Graduating in a couple of months and am moving to North GA to be near family. Clueless about opportunities, scope of practice, what to expect etc and looking for some advice and guidance. Moving from Midwest where full scope family med is extremely common with tons of opportunities. My dream job is outpatient with some OB and vaginal delivery privileges, and some rural ED moonlighting.

If you could go back before your first contract, what’s one thing you wished you knew? Besides getting a lawyer to look at it.

Looking to get out of the US while we still can. I don't think FQHCs are going to survive the next 4 years.

It looks like Alberta would be a terrible prospect and BC has a much better payment model for FM docs. Would like to be near the mountains. Prefer living among and working with lower income persons.

How hard is it to work only part time in an FM clinic? From my initial reading, it sounds like my operating costs as basically a government contractor may necessitate full time work and carrying a large panel. But I'd be interested in working in addiction too, if that's an option for family docs.

First time posting but long time lurker and new attending. I was hoping to consult you all for advice on a patient with cancer who is declining all care including chemotherapy, palliative care, and blood transfusions. I have seen this patient multiple times in clinic and begged for them to go to the ED on many occasions but they refuse. They are rapidly declining and I’m not sure what else I am able to offer them.

Should I continue scheduling visits with them in clinic? I’m struggling between respecting their wishes while also protecting myself from liability (although their condition has been explained many times by many different doctors). I’m beginning to feel like our visits are futile as we are rehashing the same conversation every visit. Would love to hear your thoughts on how you would proceed.

Edit: The patient is young and has a treatable cancer. They desire to keep fighting and their goal is to pursue homeopathic treatment. Family is on board with this. Appreciate all the comments so far, they’ve been helpful.

Yes I already have patients come in for an appointment to fill out any paperwork.

But I’m realizing disability paperwork is a whole different beast. Pages and pages of questions that can’t be answered clearly. Plus it requires pretty significant time doing chart review because I can’t remember all the meds people are on with the dosages, since when, which specialists they’ve been referred to, the ICD codes, etc.

Please give me some tips on how to do these efficiently, realistically. Do your MAs/RNs do them?

Also, are there cases of PCPs running into legal issues when filling these incorrectly? It just feels like the language is really hostile and they’re putting all the burden on me to why I think my pt’s are disabled.

EDIT: specifying that I meant private company disability paperwork (Met Life etc) The government ones are still painful but at least not super long.

https://www.ktvu.com/video/1585017

Summary from KTVU / Channel 2 Oakland:

“Kaiser Permanente officials on Wednesday said two of its researchers had been suspended following an internal audit found they broke rules and put some research volunteers at risk in a study that was terminated in 2022.”

Here is the link to the article from Bay Area News Group :

https://www.siliconvalley.com/2025/01/29/kaiser-investigation-research-doctors-disciplined/?fbclid=IwZXh0bgNhZW0CMTEAAR2c8T9Fpt_Luk-3lNi1qn5eLu0Gr3VbdVRJca2WFH_0K9YubP-xzlaYxD0_aem_hIgNqVAsYfvWHDmSO2DuIg#m6k37ds17bs41q1coqu

In my first year of practice after residency. I joined a decent sized physician group that is contracted the with local hospital system. The group has multiple offices all over the area.

Since starting, I have assumed the role of putting in my own billing codes for the most part. They then get reviewed and submitted by our offsite billers.

I have reviewed previous charts and realized that certain codes have been getting removed. Example: preventative code + 214, the 214 gets removed. I inquired about this and was told I need to be writing two notes to double bill, but they could not provide me with any actual information that confirms this. So - I actually did spend the extra time to write an extra note only to realize that it is STILL sometimes being removed. Also adding G2211 code for chronic care visits and this is being removed off basically every chart with exception of certain Medicare patients. My biggest issue with this is I’m not even being told they are removing the codes, I just happened to look myself.

1. Has anyone had experience like this, how did you address it?
2. Am I just not UTD on billing enough and maybe I am actually billing these incorrectly?
3. What are you alls favorite resource for most UTD billing codes and info I can be using to maximize RVUs.

A long time ago, someone linked a website that had excellent information on various supplements with data supporting each, side effects, interactions, etc. I can’t find my note of it. Anyone have the link/info? Just have a handful of patients who prefer the “holistic” approach. If they are going to go for it, I would like to do a better job telling them what actually has some evidence so they aren’t paying $100/mo for a glorified multivitamin.

