Any Kaiser (TPMG) docs here?

[surferboymd]

My suggestion is to dip your toe into it ASAP. Contribute 1%. This way you get familiar with the interface and have set up a habit. Low commitment, nominal cost. Then you can see all your options to take payment, how to actually kick the can down the road, etc. If you are interested now, don't procastinate. With such a nominal commitment at 1% you are just placeholding and using the annual election as a mental reminder to know that you have this option. As a 20 year veteran, I can tell you that life gets in the way and you will inevitably forget in the future to do this. YMMV.

Remember the only housekeeping you have to do is kick the can down the road if you don't want early payment (but even if you do, you haven't lost anything since you will be taxed at marginal tax rate which would have occurred anyways. The only wrinkle is when if you quit tpmg it's the election that you did 12 months before departure that matter. So you have to do a bit of preplanning if you are giving TPMG the finger.

Thanks for this input on the DCP. I know only a small percentage of physicians use the DCP. I had a few questions. What are the benefits of utilizing the DCP? Is the money deferred pre- post- tax? Is the DCP money at risk if TPMG goes under? Are there tax advantages on utilizing the DCP? I assume if you start drawing down in retirement the marginal tax rate is lower. When is the best time to start contributing to the DCP or is it more of deferring enough to get out of the next tax bracket.

Thanks!

[ROdoc13]

Thanks for this input on the DCP. I know only a small percentage of physicians use the DCP. I had a few questions. What are the benefits of utilizing the DCP? Is the money deferred pre- post- tax? Is the DCP money at risk if TPMG goes under? Are there tax advantages on utilizing the DCP? I assume if you start drawing down in retirement the marginal tax rate is lower. When is the best time to start contributing to the DCP or is it more of deferring enough to get out of the next tax bracket.

Thanks!

It is deferred compensation, so it is pre-tax. So, the benefit is reducing your taxable income now. It is a non-qualified plan, so technically it is at risk if TPMG were to go bankrupt.

[ramen]

First time long time. I'm a mid career TPMG non surgical specialist (don't want to give further details re which specialty as I don't want to out myself). Have been with TPMG my entire career. The inbox and everything is burning me out. I would love to get suggestions from someone here in a similar position who has got things under control. I can't look to the other several people in my department for help (one has taken a more inpatient role so doesn't have these issues, the others have their issues etc that I can't get into here). We are supposed to meet access for new consultations, while keeping up with our patients who have chronic conditions in my specialty and need appropriate followup. I used to be good with the inbasket but things have really exploded since the pandemic. I can't keep up with results and secure messages. I've already said no to allowing medical students etc to shadow me in an effort to save my time and sanity. I am already 7/10 in terms of units worked. Today is my day off and I've spent several hours working in my inbasket and my work is still nowhere near done. I have a great deal of sympathy for my primary care colleagues, but the problem is that there is no limit to the number of patients that I can have. We have more people in our department so the call burden is a lot better, but the odd downside is that since we take less weeks of call now, we spend more time in clinic and thus accumulate more patients.

I probably need to learn how to set limits better. I do spend a lot of time on secure messaging. I do try to honestly answer patients' questions and I know they appreciate that (having been a patient at tpmg myself and getting flippant answers from doctors, I did not want to do the same to others). Because it's hard to fit patients in for followup appointments I end up doing a lot of stuff via messaging etc.

I just want to be able to do things sustainably for another 10 years when I can retire. I did look several years ago at another job but decided to stay with tpmg. I don't want to move. Please don't tell me to move to another part of the country/ LCOL area. Been there, done that - no way. That wasn't good for my mental health either.

I am married with a spouse who works (non physician) and 3 teenagers. Overall the family is doing well but as you can imagine the 3 teenagers, their schoolwork and activities take up a lot of my non work time so that's challenging as well. Our financial situation is all right but I definitely need to work until 60 for the golden handcuffs.

Thanks in advance.

[ROdoc13]

First time long time. I'm a mid career TPMG non surgical specialist (don't want to give further details re which specialty as I don't want to out myself). Have been with TPMG my entire career. The inbox and everything is burning me out. I would love to get suggestions from someone here in a similar position who has got things under control. I can't look to the other several people in my department for help (one has taken a more inpatient role so doesn't have these issues, the others have their issues etc that I can't get into here). We are supposed to meet access for new consultations, while keeping up with our patients who have chronic conditions in my specialty and need appropriate followup. I used to be good with the inbasket but things have really exploded since the pandemic. I can't keep up with results and secure messages. I've already said no to allowing medical students etc to shadow me in an effort to save my time and sanity. I am already 7/10 in terms of units worked. Today is my day off and I've spent several hours working in my inbasket and my work is still nowhere near done. I have a great deal of sympathy for my primary care colleagues, but the problem is that there is no limit to the number of patients that I can have. We have more people in our department so the call burden is a lot better, but the odd downside is that since we take less weeks of call now, we spend more time in clinic and thus accumulate more patients.

