Is outpatient really that bad?

[BicepsTriceps]

I moved to my dream mountain state!

I'm currently a nocturnist working 10 nights a month in the form of 7 on 14 off.

I swore off doing days as a hospitalist (Social issues, daily rounding, family meetings, needy patients, being asked to do admissions while already having a full team...) as I officially burned out.

Nights are sweet and I'm a night owl but they're nights after all and taking a toll on my social life cuz I'm basically off grid for those 7 nights.

The 14 days off are incredible but do I really need to be off 14 days in a row when most activities are less than an hour drive?

So I'm seriously thinking of switching to outpatient. 3 or 4 days a week. I'll be off holidays, PTO and every weekend + 1 or 2 weekdays.

I think this will provide a much better balance to my life.

Concerns are:

Will I hate outpatient as much as I hate doing day hospitalist?
Or it's much more tolerable given the lack of acuity?

Will paper work and insurance... Etc just become part of the work/ day or it's something I'll hate every single day working as outpatient?

Should I just join DPC?

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[rokshana]

Outpt and inpt are very different… and of those are the things that bother you about day shift…you will see all that and more as a pcp.
Is there a swing shift where you are?
Or find an admitter shift during the day? Then you do t have to deal with anything but admissions

 

[collegestud2013]

Administrative burden will likely be higher on the outpatient side than hospitalist, and you have to follow up on your patient's chronic issues. If that's the may reason you're not doing daytime hospitalist it probably won't get better doing primary care. DPC or some type of cash-based concierge practice can be the way to go long-term if you want to out of a hospital employed setting and have more control over your practice; profit overheads tend to be higher (so you won't have to see 20+patients a day in clinic. Administrative burden will be less if you don't have to deal with insurance as much but there still will be some. You'll also likely have to be available on call for your patients around the clock as this is something cash-paying patients will usually expect. However the hard part will be finding an unmet niche to get enough cash-paying patients to have full panel.

Full daytime admitting hospitalist is a good option that may suit your needs and get out of nights. However, note that most places won't pay any more for someone to be their permanent daytime admitter, despite this shift typically being harder and thus less desirable than daytime rounding shifts. If part of your pay is based RVUs, your pay as admitter likely be lower due to the CMS RVU changes this year (which lowered the RVUs for H&Ps and raised the RVUs for follow-ups and discharges).

 

[DrMetal]

Will I hate outpatient as much as I hate doing day hospitalist?

It's crazy how we always seem to ask, "Which is the lesser of all the evils, which will I hate the least?!"

Does anybody like this profession?

 

[BicepsTriceps]

Administrative burden will likely be higher on the outpatient side than hospitalist, and you have to follow up on your patient's chronic issues. If that's the may reason you're not doing daytime hospitalist it probably won't get better doing primary care. DPC or some type of cash-based concierge practice can be the way to go long-term if you want to out of a hospital employed setting and have more control over your practice; profit overheads tend to be higher (so you won't have to see 20+patients a day in clinic. Administrative burden will be less if you don't have to deal with insurance as much but there still will be some. You'll also likely have to be available on call for your patients around the clock as this is something cash-paying patients will usually expect. However the hard part will be finding an unmet niche to get enough cash-paying patients to have full panel.

Full daytime admitting hospitalist is a good option that may suit your needs and get out of nights. However, note that most places won't pay any more for someone to be their permanent daytime admitter, despite this shift typically being harder and thus less desirable than daytime rounding shifts. If part of your pay is based RVUs, your pay as admitter likely be lower due to the CMS RVU changes this year (which lowered the RVUs for H&Ps and raised the RVUs for follow-ups and discharges).

How are social issues worse?

I can't imagine a worse social situation than a super sick terminal patient with insightless family OR a disposition nightmare.

What kind of social issues as outpatient will bother me?

I fill your home health paper work or your disability papers and move on.

Nonetheless I'm speaking with no experience as I didn't dive in deep yet.

 

[BicepsTriceps]

It's crazy how we always seem to ask, "Which is the lesser of all the evils, which will I hate the least?!"

Does anybody like this profession?

Unfortunately it's pick your poison in medicine currently.

I believe most physicians are not driving enjoyment from their work and just cruising by.

 

[DrMetal]

Unfortunately it's pick your poison in medicine currently.

I believe most physicians are not driving enjoyment from their work and just cruising by.

I get some enjoyment out of hospital medicine. The community hospital where I moonlight is busy, see some interesting pathology, lotta cancer, definitely things that make go "hmmm" and make me feel doctorly.

