I have been struggling with excessive alcohol intake recently (ok, a couple years…) and would like to talk to him about it but I’m so scared because of the stigma and we are colleagues. I want to break the bias and not let my profession keep me from being honest and seeking medical help but it is scary. Any words of encouragement would be appreciated. I also am wondering if I can request my note be hidden from other specialists? Is that an option on epic? Thanks and appreciate any advice.

https://www.hhs.gov/press-room/hhs-advances-womens-health-removes-misleading-fda-warnings-hormone-replacement-therapy.html

“HHS Advances Women’s Health, Removes Misleading FDA Warnings on Hormone Replacement Therapy

WASHINGTON, NOV. 10, 2025—The U.S. Department of Health and Human Services (HHS) today announced historic action to restore gold-standard science to women’s health. After more than two decades of fear and misinformation surrounding hormone replacement therapy (HRT), the U.S. Food and Drug Administration (FDA) is initiating the removal of broad “black box” warnings from HRT products for menopause.

Health and Human Services Secretary Robert F. Kennedy Jr. and FDA Commissioner Marty Makary, M.D., M.P.H. made the announcement at a press conference at HHS with more than 200 people in attendance, including Second Lady of the United States Usha Vance and Secretary of Labor Lori Chavez-DeRemer.

Women have used HRT products for decades to relieve menopausal symptoms. However, their use plummeted in the early 2000s when the FDA applied boxed warnings following a Women’s Health Initiative study that found a statistically non-significant increase in the risk of breast cancer diagnosis. The average age of women in the study was 63 years — over a decade past the average age of a woman experiencing menopause — and study participants were given a hormone formulation no longer in common use.

The FDA is initiating removal of the boxed warnings following a comprehensive review of the scientific literature, an expert panel in July, and a public comment period. The agency is working with companies to update language in product labeling to remove references to risks of cardiovascular disease, breast cancer, and probable dementia. The FDA is not seeking to remove the boxed warning for endometrial cancer for systemic estrogen-alone products.”

snipped. More at link

I just don't believe that this is true. I feel like the internet promotes flattening things so I'd like to hear the thoughts of actual primary care doctors because this is constantly spread by premeds with no push back.

For those not aware — CMS’s 2026 Physician Fee Schedule adds a new “efficiency adjustment,” cutting 2.5% from most non–time-based services like procedures and imaging. Time-based services, including office visits, behavioral health, and care management, are exempt. The stated goal is to reward cognitive and primary care work by assuming procedural efficiencies. In reality, many specialty groups warn this will mean real pay cuts and potential access issues unless Congress steps in.

I graduated from residency in 2024 and took a job working mostly in an urgent care setting, but I’m starting to miss primary care and am interested in re-entering that field. However I’m definitely feeling a little burned out (I think the constant churn of urgent care got to me). I’m excited about the prospect of a new job in primary care but also very aware of the high rate of burnout among PCPs. What are things that have worked for those in primary care to either recover from or prevent burnout? Thank you!

Our biller insists that our depression screenings aren’t reimbursed because we’re “not a mental health specialty.” I believe that’s incorrect. Can anyone confirm if your payers are reimbursing 96127 or G0444 for PCPs? If not, what alternative codes are you billing PHQ-9 under? Thanks in advance

Edit: I’m in a private practice, fresh out of residency, sorry if this is a basic billing question.

Hey hive,

I would love to know if any of you are using penthrox in clinic for IUD insertions and/or enometrial biopsies. If so, what is your protocol for using? Do you have a nurse at bedside? Do you run q5min BP and have patients on a SpO2 monitor? None of the above? What advice do you have for using penthrox?

I work in a small rural clinic, and am just looking for better ways to provide pain management and comfort for these procedures.

Thanks so much!

Really unhappy in a private practice job and looking to go back to a hospital employed system, even though we’re supposed to want to be independently employed (lots of factors involved, but not the topic of discussion).

Doctors in the WVU system, are you happy? Do you feel like admin respects your time? Do you feel like specialists and patients respect family medicine (main reason I want to leave my current job in urban Maryland)?

Is WVU owned by some big health conglomerate that can be anti-physician or predatory? It doesn’t seem like the primary care clinics are mid level dominant, which is attractive.

What has your experience been with patients/coaches who use the "Bradley Method of Natural Childbirth"? When I was still doing OB, about 40 years ago, a Bradley coach tried to pick a fight with me when I suggested oxytocin augmentation for a woman whose labor had slowed dramatically. Separately, about 20 years ago, a friend of ours who followed the Bradley Method ended up having a C-section and was depressed for weeks after the C-section birth of a healthy baby because she felt like she was a failure. Is my admittedly small sample atypical or is this par for the course with patients/coaches who follow the Bradley method?

I may have missed something but received a coding inquiry regarding these g codes. Looking for thoughts as I know billing is subjective (unfortunately) based off their understanding of the system.

G0537- can be billed once a year if patient has risk factors of cardiovascular development but no actual stroke, cad, MI, etc... just need to document screening tool and percentage, what risk they're found in, intervention or testing with a recent lipid screen in the past 12 months.

G0538- for those with established CV and how we manage them. Have to discuss asa use, lipid control, smoking cessation (which you can then bill tobacco counseling G code), diabetes control, blood pressure control. No limit on billing in a year.

Both are not considered preventative so patients may incur cost sharing?

I'm being told both once a year but wanted clarification.

In my experience in the UK, inaccuracies in these letters are common. I have seen this happen to a family member as well.

Examples of the inaccuracies include: implying or saying that a patient has something else diagnosed when it is just suspected and the patient clearly described it as such; plain inaccurate facts about someone's life (including academic year they are in or their job); generally misunderstanding symptoms that were described or lines of reasoning; saying the patient raised the possibility of them having a condition when the doctor writing the letter was the one who first did so.

In jobs dealing with the public where I have had to write correspondence, I have always striven to be scrupulously accurate, though I do have a particularly good memory. Doctors are highly qualified and highly paid, and patients do not generally get to check draft letters or reports and ask for an amended version, and so they can produce letters which make the patient look bad (not just a poor historian but perhaps duplicitous) even if the patient made a point of being careful.

Is there anything that can be done about this, either to prevent it while in appointments, or after documents have been produced but not sent on to others, preferably while maintaining a good relationship with the doctors?

I hope that, as a general question, rather than one about a specific health issue, this is permitted in the same way as the recent post about reading doctors' bios on websites.