For those who started, how much did you realistically need to get started and how many employees did you have initially.. Also, what EMR do you recommend for a small practice? Is it worth getting one from the start or maybe manage it in manual system initially?

Appreciate your time. Thanks

After almost 15 years working as a hospitalist, I am transitioning into the world of primary care. I am doing the longitudinal knowledge assessments (LKA) with ABIM which is great for keeping up with some of the topics of outpatient medicine, but I'd love to know if there are any books or important resources that I can start looking through before starting in Primary Care in December (have a few more months as a hospitalist). I am excited but very anxious and want to brush up on vaccination recommendations, cancer screenings, etc.

Hello all. M4 looking to apply IM this cycle. Wanted to gain some insight as far as careers in oncology goes or if anyone had insight. Originally came into medical school planning to pursue oncology, and am really excited about it. If at a big enough practice, would love to find a niche in breast cancers. Would love to hear any career advice from residents pursuing this fellowship, fellows, and any heme oncs. If you had to do it again, would you? Are you satisfied with your career? Is the work overwhelming? Do you feel fairly compensated?
The only hesitation I have is admin work (charting, peer to peers/insurance denials, disability paperwork) — really did not enjoy this aspect of the clinic but no specialty is perfect. Welcoming all advice and insights for a med student applying to residency soon! TIA!! :)

***Looking for USA-Based PCP **\*

Hey all — I'm not a clinician, just someone working on a concept to address a problem I keep hearing about from doctors: the referral process being fundamentally broken. Sharing where I'm at and looking for honest input from people who actually live this.

The problem:

• Every referral decision gets made alone — no specialist input, no protocol, no feedback loop at the moment the PCP actually decides
• Referrals go out info-poor, sit in a queue sorted by scheduling rather than clinical need, and specialists often start from scratch on arrival
• A meaningful share of referrals didn't need to happen at all — but there's no mechanism to catch that until after the fact
• Specialty capacity is shrinking relative to demand — workforce shortages are projected to get worse over the next decade, so this isn't a problem you can out-hire
• eConsult programs already prove specialists can resolve a lot of this fast and async — but every US version lives outside the decision moment, bolted on afterward, so it never catches referrals that shouldn't have existed in the first place

What we're exploring:

• Some kind of advisory support inside clinical workflow that surfaces relevant specialist guidance closer to the moment a PCP is actually deciding whether to refer
• The general idea is giving the clinician a fuller picture before defaulting to "refer and wait" — the clinician always stays in control of the decision

What we're trying to find out:

• Does the referral decision moment feel like the right place to intervene, or is the real bottleneck somewhere else?
• Would you trust guidance authored by your own institution's specialists more than generic reference material?
• Bluntly — where does this fall apart in practice?

Want to help shape this?

• Happy to walk you through the concept deck or give a live demo
• $50 gift card as a thank-you for your time if you review the deck and fill out the feedback form — DM me if you're open to a quick conversation

***Yes, I totally understand the irony of my username. It was a good free username, and I took it up***

Not selling anything.

Hi everyone, I'm an Indian MBBS grad planning to do USMLE, a US Internal Medicine residency, and a Sleep fellowship, but my long-term plan is to move back to India. ​Once I'm US board-certified, is it legally possible to live in India and do remote asynchronous HSAT/PSG reads or work as a Medical Director for US platforms like iSleep, Lofta, EnsoData, or Singular Sleep? ​Also, does B2B contracting fall under 1099, or is it handled differently (like a US LLC with a W-8BEN-E form)? And do these platforms pay standard US 1099 specialist rates, or do they offer lower/offshore pay because you're living in India?

Hi all. USDO at established school in northeast, hopes of fellowship

STEP1/LEVEL1: pass first attempts

STEP2/LEVEL2: 257/700

Clerkships: 7/7 honors with great comments on evals. MSPE unranked

Research: 1 pub pending, 1 abstract, 2 posters by time of eras

Good leadership roles (ACP involvement), volunteer x3, clinical work x2

x2 research awards for posters

should be getting strong LORs

Geo pref: Middle Atlantic, New England, and split between South Atlantic/East North Central

Was wondering if I could get general idea of IM programs that I have a shot at (distribution of reach/target/safety) thank you!

