I probably did one or two knee injections a few years ago in residency then none in my past two years post training due to patient population and specialist access. Now at a new job with new patients scheduled for joint injections. I know knees are relatively straightforward on paper, I’m concerned about the lack of “muscle memory” here for a procedure I’ve barely ever done and don’t remember. No ultrasound available for guidance. Can anyone recommend videos especially for learning and tips? Or should I just say it’s been too long and I never really learned this and defer to my colleagues?

Hello, I am wondering what is appropriate for inbox coverage on vacation. I'm a newer attending. I am in a private practice (7-13 providers). On my "off days" during the week people cover their own boxes mostly, myself included. I take maybe 3-4 weeks completely off a year.

Culture is most providers (not all) just take their computer with for vacation and do their box when they are away. I am anxious tending and having to check my inbox consumes my brain and it isn't healthy. Personally, I think everyone needs to be able to completely unplug occasionally and to have to check inbox on vacation is unhealthy.

Is it reasonable to completely unplug, knowing that my colleagues will have to take extra time to cover my inbox? ( I would be more than willing to return the favor). This is "allowed" and approved but I feel like it is looked down upon so i get a great deal of anxiety before doing so.

Or do i suck it up and just manage my inbox like the others?

I am wondering whats normal for others.

TLDR; i'm torn between what is normalized and my mental need to be able to disconnect

Applying for jobs in Canada (as a US trained MD), please rate thjs offer:

Downtown Toronto area
30% overhead
40 hours per week (with option to work evenings and weekends though this is not in contract)
3 year contract

Was verbally told of the following which is not listed in contract:
Salary 300-800K based on how many patients I see
3-4 weeks PTO
Will be building a roster up
Can start off seeing longer appointments (20-30 min), then decrease to 10-15 min slots
Can do one day virtual from home

Should these be in a contract?

Is it not common in Canada to have the following?
CME money
Sign on bonus
Relocation bonus

My goal is to make around 350-400K without killing myself. Is that realistic with a 40 hour work week building a roster up from scratch?

Also any other things to look out for? I am hoping to stay in Toronto/GTA but not bound to specific location.

Does anyone have any tips on managing dementia in a patient without family or with uninvolved family?

I have a 90 something year old patient with progressive dementia with only 1 estranged family member who has reluctantly agreed to be involved in her care. The patient at baseline before her dementia was fairly mean and this has only gotten worse. Every appointment is a mess with patient and family member arguing. I of course interrupt and deescalate but it just eats up so much time. Something as simple as filling out an advanced directive evolves into what can easily be a 1+hour appointment. When I give it to them as homework they never get it done.

It’s all doable with time but how on earth do you do this with the limited time we have? Typically these patients also can barely make it into the office and family is hard to reach so I feel like I’m barely moving the needle. Just asking the patient to come back in a week would be logistically challenging for her.Trying to manage her medical conditions, get advanced directive and figure out safe living situation feels like too much to do. I try to use my ancillary support like SW but they typically give up at the slightest challenge.

Do I refer to geriatrics? Do they have more support/time with patients? Better social workers?

Props to the docs that prioritize being wonderful parents in a profession that tries to act like nothing should be placed above medicine.

There's no greater gift to the world than prioritizing the next generation. And the only place you're truly irreplaceable is in your child's eyes.

I'm certain somebody needs to hear this tonight.

I'm getting pretty fed up with patients adding me as their pcp when they never came to establish or they saw me for one acute issue but were not there to establish care. I'm now getting specialists sending me notes and follow up for these patients. Some of them say would need age appropriate cancer screening.

The system should never allow people to do this. My coworker said hmo patients have to select pcp before they come in so it's not really the patients fault either. The thing is some of these patients have never seen me. It's especially worse with ppo patients who doctor hop and seem to have multiple PCPs in different health systems.

I am currently in a different patient-facing healthcare field and looking to exit as it's just not my jam anymore. I am contemplating returning to med school in my late 40s by the time I'd be accepted. There are a number of the "3 year med school" programs not too far from me that I would try to get into to reduce the amount of time in school. Most of those programs specify that you must pursue a residency in certain specialties. I feel drawn to a possible career in FM as I'm looking for something with low to zero physical procedures in private practice, a variety of clinical settings available for employment, and a shorter residency time due to my age.

I keep reading about how there is this huge need for primary care doctors now and in the foreseeable future - how does that translate into solid employment opportunities around the US and possibly Canada? I already have some financial stability from my previous career and no loans so I'm not worried about taking on some debt. I am looking for a solid, reliable income source for at least 12 - 15 years to contribute something meaningful to patient care with my knowledge and skills and earn some money to help pay for my kids to go to college.

I'm returning to primary care after years in the ED and urgent care, inheriting a panel from a retiring physician with many patients on chronic opioids, benzodiazepines, and stimulants. For those who've been through a similar transition: how did you handle these patients early on? I'd like to limit chronic controlled-substance prescribing where appropriate, but I want to assess each patient individually rather than apply blanket rules.

Looking for the pdfs of ABFM/ABOFP ITEs from 2024-2026.

I'm a current 4th year on the interview trail applying into FM. I am also couples matching with my partner so we applied broadly along the East coast and Chicago area, with a mix of both academic and community programs. I have been lucky to receive some interviews in the NY metro area, but I remember seeing a post on here a few months ago warning applicants of NY programs due to poor training and work conditions.

