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Do you like it? How was the transition? Fellowship or no fellowship?
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Nursing home rounding
Started by cyanide12345678
Do you like it? How was the transition? Fellowship or no fellowship?
I’m mid fellowship right now. PGY 18.
I’m enjoying 9-5 Mon-Fri much more than I was enjoying 6-8 shifts/month in the ED when I left. It feels like something I can enjoy and sustain through the end of my career. I likely won’t take a full time position when I’m done - something along 0.75 FTE feels right.
I kinda doubt that. There are some areas where you would be better than a new grad in those areas but I think overall you wouldn't be.
This isn't a slight against you, but despite your experience you haven't likely spent more than a day or so in an outpatient clinic since med school. A new residency grad has spent several hundred in the last couple of years. Same with hospitalist work.
I do agree that with time you'd catch up, and probably reasonably quickly, but that catch up time could be tricky for the patients since unlike residents you don't have to be supervised.
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Pfftt that’s easy— just send it to the ER
I'm on your side here, bro.
Sure, the "bones" of management are there, but I'm gonna wager that most ER docs have no idea just how nuanced and complex so many "run-of-the-mill" management items are.
I'm in a position now where people are coming to me at the FSER which I'm known to haunt for DM/HTN management because "it's easier to see you and we trust you more than the family care doc".
That's a humblebrag; but there's a few elements there that "make it make sense" for the patient.
I UpToDate'd the necessary stuff; and it's so wildly different than it was just a few years ago. It also relies a LOT upon labs that I can't readily get results for in the FSED.
I would want a formalized course if I were gonna plant a flag and manage a nursing home panel.
Literally no one wants to do full blown pcp most docs want a niche, either outpatient acute care or obesity medication. Like please be for real no one wants to manage complicated dm and to deal with insurance.
Em is also higher liability than whatever outpatient niche you decide to do and you choose what you want to see rather than seeing everything that outpatient can't deal with.
Acute care clinics/ortho and in outpatient you can just tell people to go to the ED or refer to another doctor
Also as a side note most americans will be poorly controlled with chronic issues due to insurance denials and poor lifestyle no matter what you do
Em is also higher liability than whatever outpatient niche you decide to do and you choose what you want to see rather than seeing everything that outpatient can't deal with.
Acute care clinics/ortho and in outpatient you can just tell people to go to the ED or refer to another doctor
Also as a side note most americans will be poorly controlled with chronic issues due to insurance denials and poor lifestyle no matter what you do
Yeah, it's weird how my perspective has changed over the years. I used to champion preservation of the turf wars and separation of church and state where specialties were concerned. But then...we have to co-sign an APC chart who's seeing ER patients with 6 months of post grad experience expecting them to ramp up to full confidence ER cases, at least according to the CMGs. I literally cannot physically see their patients. Are they great? Of course not. Do they become decent with time? Sure. Experience begets wisdom and better clinical care. I think the same goes for anything. Aren't FM docs doing the same in clinic with their own APCs? Same thing applies for FM docs who gravitated to EM work and became great over time. My wife was an EM APC who did EM for years and then took a FM job. She cried when she came home for 6 months to a year. Now she's phenomenal (I think?). I think all the preventative medicine stuff would be the biggest hurdle for me in outpatient along with the unfamiliarity of the chronic medical cases and insurance issues but I think with a year or two I'd catch on. Same goes for a full time IM doc who wanted to switch to EM. Give him a few tubes, central lines, LPs, etc.. (backup to call + handful of shoulder/hip reductions) and sure it might seem daunting at first but after a year or two I bet they'd be pretty solid in the ED. The funny thing is that most of us in EM who have been doing this forever grew bored of the EM stuff a long time ago and like learning, reading and trying our "FM hat" out in the ED from time to time managing chronic illness. It's even easier with AI now.
Either way, you'd better believe I'm sick enough of the EM work these days that I'd almost do anything to transition to outpatient care. They could hire me at half compensation for a year in order to "learn me up" and I'd probably take it with a silly grin on my face.
