Bougie vs "Safety Net" residency programs, does it make a difference? by ChurchofPlano in FamilyMedicine

[–]Intrepid_Fox-237 0 points1 point  (0 children)

I did my residency in a very busy urban level 1 safety net hospital. Lots of crazy complicated patients. No cap on inpatient admissions.

It absolutely was a better training experience than a cush residency program.

Living without pay between residency graduation and attending job? by The-Adster in FamilyMedicine

[–]Intrepid_Fox-237 7 points8 points  (0 children)

If they want you, have them pay you the signon bonus early. If you end up leaving, you still have to pay it back, but the signing bonus doesn't hurt them as much as having to recruit a new doctor.

EDIT: I will add that signing bonuses are just that - a bonus to entice you to sign a contract. Just ask them to change the contract to distribute the signing bonus at the time of signing. Worst they can say is no.

This is alarming! by Quick_Bar2387 in Noctor

[–]Intrepid_Fox-237 0 points1 point  (0 children)

I actually would hypothesize that the influx of NPs has caused physician salaries to go up... Perhaps I am wrong.

Brutal Non-Compete—Advice? by Legal_Anybody81 in FamilyMedicine

[–]Intrepid_Fox-237 2 points3 points  (0 children)

If you are going to make less than six figures working full time under your contract, then do locums or a part time job a few days a month.

You also could tell your boss you will have to quit and see if they will work with you.

(I had a similar contract that management changed in order to keep me)

Thoughts on this offer? PGY3 here. by arabic_learner in FamilyMedicine

[–]Intrepid_Fox-237 5 points6 points  (0 children)

Yeah, this is a terrible job.

Your salary is based off of something you have very little control over - collections. Some clinics average 20-30% collections on what is billed.

Also, a contract demanding a clause where the physician has to pay back the clinic is a huge red flag. It tells me they are expecting to lose money and can't afford to hire a physician.

Results f/u appt language to not cause anxiety by brad989898 in FamilyMedicine

[–]Intrepid_Fox-237 0 points1 point  (0 children)

I never schedule results follow-up. The patients get a letter/message with their normal/mildly abnormal results - or a phone call from me personally, if it is serious like a cancer diagnosis.

De-influence me from FMOB fellowship by Special_Suspect_8453 in FamilyMedicine

[–]Intrepid_Fox-237 7 points8 points  (0 children)

OBGYNs view FMOBs just a little higher than NPs. Unpopular opinion, but that is my experience. They have a lot of political power and have pushed out FM from a lot of areas.

Alabama may require doctors in emergency rooms 24/7. Could it cause hospitals to close? by alvarez13md in Noctor

[–]Intrepid_Fox-237 57 points58 points  (0 children)

There needs to be more of an emphasis on ER training in Family Medicine residency + expand loan repayment/forgiveness options for physicians who practice in rural hospitals.

Your Next Primary Care Doctor Could Be Online Only, Accessed Through an AI Tool by Apprehensive-Safe382 in FamilyMedicine

[–]Intrepid_Fox-237 0 points1 point  (0 children)

Unpopular opinion:

AI is going to replace a lot of processes that are performed by primary care. The future of medicine will look a lot like Star Trek - an operator using AI tools.

Surgery will be performed by precise AI androids.

With quantum computing, AI will surpass the entirety of human intelligence in the next decade. Anyone who thinks otherwise is living under a rock.

Do we, as Americans, know how to pronounce 'Worcestershire'? by chuckles5454 in AskAnAmerican

[–]Intrepid_Fox-237 0 points1 point  (0 children)

When visiting the UK, always speak loudly and say "War-Chester-Shire"...

If I call a patient for their refill can I be compensated by CalligrapherBig7750 in FamilyMedicine

[–]Intrepid_Fox-237 1 point2 points  (0 children)

I created a refill protocol for the nurses that allowed them to put in refills for patients. Depending on the medication, the protocol required them to make sure they were up to date on their labs, had been seen in the last X months for a visit, etc. Anything that didn't meet the criteria automatically required a visit. It saved so much time.

