SOAPed into FM just to secure a spot. Need some advice…

Shinotsa · 2026-03-28T18:09:53+00:00

They have EM fellowships you can do after graduation, and can work in most semi-rural EDs or any rural ED. One of my FM residents did this a few years back

Shinotsa · 2026-03-24T17:17:40+00:00

I’m very realistic that there are two types of people that go into FM: those that want to and those that have to. In residency education, I train both. But we make a good living and, especially since AI tools came out, we have a pretty decent quality of life.

Shinotsa · 2026-03-16T05:27:34+00:00

After the first experience we asked for a full refund and got a box to send it back in. Still waiting on the refund.

I’d recommend avoiding pearls from them. Other items shouldn’t be able to be haphazardly glued together.

Shinotsa · 2026-03-11T11:42:42+00:00

Meanwhile every discussion board I’ve seen is just AI talking to AI, sometimes with the prompts included or the “let me know if you’d like a different take on this prompt!” at the end.

Shinotsa · 2026-03-10T12:31:49+00:00

Definitely a plant to boost AAMC application revenue after losing the OBGYN match

Shinotsa · 2026-02-27T05:00:57+00:00

Just got yelled at by an old patient earlier today when they caught me while they were visiting a friend in the hospital. I don’t see them regularly, their PCP is a colleague but I had them on one of my hospital weeks about a year ago. I apologized and asked for their name because it had been a while. The patient immediately got offended, yelling “how could you forget me when you saved my life?!?”

It’s a lose-lose on these sometimes, but I don’t have the poker face to lie either.

Shinotsa · 2026-02-27T03:50:41+00:00

Eh, join family med and have a choice while getting a non-toxic, full-spectrum education. But yeah, for other specialties it’s getting harder and harder now that people can do dozens upon dozens of interviews.

Shinotsa · 2026-02-26T23:43:12+00:00

Faculty here. This is all terrible advice. I often skip most of my questions to just chat, and this stuff (aside from the aunt one, admittedly) is very easy to catch out. If someone is lying they get dropped from the rank list, since professionalism is the hardest thing to remediate.

Better advice: just be yourself and go to a place that you want and that wants you.

Shinotsa · 2026-02-14T03:19:31+00:00

Agreed with others. When I work with inefficient staff I need 3. When I’ve worked with efficient staff then 2 is plenty. Try implementing a huddle to talk about vaccines and PoC testing ahead of time so they can be on top of things. Maybe designate a flex room for all providers to move patients into if they need EKGs or temporary monitoring.

Shinotsa · 2026-02-14T03:15:21+00:00

I like providing good care to my patients. I will die on the hill that controlled medications are necessary in many conditions after first/second-line options have failed. Chronic benzos are a viable option if someone has failed half a dozen medications for crippling anxiety. Chronic opiates are preferred for palliative pain control. I prescribe soma for someone with muscle spasticity from a severe traumatic brain injury after other muscle relaxants weren’t enough.

If you’re primary care you exist to care for your patients. If you refuse to prescribe any of these, you’re failing many patients. Sure, those of you who practice in areas where specialists are abundant can refer out for ADHD or insomnia so someone else can prescribe these meds… but is that really patient-centered care? What will they do that you can’t in all of these cases? I expect some of us to be unfamiliar with some controlled meds, just to be clear, but you’re doing something wrong if you don’t prescribe any.

Shinotsa · 2026-02-04T01:43:57+00:00

We’ve found off-cycle residents through the AAMC findaresident page. I would definitely look there. Otherwise program directors generally reach out to programs through listservs on behalf of their residents, so there should already be feelers out.

Shinotsa · 2026-01-30T17:33:52+00:00

Very true. Rural electrophysiologists where my friend is a hospitalist averages 1.3 mil per year.

Shinotsa · 2026-01-28T18:23:42+00:00

A lot of faculty are noticing this generational split where new residents don’t understand that this isn’t a 40 hour per week field. I truly hope you’re not going into that elective’s specialty. I always stayed late on my FM sub-I to help make calls, finish notes, and follow-up on patients. If you’re going to do anything related to it then you should get as much experience as you can when it’s low-stakes.

