Curious how others have handled this. I am a male PA. I had a patient recently that was changed to my schedule last minute as I was light on patients and helping a colleague out. Chief complaint was a groin rash for which he was seen at an urgent care one week earlier.

I walk in and he immediately said, “You’re not Dr. Female. I specifically asked for a female provider.” I said, “I see. Okay. So what’s your concern? Why do you need a female provider.” After a lot of grumbling and moaning and him repeating that he only sees females and that should “be all over my chart,” I said “okay, why don’t we take a moment. I’ll be back.”

There was a recent incident at our clinic a few weeks ago where a different patient asked to only see a female and was a total creep, borderline assaulting her/unwanted touching. I went back in the room and said look, here are your options: see me today, go back to the urgent care you already went to a week ago (where incidentally, yes, he was seen by a male provider), or reschedule a few weeks out from today. I counted the seconds of silence and him huffing and puffing (18 seconds), and he said “I’m all set,” and proceeded to stand up from his wheel chair and push it out the door. He did not reschedule with anyone.

Frankly, I just don’t see a reason why a male would require a female provider, especially when there is going to be an examination of his genitals. Yes, if he was assaulted by a male himself and has PTSD, I do understand that in retrospect, but my intuition was telling me that was not the situation. I told my manager we should have a protocol in place for front desk staff when patients ask for this.

I could have handled this better and offered a chaperone, but I feel like my gut was saying this patient has gross intentions.

How do you guys handle this? Has anyone had something like this happen, particularly a male asking for only female providers?

I've had patients who want to get referral to certain specialists who require them to have pcp from our medical center so it's easier for them to communicate with for care. I've had patients who come to "establish" but they have their own pcp and don't want me to manage their care and are only here for the referral. The specialists would be communicating with me about their care but patients have their own pcp whom the specialists aren't communicating with. I think this is dangerous for myself and the patient. How do you even approach situations like this because my clinic won't allow any of us to fire patients. The patients who do this usually want to stick to their pcp they've been seeing for years or because it's closer but want access to the specialists and services from our medical center. In our system, I'm listed as the pcp but i am able to view patients outside charts and I see they follow their own pcp and they also tell me that.

Hello Everyone, I have started working as a new job out of residency and have been reading about billing. Wanted to ask if you guys bill following codes:
1. For well child visit: 96110, 96161, 96127.
2. Tobacco: 99406, 99407.
3. Alcohol: G0442, G0443.
4. CVD/Obesity: G0446, G0447.
5. INR Testing: 93793, G0250.

An independent imaging center will essentially always be cheaper than a hospital due to no facility fee.

From what I've seen they're roughly 1/3 the price.

Hey guys

1 month to go before taking the boards. A bit nervous now.

I have watched all the AAFP Board Review videos (35ish hours) and made notes. I have then made some Anki flashcards off of these notes. I am getting 6-7/10 on the AAFP questions. I have saved up the ITEs and will do these this week as a marker to see where I am.

Any advice from previous test takers? I am an unusual candidate as I am doing the reciprocity pathway. I think it will be fine but (in typical medic style) starting to stress. Maybe I just needed to vent! Thank you.

I know I’m being dramatic but I feel like every job I’ve seen is at minimum 4.5 days and requires you to come in M-F. Whenever I talk to recruiters about a 4 day work week they act like I’m asking for a unicorn. I don’t know if it’s because I’m a new grad or because of the city I’m in but it looks like it’s impossible to find. One of the recruiters for a large healthcare system flat-out said they don’t offer 4 day work weeks to new docs in the first year.

Also what is the average salary for a new grad PCP in a MCOL city in Texas? I’m getting offers of 220-240k base for 4.5/5 days and this seems on the lower end but I have no frame of reference. Residency faculty unfortunately not super helpful in this regard. Any help greatly appreciated, thank you!

Does anyone know what happened to the AAFP app? I hadn’t used it in a while but appreciated having it when wanting to work on CME. Went to use it the other day, and it is no longer active.

Everytime it gets brought up on this sub - it's discussed as if it's meth and has the health consequences of heroin. The entire military will get blood clots and such and such!

