Can you make 300K in FM? My friend says it is "easy" but every online article says FM doesn't pay.

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This is a question I'm curious about in primary care. I'm currently a PGY2 FM resident and absolutely getting killed with the amount of work I'm having to do outside of work-hours. Every lab, imaging, specialist note, paperwork forms, med refills, etc., triages through our EMR systems gets routed to me to address it ideally within 24hrs. Not to mention finishing my progress notes which are impossible to complete when I'm seeing patients back-toback. It takes up a significant amount of time when I just wanna go home after a long day and relax and not take my work home with me.

I understand residency is different than being an attending, but how do you guys manage this in your practice?
I envy hospitalists because they don't have to take their work home with them.
You can be a hospitalist as a FM doc.

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This is a question I'm curious about in primary care. I'm currently a PGY2 FM resident and absolutely getting killed with the amount of work I'm having to do outside of work-hours. Every lab, imaging, specialist note, paperwork forms, med refills, etc., triages through our EMR systems gets routed to me to address it ideally within 24hrs. Not to mention finishing my progress notes which are impossible to complete when I'm seeing patients back-toback. It takes up a significant amount of time when I just wanna go home after a long day and relax and not take my work home with me.

I understand residency is different than being an attending, but how do you guys manage this in your practice?
I envy hospitalists because they don't have to take their work home with them.
Over time you will get more efficient. Notes will get faster, labs/imaging results will take less time.

Most of my patients are trained that when they run out of refills, they need an appointment. Cuts down on those calls. Same thing with 99% of patient calls with problems.

Specialist notes I spend maybe 30 seconds looking at their A/P and then move on.
 
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As things stand currently I would not be banking on PSLF as a loan repayment strategy. Lots of people who did everything right are getting denied.

FM is about preventative care, but it is also about chronic disease management and coordination of care for complex/very sick patients. One of my patients has terminal cancer, I see them more often than the oncologist does. Not to mention the range of acute illnesses you may see in your office that could turn deadly. That preventative care is also often the first red flag to diagnose cancer and other serious illnesses. And in FM you're never just "handing off" a patient, even if you refer them out to someone they are still under your care until they die or you quit that job.

Yes, it's definitely a different feeling than watching someone die right in front of you like it happens in the hospital, but it's still very hard in its own way - you get to know and care about your patients and it's difficult when they pass away even if you didn't see it personally.

Freaking preach for the first bolded part. I have family doing PSLF for non-medicine careers and the amount of hoops they've had to jump through is a national shame. It's also why I feel, personally, I should not apply for PSLF because aside from the headaches, I feel like the money should go to other careers that don't have the same repayment options as physicians. But I digress.

Regarding the second part, as fresh PGY2 who has a crop of new patients I've started to not only manage folks (new to me) who have progressing complex and deadly diseases, but I've also started to diagnose a couple cancers. It definitely is weird--seeing someone slide in the wrong direction over time or seeing the biopsy results come back supporting worse and worse news compared to the initial symptom that you caught. It's one thing for someone to throw a clot inpatient, a whole other to see them progress over weeks despite trying to help.
 
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This is a question I'm curious about in primary care. I'm currently a PGY2 FM resident and absolutely getting killed with the amount of work I'm having to do outside of work-hours. Every lab, imaging, specialist note, paperwork forms, med refills, etc., triages through our EMR systems gets routed to me to address it ideally within 24hrs. Not to mention finishing my progress notes which are impossible to complete when I'm seeing patients back-toback. It takes up a significant amount of time when I just wanna go home after a long day and relax and not take my work home with me.

I understand residency is different than being an attending, but how do you guys manage this in your practice?
I envy hospitalists because they don't have to take their work home with them.
Freaking preach man. At our clinic we joke "Clinic more stressful than ICU? Sounds like someone's a PGY2."
 
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Lastly, to OP, this recent reddit post is very relevant:



"My starting base was 230k with sign on bonus with potential to make 260k plus as years go by. How did I feel when I was told of my base salary? Absolutely happy. I finally wised up and said, damn I do not need 300k plus in my life. With my salary, I can still do the things I want with my life. I can accomplish my life goals."
 
