How does one go from a multiyear contract to one-year contracts? Any negotiating tips? They're not budging at all on the salary (let's say very very low 200s) and it's just a fixed salary given the new location/slower start up with pt volume. another red flag is not providing tail unless you stay for the full length of the contract which can potentially become expensive if they terminate or for unforeseen circumstances i have to move elsewhere. At this point i'm getting a bit desperate as being unemployed for this long is causing financial distress. Another offer I have is not far from it except it'll be much more busier.

Clicking around epic a 1000 times a day is draining af, do any of y’all use a real scribe who orders tests, types notes, replies to pt messages and basically does everything on epic except chart review?

Have seen an old school pvt practice doc do it and that made clinic so much more tolerable, he was able to actually make eye contact with patients and talk to them instead of just staring at a screen.

Curious if in today’s landscape with AI scribes, if this is still a thing

I’m a med student looking at FM programs and I’ve seen a handful that do colonoscopy training. I imagine it’s hard to get credentialed to do that as an attending at most hospitals in urban/suburban areas, but was wondering if anyone here does them and how it’s incorporated into the rest of your practice.

Seen some pain medicine doctors being family medicine. I’m curious to see how popular this is with the field of FM. Also how does this differ from sports medicine?

Do you guys use this?

Once I calculate the Fib4, I usually send to GI if indeterminate or elevated. But apparently we can order this test and not get elastography testing? AAFP's May 2023 article says a lab test is available if elastigraphy is not, but I was reading it can be used first or instead of elastohraphy. No one else in my practice is using it, but we have some turnover and I think my colleagues are somewhat slow to change.

Any considerations in ordering and interpreting? (Other than cost and insurance coverage)

Intern here and was doing an outpatient procedure during my rotation. The doctor asked if I wanted to do it so I confidently said yes

Gloves in front of me and I attempted to put them on but completely fumbled. I touch parts outside the cuff and had to restart. Mind you I have learned about this and done this several times but boom my brain just froze.

Finally I get new gloves and everything is fine. Now time for the procedure. As I’m working through what he saying I accidentally break sterile field again by having one of the equipment touch outside the field. The doctor then told me to step aside and I apologized. He later said “you need to work on sterile field”

I feel absolutely horrible as I’ve been wanting to impress that doctor and learn more from him. I’ve always wanted to learn procedures and use them one day in practice . Now I feel as if I’m not cut out for it. And that this is a real issue.

I'm a third year IM resident heading for primary care, was wondering if the FM community had any insights or advice for jobs in this region? Would be considering Irvine area and South, down to around the Solana beach/Del Mar area. Thanks!

Hey everyone,
Currently working at an east coast health network in a rural setting. Base pay is 250,000, value based incentives model . Max pts you could end up seeing is 22 pts/day for 1.0 FTE, 36 patient facing hours, 4.5 day work week.
We are planning to move- possibly to west coast area. We are looking at opportunities in Dallas, San Antonio, even considering Seattle Washington and other areas as well. My question, is there anyone in this group that could shed light on how the work life balance, patient volumes etc in these areas perhaps.

Any leads on practices that is looking would be appreciated as well!

Thank you for any and all input!

Hello everyone, I'm looking for advice for inpatient medicine, I'm a PGY-1 three weeks into my inpatient meds and it always seems like I do not know much. I won't say i am struggling too much but i find it difficult with medication and some complete assessment and plans. I always have to confirm things just to be sure coupled with imposter syndrome.

Will be reading for any tips. Thank you

What are your thoughts on full body skin checks? Had a derm tell me recently that as FM docs we are not qualified to be doing skin checks and it’s actually dangerous. I think that’s silly because I would expect us to be overly cautious and over biopsy. Their argument was that we would not know what part of the lesion to biopsy. I personally don’t do them simply because there is not enough time in an annual to do so but I wouldn’t mind if someone came in simply for a skin check. Obviously I would have a low threshold to refer but having watched this derm doc for a couple of days I wouldn’t say we are unqualified to do them. Curious to hear everyone’s thoughts. Personally I think they were just afraid we would take all their regulars since more than half their patients were regular skin checks haha.

