I’m tired fam.

Been seeing covid, flu and respiratory viruses blow up all September and October.

I’m tired of the constant demand for an instant fix.

I’m tired of the day 2 sinus congestion stating they have sinusitis and need ABX and because they always get a sinus infection.

I’m tired of the “I can afford to be sick this week won’t a Z Pack help”

I’m tired of the mild cough demanding a 6th course of Steroids this year because “if they don’t get them it settles into the chest and turns into walking pneumonia”

I’m tired of the bounce backs 1-2 days after initial visit because they “aren’t better yet and OTC isn’t working” (it’s day 4 of flu…)

I’m tired of the messages asking for “more antibiotics to kick it as the first didn’t work, No I won’t come in again can’t you just send more”

I’m just tired. And it’s only October…

Signed, Urgent care.

I have a patient with lumbar radiculopathy who is post-laminectomy. She is followed by pain management. She used to be on Norco and failed a drug screen, which was positive for marijuana and benzos. Her prescription was changed to tramadol and she was started on Cymbalta and Lyrica. Epidural steroid injection done recently with no benefit. She’s being seen by Behavioral Health. She has written extensively through my chart to the pain management doctor berating him for not taking her pain seriously. She saw me today and I explained that if I were to write her a controlled substance, she would be discharged from the pain clinic. The pain clinic is county run and she doesn’t have any insurance to go anywhere else. I added a muscle relaxer to her regimen and encouraged her to apply for disability; after our appointment, she sends an email accusing me of being judgmental and not helping her and just being a terrible doctor. .I do not want to get into a discussion over my chart. How do I handle this patient? I certainly don’t want to hamstring the pain management provider, and I definitely believe she is in real pain, but I do think she is manipulative.

Partially rhetorical question because I keep seeing other providers giving it out like candy and I don’t really understand why because it’s not indicated first line for most things….?

I was an Lpn at an FQHC for about three years. Unfortunately they closed due to not seeing enough patients. The doctors have turned it into “family med” that is more focused on weight loss, anti aging and concierge care. I feel like I’ve seen this pattern with a lot of family clinics. Is it just because family medicine isn’t profitable enough and not enough people have the resources/insurance to see a family doctor anymore? I kind of hate this shift. I feel like it’s fueling the issue of patients only caring about how they look, not how their health is actually faring and we need just good basic family medicine out there

30yo New to attending life, but I still managed to secure over 400 K on my first year as a 4d ww outpatient PCP in the NE. I am by no means used to having all of this disposable income and I wanna make sure I don’t waste it curious to see how everybody has structured their finances and if there are any gaps in my current plan.
413k w2 income
401(k) maxed with match 24.5k
HSA Maxed 4.5k
Back door Roth maxed 7k
No kids so those tax advantage accounts are not available
No mega back door available
45K in savings which is a 7mo runway for me of fixed expenses.
I do have a 250k student loan at 3.2% and a car loan at 5.5% which I don’t mind holding, because I’d rather get into a few markets early
No mortgage

Had my fare share of travel this year hitting Japan x2 Morocco Florida, East Coast, West Coast, Mexico, and four countries in Europe. Bought a car and a few watches. I gift about 5% of ea paycheck to friends and family thru different means.
Saving for a wedding but I should be able to get through that as well.

Still sitting with the final 70k that just hit my acc.

My question is, should I buy a house even though I’m a happy renter? Should I put my money in a regular brokerage account? I don’t wanna be overly exposed to just the stock market. I’m 90% ETFs 10% bonds. I’m thinking into some real estate at this point because I can throw 30% into 350 K three bedroom apartment in an upcoming neighbourhood make it my primary residence and ride that for five years and see how that goes. I think I might start diversify my savings with 5% of savings as gold.
I’m also getting married to someone in the same financial situation as me so the problem is about to double but I’m curious to hear what people have done that has worked for them and if there are any gaps in my plan
First problem to have I’m definitely very thankful for the situation

Hear me out. I’ve got a 60 yo patient with CKD 3b which has been pretty stable for 5+ years. She sees nephrology so maybe i just need to mind my own business. But over the years, i have never seen her nephrologist check her microalbumin to creatinine ratios. With as much as i have learned about albuminuria I am tempted to order UACRs and then treat with sglt2 if indicated. Already on ARB. Am I overstepping my bounds as her PCP when she already follows with nephrology?
No judgement against her nephrologist but this particular physician is famous for the 30 second appointment, is super hard to get on the phone and once i finally make contact is already saying goodbye before i can even ask a question. No doubt this nephrologist knows what they’re doing, but I just want to give some context.

Well, I had very little confidence in the US healthcare system going into today, but I just lost some more.

I work at a facility where people stay longer-term.

This morning at around 9am I sent an otherwise healthy 36yo F to the ER with 8/10 abdominal pain and 5 episodes of large volume emesis within like 90 minutes. I call and give hand off, pretty straight forward rule out acute abdomen.