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Lastly, to OP, this recent reddit post is very relevant:



"My starting base was 230k with sign on bonus with potential to make 260k plus as years go by. How did I feel when I was told of my base salary? Absolutely happy. I finally wised up and said, damn I do not need 300k plus in my life. With my salary, I can still do the things I want with my life. I can accomplish my life goals."

Sorry dude! I need 400k+ to do what I want. My base now as a hospitalist is in the 300s; therefore, I need to work 3 extra days per month to make that 400k+
 
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Sorry dude! I need 400k+ to do what I want. My base now as a hospitalist is in the 300s; therefore, I need to work 3 extra days per month to make that 400k+
... good for you? Whatever floats your boat man--now that you're an attending and you know that's what you want, great. But I'm tired of seeing med students think they need to make ____ money or they'll be "poor."
 
... good for you? Whatever floats your boat man--now that you're an attending and you know that's what you want, great. But I'm tired of seeing med students think they need to make ____ money or they'll be "poor."
250k is ~10.5k/month after ALL deductions (Tax, 401k, 529, HSA, health insurance, etc...). If you plan to pay your student loan in 10 yrs, you can deduct 3k from that 10.5k. You are left with 7.5k. You are not poor but you are just an average middle class individual after spending a grueling 11+ yrs in school.
 
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250k is ~10.5k/month after ALL deductions (Tax, 401k, 529, HSA, health insurance, etc...). If you plan to pay your student loan in 10 yrs, you can deduct 3k from that 10.5k. You are left with 7.5k. You are not poor but you are just an average middle class individual after spending a grueling 11+ yrs in school.
The way I look at a situation like this is that you are in the top 5% or better of earners in this country and the 11+ years of grueling schooling was worth it because that income is at least stable.

There are plenty of people out there who chose careers that they really don't like and I'm sure they would do anything to make 250K in FM...if they had the means to do it.

BTW, 250K is still a lot of money unless your tastes are beyond the norm.
 
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250k is ~10.5k/month after ALL deductions (Tax, 401k, 529, HSA, health insurance, etc...). If you plan to pay your student loan in 10 yrs, you can deduct 3k from that 10.5k. You are left with 7.5k. You are not poor but you are just an average middle class individual after spending a grueling 11+ yrs in school.

This all comes down to goals and expectations. Like I said, if your priorities are making that kind of money, fantastic, all the power to you.

But while I agree with your numbers, I do not agree with the way you frame things here.

$10.5 is $126,000 per year AFTER taxes and AFTER all retirement, benefits, exactly like you said. That is more than my parents' incomes combined at the height of their careers, both of which required higher education to obtain. Dump $40-60,000 of that into loans until they're either paid off or investing provides greater returns for a COUPLE years and suddenly your income grows. I am a simple person--I do not need an unnecessarily large house or boats or cars. Even with throwing another $20,000 a year into housing, either rented or owned, I will be perfectly fine with $40,000 a year of basically spending money.

Given the average American in middle class barely even has any savings or retirement to speak of, that is not middle class at all.
 
This all comes down to goals and expectations. Like I said, if your priorities are making that kind of money, fantastic, all the power to you.

But while I agree with your numbers, I do not agree with the way you frame things here.

$10.5 is $126,000 per year AFTER taxes and AFTER all retirement, benefits, exactly like you said. That is more than my parents' incomes combined at the height of their careers, both of which required higher education to obtain. Dump $40-60,000 of that into loans until they're either paid off or investing provides greater returns for a COUPLE years and suddenly your income grows. I am a simple person--I do not need an unnecessarily large house or boats or cars. Even with throwing another $20,000 a year into housing, either rented or owned, I will be perfectly fine with $40,000 a year of basically spending money.

Given the average American in middle class barely even has any savings or retirement to speak of, that is not middle class at all.
Beyond that, don't you agree that it is exhausting to hang out with other rich people? Apparently you need to scoop up your peas with your knife onto your fork but I just like to use my fingers.

I'll take the 250K -300K and fly under the radar any time.
 
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Beyond that, don't you agree that it is exhausting to hang out with other rich people? Apparently you need to scoop up your peas with your knife onto your fork but I just like to use my fingers.

I'll take the 250K -300K and fly under the radar any time.
Well I never! I won't tolerate such ballyhoo. Jeeves, remove this ruffian at once!
 