I probably need to learn how to set limits better. I do spend a lot of time on secure messaging. I do try to honestly answer patients' questions and I know they appreciate that (having been a patient at tpmg myself and getting flippant answers from doctors, I did not want to do the same to others). Because it's hard to fit patients in for followup appointments I end up doing a lot of stuff via messaging etc.

I just want to be able to do things sustainably for another 10 years when I can retire. I did look several years ago at another job but decided to stay with tpmg. I don't want to move. Please don't tell me to move to another part of the country/ LCOL area. Been there, done that - no way. That wasn't good for my mental health either.

I am married with a spouse who works (non physician) and 3 teenagers. Overall the family is doing well but as you can imagine the 3 teenagers, their schoolwork and activities take up a lot of my non work time so that's challenging as well. Our financial situation is all right but I definitely need to work until 60 for the golden handcuffs.

Thanks in advance.

Hi Ramen -

I'm sure many of us can empathize with your issue re: inbox management. I don't have a lot to say, in part because it sounds like my inbox is probably less burdensome overall, but a couple quick things I've done that seem to have helped -- for quick secure messages where patient is asking a question and I answer without any additional info needed from patient, I click the box for "do not allow responses." Sure, they can always start a new thread, but it seems to cut back some of the additional messages, even just the "thanks" that I still need to read and done. The other thing I do, particularly for the patients that email frequently, is respond when I open message (often same day), but I delay the delivery by 1-2 days. Epic/HC allows you to delay response by up to three days I think. Both of these small changes have, I think, made it more clear to my patients that secure messaging is NOT a text thread for ongoing, back and forth communication.

Hope this helps.

[StarTrekDoc]

Speaking from internist standpoint. For the chronic stable ones, give them back to us.

I rather have access with you than you following legions of stable patients q6months with stable surv parameters.

Another thing we've instituted is MyChart billing. Even if a simple message is sent, if you're doing E/m you can drop a charge and copay bill to the patient. This lowers the oh, I have a quick question message effectively, especially if you don't have a nurse to help offload those type of messages.

Another is to response simply basic and ask to save for more indepth discussion at the visit if you actually have time to talk with them (15-20 min isn't that).

[ramen]

Thank you for the responses. I do delay the delivery often, but the idea of "do not allow responses" is good - at the very least it stops unwieldy message chains.

I wish we could do some kind of Mychart billing, but I don't see that happening anytime in the near future.

Sadly sometimes the secure messaging substitutes for a visit since we simply don't have any visit availability... I'll try to work on doing some phone appointments for those kinds of things.

I think a good internist accepts the chronic stable ones. Many primary care docs seem to be overwhelmed and need to hand stuff off to others whenever possible. It is irritating but they truly are under a tsunami of work so I don't completely blame them.

Thanks again.

[lactobacillus]

As a GI subspecialist I can emphasize. We don't have any built in follow up time in our templates so all of our chronic sick patients that need routine follow up like IBD and Cirrhosis care have to get it through special approval from a manager or chief, so you end up having to manage these patients with after hour phone calls or secure messages. This makes me scared of missing something life threatening in this really tenuous population.

All of our clinic visits are reserved for new patients which are usually functional abdominal pain 90% of time who we can't really help much so it always feels frustrating.

[KaiserMD]

Can anyone share the starting salary for Primary care full FTE Kaiser TPMG. Thanks

[ROdoc13]

Can anyone share the starting salary for Primary care full FTE Kaiser TPMG. Thanks

This should help: https://northerncalifornia.permanent...-opportunities -- select internal medicine or family medicine for starting ranges.

