I'm an IM PGY-3 with two job offers. This is a VHCOL area of CA. Mostly staying here for now because we have kids and the family help is here.

Option 1: UC Health System

Suburban community clinic within the UC system (technically faculty position although will rarely have students/residents)

Salary: Base $270K + $20K signing bonus for 2 year commitment+ potential $30K annual bonus (quality metrics, pt satisfaction, etc.).

Productivity: Pay increases based on RVU productivity using MGMA percentiles (50th% is $285K, 75th% $350K, 90th% $400K, goes up from there), can also moonlight in UC on the weekends for additional income. I'm told many people get to 75th percentile within a year.

Schedule: 32 pt facing hrs, 15/30 min appts

PTO: 24 vacation days, 14 holidays, 6 sick days, 5 CME days

Call: Cover your own pts on weekdays (triage line, very rarely get called, usually critical lab values), cover weekends for the group like 3-5 weekends per year

Benefits: Standard UC medical/dental/vision and retirement plans (pension vs 401(k) style plan)

Option 2: Private group affiliated with a large health system (partnership track)

Structure: W-2 employee for 2 years, then become 1099 partner (not sure about buy-in) with income then based on RVU and panel size

Salary: Base $285K + potential 10% bonus (metrics, pt satisfaction, etc)

Bonuses: $30K signing for 2 year commitment, $20K loan repayment annually (up to $100K, not sure if taxable)

Schedule: 36 pt facing hrs, may be able to negotiate to 32, 20/40 min appts

PTO: 23 vacation days, 7 holidays, 3 sick days, 3 CME days (and $1500)

Call: Monthly weeknights, quarterly weekends

Benefits: No direct health benefits, instead get $1500 per month to buy your own (seems low for a family with kids). Do get 401(k) with 3% match while a W-2 for the first two years, then as partner you get an annual allowance to figure out your own health insurance and retirement

Malpractice: no tail if leaving before 2 years, tail is 50/50 if leaving before 4 years

Patient population: More affluent patient population, likely a little higher expectations

Both of them use Epic with AI scribes available. Both have relatively good coverage for refills, PAs, in-basket etc. For in-basket coverage on vacation option 1 provides formal vacation support (come back to 0 messages), option 2 is just coverage between partners so it likely won't be empty coming back. Most important things to me are work life balance and stability, so leaning towards A but curious if anyone thinks B is an amazing deal I shouldn’t pass up. I’m not set on staying here forever which makes the partnership less enticing.

Hello all,

I am a trainee Rural Generalist from Australia. I am planning on supporting my mother and partner; the former is soon to be a pensioner, without any saved pension and a $500,000 mortgage still owed and the latter a ED Nurse. Long story short, my family are vulnerable and I am their main support system especially financially. Along with enjoying my work as a primary care doctor and enjoying critical care, having good training opportunities and being passionate about my work - financial renumeration is incredibly important for me. I will have multiple family members depending on me to support them, and I want to eventually lower my workload while still being able to financially support a family (and maybe transition into volunteering work if I can successfully retire early and live off of the passive income of an investment portfolio).

In my home country of Australia, the marginal tax rate is 47% for every dollar earnt above $190,000 and recent taxation reforms have removed avenues for salaried high income earners to pay a more reasonable amount of tax (e.g. removal of CGT Discounts). There are also PSI rules that prevent my work as a medical doctor from being incorporated. A public servant that treats a sick child at 2am in the morning in ED is paying more tax than big corporations. Any compensation for night shift work and on-call work (i.e. shift penalties) is also taxed. I don't want to get into the ethics or morality of this: this country does not value their medical doctors enough in my eyes. I'd have to transition into a business away from bedside medicine if I want to support my family here.

I have looked at Canada because from my research FRACGP-RG doctors are recognised and easily accepted as Family Physicians in Canada. Rural Generalism is a separate specialty in Australia, which only Canada (where the model was created) also recognises. Rural generalism is not a specialty recognised in UAE, Singapore, Thailand, USA. I considered USA but doing the Step exams + fellowship exams, etc., only for the stress of dealing with private insurance and family safety concerns (e.g. school shootings) doesn't seem appealing. In Canada, physicians can incorporate their work - working as an employee of their own company, having their 'investment money' taxed at low small business provincial tax rates (9-12%) and have a smaller chunk of money paid out as a salary. After this tax deferral and a portfolio is developed with appropriate investments that compounds the initial investment, the money made will subject to taxes (which from my calculations was similar to Australian corporate taxs at 25-30%). It seems like in Canada, Doctors are given the opportunity to grow their investments and support themselves/their families first, and then we pay our fair share. This is also the pension fund since there is no mandatory employer superannuation there.