Nice thing about inpatient, is I get to decide how much time to spend with a patient. The meth head I've admitted 3 times this month will get 5 minutes of my attention. For the new cancer diagnosis, I'll take 30 minutes to explain what happens next.

Yeah, I'm biased. I'm also human, and I'm not interested in faking empathy for the dumb$%^& s of the world.

 

[chessknt]

I do critical care inpt and pulmonary outpt so I am weird in that I like both. I like getting cancer diagnosed for people a lot more than dealing with them when they are emaciated and dieing of chemo complications in the ICU. The flip side is I am annoyed by young people with bull**** complaints like cough or 'severe asthma' that is just being obese but I like helping keep young people in the ICU alive from trauma or a bad infection or whatever knowing that they will rehab and be functional again. Find something you enjoy doing knowing that everything is going to have something crappy to it you just have to deal with.

 

[Prehealth1011]

Aren’t DPCs on call 24/7? That would stress me out, even if I’m not getting called

 

[BicepsTriceps]

Aren’t DPCs on call 24/7? That would stress me out, even if I’m not getting called

I won't be flying solo!

I'll join a practice or start a practice with other physicians to distribute the call.

I obviously care about my free time, evident by my 14 days off every 7 days of work, and there is no world in which I'll be on call 24/7 all the time no matter how much it pays.

 

[NewYorkDoctors]

I find inpatient pulmonary and critical care more "exciting, acute, and cool." But I admit it gets very exhausting doing it for a long period of time.

I find outpatient pulmonary mundane and occassionally interesting. It is more of a "slow burn" story arc of a TV show with a lot of "filler episodes." (If that makes sense). Working up a patient for EGPA who had difficult to control asthma and sinusitis took the course of several weeks but we eventually got there. big 2 part story arc concludes with the season finale!
There are a LOT of filler episodes (i.e. chronic cough that is probably GERD but patient refuses PPIs,H2,lifestyle modifications, sleeping head of bed elevated, diet changes etc...) While inpatient is blockbuster after blockbuster... but those blockbusters will have some flopbusters in there (think dead end no prognosis patient stuck on a vent and eventual trach) .

but I also find outpatient pulmonary pays way better and way more than inpatient ever could.

so accounting for that ratio and how much more time I get to spend at home with the kiddos, outpatient wins.

now this only applies since i own my own outpatient practice and PFT lab.


all this admin paper work stuff really should not be thought of as a barrier as attendings should have the proper secretarial / admin staff to help you do most of this. you just need to check off the medical parts / dictate it and sign it

 

[Drrrrrr. Celty]

I get some enjoyment out of hospital medicine. The community hospital where I moonlight is busy, see some interesting pathology, lotta cancer, definitely things that make go "hmmm" and make me feel doctorly.

Nice thing about inpatient, is I get to decide how much time to spend with a patient. The meth head I've admitted 3 times this month will get 5 minutes of my attention. For the new cancer diagnosis, I'll take 30 minutes to explain what happens next.

Yeah, I'm biased. I'm also human, and I'm not interested in faking empathy for the dumb$%^& s of the world.

Delayed gratification, being debt trapped, putting off life for a decade, going through training that is designed to more or less mellow you out into a "compliant & no problem" physician, and to then have non-physicians dictate to you how productive you need to be is a cocktail for dissatisfaction.

Furthermore the medicine pie is more and more being eaten by admin and non-physicians. There's less for the MD/DO proportionally. So you're working harder and you're not getting paid proportionally as well.

I hate to say it, but I'm happy but that's probably because my debt isn't that bad, I don't have kids, and I can do a lot of things that make me happy with my free time. Compare that to an industrial process surgeon with 3 kids and I can see why they're grouchy.

 

[DrMetal]

Delayed gratification, being debt trapped, putting off life for a decade, going through training that is designed to more or less mellow you out into a "compliant & no problem" physician, and to then have non-physicians dictate to you how productive you need to be is a cocktail for dissatisfaction.

Furthermore the medicine pie is more and more being eaten by admin and non-physicians. There's less for the MD/DO proportionally. So you're working harder and you're not getting paid proportionally as well.

I hate to say it, but I'm happy but that's probably because my debt isn't that bad, I don't have kids, and I can do a lot of things that make me happy with my free time. Compare that to an industrial process surgeon with 3 kids and I can see why they're grouchy.

Indeed, everything you said is pretty much true. I avoided debt by joining the military (a decision that I'm personally happy with, but not one that I would blanketly recommend).