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I am a Family Physician in a small, physician owned private group located in the Southeast. We are a top performer in our Medicare Advantage plans allowing us to earn as much or more in value money than we earn from fee for service. This requires an intense focus and accountability to meet quality measures. However, the average physician in our group makes $500k per year working 4.5 days per week. The goal of primary care should be prevention of high cost medical care and improving our patient outcomes. I feel that finally we are being incentivized and rewarded for doing this.
 
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The way I look at a situation like this is that you are in the top 5% or better of earners in this country and the 11+ years of grueling schooling was worth it because that income is at least stable.

There are plenty of people out there who chose careers that they really don't like and I'm sure they would do anything to make 250K in FM...if they had the means to do it.

BTW, 250K is still a lot of money unless your tastes are beyond the norm.
My taste is not beyond the norm.

Top 5% is good but when you are paying 3k/month in student loan, that top 5% turns out to be top 15% in real life in term of what you can afford.
 
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My taste is not beyond the norm.

Top 5% is good but when you are paying 3k/month in student loan, that top 5% turns out to be top 15% in real life in term of what you can afford.
You're not going to be paying those student loans forever though. Also, with time you will make even more money than you do currently minus the loan bill.
 
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I am a Family Physician in a small, physician owned private group located in the Southeast. We are a top performer in our Medicare Advantage plans allowing us to earn as much or more in value money than we earn from fee for service. This requires an intense focus and accountability to meet quality measures. However, the average physician in our group makes $500k per year working 4.5 days per week. The goal of primary care should be prevention of high cost medical care and improving our patient outcomes. I feel that finally we are being incentivized and rewarded for doing this.
500K sounds real good. If I made that amount of money, I would tip people $100 bills and say "and there's more where that came from."
 
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Far enough
I'm getting senior in high school vibes. Come back after your third year of medical school or during that year. See how much debt you have. See what youve liked. See where (hospital, outpatient, operating room) you are more happy. 300 is a number. it might be meaningless at that point compared to other things.
 
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I'm getting senior in high school vibes. Come back after your third year of medical school or during that year. See how much debt you have. See what youve liked. See where (hospital, outpatient, operating room) you are more happy. 300 is a number. it might be meaningless at that point compared to other things.
Someone saying “500k sounds real good” must be senior in HS. Okay, got it.
 
I'm getting senior in high school vibes. Come back after your third year of medical school or during that year. See how much debt you have. See what youve liked. See where (hospital, outpatient, operating room) you are more happy. 300 is a number. it might be meaningless at that point compared to other things.
Ugh. You're one of those people?

I'm a little past that stage actually. I'm currently in an MS with a linkage. I don't think you need to be in medical school to understand the financials or what area of medicine interests you.
 
I am a Family Physician in a small, physician owned private group located in the Southeast. We are a top performer in our Medicare Advantage plans allowing us to earn as much or more in value money than we earn from fee for service. This requires an intense focus and accountability to meet quality measures. However, the average physician in our group makes $500k per year working 4.5 days per week. The goal of primary care should be prevention of high cost medical care and improving our patient outcomes. I feel that finally we are being incentivized and rewarded for doing this.

Bingo.
 
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I am a Family Physician in a small, physician owned private group located in the Southeast. We are a top performer in our Medicare Advantage plans allowing us to earn as much or more in value money than we earn from fee for service. This requires an intense focus and accountability to meet quality measures. However, the average physician in our group makes $500k per year working 4.5 days per week. The goal of primary care should be prevention of high cost medical care and improving our patient outcomes. I feel that finally we are being incentivized and rewarded for doing this.
Do you feel that this is a trend that is going to continue?
 
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Say the guy/gal who 'will take 250-300k and fly under the radar.'
I was just asking. If I made a million I would invest most of it anyway.

I guess they don't teach you about money management in medical then I'm assuming.
 
I was just asking. If I made a million I would invest most of it anyway.

I guess they don't teach you about money management in medical then I'm assuming.
They really don't.

But the usual ways that doctors screw up their wealth has been discussed multiple times on this particular forum. That said, discussing the possibility of making $1,000,000 a year as an FM is the definition of counting your chickens before they hatch. No point in it.
 