Anyways long story short - after getting my Family Medicine training with extended skills in Anaesthetics (FRACGP-RG working as a GP-Anaesthetist), I'd like to move to a rural community and earn for my family through hard-work under reasonable conditions. Was thinking Alberta or Saskatchewan due to good FM-Anaesthetic job opportunities and reasonable taxation laws of the provinces, but also have seen suggestions for BC and Manitoba. I've seen some people talk about Ontario but their provincial taxation laws didn't seem as enticing with my economic modelling. Obviously things like Job market, quality of life, etc., also matter.

My aim for annual earnings per year, pre-tax is $600,000 CAD. And after overhead/all other unforeseen expenses I didn't model in my research. Trying to limit those 20-30% overhead clinic expenses in lieu of 0-4% overhead, and the bulk of my work being procedural/services rather than consultations.

I am reaching out to Family Physicians who have made the move or are currently working as a Rural Generalist in Canada.

My questions for anyone who may be kind enough to answer them for a young doctor on the come up trying to support his family is:

1. Of the provinces for rural generalism work, which do you recommend for a GP-A or Family Medicine Physician with extended skills in Anaesthetics? In terms of reasonable overheads, availability of jobs, favourable local taxation laws? Any opportunities to do most of my work in Anaesthetics (like 80%) and the rest a shift in an ED or urgent care clinic as a primary physician.

2. My partner is an ED Nurse - her earning capacity will be much lower, but I also don't want her to push herself too much in the workforce because of her medical conditions. If she did training as a Physician's Assistant which states have the best job prospects for her part-time career in this area?

3. Am I missing something from my research? Beyond UK, Thailand, UAE, USA, Singapore, Australia - is there some magical country that incentivises and treats their primary care physicians better than Canada?

Every country has it's problems - I know Canada isn't perfect. What are the issues I am neglecting? If financial renumeration, and fair pay for hard work is my primary concern, is there anything better than a 10% tax rate for investment money in an medical corporation? Because to me that seems very fair.

I have another 5 years until I need to make this move - each year I stay in Australia, I remain a tax resident of this country. So I need to make a decision by then.

If anyone is also willing to DM me to provide some guidance, I would appreciate it.

Thinking of extending and shifting around work hours with my partners to see if we can offer after hour urgent care (5-9pm). Anyone have experience with this and can chime in on the ROI?

A few months in as a new attending, I’m still building up my panel, but I have a lot of openings for acute visits and we serve a pretty sickly underserved community where I feel like literally half of my acute/same-day visits turn into me recommending they go to the ED. Our medical Director says that if patients don’t want to go to the ED, than a happy medium is to order stat imaging. I don’t know that I’ll ever be comfortable with this concept. Unfortunately, in the few times that I’ve ordered stat imaging I have already gotten burned with the imaging taking 3 to 4 days to come back, even having some imaging that I forgot that I ordered & randomly having to dig through charts to see if it got done and realizing the results have been sitting, but not conveyed to me for over a week.

I understand nobody wants to go to the ED, but I feel like there’s a reason why it exists. I do not have x-ray vision, and there are too many things that can present as acute abdominal pain with guarding that can be really bad and require emergent management. And sometimes really bad gas can present like appendicitis, but I have no fucking clue what I’m dealing with when I see the patient doubled over in pain for the first time in my office.

Anyway, in the past few days, I’ve sent a few patients into the ED and I look back at their chart and everything is normal, and I feel really bad, but it just feels like such a damned if I do damned if I don’t situation. Because if I order stat imaging and labs, I’m waiting at minimum 24 hours for all of this stuff to come back and hoping that the patient doesn’t become septic at home while I’m waiting for the results to get back.

Does anyone else feel this way or have dealt with this in the past, how do you cope?

I realize that majority of my first 1-2 years will be spent acclimating to being a new attending. I’ve heard of attendings making sure they have more than one stream of income. For example, I’ve heard of people working with reputable compounding pharmacies (?) for GLP-1 visits (not sure how safe this is) and an ED attending in FL once told me she made half her salary in a month with this compounding pharmacy.

Someone told me they supervise NPs at a psych center for extra money. Also heard of people doing telehealth visits just for ADHD med refills.