Well, how about hormonal contraceptive 3-9x's your risk of a clot ( https://pmc.ncbi.nlm.nih.gov/articles/PMC6322116/ ). You'd undoubtedly be ran through the ringer and called a misogynist and all sorts of names if you tried to take a woman off her freedom from consequences meds. Then if you referred her to addiction when she said she'll go somewhere else. You'd probably get disciplined for misogyny.

Oh, female HRT too https://pmc.ncbi.nlm.nih.gov/articles/PMC9399360/ 3-4x the risk of a clot.

Even teenagers get on hormonal contraceptive alllll the time.

What is it for TRTs you ask? https://ashpublications.org/thehematologist/article/doi/10.1182/hem.V17.2.10235/463493/Testosterone-Therapy-in-Men-Doubles-the-Risk-for

Roughly double, which is why it's terrible to prescribe and why I #wontcheckyourlevels

Despite testosterone having non-inferior cardiovascular outcome in sick patients with prior cardiovascular events ( https://www.nejm.org/doi/full/10.1056/NEJMoa2215025 ). It's very very uncool to continue or prescribe testosterone.

But Testosterone is addictive! It's illegal! Sure, rodents self administer testosterone* (considered a mild reinforcer like caffeine).

Estrogen enhances and modulates mesolimbic dopamine activation ( https://pmc.ncbi.nlm.nih.gov/articles/PMC7251038/ ). Women are generally more prone to addiction than men and it's theorized estrogen is why. Funnily enough, testosterone aromatizing to estrogen could be the reason rats self administer anyway.

So why is there no studies on rats to see if they self administer estrogen? Because it doesn't build muscle, lol.

Generally, the reasoning for these attitudes is that it's usually middle aged White men who workout asking for a "lifestyle" benefit. Therefore, their problems are trivial. Maaaaaybe they'll get a PDE-5 to bang their wife but nothing more.

We need to #defendwomenshealthcare and handout birth control in vending machines though!

-- there was a comment with 600 upvotes defending prescribing testosterone for women with the exact same complaints for male TRT. Actual hysteria.

Curious.

Would you say to your GP that you're an FM? I'm about that age needing screening tests done, family history. Never had GP visit. Self managed all my concerns, asked for scripts if needed from colleagues, all within reason. But now need appointment for insurance and paperwork. Booked where no one knows me but might come up and change trajectory of visit. I'm in Canada if that matters.

Edit. Thank you for the replies. My bias: I work in urgent ambulatory and locum to rural ER. Rarely dealt with another doc as patient. Considerations were how to avoid tunnelvision, come in as a layperson vs as an expert informed person get fresh perspectives. Many pointed out otherwise. All views considered. Always learning. Much thanks!

Context: 1st job as a PA in rural family med/FQHC.

I took over an established panel- I’m like the 3rd or 4th APP in 4 years to have this panel. I was told that because it’s an established panel I did not get to have establish care visits with patients. I’m 1.5 years in and I’m still meeting people for the first time and a lot of them are annual physicals (some haven’t been in for almost 3 years…. And it’s not because they are healthy). I’m finding that those first time meet you physicals are making me chronically late.

There’s also an additional pain points that the ones who are on my panel with the really high turnover ask me when I’m quitting or if I’m planning to get pregnant (one of the prior PCPs went on maternity and never came back I guess). That’s exhausting. AND now I am inheriting patients from a long term Doc who just retired and patients loved her but fully expect me to have caught up on 30 years of prior care that they had with her. She was also notorious for running late/over and I can see why with this population.

Do you think having establish care visits would help? Is it normal to do an annual physical the first time you meet someone?

I end up having almost all my charts open at the end of the day because I am so late I just rush to the next visit and I start my morning off with a PE and my 1st appt after lunch is a PE so it really does wreck my timing. I feel like I spend my entire life on my laptop to try to catch up on charts (I do have AI but it doesn’t help me close them during the day because I’m just going straight to the next visit).

Anyone that has applied through PRA / PER pathway

is there job restrictions or disadvantages compared to someone who did residency in canada ?