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This is a question I'm curious about in primary care. I'm currently a PGY2 FM resident and absolutely getting killed with the amount of work I'm having to do outside of work-hours. Every lab, imaging, specialist note, paperwork forms, med refills, etc., triages through our EMR systems gets routed to me to address it ideally within 24hrs. Not to mention finishing my progress notes which are impossible to complete when I'm seeing patients back-toback. It takes up a significant amount of time when I just wanna go home after a long day and relax and not take my work home with me.

I understand residency is different than being an attending, but how do you guys manage this in your practice?
I envy hospitalists because they don't have to take their work home with them.
An alternative is to continue to be very detailed oriented post residency and open your own practice.

Work smarter not harder.

In other words, get paneled with insurance in your geographic area of choice that pay better than medicare. Forget the rest. It'll take more time to build up the panel, but you'll also get paid relatively more per hour, so as not to feel the pressure of the volume game typical of most employed jobs.

Better yet, explore the cash/retainer/DPC/concierge option, too.
 
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Hahaha. Slow day at the office I take it?
Well dude/tte,
You: 300K?
Multiple attendings: real answers
You: nope
Attendings: where are you in training?
You: far enough
Attendings: you are in high school right?
You: over 300k too much knife peas, stay under radar etc.
Attending: making 500k
You: how about a mil?
Attending: you just said 300k too much
You: bla bla invest

I beginning to suspect your MS program doesn't have a linkage after all.
 
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Well dude/tte,
You: 300K?
Multiple attendings: real answers
You: nope
Attendings: where are you in training?
You: far enough
Attendings: you are in high school right?
You: over 300k too much knife peas, stay under radar etc.
Attending: making 500k
You: how about a mil?
Attending: you just said 300k too much
You: bla bla invest

I beginning to suspect your MS program doesn't have a linkage after all.
??? We finished epithelium today. I didn't think it was that hard. Sorry if you feel that I should be spending more time with it.
 
Going into FM I have sort of been getting cold feet over money. These posts are reassuring, but is there a good way to get income by region? I don't really trust salary.com and all of that stuff. Mostly interested in the mid-atlantic and new england.

Is everyone making $300k+ in the midwest?
 
Going into FM I have sort of been getting cold feet over money. These posts are reassuring, but is there a good way to get income by region? I don't really trust salary.com and all of that stuff. Mostly interested in the mid-atlantic and new england.

Is everyone making $300k+ in the midwest?
Is everyone? No. Does that inherently make them unhappy? No. Is choosing a specialty solely on income a good idea? We ask the questions, you decide.

Meanwhile here's some data like you asked:
 
Is everyone? No. Does that inherently make them unhappy? No. Is choosing a specialty solely on income a good idea? We ask the questions, you decide.

Meanwhile here's some data like you asked:
Appreciate the information!

I guess I phrased my question poorly. I was more curious if that kind of money 'required' a location change, rather than everyone in the location being lucrative!
 
Although OP may have been trolling us...you guys really helped me realize that the physician that I just let go....it was all them and not me.

They were on track to make about 230k a year averaging 13-14 patients a day plus with benefits.

Its hard cutting a physician but somehow, this really helped me not feel guilty about it.
 
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Although OP may have been trolling us...you guys really helped me realize that the physician that I just let go....it was all them and not me.

They were on track to make about 230k a year averaging 13-14 patients a day plus with benefits.

Its hard cutting a physician but somehow, this really helped me not feel guilty about it.
Why did you fire them?
 
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Although OP may have been trolling us...you guys really helped me realize that the physician that I just let go....it was all them and not me.

They were on track to make about 230k a year averaging 13-14 patients a day plus with benefits.

Its hard cutting a physician but somehow, this really helped me not feel guilty about it.

Because you were paying this person too much for production?
 
Although OP may have been trolling us...you guys really helped me realize that the physician that I just let go....it was all them and not me.

They were on track to make about 230k a year averaging 13-14 patients a day plus with benefits.

Its hard cutting a physician but somehow, this really helped me not feel guilty about it.

Basically they just kept getting tons of negative feedback and were not a team player. I kept trying to give them more and more time to correct issues. Lots of feedback about how to correct deficiencies but it seemed to never get rectified.

