A practical, future-focused conference on outpatient clinical care, risk reduction, practice growth, financial resilience, and the changing landscape of medicine.

This conference offers a practical, forward-looking update on the clinical, legal, financial, and operational challenges of modern medical practice. Learners will strengthen their approach to common outpatient conditions including hypertension, dyslipidemia, obesity, gastrointestinal disease, cancer screening, sleep medicine, sexual health, infection, longevity, aging, kidney health, and muscular-skeletal health, while also addressing the risks that shape contemporary care, such as opioid prescribing, malpractice exposure, litigation, documentation, communication, and digital reputation. Beyond clinical care, the program examines practice finance, fraud prevention, efficiency, burnout, asset protection, retirement planning, and the evolving technologies and care models that are reshaping the future of medicine.

A focused clinical update on cardiometabolic disease, obesity, gastrointestinal conditions, cancer screening, and sleep medicine for everyday practice.

Day 1

Integrated approach to assessing and treating hypertension and dyslipidemia while estimating and lowering overall cardiovascular risk.

Hypertension, Lipids, and Global Cardiovascular Risk

Review cardiovascular risk calculators, blood pressure classifications, and target-setting strategies for everyday care.

Risk Assessment and Blood Pressure Targets in Clinical Practice

Practical strategies for stepwise pharmacologic treatment of primary hypertension, including use of combination therapy.

Managing Primary Hypertension and Combination Therapy

Recognizing resistant and secondary hypertension and choosing appropriate diagnostic and referral pathways.

Resistant and Secondary Hypertension: When to Investigate and Refer

Evidence-based approach to statins, nonstatin therapies, and ASCVD prevention for primary and secondary prevention populations.

Lipid Management and ASCVD Prevention Across Risk Groups

Break

Comprehensive approach to lifestyle, pharmacologic, and GLP-1–based treatments for obesity in clinical practice.

Obesity and Weight Management in the Era of GLP-1–Based Therapies

Key elements of nutrition, physical activity, and behavioral counseling for long-term weight management.

Foundations of Lifestyle and Behavioral Treatment for Obesity

Determining who is an appropriate candidate for anti-obesity medications and engaging patients in shared decisions.

Patient Selection and Shared Decision-Making for Anti-Obesity Medications

Dosing, titration, monitoring, and adverse effect management for GLP-1–based therapies used in obesity.

Practical Use of GLP-1–Based Therapies in Obesity Care

Strategies for maintaining weight loss, addressing weight regain, and individualizing care for special populations.

 Long-Term Follow-Up, Weight Maintenance, and Special Populations

Evidence-based management of GERD and dyspepsia and practical approaches to colorectal cancer screening and surveillance.

GI and Cancer Screening Update: From GERD to Colorectal Cancer

Recognizing typical and atypical GERD presentations and choosing initial empiric therapies.

Evaluation and Initial Management of GERD in Primary Care

Identifying alarm features, indications for endoscopy, and management implications of Barrett esophagus.

Alarm Features, Endoscopy, and Barrett Esophagus

Comparing stool-based tests, sigmoidoscopy, colonoscopy, and other options for colorectal cancer screening.

Colorectal Cancer Screening Modalities and Risk Stratification

Determining surveillance intervals after polypectomy and closing the loop on results with patients.

Post-Polypectomy Surveillance and Communication of Results

Connections between sleep, cognition, mood, cardiometabolic risk, and practical approaches to common sleep complaints.

Sleep, Brain Health, and Metabolic Disease

Identifying insomnia, circadian rhythm disorders, and other sleep problems in busy clinical encounters.

Recognizing Sleep Disorders in the Outpatient Visit

Understanding when to suspect obstructive sleep apnea, order testing, and collaborate with sleep specialists.

Obstructive Sleep Apnea, Cardiometabolic Risk, and Referral Pathways

How sleep disturbance intersects with cognitive complaints, depression, and anxiety in adult patients.

Sleep, Cognition, and Mood: Implications for Clinical Practice

Combining sleep hygiene, CBT-I principles, and judicious use of medications for insomnia.

Nonpharmacologic and Pharmacologic Approaches to Insomnia

End of Day

A practical clinical update on infection prevention, chronic kidney disease, sexual health and HIV prophylaxis, and evidence-based approaches to hormonal aging and longevity medicine.

Day 2

High-yield prevention and treatment decisions for common outpatient infectious disease problems, with emphasis on immunization and antibiotic stewardship.

Vaccines, Common Infections, and Antimicrobial Stewardship

Practical vaccine delivery for adults, including age-based, risk-based, and catch-up indications.