Either way, you'd better believe I'm sick enough of the EM work these days that I'd almost do anything to transition to outpatient care. They could hire me at half compensation for a year in order to "learn me up" and I'd probably take it with a silly grin on my face.
Yeah need ozempic need 12 meds and the turkey sandwich. Honestly this managing "DM and HTN" is just treading water you are just managing how fast they will decline that's why you are titrating up and not removing meds hence why its more difficult.
They don't exercise they eat whatever don't schedule an appointment. Nursing home patients don't get exercise and you will have less and less staff and private equity wants more and more.
Resulting turf wars got us to this we have to do a fellowship in which you make way less and work several hours while being geographically restrained
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The state of EM is so bad that people would rather take care of corpses. Take note, medical student lurkers.
It's corpses in either place, really.
I think the sky is falling only on SDN. This place is the moat of negativity.
What about the EM job projection of 2027?
I think that projection should be improving dramatically if that 4 year proposal comes through and if a lot of programs end up with fewer residents due to increased volume requirements. I think in 1 swoop, we would start going back to the job market of pre-covid days.
For real.
America could do so much better, but it's going to take radical sociopolitical change.
Return masculinity to America.
Return femininity to America.
Recognize that those are two different things; both necessary.
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Maybe but there is a lot of pushback on making all programs 4 years
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Dumbest thing ever. Making all programs 4 years.
Smartest thing ever. Making all programs 4 years.
I went to a 3 year program. I was absolutely ready by year 3 to be fed to the EM grindhouse.
That fourth year needs to include an "escape hatch".
Give us a year of clinic and longitudinal care.
Give us a year of palli, occ, or something similar.
The future of healthcare in America isn't "MOAR EM".
It's bridging that acute-care gap.
1. Complex problems require complex solutions, and this ain’t it
2. Barf
Has this 4 year thing happened yet? I support it just to limit our numbers and get our demand/quality back up. When will we know for sure it is being implemented?
Yeah not so much anymore.
With ozempic and Mounjaro I absolutely am titrating down/removing meds when the weight comes off. It's crazy how much those things help.
The blue haired disagreeable variety has entered the chat.
Also, most of you are forgetting about the elephant in the room which is AI leveraged cross over between specialties. With AI, it's now even easier than ever to practice new forms of medicine that don't require procedures or surgery training. AI has already proven to be comparable if not better than physicians when it comes to diagnostic interpretation. It will only improve from here and will absolutely surpass our ability in the next year. That is a complete game changer.
| Domain/Study Type | AI Performance | Physicians Performance | Key Insight (2023–2025) |
|---|---|---|---|
| General clinical vignettes (e.g., JAMA, NEJM) | 76–92% accuracy (standalone AI) | 73–76% (with/without AI aid) | AI often better alone; aid doesn't always improve doctors |
| Complex NEJM cases (Microsoft MAI-DxO) | ~85% | ~20% | AI excels on "stumpers" in controlled tests |
| Radiology (e.g., chest X-rays, mammography) | Matches or slightly higher sensitivity | High, but AI reduces workload | AI strong in pattern recognition; needs human oversight |
| Meta-analyses (generative AI) | ~52% overall accuracy | Often comparable or higher | Not yet reliable substitute |
Strange to me that there's all this hype about LLMs being better than docs. Yet for other fields, which are less complex and have lower stakes, people are starting to **** on it as they realize that it's massively over-hyped. These studies are basically tailor-made for an LLM and dont' translate to real life. (radiology and pathology I don't know enough about, but it seems like it would seem to have potential utility in performing rapid wet reads). Not to mention nerds getting hard-ons about publishing in a new field that's gonna get plenty of media coverage.
Also, I'm not sure why there's this expectation that it's going to be exponentially better *next year. Is chatgpt that much better now than last year? Most of these tech things rapidly plateau in utility imo.
