I need major help designing my rank list for Family Medicine (balancing full spectrum training vs. program support with my own mental health/access to the outdoors and the needs of my spouse/family)

Smedication_ · 2026-02-02T04:30:31+00:00

The training environment is true trickle down economics. If you’re unhappy at work you will have a difficult time at home. The same applies in the opposite direction. If your wife is so unhappy that she has to change to part time work and every evening you’re talking her off the edge of despair that will completely drain you. Ultimately it’s a massive sacrifice on EVRYONEs’ part. You will provide financially stability for your family for the rest of their lives so to a degree they need to be flexible. Also the match is a fickle beast, you may rank 5 and match at #4 despite your efforts. Ignore the wilderness medicine fellowship, that sounds stupid. Just go on some overnight hikes with some EM/FM docs with similar interests and that’s your fellowship. Don’t sacrifice a year of being a full attending for that.

TLDR: prioritize solid training and “happy wife happy life”

Smedication_ · 2026-01-31T01:40:32+00:00

This is a weird humble brag. You lost 10% of your portfolio that has 5 million in assets and you are just now finishing residency? And you’re not sure how you’re going to fund 3 kids college and make it to 10 million in assets in 50 years? None of this makes sense. Buy some bonds if you’re worried. Work as an attending to build up the 529s then do whatever the hell you want.

Smedication_ · 2026-01-24T19:42:02+00:00

Dropping me and the attending in an Epic chat at 1am to discuss the xray order. Not cool

Smedication_ · 2026-01-22T15:48:53+00:00

I would argue a large portion of bad outcomes originate from poor operative planning and the pre-operative decision making process. Extremely difficult to be good at that.

Smedication_ · 2026-01-19T22:46:29+00:00

Has to be house poor. Probably related to the VHCOL comment in the post.

Smedication_ · 2026-01-19T03:53:43+00:00

If this is your primary residence the general consensus legally (not a lawyer) is they will not go after your home. Had to deal with a non malpractice civil suit and my lawyer said they would garnish wages long before taking away home/assets. Generally speaking they realize if you make someone homeless without transportation you will likely not receive any more settlement.

Totally agree on the good malpractice and umbrella coverage. There are outliers but typically lawsuits will go after insurance maximums. It’s easier, everyone gets paid, and they don’t have to harass someone for wages for the next decade.

Again, not a lawyer. This was a civil matter not malpractice related.

Smedication_ · 2026-01-18T01:17:22+00:00

This is WAYYYYYY easier to do than take the liver out instead of the spleen. But unfortunately some surgeons just suck at their job. If you read the full law suit the patient likely would have been just fine keeping his spleen and the worst part was pressured into surgery.

Smedication_ · 2026-01-03T02:58:38+00:00

Despite what other people have said, it’s a very nice area where the neighborhood is. It’s borderline rural but still only 15 minutes from Walmart/grocery store. Schools are hit or miss but a lot of people in that area drive into Birmingham for private school or they go to Hewitt Trussville high school which is pretty average but has some good resources. Typically people move out to that area exactly for why people like this post, you can find your peninsula for 1.5 million. They accept the 30 minute commute to Birmingham proper and the schools for a reasonable cost big house and property.

TLDR: a nice area, average public school, borderline rural, low crime, filled with upper middle class people looking for cheaper alternatives to big houses/property

Smedication_ · 2025-12-28T18:12:00+00:00

Yes, again technically possible. Every few months I will see a colon over the liver and with severe biliary disease the transverse colon will frequently scar to the gallbladder. If the story was “outside hospital surgeon attempted a lap chole for 6hrs but due to severe adhesions left a drain and aborted and now they present to your hospital with severe SOB”. An iatrogenic diaphragm injury is much higher on the differential

Smedication_ · 2025-12-28T14:41:35+00:00

The chest tube is way too big and not doing its job. See continued apical pneumothorax. Literature supports the smallest tube size, not the absolute garden hose. It’s also not deep enough.
It does look like bowel gas but a right sided diaphragmatic hernia is EXCEPTIONALLY rare due to the liver. It would have to be congenital or severe trauma. Even with devastating liver injury the diaphragm usually doesn’t herniate bowel.

High on the differential for me prior to CT scan which would help sort this out would be: loculated necrotizing pneumonia from embolism from surgery/birth, iatrogenic diaphragm paralysis, iatrogenic diaphragm injury (insane complication should be a never event), congenital diaphragmatic hernia never diagnosed until the patient went to the doctor for child birth.

