r/FamilyMedicine

Hello all

Just started intern year last week and my first rotation is surgery. A little afraid of the workflow of it and how I’ll be perceived. Surgery wasn’t my best rotation in med school and didn’t think I’d see it again matching into FM

So far the surgery team has been very nice but nervous about clinic and the rest of how it’ll go. And how I’ll be perceived.

Any advice for a dumb confused intern? Will they be expecting a lot from me as an FM intern?

I unfortunately saw an advertisement for this company on Instagram, and it was one of their creators (Manoj Arachige, MD) ranking different types of lab tests. I can’t find the advertisement anymore, but basically he ranked lipid panel as low tier and hormone testing as high tier. His reasoning for ranking hormone testing high was because they weren’t being tested enough. Massive eye roll.

I really hate when medical doctors leave clinical medicine and create a startup and decide their advertisement tactic is to start seeding doubt into the general population’s brain about the legitimacy of evidence based medicine and community doctors, so that THEY can make money. Like bro, do you not remember where you came from? It’s this type of propaganda that patients see very readily, which bleeds into our workday and seeds more and more distrust.

Check these reels out if you wanna get irked today:

https://www.instagram.com/reel/DSpv9l8CmjP/

https://www.instagram.com/reel/DSc3tW9iPt3/

https://www.instagram.com/reel/DSXt460FXdp/

Our training is long, arduous, and expensive for a reason. We give up years of earning potential, miss milestones, work nights, weekends, and holidays, and take on enormous responsibility to develop the judgment that patients depend on.
You deserve to be compensated in a way that reflects that sacrifice and allows you to have a good life.

If it were up to admin, they’d reduce us to productivity metrics and pretend we’re interchangeable, as if the decade or more spent becoming a physician doesn’t matter.
Don’t buy into that mindset. Your expertise is what you’re being paid for. Volume is simply the easiest thing for admin to measure.

Genuinely asking because the charting alone feels like a second job and then renewal deadlines show up and its another thing to figure out on top of everything else

Finding courses that actually count for the right requirements isnt straightforward either. Some states want specific topics, some have hours minimums for certain categories, and piecing it all together while seeing a full panel is its own research project

Wondering if anyone has found a more efficient way to handle this or if its just concentrated bursts of catching up every cycle

So we as family physicians see all sorts of interesting family structures. Some memorable ones:

• Guy gets his girlfriend pregnant, then marries her mom before the kid is born. Makes him father AND grandfather.
• Kid being raised by his aunt, but he been told she's his biological mom, even though biological mom lives nearby. Mom is aunt, and aunt is mom. I was told it's a family secret. "Don't put it in the medical records."
• Long-time married patient couple of mine get an acrimonious divorce. I see them separately for a while, hearing both sides of the battle. I even start treating guy's 2nd wife. Until they bump into each other in the waiting room. They both fire me for treating the enemy.

I am not making light of these situations. They are just so different from my own upbringing that I feel like I was born on another planet sometimes.

Any other interesting non-nuclear family structures you can share?

In the residency world there is a huge push to get pocus training in FM. None of the faculty have ever touched an ultrasound. We have a tech rep come once a year to give a demonstration but that’s it. Residency programs are now required to check off that a physician has had pocus training for the ABFM but barely anyone uses it. Also, I’ve never seen practicing docs around here touch it. I know for our hospital, they wouldn’t give the clinic a machine because of liability purposes.

I haven’t heard of anyone using point of care ultrasound in primary care, and if so, what do they use it for? If they find something, do they refer to specialist? I dunno, it just seems too much. And residency programs are scrambling since not one person knows how to use POCUS, in our shop they shadow a ultrasound tech and maybe see some u/s in ed and that checks the box

Our practice has been bleeding time on documentation for a while now. Providers are staying late just to finish notes, and we're starting to see the effects on morale. I've been tasked with finding a solution, but I genuinely don't have the bandwidth to do a deep comparison of every vendor out there.

I've heard everything from traditional human scribes to AI-assisted tools to fully automated platforms. The problem is the landscape feels enormous and the sales pitches all sound the same. I need something that gets us to a solid result without a six-month evaluation process.

If you've been through this before, what actually helped you narrow it down quickly? And which companies ended up being worth your time?

Which speciality are you working in and how's your experience? Do you recommend working there?

Do you do a lot of opioid/benzo management? How's the inbox coverage, hours per day, etc? I would appreciate if you can share any details.

Thank you!

Hello. Many of you may have read my question from yesterday. I have a follow up question. Has anyone ever had success with finding temporary work to fill the gap between finishing residency and starting your real job. I guess I'm thinking about moon-lighting or locums while I finish credentialing for my main job. Does anybody know if this is a viable option?