People hate doctors and think that we are the cost center in medicine.
77-90K jobs in tech industry alone were directly attributed to AI in the first 7-10 months in 2025.
14 million jobs worldwide have been displaced by AI or AI-driven technologies
2 million manufacturing jobs estimated to be replaced by AI + robotics in the next year (MIT Research)
92 million roles displaced globally by 2030 (World Economic Forum Future of Jobs Report)
300 million full time jobs globally either affected or degraded by AI (Goldman Sachs)
80% customer service roles projected to be automated displacing millions
Does that feel like some sort of plateauing glorified LLM Magic 8-ball? Do you think medicine is somehow protected going forward? AI can already read X-rays and interpret EKGs better than a radiologist or a cardiologist.
LLMs and AI tech is leapfrogging each year. Reasoning chains, inference-time scaling, multimodal training, etc.. Exponential leaps in capability. We have gone from "AI can pass the USMLE" in 2023 to "AI is outperforming PhD-level experts on graduate science questions in 2025". We'll be solving unsolved math/Millennium Prize Problems. We are very close to AI powerful enough to come up with new technologies and when AGI arrives (right around the corner) the possibilities and potential is limitless.
If you don't follow this stuff, you really should. I know I'm probably the AI nerd on this forum but I voraciously consume this stuff and it's almost all I read about in my free time and I think of this time as the quiet before the Dawn. Literally. As if Dawn hasn't arrived yet because the degree of productivity, advancement (in almost all industries) and societal/economical change will be completely mind blowing and profound. When we reach Super Intelligence (Definitely by 2030, I predict 2027) it will be arrive like thunder and change everything forever. The old narrative of LLM plateauing from running out of high quality human generated data is old news. We're now in inference-time scaling where reasoning tasks have doubled every 7 months. Post training breakthroughs (RLVR), synthetic data at scale with self improvement loops, etc... (with AI coming up with more and more ways to push forward).
We aren't plateauing and we're way beyond a single exponential curve. We're now on multiple overlapping S-curves. In the middle of a transition between S curves actually where the old one is flattening and the new ones are still in their steep growth phases. The trajectory is still exponential though and will continue to be for the foreseeable near future.
I totally get the doubt and I hear it all the time. The skepticism. But people just aren't prepared for what's in store for us with this tech. I'm so incredibly pumped. I not only use AI to figure out ways to utilize current tech but I have it try to help me comprehend ways to use future tech that's not quite here yet. I'm so excited for 2026 and 2027. Things are about to go off the rails and all of us need to be ready and prepared.
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Anybody remember this? This is our future in medicine. It'll start as robotics production gets to scale and AI gets advanced enough and it will probably start as AI treating patients and diagnosing disease and performing medical management but probably with remote humans reviewing the decision trees and rubber stamping the medical management. It seems far fetched and way in the future but I predict it's closer than any of us realize.
I could easily see this in 25 years. Why do I think I'll be here to see it? That's easy....because we'll crack longevity by 2032 with epigenetic reprogramming and arrive at technology that adds 25-50 years to our lifespans in the next 15 years. You just wait and see. All through AI driven biotech breakthroughs I might add.
Uhhh….
Does this forum have a remind me? Cause none of that is happening. (On the timescale provided)
Does this forum have a remind me? Cause none of that is happening. (On the timescale provided)
I know, right?
This thread went wild.
Best thread on here in a good bit.
We went from "Nursing homes are ripe for EM encroachment"
To: "FM is the wey. Eff-off."
To: "We are teh (sic) better than MPS becuz we can learn better (true)."
To: "Return greatness to the west."
To: "Barf: Women and men are the same (lolz)."
To: "AGI will maek (sic) us all irrelevant."
Great SDN thred (sic). Keep it going SDNiggaz.
You know what we need on here?
....
GeneralVeers.
.... Shut up if you think I'm wrong. Effing guy has aura.
....
GeneralVeers.
