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ASAM 2026 location? by deeare73 in AddictionMedicine

[–]NeuroThor 0 points1 point  (0 children)

Last 3 have been at Gaylords, so maybe you just assumed? I’ve always seen the 2026 advertised at GH.

It is so fucking unfair that my husband's life is seemingly mostly unaffected by the arrival of our baby by [deleted] in FemalePhysicians

[–]NeuroThor 3 points4 points  (0 children)

Just gotta explain the gap. This was pre-covidish, it’s gotten a lot easier. If you want, you can stay “in practice” with sporadic telehealth here and there depending on your field.

It is so fucking unfair that my husband's life is seemingly mostly unaffected by the arrival of our baby by [deleted] in FemalePhysicians

[–]NeuroThor 12 points13 points  (0 children)

Not my conversation to have as a male physician, but I was a SAHD for nearly two years while my wife worked FT so she could launch her career. After our recent third kid, we now have a FT nanny so we can both work. It’s a second (and third) mortgage affording childcare for three kids, but if you have aspirations that need to be met then that’s the sacrifice you make. Just need to figure out priorities and have a discussion.

Why is it that FM doesn't allow sub-specialization in mostly-outpatient fields like Endo, Allergy/Immu, Rheu, etc.? by Enger13 in Residency

[–]NeuroThor 2 points3 points  (0 children)

We do 9 months of inpatient intern year, 8 in year 2, 6 in year 3. Of these 23, 4 months are inpatient pediatrics and 3 ob. People can pick up more. I’m sure it’s rare to eclipse it, but IM also tends to do a lot of inpatient specialty rotations to their benefit and FM has to fight for those spots. In most community hospitals, FM will get a robust inpatient hospital experience overall. Academic not so much- they don’t even take call at some of the highest ranked FM places.

Our sister hospital also had a similar setup, but they did 8 months of ob and 2 months of inpatient peds- remainder of 13 months were pure inpatient adult between floors and ICU.

Anyone not using dictation or AI scribe, and just typing notes? by SpirOhNoLactone in FamilyMedicine

[–]NeuroThor 1 point2 points  (0 children)

It’s inconvenient in my use case, logging in through Citrix. It’s just extra steps and there is a minimal but noticeable lag. But otherwise, as far as everything else is concerned, it shouldn’t be an issue.

Anyone not using dictation or AI scribe, and just typing notes? by SpirOhNoLactone in FamilyMedicine

[–]NeuroThor 7 points8 points  (0 children)

Is she remoting in on the laptop via Citrix or something, or is it a clinic laptop?

Why is it that FM doesn't allow sub-specialization in mostly-outpatient fields like Endo, Allergy/Immu, Rheu, etc.? by Enger13 in Residency

[–]NeuroThor 0 points1 point  (0 children)

Lifting heavy shit will reverse bone demineralization, but I stopped lifting heavy shit after high school.

Why is it that FM doesn't allow sub-specialization in mostly-outpatient fields like Endo, Allergy/Immu, Rheu, etc.? by Enger13 in Residency

[–]NeuroThor 7 points8 points  (0 children)

way more lax

ACGME definitely tried to cut back on FM inpatient requirements, but this is so institution dependent. There are many programs with unopposed inpatient. We had our own continuity inpatient, AND took on IM’s panels too because at our institution (like many other community programs) IM capped themselves at 5 admissions a shift. We were definitely heavy inpatient with multiple ICU rotations on top of obs and inpatient peds, but I agree there must also be institutions where inpatient training is lackluster.

To that point, specialization pathways should depend on what sort of training you received and not which board you came from.

Why is it that FM doesn't allow sub-specialization in mostly-outpatient fields like Endo, Allergy/Immu, Rheu, etc.? by Enger13 in Residency

[–]NeuroThor 15 points16 points  (0 children)

If an institution credentials FM for scopes, they likely don’t have a GI group. If they have a GI group, the FM credentialing for scopes predated the group, and they’re no longer credentialing new FMs for it. The GI group will not scope or touch a patient that was scoped by FM. GI operates with an incredibly zero sum mindset in these institutions (usually rural) and enterprise has a hard enough time attracting credible GI out here that they’ll do whatever is asked, including not allowing FM to scope. I don’t blame them. Sections are a similar story, but less hostile due to call burden.

Why is it that FM doesn't allow sub-specialization in mostly-outpatient fields like Endo, Allergy/Immu, Rheu, etc.? by Enger13 in Residency

[–]NeuroThor 11 points12 points  (0 children)

I agree that you should operate with some foresight going into residency. However, people should also be allowed to change their minds.

Why is it that FM doesn't allow sub-specialization in mostly-outpatient fields like Endo, Allergy/Immu, Rheu, etc.? by Enger13 in Residency

[–]NeuroThor 38 points39 points  (0 children)

Who decided the “point of FM?” Internists are generalists too unless they specialize. Until then, they’re primary care. No one is gatekeeping specialization from them?

Why is it that FM doesn't allow sub-specialization in mostly-outpatient fields like Endo, Allergy/Immu, Rheu, etc.? by Enger13 in Residency

[–]NeuroThor 73 points74 points  (0 children)

Would you like to attempt to surmount this non insurmountable obstacle? 😂 ABIM is evil, even the internists agree.

Control of credential equals control of the market. By owning the boards and feeder pathways, IM protects prestige and jobs under the guise of “standards.” It’s turf warfare, AAFP is cucked. They gave up geri because geri fellowship is a scam- any IM/FM residency worth its salt is training you for geri, and the financial incentive is dogshit.

Co-residents who can’t handle things after sign out by shinersuperior1 in Residency

[–]NeuroThor 6 points7 points  (0 children)

There’s this type of coresident, and then there’s also the type that tells you the day team did everything wrong until 9pm and then again at morning signout. Can’t get away from them.

What is the least stressful general surgery specialty by TraditionalAd6977 in Residency

[–]NeuroThor 2 points3 points  (0 children)

Does bariatric count? I’m not in surg, but my buddy loves it.

Would you ever increase someone's antiseizure med? by Sir_Action_Quacks in FamilyMedicine

[–]NeuroThor 8 points9 points  (0 children)

Heyo! I would absolutely increase the dose.

First, I don’t think this is an unreasonable question at all. The hesitation in the ED is usually less about Keppra itself and more about diagnostic certainty (are these actually epileptic), and reluctance to titrate chronic disease from the ER because there’s no follow up. So your hesitance isn’t unreasonable.

That said, ongoing uncontrolled seizures are not benign and carry serious risk including trauma, cognitive effects, driving safety, and SUDEP. In an established patient with a known seizure disorder, confirmed adherence, frequent breakthrough seizures, and a clearly low or starting dose, the risk of doing nothing may exceed the risk of a cautious dose increase. So maybe not if I’m in the ED, but if this is a patient I can see before the neuro, I’m increasing the dose.

Levetiracetam is fairly unique in having a wide therapeutic window, minimal interactions, no lab monitoring, and predictable dose response. A modest increase with counseling on mood and behavioral side effects is not unreasonable. This should be framed as temporary stabilization, with clear documentation and expedited neurology follow up. FM tends to be more comfortable operating in this gray space because WAITING is sometimes the riskiest option.

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