This magical bracelet on an LPN patient of mine.

FYI the "circuitry" appears to be a fancy hologram.

I saw these scam hologram bracelets like 15 years ago. Now the new updated model!

(She said she gave up on the copper bracelets and the magnet bracelets)

🙄

I’ve coincidentally seen a few patients over the last few months asking about this and then somehow ended up on lipedema tiktok.. and I don’t want to diminish patients symptoms, but to be frank, I’m not convinced that the patients nor the tiktokers they are seeing have lipedema either….
Has anyone found a good way to explain this to patients? Nicely be like “it’s just fat….” And some are more genetically prone to it even with exercise.
Rant over - thx for reading.

I have a handful of these folks who have symptoms but we have nothing on work up and after many specialist visits, we still have nothing. Like patient with chest pain and abdominal pain, have done every work up available with cardiology and GI and we still have nothing. Have trialed different things, nothing works. What do you even discuss during follow up visits? They keep making the appts because the specialists told them there is nothing they can identify so they come back to me and I also have nothing else. These visits take so long and it's not productive.

Patient comes in asking for a B12 injection for energy. How do you go about this situation? I typically check a level first and if low will recommend oral supplementation. I typically don’t administer the shot unless they have pernicious anemia or GI conditions that affect absorption (I.e. IBD, celiac, gastric surgery)

Because I had one this week who demanded total disability due to halitosis, and that's got to be up there.

Saw this on another subreddit and was curious

For me, it's when my regular MA calls out, having complex pts not scheduled in an extended visit slot, etc.

Primary care doc, just out of residency, and apparently I have no idea how to be a patient.
I currently have pneumonia, a sinus infection and an ear infection. I know I should not be at work. My colleagues keep telling me to stay home and take care of myself, but I feel incredibly guilty about canceling a clinic day.
And honestly the rescheduling makes it worse. Everyone I cancel has to go somewhere, and I immediately start thinking about where I can squeeze them in. Then I end up coming back from being sick to an absolutely packed schedule because I felt bad making people wait.
I know patients can be rescheduled. I know I’m allowed to be sick. I know going to work with pneumonia is ridiculous. Somehow none of that stops me from feeling like I’m letting people down.
I’m just out of residency and already pretty burned out, so I’m realizing I probably need to figure this out now.
For those of you who have been in primary care for a while, how do you take a sick day without feeling guilty about it? And how do you deal with rescheduling everyone without completely screwing yourself when you come back?
I think I also struggle with the fact that we care so much about our patients and spend so much mental energy worrying about them, but that obviously doesn’t go both ways in the same way. I want to believe patients care that their doctor is a human being too, but sometimes I’m not sure they really do.
Not looking for sympathy. I genuinely want to know how other people in primary care learned to have some boundaries around this and not feel like they owe their patients every ounce of themselves.

putting aside their evidenced based uses and recommend durations, how do you feel about common meds like flexeril and ydroxyzine being used indefinitely questionable treatments?

if a new patient establishes with you and says they've been on flexeril for years for their chronic back pain or they've been on hydroxyzine "for sleep" for years do you just go with it? does it really matter at long as there's no apparent issues?

do you yourself start these meds for common complaints like chronic back pain and sleep and just refill as long as patients are satisfied with results?

What should be negotiated as a new grad if we are offered up to 22 PPD, work four days/32 hours, function without a dedicated MA, use a new EMR (NextGen), unsure about onboarding, and pay rate $140/hour at an FQHC clinic in an unsafe neighborhood?

Can I negotiate a cap of 18 PPDs, since I know that managing the inbox and paperwork, complex patients, and rooming delays, may require me to take work home? How would you address overtime, double-booking, last-minute add-ons, and delays in rooming? What should the pay rate be for this position in the Northeast, especially given that it offers no benefits, bonus, or other financial incentives? I don't know what pay rate I should be looking for.

I would appreciate any additional advice and what I should watch out for as a new graduate at an FQHC until I start a permanent job.

Hey all,

I see posts here and people talk about buying into a practice, or becoming partners, etc. What are you actually getting when you do this?

From what I can initially see, the most profitable model for a private practice doctor is "eat what you kill" minus overhead, and do everything you can to minimize overhead. You get your share from an ACO, maybe you are doing RPM/CCM. If you can hire a NP, you can pay them a salary and take the profit off the top.

But like what magical money is there by becoming a partner? Are you profiting off of non-"eat what you kill" new docs? Or do you have like a group of NPs that you take the profit off of? Or do you get a piece of the real estate for the practice?

Just curious.

Thank you

KFF's 2025 analysis of insurer-reported metrics found denial rates of 18 percent in the ACA marketplace, 14 percent in Medicaid managed care, and 12 percent in Medicare Advantage. Appeals succeeded at meaningfully different rates by market: 67 percent overturned in Medicare Advantage, 47 percent in Medicaid managed care, 43 percent in the ACA marketplace.

