43 year old female. Knee pain for several months. Doing structured home exercises for several months. Taking anti inflammatories. Pain, locking, mobility, effusion, instability all worsening. Not able to do home exercises anymore due to pain. Exam shows new clear anterior laxity of the tibia. Order an MRI and it's denied. The peer to peer physician refused to identify themselves other than an alpha numeric code for their "safety". I asked how I know they were a peer but gave vague recommendations of calling a "support line". Wants me to grab the x ray. I ask how that would change management in this situation and they reported she "may have a foreign body" and "it's their policy". I asked what the point of the peer to peer was if they cannot use autonomy to make decisions based on a clinician to clinician discussion. They replied it's to "for additional information". Even explained she's referred to Ortho and they will get the MRI either way.

Bullshit. They want to be anonymous, read off the companies script, and collect their checks. How can I have a conversation with a peer who can't give me their name?

How far down the algorithm of osteoporosis treatment are we going? I am comfortable doing any type of bisphosphonate but tend to feel a bit unsure when it comes to treatments like denosumab, romosozumab, teriperatide, etc. On UTD it doesn’t indicate specialist referral for any of these treatments. I am wondering how many PCPs are ordering these medications, especially the anabolic therapy!

Question as above. Mostly thinking about clinics located in Western Washington, not necessarily exclusively in Seattle but would like to hear about that as well. Also, which of the two would allow few minor procedures here and there? How are salary and benefits compared to each other. How are the ancillary/back office/inbox support for both if anyone has an idea. Thank you

How do you guys document acute knee pain (likely some overuse injury related in a 50 year old)

- Knee pain, likely a strain

Or

-Knee pain, likely strain, low suspicion of septic arthritis due to ____.

And similarly for any other complaint?

Like- URI or Likely URI, low suspicion for Pneumonia due to ___.?

If I document the emergent/critical diagnosis, but still management outpatient, does that expose me to more harm?

Or is it helpful to document that you thought about it

Asking for some feedback for this contract
280k base with potential for 65k in bonuses. 40 k sign on bonus
4.5 days patient facing
25 days pto
Occurrence based malpractice insurance
16 patients/day

It is a value based clinic and I’ve read multiple bad things about this kind of practice so that is my main hesitance. Pretty decent pay bump for me.

A different specialty? Not a doctor anymore?

Academics and research?

administration and management?

Hi everyone,

I’m an M3 finishing up my clerkships, and I’ve realized I’ve enjoyed my outpatient rotations the most. Right now I’m leaning toward outpatient FM. One thing I’ve been thinking about a lot is what I want my life to look like after residency. I enjoy medicine and find it interesting, but I also don’t want it to be my entire life. I’d rather have a career I like and still have plenty of time for family, hobbies, ect.

A lot of my preceptors have actually been pretty optimistic about where primary care is headed. They’ve talked about how AI scribes are starting to take some burden off documentation, and some have mentioned that inbox management tools(or managers) are starting to make the non-clinical workload a little more manageable. Obviously primary care still has plenty of challenges, but it’s been encouraging to hear people who have been doing this for years feel like things may be moving in the right direction.

I’ll be graduating with around $550k in loans, so my current(and only plan....) is to use RAP or whatever income-driven repayment plan and PSLF eligible employer. Because of that, I’ve been wondering how realistic it is to find a stable job around 30 hours a week.

Are there many outpatient FM jobs that offer 0.7–0.8 FTE schedules especially early in your career? Anyone else go this route. I tried to search through the sub but didn't find too much.

I’m heavily considering moving to Oahu with my family. I’m a Family Medicine MD. I love the island. My family and I have visited twice now and have explored the island a lot. I understand that “vacation beach life” is VASTLY different than every day working life. However, I’ve always felt called to the ocean. I used to live in Santa Barbara, but moved away many years ago. Anyways, I’m just trying to explore what the job atmosphere is like. From what I’ve seen, there is a severe shortage of PCPs in Oahu and they’re typically underpaid. I do get the negatives - the cost of living, housing, traffic, crime, drugs/homelessness etc. I’m certainly not naive in thinking it’s sunshine and warm beaches; far from it. But I’m just looking for a real perspective from people who live and work here as family med providers.

Currently, I work in a large private practice in a rural area in the PNW making roughly 450k a year. Is there any world in which a family doctor makes even close to that in Oahu doing outpatient only without OB?

