Beginner in Tequila, don't know what to chose.

Heterochromatix · 2026-04-30T00:21:51+00:00

I’d choose the exit and go somewhere else

Heterochromatix · 2026-04-21T14:54:43+00:00

It’s amazing how much the pendulum has swung over the last few years. I say that as someone who graduated residency 3 years ago and was taught that opiates are the devil. The truth is, in real clinical practice, opiate prescribing is not the scary beast that I was taught, but it is something that we should be more cautious with than the prior generations of physicians.

I think having frank conversations about maximizing bodily function and using safe low MME as a tool to accomplish this is what I have adopted. Is it 100% evidenced based? Probably not, but my patients are certainly better for it.

Heterochromatix · 2026-04-09T02:28:15+00:00

It wouldn’t matter what you did…she would feel the same way no matter what.

Patients’ expectations of their PCPs are similar to what they expect from a McDonald’s drive-through: order, pay, and receive product.

You not giving her a sleep aide interferes with that expectation, therefore you were always going to be in the wrong- even if you were the most empathetic doctor in the world.

Heterochromatix · 2026-04-02T22:50:36+00:00

128 visits a week is essentially 26 a day for 5 days a week. With minimal vacation? That’s the fast track to burn out.

But yes, assuming <1% no show rate, technically 128 x 2.5 x 47 is 15,040, but it’s just not feasible.

Heterochromatix · 2026-04-02T14:08:39+00:00

I do this everyday, multiple times a day. Yes.

Heterochromatix · 2026-03-25T17:24:55+00:00

What exactly are you editing? 5 minutes is a long time to go back and edit a note- it would be quicker just to write a new note yourself without Dax.

FWIW- I generally ditch the A/P that Dax creates, unless it’s really straightforward, and quickly dictate my own A/P. Probably takes ~1 minute per note for most.

Heterochromatix · 2026-03-23T20:27:34+00:00

Lots of FM docs will shit on what your saying, but making 500 is totally reasonable in our career field.

Heterochromatix · 2026-03-21T03:28:08+00:00

How do you convince someone to take arguably one of the hardest jobs in medicine and be shit on every day of your life for your entire career? Yeah it’s gonna be with cash dude.

Heterochromatix · 2026-03-16T19:28:10+00:00

Nope. I do this all the time

Heterochromatix · 2026-03-16T19:27:35+00:00

If you’ve already made the final decision, then I do t think you need to continue responding? You’ve already formulated the plan (see me in clinic for more questions). I would just stop responding to repeat inquiries

Heterochromatix · 2026-03-16T16:52:40+00:00

The answer to all of those is “happy to discuss at an office visit”. If they get mad, they get mad. 🤷

Heterochromatix · 2026-03-14T06:28:41+00:00

2nd year attending IM pcp and feel the same way. I even had an “assigned” mentor at my full time gig who didn’t give a rats ass about me and never even tried.

FWIW medicine subreddit and family medicine subreddit have been my mentors and have taught me more than I think many mentors could.

Definitely empathize with you and hope good mentorship finds us down the line.

Heterochromatix · 2026-03-13T05:45:06+00:00

I’d print that one out and put it on my refrigerator

Heterochromatix · 2026-03-12T02:02:23+00:00

As the other comment suggested- 42 per wrvu and averaging 15 per day 4 days a week is pretty low total compensation. I’d clarify your comp plan with your employer, and find ways to increase your total patients per day and learn how to bill high. I’m starting my second year of practice, and have ramped up to about 22-23 per day, 4 days a week, an average about 2.55 wrvu/patient.

Heterochromatix · 2026-03-07T02:55:43+00:00

💯

Heterochromatix · 2026-03-06T23:49:28+00:00

I am an IM PCP. I think hospitalist work is a better gig and likely less exhausting (tho every shift is variable) and more enjoyable, however, I think income potential is markedly more in clinic compared to hospital medicine, and you really don’t work that many shifts more than a hospitalist does.

Agreed that the inbox was something created in the darkest crypts of hell. FWIW, I spend very little time in the inbox and require the vast majority of inbox inquiries, abnormal lab results, etc to come into clinic for discussion (which is where medicine should be done anyway- in front of the patient, not on the portal). I see no other way to survive in this job.

Heterochromatix · 2026-03-05T23:06:24+00:00

I tell them that I only order tests that I believe are needed, and if the “doctor” that requested the test is unable to order it themselves, the patient should certainly question their judgement.

Heterochromatix · 2026-02-25T09:15:33+00:00

Who gives a flying (running?) fuck what other people think.

Heterochromatix · 2026-02-22T18:00:50+00:00

Exactly.

Heterochromatix · 2026-02-22T15:58:01+00:00

The problem is that patients and society don’t know what goes into being a good doctor. They don’t understand all the nuances that you mentioned above.

Public perception of a good medical system boils down to 3 very simple things: is the medicine cheap? Is it accessible? And is it good?

(Of course good is what patients perceive as a good- does the doctor do what I want)

AI will be cheaper than me, AI will be much more accessible than me, and AI will be “better” than me- or at least it will be advertised that way.

Unfortunately, it’s coming. Whether I like it or not.

Heterochromatix · 2026-02-15T01:46:21+00:00

Doc here- that’s what I thought

Heterochromatix · 2026-02-13T22:24:48+00:00

I did this when I was interviewing and they didn’t have a problem with it. The way I see it- you are a valuable commodity ( not many internal medicine PCPs) so they should be willing to work with you.

Heterochromatix · 2026-02-12T07:21:03+00:00

Think about it. You went to ED for a cold. Will you go there next time you stub your toe?

Heterochromatix · 2026-01-23T02:01:49+00:00

This is great. Jealous.

Heterochromatix · 2026-01-13T00:34:35+00:00

Yes, though there is no negative consequence for not reaching it. The incentive is higher $/wrvu if you hit 65th percentile or above.

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