My partner and I would love to live in a large metro area (currently in a more conservative state), but I also don't want to risk the quality of my training. I wanted to ask if any current residents or attendings had any insight into the quality of programs in large cities on the east coast and whether some of the myths are true.

Are there any downsides?
Is it common, doable, realistic, etc. Thanks! Let me know.

Our MD is retiring soon, I am considering applying for the position for the clinic, by the time she leaves I will have almost 5 years experience. The main reason honestly is to reduce patient facing hours, also I think some protocols in our clinic could be streamlined to make everyone's lives better including support staff and FD.

On the other hand I have a closed panel and work part time and I am pretty content with the responsibilities I have. I have joined zero commities in my organization which I figure I will need to do if I want to be MD. I also want to have kids in the next few years. For anyone who has made the transition what are the pros and cons ?

Hey all! Have people had luck getting drug company-sponsored models of different disease, pathology or anatomy to use with patients? It seems like specialty offices always have great models but I don’t see these as much in our local primary care offices and I’d love to incorporate more into my own future practice.

I am transitioning from military to civilian practice and plan to relocate to another state. Since I have not yet secured a job offer, would you recommend obtaining medical licensure in my intended state of residence now or waiting until I have a job offer?

For Canadian family physicians

Would you recommend taking over a panel of 1500-2000 patients or starting from scratch?

With taking over, concerned about picking up patients with bad habits/requests/behaviors that the former physician has tolerated or reinforced. Set up meet and greet with these patients perhaps?

Went to a symposium this morning in manhattan and met the founder of this company that’s making AI powered medical assistants!
she told me she was an MA herself and built it to do everything she did :O

. i just had to come on here and share because i am genuinely still in awe. i saw a demo with some other doctors and we were all pretty shocked. it’s basically like this skinny tall machine that has these vitals components built into it,(idk if i explained that properly lol). it has an ai voice that surprisingly sounded very humans. like a facetime call of sorts with someone through the screen. it spoke to another doctor in another language as well which i found prettty cool (full on hindi show down haha).. it cracked jokes, It took the vitals of us on its own, asked me the regular intake questions. the founder showed us how it makes summary for dr, scribes, orders medication/diagnostic test, documents, charts, and puts it all into whatever ehr you use. i’m curious to see how it would actually operate in a practice with chaos and patients who may be a bit slower but from what i saw, someone could genuinely run their practice with those machines, and maybe one MA and Admin in my personal opinion.
i had to come and share with others who would get my sentiment. AI is getting so advanced.
I wouldn’t be surprised if this was the next “computer” adjacent standard in 10 years.

Do you guys think with this tech MA’s will kind of be a thing of the past in the future? They’re also selling these machines for half the price of an MA, so i can see how some may be incentivized to buy one to cut operating cost?

I never imagined that i would live to see something like this in medicine.

crazy stuff.

As in no more co-testing.

Just want to make sure I'm understanding the guidelines right. I just saw a pt who had seen OB a week prior and they were still doing cotesting for her (she's 42).

A specific course, or fellowship opportunity thats flexible enough where I dont have relocate my family or leave my growing private practice?

I work rurally and would like to pursue advanced pain options. Such as an APP can switch specialities by learning as they go or via shadowing prior to practicing independently, I would like to explore options of select subspeciality procedures to practice independently to fill gaps in our community.

For example, the other family physician was able to get credentialed in sigmoidoscopies by performing enough under the guidance of GI, can I do the same with epidural infections under PM&R? How about radiofrequency ablations? Maybe even iron infusions?

Basically, is there a way I can learn select skills in other specialities, and bill for them successfully through insurance or even just for cash pay?

Is there a resource for programs like this?

Or has that ship sailed?

I apologize if this is an inappropriate forum, however I simply do not know who to ask these questions to.

Small practice on athena. The inbox is killing us. Doc spends an hour a day on it and I spend way more. Most of it is routine stuff. but someone still has to read it, check the chart, and reply. And we don't get paid for any of this

What’s actually worked for you all? Hired someone for it? Scripts for your MAs? Are you billing?

Anyone here on their own an obesity medicine practice?
If so, how did you get started and how’s it going? Is it worth entering into the space? It seems as though saturation is new concern to those looking to enter the space. For context, I am an early career family medicine physician currently working at an FQHC doing primary care and quite a bit of obesity medicine. I’m considering starting my own practice in the next year or two. I did just take my Obesity Medicine boards and feel pretty confident; are there any other opportunities that board certification would lend itself to as well? Thanks all.

Looking for any and all tips that people have including smart phrases, tools, prompts, templates; anything and everything people have done to make charting easier.

Our institution has DAX AI and that has helped immensely but I still find myself not being as efficient on my off days.

I will spend about 1.5 hours just prepping my charts on my admin day and Saturday. My patient volume is such that it’s not sustainable but it’s hard for me to fully give it up. My smart phrases will also sometimes include specific details such as the dates of the last labs.

So I’m looking for all help I can to improve my efficiency and hopefully others in my spot can also find use of those resources.

Patients have their requests (usually for meds you think are inappropriate). You have yours. Do you ever make deals to meet in the middle?

Examples:

Short term opioids for starting physical therapy.

Benzos for starting counseling.

Is this ever worth it? Should it just be avoided?

I'm an internal medicine physician, and I'm curious about the most challenging AF cases you've managed in elderly patients. Especially cases involving anticoagulation, GI bleeding, kidney problems, or other complications. Have you ever had a patient where you really struggled to decide what to do next? I'd love to hear your experiences and how you managed the situation. Please don't share any identifying patient details.