busy making certain that her husband (OtherDoc) was getting all he could. I was (and still am) considered second priority. I found out, almost a year after I had started practice, that my office manager hadn't been billing circs for me. When I asked her why, she said it was because I didn't pull face sheets on the patients. This is fairly standard procedure, and easy enough to do, except *she never told me* this was necessary for reimbursement. She had to know that I was doing them, she just didn't care to point it out until I asked. I know for a fact that OtherDoc does not pull facesheets (I've asked), nor does he do anything special to document his procedures. Our office manager (his wife) just checks his patient lists on the computer and does it for him. She, in theory, could do the exact same thing for me, but she doesn't. Instead of letting me know, however, she let me just "lose" revenue that I was honestly earning. Let me state that I do *know* that it is ultimately my responsibility to make certain I was being reimbursed, but I was naive. I just didn't realize that was good for the gander (in our office) did not apply to the goose!

There are numerous other instances of the gross inequality in our practice, like when she told the front office staff that OtherDoc was first priority when it came to scheduling, or when she flat refuses to let patients transfer from OtherDoc to me (illegal, anyone?) and insists that I (or my nurse) write all insurance letters myself while she writes OtherDoc's for him. I have become aware and wary of her motives, and have accordingly made adjustments. It really sucks to have an office manager that not only couldn't care less about how my practice is going, but openly attempts to sabotage it.

At any rate, I have been in a constant battle with the front office staff (no doubt due to her behind the scenes machinations) over the scheduling of patients. I have been trying to cut my patient schedule back to no more than 35 patients in a full day (down from nearly 50 a day). When I returned to work after the Bean was born, I wrote out a detailed, day-by-day (even hour-by-hour) outline of how I wanted my schedule to flow and gave it to her. I didn't expect it to happen right away, because I knew I had been booked through December before I even left on maternity leave, but I figured that things would start flowing by the end of December/early January. This past week, not once, but twice, I had 8 patients scheduled between 8:45a and 9:45a and 7 patients scheduled between 1p and 2p. This is extremely problematic, as it is damn near impossible to see that many patients in that amount of time, and therefore puts me far behind both morning and afternoon, eating substantially into my "lunch hour" (in which I chart, sign off labs, field office phone calls, eat, and pump) and keeps me up to an hour later in the office in the evening (exactly what I didn't want when I came back). I also asked for a 15 minute block of time in which to pump in the afternoons, which has increasingly been forgotten, forcing me to pump anyway and fall even further behind.

When I brought the scheduling discrepancy to the office manager's attention, she blithely replied, "Well, the girls are doing the best that they can. Doctor's offices run behind all the time, people expect it." To which I bluntly, and probably not very nicely, stated in no uncertain terms that I wanted my schedule the way I had requested (back in September!) and did not want patients overbooked on my schedule at the discretion of the front office staff. I realize that, compared to OtherDoc's schedule, my schedule looks like a cake walk, but I am *not* OtherDoc, I am a wife and a mother and I do patient care differently than he, and I deserve to practice the way I want to practice up until the time that it is shown that I am financially sinking faster than the Titanic.

After my short tirade, she countered, "Oh, and I've been meaning to tell you. We can't bill for your pre-op visits, so you should really quit doing them, and when you code your visits, the time limit means nothing (level 1, 2, 3 visits, etc.) in order to be compensated you have to have pages and pages of documentation." Say *what?* First of all, I think that the pre-op examination (an appointment the day or two before surgery to sign consents, answer questions, and do a physical exam) is crucial in many respects, not to mention the medico-legal aspect, and I don't care if it is included in the surgery fee, I'm still going to do them, thankyouverymuch. And huh? on the coding levels based on time spent in counseling? Is this something recent or is she smoking crack? I know that my attendings in residency used the same forms that I use (complete with review of systems, etc.) and were able to bill high level visits based on that documentation alone. At any rate, I said my piece, but I know it will be at least a week before anything gets done (if it ever does) since she and OtherDoc are now on vacation.

So I guess I am just wondering if I am being a completely naive Jackhole for wanting the things that I want for my practice? What is the average amount of patients seen in *your* office on any given day? 20? 40? 60? What is the proper role of the office manager? What about coding? What is standard practice? Am I expecting too much? So many questions...if anyone has any insight, it is much appreciated. Whew, now I am tired! Thanks for "listening."