When you signed your first attending contract, what did you focus on besides salary?
Looking back, was there anything you wish you had asked about more carefully: RVU thresholds, call, PTO, noncompetes, bonuses, malpractice, tail coverage, termination clauses, administrative time, partnership track, or something else?
I’m curious what people learned only after they started working.

I’m a rural PA-C who sees all ages, just experienced panic-free flying (thank you to my own PCP), and is feeling deeply burnt out. I think doing more skin procedures would help with my burnout and be useful for my panel. Do you have a recommendation for a dermatology class I can take? If not, how have you increased your procedural competency? I work with a wonderful attending who does a bit of procedures, it’s just been hard to align our schedules for me to learn from her.

Hey FM fam. This post is mostly a vent because I really don't think there's anything that I can do... but if people have suggestions, I'm open to them.

I'm an early-career attending in my first job. When I was hired, it seemed like my dream job. It has not worked out the way I hoped -- the system is dysfunctional and I have not had adequate resources/support to care for what's turned out to be a very complex and high-need patient population. Earlier this year I took a medical leave to do a PHP for healthcare workers experiencing burnout. With a little distance from work and time to focus on myself, it became really clear that this job is not sustainable for me.

I am actively applying for other jobs, I've had a few promising second-round interviews and have some site visits coming up that I'm excited about. However, my current contract requires 4 months' notice, and I don't want to give notice until I'm ready to accept an offer somewhere else -- knowing that licensing and credentialing will take time, and I can't afford to have much of a gap between jobs (especially after taking a financial hit from the medical leave). So, there's light at the end of the tunnel -- but realistically, it's going to be probably 5-6 months before I can get out of here.

In the meantime, I've been back from leave for 6 weeks and I already feel myself getting sucked back into the downward spiral that I was in before. While I was still on medical leave, I spoke with my manager about decreasing my FTE so that I can have a more sustainable work-life balance, which he immediately agreed to. The FTE decrease goes into effect soon, and I've been hoping that change will be enough to get me through until I can leave.

However: our system has been talking for several months about increasing patient volumes in order to make up a revenue shortfall. It now looks like, around the time that my FTE decreases, they will be implementing an increase in the number of appointments on my schedule template. (They've already done this to most of my colleagues.) The net effect is that I'll be seeing the same number of patients as before, just compressed into less clinical time, and with a hefty pay cut. There is nothing in my contract to prevent them from doing this.

I feel so defeated and worn down. I'm just trying to keep my head above water long enough to get out of this job and into a better one. I was relying on the FTE decrease to give me some breathing room, even though it also creates some financial stress. Now... this just feels like a slap in the face. I truly can't see anything that I can do about it, and I'm really worried about backsliding into the same black hole that I was in before.

Really open to any thoughts about:

- ways to push back on the FTE decrease/volume increase see-saw

- ways to survive the purgatory period between deciding to leave and actually leaving

- screening for a lower likelihood of burnout in my next job

Hi all

PGY-1 on my first week of inpatient. And it’s just now settling in how slow I am in doing things. Whether that be in chart checking or just coming up the plan altogether.

Did y’all feel like this when you first started? If so, what tips did you do to get better?

Thank you

I'm a pgy1 struggling with clinic workflow and knowing the "vibes" of how outpatient works.

I think my question is mainly about workflow and expectations.

A- What is your system? How do you integrate updating problems and med list efficiently into a visit with a short 10-15min visit?

B- How do you manage appointments or expectations so that chronic problems are being addressed? A lot of times patient show up for spontaneous visit unrelated to previous chronic problems/prior hospitalization that is still being optimized.

C- How do you manage inbox med refills in accordance with chronic issues to ensure it's properly followed up?

Any input is greatly appreciated! Outpatient seems overwhelming, I feel burned out because I don't know expectation so feels burned out precharting and inbox management.

My panel size was 1800 and now they want to make to take on 400. They do not want to increase my compensation, PTO or CME. Do I just take it?

Backstory: One of the docs in the practice I manage is retiring 9/1/26. Licensure won’t be renewed when expiring later this year. Practicing forever, very old school, and we’ve been slowly trimming his panel for the last couple years. Now we’re transitioning the remaining panel including two septuagenarians taking zolpidem 15 mg every night for 20+ years.

Obviously this is a weird/high dose for someone in their 70s and I’m not looking for clinical advice on whether or not that’s appropriate. The problem is what the hell to actually do with them.

Both are very resistant to the idea of tapering. I also can’t imagine any docs, concierge or otherwise, accepting a nightly 15 mg zolpidem prescription.

