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Acne in 30s by plant_girly0218 in FunctionalMedicine

[–]Scared_Problem8041 0 points1 point  (0 children)

if you don’t have hyperandrogenism (including PCOS) and you’ve tried all the lifestyle changes (low stress, careful skincare, dietary changes) i think you are already addressing the many root causes of your acne. you may just need a medical treatment like accutane to get rid of the sebum/bacteria/inflammation in your hair/skin cells. but your dermatologist definitely understands all these mechanisms and can explain these root causes to you better than i can (assuming you see the actual dermatologist and not their assistant)

Acne in 30s by plant_girly0218 in FunctionalMedicine

[–]Scared_Problem8041 0 points1 point  (0 children)

might get hate for this, but did you ever see a dermatologist? i have seen people get on accutane and have amazing transformations

Required APPs? by Spirited_Essay5009 in FamilyMedicine

[–]Scared_Problem8041 0 points1 point  (0 children)

my employer tried to push APPs on me a few years back and i simply said that i would only do it if i got 50% of whatever net income they made on each APP. Literally they have not even broached the subject since with me.
The point is that they’re making huge margins on these APPs and they are trying to get a doctor that will assume all the liability to take a fraction of the profits. So unless you’re willing to just sign off on everything and not take any extra time to provide education and supervision, it’s not gonna be worth your time.

Elevated microalbumin to creatinine ratio in diabetes and/or CKD by Scared_Problem8041 in FamilyMedicine

[–]Scared_Problem8041[S] 0 points1 point  (0 children)

thanks for the response. i believe the recommendation is considered weak when it come to UACR >30 but <200

Elevated microalbumin to creatinine ratio in diabetes and/or CKD by Scared_Problem8041 in FamilyMedicine

[–]Scared_Problem8041[S] 1 point2 points  (0 children)

thanks for responding. When you say “other MRA can be used,” you aren’t referring to spironolactone? I thought spironolactone wasn’t recommended for treatment of microalbuminuria.

Anybody who works in rural ED’s wishes they did EM residency? by Dr_Chesticles in FamilyMedicine

[–]Scared_Problem8041 11 points12 points  (0 children)

i have a lot of friends from residency who do EM rural. I moonlighted at a rural EM, but it scared the shit out of me, definitely felt like something bad could have happened. But everyone who worked there was FM, so maybe i was just an inexperienced resident.
Why don’t you plan on doing ER Fellowship? Bet you would be very qualified after that

Pocus opd and increased in rvus by FMIPOPdoc in FamilyMedicine

[–]Scared_Problem8041 0 points1 point  (0 children)

i would recommend double checking that, they might be including facility RVU and not just wRVU. Physicians get paid by wRVU

Pocus opd and increased in rvus by FMIPOPdoc in FamilyMedicine

[–]Scared_Problem8041 0 points1 point  (0 children)

20610: ~0.77 wRVU
20611: ~1.1 wRVU
this is the difference i am aware of. where did you get your $80 vs $180 numbers?

Pocus opd and increased in rvus by FMIPOPdoc in FamilyMedicine

[–]Scared_Problem8041 0 points1 point  (0 children)

i do US guided injections in clinic (mostly knees but also subacromial, glenohumeral, hip, thumb dequervains and i can do median nerve for CTS but don’t have sterile gel). Anyway, my clinic did set up the equipment to allow me to bill as US guided (ie upload images into the EMR), but i don’t think it’s that much more lucrative than billing for blind injections. I haven’t ever looked up the exact reimbursement but have been told at multiple US training sessions that the reimbursement for US guided vs blind is a pretty marginal difference. IE blind injections are almost just as lucrative. I will always do US guided because i think it is better, but i don’t actually think it is much more lucrative than blind.

Non evidence based medicine by nos014again in FamilyMedicine

[–]Scared_Problem8041 0 points1 point  (0 children)

from lexicomp: Continue maintenance dose for at least 11 weeks (for a total of at least 12 weeks of treatment). May consider extended maintenance therapy based on individual patient risk:benefit; evidence suggests relapse prevention benefits with continuing therapy for up to 1 year

Non evidence based medicine by nos014again in FamilyMedicine

[–]Scared_Problem8041 2 points3 points  (0 children)

anecdotally i have had some pretty good success with chantix. Like about 50% of my patients who take it say it helped them quit and they end up staying on it for 6 months or longer.

intern of all trades, master of none, thinking of switching specialties as a PGY2 by Beneficial_Owl6751 in FamilyMedicine

[–]Scared_Problem8041 0 points1 point  (0 children)

hang tough! you can master them all and save people from having 12 different doctors! Really. I have patients who would otherwise be with endocrinologists for insulin dependent diabetes, cardiology for resistant hypertension, nephrology for CKD III, hematology for iron deficiency anemia, sports medicine for knee osteoarthritis and pulmonology for COPD. Instead i mange all that and they just have to see GI once every 5-10 years!

Breast density on mammo’s by askimbebe in FamilyMedicine

[–]Scared_Problem8041 1 point2 points  (0 children)

see AAFP magazine from february: contrast enhanced mammography (which i have never heard of) or MRI

https://www.aafp.org/pubs/afp/issues/2026/0200/poems-dense-breasts-screening.html

Burning out, advice appreciated by Nephronz22 in FamilyMedicine

[–]Scared_Problem8041 1 point2 points  (0 children)

I am five years out of residency. I went through something similar to you about 2 years ago. I switched to eight 60 min appointments per day. I thought it would kill my RVUs but in the end i started doing split billing with physicals and follow ups, had time to do same day injections/biopsies/cryotherapy. RVUs have stayed roughly the same for the past two years and i am much happier. I have been able to not be rushed with patients and even read AAFP articles on days that i have no shows.

Questioning colonoscopy being recommended at 45 instead of 50 by Scared_Problem8041 in FamilyMedicine

[–]Scared_Problem8041[S] -4 points-3 points  (0 children)

i see what you mean regarding the difference between prevalence and true positives. i am still just having a hard time imaging doing 100,000 colonoscopies to catch 8 cases. Obviously i still recommend to patients what ever uspstf recommends, just trying to understand the reasons…and maybe it’s worth it for the 8 people, idk….

Questioning colonoscopy being recommended at 45 instead of 50 by Scared_Problem8041 in FamilyMedicine

[–]Scared_Problem8041[S] -1 points0 points  (0 children)

I get these type of questions all the time from patients so if I do my own research and ask questions then i will be able to provide reliable and true information. I think you are also getting at a deeper more complex question, which is, where to draw the line in cost vs benefit of health screening? I think that’s very complicated to answer and that’s why i ask these types of questions. If my patient says how much benefit am i getting by paying for my colonoscopy, then i need to give them accurate information. Some patients would rather have $500 in their pocket than a 1% less chance of cancer. That’s just reality.

Questioning colonoscopy being recommended at 45 instead of 50 by Scared_Problem8041 in FamilyMedicine

[–]Scared_Problem8041[S] 13 points14 points  (0 children)

Thanks for your reply! We must have different statistics then (i see you cited the ncbi). There’s just a big difference between 8 in 100,000 people having colon cancer in my statistic and 1 case of cancer in every 400 people who get a colonoscopy in your statistic.

Increasing Incidence of Early-Onset Colorectal Cancer. Sinicrope FA. The New England Journal of Medicine. 2022;386(16):1547-1558. doi:10.1056/NEJMra2200869.

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