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

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?

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.

FM doc working at a FQHC using eCW. We tried Sunoh which was horrible and received exactly 0 support from eCW about it. Looking to make a switch to something that can import directly into a progress note and doesn’t require being copied and pasted. Trialed both Freed and Heidi in controlled settings and both seemed ok. We’re also paying for dragon which isn’t compatible with ECW any more so bonus points if the AI can also do dictation. Any thoughts or experiences people have had would be great.

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.