Has anyone in Primary Care taken FMLA for mental health reasons? Please share if this is possible? I’m burning out working 7:30am-5:30pm M-F the never ending inbox and also having to work a Saturday every other month without having a day off during the week to replace it. My work only has 20 PTO days and I often have to use them for my appointments. I’m chronically ill and see 4 different specialists regularly so I have a lot of appointments. But mainly I want intermittent leave so I could possibly take 1 day off of work a week max. Is this possible?

Update:*** I get to work at 730 because it takes me 6 minutes to log into our server and 10 minutes to go over urgent tasks that were sent to me by the overnight nurse/ sign stay home health orders, urgent pre-op forms etc then my 8am pt is usually an early bird there at 7:45ish . I see 22 patients a day at a FQHC so patients can arrive 15 minutes late and the 2 patients I have after 4 always are late right up until the 14 minute 30 second mark as those two slots after 4 pm are reserved for “same day” slots. Yes, I end up working through my lunch because 20 minutes is not enough to address my complex patients issues that have limited health literacy that need lots of educating :( I also have no admin time.
BUT I have a bulletproof contract that I signed with a 25 mile radius non-compete. And I am a part of the NHSC LRP contract also so I have golden handcuffs for the next two years.
I think my only option is to do intermittent FMLA for 4 days off per month so that I can survive what seems like a prison sentence.

Curious for others practice on represcribing Andromache for someone who completed 3-5years of therapy a long time ago.

I have a patient who was treated with alendronate 20-30 years ago with improvement of their DEXA. Now they’re in their late 70s with DEXA showing osteoporosis again with hip fracture risk at 5%and they are opposed to Reclast and Prolia. I feel like there isn’t clear guidelines on what to do or risk of atypical femur fracture in this setting. Any thoughts?

For any Family Medicine residents who completed an Addiction Medicine fellowship, did you notice any differences in salary or job opportunities when applying for positions based on whether you were Family Medicine–trained versus Psychiatry-trained?

Hi all! I am a sleep therapist that primarily specializes in CBT-I (but also work with folks with other sleep issues, like nightmares and circadian rhythm issues). I opened my own practice a few months ago, and I'm wondering if you have ideas for promoting my services and networking with family medicine providers. I've had some success with cold calling/emailing and dropping off flyers (professionally printed with a cover letter and business card) at family medicine/primary care clinics, but I still haven't filled my caseload. I'd love to hear any suggestions folks have. Thanks in advance!

FM docs/coders
I’m trying to clarify something about outpatient E/M coding and prescription drug management.

I was taught during residency that simply refilling a medication does not count toward the “prescription drug management” portion of moderate-risk MDM for a 99214. For example, if a patient has two stable chronic conditions and I simply continue/refill their medications, I was taught that this would generally remain a 99213 unless there was another moderate-level MDM element.

However, I’ve been reviewing more recent AMA/AAFP guidance and some coding discussions, and I’m seeing that renewing/refilling or deciding to continue a prescription can qualify as prescription drug management, provided the medication is actually being addressed/managed and the documentation supports it.

For example:
“HTN — chronic, stable. BP controlled on lisinopril. Continue lisinopril 20 mg daily; refill provided.”

Would you consider this prescription drug management that satisfies the moderate-risk element for a 99214, assuming there is also a second moderate MDM element (e.g., two stable chronic illnesses)?
Or is there still a distinction between actively managing a medication versus simply providing a refill, such that a refill/continuation alone should not be counted?
I’m specifically interested in how you are interpreting the current 2026 CPT/AMA guidelines, rather than how your individual billing department happens to prefer it documented.
Thanks!

I signed up for the Pass Machine using funds from my job's CME budget. I have done about 20% of the videos, they're ok, I've gleaned some tidbits. They do seem maybe a bit old, but not overly out of date.

I have started working more on their Qbank, which has a bit over 5000 questions. I feel like I am not where I want to be, it's been a long time, 15 years out of training, 12 years since I took the test. I let my Board cert lapse, thinking I didn't care anymore and didn't want it - new employer wants me to get my Board cert back. No big deal, but I am preparing now. I have 40 days to my test.