The amount of time and debt required to become a physician is strangulating. 15 years of higher education and training, so I can titrate someone's insulin by 4 units? have a $500K debt? It's a dicey proposition.

 

[VA Hopeful Dr]

Indeed, everything you said is pretty much true. I avoided debt by joining the military (a decision that I'm personally happy with, but not one that I would blanketly recommend).

The amount of time and debt required to become a physician is strangulating. 15 years of higher education and training, so I can titrate someone's insulin by 4 units? have a $500K debt? It's a dicey proposition.

4 years college + 4 years med school + 3 years residency =/= 15 years.

500k debt is also not standard unless you want to a private undergrad and took out loans for everything and private med school with same.

 

[dozitgetchahi]

4 years college + 4 years med school + 3 years residency =/= 15 years.

500k debt is also not standard unless you want to a private undergrad and took out loans for everything and private med school with same.

$500k seems to be a pretty common debt load among most of the younger physicians I know.

 

[DrMetal]

4 years college + 4 years med school + 3 years residency =/= 15 years.

I Include high school in my calculations. It was a very lonely time. All I did was sit in my bedroom, study, play guitar, and #$%^ off.

[Come to think of it, not much has changed!]

 

[VA Hopeful Dr]

$500k seems to be a pretty common debt load among most of the younger physicians I know.

I precept DO students and most of them aren't breaking 300k. Did all the younger physicians you know graduate from Tufts?

 

[Drrrrrr. Celty]

Indeed, everything you said is pretty much true. I avoided debt by joining the military (a decision that I'm personally happy with, but not one that I would blanketly recommend).

The amount of time and debt required to become a physician is strangulating. 15 years of higher education and training, so I can titrate someone's insulin by 4 units? have a $500K debt? It's a dicey proposition.

It doesn't help that the main love language physicians have is complaining about medicine.

We complain about everything. But do nothing about it.

But that may have to do with our organizing bodies being spineless, our willingness to due to the above be willing to take massive cuts in quality of life, and our progressively failing social lives leaving us with enough time to work it without fail...

$500k seems to be a pretty common debt load among most of the younger physicians I know.

If I had 500k debt I don't think I would have become an endocrinologist. I would have gotten a job doing night admitting for 10 years and become an empty joyless husk.

I mean even with 300k debt combined from medicine and rent - you're looking at some legitimately catastrophic weights on you for at least the next 5 years. Combine that with any sort of significant other monetary purchase or investment and you're putting away most of your paycheck.

 

[DrMetal]

If I had 500k debt I don't think I would have become an endocrinologist. I would have gotten a job doing night admitting for 10 years and become an empty joyless husk.

I love how we think $300K isn't a lot of debt.

The other consideration is, we lose a good decade of our adult lives, there's a profound loss of potential earnings there [We're all smart people, especially me. We could've gone into business, law, engineering, and made well into six figures.]

So if you're 35-yo and just out of training, starting to practice . . .not only might you have a $500K debt, but that's potentially 10 years of your life wasted, not making an adult salary. So really, compared to your MBA friends (who are now your boss), you're in the red some $750K to $1 mill.

It's no wonder physicians demand large salaries, and they deserve it. Problem is, the industry is starting to disagree.

But that may have to do with our organizing bodies being spineless, our willingness to due to the above be willing to take massive cuts in quality of life, and our progressively failing social lives leaving us with enough time to work it without fail...

They're absolutely worthless. I gave up my SHM membership as soon as they started to support the mid-level agenda. I'm about done with ACP too. The ABIM? Forget that fascist regime.

The only organization that I've seen actually advocate for physicians and try to do something for them (with respect to BS MOC) is NBPAS. [whether they succeed or not is still TBD, but they're trying.]

 

[Drrrrrr. Celty]

I love how we think $300K isn't a lot of debt.

The other consideration is, we lose a good decade of our adult lives, there's a profound loss of potential earnings there [We're all smart people, especially me. We could've gone into business, law, engineering, and made well into six figures.]

So if you're 35-yo and just out of training, starting to practice . . .not only might you have a $500K debt, but that's potentially 10 years of your life wasted, not making an adult salary. So really, compared to your MBA friends (who are now your boss), you're in the red some $750K to $1 mill.

It's no wonder physicians demand large salaries, and they deserve it. Problem is, the industry is starting to disagree.




They're absolutely worthless. I gave up my SHM membership as soon as they started to support the mid-level agenda. I'm about done with ACP too. The ABIM? Forget that fascist regime.

