Hi everyone!

Excited to share that our systematic review and meta-analysis, “Oral Factor XIa Inhibitors for Secondary Prevention After Noncardioembolic Ischemic Stroke or High-Risk Transient Ischemic Attack,” has recently been published in Brain and Behavior (Wiley).

We investigated whether oral Factor XIa inhibitors, when added to antiplatelet therapy, could reduce recurrent ischemic stroke without substantially increasing bleeding risk.

🔬 Key Findings:

• 3 randomized controlled trials involving 16,501 participants, with 14,239 included in the primary efficacy analysis.
• 26% relative reduction in recurrent ischemic stroke (RR: 0.74; 95% CI: 0.65–0.84).
• No statistically significant increase in major bleeding (RR: 1.12; 95% CI: 0.87–1.44).
• No significant differences in intracranial hemorrhage or fatal bleeding.
• Trial sequential analysis supported the evidence for recurrent ischemic stroke reduction, while the evidence for major bleeding remained inconclusive.
• Despite antiplatelet therapy, patients with noncardioembolic ischemic stroke remain at risk of recurrent events. Factor XIa inhibition represents a promising therapeutic approach that may improve secondary stroke prevention without substantially compromising safety.

📄 Full article: Oral Factor XIa Inhibitors for Secondary Prevention After Noncardioembolic Ischemic Stroke or High-Risk Transient Ischemic Attack

I'm grateful to the Research Council of Pakistan (RCOP), Dr. Shariq, Dr. Shahzeb, and Dr. Asad Ali Ahmed Cheema for their guidance and mentorship, and to all my co-authors for their contributions. I'd love to hear the community's thoughts.

Do you think Factor XIa inhibitors could become a meaningful addition to secondary stroke prevention, or do we still need more evidence before considering their broader clinical use?

Looking forward to an interesting discussion!

I am a PGY-2 Internal Medicine resident struggling to decide which subspecialty to pursue. I am interested in a few fields but finding it difficult to figure out which would be the best fit long-term.

For those who have been through this process, how did you make your decision?

How much did your rotations influence your choice?
Did you prioritize genuine interest, lifestyle, compensation, or job opportunities?

If you were torn between multiple subspecialties, what ultimately helped you decide?

Looking back, are you happy with your choice, and is there anything you wish you had considered earlier?

I would especially appreciate advice from residents and attendings who were undecided during PGY-2 or PGY-3. I want to make a thoughtful decision based on long-term fit rather than feeling pressured to choose.

Thank you!

I’m feeling completely lost right now, and I’m hoping to get some advice from people who have been in a similar situation or have navigated this successfully.

I’m currently in the second year of a two-year fellowship, which is scheduled to end in June 2027. Unfortunately, I failed the ABIM exam again. Even though I felt more confident and comfortable this time..
This was my second attempt, and I’m honestly struggling to figure out what to do next.

The biggest concern is that my fellowship will be ending before I’ve passed ABIM. Almost every clinic job I’ve been interested in requires board eligibility or board certification (BE/BC), and I’m terrified that I won’t be able to find a position or that my career options will be severely limited.

My program director has offered to look into whether I can still graduate from fellowship if I haven’t passed ABIM by the time I finish. I’m grateful that they’re helping me figure this out, but even if I’m able to graduate, I’m scared about what comes next and whether this will prevent me from moving forward in my career.

I genuinely don’t know what my options are right now, and the uncertainty is overwhelming.

If anyone has been through something similar, knows someone who has, or has any advice on possible career paths or next steps, I would sincerely appreciate hearing your experiences.
Thank you so much for taking the time to read this.

I'm reaching out because I'm feeling really lost right now, and I could use some advice from people who have been through something similar.

I recently failed the ABIM exam for the second time. I honestly thought I did better this time. I felt more prepared and confident than I did on my first attempt, but my score ended up being even lower..

I'm really discouraged, and I'm worried about my future..

My fellowship ends in June next year, and I had planned to look for clinical jobs after graduation. However, most of the positions I'm interested in require board eligibility, and I'm afraid I won't be able to find a job without it.