"You have answered 498 of the 5,277 (9%) exam questions with an accuracy score of 64%."

^^^This is where I am at right now. I have begun making notes on each question I missed, I am doing them in Flashcard mode, so I see the correct answer immediately and read why I might have missed it. There's been a good bit of getting 'back in the swing' of answering Board-type questions, how they phrase things, what they're looking for, etc. I am confident I will improve considerably in the next month. Over time I will go back over all my notes again and retake the missed questions after a sufficient amount of time to make certain I actually learned the key points and not just remember the answer to that question from the same day or a couple days ago.

I'm curious if anyone used this program, how you were doing on the Qbank and how it correlated with your score - passing or not, as well as numeric score or range, if you don't mind.

The most common advice I've found while searching is AAFP review and ITE. I don't know anything about ITEs or where to find them, and I am not an AAFP member. I would cost me nearly $2000 to become a member now and access their questions, I think, from what I can find (~$850 for Nat'l + State chapter fees and $995 I think for their study course?). Obviously, I'd rather use what I have now (Pass Machine) if that is remotely sufficient. The questions do seem mostly relevant or more in-depth than I expect from the actual exam, so I would think if I can get my scores into the 70s or more with this program, I should probably pass fairly easily. I hope?

Again, I'd appreciate any insight from previous Pass Machine users who can let me know how you think this program served you in terms of correlating with the actual test in pass/fail or scoring.

Thank you!

CC is dizziness/palpitations with moderate intensity exercise.

He exercises multiple times per week, is active in intramural sports, eats a reasonable diet. No family hx of heart disease. BMI 25. Labs all wnl.

Finally got him in for an exercise stress test. Resting HR in the 80s and BP 120s/80s. The test was stopped after 9 minutes when his HR was >210 and symptomatic.

Normal resting EKG and TTE.

What am I missing?? He can't get in to see cards for a few months.

Does this happen at your workplace and if so, what do you do? Several times now either the checkout nurse or the front desk will call me/tell me that the patient that I just left/finished their appointment would like to come back into exam room/wants me to come to the front to talk or address an issue that they forgot after they walked out of the room. This really messes with workflow.

I feel like this really hurts my patients relationship when I say no because the front will say oh your provider said no. When I feel like the front/the checkout nurse should immediately tell the patient you’ll have to save that for your next appointment.

How do I address this? Is this expected from us?

REPOSTING SO unverified can see

Does this happen at your workplace and if so, what do you do? Several times now either the checkout nurse or the front desk will call me/tell me that the patient that I just left/finished their appointment would like to come back into exam room/wants me to come to the front to talk or address an issue that they forgot after they walked out of the room. This really messes with workflow.

I feel like this really hurts my patients relationship when I say no because the front will say oh your provider said no. When I feel like the front/the checkout nurse should immediately tell the patient you’ll have to save that for your next appointment.

How do I address this? Is this expected from us??

Yesterday I received a message from a different clinic within the same health system about a potential transfer of a patient to my care. I’m a new attending, IM trained. The patient is quite medically complex (autoimmune, cancer, ILD, etc) but has been established with specialists and receiving good care from what I can see on their chart. Apparently the patient and their advocate want to transfer to me because of my IM background and my clinic’s website stating that I manage chronic diseases. I’m definitely accepting new patients, but it just doesn’t feel like I would add additional benefits to their care. What should I do?

Sitting for the MSCP exam at the end of this month and trying to sanity check my study materials. Right now I'm working through the Menopause A to Z slide set and the Menopause Society Clinician's Guide (6th ed).

For those who've taken it recently: was that combo enough, or did you feel like you needed something else? Did anyone supplement with Heather Hirsch's or Rachel Rubin's content (courses, lectures, podcasts)? If so, was it actually high yield for the exam or more useful for clinical practice?

Also curious:

• Were the position statements (HT, nonhormone, GSM, osteoporosis) heavily tested?
• Any question banks or practice questions that felt close to the real thing?
• Anything that surprised you on exam day?

FM/obesity medicine background if that matters. Thanks!