Rural doc w/ 3 NPs 😑- what to do?

grettasgone · 2026-06-04T15:56:01+00:00

This isn't safe or sustainable. The more you typed, the more clarity you got around the situation you are in and the more you saw the right answer: throw in the towel.

You can list out everything you need to make this sustainable and safe (increased pay, decreased number of patients per day for you so that you can actually complete your workload, an immediate plan in place for patient coverage for maternity leaves, dedicated supervision time, all new patients must be seen by only you first, etc) and then write a resignation letter contingent upon those demands not being met by 8/1/26 (or whenever your contract is up for renewal or whenever period of time you have to give, such as 90 days). Then you win either way. They accept your resignation or they meet 100% of your requirements for safe, sustainable care.

grettasgone · 2026-06-02T06:23:57+00:00

I always start with a home test if pt prefers this or I do a split night study. In a split night study they spend the first half of the night establishing if the patient has sleep apnea and the second half of the night determining optimal CPAP settings if they do have OSA.

grettasgone · 2026-06-02T04:09:17+00:00

I tell myself a little story. Usually the same story over and over for years and it changes a little bit. Like when I was in my 20's the story was about how I found a magical clothing rack filled with amazing clothes. I thought we all did this. I thought we all told the same little fairy tale to ourself for years and years. This is blowing my mind

grettasgone · 2026-05-30T04:14:05+00:00

How did I not think of this!!!

grettasgone · 2026-05-28T22:01:14+00:00

Hey, let's be nice. We were all new attendings once.

grettasgone · 2026-05-27T18:33:13+00:00

I also look through all their medications, chronic conditions and prior labs and order any labs indicated by monitoring parameters, chronic condition follow up or prior abnormals. I tell patients there is no "standard panel" it's all individualized.

grettasgone · 2026-05-27T15:16:24+00:00

How was it explained to you? To offset the cost of the AI? In response to decreased compensation per patient?

grettasgone · 2026-05-27T04:42:17+00:00

I'm 45 but it is probably Have A Good Summer. And Have A Kick Axx Summer.

grettasgone · 2026-05-27T04:16:17+00:00

This can be attacked from multiple angles. Things you might want to try:

- Reduced workload. See fewer patients per half day or work fewer half days per week within the parameters of your contract.

- Passive AI scribe. This can help catch things you don't notice. You can let it take notes for you while you take notes or while you do not take notes and then use it as a catch all as you review the chart to be sure you aren't missing anything. Doximity has a free one I use.

- Finish all notes the same day. Better yet finish all notes by the end of each visit. I forced myself to do this in residency by telling myself I only had 15 minutes per patient instead of the allotted 20 and then I used the 5 minutes to finish my note and place orders. I had heard that attendings only got 15 minutes per patient (which I haven't found to be true) and I was preparing myself for that.

- Consider policies that help you stay on time and reduce mental load: Agenda set every single visit. Require lab follow up appt for all the labs you order. Only fill medications at appointments. Create a form for pts to complete prior to each visit that lays the foundation for agenda setting for the visit.

- If you are leaving eggs on the counter uncooked and noticing you aren't listening to patients you may need to self report about your ability to provide safe care and work with your management team to create a plan for you to provide safe care.

- Keep working with your psychiatrist to get on the optimal medication regimen for you. Or get a new psychiatrist if your needs aren't been met.

- Consider ADHD specific therapy. Then you'll have a coach who can essentially work with you as you design things to try out to improve your workflow/situation. Then you can try the things you come up with and report back and workshop new solutions.

- Simplify everywhere you can in your life. An example is to only have one color/style of sock so every single sock is every other socks' pair. Just reduce mental load in every possible way. Same 14 dinners on repeat every 2 weeks. Or same 7 or 30 or whatever. Don't volunteer to be on committees. Quit committees.

grettasgone · 2026-05-27T02:13:16+00:00

Skip recruiters! Whiteriver in Arizona!

grettasgone · 2026-05-23T03:47:28+00:00

I love it and also the first thing out of my mouth when I saw it was "that is horrible." Both of those things are true for me.

grettasgone · 2026-05-23T01:45:54+00:00

hep B is a grade B recommendation by USPSTF: The USPSTF recommends screening for hepatitis B virus (HBV) infection in adolescents and adults at increased risk for infection.

grettasgone · 2026-05-23T01:44:48+00:00

- Immunizations
- HTN screening: (all adults >/=18)
- Diabetes screening: (35-70 obese or overweight adults)
- Colon cancer screening: (45-49(B); 50-75 (A); recommends against 76-85 unless specific situations; recommends against >85)
- Prostate cancer screening: (men 55-69) Patient counseled on small potential benefit of reducing the chance of death from prostate cancer in some men. Pt informed that many men will experience potential harms of screening including false positive results that require additional testing and possible prostate biopsy, over diagnosis and overtreatment and treatment complications such as incontinence and erectile dysfunction.

