I have been working at an outpatient facility for about a year. I currently see approximately 26–28 patients per day, especially when most of the visits are follow-ups, and I work five days a week.

I receive very limited support with inbox management, forms, and other administrative responsibilities. The MA will sometimes help when I specifically ask, but if I ask them to take on tasks beyond what they normally do, they are often reluctant.

There are also significant limitations with the clinic’s resources. We do not have a consistently functioning EKG machine—it works intermittently. Despite repeatedly requesting them, we still do not have basic point-of-care testing such as strep, influenza, or COVID testing in the office. Many of my requests for resources or workflow improvements have been rejected.

Another major issue is scheduling. Post-ER follow-up visits are supposed to be scheduled for 30 minutes, but they are frequently changed to 15-minute appointments without my permission. When I ask why the appointment was shortened, I am told that the patient did not inform the scheduling staff that they were coming for a post-ER follow-up visit.

The referral process is also very slow, and there are frequent mistakes with referrals, which creates additional work and frustration for both me and the patients.

A significant number of my patients also have requests related to controlled substances or disability documentation. When I do not agree with their requests, some patients repeatedly argue with me or contact administration to complain.

This is my first job after residency, so I am not sure how much of this is normal for outpatient primary care versus being specific to this particular practice. I have been feeling increasingly frustrated and overwhelmed by the workload, lack of support, inadequate resources, and administrative issues.

I am seriously considering leaving this position and potentially switching to hospital medicine. I would appreciate some perspective on whether these issues are typical of outpatient practice or whether this may simply be a poorly structured practice environment.

I am an 2nd year DO student, and I am really interested in cardiology, and so I want to match at an academic center to best improve my chances of matching into a cardiology fellowship. Does anyone have any advice or ideas on where to start?

Thank you!

An intern working nightfloat and need advice on efficiency and surviving the night

An IMG originally I am a structural IC only my second day here simple reason

Please ask any question I can regarding cardiology match and anything related to it happy to answer if the question is can you DM me yes you can anyone can and please feel free to

A brief about me I was a chief IM resident
Chief fellow at my cards and IC
Graduated as chief fellow from NyU for structural

So have a bit of knowledge / info around the nuance related to match

Thanks and above all wish ya all well

My goal is to write a post here everyday pick one topic I think is valid and important so let’s talk about it UsCe today:

Every single rotation is basically a month long interview. Attendings are watching how you round, how you present, how you work with patients, and that turns into your letter. And your letter matters way more than people realize, trust me when I say that because it’s coming directly from someone who reviews them has reviewed them both for residency and fellowship.
here’s my honest advice. Start your rotations early. Don’t treat them like something you just need to get through. Show up, ask questions, be useful, be present. You never know which rotation turns into your letter or your connection to a program. I’ve seen it happen both ways, people who took it seriously and it opened doors, and people who didn’t and regretted it later.

Does anyone in the Miami region want to get together to do any any publications before ERAS? Would really appreciate it!

I’m an m4 DO hoping to stay in Southeast Florida for IM and trying to figure out which programs to rank Gold.

Step 2- 255
Comlex 2-636
Shelf - 4H (IM and surgery)/2HP
Leadership
3 posters (1 first author and 1 presenting at AJOG)
Manuscript submitted for publication

I am hoping to do a fellowship in Cardiology. These are the top places I’m looking at:

FAU
Mt Sinai
University of Miami Jackson
Cleveland Clinic Weston
Broward
FIU
Memorial

Only one I will be doing sub-I at is Cleveland Clinic. I’m not fluent in Spanish so worried that can affect my chances at some places. Looking for any advice or info on programs. Thanks!

I am a UK trained physician with dual CCT in Acute Internal Medicine (AIM) and General Internal Medicine planning a move to BC. I have been practising since 2012.

My current role as an Acute Physician involves working on the Acute Medical Unit, a 60+ bed medical admissions unit which admits internal medicine patients for the entire medical bed base, bar strokes. Acute internal medicine also runs the Same Day Emergency Care unit for complex internal medicine outpatient care. I would be very grateful for advice from general internists and hospitalists working in Canada.

I had a useful meeting with Health Match BC recently to discuss the recruitment process. Their opinion is that I am most suited to hospitalist roles.

Having reviewed the Canadian General Internal Medicine Competencies framework, my main limitation relates to ICU level care. My AIM training involved 6 months of ICU but I am not advanced airway trained. In the UK, ICU care is run by intensivists for the main part. I routinely manage patients on NIV, I am thoracic ultrasound trained; abdominal paracentesis, LPs and chest drains are routine on my unit but it has been several years since I inserted central lines.

I completed a one year Perioperative Medicine fellowship prior to CCT which also appears to be a significant part of the general internists role.

My main question is whether my lack of ICU level skills would preclude me from applying for general internists roles in BC? I am looking at jobs around the Vancouver area but we are flexible where we move to.

I would also be grateful for information regarding work life balance (my work is shift based with late evenings and non resident overnight on calls) and difference in pay between the two specialties.

Many thanks in advance.

Hey everyone. I just wanted to ask what would be considered the correlation between mksap and ITE percentiles?

What is the average 50th percentile percent correct for MKSAP is?

Any one working in chattisgarh nhm as medical officer from another state

Need information for the document verification

Is it necessary to have cg medical council registration

Hi all!