The only organization that I've seen actually advocate for physicians and try to do something for them (with respect to BS MOC) is NBPAS. [whether they succeed or not is still TBD, but they're trying.]

Oh I don't disagree. I think 300k is a a big shackle. It's just not as painful as half a million dollars. That I think is at that point is monthly half your earnings over a 10 year period when you start making real payments.

Board certification is a scam.

 

[sah]

Getting back to original issue inpatient vs outpatient: I would choose what you prefer. For me, I hated inpatient care and loved the outpatient clinic so that is where I thrive. Both (in my area) will bring in the same compensation so that is not a factor. Important is control. Without self-control over your work requirements, metrics, you can get burned out. I would look for a position where you can define hours, patient numbers, etc. If you do what you like, and have control, its easier to deal with the extra baloney that is mixed in with any position.

 

[Drrrrrr. Celty]

Getting back to original issue inpatient vs outpatient: I would choose what you prefer. For me, I hated inpatient care and loved the outpatient clinic so that is where I thrive. Both (in my area) will bring in the same compensation so that is not a factor. Important is control. Without self-control over your work requirements, metrics, you can get burned out. I would look for a position where you can define hours, patient numbers, etc. If you do what you like, and have control, its easier to deal with the extra baloney that is mixed in with any position.

I think both have unsavory elements. Inpatient you're the pager's bitch. Outpt you're the inbox's bitch.

 

[Osteoth]

Whatever you do, keep your independence. Private practice isn’t dead, but they’re trying.

 

[bronx43]

Whatever you do, keep your independence. Private practice isn’t dead, but they’re trying.

It’s holding on by a thread, but the writing’s on the wall. CMS wants everyone employed.

 

[Splenda88]

How are social issues worse?

I can't imagine a worse social situation than a super sick terminal patient with insightless family OR a disposition nightmare.

What kind of social issues as outpatient will bother me?

I fill your home health paper work or your disability papers and move on.

Nonetheless I'm speaking with no experience as I didn't dive in deep yet.

IMO, I think social issues is somewhat overemphasized here. SW/CM are the ones who mostly deal with social issues. Yes there are unreasonable patients/families, the same way outpatient docs deal with unreasonable patients, probably less so than hospitalists.

When it comes to lifestyle, HM is arguably one of the best deals out there.

 

[Splenda88]

I mean even with 300k debt combined from medicine and rent - you're looking at some legitimately catastrophic weights on you for at least the next 5 years. Combine that with any sort of significant other monetary purchase or investment and you're putting away most of your paycheck.

300k is a huge number but most of us can pay that in < 3 years while enjoying a middle class lifestyle.

 

[Drrrrrr. Celty]

300k is a huge number but most of us can pay that in < 3 years while enjoying a middle class lifestyle.

I'm not sure how a person with a pre-tax income of 250k is supposed to do that. Maybe a pre-tax income of 350k could do that? But even then you'd be bleeding 1/2 your earnings into your debt. And that's if you don't buy a house, a new car, etc.

IMO, I think social issues is somewhat overemphasized here. SW/CM are the ones who mostly deal with social issues. Yes there are unreasonable patients/families, the same way outpatient docs deal with unreasonable patients, probably less so than hospitalists.

When it comes to lifestyle, HM is arguably one of the best deals out there.

Fundamentally it's your job to talk to the family about a reality check. Not CM or SW.

But it also depends on how much you care about your own convictions. I found it really difficult to stomach watching someone force their barely gasping for air above the water loved ones through chemo or intensive care.

It’s holding on by a thread, but the writing’s on the wall. CMS wants everyone employed.

I think being employed is fine. It's the way you're employed and your negotiating power as a group in the face of your contractor that matters.

 

[Splenda88]

I'm not sure how a person with a pre-tax income of 250k is supposed to do that. Maybe a pre-tax income of 350k could do that? But even then you'd be bleeding 1/2 your earnings into your debt. And that's if you don't buy a house, a new car, etc.



Fundamentally it's your job to talk to the family about a reality check. Not CM or SW.

But it also depends on how much you care about your own convictions. I found it really difficult to stomach watching someone force their barely gasping for air above the water loved ones through chemo or intensive care.




I think being employed is fine. It's the way you're employed and your negotiating power as a group in the face of your contractor that matters.

Pretax 300k (post tax 190k). No new car and house. 120k goes to student loan.

Most physicians (except peds) should be able to make 300k easily these days.


I talk to families. I got hospice/palliative involved. You will always find these people, but fortunately these things happen few and far between.

