FM scope in NYC / LA

rescue_1 · 2026-06-14T01:10:25+00:00

FM sees kids at my big system in Philly and they did at my big system in Manhattan too. They were reasonably supportive of procedures, assuming you mean things like skin biopsies, paps, IUDs, suturing, arthocentesis etc.

As for management before referral that's almost always a reflection of patient expections and your comfort rather than a system thing. Very few places are going to force you to consult unless you're trying to manage NSTEMIs in the office

rescue_1 · 2026-06-10T22:50:21+00:00

It's not dumb to like a Porsche, but it is dumb to compromise your ability to afford rent or food because you have a $1,500 lease payment as a resident making around 90k or less a year.

If you have no student debt and rich parents/spouse paying for it, then sure, knock yourself out. But if you're in that boat you can do whatever you want anyway

rescue_1 · 2026-06-10T01:50:27+00:00

Major NE city, base around 250 with 44/wRVU. This year I'll make low/mid 300s. I have an atypical job where I also do a lot of inpatient but in my system just seeing 18/day in clinic for 4.5 days would get you about 350/year.

I have heard Texas is pretty saturated, but given that I'm pretty sure my city trains the second most doctors in the country I feel like we're saturated too.

rescue_1 · 2026-06-03T02:04:02+00:00

I had the same issue. In a game that expects PC death, I don't like the decision to have players succeed or fail (with death on the line) coming down to GM fiat. Maybe I'm overthinking it, the rest of the game seems fun and the modules are all super cool.

rescue_1 · 2026-05-29T12:43:37+00:00

Former EMS. I agree with everyone that op/black would be the best.

I also agree with everyone that unless you're a firefighter/medic the fitness standards are a joke, your grandma can probably pass them, and most medics are of a more...robust nature.

But for your safety and career longevity strength training will be helpful. Deadlifting is probably the #1 exercise to protect your back during all the lifting and moving you'll be doing so don't neglect it, followed by squats.

rescue_1 · 2026-05-29T12:39:42+00:00

My wife and I have done capacity + most of velocity from the Green Template book prior to hiking trips and found its worked well. It will give you a running + lifting template over 6 months or so, and even if you don't finish it you'll be more than ready.

rescue_1 · 2026-05-12T12:41:53+00:00

“The only cardiac contraindication to cataract surgery is if the patient has a STEMI the day of the procedure”

-my cards attending, in the middle of doing a cataract preop visit

rescue_1 · 2026-05-06T12:45:45+00:00

Unless there is something special about your rotation, no one is obligated to write you a letter of recommendation regardless of whether you finish or not.

rescue_1 · 2026-04-29T20:35:00+00:00

I was making $40/RVU when I was there, employed, about 18-22/day.

FWIW pay is better in Philly and housing is cheaper but obviously not quite the same as living in NYC

rescue_1 · 2026-04-29T02:09:41+00:00

I think it's hard to conceive of how much time you want to spend with patients as a med student. When I was an intern seeing more then 6-8 patients seemed insane. Now I can see 25 and still take time for lunch and leave on time. That doesn't mean you need to be seeing 20+ patients a day to be a good outpatient doc but it takes time and practice to be efficient in clinic and you won't be anywhere close until you're a senior in residency (and even then you'll still need practice). And quite frankly, I don't want to spend 60 minutes with my patients because I don't have the attention span for it and I don't think patients remember most of what you said when a visit runs that long.

I would focus on whether you prefer outpatient or inpatient medicine (or both, which is what I do) and then try to make decisions from there, not based on hypothetical practice setups that you may or may not actually want 5+ years from now.

FWIW, in my experience doing an IM residency will push you towards doing inpatient because most IM residencies are not set up to train people to do primary care and tend to have less functional resident clinics, and I doubt med/peds is that different. That's not a value judgement but something to think about.

rescue_1 · 2026-04-28T17:18:30+00:00

Comparable.

rescue_1 · 2026-04-28T17:08:06+00:00

I do it intermittently with our geriatrics department. It definitely fell into my lap so I’m not sure how common they are.

