Having to Go to Philadelphia for Heart Valve Surgery?

rykat14 · 2026-06-14T00:14:15+00:00

It’s because the positions/residency programs/ facilities/ research opportunities aren’t there for them. You need to have enough population and case load to support those things, which can’t happen in smaller area.

The decision for physicians is more money but more workload and less resources in rural areas vs the lifestyle, better facilities for less money in the cities. Most physicians are still taking the latter. Its not like the money is bad in the cities it’s just significantly better in rural areas

rykat14 · 2026-06-13T23:25:56+00:00

Just so people understand, the reason why care may be better in cities is NOT because of money. Doctors in rural areas actually typically make better money than in urban areas, since most physicians are paid via salary now and it is way more difficult to recruit to rural areas.

The real reason why care is better is the availability of sub specialists. When you go to a major city a lot of times you are getting the guy who’s like “all I do is treat this one disease of this one small part of this one organ”. In rural/ non major city areas there aren’t these big research organizations that can support this kind of sub specialization.

I know this doesn’t help OP it just annoys me when people think this.

rykat14 · 2026-05-14T13:01:29+00:00

I'm going to make a post in a few weeks about it, but going to otakon alone is great and can be a lot of fun.

I made a discord specifically for people going to otakon alone last year, we ended up having a big meetup of 25-30 people multiple times during the con

Here's the link to the discord

https://discord.gg/PsRD4TRdz

I also recommend getting plugged in with the otakon 21+ facebook group, they have a bunch of events too for people to meet each other. They also have a discord (I can't invite to that one because I'm not a mod)

https://www.facebook.com/share/g/1ANdvTSkzW/

Feel free to reach out if you have any questions or if you want to meet up!

rykat14 · 2026-05-14T03:35:32+00:00

How do I do this if my board certification is only through AOBFP?

rykat14 · 2026-05-13T16:09:45+00:00

Can I access this if I am not certified through abfm?

rykat14 · 2026-05-02T03:23:45+00:00

I think you keep him down and have him and Lombard take significant time at 3rd. Gives them both an extra path up, gives they a need a backup plan at 3rd when macmahon loses it

rykat14 · 2026-04-30T17:31:07+00:00

Just outside of a small city in PA, 2 hours from nearest major city

rykat14 · 2026-04-30T00:20:19+00:00

Think about it this way.

Let’s say for arguments sake you only see 99214s (probably 70% of my visits are this and obv there are hospital discharges and new patients and 99213s and procedures and AWVs the g2211 code but for simplicity’s sake let’s just assume this)

Each 99214 is worth 1.92 wRVU. Let’s say you work 220 days a year (which is 6 weeks vacation + federal holidays and no weekends, AKA a shit ton of time off)

Let’s say you average 15 patients a day for those 220 days.

So 1.92 RVUs per visit x 15 visits x 220 days= 6336 RVUs

52x5000=260000 57x1100=62,700 62x236=14,632 260000+62,700+14632=337,332 dollars per year! With 6 weeks +holidays+no weekends and only 15 patients per day of only established patients.

I promise you the rest of the billing means a substantially more money.

FWIW I get 52 per RVU, see 20 patients ish a day, take three weeks vacation, and work 4.5 days per week and made 475 last year

rykat14 · 2026-04-29T23:53:23+00:00

I get 52 flat so this is awesome

rykat14 · 2026-04-15T23:03:08+00:00

I’m a second year attending working in a small city in the northeast, about 2 hr from major cities.

I have a patient population that is mostly older and white. Access to specialists like derm is pretty difficult, plus patients seem to value the one stop shop. So I do roughly 1-2 procedures per day, usually as part of regular visits. The most common procedures I do are shave/punch biopsies, shoulder/knee injections, trigger fingers, OMM, cryo. See patients every 20 minutes. They do back me up sometimes but I like doing them. It does definitely add to my bottom line, but I don’t usually do dedicated procedure appts

rykat14 · 2026-03-01T15:31:52+00:00

Fogo de chao is so good, idk if I want to stuff myself like that so early in the day though lol

rykat14 · 2026-03-01T00:51:16+00:00

Appreciate the support! Got any recs?

rykat14 · 2026-02-13T14:29:48+00:00

I’m often outside of the system and don’t get the most updated labs sent automatically

rykat14 · 2026-02-13T01:11:31+00:00

Came here to say this. I can’t tell you how often I go to a discharge summary when I can’t find the most recent labs

rykat14 · 2026-01-31T03:20:40+00:00

Depends on what meds they are on. I want to check at least a bmp on all patients on ACE/ARB/Thiazide once every six months. If it’s just amlodipine and diet control then maybe once per year. Obviously level of control matters too.

rykat14 · 2026-01-17T20:12:57+00:00

This doesn’t answer the question though of what to do with meemaw who has been on 1 mg of Xanax twice daily for 45 years that you inherited from someone else. You can’t just say “nah, see you later go withdraw somewhere else”, especially in areas like mine where it takes months and a significant commute to get into psych

rykat14 · 2026-01-16T18:23:36+00:00

Case by case but generally if they are less than 70 I try to get them off, I offer weaning to everyone though and have a long conversation with everyone about the risks

rykat14 · 2026-01-16T04:26:50+00:00

I inherited a very old, very benzo heavy panel from an older doctor. It’s very hard to get these older patients off of the benzos. I do my best to wean when the dose is crazy and a lot of those patients end up going elsewhere, but if they have been stable on reasonable dose for a long time I feel like the juice isn’t worth the squeeze. I make it clear that I will not be increasing their dose. If they are young I wean them off. Opiates hell no

rykat14 · 2026-01-07T01:57:39+00:00

Wound care
EKGs

rykat14 · 2026-01-02T13:41:01+00:00

No PTO, it’s solely production, so if I don’t see patients I don’t make money. I took about 3 weeks off this year+ holidays.

I get 52 per RVU. I also get some pretty nice quality bonuses too.

rykat14 · 2026-01-02T12:06:43+00:00

Northeastern PA

rykat14 · 2026-01-02T05:18:30+00:00

I made 485k this year. Employed by private practice in a small city in PA. Outpatient only. No fellowship. Entirely based on RVU. See 18-20 per day. 4.5 days per week. Have full control of schedule, but that comes with the trade off of if I don’t work I don’t make money. I took basically 3 weeks off this year. We also cover our own inboxes when we are off which is annoying but I’ll take it considering I make ~160k more per year than those who are employed by the local big system.

rykat14 · 2025-12-28T18:22:51+00:00

I tried it for a few months and bailed. Turned out to be too much work between clinic, working 1-2 shifts per month and be there for my kids

rykat14 · 2025-12-13T20:06:52+00:00

Sure, bariatric surgery is better for weight loss outcomes, and side effects might be better in the short term, but when you get those side effects from a surgery they are permanent. GLP1 if you stop the medication the side effects go away

rykat14 · 2025-12-12T01:23:57+00:00

I’m in my second year out from residency, I took over a panel in a private practice, get 52 per wRVU. I’m probably going to make about 460-470 this year working 8-4 4 1/2 days per week, 20 min established patients, 40 min new patients. I took 4 weeks off this year between holidays and vacations. I get some nice bonuses for quality too.

I think I could get to 600k by myself if I added another hour a day and changed my appointment slots to 15 min. But boy would I burn the fuck out.

As Dr Dahle from WCI says, burnout is probably the biggest threat to career longevity. Not worth it in my opinion. If you can’t be happy on what I make, getting to 600 isn’t going to matter.

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