 

[Nocturnist]

I moved to my dream mountain state!

I'm currently a nocturnist working 10 nights a month in the form of 7 on 14 off.

I swore off doing days as a hospitalist (Social issues, daily rounding, family meetings, needy patients, being asked to do admissions while already having a full team...) as I officially burned out.

Nights are sweet and I'm a night owl but they're nights after all and taking a toll on my social life cuz I'm basically off grid for those 7 nights.

The 14 days off are incredible but do I really need to be off 14 days in a row when most activities are less than an hour drive?

So I'm seriously thinking of switching to outpatient. 3 or 4 days a week. I'll be off holidays, PTO and every weekend + 1 or 2 weekdays.

I think this will provide a much better balance to my life.

Concerns are:

Will I hate outpatient as much as I hate doing day hospitalist?
Or it's much more tolerable given the lack of acuity?

Will paper work and insurance... Etc just become part of the work/ day or it's something I'll hate every single day working as outpatient?

Should I just join DPC?

There's stupid flexibility in nocturnist medicine. Anyone working less than 10 shifts a month at my shop only has to work one weekend a month and one winter/summer holiday.
If you like nights but looking for a better work-life balance (i.e less holidays and weekends), why not go part time and moonlight only the shifts that suit your lifestyle on top of that? Or better yet, go locums and cherry pick your exact dream schedule?

 

[Drrrrrr. Celty]

Pretax 300k (post tax 190k). No new car and house. 120k goes to student loan.

Most physicians (except peds) should be able to make 300k easily these days.


I talk to families. I got hospice/palliative involved. You will always find these people, but fortunately these things happen few and far between.

I won't likely start above 240-250k a year because I'll need to build up my census for at least a year or two.

Also most people really can't throw 65% of their pure income at loans. A lot of people buy homes. A lot of people are already paying off mortgages for homes. Some are starting to pay for kids. etc.

 

[aafisahar]

I won't likely start above 240-250k a year because I'll need to build up my census for at least a year or two.

Also most people really can't throw 65% of their pure income at loans. A lot of people buy homes. A lot of people are already paying off mortgages for homes. Some are starting to pay for kids. etc.

sounds like a lot of people are living beyond their means.

 

[Drrrrrr. Celty]

sounds like a lot of people are living beyond their means.

Or would like their partners to not divorce them after living like a hermit?

Hell, I'm not even married and have low debt. I am craving to buy someting the moment I finish my fellowship so I can have a house.

 

[BicepsTriceps]

There's stupid flexibility in nocturnist medicine. Anyone working less than 10 shifts a month at my shop only has to work one weekend a month and one winter/summer holiday.
If you like nights but looking for a better work-life balance (i.e less holidays and weekends), why not go part time and moonlight only the shifts that suit your lifestyle on top of that? Or better yet, go locums and cherry pick your exact dream schedule?

I might look into it but the main point is I don't want to keep flip flopping between sleeping during the day then switch to nights ... Etc

 

[Splenda88]

I won't likely start above 240-250k a year because I'll need to build up my census for at least a year or two.

Also most people really can't throw 65% of their pure income at loans. A lot of people buy homes. A lot of people are already paying off mortgages for homes. Some are starting to pay for kids. etc.

Are you telling people who were living on ~45k post taxes/deductions (during residency) suddenly can't live on a 70k (which is 95-100k pretax?

 

[Drrrrrr. Celty]

Are you telling people who were living on ~45k post taxes/deductions (during residency) suddenly can't live on a 70k (which is 95-100k pretax?

Can. Could. Will. Wont?

 

[Osteoth]

Can. Could. Will. Wont?

Lifestyle creep creep creep.

 

[Drrrrrr. Celty]

Lifestyle creep creep creep.

I'm just happy I didn't inherit my dad's fancy car love.

 

[FormerNFLQB]

I precept DO students and most of them aren't breaking 300k. Did all the younger physicians you know graduate from Tufts?

Im at $300k and just started my third year. However that includes undergrad, med school, and now starting a masters.

 

[VA Hopeful Dr]

Im at $300k and just started my third year. However that includes undergrad, med school, and now starting a masters.

I have a partner who was in for 500k by the time she finished residency, but that was a small private undergrad with no scholarships at all (140k) and around 250k med school (state school but had to repeat a year). Then interest on all of that.

If she did her PSLF paperwork right, that should be wiped clean at the end of this year.