ABFM board-certified and already have a CA license. Planning to relocate to LA/SoCal area next year after finishing a fellowship and will be looking for outpatient FM jobs - open to academic and community-type gigs but looking to be with a bigger system. So far the contenders seem to be UCLA, Kaiser, Cedars-Sinai, and the UC system (specifically Irvine). How do these compare in terms of pay, quality of life/burnout factor, EHR (I want AI scribing), etc.? Any other systems I should be looking at?

PGY-(newly)3 here, love FM and planning to do fully outpatient practice after graduation, but really really struggling to not fall behind during clinic. We have a graduated system where each semester we increase visits per half day, just went to 8- 25 min patient slots each 1/2 (previously was doing 7 with a 25 min buffer in the middle) and I’m consistently ending the day ~25 min behind. Feel like I’m finally starting to build rapport with my panel and I really struggle to redirect / “cut off” people when stories get long or as they bring up more and more topics to cover. I feel like I am doing good agenda setting at the beginning of the visit, but maybe I’m biting off more than I can chew, or stuff comes up (like significant mental health struggles) in the middle of the visit that feels wrong to not address. The classic is the physical with carve out additional topics. A lot of my patients have difficult access so it’s hard to not try to cover what we can during the visit, and then when I get behind I feel bad being late to the next one and maybe agree to do more for them than I have time for too, and it spirals. Would love ANY tips/tricks or even specific phrases you use to keep time spent during appointments to a healthy amount without getting crazy behind on your day or ruining connection with patients.

Is anyone’s clinic closed on Friday but open on Saturday the 4th? Not an urgent care, but just a regular, Monday-Saturday family medicine clinic? My friend works for one. I didn’t believe it until he showed me his open schedule. Why not just let people go to the ED? Who’s going to schedule their annual pap or well-child visit on the 4th of July? The firework finger amputations have to go to the ED anyway!

Hey everyone. I'm a newly graduated FM doc. I'm taking a job in an outpatient clinic that is attached to a hospital. The clinic is run by a large health system, but the hospital is a separate entity. I have to credential both with the hospital and the health system that runs the clinic. I was supposed to start in September, but I just found out that due to some new credentialing rules (whatever that means), I will likely be delayed until October. As you can imagine, this concerning because I'm in a tight budget and an extra month of no income is frustrating. I know the credentialing process is antiquated and laborious, but I'm wondering if there is any way I can expedite the process. Or if there is such a thing as provisional credential that would allow me to work while the final approval is pending. I'm sure many of you have been in a similar situation.Any advise would be appreciated?

Is a commute of approx 1 hour each way from outpatient clinic and home advisable for a newly graduate starting as an attending?

My original commute went from ten minutes each way to an hour each way at a different site due to a change to the original clinic‘s business. Not able, personally, to move to the city the new clinic is in.

Edit: It was not my choice or decision to change clinics. The original clinic could no longer support another physician coming in due to lack of patients available to fill my prospective panel. During my interview several months back, I asked and was assured that there would be enough patients to fill my panel. However now that has changed.

They also did not offer any changes to the contract I signed. I know that makes the change of clinics even worse. What can I do as I love the original city and there are no other positions in the city available?

I have worked at two separate primary care clinics, and at both of them I have rapidly become known as the black cloud. Yesterday I had a confirmed case of herpes ophthalmicus (HSV-1) in a otherwise healthy mid-20s male. This is the second confirmed case of this I've seen in otherwise healthy people. Before discharging him I reviewed the plan with my SP and unprompted asked me "why do you always get the weird stuff?"

Before leaving my previous job I had 4 confirmed pulmonary embolisms walk in for scheduled primary care appointments over the span of 5.5 years. That clinic had 4 other FTE spread between 5 other providers, and, of my colleagues, only 1 other PE was seen in the clinic.

I've had a few other notable weird things, but I'm sure we all have. Has anyone else ever noticed that they (or someone else they know) is a magnet for weird things, or is this just the Baader-Meinhof phenomenon, and now every time I get something odd people just see what they expect confirmed? (My rate of outpatient primary care pulmonary embolisms not with standing).

What does everyone think about invitations from patients to birthday parties, anniversary parties, graduations, funerals, etc? I’ve been invited to a few but haven’t attended.

Have you gone? Is it awkward? How do you make a strategic exit?

Just curious!

So.. I'm wondering, in my country, when people are trying to talk to a psychiatrist or therapist, the standard practice is to first send a message on WhatsApp, which is basically what everyone uses. Is not that normal to just call upfront.. some people find it fine, but others don't.