He never checked any uploaded documents from consultants.

When they covered my patients....they never helped me out. They may have done 4 face to face visits since I last saw a patient and highlighted in my last note was things like NEXT VISIT PT NEEDS TO HAVE PSA CHECKED TO FOLLOW ELEVATED PSA TREND. and it never got checked....he just seemed to ignore our notes and reminders and just billed quick level 4 visits and would put things like below this point pcp to follow up....like bro....you are a ****ing pcp now not an urgent care.

He started to cherry pick his patients.....Only wanted to do the quick level 4 visits and started to cancel "complicated visits" such as walking out on a patient who told him that he was there for chronic fatigue. I get it, its a ****ty visit but you just can't cherry pick the easy visits.

Started to get loose with the meds. Oh new patient that we have never bet before, here is 90 days worth of Adderall....

Tons and tons of negative feedback about how rude he was, didn't seem to care, or just referred out for everything. One patient literally came back the next day to see me instead of him and reading his note it was clear he was checked out.

hand pain -referral to ortho
reports of neck nodule ---referral to ent
pt reports abnormal mole ---derm referral
diarrhea ---GI referral
SOB - sending to pulm for PFTs


I really tried to make it work for him and lost my ass off of him being there. I lost probably about $100,000 hiring him which is my biggest financial mistake to date in the clinic.

Despite often having 20% less patients on his schedule his no show rate was 3.5 times the other doctors in the practice. Huge sign that his patients just didn't like him.

Nice guy, just not meant to be in outpatient medicine and hes going back to hospitalist. I wish him the best.
 
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Basically they just kept getting tons of negative feedback and were not a team player. I kept trying to give them more and more time to correct issues. Lots of feedback about how to correct deficiencies but it seemed to never get rectified.

He never checked any uploaded documents from consultants.

When they covered my patients....they never helped me out. They may have done 4 face to face visits since I last saw a patient and highlighted in my last note was things like NEXT VISIT PT NEEDS TO HAVE PSA CHECKED TO FOLLOW ELEVATED PSA TREND. and it never got checked....he just seemed to ignore our notes and reminders and just billed quick level 4 visits and would put things like below this point pcp to follow up....like bro....you are a ****ing pcp now not an urgent care.

He started to cherry pick his patients.....Only wanted to do the quick level 4 visits and started to cancel "complicated visits" such as walking out on a patient who told him that he was there for chronic fatigue. I get it, its a ****ty visit but you just can't cherry pick the easy visits.

Started to get loose with the meds. Oh new patient that we have never bet before, here is 90 days worth of Adderall....

Tons and tons of negative feedback about how rude he was, didn't seem to care, or just referred out for everything. One patient literally came back the next day to see me instead of him and reading his note it was clear he was checked out.

hand pain -referral to ortho
reports of neck nodule ---referral to ent
pt reports abnormal mole ---derm referral
diarrhea ---GI referral
SOB - sending to pulm for PFTs


I really tried to make it work for him and lost my ass off of him being there. I lost probably about $100,000 hiring him which is my biggest financial mistake to date in the clinic.

Despite often having 20% less patients on his schedule his no show rate was 3.5 times the other doctors in the practice. Huge sign that his patients just didn't like him.

Nice guy, just not meant to be in outpatient medicine and hes going back to hospitalist. I wish him the best.
Very bad, good job for firing him I hope that’s a wake up call…
 
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230k/year to see only 14 patients a day sounds like a very reasonable deal. In that scenario you could probably see all of your patients in 6 hours
 
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Basically they just kept getting tons of negative feedback and were not a team player. I kept trying to give them more and more time to correct issues. Lots of feedback about how to correct deficiencies but it seemed to never get rectified.

He never checked any uploaded documents from consultants.

When they covered my patients....they never helped me out. They may have done 4 face to face visits since I last saw a patient and highlighted in my last note was things like NEXT VISIT PT NEEDS TO HAVE PSA CHECKED TO FOLLOW ELEVATED PSA TREND. and it never got checked....he just seemed to ignore our notes and reminders and just billed quick level 4 visits and would put things like below this point pcp to follow up....like bro....you are a ****ing pcp now not an urgent care.