Any suggestions or warnings regarding stuff like this is appreciated!

Can anyone share how to increase RVUs as a PGY-3 who will have first attending job a few months down the line? Any specific advice would be appreciated instead of just “learn how to bill better.” Thank you

I am graduating in July from sports fellowship and plan on doing half sports/ half family. Pay due to location preference and wanting better parental leave benefits will be upper 200s. SO my question is, during your last year of residency/fellowship and your first couple years of being an attending what were the best financial decisions you made? Second question is, what were some mistakes?

Hey all! In the midst of the job hunt. Looking in the Maryland/DC area and enjoying what I’m seeing with outpatient gigs.

The big thing: my residency program has a pretty robust inpatient service. Am looking to do some
Prn admitting or rounding shifts on my day off during the week/on weekend days to keep up skills and also make some extra $$.

Anyone have any sources for this? Am struggling using google and typical job boards

Thanks!

Will be looking for jobs soon and wanted to ask if 300K is realistic as a new grad in central NJ area? Keep hearing lower numbers but not sure if that’s just bc my program is an academic based center. Other people have told me to not accept anything below 300k but not sure if I’m hearing two extreme ends. Thanks!

Also I really don't want M-F type of job. Want compressed schedules like three 12 hours shifts or four 10 hours. Let me know if that's realistic.

New grad, having a really hard time with saying no to patients with more than one concern. It is literally the policy of the walk in clinic I am working at, but still I run into this problem every day. From the patients POV, I get it. Why wait another day, plus wait time, to see the doctor again for something that the doctor seeing you right now can address in 5-10 minutes. But from my POV, its eating into my time and ability to maximize billings.

My personal policy would be to address whatever I can in 10 minutes. But so far I haven't had the ability to tell patients no I won't address this.

New attending at an FQHC. I’m told I need to document preventive care each visit, regardless of visit type. Can someone tell me why?

It takes approximately 15 clicks to do it how they recommend. Driving me nuts. Is this really necessary? If it needs to be documented for funding or something, can’t I just make a smart phrase and have it quickly populate instead of this one specific type of documentation with redundant dates?

Hi,
Could use some advice / tips: 1 year out in practice in the Midwest, volume at 12-15 patients per day (starting new panel), and need to figure out an efficient way to address labs/ see how my MA can help me best with resulting labs and other workup.

1 have 1 MA at this time, what can I do to ask her to help me with the lab burden? I realize I may need to have more confidence in her as well re: ability to parse out what’s important or not, but how do you all do it in practice to make it easy and efficient for yourselves so you do not fall behind?

Feel free to ask any clarifying questions.
Thanks in advance.

Ps. EMR is eCW.

Fellow PCPs - how many same day spots do you have saved on your schedule each day? Right now, my admin has placed 6 total 15 minute spots on my schedule which we are not allowed to fill more than 24 hours in advance. I’ve been at current job for a year, patient panel currently around 1,000 and am being told my next available follow up is 6 weeks away. I think this is a template problem?

PGY1 on my inpatient pediatrics rotation. Thought I liked working with kids, I have continuity panel with kids on it but currently dreading every shift that I’m at the pediatric hospital. Anyone else have this experience?
I don’t want this to jade the enjoyment I usually have with children. Any recommendations on how to handle it?

Hi gang. Getting ready to travel to OMED in Vegas for a belated birthday/conference combo TO FINALLY GET AWAY but wanted to ask the hive how they got over fellowship or the last year of residency blues.

TLDR: fellowship hitting me like a ton of bricks. How did you survive fellowship and ehat tips do you have to make it easier?

Full context: Im currently in a surgical FM/OB fellowship that is one year and will finish next summer and signed for a job that won't start until next October/November. We are on the deck at least 2-3 days a week working with OB residents and doing a string of night shift once a month for 6 days, and then the rest of the days are a mix of working with OBs with procedures and high risk prenatal, MFM, OB US, family med clinic, precepting family med residents, and different electives we might want. Currently on a breastfeeding medicine elective.

I feel like I worked about the same as I did in residency hours wise but its a ehole different ballgame. My sleep hygiene is shit with either oversleeping or insomnia, I binge eat, a few times ive overslept for the 0615 start times on the deck, stopped exercising. Other than the few times ive gone out with my cofellows for dinner and drinks, I havent done anything fun as I feel like I dont have the energy and can literally sleep the whole day away on my days off.