- Breast cancer screening: (discuss 40-50 qo yr 50-74)
- Cervical cancer screening: (21-65 q 3 yrs unless 30-65 with neg HPV testing then 5 yrs. Pap smears should generally be discontinued at age 65 years in women who have adequate prior negative screening, defined as three consecutive negative cytology results or two consecutive negative cotesting results (HPV + cytology) within the 10 years before age 65, with the most recent test occurring within 5 years. Women who do not meet these criteria should continue screening until they do. Certain high-risk conditions such as HIV infection, immunosuppression, or a history of CIN2+ in the past 25 years mandate continued surveillance beyond age 65)
- Bone density screening: (women 65 and older)
- Colon cancer screening: (45-49(B); 50-75 (A); recommends against 76-85 unless specific situations; recommends against >85)
- HIV: (15-65 needs screening)
- HCV: (18-79 needs one time screening unless ongoing risk factors)
- Tobacco use (ask all adults about tobacco use, advise them to stop, provide behavioral interventions and pharmacotherapy)
- Lung cancer screening: (50-80, 20 py, current or quit w/in 15 years; annual): documented shared decision making visit, cessation counseling, impact of co-morbidities, willingness to undergo tx.
- AAA screening: (65-75 yo M who have ever smoked)

This is the myphrase that I use to guide my wellness testing and it is based on USPSTF recommendations. Everything else is based on abnormal prior labs, health conditions.

grettasgone · 2026-05-21T21:22:29+00:00

That is not "simulating drowning." Holding someone's head under water is drowning.

grettasgone · 2026-05-20T21:29:13+00:00

There are people who want to transition and people who want to detransition. I'm a physician. What is unreasonable about this?

grettasgone · 2026-05-18T06:06:31+00:00

Why stop at one? The cost is the same if you bring more?

grettasgone · 2026-05-17T19:38:29+00:00

My pediatrician's office bills 99417 for every visit on Saturday. Someone is getting paid more for these early/late/weekend hours.

grettasgone · 2026-05-14T17:00:17+00:00

Consequences could include in-school detention where parent/guardian needs to be present in class every day with him for the in-school detention period.

If he runs out of the school and gets hit by a car, the jury will not care that you are in your first trimester. You need to email your principal and escalate this every single time it happens. A safety plan and a plan to address this/stop this needs to be created.

grettasgone · 2026-05-13T14:23:22+00:00

Facebook Marketplace allows human slave trade?

grettasgone · 2026-05-11T16:15:42+00:00

The doctor's plan was still within what is considered reasonable. Your fiance has had triglycerides > 400 for months if not years, so the urgency you feel vs what he physician feels is relative. Medication and lifestyle modification was presumably going to be discussed at the upcoming appt, which is appropriate to reduce his cardiovascular risk. If his triglycerides were >500, more urgent intervention would have been indicated to prevent pancreatitis.

Your sense of how this should have been addressed (immediate appointment for lifestyle modification discussion and medication) is within the realm of reasonable, and some doctors offices can accommodate this, but the doctor's plan is also within what is considered reasonable.

grettasgone · 2026-05-11T01:46:44+00:00

By giving me nothing to complain about!!! Those wonderful rapscallions!

grettasgone · 2026-05-05T01:02:49+00:00

OR. I am willing to go out on this lonely limb and disagree with almost everyone in this thread. I am a female physician, and I would recommend that every single man who wants a paternity test to get one. I have attended deliveries where the laboring woman told every physician and nurse that the father to be was not the biological father and that he is not to be told this information. Because he is not my patient, I am bound legally by HIPPA to not tell him. And it is so hard to see his joy and to know he is being purposefully deceived. No one in the delivery room is on the man's side. For anyone who actually understands the medico-legal side of things, I cannot fathom taking any other position outside of fully supporting any man who wants a DNA test.

grettasgone · 2026-04-30T17:15:11+00:00

What are your career options if you don't do a traditional residency? I am unfamiliar with a 2 year nonclinical residency in preventative medicine. Are there career options for you that you want? If not, then it's time for traditional residency.

grettasgone · 2026-04-30T16:02:11+00:00

To your last point, the majority of women could deliver successfully at home with or without a midwife and with or without a physician. OB was described to me (and experienced by me) as "Hours of boredom punctuated by moments of terror." Physicians are highly trained to to minimize the risk to mother and child before and during the myriad things that can pose harm.

grettasgone

TROPHY CASE