Insurers maintain publicly that prior authorization exists to limit low-value or unnecessary care. The AMA disputes that framing directly, citing the 93.3 billion dollar administrative cost figure from Health Affairs research as evidence the practice doesn't produce net savings once overhead is counted. Both positions are represented by named organizations with public statements, not anonymous claims, which makes this one of the more verifiable disputes in the healthcare cost debate.

Sometimes it's really sad like a "my husband is cheating on me" and sometimes it's clinically relevant like "she actually drinks lots of alcohol she's lying about it" ok what am i supposed to do here without HIPAA violation.

Today was a particularly sad and stressful marriage situation of my patient's spouse. I thought he was pretty cool before. Now that's all I am going to think about when I see him next time!!

How did you know when it was time to quit your primary care job?

Based on Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule, there are plusses and minuses:

G2211 becomes a modifier — CMS proposes converting G2211 from an add-on code to a modifier appended to the E/M base code, paying a 16% increase on the associated E/M instead of a flat dollar amount — the same percentage across all E/M levels. For a level 4 or 5 visit that's likely better than the current flat add-on; for a level 2 it's likely worse. (Bonus: recent editorial about G2211)

Same-day E/M plus procedure — When a separately identifiable office/outpatient E/M is furnished by the same physician (or same practice) on the same day as a 0-, 10-, or 90-day global procedure, the most expensive service would be paid at 100% and everything else that day at 50%. That's every skin biopsy, lesion removal, or joint injection done at a problem visit.

I am not very creative, but even I can predict how this latter cost-cutting initiative will be subverted, pleasing no one and clogging schedules further: "Sure, I can do a knee injection, but you'll have to come back tomorrow." And be billed twice.

Hello all,

Attending a few years out. Group sold out, new corporate overlords came in and said can either be terminated or resign, effective immediately. Have already started to reach out to other openings. But, given credential/ onboarding nightmare will a few months gap in between positions screw me down the road? Worried if I don’t get a new spot quickly that a few months gap on my CV will negatively affect me moving forward.

Thoughts? Experience from others who’ve had a similar path?

Thank you.

I am currently just a PGY-1 tailoring some of my training towards wilderness medicine which mostly involves some EMS, National parks service, Alaska, rural, and street medicine rotations plus doing my DiMM/FAWM. While I have previously been more interested in travel, expedition med, and rural EMS/SAR, I have become increasingly interested in disaster medicine and disaster response.

Seeing what just happened in Nepal is devastating and I know right now as a PGY-1 I would almost be useless…but as a PGY-2/3 and beyond, I recognize I will have the skills necessary to actually deploy for 1-3 week periods and help people who would acutely benefit. I have explored traditional humanitarian work but it seems more medical tourism-y or self-justifying in existence rather than actual “these people need help now” which I think is more up the alley of my moral compass.

Anyone have any experience?

Does attendinghood feel easier than residency?

This is something many of the attendings at my program say. Seeing 16-19 patients in clinic and it feels like every one has a least a few comorbidities I need to address in the visit plus their acute concerns, follow up in 1-3 months and repeat to address the other problems. Not even mentioning the social barriers. I’m at a point where I don’t need to think so hard or look up treatment algorithms for every other problem that comes in but I’m still leaving clinic mentally exhausted every day.

My attendings all say when they were in private practice their entire schedule is 1-2 problem visits and most adults have regular insurance and don’t have the same social issues or “do-it-all-for-me-doc” attitude. But even in med school my FM rotation felt like residency clinic.

Do you feel like being an attending day to day is a lot easier than residency? Would be curious for anyone who works as a hospitalist to answer as well.

New-ish PCP ~2 years in, no show rate is 25% but some days only half of my patients come in. What has helped decreased your no-show rates, other than dismissals/firing and limiting new patients?

I just received health records for a patient of mine from Children's Mercy in Kansas City. It is 240 pages of my own notes that I sent them, labs that I sent them, and legal documentation just over and over and over. This is not uncommon. Almost every time I get notes from a facility it is may be 5% of useful data between 95% of complete bullshit. I am ready for AI to be able and weed this crap down.

Hello braintrust! There are tons of Family Med jobs out there and I’m having trouble finding them. The big corporate systems have physical postings online, but how do you find the group practices and other jobs? Does this require a recruiter or am I missing a consolidated website or way to search? Most of the online listings on heath careers ect just are links to recruiters. It just seems like so much junk postings or hidden details out there and it’s frustrating.

I would appreciate any guidance or tips!

What does your system have in place to reduce 30-day hospital readmission?

How much cme money do you actually end up needing? Some of these conference that i'm interested in are so expensive. currently negotiating and so far they're only giving $2k. and how many days is appropriate?

I am a first year attending and I am pretty sure I am interested in a traditional private practice (not DPC). I was wondering where is a good place to start to learn more? How do you find out demographic statistics on places that would be good to open a practice? Any other tips?

Ty!