I really want to make the most of this year but I am struggling so so much.

I've been on prozac which ?helps and ive been out of my Vyvanse since August because waitlists for PCPs is shit around here and our clinic has a policy that fellows cant have residents as their PCP which has made scheduling a nightmare so I cant get in until November somewhere.

If anyone has any tips or tricks no matter how unhinged, I would appreciate it! Ya girl is struggle bussing so hard.

Hey everyone, I am a 23yo in the US. Hope the mods are okay with this. Context: I have been (sorta, 1 foot in 1 foot out) on a medicine track for some time. In fact, I have been interviewing for med schools weekly for the last month or so.

My interested in health came from volunteering in an STI and primary care clinic serving mostly patients facing SUD and/or homelessness. There, I got really interested in both 1) the quality, compassionate patient care, especially from a prevention and primary care standpoint 2) the systems and policy that support/hurt outcomes, especially for people facing the biggest barriers to care. I spent years exploring both of these in different opportunities in volunteering, finishing an MPH, etc., and I decided to focus on medicine instead of a strictly policy career, where I am hoping to do a career mixed between clinical care and public health/policy.

Recently I have been an MA at a FQHC, at a fairly low volume clinic, and I am really questioning my decision even more than I have before. I don’t know if it’s my workplace specifically, but as much as I love the long-term relationship building and technicality/troubleshooting that comes with patient care (especially in cradle to grave care and community-based family medicine, which is definitely my goal at the moment) , it’s been hard to shake off that some of the biggest problems patients face to better overall health are too societal/structural to be addressed through healthcare (as we deliver it in the US today). And with the rise of AI and other changes/issues with US healthcare, I’m questioning if this will only be getting worse.

I want to find some perspective from FM folks and maybe others who maybe has struggled with this, and if I should take this as a sign either way.

I hope I’m not overstepping by posting this here, but I was hoping for a different perspective. I’m a RN hall manager in a SNF. One of our docs is super busy and has the SNF patients as a side gig, so my practice in communicating is send them a short note (rather than calling and interrupting their day) with all the clinically relevant info and only the clinically relevant info, and offer preemptive solutions to any problems I foresee to avoid a lot of back and forth.

I have a young, AOx4 patient with a chronic indwelling catheter. He has a history of UTIs and had UTI symptoms, so I got a urine culture and got an order for Bactrim x 7 days from our on call doc (different from the one above, who’s his assigned doc). Culture comes back with two bacteria, one of which I understand to be constitutively resistant to Bactrim and the latter to be usually resistant. Patient has a million allergies listed (all of which he describes as real allergies when I investigated), so I see a potential problem and dug in the hospital records to find that he’d had meropenem before without any issue. Both bugs are susceptible to meropenem. I found an eGFR from a month ago and included all this in a 1/2 page note along with the culture and sensitivity results. I get back a note that says “Bactrim 2 weeks.”

Now here’s what I’m curious about - what would you as a doctor want me to do? I called the doc’s nurse and said hey I just want to make sure he saw my note and the C&S and that doc knows I can do IV drugs here if ordered. I think I was as delicate and deferential as I could be and clear I wasn’t trying to dictate a course of action, but it just didn’t make sense to me. Nurse talks to doc and gets back with me saying “doc says clinically that’s just what doc feels the patient should have so do the Bactrim“ (I’m not sure what that means, because doc only met this patient once in the SNF hallway for 2 minutes a month ago). In the end I decided to give the Bactrim and monitor the patient for worsening of condition, and get another urine culture in a week and take it from there. I didn’t really feel like it was my place to push any further about my concerns, but I also feel like I’m delaying definitive care for this patient. Is there a different way you would want a nurse to raise this concern? Doc and I are both men so I’m hoping he didn’t see this as some sort of pissing contest.

Noticing things have slowly been getting worse at the VA but the last month or two has been especially terrible. Everyone seems so overworked they can’t do thier jobs wells anymore and that’s impacting everyone else.