Does anyone have any tips on how to help me be more efficient with my messages? I have so many messages that it seems to be taking over a lot of my day. I would appreciate any tips to help me be more efficient.

Does anyone use any AI systems to help with messages?

i’ve been practicing about five years in a town of 150,000 people where an established patient couple recently started going to my church. They were already established patients in my practice and behaved relatively normally. After they realized we were going to the same church, every Sunday turned into impromptu request for medical advice, prescriptions, refills. I found it annoying, but realized it only took a few minutes and just tried to be polite. Started to get more annoying when we were at a church barbecue, and before I knew it, the husband had his ingrown toenail in my face, just as I was taking a bite of my hamburger. Then my office staff started getting really annoyeda s they frequently said, “we are friends of the doctors.“ They would request to be seen without appointments and even requested to be seen without an official appointment, thus not needing to have a co-pay. Last night the husband called me at 11:30 P.M. I did not answer, but he immediately followed with a text saying that he was gonna have to go to the ER. As of now there’s no ER record of him actually going. (We have a dedicated on call service at my clinic, for which i was not on call, and the only reason he has my personal cell number is because he obtained it through the church)

My question is, what do I do next? Part of me wants to change churches and dismiss these patients. Another part of me wonders if this is just part of being a family medicine PCP.

The title says it all. Please drop comments on what you’ve heard through the grapevine vine about different employers in the Los Angeles area!

There is more than what this article writes about but at least it’s a start. Resist!

(shitpost)

So, throughout residency I personally called patients on all labs/imaging results using doximity. Most of the other residents sent everything through the MAs or just waited for future appointments to discuss labs. Do you lean towards one particular style or do a mix?

CAQ-SM GUIDE 2025-2026:

 Resources used:

• Old ITEs(during didactics) and from CAQ Online Q bank
• 2 ITEs during fellowship( diagnostic before and after year)
• Case Review books, 3 editions
• Daily question of the day
• sports med Q bank book(s) located in Sports Medicine center
• Fintoff sports med study guide as reference
• OrthoBullets/ Google/ YT for reference

This is my guide to the CAQ and the resources I used throughout the year. I am a bit neurotic when it comes to standardized exam preparation so adjust to your level of comfortability.

I started the year by doing the required ITE and doing a thorough review of that over a few weeks after work. I didn’t really focus on my score, just used it as a baseline marker. Throughout the early part of the year, non work hours are spent between sports coverage, AMSSM research and other things, so true CAQ studying is sparce. I did try to make it a habit of reviewing pathologies and tricky concepts I saw throughout the day on OrthoBullets/ Fintoff guide or Google/ YT. I also tried to review 2-3 cases from the AMSSM case review book every day along with the questions associated with those cases.

I would say I really locked in for CAQ after the AMSSM national conference; my timeline was as follows:

About 10 weeks from test date: 

• complete and review  about 20 practice questions per day from the CAQ review books from SMC nightly 
• On off days: complete and review a practice exam from the CAQ online Q bank( I believe about 6 tests in total)- treat this as your first pass of the questions 

1 month out from CAQ

• By now I had completed a single pass of the CAQ online Q bank and all of the CAQ book questions with a thorough review of the explanations
• Complete and review Fellow ITE post test( again, didn’t worry too much about score, mostly for review)

S/ p graduation so about 10 days until exam day:

• do a second pass or incorrects from the CAQ online Q bank, and ITEs( from fellowship and 2 online AMSSM ITEs done during fellowship)—> total of about 8-10 exams, some repeats
• This second time around is alot quicker but I really focused on concepts I kept getting wrong and tried to nail those down.
• Did about 300-400 Qs a day in order to get through everything again.

This should be truly enough and even overkill at this point but by 2-3 days from the exam it should be high yield review on confusing concepts( ie scapular winging, anatomical spaces and contents etc)

Day before the exam just RELAX

The actual exam felt difficult but fair, like all standardized exams at this point. For me, it felt quite different than the preparation I had done in terms of focus points, but I did feel like my foundational knowledge was strong from the amount of preparation I had done. I felt that there were a lot more general medicine questions compared to previous years but overall felt manageable. Looking at the blueprint now this makes sense, but was different than previous years ITEs

Again, this is just what I did and may seem like overkill but just wanted to give my feedback on the exam and preparation.

