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Documentation Tips: Teaching Interns and Residents

Posted on Mon, Mar 27, 2017
Documentation Tips: Teaching Interns and Residents

Our recurring series of documentation tips for clinicians.

By Timothy Brundage, MD

A countersignature by itself is insufficient for both documentation and billing purposes.

Acceptable Documentation

According to CMS, at minimum, the following documentation must be included when billing for services provided by the intern/resident with a teaching physician:
 

  • "I performed a history and physical examination of the patient and discussed his management with the resident. I reviewed the resident's note and agree with the documented findings and plan of care."
  • "I was present with resident during the history and exam. I discussed the case with the resident and agree with the findings and plan as documented in the resident's note."
  • "I saw and evaluated the patient. I reviewed the resident's note and agree, except that picture is more consistent with pericarditis than myocardial ischemia. Will begin NSAIDs.”

Unacceptable Documentation

Unacceptable documentation by a teaching physician includes the following examples with a countersignature:
 
  • “I saw and evaluated the patient”
  • “I reviewed the resident’s note and agree with the plan”
  • “Agree with the above...”
  • "Patient seen and evaluated...”
  • “Discussed with resident and agree with plan...”

Resources:
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Timothy Brundage, MD, CCDS, is a hospitalist at St. Petersburg General Hospital in St. Petersburg, Fla. Dr. Brundage earned his bachelor’s degree in chemistry and molecular biology at the University of Michigan, his medical degree at the Wayne State University School of Medicine and completed his residency in internal medicine at the University of South Florida College of Medicine. Subscribe to Dr. Brundage’s weekly documentation tips, or ask him about specific documentation issues, by emailing him at DrBrundage@gmail.com.

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How to Choose the Right Clinical Job Opportunity

Posted on Mon, Oct 31, 2016
How to Choose the Right Clinical Job Opportunity

It’s hard to believe that we are already two months into the 2017 residency recruitment season.

Over the next several months, residents across the country will interview at multiple places until they find the ideal opportunity. Residents will receive advice from current and former colleagues, their residency directors and others. So for what it's worth, I’m going to offer you my advice.

First, enjoy the moment. Reflect on what you are about to accomplish. Ten-plus years of learning, training, dedication and sacrifice is finally leading to the start of your emergency medicine career.

Choosing the right opportunity brings a mixture of excitement and stress, so I encourage you to develop a career plan. The first step is to ask yourself what’s truly important to you today. Long term, the number one criteria for landing an ideal opportunity is location. In the short term, you may want to travel, practice in a variety of settings, pursue a leadership track or find a location that will assist in paying down your student loans. Once you answer this question, you can plan accordingly.

Several years ago, I recruited an EM physician. His first name was Dan, and for a five years, worked on average 1,800 hours per year. During his residency, Dan was a chief resident. He was brilliant physician. The nursing staff liked working with him and his patient satisfaction scores were always high. Our leadership team easily formed the opinion that he would make an outstanding medical director in the future. When Dan interviewed with us, he expressed that his long-term goal was to become a medical director or chief medical officer. At the end of Dan's second year, he was offered an associate medical directorship. He turned me down. When I asked him why he stated, "It is not part of my plan today." His plan was to pay off all of his student loans within the first five years after he completed residency. Once Dan paid off his loans, within one year, he accepted a leadership position.

The second step of finding the right opportunity occurs during the interview process. During the interview, you must evaluate who you will work with. This starts with evaluating the medical director during and after the interview. Finding a medical director who will mentor, guide, teach and inspire you will create an environment that will encourage you to stay long term or prepare you for the next opportunity. This is not always easy to determine, but you can assess the medical director by asking questions to the other physicians, nursing staff or other members of the hospital leadership team. The second part is evaluating the physicians and advanced practice providers that you will work with. The medical director and nursing staff will help you to determine if these are the types of colleagues you want to work with.