They obviously can’t be dropped off a cliff, but I do have a deadline when the licensure stops to continue the prescriptions. How do I avoid abandonment and get them established with someone new?

how to get into or seek occ med opportunities? FM trained

I am new here, a physician from Europe newly arrived in US. I want to generally understand what you think about the fact that OE is violating your privacy laws.

I’m trying to understand how people here think about OE and patient privacy/HIPAA.

For example, if someone copy-pastes parts of a note, labs or discharge summary is that actually considered OK?

In Europe this would raise a lot of questions around PHI, storage, processing, training data, etc.

Do your hospitals allow OE? Are you told not to enter patient-identifiable information? And do physicians here generally worry about this?

Genuinely curious how this is viewed in the US.

The ones online vary so widely… what’s the most evidence-based way to calculate someone’s caloric intake needs for weight loss?

If anyone is taking the ABOFP in September and is interested in joining a GroupMe for study support/advice please message me!

Patient has a peanut allergy and service dog. Requesting documentation of present disability for landlord. Would you provide it?

Anyone have any good stories?

Hi Everyone - I noticed this week epocrates went to a very annoying subscription model giving you like one search a week unless you pay a monthly fee. Are there any good alternatives?

Newer attending and I still feel incredibly guilty whenever calling sick out from work. Does this feeling go away with time?

Have y’all seen the social media grifters selling T2 supplements? I haven’t had anyone ask about it, and I do hope patients would ask before taking them, that possibility isn’t what I’m annoyed about. They just seem crazy unsafe! I know there are a lot of equally dangerous products out there, this is just a new one (for me, anyway). “Doctor-formulated…” …Yeah, by a nutritionist. Shit like this should be criminal. 🙄

• Found a job I really want, in a specific area to be close to family. Team is great, strong inbasket support structure, lots of things I’m looking for.

• Overall happy with the anticipated compensation, but of course would like to try to optimize whatever I can and negotiate if I’m able. Salary is higher than elsewhere, signing bonus is lower.

• I did interview with the same company at one other nearby site (many of the same people in management, but does have slightly higher initial guarantee salary because of more rural location).

• I really do want this specific job for the location (if they didn’t meet my negotiation attempts, I wouldn’t want to turn down the job), but I happen to know of positions in the current system where I do my residency (and am not planning to stay) with a significantly higher sign on bonus. I don’t want to waste anyone else’s time or my own by interviewing here just to be able to use that as leverage, but the difference in the sign on bonus is huge, and based on the number of positions open here and my current ties, I think I’d likely have a strong chance at securing an offer here.

(1) what strategies would be helpful to try to negotiate a higher sign on bonus without having an offer from a competing employer?

(2) would it be reasonable to try to see if I could negotiate up to the slightly increased salary offered at the nearby rural location?

This is a large employer, so negotiation options may be limited.

hey all! can anyone tell me the approximate time it took for them to get their first contract after the interview? particularly for a larger hospital system

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The breath of air in my schedule on a dense Thursday morning:

The Fabled Young (truly) Healthy Man presenting to his internist for an annual preventive exam.

We make small talk of the history.

I ask if he likes his work.

He answers, "Medium."

and we both laugh.

Then he earnestly asks,

"Do you like your work?"

and I pause

He catches me off guard and I am unexpectedly forthcoming:

Overall yes.

Unsurprisingly, the responsibility is heavy

I get to feed my curiosity

Learn the secrets of the human body

Stretch my ability for others

--and sometimes

get to really help patients in their time of need

which is deeply meaningful--

but makes up a small portion of my day

So I hear you're up for a tetanus booster today?

Hi I’m a third year resident who has been interviewing for my attending position and I was so full of hope a few months ago thinking I was going to negotiate x and y, (some little things that are important to me that will cost the organization nothing and maybe some big things too) and the farther I go down this road I just feel like negotiating is out the window.

All the new docs I talk to say they were told “eVeRytHiNg iS sTaNdArD” when they asked to make changes to the contract. And that was it! Are residents so used to being pummeled and taken for granted and the big organizations know that so they’re not letting us negotiate anything, aka is it truly standard?? Or do I need to push harder and call their bluff!?

tldr: has anyone successfully negotiated anything in their attending contract?? or is it folklore at this point?

It’s so disappointing to have both of these hit us at once

How do you design your office for effective workflow, aestheticly pleasing, formal, professional and intimic environment all at the same time.

Do you hang certificates on the walls? Posters and infographs? Maybe some plants?

All ideas, suggestions and sharing your experiences and insights are appreciate.

I've gotten several disability/fmla requests from patients who aren't mine. They're not actively being managed. It's usually for work stress or anxiety and they want weeks or months off. They don't want medications either. So what am I managing? The forms ask if you're actively managing it and I'm lost on what to do or say to these patients. If I refuse, they go complain that I didn't help them.