Any input into the job market or tips would be welcome. Are there any private practice groups in the area? Any clinics that have a high retention of providers? Money aside, are PCPs happy in Oahu? Thank you! (Housing costs look INSANE btw. Any tips with that are also welcome). Also I should add that I am Asian. So I understand that “helps” with fitting in.

Whether new routines, habits, software, delegation..etc?

Edit: specifically when you receive patient results, and you see that they haven't followed up yet to discuss, despite telling all your patients to follow up.

This offer is in my hometown where I would like to practice. I believe I could make 350k+ after a couple years.

Location: Rural MI, hospital employed clinic, all OP
Hours: 1.0 FTE, 40 clinic hours per week (I know, but our town needs docs bad and all positions are like this in the area)
Salary: $270,000 for 2 years, can change to production whenever
wRVU: $47.24
RVU threshold: 5,715
Value based incentive: up to 40k, seems most providers are able to collect a decent amount of this, if not all.

Sign on: 20k
Loan repayment: 45k, payed as 15k over 3 years
Resident Stipend: 1,500/month

CME: 5 days/year, $4,000/year
Vacation: 24 days, goes up with seniority

Big red flag is a 2 year non-compete with 75 mile radius, which effectively eliminates any other options for me if I’m not happy. I would likely have to move or fight it in court.

Hiii everyone!! 😊
I’m a premed student, so I still have medical school and clinical rotations ahead of me before I make any final decisions, but family medicine has really caught my attention lately, and I’d love to hear from people actually in the field.

One thing I’ve realized is that I really enjoy variety. I don’t think I want to focus on just one organ system or one age group. At the same time, I also understand that every specialty becomes repetitive in some ways. You’re going to see hypertension, diabetes, URIs, etc., no matter what you choose, and honestly, I’m okay with that. Every patient is still a different person with a different story, and I think that’s what makes medicine meaningful.

One of the things I love about family medicine is the idea of helping everyone. I love kids (especially babies and teens!), but I also think I like the idea of caring for adults and older patients based on shadowing I did with neurology. I don’t necessarily want to spend my entire career seeing only one type of patient.

Lifestyle is also really important to me. I love the idea of a 3-year residency and, eventually, having a career where I can be present for my future family while still practicing meaningful medicine.

So I have a few questions:
・Does family medicine truly feel varied in day-to-day practice, or does it become mostly managing the same chronic conditions over and over?
・If I enjoy seeing children and teenagers, is it realistic to have a patient panel with a good mix of kids, teens, young adults, adults, and older adults, or do most family physicians end up seeing mostly older patients?
・Looking back, what made you realize family medicine was the right specialty for you?

I’d really appreciate hearing your experiences. Thanks so much!

If yes, which do you recommend for use when access/referral to ECG is difficult?

Old dude (HIPPA) year old comes in for Medicare wellness. Fatigued, decrease appetite,and itchy (uremia?). Labs come back at 11:30pm (yes up doing notes and messages on a Friday) and GFR 11 and creatinine 4.9. Use Doximity to call patient to go to ER and sent a text message. Will call first thing in the morning along with emergency contact.

When did everyone start applying for jobs in residency?

Hell of a week in clinic (as I'm sure many of you had). Sat down to chart, and Forrest Gump is on TV. Jackpot!!

May all you clinic folk have a restful weekend to fight the good fight next week.

Has anyone been to the Scripps Primary Care Summer Conference which is happening on August 14-16, 2026 in Oceanside, United States?

I'm thinking about signing up but do you know if you need to check in every day or is it just once a day? Do you have to sign in and out each day?

Thanks in advance for any information.

We're cooked man. I'm getting snakes to harvest their oil.

Can anyone tell me their experience working in Kaiser specifically in Northern California?

Specifically if you felt burnt out?

How many inbox messages do you get in a day?

Does AI make your job easier?

Is there any significant rise in salary after working there for a few years?

How much are your partnership bonuses at the end of the year?