Adult Immunization in 2026: What Busy Practices Need to Get Right

Choosing when antibiotics are and are not warranted for common outpatient infectious presentations.

Antibiotic Decisions for Respiratory, Sinus, and Urinary Complaints

Evaluating common outpatient infection complaints while avoiding unnecessary broad therapy.

Skin, Soft Tissue, and Tick-Related Infections Without Reflex Overtreatment

Creating office systems that support delayed prescribing, reassessment, and fewer avoidable antibiotic harms.

Follow-Up, Safety Nets, and Stewardship Systems That Actually Work

Recognizing CKD early, interpreting albuminuria and eGFR trends, and slowing progression through evidence-based outpatient care.

Chronic Kidney Disease and Albuminuria: Early Detection and Progression Prevention

Using kidney function data correctly to recognize CKD before complications or rapid decline emerge.

Screening for CKD and Interpreting eGFR and Albuminuria

Practical treatment of CKD with RAAS blockade, SGLT2 inhibitors, and risk-factor control.

Slowing CKD Progression: Blood Pressure, Glycemia, and Kidney-Protective Drugs

Managing common CKD complications and knowing what can stay in primary care versus what needs specialist input.

Potassium, Anemia, Acidosis, and Other CKD Complications in Primary Care

Referral decisions, patient counseling, and transition planning for patients with worsening kidney disease.

When to Refer: Nephrology Collaboration and Preparing for Advanced CKD

Evidence-based screening and treatment of common STIs - including the syphilis resurgence, mpox, and the emerging sexually transmitted fungal infection TMVII - current HIV prophylaxis strategies including PrEP (oral and twice-yearly injectable) and PEP, doxy-PEP for bacterial STI prevention, and practical communication skills for sexual health conversations in adult primary care.

Sexual Health: STI Care, HIV Prevention, and Conversations That Build Trust

Applying current screening criteria and first-line regimens for common STIs while addressing the ongoing syphilis resurgence, mpox, and the newly identified sexually transmitted fungal infection Trichophyton mentagrophytes genotype VII (TMVII).

Gonorrhea, Chlamydia, Syphilis, Herpes, Mpox, and TMVII: What's Changing and Why It Matters

Identifying candidates for HIV pre-exposure prophylaxis and managing PrEP safely across oral daily and twice-yearly injectable (lenacapavir) formulations, with attention to access barriers and health equity.

PrEP: Oral, Injectable, and Equitable  -  Prescribing and Monitoring in Primary Care

Managing both HIV post-exposure prophylaxis (PEP) and bacterial STI post-exposure prophylaxis (doxy-PEP) in primary care: eligibility, timing, prescribing, follow-up, and the stewardship considerations that come with both.

PEP and Doxy-PEP: Post-Exposure Prevention for HIV and Bacterial STIs

Using inclusive, structured communication techniques to normalize sexual health screening, reduce shame, and build trust with patients of all sexual orientations, gender identities, and risk profiles.

Talking About Sex and Risk: Nonjudgmental Sexual Health Conversations Across All Patients

Current evidence on managing perimenopause and the full menopausal transition with hormone and nonhormonal therapy, male hormonal aging and testosterone deficiency, and practical guidance on diet, supplements, GLP-1s, and the longevity interventions patients are increasingly asking about.

Menopause, Male Hormonal Aging, and Longevity Medicine in Primary Care

Recognizing the distinct clinical phases of perimenopause and established menopause, individualizing hormone therapy decisions using current evidence, correcting WHI-era misconceptions that drive underprescribing, and selecting evidence-based nonhormonal options for patients who cannot or will not use hormones.

Perimenopause and Menopause: Diagnosis, Hormone Therapy, and Nonhormonal Alternatives

Distinguishing symptomatic hypogonadism from normal aging and applying current evidence on testosterone therapy in older men.

Testosterone Deficiency, Male Aging, and When to Treat

Evaluating the evidence - and the absence of it - behind popular longevity supplements, peptides, and GLP-1-adjacent compounds patients are increasingly using, with particular attention to regulatory status, risks, and the muscle and bone preservation considerations of GLP-1 use.

Peptides, GLP-1s, NAD+, and Longevity Supplements: What Patients Are Taking and What the Evidence Shows

Reviewing the clinical trial evidence for major dietary patterns and building practical counseling recommendations for common patient goals.

Dietary Patterns That Work: Mediterranean, Low-Carb, Time-Restricted Eating, and What to Recommend

A clinically focused day on healthy aging and falls, musculoskeletal care, high-value diagnostic reasoning, and evidence-based communication with skeptical patients.