So just a shot in the dark to find the right website again. I think it was this subreddit at least.

…odds are good they’re about to ask for something suuuuuuuper sketchy.

Hello, I am only a second year medical student so forgive me for any ignorance. I have future aspirations of creating a DPC and I feel like the best specialty for it is either FM or MedPeds but I am having a hard time trying to figure out which is better. Here is my rationale in pro/ con format.

Family Medicine

Pros

- The largest scope of all of medicine, so could craft practice to fit needs of patient population while still being in scope

-Shorter residency by one year and easier to match into with geographic control

- I believe most programs have more out patient procedure training which is good for DPC 

- I believe more training in MSK, Psych, Derm, Gyn

Cons

- Compared to MedPeds, has a fraction of Peds expertise and I feel like parents who seek out a DPC doctors have certain expectations,  and with most parents already preferring to see a pediatrician for their kid rather than an FM doctor, I feel like the lack of training in Peds would make one less marketable

-Less competent in Peds, from what I have seen on reddit, it seems like fm doctors can handle the regular cold like symptoms, ear ache, strep throat, physicals, etc but once it becomes more than that then they refer to peds, I feel like that would defeat the purpose of a DPC

-Can't specialize into one of the ologies so if DPC becomes unviable for some reason, stuck (would not want to do primary care if it is not through DPC)

- Rotations in Surgery and OB, which for me is essentially wasting time in something that I will never do in any city that I would like to live in, I am also not a fan of surgery or OB 

MedPeds

Pros

- 4 years of training dedicated to strictly adults or peds, so trades out the breadth in FM for more depth in the things that you would actually do in practice

- Marketable: Being double certified in both Internal medicine and Pediatrics seems marketable to me, and parents that prefer their children seeing a pediatrician may appreciate that

- More Peds knowledge: Has a higher threshold for handling complex kids without having to refer, which I think is great for DPC

- Can further specialize incase DPC does not work out for some reason

Cons

- Less procedure training, which would not be ideal for DPC

- Less out patient experience in Psych, derm, gyn, etc

- One year longer and harder to match into, and with there being less than 80 residencies in the country, very few options for desirable locations to live in

So overall I feel like there is no clear winner in terms of what would be better to match into for hopes of a dpc practice in the future, so I would love feedback from anyone who may have some insightful ideas

I’m curious if it’s alright to apply to multiple jobs at once for locums?

Applied two days ago for a position through one locum agency (formally presented). Now there is another job with another locum agency that also seems appealing.

Is it alright if I apply for that job too? I only have time for one job. I’d rather not wait a week to see if my first position went through and then miss this second opportunity if I don’t get picked for the first job.

First time doing locums, so not entirely sure how it works or what the etiquette is.

So im an RN and critical care paramedic with about a decade + of experience also in ED and CTICU, going through NP school while working in an urgent care.

I am seeing a plethora of patients who NEED to be in the ER, but are refusing to go. The near-septic or hypoxic PNA etc.

My question is, are you guys telling these patients they need to go, then having them sign a refusal if they dont? Or are are you caving and ordering ridiculous outpatient workups?

What is the route with less liability for my own knowledge and future practice. Im very comfortable given my background with knowing what to do and who is sick and needs to go… but when they refuse I feel like you are very much stuck between a rock and a hard place.

Thanks in advance for the fostering of conversation!

Looking to compile a list of niche items FM doctors are doing that is not the standard outpatient 9-5 practice. Apart from hospitalist, urgent care, and EM, what niche things are you doing as an FM doctor?

I inherited a patient with chronic lower back pain on tramadol 50 mg 3 times a day. I was able to reduce her dose to twice a day as needed and discussed continuing to taper. She has been doing PT as well.

I referred her to pain management who tried a 3 different injections. On the most recent note, pain specialist said they exhausted all interventions and now recommends increasing tramadol back to 3 times a day. The note mentioned that this treatment plan is "extremely safe". Of course, patient messaged me to request increasing tramadol prescription. Also, the pain specialists from my organization has a rule that they do not take over or prescribe opiates.

What do you guys think about the situation? Thanks.