[highdoseamox]

First time long time. I'm a mid career TPMG non surgical specialist (don't want to give further details re which specialty as I don't want to out myself). Have been with TPMG my entire career. The inbox and everything is burning me out. I would love to get suggestions from someone here in a similar position who has got things under control. I can't look to the other several people in my department for help (one has taken a more inpatient role so doesn't have these issues, the others have their issues etc that I can't get into here). We are supposed to meet access for new consultations, while keeping up with our patients who have chronic conditions in my specialty and need appropriate followup. I used to be good with the inbasket but things have really exploded since the pandemic. I can't keep up with results and secure messages. I've already said no to allowing medical students etc to shadow me in an effort to save my time and sanity. I am already 7/10 in terms of units worked. Today is my day off and I've spent several hours working in my inbasket and my work is still nowhere near done. I have a great deal of sympathy for my primary care colleagues, but the problem is that there is no limit to the number of patients that I can have. We have more people in our department so the call burden is a lot better, but the odd downside is that since we take less weeks of call now, we spend more time in clinic and thus accumulate more patients.

I probably need to learn how to set limits better. I do spend a lot of time on secure messaging. I do try to honestly answer patients' questions and I know they appreciate that (having been a patient at tpmg myself and getting flippant answers from doctors, I did not want to do the same to others). Because it's hard to fit patients in for followup appointments I end up doing a lot of stuff via messaging etc.

I just want to be able to do things sustainably for another 10 years when I can retire. I did look several years ago at another job but decided to stay with tpmg. I don't want to move. Please don't tell me to move to another part of the country/ LCOL area. Been there, done that - no way. That wasn't good for my mental health either.

I am married with a spouse who works (non physician) and 3 teenagers. Overall the family is doing well but as you can imagine the 3 teenagers, their schoolwork and activities take up a lot of my non work time so that's challenging as well. Our financial situation is all right but I definitely need to work until 60 for the golden handcuffs.

Thanks in advance.

I guess we'll see what Dr Ansari can deliver. I am happy that the inbasket is a focal point for her. I'm in primary care, desktop medicine rolled out this year and has helped, though we fund it by taking people out of the office... Even in primary care there is so much push for "access" that I do most of my follow-up by secure message

[highdoseamox]

Ok, so TPMG docs can apply for PSLF now. Am I correct though that since I consolidated into private several years ago it's just tough luck for me?

[StarTrekDoc]

I guess we'll see what Dr Ansari can deliver. I am happy that the inbasket is a focal point for her. I'm in primary care, desktop medicine rolled out this year and has helped, though we fund it by taking people out of the office... Even in primary care there is so much push for "access" that I do most of my follow-up by secure message

Can you clarify what 'desktop medicine' project is specifically? We are hearing salaried folk in PC are starting to roll back clinical sessions to 8 to be considered full 1.0 FTE as a nod to the increased non-F2F work that's encroaching on everyone's workload.

[highdoseamox]

Can you clarify what 'desktop medicine' project is specifically? We are hearing salaried folk in PC are starting to roll back clinical sessions to 8 to be considered full 1.0 FTE as a nod to the increased non-F2F work that's encroaching on everyone's workload.

When patient sends a secure message, instead of going to my inbasket, it goes to a "sorting pool" staffed by TSRs and MAs. Based on the issue, they may 1) handle it on their own (clerical things such as form requests, building hours, etc), 2) send it on to the PCP (chronic or ongoing issues) or 3) send it to a pool manned by physicians who are just replying to secure messages (symptomatic complaints that are more one and done, basically email urgent care). Eventually we hope they can send it to pharmacy (med questions, refill requests for stable meds, etc). It's not the most efficient, there are no nurses involved (some sort of union issue) so docs are doing advice that nurses should be able to do. But over time especially with some tech/AI solutions it hopefully will get more efficient.

[StarTrekDoc]

When patient sends a secure message, instead of going to my inbasket, it goes to a "sorting pool" staffed by TSRs and MAs. Based on the issue, they may 1) handle it on their own (clerical things such as form requests, building hours, etc), 2) send it on to the PCP (chronic or ongoing issues) or 3) send it to a pool manned by physicians who are just replying to secure messages (symptomatic complaints that are more one and done, basically email urgent care). Eventually we hope they can send it to pharmacy (med questions, refill requests for stable meds, etc). It's not the most efficient, there are no nurses involved (some sort of union issue) so docs are doing advice that nurses should be able to do. But over time especially with some tech/AI solutions it hopefully will get more efficient.

So desktop medicine is what... Bucket number three? The way your phrased it is some amount of protected time is carved out to do the work, hence the question, is full time still 36 in person contact hours or has that changed with this desktop medicine?

[ROdoc13]

Ok, so TPMG docs can apply for PSLF now. Am I correct though that since I consolidated into private several years ago it's just tough luck for me?

Unfortunately, I think that's the case (same goes for me...though at this point I have <18 months left on my First Republic consolidated private loan, so c'est la vie)