u/MzJay453

What’s that like? (And how do you legally discharge them from your practice without getting hit with patient abandonment or retaliation?)

New attending kinda confused on what best to advise patient on. Guidelines changed as I was on my way out of residency and I feel like there was no great consensus on when to check and what goal to supplement to? Just circled back and reviewed the data, and it kinda seems like generally, vit D is often a non-factor and we check it too much and supplement it too aggresively? So should I stop checking it for fatigue (Open Evidence says yes, I should stop checking it lol).

Just had my first full day of patients, and NOTHING was straightforward. Felt like I was looking up every single question/diagnosis. And then I came home and thought about my management, and I'm like - shit. I forgot to warn that one about that one side effect of that med. Or...damn, was that the proper workup for that?

It's like that feeling after taking a test and ruminating on everything you must've got wrong. I got myself out of clinic by saying "None of these decisions I made today should kill anyone" and then I started thinking/catastrophizing more of anything that could go wrong and that mental safety net was no longer accurate either.

I'm honestly spiraling, and I haven't even gotten abnormal labs back yet.

Help!

Sorry if this comes across tone deaf. Will be starting new attending job soon, but just sat down to crunch numbers today and despite my salary (theoretically) being almost 4x more, with the addition of loans & a few more bills, I feel like I’m still gonna be a tad bit stretched thin.

I’ve been hemorrhaging funds since graduating residency, my sign on & relocation was helpful, but moderate and did help me not have to take out a loan but I still have a lot of aggressive saving to do to replete my savings. Just curious if others felt this squeeze with the transition from residency to attending life? Almost feels like more money, more bills right now lol.

I have a good friend throwing a party, she's invited a bunch of people I don't know and a few I do know but they will be with their significant others. Essentially I will be at this party alone, and this is honestly my personal hell because I despise small talk.

When I'm uncomfortable, I generally just stay quiet and retreat into myself. I will essentially be a wallflower at this dinner.

I've had situations like this before where I've asked her if she would care if I didn't come (because she won't notice I'm there anyways because I'll be so quiet), and she gets genuinely upset. And I honestly don't understand why? Like I'm happy to celebrate her one on one, but with 20 other people, I will be internally dying.

Just help me understand, give me some motivation to suffer.

I have a good friend throwing a party, she's invited a bunch of people I don't know and a few I do know but they will be with their significant others. Essentially I will be at this party alone, and this is honestly my personal hell because I despise small talk.

When I'm uncomfortable, I generally just stay quiet and retreat into myself. I will essentially be a wallflower at this dinner.

I've had situations like this before where I've asked her if she would care if I didn't come (because she won't notice I'm there anyways because I'll be so quiet), and she gets genuinely upset. And I honestly don't understand why? Like I'm happy to celebrate her one on one, but with 20 other people, I will be internally dying.

Edit: I meant to specify for those of us starting as attendings with no income lol

Thought I had an enough in savings to last me 2-3 months, but I’m adding up the math, and I feel like it’ll be quite a squeeze.

For those of us that don’t have rich parents, are we just putting it all on credit?

Is this excessive?

Kinda rhetorical & looking for some confirmation bias. But my realtor made a comment about the townhome being "too much" for me. Starting a new job, sick of apartment living, and I would've been fine with 2, but it was damn near impossible to find a 2 bedroom in a nice area with the safety amenities I wanted as well (this community is gated & in a nice location).

Anyone can relate? The townhome is not huge, the rooms are pretty modest size, but I like having the extra space & hoping to have quiet(er) neighbors.

Edit: I'll be renting, so the yardwork and general appliance maintenance won't be on me.

Single female living alone outside of apartment for first time. Found a townhome I really like but after thinking about it, I’m nervous about the patio door with access to outside. It’s on an end unit & in a culdesac (which I love for privacy) and my bedroom is on the second floor, doesn’t share walls with anyone, but upon second thought I was worried the extra privacy might also make it more attractive for an intruder. I also have 2 windows on the ground floor.

The area overall is really safe, quiet suburb, pretty much zero random violent crime (but there’s a first time for everything….🫠) I do wish it was gated community, but it’s not lol.

I was thinking of getting some type of invisible window bars, of course ring camera, and maybe glass shatter alarm. I also am considering asking the owner if he’d let me fence around the small patio area where the patio door is open to the backyard right now.

Thoughts?

And when do repayments start?

Graduating in June, looking to do IDR, do I apply as resident or wait until official July 1st date when I get the email from my loan servicer? I'm seeing conflicting things...?

I will be doing private practice, so won't qualify for PSLF.