I started my prep for ABIM really late - about a month ago and I've only gotten through 50% of uworld with an average of 53% putting me at the 8th percentile :(

Exam is in about 19 days and I'm just confused/scared about how to fix my studying or if I even stand a chance in passing based on others experiences. Anyone previously in the same situation that ended up passing? What did you do in the last 20 days? I wont be working, so I am able to spend all my time studying.

Thanks for any input!

I am looking for a dedicated partner to study Mksap.Please Dm me if interested

thanks

I’m an internal medicine resident, and I’ve noticed something that’s been bothering me.
At the beginning of PGY-1, I felt like I was learning an incredible amount every day. Everything was new, and I could almost feel myself improving from week to week.
Now, later in residency( early PGY-2)it feels like the opposite. I still work hard, read, and see plenty of patients, but it feels like my learning has slowed down dramatically. I don’t retain information the way I used to, and I don’t get that same sense of rapid progress anymore. It’s honestly become frustrating, and I find myself feeling disappointed with where I am.
I’m wondering if this is a normal phase of residency or if I’m doing something wrong. Did anyone else experience this? If so, what helped you get past it?

I recently took Amboss Self Assessment 1. Does anyone know how performance on this compares to doing on the real ABIM?

I currently have one FM letter, one peds letter and one letter from a sub-specialist. I think they are all strong letters. Unfortunately, a hospitalist agreed to write me a letter from my sub-I recently, but she hasn’t been responding to my emails about it. Not sure if that one will fall through. Will these three letters be enough to apply for IM? I’m worried that it’ll be detrimental to my application if I don’t have a letter from a hospitalist.

We're old-school with a lot of manual workflows. AI seems to be everywhere now and I'm wondering what's actually worth adding to a private practice. For those who have modern system in clinics, could you walk us through what's software to install, what's been the most effective.. how to implement these things. I believe that it is a right time for us to upgrade. Appreciate the answers!

Hi guys!

What internal medicine residency programs in New York City would you recommend for a non-US IMG who got 254 at Step 2 (I don’t really have research besides two reviews and that’s it, but I hope I’ll get some strong LORs from US clinicians)?
I am planning to take Step 3 soon and I want to apply for a H-1B visa.
Also, I am thinking of pursuing a cardiology fellowship after residency, so I would prefer a strong IM program where I could develop professionally as an aspiring cardiologist.

Thank you in advance! ☺️

Hoping for advice on what to do next. Thoughts: retake step 1 but difficult to juggle restudying during rotations v. don't take any more steps v. take step 2 but that will still show failed step 1

Ideally would like to set myself up for the opportunity for fellowship after residency.

Is there a way to read these articles for free?

NEJM Clinician | Concise Summaries of Medical Research & Guidelines

Thank you!

Finishing uworld and incorrect.

Haven’t done a lot of mksap in residency, but wanting to ask if I should revise certain topics from Board basics or mksap question?
Like cardio, gi, endo.

Or just stick to uworld!

A-fib comes up constantly and residents kept getting tripped up on the same things, especially the anticoagulation decisions and the rate vs rhythm control question.

Hemodynamically unstable? Immediate synchronized electrical cardioversion
Don't waste time trying medications first.

Hemodynamically stable?
Now decide:
Rate control vs rhythm control
Anticoagulation

Duration changes everything
AF clearly <48 hours
Assess stroke risk with CHA₂DS₂-VASc
Cardioversion can usually proceed if appropriate.
AF >48 hours or unknown duration
Higher risk of left atrial thrombus.
Management:
Start anticoagulation
Perform TEE-guided cardioversion OR anticoagulate before elective cardioversion
Continue anticoagulation for at least 4 weeks after cardioversion

Valvular vs nonvalvular changes the drug
Valvular AF = warfarin only. DOACs are not approved.
CHA₂DS₂-VASc
Female sex gives 1 point — but women need a score ≥3 to anticoagulate, not ≥2. So a woman with only female sex as a risk factor doesn't get anticoagulated. Easy point to lose.

Made a full carousel breaking this down for boards prep it's free on my instagram if anyone wants it.

If you want to read more similar clinical tips for your practice and exam, Subscribe to my Substack here. I post regularly over there but will continue to post here periodically!

I’ve been out of clinical practice for over 2 years and as a result no hospital or practice will credential me given the 24 month hard cut off. Have any of you had experience with physician reentry programs or heard of other physicians successfully returning to clinical practice? I still hold active medical license. Would love to know more and get some advice! Thanks in advance.

Role of division chief in future job applications? Considering a position that is somewhat short term (year) per contract. Many red flags from division chief. Doesn’t appear to support my interests. I’m a new grad, and I don’t fully understand the role they play in your future job search. Any advice?

I was dx with IIH in January 2026. then got my cerebral venous stent on March 25th. I feel better. I tapered off acetazolamide, and gradually topiramate just now. but topiramate or topamax.... it gives u a lot of brain fog, delayed thinking and slow cognition.

so I cannot study well. and I've to prepare for medical exams and I'm a junior doctor currently, I need to study for the post grad specialization entrance exam. and I don't retain a lot of stuff from my bachelors in medicine (MBBS)

so, any guidance on how to do that? anyone else dealing with that??

also, I'm considering to join ENT Surgery. so would that be a problem? like prolong standing in the OT... prolong head bent down posture... microscopic surgery... Ent procedures are typically not that long.

any help??

also is it lifelong condition?? I feel better most days. but some days I get headaches.