He started to cherry pick his patients.....Only wanted to do the quick level 4 visits and started to cancel "complicated visits" such as walking out on a patient who told him that he was there for chronic fatigue. I get it, its a ****ty visit but you just can't cherry pick the easy visits.

Started to get loose with the meds. Oh new patient that we have never bet before, here is 90 days worth of Adderall....

Tons and tons of negative feedback about how rude he was, didn't seem to care, or just referred out for everything. One patient literally came back the next day to see me instead of him and reading his note it was clear he was checked out.

hand pain -referral to ortho
reports of neck nodule ---referral to ent
pt reports abnormal mole ---derm referral
diarrhea ---GI referral
SOB - sending to pulm for PFTs


I really tried to make it work for him and lost my ass off of him being there. I lost probably about $100,000 hiring him which is my biggest financial mistake to date in the clinic.

Despite often having 20% less patients on his schedule his no show rate was 3.5 times the other doctors in the practice. Huge sign that his patients just didn't like him.

Nice guy, just not meant to be in outpatient medicine and hes going back to hospitalist. I wish him the best.
I work for a large practice, and the couple people like this drive me crazy. BTW your blog and posts have given me a huge push to start my own thing. Hopefully early 2022!.
 
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Basically they just kept getting tons of negative feedback and were not a team player. I kept trying to give them more and more time to correct issues. Lots of feedback about how to correct deficiencies but it seemed to never get rectified.

He never checked any uploaded documents from consultants.

When they covered my patients....they never helped me out. They may have done 4 face to face visits since I last saw a patient and highlighted in my last note was things like NEXT VISIT PT NEEDS TO HAVE PSA CHECKED TO FOLLOW ELEVATED PSA TREND. and it never got checked....he just seemed to ignore our notes and reminders and just billed quick level 4 visits and would put things like below this point pcp to follow up....like bro....you are a ****ing pcp now not an urgent care.

He started to cherry pick his patients.....Only wanted to do the quick level 4 visits and started to cancel "complicated visits" such as walking out on a patient who told him that he was there for chronic fatigue. I get it, its a ****ty visit but you just can't cherry pick the easy visits.

Started to get loose with the meds. Oh new patient that we have never bet before, here is 90 days worth of Adderall....

Tons and tons of negative feedback about how rude he was, didn't seem to care, or just referred out for everything. One patient literally came back the next day to see me instead of him and reading his note it was clear he was checked out.

hand pain -referral to ortho
reports of neck nodule ---referral to ent
pt reports abnormal mole ---derm referral
diarrhea ---GI referral
SOB - sending to pulm for PFTs


I really tried to make it work for him and lost my ass off of him being there. I lost probably about $100,000 hiring him which is my biggest financial mistake to date in the clinic.

Despite often having 20% less patients on his schedule his no show rate was 3.5 times the other doctors in the practice. Huge sign that his patients just didn't like him.

Nice guy, just not meant to be in outpatient medicine and hes going back to hospitalist. I wish him the best.
Hope his attitude changes. That person seems to be someone who does not care at all. I hope to never work alongside someone like that.
 
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Hope his/her attitude changes. That person seems to be someone who did not care at all. I hope to never work alongside someone like that.
Fully agree. Not everyone is meant for FM/primary care. You could be the only physician a patient sees, that kind of apathy could be a death sentence for a patient who puts all their trust in you.
 
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Hope his attitude changes. That person seems to be someone who does not care at all. I hope to never work alongside someone like that.
Well, this person that I hired did have a history of a malpractice case 7 years ago but it seemed like a pretty legit explanation. It also helped that he worked with a few of my friends with a totally different group that gave him glowing recommendations. Now looking back at his behavior, I can see how the chain of events may have been slightly different than the picture he painted and he was not totally just blindsided with bad luck and a malpractice case.
 
Well, this person that I hired did have a history of a malpractice case 7 years ago but it seemed like a pretty legit explanation. It also helped that he worked with a few of my friends with a totally different group that gave him glowing recommendations. Now looking back at his behavior, I can see how the chain of events may have been slightly different than the picture he painted and he was not totally just blindsided with bad luck and a malpractice case.

Oh wow, was totally thinking this was "fresh out of residency" kind of behavior rather than someone with nearly a decade out of training.
 
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