.... Shut up if you think I'm wrong. Effing guy has aura.
Yeah, I'm gonna reply to my own post. FREE GENERAL VEERS>
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#freegeneralveers
In before mod nerds with nothing to do besides police speech lock thread
In before mod nerds with nothing to do besides police speech lock thread
So did Ted Bundy. And David Koresh, at that.
Hey now, I have lots to do.
But this is better than most of those things.
Except this:
I miss that guy
Our local nursing homes have essentially all NP rounding and when I see these patients, which is frequently, basically nothing ever changes in their management, even when I recommend changes. Sometimes I see them often enough that I am the one primarily modifying their chronic disease medications anyway.
For real. I'm not FP/IM, but I would do a far better job.
Wife obviously works with a NP at these nursing homes. One of the homes has had a new NP. She went around changing my wife’s parameters for blood glucose and blood pressure on patients when the NP went in.
She put orders to continue blood pressure medications unless systolic pressure less than 85.
And she put orders to continue insulin unless blood glucose less than 50.
My wife had to have a talk with her and admin and had flat out told them she’s not going to be her supervisor. Interestingly, NP was justifying giving insulin at a blood glucose of 60 in a 80 year old 🤣
Apparently that’s how she always did it as a ‘hospitalist’ 🤣🤣
I do this. I work for TeamHealth as medical director for two facilities. I usually spend about 6-7 hours a week at each place (one day a week at each place, go in around 7am, leave around 2pm). Very flexible, can come and go as I need. Occasional phone calls with questions otherwise a few times a week. This year I made about 65K at each facility. Half from RVU, half from a monthly flat medical director fee. It's great. I went from full time to PRN at my ED, and only work about 4-6 ED shifts a month. I stopped doing ED nights because of this. I work mostly weekends and try to pick up extra shifts if they need it to be helpful.
- I do use AI to help with things I don't know
- My wife is FM, so I ask her questions when I need help
- Of course I don't provide top quality primary care, but you should have seen the degenerates who worked here previously. One guy hadn't even show up in person for two years because "he was afraid of catching covid". The nursing homes and patients love me because I work fast, am responsive, and see a ton of patients each day.
- I do use AI to help with things I don't know
- My wife is FM, so I ask her questions when I need help
- Of course I don't provide top quality primary care, but you should have seen the degenerates who worked here previously. One guy hadn't even show up in person for two years because "he was afraid of catching covid". The nursing homes and patients love me because I work fast, am responsive, and see a ton of patients each day.
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I think I’m going to be just like you very soon.
Contract for two nursing homes in my inbox right now, negotiating with them the medical director stipend. Already visited the nursing home facility too and met with their staff. they’ve matched my wife’s $1550/20 patients seen. But they’re giving push back in matching her 60% medical director fee split due to my ‘lack of experience’ - i told them I’m not signing at 45 🤣 will see what happens
I think it’s a relationships game. Sit down with the nursing staff, ask them what they needthem, be available for them and they’ll be very happy. One of the sites that my wife took over - same problem the guy never showed up. But he kept putting notes in the medical charts and claiming to see patients.
Damn man with emotional IQ like this youre gonna be getting 110% split
They’ll budge.
They’ve been recruiting for 3 months and haven’t found anyone.
They will likely lose the sites if they don’t replace the current doctor there as the facilities are extremely unhappy with the current guy.
Can confirm it's all about relationships. I do PM&R at SNFs and half the job is keeping everyone at the facilities happy.
As an EM doc, Nursing home sounds terrible. Chronic care was one reason I went into EM. I get the work may be easy, but nursing home just gives me the ick.
A job is a job. It's a means to provide for more important things in life.
Being home at 1 pm, being there to drop off my daughters to school, being there to pick them up from school, being there at every event of their life. That's the important stuff.
A job where I'm healthy, without sleep disruptions, available for my kids - thats the job I want. Whether it's chronic care or "exciting" Emergency medicine - It's all just a job.
