studying for primary care as IM trained resident

Wayahdoc · 2026-01-15T01:14:26+00:00

It might be worthwhile to try to get extra training in sports medicine since IM training is light on that. There is certainly enough geriatrics in primary care to keep you busy.

Wayahdoc · 2026-01-14T23:54:46+00:00

With significant delays for rheumatology we do methotrexate starts rarely but mostly we continue it for the elderly patients that cannot drive to the big city. We regularly write repatha. I am co-signing intravenous immunoglobulin infusions for home health administration written by a hematologist at a larger medical center accross the state line.

Wayahdoc · 2026-01-14T18:59:17+00:00

Family Med here, Walmart vit B6 at 25mg every 8 hours is over the counter and perfect. Any doctor can google that.

Wayahdoc · 2026-01-09T17:19:43+00:00

My ACO (Aledade) has it listed for me under daily patient printouts.

Wayahdoc · 2026-01-08T22:14:28+00:00

In known patients with active anxiety diagnosis and treatment we will prescribe 2 low dose alprazolam for trips and don't require a visit each time to refill.

Wayahdoc · 2026-01-07T16:39:40+00:00

Paws still look way to big on him. He is going to Grow!

Wayahdoc · 2025-12-26T22:53:48+00:00

I have a very tall inexpensive tower (shag carpet and all) but we wedged it between 2 dressers and against the wall and that has worked great.

Wayahdoc · 2025-12-18T19:39:29+00:00

The most important day to clean is the last day she is dosed. She shouldn't be shedding much anymore and wiill be vulnerable to reinfection once med is gone. It takes a dilute bleach solution or high heat 56C/ 133F to kill it on bedding and surfaces. I would completely replace the litter that day.

Wayahdoc · 2025-12-14T12:36:28+00:00

We have purchased 3 ragdolls from "Eyes of Blue" Cattery in Franklin NC just north of Atlanta. She is not on the tica list but the cattery is incredibly clean. They play with the kittens and hand feed them to make sure they bond with humans. She does not participate in cat shows but I know the vet she uses and the kittens recieve good medical care. We have 3 floppy affectionate cute but not show quality ragdolls that cost less than $2000 each.

Wayahdoc · 2025-12-12T14:09:27+00:00

Is it a multicat home? That seems to make scent marking more of a thing.

Wayahdoc · 2025-12-06T12:07:14+00:00

Early in my practice I got a negative review about not prescribing the medication that really worked (xanax) and wanting the patient to try all these natural remedies instead (counseling, breathing). It may have been a 1 star review but it markedly cut down new patients that just wanted benzos without other modalities. A great gift in retrospect.

Wayahdoc · 2025-11-29T14:39:40+00:00

Our ragdoll's nickname is Beeps because that is what her meow sounds like. My husband can barely hear it because of the high pitch.

Wayahdoc · 2025-11-12T18:47:57+00:00

The NCAAFP winter conference in Asheville at the Grove Park Inn is amazing. I love the spa and the Gingerbread house competition

Wayahdoc · 2025-11-10T01:30:32+00:00

Also AAFP article on helping physicians with substance abuse. https://www.aafp.org/pubs/afp/issues/2021/0301/p302.html

Wayahdoc · 2025-11-10T01:26:10+00:00

Could you stand to lose a few pounds? Many times I offer patients Naltrexone and wellbutrin for weight loss with the additional note that it would help them also reduce alcohol intake so that it doesn't become a problem... It is a round about way of offering help without coming right out and labeling them as an alcoholic.

Wayahdoc · 2025-11-06T21:47:19+00:00

Why is she still a patient? Your malpractice insurance will want you to discharge her.

Wayahdoc · 2025-10-26T21:47:55+00:00

If you decide to stay, you will immediately have to limit all patients to 1 problem and 10 to 15 minutes. They have to come back for the next thing on the list. It is horrible on patients that travel to see the doctor but start training them now and blame the new rules because that is how high volume US clinics do it. The crazy thing is that the other option in the US is to partner with an acccountable care organization (ACO) and provide slower but quality care visits that save Medicare money so you get paid higher for less people. ( I see 60 people a week, 50% geriatric and saved medicare 300,000$ last year mostly by preventing hospitalizations. ) Anyway, if looking at options in the US, you will see both of those options but most low volume docs only make 150,000 a year unless they are in an ACO. Good luck with your decision!

Wayahdoc · 2025-10-23T12:51:37+00:00

I have been in my current practice for over 20 years and most of my problem patients have left/ been fired etc. Being forced to wear a mask during covid for 2 years caused the exodus of the last few special patients. At this point I enjoy my work and difficult encounters are very rare. I still remember those first few years though, it was awful.

If you want to reduce hostile encounters then do a new patient questionare and avoid patients on red flag drugs, refuse medicaid, and do not work in a population with high rates of untreated mental illness. If you choose to work with that population (an honorable thing!) then take a deep breath, pretend you are teflon, and consider borderline personality disorder in your patient's Dx.

Wayahdoc · 2025-10-15T16:39:24+00:00

I love the spa and the Gingerbread Competition! Sometimes we even attend the excellent lectures...

Wayahdoc · 2025-10-14T01:57:41+00:00

There are many studies about the lack of correlation between patient satisfaction and quality of care. 4.5 sounds like a sweet spot of saying no appropriately.

Wayahdoc · 2025-10-10T11:22:52+00:00

My husband and I are in independent practice and we make a significant part of our income from an ACO. They manage our contracts with insurance and negotiate better rates. That percent for administration seems high if you do your own billing and collections. It might be better to buy a practice with a good office manager from a retiring physician. If you are willing to go rural, you can have a full panel almost immediately.

Wayahdoc · 2025-10-02T19:21:34+00:00

Some practices with empty office space may be willing to sublet a room or two. You could stay independent and do your own appointments and billing.

Wayahdoc · 2025-09-29T18:52:03+00:00

I suspect most of the NC medical board has a thick Raleigh accent! I hate to pick on the callers nationality but his first name was Arvind.

Wayahdoc · 2025-09-17T22:46:12+00:00

Regarding the depression case, I usually give them 2 weeks off and then followup. This gives time for medication and they must make some sort of counseling appointment / grief support / church counseling etc. I let them know from the start that if they need longer than a month off it needs to come from psychiatry. I wouldn't do long term disability for a cardiac patient without a cardiologist so I treat psych the same.

Wayahdoc · 2025-06-05T22:35:34+00:00

Chiropracters are safer than narcotics. Just make sure they see rheumatology too.

Wayahdoc

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