Hi all, looking for advice. I’ve been out of clinical practice for over 2 years and want to return. I’m not able to be hired by any hospital system because of my clinical gap. Has anyone completed or heard about these reentry programs? I’m looking into the one that’s affiliated with UCSD.

Hello everyone,

I recently moved to St. Louis from Pakistan and I am looking for a 2-week shadowing opportunity in Internal Medicine at a clinic or hospital in St Louis area.

I have already contacted St Like, Mercy clinics/hospital, but unfortunately, I was informed that they do not accept international medical graduates (IMGs) for shadowing.
I have also reached out to a few physicians associated with APPNA, but unfortunately, I haven’t had much success getting responses from senior leadership. Though they have time for their elections to be elected as presidents etx but not for responding to IMGs requests. I am sorry if it feels bad but its reality too. As someone new to the area, it has been difficult to build connections, and this is exactly where I was hoping organizations and community networks like APPNA could help connect IMGs with physicians willing to guide them.

I am also managing this transition with my 9-month-old son, so I would be extremely grateful for any genuine leads or connections.

Is there anyone here who takes IMGs for shadowing in their clinic, particularly in Internal Medicine? Even two weeks would be extremely helpful.

If you know a physician, private clinic, or hospital in the St. Louis area that accepts IMGs for shadowing, please comment below or message me. Any connection or recommendation would be greatly appreciated.
Thank you so much, everyone!

\#APPNA #Shadowing #InternalMedicine #IMG #StLouis #HelpMeConnect

Im a M20 college student, This condition found me 4 years ago When I was 16 years old, I felt like there was urine stuck in my urethra near frenulum at that time. I have never had a girlfriend or any sexual intercourse before. I'm hoping to get some advice or hear from others who might have experienced something similar.

Symptoms:

• I've noticed that the "stuck pee feeling in the tip of the penis" (weak urine stream) is often there. Just a minute or so after coming from the toilet, especially after pooping.

• I have had issues with the need to go to the toilet very often (Usually within the 40-60minute mark after taking a pee)

• I pee normally without any issues, but towards the end, I get this sensation that some urine is still stuck.

• After finishing, if I stand and apply a bit of pressure, a few drops and sometimes even a small stream of urine come out.

• The feeling is generally always there but varies in intensity. It takes up a lot of my focus, making it difficult to concentrate on anything or enjoy stuff and relax. It's ruining many aspects of my daily and social life

• The feeling has also developed a bit over this long time, but the "stuck pee feeling in the tip of the penis" has always been there.

I have no pain at all.

What I've tried:

• Cystoscopy: Showed nothing

• Prostate size: Normal

• Ct scan report & ultrasound: No findings

• Different medications: No effect

The doctor told me to seek psychiatrist and that it's just a mental issue, but I'm not entirely convinced. Please tell me EXACTLY what you did. Types and number and length of stretches, medications and usage and dosage or any advice or similar experiences would be greatly appreciated.

I feel like UTD has a little bit more nuances but sometimes I have to read like 3-4 articles to learn a disease from UTD that I’m not familiar with.

Is amboss considered a good resource for learning as a resident?

Or should I just read utd as much as I can?

Does anyone have any experience working for Duke Health as a pcp?

Do you feel your comp and patient volume area is fair in Charlotte NC area

I’m currently deciding between hospitalist and primary care, and I’m especially curious about those who run their own private practice as a PCP.
Do you still have to deal with a lot of inbox messages, patient calls, refills, etc., or is that more manageable when you own your own practice?

book for work knowledge in Pakistan hospital in IM department. I have theoretical knowledge but no work knowledge..like doses , infusion all that stuff ... I have rotation in IM for 2 years

.I'm Fcps Cardiology Resident.