-------------------------------------------------------------

Follow-up question:

A lot of people are agreeing with this pain specialist to continue Tramadol for life. Please enlighten me with a recent study that reports the efficacy and safety of long-term use of opiates for chronic pain management.

I've had a string of patients come to me for firm, nontender subcutaneous <1cm nodule usually somewhere on the trunk. Sometimes mobile, sometimes fixed. No symptoms, they just happened to notice it one day. Unchanged in size since they noticed it. No overlying skin changes. No fevers/chills/etc.

My approach to this had been "not sure what it is, but if it's not causing symptoms and not changing there's no need to do anything, continue to monitor." I've considered getting US but it seems silly to get an US for something so minor and so small I'm not even sure if US can even detect it.

What's the actual differential for this? Doesn't look or feel like a lipoma/ganglion cyst.

Hey all! I have some unusual hearing loss at a young age and would like to get a better stethoscope rather than hearing aids, since I hear conversations fine in an exam room. Currently I have a master cardiology and it’s fine for most patients but I have noticed a harder time with obese patients or those with soft heart sounds. I don’t want to miss subtle sounds on my exam.

I’m considering buying the Eko stethoscope but wanted to get experiences from others. Alternatively I was considering getting the Eko core attachment for my current stethoscope.

Does anyone have experience with either of these to list pros and cons?

Internal Medicine grad, currently doing Nocturnist hospitalist 1 week in a month. Ive a target group, immigrant population and community. I know a couple languages that community speaks. My plan is slowly growing/transition to outpatient clinic while working as hospitalist. Any thoughts about Philly suburbs? Litigation? Possible DPC ?

Thanks

Hey just looking for any insight from current one care users. Pros Cons

Thanks

I have a patient I inherited on chronic hydrocodone. It was kind of unclear how he was started on this, he stated it was for chronic low back pain but never really had his back pain worked up. I got an MRI which did show some nerve root compression. He saw spine surgery who referred him to PT, although he stopped going to PT after a couple sessions and never returned. I’m still filling his opioids monthly, which he says he takes about every other day. However, his last 3 drug screens were negative for opioids which makes me concerned for possible diversion. So, what should I do at this point? I could give him a warning, but then he could just intentionally take the opioid prior to his next appointment when I do a drug screen. Do I cut him off completely right away? Is there any possible legitimate reason the drug screens may have been negative? I’m thinking of sending him a detailed message explaining that I’m cutting him off, and recommending he find a pain specialist. But I’ve never had to do this before and don’t have much experience with chronic opioids in general.

I need some advice, or justification? I am not sure which one. I’m signing this paper that a patient is unsafe to drive. I feel good about it. Any thoughts to the contrary?

62yo patient with history of gastic bypass, IDA, lacunar stroke, serious vitamin B12 deficiency, ataxia, frequent syncope most recently with SDH, chronic pain, alcohol abuse, insomnia, wild polypharmacy, and most recently "overdose of undetermined intent". Multiple hospitalizations with nothing improving.

She has worked with ENT, neuro, psych.

Since I met her in fall 2022, EVERY SINGLE visit of ours is about her "vertigo" and at every visit I have been trying to get her to quit drinking, while reducing the wild amount of medications that can cause her symptoms. Her only response is to ask for more Xanax, Ativan, Ambien, Seroquel, Benadryl (even though its OTC), massively high doses of gabapentin, hydroxyzine, Lamotrigine, Trazodone. Her Psych NP has been filling all of these. Not to mention her Oxycodone from her pain doctor. I have sent letters to her NP to please reduce medications and she has been helping do this.

Yesterday the patient presents to my office to tell me she was pulled over going 40mph in a 75mph. The office said she seemed confused, she fell and hit her head, and EMS evaluated her. She wants me to simply sign this paper for the department of licensing saying she is safe to drive. If she doesn't get it they will revoke her license.

My immediate answer is Hell to the NO I will not say she is safe. She has a neurologist who could evaluate her and sign this paper but she said it "has to" be her primary care physician. She knows I think she’s unsafe and that when she sent me the paper I would be saying that.

I am about to check all the boxes showing my concern, and I feel pretty good about it. She isn’t safe. I didn’t even know she was driving. She usually came in with a caregiver.

Edit: I’m signing this, I feel good about it, she’s unsafe, but it’s nice to know I’m doing this right when I’ve never done it before.