I've looked into research positions that could allow me to extend my fellowship, but the application deadlines have already passed. At this point, I honestly don't know what my options are.

I'm also worried about job interviews. If employers ask whether I've taken ABIM before or how many times I've taken it, I'm not sure how to answer. I'm afraid that failing twice will make them question my abilities or hurt my chances of getting hired. It's hard not to feel overwhelmed when this could affect my job prospects and delay my career..

I looked into AOBIM as well, but unfortunately, I need to pass the ABIM exam specifically to be eligibletoapply for my subspecialty board exam. Passing AOBIM would not meet that requirement.

I would really appreciate any advice from those of you who have been in a similar situation, especially those who completed fellowship without having passed the ABIM exam. I know everyone's circumstances are different, but hearing about your experiences and how you navigated this transition would mean a lot to me..

I'm trying to figure out my next steps, but right now, I'm genuinely scared about what comes next. Any practical advice or personal experiences would mean a lot to me.

Thank you so much for reading.

I’ve never posted on Reddit before but I hope it’ll help someone next year when prepping for ABIM. I passed first time with 420 score in fellowship (which has turned out to be more intense than I thought). I did move across country for fellowship as well. My ITE score were 36%>72%>52%. No failed exams before. I only did UWorld one time through and was scoring 55% or so. I did have two days of going over wrongs. I maybe had time to study 30 min a night and 6-8 hours on weekends I had off. I didn’t purchase UWorld until May 2026. Basically as an average to low test taker it is possible to pass! I listened to podcasts (ABIM review) going back and forth to work.
Hope it helps and best of luck!

Pgy2 IM here. Feel absolutely shit about scoring 61st and 21 percentile. Improved % from last year but percentile dropped 2 points. Feel like a failure 😔😔😔

Hello! Due to some personal life circumstances, I am looking for work from home jobs. Are there any work from home jobs available in IM?

I'm an IM resident in the Primary Care Track, currently rotating in the ICU.

I don't like doing procedures, mainly because I haven't had much exposure to them. I'm trying to observe and learn, but I avoid performing them because I don't feel ready. My senior resident got upset because she thinks I'm avoiding procedures and doesn't want to do them all herself. Am I wrong for this?

I've also been assigned 10 patients, and I feel overwhelmed. I sometimes forget patient details, especially when things get busy. I tend to get nervous in high-acuity settings, which makes it harder to stay organized and think clearly.

People keep telling me I'll get used to it, but I feel really disappointed in myself.

Has anyone experienced something similar? Any advice?

What kindof a mindset and personality is preferred by programs to accept an applicant as a resident for US internal medicine residency ?

With the new prioritisation rules, could all interview slots be filled by priority applicants, leaving no interviews for non-priority applicants, regardless of how high their portfolio score is?

Is it possible that not a single IMG will get an interview this year? What do you think?

I am taking ABIM 10 year recertification exam next week. I wanted to know whether the version of uptodate they provide:

1. Will it have graphs, images, algorithms ?

2. Will it have find function available to type it out within the page to look for keywords ?

Hi everyone

Is there a full length practice ABIM, aside from the ITE?

Thanks

Can anyone recommend a healthcare system that's a good place to work as a PCP? I'd love to hear about your experiences, including the pros and cons of working there. Thanks!

Hi everyone. Anyone interested in having a regular study partner to work through MKSAP questions together? If so please DM me. Thank you!

Any OKC area PCPs in the group? I'm currently outpatient IM in Dallas and considering a relocation to OKC to be closer to friends/family. Curious the average RVU in the OKC area. My current RVU is low at $33.50 and I'm locked in until next fall. I need to prepare for a change assuming my RVU won't go up much with my current employer. Hoping to stay outpatient

I’m a physician building a small SNF/post-acute practice using part-time/PRN employed physicians and NPs/PAs. The practice handles billing, malpractice, EMR, and administrative support. Cash flow is limited while patient volume ramps up.