 

[Osteoth]

I have a partner who was in for 500k by the time she finished residency, but that was a small private undergrad with no scholarships at all (140k) and around 250k med school (state school but had to repeat a year). Then interest on all of that.

If she did her PSLF paperwork right, that should be wiped clean at the end of this year.

What’s the tax bill on that, $175k? (35%)?

 

[VA Hopeful Dr]

What’s the tax bill on that, $175k? (35%)?

No idea

 

[greatnt249]

What’s the tax bill on that, $175k? (35%)?

There is no federal tax on PSLF to my understanding; states might be a different story.

 

[Osteoth]

There is no federal tax on PSLF to my understanding; states might be a different story.

Doesn’t that get phase out in 25 or 26?

 

[greatnt249]

Doesn’t that get phase out in 25 or 26?

https://studentaid.gov/help-center/answers/article/loan-amounts-forgiven-under-pslf-taxable

They didn't put a time limit on it, but it would seem for now that forgiven loans are not considered income.

 

[smq123]

I won't be flying solo!

I'll join a practice or start a practice with other physicians to distribute the call.

I obviously care about my free time, evident by my 14 days off every 7 days of work, and there is no world in which I'll be on call 24/7 all the time no matter how much it pays.

How populous is your "dream mountain state" that it can have a DPC practice with multiple physicians? That's the main problem with DPC - you do need a certain population level in order to maintain it.

 

[BicepsTriceps]

How populous is your "dream mountain state" that it can have a DPC practice with multiple physicians? That's the main problem with DPC - you do need a certain population level in order to maintain it.

Colorado. Populous enough?

 

[smq123]

Colorado. Populous enough?

Fair. Just asking because "dream mountain state" could encompass anything from Boulder, CO to St. George, UT, to middle-of-nowhere, MT.

One thing to watch out for in outpatient practices in places like Boulder or Sedona, where there stereotypically is a lot of local focus on "wellness culture" is the worried walking well who often have more money than sense and watch FoodBabe videos religiously. Be prepared for requests to be referred for full body PET-CTs, requests for rapamycin prescriptions, a lot of long discussion about ApoB or Lipoprotein A levels (brush up on your Paul Attia podcasts), or (my personal favorite), "My naturopath wants me to get these 25 extremely esoteric labs checked."

 

[dozitgetchahi]

Fair. Just asking because "dream mountain state" could encompass anything from Boulder, CO to St. George, UT, to middle-of-nowhere, MT.

One thing to watch out for in outpatient practices in places like Boulder or Sedona, where there stereotypically is a lot of local focus on "wellness culture" is the worried walking well who often have more money than sense and watch FoodBabe videos religiously. Be prepared for requests to be referred for full body PET-CTs, requests for rapamycin prescriptions, a lot of long discussion about ApoB or Lipoprotein A levels (brush up on your Paul Attia podcasts), or (my personal favorite), "My naturopath wants me to get these 25 extremely esoteric labs checked."

I always find it hilarious that boujee healthy people who otherwise exercise, follow complicated diets for “longevity” or “anti-inflammatory effects”, and “don’t like taking medication” also want to have dozens of weird and obscure labs checked and also take dozens of weird and obscure supplements. You’re healthy, guys…less is more…

I also found it interesting that during the pandemic, liberal crunchy hippies and blue collar, diehard conservatives both somehow agreed that the CoVID vaccine was the root of all evil. Possibly the first time these two groups have agreed on anything, ever.

 

[DrMetal]

I always find it hilarious that boujee healthy people who otherwise exercise, follow complicated diets for “longevity” or “anti-inflammatory effects”, and “don’t like taking medication” also want to have dozens of weird and obscure labs checked and also take dozens of weird and obscure supplements. You’re healthy, guys…less is more…

And this is essentially why I detest outpatient medicine. Everyone thinks they know better. Well then, go do WTF you want, what do you need me for?

 

[sloh]

Fair. Just asking because "dream mountain state" could encompass anything from Boulder, CO to St. George, UT, to middle-of-nowhere, MT.

One thing to watch out for in outpatient practices in places like Boulder or Sedona, where there stereotypically is a lot of local focus on "wellness culture" is the worried walking well who often have more money than sense and watch FoodBabe videos religiously. Be prepared for requests to be referred for full body PET-CTs, requests for rapamycin prescriptions, a lot of long discussion about ApoB or Lipoprotein A levels (brush up on your Paul Attia podcasts), or (my personal favorite), "My naturopath wants me to get these 25 extremely esoteric labs checked."

Always question the intelligence of people who follow Peter Attia and Huberman. Midwit alert.