u/Funny-Diamond-7677

I am done with residency and will be starting my first attending job soon at a rural critical access hospital. My training has been in an unopposed rural FM program with a busy outpatient clinic, inpatient service (cross coverage with 8-15 admissions per night), open ICU, and emergency department. I've been fortunate to get a lot of hands-on experience with outpatient procedures (joint injections, skin procedures, etc.), ICU care, ventilator management, intubations, central lines, chest tubes, and the usual inpatient/ER management.

The job will be mostly outpatient clinic (4-day work week), with ER and inpatient responsibilities one weeknight each week plus one weekend in every five.

I've already asked to meet with the clinic manager before I start so I can understand how everything works and set expectations early. Some of the things I plan to discuss are:

What my typical daily schedule and template will look like.
Inbox management and expectations (results, refill requests, patient messages, etc.).
How FMLA, disability, and other paperwork are handled.
Expectations for documentation and turnaround times.
Whether I can eventually dedicate part of a day to procedures once my patient panel grows.

For those of you practicing in similar rural full-spectrum FM jobs:

What surprised you the most during your first year?
How did you learn billing in this kind of environment?
What do you wish you had discussed before your first day?
What expectations or boundaries are worth establishing from the beginning?
How do you keep your inbox and paperwork from becoming overwhelming?
If you have a dedicated procedure clinic, how did you build it?
Any advice for balancing clinic, ER, inpatient, and call without burning out?

I'd especially love to hear from physicians practicing in rural critical access hospitals or similar full-spectrum FM positions. Looking back, what advice would you give your new-attending self?

Billing

Starting my first job at a critical access hospital