For people who run or work in similar groups:

1. What is reasonable clinician pay per encounter? I’d especially appreciate actual examples for 99309 follow-ups and 99306 admissions, separately for physicians versus NPs/PAs. Do you use fixed CPT rates, a percentage of collections, or a minimum plus incentives?

2. How much should the practice retain? What percentage remains after clinician compensation, and what is a reasonable actual profit margin after billing, malpractice, employer taxes, software, support staff, and coverage costs? How does that differ for physicians versus APPs?

3. When do you pay clinicians? Regular payroll after encounters are signed/submitted, or after collections arrive? If collections-based, how do you handle the delay, guarantees/draws, denied claims, and downcoding?

4. What should billing and EMR cost? What billing percentage or minimum is reasonable, what services should it include, and which systems work well for a small group rounding across multiple SNFs with occasional PRN clinicians?

5. How much cash reserve would you want before hiring, and what minimum census makes adding a clinician worthwhile?

An anonymized example would help tremendously: clinician type → CPT → actual collection → clinician pay → practice costs → amount remaining.

Thanks—especially interested in real SNF/post-acute experience.

Whats the national average for ITE scores this year? and how skewed the percentiles are based on minor changes in percentage this year?

I'm a physician doing SNF/subacute rehab work and choosing a practice EMR and billing setup. The SNF facilities I work with use PointClickCare (PCC).

My goal is to send authorized PCC chart information plus my visit findings into AI, get an editable, unsigned draft in my practice EMR for review and signature, then return the final note to PCC. This is still a proposed workflow.

I'm considering Athena/HybridChart and have heard about Claimocity and Ethizo, but I'm open to other options.

For clinicians working in SNFs, post-acute rehab, long-term care or memory care:

- Which EMR works best with PCC and AI that uses existing chart information?

- What professional billing/coding/claims setup works for physician encounters?

- What are the actual fees, support issues and requirements to use the vendor's billing service?

Firsthand experience would be helpful.

Any information about Mumbai and pune hospitals dnb Medicine residency?? please, at rank of 6800 general category , toxicity, patient load, and passing rate??

Why are some IM programs almost 100% IMG in major cities. I would consider these desirable location (NYC Philly NJ Chicago etc.) are they specifically built to train foreign medical graduates or something? And is it worth it to apply to them as a USDO average stats? Just curious.

Hello! I am a current MS2. I have a huge passion for both internal medicine and psychiatry. I am very interested in exploring Med/Psych residency. My main reason for doing this, other than my interest in the medicine of both, is that from my understanding many inpatient and outpatient IM patients have both complex medical and complex psychiatric conditions. Several of my mentor IM attendings have expressed to me how they come across so much psych in their practice that they are simply not trained to handle. These patients (specifically in the outpatient setting) typically never get the specialized psychiatric care they need because either they do not want the stigma of going to a psych, cant afford it, or simply do not have access to one. Said mentors have pointed me towards Med/Psych training. I think the way I ideally envision using this training would be in more of a community hospital setting. Hospitalist who takes psych consults and on off weeks works psych outpatient a few days a week, or entirely outpatient dealing with patients that have med and psych comorbidities.

I would love to hear thoughts and any info one might have on this. It is sort of niche, so I am having trouble finding a ton of info on it. Any guidance is greatly appreciated, as I am obviously very early on in my medical training and still a bit naive to how everything works. Thanks guys!!

Hello all,

I’m a new-grad physician assistant working in rural internal medicine and am seeking to form a mentorship with physician(s) who are open to education and general career support by meeting on a regular scheduled basis to discuss deidentified cases and such. Not sure if this is a thing but I know it’s something that I would truly value, as I currently am not in such a supportive relationship with my SP and may soon be inbetween jobs. I guess it would be similar to those collaborating physician websites but without wanting to establish a clinic, just for ongoing education and career support. If you offer any service such as this feel free to DM me with info and rates.

I would like to share with you the latest article published on the zinc nutritional status of children and adolescents with chronic diseases.