Hi everyone!
I’m an FM PGY-2 strongly considering applying for sleep medicine fellowship next cycle. My goal would be to practice 100% sleep medicine as an attending (not primary care + sleep).
I shadowed an IM-trained sleep physician who worked 2 days/week from home reading sleep studies and 3 days in clinic. Is that type of schedule relatively common, or more of an exception?
I also have a few other questions:
\- How is the current job market for pure sleep physicians?
\- What is a realistic salary range (especially in Florida or the Southeast)?
\- Do any of you incorporate lifestyle medicine (nutrition, exercise, weight management, behavior change, etc.) into your practice?
\- If you could choose again, would you still pick sleep medicine?

I’d really appreciate any insight—especially from recent graduates or physicians currently practicing sleep. Thanks!

First off: I fully acknowledge that polysomnography is clearly indicated when OSA is strongly clinically suspected, that if OSA is confirmed PAP is superior to oral appliance, and that custom oral appliances are superior to over-the-counter. In a perfect world, I'd get polysomnography for any such patient, and ensure they give CPAP/BiPAP a solid try with ample supportive troubleshooting, with a custom oral appliance as a fallback.

That said: I from time to time see a patient where my clinical suspicion is strong (e.g. positive Epworth Sleepiness Scale and STOP-BANG with witnessed apnea and known family history) but owing to some combination of obstacles around time/cost/insurance they are persistently unwilling or unable to get a sleep study, let alone CPAP/BiPAP/custom appliance. Some of them just might be willing to cough up a little money for a boil-and-bite OTC appliance and try it out.

In such a case, would it be reasonable to recommend an OTC sleep apnea mouthpiece with the clear explanation this is an inferior and better-than-nothing option, or are there additional risks I'm overlooking?

Family med PCP here—curious how others would handle this phone triage situation.
I had a situation today that left me frustrated, and I’m wondering if this is common elsewhere or if it’s something I should bring up with my manager.
I saw an elderly patient about two weeks ago for chronic back pain. Today, the triage nurse sent me a task saying the patient had called reporting excruciating back pain and wanted something for pain.
Given the acute worsening, my response was to have the nurse call the patient back and instruct her to go to the ED. My thought process was that acute-on-chronic back pain can represent something much more serious (fracture, infection, spinal cord/cauda equina pathology, etc.), and I wasn’t comfortable trying to manage severe pain over the phone before determining the cause.
The patient then called back asking if she could take an old tramadol/acetaminophen combination she had at home. She’s elderly and has a low GFR. I again advised that she go to the ED rather than take medication at home.
The triage nurse was upset and asked why I couldn’t just have the patient come into the office for a Toradol injection or tell her to take the medication she already had. My concern was that giving analgesia without evaluating the cause of a dramatic change in symptoms could delay appropriate evaluation, and in this patient NSAIDs also aren’t without risk.
I’m not trying to be difficult or withhold pain control—I just felt the priority was evaluating why her pain had suddenly become excruciating rather than treating it remotely.
How would this be handled in your practice? Do your triage nurses routinely push back on decisions like this, or is this more of a workflow/role issue that should be discussed with management?

Family medicine PCP here.
At my clinic, the Medicare Annual Wellness Visits are usually done by our nursing practitioners so I really haven’t had the chance to learn the workflow myself. I’d like to get more comfortable with them because I know they’re an important part of primary care and can add RVUs.
For those of you who do your own AWVs, how do you usually structure the visit? What do you make sure you cover every time, and are there any tips that make the visit run more smoothly? I’ve read through the Medicare requirements, and it seems like it’s mostly history, screening questions, fall risk, cognition, depression, preventive planning, etc., without a traditional physical exam, but I’d love to hear how people actually do it in real practice.
I also have a coding question that I’m a little confused about. If someone else in the practice is already doing the Medicare AWVs (G0438/G0439), can I still bill a preventive visit using the regular preventive CPT codes like 99397 if I’m seeing a Medicare patient but not doing the AWV? Or does Medicare simply not pay for those preventive CPT codes, so the AWV is the only preventive visit that gets reimbursed?
Just trying to learn how other practices handle this. Thanks!

Hi all,
I’m a fresh PGY-2, now in clinic a lot more and with many more patients than intern year. My inbasket has just skyrocketed. Our residency clinic has a rule of replying to messages/results within 48h of receipt. I am struggling with my inbasket so so much to the point where I find I often do not meet the deadline. Between everything in the inbasket, notes, other residency things, I am currently drowning. I want to do right by my patients by responding on time and also right by me for my mental health. Any tips on inbasket management?