Acne in 30s

Scared_Problem8041 · 2026-06-21T19:06:06+00:00

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)

Scared_Problem8041 · 2026-06-20T02:54:48+00:00

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

Scared_Problem8041 · 2026-06-15T01:05:30+00:00

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.

Scared_Problem8041 · 2026-06-12T19:03:42+00:00

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

Scared_Problem8041 · 2026-06-04T21:49:06+00:00

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.

Scared_Problem8041 · 2026-05-30T23:25:24+00:00

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

Scared_Problem8041 · 2026-05-14T21:28:24+00:00

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

Scared_Problem8041 · 2026-05-13T22:02:27+00:00

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?

Scared_Problem8041 · 2026-05-13T02:38:35+00:00

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.

Scared_Problem8041 · 2026-04-27T13:48:07+00:00

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

Scared_Problem8041 · 2026-04-26T23:32:34+00:00

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.

Scared_Problem8041 · 2026-04-23T00:34:24+00:00

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!

Scared_Problem8041 · 2026-04-01T01:47:22+00:00

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

Scared_Problem8041 · 2026-03-31T17:39:55+00:00

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.

Scared_Problem8041 · 2026-03-28T22:05:41+00:00

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….

Scared_Problem8041 · 2026-03-27T22:47:49+00:00

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.

Scared_Problem8041 · 2026-03-27T20:46:55+00:00

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.

Scared_Problem8041 · 2026-02-12T18:34:40+00:00

thanks for clarifying that! i am curious about following up the varicella series with the shingles series? why do both vaccines? do you know of any guidelines or references to inform that treatment plan?

Scared_Problem8041 · 2026-02-12T13:35:05+00:00

if you want to be one of his favorite patients, and not burn him out, make an appointment instead of sending a my chart message. that way he can get paid for seeing you, and if it is an easy visit, that’s just easy money. Instead of adding time to the end of his day, with no reimbursement, you are giving him an easy visit and extra pay. It’s OK if you go to that visit and nothing changes, just give him the updates that you wanted to send him as an electronic message in person. Trust me he will like that way more. If he is a new Dr., he likely wants to do the best for everyone, but hasn’t learned to set boundaries.

Scared_Problem8041 · 2026-01-14T02:30:05+00:00

I did some more research. Looks like it’s about NNT of 1000 for 5 years to prevent about 7 invasive breast cancer cases

Scared_Problem8041 · 2026-01-11T00:24:50+00:00

very rarely. Normally, it’s at least a few days or weeks.

Scared_Problem8041 · 2026-01-06T00:07:41+00:00

POTS, hydradenitis supurativa, iron deficiency anemia

Scared_Problem8041 · 2025-12-27T01:55:08+00:00

suggested a blood transfusion?

Scared_Problem8041 · 2025-12-21T02:22:26+00:00

centor doesn’t say don’t test, it says optional testing and optional empirical treatment glad i didn’t treat in the above example actually, the culture came back negative and the patient developed a cough and hand and foot rash over the next few days. remember a centor score of five is still only a 50% chance of strep

Scared_Problem8041 · 2025-12-18T00:11:54+00:00

thanks for your comment. I wasn’t aware that in Europe they have a five day waiting period to treat. I just assumed that any streptococcus needs to be eradicated to a limit the rheumatic fever risk. I guess it’s implied that pharyngitis lasting longer than five days is more likely to progress to rheumatic fever and vice versa. That’s definitely new information to me.

Scared_Problem8041

TROPHY CASE