I thought the good folks at r/FamilyMedicine would steer me in the right direction. (pun intended).

disclaimer please don’t make this a political discussion as this is a general question about funding and not political ideas.

Will FQHCs be affected or lose funding with the new spending/funding freeze put into effect by the recent executive order?

I have created bunch of SOAP templates using ChatGPT and use that in my EHR for custom templates. Anyone used Deep Seek so far ? That’s my agenda for this weekend :)

Aside from its questionable efficacy. I wonder, why is it so expensive. It’s just a little bit of blood that is centrifuged and put back into a joint etc. Why does it cost 500$ in the US ? Or 1000$ ?

Has anyone taken NAMS/North American menopause society certification examination?. If yes, is there any book you recommend for the exam?

I volunteer at a free clinic that serves a primarily immigrant population in the midwest. Given the executive orders by the new administration, I was wondering if anyone had any up-to-date resources that we could post in the clinic regarding patient rights/what to do if questioned by ICE/ability for us to keep records safe/etc.

It would be great to have some more resources on this so both our patients and our staff have a better idea of what to do in case ICE shows up on our doorstep.

Edit: lol if you're going to downvote me for asking this question you can gtfo. Regardless of your opinion/political affiliation, we have rights per the constitution and UDHR. The right to a fair trial, to remain silent, to not be rounded up without a warrant certified by a judge, to free speech, to access medical care, to have private medical information protected, etc. Rounding up immigrants (illegal or legal) or citizens without a warrant/probable cause in places like churches and hospitals is not only morally bankrupt (an opinion), it is also against the law (a fact).

Freely exercising your rights (second amendment, free speech, etc.) when it suits you and then being mad at others for educating their patients to do the same is hypocrisy at its finest.

For set 48, question 3 - the patient has De Quervain’s tenosynovitis. Which next step is most appropriate?

I picked "A corticosteroid injection into the first extensor compartment" which was considered wrong. The "correct" answer was "Immobilization in a thumb spica splint and an NSAID for 1–4 weeks."

The explanation says: A corticosteroid injection is helpful but is typically reserved for severe cases or if conservative therapy fails.

However, if you look at the most recent AAFP article on the subject, it says "This condition is typically treated conservatively with palpation- or ultrasound-guided corticosteroid injection, splinting, occupational therapy, and activity modification."

And if you look at the original article cited by the AAFP article, there is an algorithm given that clearly lists corticosteroid injection as one of the first steps in management: https://i.imgur.com/KNS8yQh.png

I know you guys are probably going to think I'm some crazy guy ranting about nothing, but it's frustrating because this isn't the first inaccuracy I've seen. I've tried emailing the faculty listed (David Weismiller) several months ago and haven't gotten any response.

And yea it's just a question bank - but it affects patient management! Shouldn't we strive to be as accurate as possible? I don't want to constantly have to be second guessing my learning material.

Obviously there's going to be inaccuracies in a question bank with so many questions in a field that is as broad as family medicine. If anything, though, I feel like that just means we have to be that much MORE responsive to feedback.

Maybe we need more faculty members helping to write/edit questions?

I get paid percentage of collections. 42% in office 50% telehealth. Privately owned group practice . I work 3.5 days per week , Midwest . Outpatient only. Mix of kids and adults . Average full day is 17-22 patients and half is 7-12 patients . 8 of them are telehealth per week . My gross pay was 200,000 Just wondering if I’m underpaid.

I'm planning to get a new laptop and considering a MacBook. Is it good for running statistical applications and compatible with MS Office for writing papers?

I love family medicine.

It changed my life. I considered other specialties and sometimes I wish I had gone into x other specialty but overall I like what I do.

Why does it seem that people just love to shit on it so much. Other physicians on here with a the world is burning down attitude about it.

Look at all the wonderful things happening all around us. We’re able to treat people in better and more interesting ways.

We have obesity medicine really becoming prominent in the world.

But whenever something positive is posted on here, the goons come out to play. They ridicule and downvote and go scorched earth on any positivity or post cherry picked pieces of information to support their world view that their job sucks.

How will we as a collective ever improve and foster a better future for ourselves? This attitude is why the private practices died off.

We never fought for ours when other specialties keep fighting for theirs.

Oh god forbid someone actually happy in as a doctor? Let me downvote them to oblivion or attack their character.

I for one choose not to be that way. I love my job.