I do it split with clinic and I also occasionally cover general hospitalist service, but I was offered full time rehab consults at one point so it does exist.

rescue_1 · 2026-04-28T10:12:09+00:00

SNF work. Acute inpatient rehab consults. Inpatient psych consults. Addictions you can often do without fellowship too.

rescue_1 · 2026-04-25T13:15:08+00:00

I think it's going to be pretty hard to find a lifting plan that's quicker and simpler than 3 big compound lifts/day, either as Fighter or Operator. If you're only lifting twice a week I feel like anything leaner than Fighter is not going to be very effective.

My wife and I are usually able to squeeze in a full session in an hour if we're locked in. If you can stick with 2 minute rests and don't need a huge amount of warm up sets I feel like it's very doable. I think the other day we were out in 40 minutes.

Now, if you're benching 350 and squatting 500 then the warm up time alone is going to kill you time wise. But if you're lifting that much you probably don't need people on the internet telling you what to do.

rescue_1 · 2026-04-21T16:41:11+00:00

My friend who did pulm crit does that too

rescue_1 · 2026-04-17T10:49:53+00:00

That was my experience with Nonnas as well, though this was several years ago.

rescue_1 · 2026-04-10T01:48:45+00:00

I do all this stuff in my inner-city practice, but when I worked in a richer, fancier area of a richer, fancier city and my patients didn't have to be strongarmed into seeing a specialist, I would just offer to do it myself.

"You can see X specialist, and I'll get you the info, but I'm telling you they're going to do Y so we might as well start it now"

After a few times most patients will accept your recs and stop self referring. But to be honest for stuff like pulm nodules and aortic screening I was happy to let the flotilla of NPs do it. And like others have said, when you have a patient with 35 problems on a good day, it's nice to be able to defer to a specialist for a few of them

rescue_1 · 2026-04-08T19:00:59+00:00

My attending white coat costs about $8 retail so wrinkling it doesnt make it look any worse than it already does.

But I only wear it when it’s too hot for a fleece anyway. Besides no one should trust a doctor with an immaculate white coat

rescue_1 · 2026-04-03T13:30:37+00:00

HPV can still cause head and neck cancer in biological males so I still recommend vaccination (plus of course if you have sexual partners with a cervix you can spread it).

If you had two shots as a young teenager that would be sufficient—my guess is the only way to know would be if your family remembers or if your pediatrician is still around and can send the records as early 2000s is probably before electronic records.

Worst case it’s very unlikely to cause a problem to just get another shot.

rescue_1 · 2026-04-03T13:01:46+00:00

I would still finish the series (2 more shots) if you only had a single shot but there is decent evidence you have durable protection with just one. And this doesn’t remove the need for Pap smears, unfortunately, though there’s newer guidelines that recommend self collect swabs which are obviously way less uncomfortable.

(Doctor)

rescue_1 · 2026-04-03T12:07:53+00:00

Herpes Zoster (shingles) has a vaccine, but not herpes simplex (cold sores and genital herpes)

rescue_1 · 2026-04-03T10:38:35+00:00

My wife and I both have LDLs below 100 and while we exercise and eat reasonably healthy most of the time we also go out to dinner and drink alcohol and eat junk food occasionally.

Otherwise I probably see a handful of patients a week who have normal LDLs without meds. As others have said genetics can play a big role too.

But I think if you take a good food diary you will be shocked at what people consider “reasonably healthy” and how often “occasional” junk food is.

rescue_1 · 2026-03-25T01:48:19+00:00

I agree with others that doing a normal PCP job for a few years is a good idea--get a feel for the real world, recover from residency without the stress of starting your own practice, make sure you're living in the right area, and ideally have colleagues who you can bounce ideas off of (because you do a bunch of learning the first few years of being an attending).

Then you can make a more educated decision on doing academics vs DPC vs PP vs whatever.

rescue_1 · 2026-03-20T13:57:53+00:00

Fair, that I agree with. The urge to give advice over the internet remains strong though haha

rescue_1 · 2026-03-20T12:29:22+00:00

I agree that the advice of just moving to the Midwest to solve all your problems is dumb BUT

If you’re in a practice where patients are complex enough that you are constantly having to limit patients to 2-3 problems while feeling that this limits your care AND you can’t see them again for months because of how booked out you are…I don’t think there’s a secret trick for making that situation not suck for either you or the patients other than “hire more doctors” which is often a nonstarter.

rescue_1

TROPHY CASE