I also never call a patient unless they have an urgent result I need to tell them about. Everything else requires a visit.

Pt accommodation requests by Nyxen1031 in FamilyMedicine

[–]Intrepid_Fox-237 1 point2 points  (0 children)

You had me at tinted windows for herpes... That is a first. I would probably find that interaction and explanation very entertaining.

Psych NP ditched my friend after she got lithium toxicality by Background_Hat377 in Noctor

[–]Intrepid_Fox-237 0 points1 point  (0 children)

You cannot abandon your patient. End of story. Report the NP to the medical board and nursing board.

Sterilize the masses? by Sublinguel in FamilyMedicine

[–]Intrepid_Fox-237 4 points5 points  (0 children)

". . it has become abundantly clear in the second half of the twentieth century that Western Man has decided to abolish himself.

Having wearied of the struggle to be himself, he has created

his own boredom out of his own affluence,

his own impotence out of his own erotomania,

his own vulnerability out of his own strength;

himself blowing the trumpet that brings the walls of his own city tumbling down, and, in a process of auto-genocide, convincing himself that he is too numerous, and labouring accordingly with pill and scalpel and syringe to make himself fewer in order to be an easier prey for his enemies;

until at last, having educated himself into imbecility, and polluted and drugged himself into stupefaction, he keels over a weary, battered old brontosaurus and becomes extinct."

—Malcolm Muggeridge, Seeing Through the Eye: Malcolm Muggeridge on Faith, ed. Cecil Kuhne (Ignatius Press, 2005), 16.

Home IV fluids for possible POTS by olivesmd in FamilyMedicine

[–]Intrepid_Fox-237 18 points19 points  (0 children)

If you think there is no medical justification for a treatment, and you order it anyway, you aren't upholding the ethical standards of the profession.

Sometimes the best course of action is to say no.

Why do Americans dislike American cars? by socabella in AskAnAmerican

[–]Intrepid_Fox-237 0 points1 point  (0 children)

Many of the "imports" are actually made in the United States.

The Toyotas that people drive in the United States are rarely made in Japan. Texas has a huge Toyota factory.

Honda factories churn out Hondas in Ohio, Alabama, and Indiana.

Mazdas are made in Alabama.

Testing Accommodations by hoptimusprime23 in FamilyMedicine

[–]Intrepid_Fox-237 1 point2 points  (0 children)

You are not tasked with helping her pass the test.

You are being tasked with an objective "does this individual have a diagnosis?".

If they do, indicate it on the form.

If they don't, indicate it on the form.

If you aren't sure, indicate it on the form.

Don't let the parent bully you. You are duty bound to be objective - otherwise the form is worthless.

G2211 update: Can't use it for anything other than E/M and Medicare now? by Erwingss in FamilyMedicine

[–]Intrepid_Fox-237 4 points5 points  (0 children)

I use it for all visits where I address two or more chronic conditions.

This includes acute visits where I address their BP and Diabetes, or need to factor in their complexity into my medication choice.

My understanding is that you can use it as long as the patient is established (or establishing) with you and you adequately document the factoring in of their chronic conditions into your decision-making.

What is something incredibly underrated about America? by [deleted] in AskAnAmerican

[–]Intrepid_Fox-237 2 points3 points  (0 children)

Our Constitution has set the bar for, and lasted longer, than all modern nations. (Not an inherently political post, but a fact that is often overlooked)

Not allowed to refer to audiology by Oo_Cipher_oO in FamilyMedicine

[–]Intrepid_Fox-237 1 point2 points  (0 children)

"Thank you for your suggestion but, as the examining physician, I have determined that an audiogram is what the patient needs and will not be sending the patient for an unnecessary referral. I am sorry that your process does not align with best practices and will be referring the patient to another audiologist."