I'm mostly trying to understand the common etiquette for this situation. For portals I know you can just follow the form.. I'm trying to understand it when they provide their phone on the website for example.

Do I send a message or is it weird to send a message? Do I call directly or is also not common?

Does anyone use email? In my country no one even checks email..
What do you guys think?

Medicare just started covering GLP-1s for $50/month through a new program called Bridge. It goes from today (July 1) to the end of 2027 (another GLP-1 program, BALANCE, is anticipated to start after that). Here's some info about which patients are eligible, and what needs to happen to actually get GLP-1s covered for your patients.

All patients with BMIs of 35, and some patients with BMIs 27-35, have coverage, so long as their Medicare Part D plan wouldn't normally cover a GLP-1 (more on that in a sec). Patients with a BMI of 27-35 are eligible if they have other chronic conditions or medical history in this table:

Patient BMI	What else they need
35 or higher	Nothing else required
30 or higher	Heart failure with preserved ejection fraction, uncontrolled high blood pressure, or chronic kidney disease (stage 3a or higher)
27 or higher	Pre-diabetes, a prior heart attack, a prior stroke, or symptomatic peripheral artery disease

Medicare Bridge covers Foundayo tablets, Wegovy as an injection OR tablets, and Zepbound.

• Single-dose Zepbound pens and vials are NOT covered.

To get coverage, the patient's physician needs to submit a prior authorization form. You can download the PDF directly from Medicare here or use this Medicare GLP1 prior auth PDF form filler to generate a PDF ready for signing. The form itself has various questions about the patient that correspond to the eligibility criteria above. Note that before submitting this form, the pharmacy should submit a claim which is denied.

A few more notes on eligibility, edge cases, operations, etc:

• You don't actually have to be enrolled in Medicare to prescribe your Medicare patients GLP-1s, but you can't be on the Preclusion List.
• Medicare Part D coverage. Some patients were already eligible for GLP-1 coverage through Medicare Part D. If that's the case, they're not eligible for Bridge. However, there is a new cost cap of $2,100 per year for Medicare Part D, so your patients in this category do have cheaper access to GLP-1s than before (even if the out of pocket cost is higher than most of us would like). Medicare Part D covers GLP-1s for T2D, moderate-to-severe sleep apnea, or MASH; for those patients, the pharmacy submits claims directly to the Part D plan as usual and nothing changes.
• Prior auth claims can be submitted starting today, July 1. Medicare says you'll hear back within 72 hours.
• After the prior auth is is approved, subsequent fills don’t require a new prior auth (unless you change the patient to a different medication). Only 28-day or 30-day fills are covered under Medicare GLP-1 Bridge for now.

Medicare has more official documentation here, but the above covers the basics and I hope it's helpful!

Saw a patient yesterday who has the classic “chronic fatigue” and “chronic joint pain” with a negative million dollar work up. This patient has been seeing a functional medicine clinic, which normally I don’t care about, but yesterday a switch flipped.

This patient believes they have “chronic Lyme disease” despite never being diagnosed with Lyme disease and any testing being negative. We discussed possible fibromyalgia, but of course they want to “get to the root cause.” So they’ve been seeing a “chronic Lyme disease expert.”

Come to find out this “expert” is an RN. Not an NP or PA or MD. But an RN passing herself off as a “holistic practitioner.” I have NO idea how this is even legal. I told the Patient point blank this person does not have the training to be an expert on it and furthermore the patient has been through a battery of expensive tests and “treatments” to the tune of thousands of dollars with none of it making a lick of difference or being “inconclusive.”

How is this even legal??

41 yo FM doc here. Recently found out that I lost a high school classmate. Great dude, seemingly in great shape. May have had some drug issues, and probably was on steroids. Left a beautiful young family with beautiful young kids.

And here I am, going through labwork on stable elderly patients, working up trivial complaints late into the evenings. The guy that needed all of the healthcare resources in the world was my classmate that passed away. And now his family needs them. But I have a feeling they won't get them.

I chose FM because it seemed to be more about the bigger picture. But American medicine seems to have me chasing urine protein on people with well controlled diabetes, ordering stress tests because somebody just won't stop complaining about their MSK pain, sifting through unnecessary tests because some moronic influencer suggested everybody on the planet has Hashimoto's or chronic Lyme.

You guys ever think it'll change? I chronically feel like I'm trying to compensate for a failing public health system - addictive and horrible foods, zero physical activity, failing mental health due to lack of social support and the evils of social media, drugs, alcohol, cigarettes, etc etc etc.

We've lost our way, and we've completely lost the big picture.

Here's hoping. I'll quit complaining - I've got to go finish some charts...