Around 3pm I get a call that they are sending her back. I ask to talk to the doctor taking care of her and got connected with an NP. She started off by telling me that her CBC and CMP were normal except for a mildly low white count that she was attributing to a “viral response” and that she felt better after 1L of IV fluids and then kind of stopped talking.

So I asked what her imaging showed. Turns out no imaging was done because she was “no longer having abdominal pain” evidenced by the fact that she could “crawl to the bathroom and back to bed just fine.” (yes, she used the word “crawl”)

I then asked about lipase and she said she “didn’t get one because her liver tests were stone cold normal.” I actually had to say “lipase is for the pancreas not the liver.” She said “yeah but if it was her pancreas her liver labs would be elevated too.” I said “well…no…not necessarily…” and she was like “I’ll add on a lipase.”

I asked if she passed a PO challenge and she said she gave her a popsicle but didn’t know when the last time she vomited was because it “wasn’t documented.” I told her that the nurse I work with had talked to the nurse she works with earlier in the afternoon to get an update and at that time she had vomited within the hour, around 1pm. The NP replied that that was “news to her.”

The more I’m talking to this woman the more horrified I am. She got Tylenol for complaints of a headache but no medication for nausea or vomiting. She did not do a pregnancy test. She was there for 6 hours and all she got was a CBC, CMP, EKG, Tylenol, a popsicle, and 1L of IV fluids.

How did we get here? How is this woman allowed to practice independently?

Do any of you prescribe repatha (patients either intolerant or not meeting goal with statin/zetia/bempedoic acid). At my place no PCP prescribes repatha and patients are refer to cardiology. It seems we prescribe other medications with higher risk but repatha is where some seem to draw the line.

No idea if I want advice or just to rant as Im just feeling frustrated/ questioning if I made the right choice taking this job.

New attending at a large hospital owned practice. I am essentially taking overflow from all the docs in our healthcare system including my practice as well as nearby practices. Press Ganey scores are affecting me more than they should. Ive gotten mixed reviews from patients saying how much they loved me and switched to me as PCP to horrible reviews because their PCP was booked out months in advance and they had to see me aka not their PCP (so negative review has nothing to do with me but still attached to me) or because I wouldn’t give them antibiotics for their 2 days of runny nose/post nasal drip. I would be fine with this if it ended with the survey but our manager prints all the reviews out weekly and displays it out for literally everyone to see. As a new attending, I feel like it has crushed my spirit honestly and affected my mental health. Im already anxious and trying really hard to practice evidence based medicine but I feel like I work at Burger King where the motto is always “have it your way” regardless of whether that is medically necessary or not. Im also getting overloaded with preop clearance visits for patients I have never seen before and have limited information about. I’ve verbalized how inappropriate I feel this is as these patients should be cleared by their PCP who knows them. Ive relayed my concerns to management but feel like they talk around it in circles without any meaningful change.

I still can’t find a good reason for this. Had a 51 yo with hyperlipidemia, uncontrolled hypertension tell me that he could never consider a statin because of how much damage they do to the body. Meanwhile this dude has been on hydrocodone 10 mg QID from pain management for the entire 5 years i have seen him and recently started IM testosterone at a local hormone clinic.
Is this all just fear mongering or are the increased risks of dementia, accelerated diabetes, etc really legitimate? I assumed statins got a bad wrap cause of the relatively high frequency of myalgia, arthralgia, fatigue but so many patients view them as actually toxic and sinister!

Hello everyone!

I'm a visa-requiring IMG applying for the 2027 Family Medicine Match, and I'm getting increasingly concerned about my application.

My profile:

- Graduation year: 2023

- Step 2 CK: 26X

- Step 3: Result pending, hopefully coming next week

- USCE: 4 months of observerships

- US LORs: 3 Family Medicine letters

- 3 Family Medicine observerships

- Clinical experience: 3 years post-graduation

- Currently a PGY-2 resident in General Medicine in my home country

- Applying exclusively to Family Medicine

- Applied to 94 FM programs

- Visa-requiring IMG

Unfortunately, I haven't received a single interview invitation yet. I've noticed that other visa-requiring IMGs are receiving interviews from some of the same programs I applied to, which has made me wonder whether there's something I can still do to improve my chances.

I've also sent letters of interest to my signaled programs but haven't received any responses so far.

At this point, I'd really appreciate some advice:

1. Is it still too early to be concerned, or should I be worried about having no interviews?

2. Could my pending Step 3 result be affecting my chances?

3. Is there anything else I can do at this stage to improve my chances of receiving interviews?

4. Would sending letters of interest to additional programs be worthwhile?

5. Given my profile, is there still a reasonable chance of receiving interview invitations?

I'd really appreciate honest feedback and suggestions from applicants in a similar situation or anyone who has experience with the residency application process.

Thank you!