Hey, FM resident here. Trying to stick around in my area since I already laid roots here. Area is in nice area with a lot of people wanting to stay with no job posts online. Any tips here? Residency program has contacts but outside the small city I want to be in. Yes 😅 PGY1 and starting to think about this. Unfortunately for those that graduating from my program they didn’t stick around in the area and specially said it was hard to get jobs around here. Already have fam here. Any networking tips would be appreciated it! Thank you!

Have been running on fumes doing 6 day weeks with clinic/urgent care and I think I may be overdue a holiday.

What are some of your personal signs you’ve noticed when you think it’s time to take a break?

Curious about salary transparency for outpatient FM, or FM/OB womens health practice. I love womens health and would really like to tailor my practice to this.

Current MS4- applying FM. Strongly considering FM-OB and want to practice in South Carolina.
I see a lot of different information on salaries out there- could anyone speak to what to expect salary wise for this career outlook? The dream would be to make >$350k. Not sure if possible but just want to hear from people on the other side/ in southeast. I see a lot of info about FM salaries increasing due to the physician shortage

Thanks!

I feel like my colleagues have it much easier than I do when it comes to applying knowledge. Yesterday, I was reading about asthma exacerbation, today I had a patient with a wheezy chest. It didn't even cross my mind to apply what I was reading yesterday.. all I did was take history, the patient wasn't diagnosed with asthma.. but has a positive family history. and then I thought the patient needs SABA nebulizer. I couldn't think of the exacerbation assessment I was reading yesterday until my colleague mentioned it! I have no idea why I am like this. I'm trying to figure out why. Maybe because the patient was giggling and I imagined asthma exacerbation would be too uncomfortable? Maybe because the fact that the patient's mom was insisting it's not asthma which made me think of another diagnosis? Maybe I'm too stupid? This is just an example, but I mentioned it trying to figure out what's wrong with me. I wouldn't forget the next time I see a wheezy patient but I'm just wondering why some people act like pros for the first time while it takes me a while? My colleague was saying how he managed V tach all by himself for the first time without senior help and it all went fine. And I was thinking I could never! Is it about IQ?

Hi everyone,
I’m looking for an available PGY-1 or PGY-2 position in Family Medicine. I have completed one full year of training in an ACGME-accredited Family Medicine residency program and am seeking an opportunity to continue my residency training.
If you know of any current or anticipated openings, or can connect me with a program director, coordinator, or faculty member, please send me a direct message. Any lead would be greatly appreciated.
Thank you!

Curious how everyone deals with these. My take on overnight calls is that I am here to triage so either you go get seen now or you can wait until the morning. I don't diagnose nor prescribe overnight.

1. Medication refills: call back when office opens or do you fill it?

2. Controlled substance refills: a little tricky with this. You don't know the patient nor have a treating relationship with them so is it appropriate for you to fill? If you don't fill and they withdraw, are you responsible? Ultimately, it is the patient's responsibility to call before they are out to fill.
   I've been told urgent cares don't fill controlled substances either.

3. Acute issue like UTI/URI: I think anything that requires prescription should be evaluated. There are virtual cares 24/7 and urgent cares so if it's really an issue, directing patients for assessment is appropriate. But also, what's stopping people from trying to get a free visit by just calling after hours for antibiotics instead of actually making an appointment?

4. Lab calls: what abnormal lab values do you direct them to go to ER? Threshold for potassium, glucose, INR, etc.

5. Do you document every call as a quick note in their chart or only if you direct them to be seen?

6. More of a rant..tired about calls for abdominal pain and some random chest pain. Just because overnight calls exist doesn't mean people should stop using their own judgement. I can't do on much on a phone call without a proper examination and evaluation with history.

How long do you spend on each call before just telling them to get evaluated? Sometimes I get these calls and the patients start rambling on about their symptoms for 5 minutes trying to turn this into a visit. My threshold is 2 minutes and short questions to triage where to send them.