Graduating in June, looking to do IDR, do I apply as resident or wait until official July 1st date when I get the email from my loan servicer? I'm seeing conflicting things?

I thought it was ok, learned a little bit more.

Was a pain in the ass to find the documentary on a streaming service, but finally found it, as I had been on the lookout for it to drop.

I found the reenactments to be a bit cringe, but I guess in the absence of crime scene photos (which I was surprised he didn’t include), I guess it was necessary. But the wigs were distractingly bad. Also the directors interviewing style could be a bit blunt/crude at times.

I agree with the prosecutor that it’s kinda wild this hasn’t been solved yet, but also agree with the detective that the perpetrator is likely dead & we probably won’t crack it without a indirect ancestry DNA link. Although it sounds like the Tinley PD has some leads they’re keeping close to their chest for whatever reason. If the perpetrator is dead though idk what they have to lose.

The theory about the survivor being in on it doesn’t really make sense to me because a neck wound is very hard to fake. Unless her injury is significantly less serious than made out to be, and it was self inflicted but I would think/hope they could look at her injury and determine if caused by a bullet or not, as the commentator said a “Graze wound can just be a scratch.” My question would be, how serious is the wound?

Rhoda, the manager sounded like an amazing person. Especially the bit about how she technically could’ve escaped through a back door but she chose to stay and get help. I didn’t realize the whole 911 call has yet to be shared so it likely does include the sounds of him shooting them in their final moments. She was whispering so softly though idk how the killer could hear her.

And when? I feel like I’ve always been told that hormone testing in and of itself is unnecessary and unreliable as the levels fluctuate so much depending on the time of the cycle. However, I was listening to a lecture today from an OB/GYN that does a lot of hormone replacement and she mentioned that checking the estrogen levels can be helpful, especially for seeing if estrogen is at a sufficient level to prevent osteoporosis.

I have been hearing more and more from patients and other clinicians that specialize in hormone test testing that we should be doing more for these patients requesting hormone testing and replacement. I still don’t feel like I have a straight answer on bioidentical hormones and stuff like BioTe. Is it legit or bullshit? Does it even matter if it helps the patient?

How often are you calling patients back in these circumstances (outside of delivering cancer diagnoses). Get routed these messages a lot from MAs & don’t understand why it’s so hard to just hardline tell patients to make an appointment?

Is it just me or is the scent quite fleeting? Maybe I’m too lighthanded with spraying?

Any practice changing guidelines? Thought it'd be fun to keep each other up to date.

I learned today from an attending that we should be using the PREVENT calculator instead of ASCVD. Also apparently LDL<100 is the new <130.

I feel like this is something that is not discussed commonly here because everyone thinks primary care jobs are a dime a dozen, but for those of you who wish to work in relatively popular, vibrant locations, recognize that sometimes even PCP jobs can be in fierce competition. Often times you are competing against multiple other applicants, and many jobs do tend to value more experienced candidates.

At least in the area I was looking in for a major hospital, I was specifically told more docs are moving away from small towns and moving more towards the city. Docs are also not retiring in these inner cities as much as you'd suspect, and their is minimal turnover

I don't say this to cause alarm, but I do think it's important that graduates know to keep their options open. And I only want to emphasize this because it's happened to both myself and multiple colleagues now, recruiters will lead you on (especially for major hospital systems), take you through multiple interviews and then vanish into thin air &/or completely pivot on job availability/locations. I've noticed an influx of recruiters connected to hospital systems that have been ghosting candidates and/or not being transparent about job positions being filled (but they waste your time having you talk to leadership anyways, with the purpose of filing you in the backup box if their first few choices don't work out).

But ultimately my recommendation is: always have multiple options, always keep talking to multiple people, because until you have a contract offer in your hands, nothing really counts, and even with a contract in hand, things can still fall apart when you read the fine print. Just be smart, and always keep options open, and aim to have multiple options, because things can always fall apart or completely go radio silent when you least expect it. And if you only have one option on the table, it limits your negotiating power when you do finally have a contract & want to make changes.

Private practice job is offering 15 PTO days (which includes personal & sick days), 7 holidays, 5 CME days.

Idk if private practice is just more stingy, but I feel like my friends signing with hospitals are getting a lot more? How do I ask/justify more days off, especially if they try to say it will affect my productivity bonus?

Tips? 👀

Ok, I’m being dramatic. It’s not the worst but there are multiple asks, and I feel like I’m going to really have to do some prioritizing with what I want. Unfortunately I have no other offer to compare it with right now & I don’t have time/patience to fish for new jobs right now lol.