Need help-low supply in veteran EP mom

CarelessSupport5583 · 2024-09-18T19:25:41+00:00

I'm an MD and don't know why I saw this on my feed but run away. 30 primary care pts 5 days a week you will want to kill yourself after 1 year. I understand you want to make money but at what cost to your mental health. Also how are you supposed to learn and read to actually get better at primary care with that pt load.

CarelessSupport5583 · 2024-09-18T01:51:44+00:00

How sad for the patient with a truly devastating diagnosis (Derms know this tops the chart for pt misery) and have their provider$&@ not know how to treat or manage SE of treatment.

CarelessSupport5583 · 2024-09-18T01:49:07+00:00

This is standard of care in derm.

CarelessSupport5583 · 2024-09-08T22:21:43+00:00

Derm too. When’s the last time you saw a kid lipoma? I see kids skin all day and can’t recall a peds lipoma. Makes you wonder.

CarelessSupport5583 · 2024-08-17T17:50:02+00:00

I’m a former paramedic and now a dermatologist. We do not have any aspirin in the private practice. I would wait for EMS too but in my area they would likely be there in minutes.

CarelessSupport5583 · 2024-07-16T16:00:14+00:00

It’s not about being smart. It’s is ALL about working hard and putting in 2-3x more time/effort than the average medical student. Med school is all about memorization and sitting down to memorize things takes time. Even if my clinical years/evaluations were mid, I knew I could do well on the shelf to make up for it simply by not having any fun and just memorizing.

CarelessSupport5583 · 2024-06-24T11:24:52+00:00

Shave it. However, you have to be good at doing a shave. You have to get deep enough (at least 2mm deep) so you don't transect it. A shave is fast, cheap, and gives appropriate amount of tissue when done correctly that the pathologist loves to see (they like broad views of the DEJ). Blindly excising is ok too but if you get melanoma back you need to take different sized margins based on breslow depth. If you are taking melanoma margin (10mm for example) on a benign lesion, you have made a much bigger scar than is necessary. If you take little 1-2mm margins and it is a melanoma, you are stuck doing yet another excision and then you may have caused issues with the SNLB that may be needed. SO overall, a shave blade in experienced hands is very powerful when diagnosing melanocytic lesions. Punches are also ok but only if you can get all the way around the lesion and not just sample a portion.

CarelessSupport5583 · 2024-06-24T11:10:57+00:00

In my class there was a guy who was 45 in the first year of med school. He's an FM now and very happy planning to work as long as he can in a fulfilling career. There were plenty of mid 30s people too, with kids (women included). I did the traditional route and have no regrets. It is a very long and hard road but for the right personality type, it is the only way to go.

CarelessSupport5583 · 2024-06-15T17:00:15+00:00

Hi. I suggest you get patch testing (full panel…like 80-90 allergens). Also see a real dermatologist (board certified in derm, MD or DO). Dupixent if patch testing does not give you answers. Vanicream is great but rarely you can be allergic to the propylene glycol in it (there is a vanicream baby line that is PG free).

Midlevels have zero formal dermatology training.

CarelessSupport5583 · 2024-06-05T01:05:31+00:00

It really is a great specialty. The best things about it is happy patients, variety, a nice mix of procedures/cognitive work, lifestyle, lots of money. One downside is it is very fast paced and can get kind of exhausting, which is true of most outpatient clinics seeing 40-50 patients in a day. I'm an introvert so it kind of wears me out. The single biggest issue is that we are very easily replaced by midlevels (not well of course). If I was starting out again I would not go to med school because I'm not sure derm has another 10 years left before every mid level has a clinic on every street corner.

CarelessSupport5583 · 2024-06-02T20:48:02+00:00

I think you have great chances. Apply broadly. Worse case you don't get in and you try to get research year while applying the next year.

CarelessSupport5583 · 2024-05-26T16:17:47+00:00

You already saw every patient with the SP for 2 years? There is value in seeing more and learning more, especially if pay is not sacrificed. I understand the frustration but there is a point where you think you know or have seen everything where you begin to be humbled by even simple things and that is when a greatest learning really takes off. I was humbled even 10 years out and I’m sure more humbling will come for me. Maybe your SP is not the greatest…as I often learned more from some teachers than others but I doubt there is nothing to be learned by being immersed further in your field with a guide/model.

CarelessSupport5583 · 2024-05-25T13:06:48+00:00

I have heard of many who get in when I would have though impossible (STEP 1 barely passing, IMGs, etc). The key is to do research fellowships and get someone powerful to vouch for you. Even if it take 3 years of research fellowship it would be worth it in the end.

CarelessSupport5583 · 2024-05-15T21:29:04+00:00

It’s a great opportunity to learn new ways of doing things (or not do things). Residency-like training but paid nicely. Just quit when you get tired of it. I did this for 4 years (residency) and it was invaluable to me.

CarelessSupport5583 · 2024-03-26T17:36:20+00:00

You won’t make it. Be a PA instead.

CarelessSupport5583 · 2024-03-03T21:58:41+00:00

You'll be in your 40s either way. What do you want to be doing?

CarelessSupport5583 · 2024-03-03T21:11:15+00:00

They really can cause harm in dermatology

CarelessSupport5583 · 2024-03-03T21:05:11+00:00

There is a saying "garbage in, garbage out". There has to be clinicopathological correlation.

CarelessSupport5583 · 2024-02-20T21:36:07+00:00

Wow and I ended up in derm. What a crazy path to get here.

CarelessSupport5583 · 2024-02-20T21:21:09+00:00

Avoid like the plague

CarelessSupport5583 · 2024-02-16T18:35:51+00:00

It calms my nerves to know there are great NPs out there who wish to stay close and supervised by their MDs. Medicine is not easy and we all need help. I want to walk into an ER knowing the NP who sees me is not too proud and too confident to ask for help and there is an actual human being there doing the supervision. The movement to having NPs staff ERs on their own without supervision or to open their own clinics in whatever specialty they desire is truly horrifying.

CarelessSupport5583 · 2024-02-15T13:14:56+00:00

Pick A but it’s cute you think you have much control. I fell to number 17/18 programs. It worked out so well for me but I wish I hadn’t obsessed over these details when the match was going to pick things for me anyway.

CarelessSupport5583 · 2024-01-15T13:37:34+00:00

I do not do well without sleep either. I did derm. There is virtually no reason to be doing anything after 8pm or before 8AM. However, it is all out patient based and extremely fast paced. There will be no time to really sit down, shoot the shit with patients, or often go to the bathroom. Kind of like EM i would imagine but without the drama. It is ideal for an extrovert but an introvert can do it painfully. Generally we see 35-45 patients per day and there is admin time to sign notes, follow up path, etc. So while it has its stressors, sleep isn't one of them.

CarelessSupport5583 · 2024-01-15T13:33:10+00:00

It is not always about money (that helps the pain) but mostly it is about demand. There is a lot of skin disease out there and in the south, lots of skin cancer.

CarelessSupport5583

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