The third step is determining if the location has what you are looking for, from housing, schools and shopping to recreational activities, religious activities and other considerations. This may conflict with your first plan out of residency, but the location will be the primary factor for choosing an opportunity for your long-term plan.

The last piece of free advice is when you find the right opportunity, one month before you start work, and before you start making 4 to 6 times what you were making as a resident, hire a financial advisor to help you develop a plan. You'll sleep better at night knowing your financial future is in good hands.

Jim McMillin


Jim McMillin is the National Director of Provider Recruitment for EmCare.

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7 Tips for Getting the Most Out of Residency Networking Events

Posted on Mon, Sep 21, 2015
7 Tips for Getting the Most Out of Residency Networking Events

By Amanda DiRuggieri

On August 18, EmCare invited emergency medicine residents from Philadelphia-area residency programs to a fun and unique event, “An Evening with the Big Cats,” at the Philadelphia Zoo.

Luckily, a heat wave of more than 90 degrees didn’t keep the cats or the residents away. More than 100 guests enjoyed an evening of cocktails, hors d’oeuvres and networking with both recruiters and fellow residents. Residents were able to participate in our special “Passport to Prizes” program, where they had the opportunity to earn raffle tickets for great prizes by visiting stations throughout the venue and interacting with our recruiters.

Events like this give residents and recruiters a chance to make valuable connections with peers, building relationships that will likely lead to job placements, referrals and numerous other potential opportunities. You never know who you’ll meet and how they might be able to help you in the future, so it’s always a good idea to be prepared and ready to mingle!

Here are some tips for successful networking at events:
 

  1. Step outside of your comfort zone: Of course you’re comfortable talking to another physician in your scrubs at the hospital, but a networking event in a business suit might not have you at ease. Work up the confidence to introduce yourself to someone you’ve never met before.
  2. Be aware of your body language: Be warm and welcoming, and others will naturally gravitate toward you. Smile!
  3. Ask questions: Show interest in what someone is saying and learn more about them by asking thoughtful and open-ended questions. People enjoy talking about themselves. Let them talk and you can find out more about your mutual interest, connections and more.
  4. Be yourself! Don’t try to be someone you think others want you to be. Be genuine and you will make authentic connections.
  5. Use the other person’s name: As soon as possible after meeting someone, use the person’s name in the conversation. This will not only help you remember their name, but it makes them feel important.
  6. Take notes: When you walk away from a conversation, jot down important thoughts on the person’s business card or a piece of paper so that you’ll remember them later. For example, Sam is from California and works for the hospital where you interviewed for residency.
  7. Follow Up: After the event, send an e-mail or text continuing the conversation or asking for a small favor to further develop the relationship.

Amanda DiRuggieri is a National Residency Program Coordinator with EmCare.


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Geographic Location Most Important for Residents

Posted on Sat, Jun 13, 2015
Geographic Location Most Important for Residents

Lifestyle, adequate call hours and personal time, good financial package also important

WEDNESDAY, June 10, 2015 (HealthDay News) -- For residents, the most important element in a future practice is geographic location, with lifestyle, adequate call hours and personal time, and a good financial package also cited as being important, according to the American Medical Association (AMA).

As part of a national survey, more than 1,000 residents answered questions relating to what they want in a future practice. A total of 24,000 residents were sent the Meritt Hawkins survey by e-mail, and 1,208 responses were received (5 percent). Residents ranked nine elements in order of importance.

According to the respondents, the most important element in a future practice is geographic location (69 percent), followed by lifestyle (61 percent), and adequate call hours and personal time (60 percent). A good financial package was important for 58 percent of respondents, while 48 percent wanted proximity to family and good medical facilities/equipment. Specialty support, educational loan forgiveness, and low malpractice area were important for 32, 19, and 18 percent of residents, respectively.

According to the report authors, residents "have a specific location in mind for their first practice option," and "this preference may override more practical considerations."

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