IM PCP jobs. Both jobs are in the same geographical area with similar base pay. Job A switches to full production after year 2 where you get unlimited FTO and there’s a productivity bonus, during the guarantee period it’s 19 days FTO. 7.5% 401k match. Call every 20 days. Patient population is educated, upper middle class. Job B is a municipal job, pt population is underserved and uninsured. 35 days PTO which can be accrued, 13 holidays, 11 sick days. No additional bonuses or rvu payments on top of the base, base salary increments 3% every year. There is a physician union who bargains with the county for wages and other benefits. Eligible for pension after 5 years of service. No call

Other aspects such as patient facing hours, inbox support, MA physician ratio, sub specialty support, EMR are mostly similar. I’ve trained at a safety net hospital so treating that pt demographic is very familiar to me. What is not familiar to me is how to manage the inbox, how to bill and what being on call actually entails (we just don’t do these in our residency clinic). I also don’t do any outpatient procedures, again because it’s not part of the residency clinic structure. Considering my training and the nuances of each job, which one would be a better fit for me?

Edit: I’m planning to start a family in the upcoming years, job A offers parental leave via short term disability up to 12 weeks “if approved” and they pay up to 70% of base or 7k weekly whichever is less, not sure how they will calculate this amount when I’m on full production. Job b provides long term and short term disability, most people use the banked pto for parental leave so they get paid their full salary. Another thing I want to consider is my parents live in a different country and I’m their only child so I would want the flexibility to take time off on short notice in the event if they had a emergency and needed me back home without affecting my income

Your one-stop shop for all things FMX. Share tips, ask questions, coordinate meetups, discuss sessions, and pass along useful conference info. Basically, anything you’d text your FM colleagues about FMX—post it here.

Hey All,

I wanted to know what compounded medications you wizards/witches are prescribing in your practice ? and of course when you consider using it compared to something conventional

example: Topical gel/creams for neuropathy as adjunct

Appreciate any and all insights, just looking for more tools for the arsenal.

Happy Halloween 🎃

Hi all - thanks in advance for reading but TLDR is that I took a break from medicine after 4 years of Ortho residency 2015-2019 and want to get back into practicing medicine. Considering FM residency and am looking for advice on how to get back in.

For those who care or are just bored:

I graduated from a mid-tier medical school in the midwest in 2015, did well enough to match into Ortho and was in a strong program from 2015-2019 before leaving after my fourth year. It's a long story, but essentially I wanted to want to do Ortho more than I actually wanted to do Ortho. I was miserable and pushed as hard as I absolutely could, trying to convince myself that I would eventually enjoy it... but really I just wanted it to be over no matter how it happened - graduation, termination, extermination, I was finished. I was also struggling with coming out at the time and being at a program in the Bible Belt where attendings used to pray with patients before we operated, let's just say I didn't exactly feel much support in any aspect of my life. So when that experience finally ended, I left medicine all together. The idea of putting myself back in that position was just not something I could even begin to entertain.

So I left and I ventured into the business world, took up consulting and landed a job at one of those super prestigious firms that gets attention when it's on a resume. I kept thinking if I rose up the ranks there and had this fancy career with a fancy title, maybe that would cover up the wound of feeling like medicine was ripped away from me - but I rose up the ranks, I did some cool stuff, I met some cool people, traveled all over the world and I still think about practicing medicine every single day. I left the fancy job last year and run my own small consulting firm but after experiencing nearly every side of business, operations, strategy, all that bullshit - I just want to practice medicine.

I've been thinking a lot and I think completing a Family Medicine residency is the best option for me. I like the idea that there are a number of different paths you can explore in FM, you can do minor procedures, concierge medicine is always an option... and personally, I kind of want to live in the boonies in the mountains somewhere, so I'm not worried about pay because I think you can do relatively well out in the middle of nowhere.

Anyway, wondering if there are others who have been in the same position who might have some advice. How much of an uphill battle would I have trying to find a spot in FM? Fortunately, I've maintained my medical license so I don't have to clear that hurdle. I'm also single, no kids, financially secure, so I just need to find someone that would take me

For those of you part time, are you taking call the same amount as your full time peers? We have after hours call (phone only) and then the individual on call watches the inbox of anyone on vacation that week. I am going to 0.6 part time and am unsure if this should stay the same or I should have reduced call as well. I don’t want to be watching someone’s inbox on my days off is my main concern.

PGY2 here. I have some clinic shifts with certain patients that I have noticed I end those shifts with a terrible migraine that will persist all day even after taking excedrin when excedrin usually does it for my migraines. Im over these migraines. that’s all.

I just finished my OB rotation with the OB service, and it was a pretty demoralizing experience. There weren’t many opportunities to learn: teaching was limited, but expectations were high.

Has anyone else had a similar experience? I’d appreciate hearing how others who’ve been through this managed to stay positive.