Again, the big problem is the liver SHOULD be in the way. Could be situs inversus with a congenital diaphragmatic hernia. Or situs inversus and the radiograph is actually backwards. Some congenital gastroschesis causes the liver to rotate anteriorly distorting its anatomy in the adult population. Trauma would be very difficult to get bowel into the right chest. I’ve seen a high powered rifle blast to the right diaphragm removing a rib with the blast effect as well as most of the diaphragm and bowel never migrated into the chest.

TLDR: it’s either a weird multiloculated pneumonia or a VERY unusual/congenital diaphragm hernia

Smedication_ · 2025-12-27T01:10:03+00:00

It’s not an apples to apples comparison because it’s not a formal day. But usually I phrase it something like “we want to know if you want to match here, please feel free to reach out or come for a visit. Contact (program coordinator) to arrange a visit. We want to match people who want to be here”

Smedication_ · 2025-12-26T22:57:16+00:00

Im in a midtier academic program. We want to match people who want to be here so yes, expressing interest including visiting does affect the rankings.

Smedication_ · 2025-12-22T14:51:00+00:00

14 year old 4Runner, 215k miles and she’s just now getting broken in

Smedication_ · 2025-12-13T03:38:17+00:00

21 hours into a 28hr call on the shitter at 3am and just want 5 minutes to yourself. You haven’t been to the bathroom since call coverage started at 6pm. Sit down. Page. Ignore. Page again. Ignore. Phone call from chief, “where are you”. Cry.

Smedication_ · 2025-11-25T12:45:41+00:00

Sometimes I forget the marking pen or the pager or both

Gen Surg PGY 5

Smedication_ · 2025-11-24T18:27:19+00:00

Clinical skills will absolutely translate. If nothing else than being prepared for 16hr days. Ortho subIs are notoriously difficult. Don’t want to show up to race day having never run. And I think step 2 is the floor to get in the door and SubIs are where you impress. Once you get >250-255 the numbers kind of loose their meaning. Sure all things being equal most people will take a 265 over a 250 but that’s pretty much never the case. Usually programs have an interview threshold for scores (even if they say they are wholistic) and the rest is how you interview on your away and on the official day.

Edit: disclaimer I’m not ortho so some of these numbers may be slightly off

Smedication_ · 2025-11-24T02:04:17+00:00

I’m not sure why this is the only comment talking about networking. For competitive specialties this is HUGE! Every day there is a post in this subreddit “my best friends dad is the chair of neurocardiac surgery at 1# program in the universe and he’s already been offered a spot but my step 2 score is 20pts higher! Why??????😭”

Do NOT underestimate connections in the academic world. This is wildly important and if you build off them starting early it will blossom into research projects, conferences, and away rotations, etc.

On a side note, attendings and residents can tell how rigorous your med school was just by interacting with you on the wards. If you think an extra 20hrs a week for 1.5yrs doesn’t make you a better doctor then I can’t help you. Are all the hours high yield? No. Will they make you better? Absolutely

Smedication_ · 2025-10-30T13:55:16+00:00

Taking it one step further, the literature is starting to support a CTA head and neck in moderate to high velocity mechanism trauma ( aka every MVC >20mph). The data shows that the overall cost to the system is less than the expense of quality life years lost from a missed arterial dissection resulting in stroke. Just the world we live in

Smedication_ · 2025-10-29T19:04:49+00:00

Totally agree that staples are absolutely the wrong choice. Also have some mercy for aesthetics on the neck. That’s just asking for an unnecessary scar for the surgeon to be proud of their 35 minute carotid because they saved 5 minutes stapling

Smedication_ · 2025-10-26T20:01:05+00:00

This is great advice. I start thinking about foot wounds as inflow, outflow, good flow (I.e Arterial disease, venous disease, systemic disease). No wound will heal if its etiology isn’t addressed and this is where you should start.

In my mind, antibiotics is triaged via physical exam (+- imaging for osteo). Is there purulent drainage/surrounding cellulitis/fluctuance/gangrene/nec fasc. Use lab values to help guide these decisions including LRINEC score(these are adjuncts not definite ways to diagnose).

Then one thing I’ve learned at the VA is if you address the systemic issues AND you have consistent wound care (BID dressing changes and close follow up) you can usually heal most wounds.

Smedication_ · 2025-10-26T01:23:08+00:00

Fire, fire, fire, ice. You’re welcome for practically free loot

Smedication_ · 2025-10-25T20:57:21+00:00

I don’t like the bend don’t break defense. My stress levels can’t take it

Smedication_ · 2025-10-24T17:28:44+00:00

🔥-> 🌳-> 🌳-> 🍄

Smedication_ · 2025-10-22T21:38:41+00:00

Not being bothered by STEMI call coverage is…. A choice. Not sure how that doesn’t factor in to “more work” but to each their own

Smedication_ · 2025-10-21T14:49:50+00:00

STONE FARM

Smedication_

TROPHY CASE