wighty

> Which is basically the same drug but without glycemic control

No... The effects are the same because they are exactly the same drug (semaglutide), the difference is the dosing schedule and max dose (wegovy is 2.4mg and ozempic is 2mg).

> After all, the communication portal in MyChart is "Message My Provider", not "Message An MA To Message My Provider".

That is semantics, could be changed to "Message the office" but that isn't going to be the most clear title for the majority of people to understand what it is doing. It's the same as calling the office, 99.9% of offices (basically all outside of concierge/direct care) are going to be triaged by an MA/nurse first.

As far as the payment requirements I've heard of, I have never seen anyone bill just for the MA reply.

There are some codes that can be used for asynchronous portal messages, but to be honest the AMA is still pretty broken as far as how much time we need to spend for things... the codes are 99421 (5-10 minutes over 7 days), 99422 (11-20 minutes), 99423 (21+). It is not clear to me how well these codes are actually paid for by private insurance. In a wRVU system a PCP may get paid like $5-13 for the first code, $15-30 for the 2nd, $24-44 for the 3rd. This is a lot less than a visit... and you must spend the minimum 5 minutes on the portal message or you are billing it fraudulently. I can cover an in person level 4 visit (99214) in 5 minutes in some cases, which pays something like $100.

> The nurses have left and you can't legally 'bill' or code the appointment without the nurses.

What? I've never heard this requirement and I cannot think of why it would be the case (I'm a PCP). The rest of your comment is pretty much the issue as PCP though. I have at least 30 minutes a day of "out of visit" requests (reviewing documents from outside hospital/consults, labs, imaging, other results, extra nurse patient triages) in addition to anywhere from 30 minutes to 2 hours of completing my notes each night.

The payment methods for primary care do not work.

I'm a family physician working in an outpatient office... there's just so many viruses that can explain those types of symptoms that are STILL more common than sars-cov-2.

I saw a 31yo 2/18 with primarily sore throat, aches/feverish (not documented), and again on 2/20 because the sore throat got significantly worse. I started feeling iffy 2/21 (Friday) evening and worse Saturday with a bad sore throat and fever around 102F, lymphadenopathy, this persisted for at least 2 days. I went to work on Tuesday and did a rapid strep (I did not feel I had strep but the other doctor wanted to do it)... I'm not really thinking that was covid19.

> patient handoffs are dangerous.

I hate when this gets brought up, because it inherently implies that we can't improve them. Everyone talks about increases in handoffs causing increases in medical errors. I think handoffs have a long way to go, and we need to better utilize technology to help in this (ie make better EMRs).

The overworked doctor is just as bad IMO. I've been there on solo 28 hour calls going on my 11th admission. In the morning I'm next to useless and my handoff to that team was less than stellar.

That's not true, see the reply above yours for a better explanation.

House of God is indeed an interesting book and a good read. I read it during second year of my residency, and it is incredibly sad how the stuff that is talked about in the book has gotten worse in some ways, though better in others.

I'm actively against the "bowel run" mentality. I do my best to avoid even the CYA test ordering, though I'm not in the ED where this can be the most rife. I see first hand the "ponzi scheme" (though IMO it is not the correct term) of the system and I chose to go into primary care because I actively want to fix this in any way I can, and being a specialist was not the way I thought would be best to do this.