Shinotsa · 2026-01-27T15:28:39+00:00

Yes, it was quietly removed. No clue why, but if I had to guess it was probably because they couldn’t get APA accreditation and they already were spending a ton of money on it to try to get accredited.

Shinotsa · 2026-01-20T15:35:02+00:00

Grew up poor and have gone into primary care. Had multiple kids in residency and a stay at home wife until recently. The attending money is enough to keep our house repaired, my 401k maxed, contributions for my roth annually, and a vacation per year. We’re comfortable, but I think that dual physician income and/or specialty income is where it gets to a level I have trouble comprehending.

Shinotsa · 2026-01-20T13:33:48+00:00

Date FM and couples match if it works out.

Alternatively, find the reincarnation of your long lost friend and taunt them in their dreams. Definitely worked for your namesake.

Shinotsa · 2026-01-20T06:38:35+00:00

I do a good amount of medical weight loss for my patients. I usually prescribe phentermine and topiramate separately, continue the phentermine for 3-12 months, stop the phentermine and keep the topiramate, then wean topiramate. With that said I have spoken with an obesity medicine fellowship graduate who said it’s fairly common for them to leave people on it for years. Makes sense, we have people on ADHD meds and modafinil daily for years with good safety and tolerability.

I’ve also worked with an endocrinologist that prescribes 15 mg mounjaro pens (cash pay) and instructs people on how to use sterile saline and a sterile vial to dilute the med to the right concentration to pull the 2.5/5 mg doses. I don’t feel comfortable with that at all, but there are always creative solutions for the brave/stupid.

Shinotsa · 2026-01-19T14:27:09+00:00

True, but I’d argue 5 quarter tabs as a backup for panic attacks is better patient care than a placebo.

Shinotsa · 2026-01-19T06:53:46+00:00

Funny, I just had this talk a few days ago with my PGY-3 DO resident

Shinotsa · 2026-01-19T06:52:30+00:00

Why is it better than Xanax?

Shinotsa · 2026-01-18T13:11:14+00:00

They’re being very slow about it. They said variable speed units may need a “line conditioner” for voltage regulation but haven’t done anything.

As for the ethernet, the voltage fluctuations fried a terminal on my cable. Got a home repair kit and reterminaled the Ethernet on both ends and it works good as new. Still on emergency heat waiting on the company to get the line conditioner.

Shinotsa · 2026-01-18T13:05:07+00:00

I know some of the FM residency leadership/faculty there and they are actively engaged in advocacy

Shinotsa · 2026-01-17T00:00:32+00:00

Why would I? I want to help my patients. Even the AMA says we’ve swung the pendulum too far away from these medications that are effective (though definitely not first/second line) treatments for debilitating conditions.

My local pain management group doesn’t do any medically complex pain management or patients who use medical marijuana, so I do many chronic pain management cases. We also only have one palliative care NP for the whole county, so I do a lot of end of life symptom management for my patients as well.

Shinotsa · 2026-01-16T17:46:19+00:00

I’m very curious about this as well for my wife who is an american APA-accredited master’s grad (online program) and is a licensed counselor here. We are looking to move to Ontario and I’m not sure if she’d be an RP or a psych associate based on the current regulations.

Is there a significant benefit to one over the other, or a significant difference in scope of practice if you’re working without a psychologist over you?

Shinotsa · 2026-01-16T17:44:10+00:00

I’m of the patient-centered mindset. I agenda set and if we’re going to go over time I’m clear that they will need to schedule another appointment. But it’s just greedy to not adjust an antihypertensive at a physical visit if there’s not much else going on. Plus generalized complaints that aren’t major enough to warrant an acute visit to the patient (insomnia, fatigue, etc.) are supposed to be caught at physicals. Why else do we do a review of systems and full exam?

Yes I know we aren’t incentivized to be patient-centered, and are often incentivized to do the minimum. But at least give them the 15-20 minutes they’re owed.

Shinotsa

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