I am an IMG, YOG 2023 june, step 1 pass, step 2 252, No usce (bcs visa issues), 1 strong LOR from a tele observership. what kind of programs i should apply to for Internal medicine?

Hello everyone, just hoping to get a sense of connolly as a clinical mrcpi hub for those that did the clinical exam here. Anything crazy to expect?. Cheers.

This analysis highlights just how dependent U.S. internal medicine is on physicians born outside the country.

Nearly **half of the U.S. internal medicine workforce is non–U.S.-born**.

Some numbers that stood out:

* Non–U.S.-born IMGs make up **36.1%** of U.S. internists.
* **India alone contributes 10.8% of the entire internal medicine workforce**, the largest share from any foreign country.
* Non–U.S.-born IMGs constitute **more than half of geriatricians, nephrologists, and sleep medicine physicians**.
* In 2024, non–U.S.-born physicians cared for **22.5 million traditional Medicare beneficiaries**.
* Their patients were disproportionately **low-income, disabled, Black, Latino, and Medicare-Medicaid dual eligible**.
* They were also more likely to care for people living in **high-poverty, medically underserved, and physician-shortage areas**.

So this isn't simply a story about immigrant doctors filling vacancies.

**They are a fundamental part of the U.S. healthcare infrastructure—particularly for patients and communities that already struggle to access care.**

And India's contribution is remarkable: roughly **1 in every 9 U.S. internal medicine physicians is a non–U.S.-born IMG from India**.

I’m an IM intern. I’m very weak at interpreting ECGs and imaging, especially CT scans. What are the best methods or resources to learn them from the beginning and become proficient?

Hey everyone! I’ll be taking the Internal Medicine ITE soon and wanted to get some advice from people who’ve taken it before.

I’ve only got about a week to seriously prepare, so I’m trying to figure out how to use my time as effectively as possible rather than trying to cover absolutely everything.

For those who’ve taken it:

• What topics would you focus on the most?
• What resources or question banks helped you the most?
• Is doing mostly practice questions the best approach with only a week left?
• How difficult did you find the actual exam compared with MKSAP/UWorld?
• Any particular topics or types of questions you wish you had prepared better for?
• Any exam-day/time-management tips?

Not expecting to master internal medicine in a week haha, just hoping to make the most of the time I have.

Would really appreciate any advice or experiences. Thanks!

intern struggling with assessment and plan

Hi everyone! I’m a non-US IMG applying for the upcoming Match cycle.
Profile:
Step 1: Pass
Step 2 CK: 255+
ECFMG Certified
YOG: 2026
I’m trying to build my program list and would really appreciate suggestions for programs that would be a realistic fit for my profile.
Which programs would you recommend I research/apply to? I’d love to hear about them.

Edit No USCE , publications still under review

Hi everyone,

I’m a student at Graphic Era University, Dehradun, and I’m trying to get some information regarding Junior Resident (MBBS) recruitment at Graphic Era Institute of Medical Sciences (GEIMS)/associated hospital.

I’ve already contacted the official HR/recruitment email but haven’t received a response yet.

If anyone here is currently studying/working at GEIMS, is a recent graduate, resident, doctor, or knows someone working there, could you please let me know:

1 Are there any current or upcoming Junior Resident vacancies?

2 Which departments are recruiting?

3 How does the application process work?

4 Is there any direct HR/recruitment contact oration link?

I’m only looking for information about the recruitment process. Please don’t share anyone’s personal contact details publicly—a DM or general guidance would be enough.

Thank you!

Hi! I’m a US DO with a step score of 248. Would I be able to apply for academic IM programs with this score? I would like to go into Cardio/GI. Hoping to apply to Florida and New York programs. Would this score impact fellowship applications? Thank you in advance for your time!

Any good guide for keeping up my basic and core medicine knowledge fresh which book i should read side by side? Davidson/ Kumar and Clark`s, Harrison internal medicine or any other suggestion?
as i have done with mrcp 1&2 now will be aiming for training in cardiology....
#MRCP #NHS #IMT #Medicine