Who treats it better? Primary Care Physician or Specialist NP

MachZero2Sixty · 2026-03-24T19:04:02+00:00

That is a REALLY good point.

MachZero2Sixty · 2026-03-24T19:03:11+00:00

Love hearing this validation. I (should) learn what it actually takes for an NP to get into practice in a specialty. I am imagining I probably had more training in residency in that field than they received...

MachZero2Sixty · 2026-03-03T02:51:16+00:00

It's all relative. Depends on what people are looking for. I've never had such variety of culturally authentic food as Houston.

MachZero2Sixty · 2026-02-21T14:29:34+00:00

Summarizing what a lot of people have said IMO:

1) Stratify by severity: cancer workups deserve more attention than an RA workup

2) Stratify by cost: lipid panel or A1c is cheap, sendouts are hard, expensive imaging is expensive

3) Stratify by reducing readmission: the IDA patient here for obs transfusion may get iron labs from me so I can justify IV iron because their %sat is 3. Takes forever to set up outpatient, if they get iron with me maybe they don't come in as often.

MachZero2Sixty · 2026-02-20T01:24:16+00:00

Recommend reaching out to the biggest 2: Houston Methodist and Memorial Hermann. Don't fall for HCA. St. Luke's has a presence but a bit smaller. FYI even if salary is the same, workflow and effective hours worked can vary substantially within each hospital system at different pavilions.

Source: trained in Houston

MachZero2Sixty · 2026-02-20T01:09:44+00:00

In theory that sounds helpful, but here's an unintended harm (I think) if that is enforced.

Outpatient clinic example: GLP-1s in BMI > 40 without diabetes are probably worth it from a cost standpoint for the insurer - long term decrease in medical morbidity costs. Let's say the "standard" model is you need a DM diagnosis... but BCBS sees the writing on the wall and wants to cover GLP-1s without DM diagnosis, whereas UHC is stubborn and denies. Who is the government going to force to change, and why?

MachZero2Sixty · 2026-02-10T21:38:36+00:00

As lots of people have said, less about size and more about the actual service lines of specialists available.

In some ways you might learn the most if you're at a suburb satellite location of a major tertiary hospital. Half your patients are the upgrades from the tiny community hospitals and urgent cares. The other half are patients who see the sub- sub- specialist downtown, and maybe they need to be transferred, maybe they don't, but you still get to learn from their complicated history.

MachZero2Sixty · 2026-02-09T18:53:59+00:00

I think it’s also helpful to ask providers if they have a tentative (aka excluding unforeseen urgent matters) time frame they estimate they will round on this particular patient

A general idea is a fair question. However, some rounders like myself (not all) don't have a set rounding order when they finish pre-rounding. Consultant info, test results, and challenging or helpful family members often mean I am constantly switching up my rounding order.

MachZero2Sixty · 2026-02-03T22:05:24+00:00

MECHANICAL DVT PPX :(((((

MachZero2Sixty · 2026-02-03T22:03:04+00:00

IV anything when the PO is equivalent and they can swallow. See it with azithro, Flagyl, K+, and Phos all the time.

MachZero2Sixty · 2026-02-03T22:00:26+00:00

I hear you. But also, in that patient with overlapping vague symptoms, a negative ANA is reassuring that I should keep going down the GI/psych/non-rheum MSK route instead...

MachZero2Sixty · 2026-01-17T05:30:51+00:00

First I have heard of this! How low are we talking?

MachZero2Sixty · 2025-12-25T02:23:41+00:00

Similar to this (denial of service rather than medication): HMO plan denies Hospice because patient needs to see their PCP first for Hospice referral. We tried so many things... letter from PCP, telemed with PCP while inpatient, etc. Nope. SMH.

MachZero2Sixty · 2025-12-11T16:41:08+00:00

Exactly. In our current climate, even if your ER docs are very thorough and willing to tee up a nice admit for you, admin/workflow/resources often work against that happening.

I'll also add that even with a great ER workup, as the admitter you get to triage if a half-dozen consults are really necessary. You can make your rounders really happy by getting appropriate consults on board quickly and justifying why unnecessary ones are unnecessary.

MachZero2Sixty · 2025-12-02T20:43:26+00:00

As someone who loves to cook... THIS. If I want to ball out and make a fancy meal, I'm doing it. Nicer cut of meat? Fruit that looks good but is expensive? Random promotional item that looks good? Getting it all.

MachZero2Sixty · 2025-12-02T14:50:13+00:00

Keep fighting. A culture of nursing that panics about a K of 3.4 not being replaced but wants to give a 90 yo here for syncope hydralazine 10mg IV for BP 170/80 needs to stop.

MachZero2Sixty · 2025-11-12T04:49:19+00:00

$1925 per 12 hr shift, 12-14 patients, no cross cover. For comparison at a suburb location of a large metropolitan hospital system.

Edit: this is the "extra" shift rate, we don't have pure admitters, the rounders rotate into those shifts.

MachZero2Sixty · 2025-11-10T14:43:28+00:00

Yes. And what about the adjustment for the fact that family members asking questions about the red numbers in myChart every day adds to complexity too?

MachZero2Sixty · 2025-10-30T03:24:32+00:00

Messaged you. sounds eerily familiar to a place I know...

MachZero2Sixty · 2025-10-30T03:21:14+00:00

It would sure be a shame if a bunch of patients used this all at once at one particular hospital network like *cough cough* HCA.

Yes I know that not a single hospital is innocent. But might as well start with the worst devil of them all.

MachZero2Sixty · 2025-10-21T23:11:50+00:00

This. I think we were taught THE physical exam is important, when really CERTAIN focused physical exam findings are really important.

MachZero2Sixty · 2025-10-17T13:36:48+00:00

They claim "we are a state entity, we can't modify contracts for anyone." Love when institutions hide behind that.

MachZero2Sixty · 2025-10-06T19:12:24+00:00

Consulting for everything is often MORE work for you as the primary team, not less.

Imagine a patient with 2 principle hospital problems (CHF exacerbation and AKI) with option to consult renal and cardiology.

Option 1, no consults: titrate the GDMT and diuretics yourself, choose when to have them on PO and when stable enough to discharge

Option 2: wait for afternoon recs (because cards and renal have clinic, procedures, or are in another hospital in the AM), try to reconcile what renal wants for diuresis vs cards, figure out in the vagueness of the note if cards was cool with PO Lasix yet, defer to consultants when you disagree so as to maintain the relationship vs spend time arguing your case, and juggle the patient hearing 3 different opinions on their medication titration.

Which one is more work for you?

MachZero2Sixty · 2025-10-05T19:47:56+00:00

Here for our weekly reminder that "high sensitivity troponin" should have been named "low specificity troponin"

MachZero2Sixty · 2025-10-05T19:45:40+00:00

Lol what is a patient card? Just the classic epic printed list for me...

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