Curious how any of you all would approach this situation. I have a patient in her 60s with ESRD who is also on chronic opioid therapy with difficulty weaning off the opioids due to legitimate post traumatic pain. Her insurance apparently dictates that Mayo is the only place she can go for a transplant. Mayo rejected her for a transplant since she's on chronic opioid therapy. Tried to send her to a local transplant center and she was refused since her insurance prefers she goes to Mayo. Do I tell her to suffer with the pain and come off opioids just so she can get a new kidney? Plead with her insurance to let a local team do it? Plead with Mayo to give her a new kidney without making her suffer severe uncontrolled pain? Just leave her on dialysis for the rest of her life?

Obviously my multimodal pain options are extremely limited with her kidney disease. Already has lidocaine patches, every other day duloxetine, and tylenol. Had swelling with gabapentin and lyrica. Would switching to suboxone be an option or would she still be denied since this is still an opioid? Thanks for your thoughts!

I’ll preface this by saying I’m a smidge low on patience since I’m approaching 31 weeks pregnant with twins lol. That being said, I’m an introvert by nature anyway.
Anywho, my new office has drug reps here for breakfast or lunch 2-3x a week. They inevitably want to meet “the new doc”. Problem is, during my 1 hour lunch all I want to do is hide out and take that time to decompress. I want to chill on my phone, eat, maybe even catch a quick snooze. I also only live 5 mins from clinic and like running home sometimes. I don’t eat the food they bring (I bring lunch and eat breakfast at home). So…. How bad is it to hide from most of them? The other docs/PA/NPs interact with them but they also eat the food they bring. Am I overthinking this? 😅

Where I work messages from patients are often just passed on to pcp. Sometimes as bad as a call center employee writing “patient requests neuro referral” or ortho. Or whatever. With no context and tags the pcp to sign off on it.

It’s absurdly common in this system for these kind of notes to just be tagged like this.

How do you all handle this? Or does it even reach you since, in a referral-based system, a specialist referral typically needs an appointment to determine necessity, and the patient would be scheduled to discuss the issue.

I’m getting burned out by in basket. I currently average 1500 messages per month or about 75 per day when averaged over five work days. Is this a lot?

I never get any downtime because my schedule utilization is nearly 100% due to a combination of being over empaneled and filling in cancelations with add-on patients. I accept this because that is the price that you pay when you become an employed physician, but the basket side is getting ridiculous.

As it takes time for credentialing and interviews process, I want to check what’s good time to ask for renewal. I don’t want to stuck and have lower leverage. I am asking who has experienced contract renewals. Thanks

I’m crowdsourcing. Thanks fam.

Preface: lots of emergency medical personnel are amazing and provide great service to patients but this one left me confused

Patient comes in with severely jaundiced to clinic.

He’s encephalopathic and disoriented and has no relatives at all
Abdomen is distended and rigid.

I decide that to send him to the ED and since he has no relatives calling the squad was the best option.

They come and the head guy is the rudest person I’ve ever seen in this profession.

Proceeds to tell me what emergent and non emergent is and throws a huge fit telling me jaundice is no big deal.

So they go begrudgingly and patient does not live past that day.

Has anyone else seen this kind of behavior ?

Hello all, asking as a resident looking at outpatient/clinic jobs.

I’m in East Texas and there are not that many health systems here. Some of the options seem decent in terms of benefits like 1. actual nurses for patient messages, 2. Epic and AI, and 3. nice places to work. But, I feel like I’m being distracted by the signing bonus while the non-negotiable term is the ~$42/RVU. Is this just the new normal for RVU?

I looked online and I think the average is around $48/RVU while I’m reading some talking about $50 or $55 per RVU. What employers actually offer this to primary care docs?

I don’t want something signed that’s golden handcuffs when I’m missing the big picture compensation wise.

Can someone please explain CME to me like I’m 5? I know I need 200 hours before 2029. What are easy low stress ways to get it? I plan on doing a few conferences.
How much can I get from open evidence or AAFP?

TIA

Hello, I am an ob gyn taking a pause in practice. Happy to be getting more sleep soon but sad to lose my work-sponsored UpToDate subscription. I would like to fill in some of my rather large knowledge gaps in family medicine care while I have time off. Med school was a long time ago, I know there are blood pressure meds beyond labetalol and nifedipine but it’s been a minute... Any recommendations for basic textbooks/manuals for family medicine care that I should use my CME $ on before I go? Thanks!

Patient with multiple conditions and cancer under treatment with specialists. I'm not managing any of the conditions but patient wants me to verify their long term disability. Do you guys certify and what do you document?

So I'm looking at possibly relocating from my current position. Work private practice in the midwest, and looking to relocate to Columbus OH to be closer to my spouses family. Just kind of browsing and seeing what is out there, but I've done private practice since finishing residency, I'm trying to gauge what it would be like working for a larger system.

Title.