Day 3

Practical outpatient care for older adults with emphasis on fracture prevention, fall risk, medication safety, and functional independence.

Healthy Aging, Bone Health, Falls, and Medication Safety

Brief, practical approaches to identifying mobility problems, frailty, and fall risk in adult outpatient care.

Screening for Frailty, Functional Decline, and Fall Risk

Applying bone density testing, fracture risk assessment, and initial pharmacologic and nonpharmacologic treatment strategies.

Osteoporosis Screening, Fracture Prevention, and First-Line Treatment

Reducing medication burden and adverse drug effects in medically complex and older adults.

Polypharmacy, Deprescribing, and Medication Harm Reduction

Supporting independent living and goal-concordant care through mobility planning, caregiver conversations, and advance care planning.

Advance Care Planning, Mobility, and Aging in Place

A practical diagnostic and management approach to frequent musculoskeletal complaints seen in adult outpatient medicine.

Common Musculoskeletal Problems in Outpatient Practice

Evaluating common back pain presentations, recognizing red flags, and using imaging judiciously.

Low Back Pain, Sciatica, and When Imaging Actually Helps

Choosing medications, exercise, therapy, injections, and referral strategies for common osteoarthritis presentations.

Osteoarthritis of the Knee, Hip, and Hand: Practical Treatment Choices

Approaching frequent upper-extremity and soft-tissue complaints without overtesting or missing serious disease.

Shoulder, Neck, and Overuse Problems in the Adult Patient

Recognizing inflammatory and crystal-related disease when musculoskeletal symptoms should not be dismissed as routine degenerative pain.

Gout, Polymyalgia, and Other Clues It Is Not Just Wear-and-Tear

How to reduce low-value testing, avoid diagnostic cascades, and make more disciplined choices about labs, imaging, and referrals.

High-Value Care, Diagnostic Stewardship, and Smarter Testing

Using pretest probability, symptom evolution, and watchful waiting to avoid reflexive testing.

When to Order, When to Wait, and How to Reduce Low-Value Testing

Recognizing how low-yield tests can create downstream harms, costs, and patient anxiety.

Avoiding Diagnostic Cascades and Incidentaloma-Driven Harm

A scenario-based approach to choosing the right next step for common symptoms and abnormal results.

Smarter Imaging, Labs, and Referrals in Common Outpatient Scenarios

Communicating diagnostic reasoning in ways that preserve trust while supporting evidence-based restraint.

Talking With Patients About Uncertainty and Why More Is Not Always Better

Evidence-based frameworks and practical scripts for physicians managing patient skepticism about vaccines, medications, and medical institutions - including distrust shaped by COVID-19, social media, and AI-generated health content - with skills for motivational interviewing, de-escalating conflict, and maintaining productive clinical relationships.

Communication Under Pressure: Navigating Patient Distrust, Difficult Encounters, and High-Resistance Conversations

Mapping the modern sources of patient institutional distrust - from COVID-19 policy failures and the WHI's lasting shadow on hormone therapy to algorithmically amplified social media and AI-generated health content - and understanding how each shapes the clinical encounter.

The Distrust Landscape: COVID, Social Media, AI Content, and the WHI Legacy

Applying core motivational interviewing techniques - including the readiness ruler, change talk elicitation, and rolling with resistance - to clinical conversations where patients push back on evidence-based recommendations.

Motivational Interviewing and Evidence-Based Scripts for High-Resistance Conversations

Practical communication frameworks for the clinical topics most likely to generate patient skepticism, refusal, or unsupported demand in 2026 - including how to respond when patients arrive with AI-generated content or social media health beliefs.

Topic by Topic: Vaccines, Obesity Meds, Hormones, Opioids, Stimulants, Antibiotics, and AI Content

Managing the full arc of a difficult clinical relationship, from initial boundary-setting to professional termination when necessary.

Difficult Encounters: Setting Limits, De-escalating Conflict, and Ending Relationships

A practical day on risk, marketing, and growth that links pain and opioid prescribing, malpractice and litigation, digital reputation, and communication strategies for safer, stronger practices.

Day 4

Balancing effective pain relief with safe opioid prescribing and recognition of opioid use disorder in clinical practice.

Pain Management, Opioids, and Addiction Risk

Structured approaches to pain assessment, functional goals, and expectation-setting with patients.

Assessing Pain and Setting Realistic Treatment Goals

Evidence-based use of non-opioid medications and nonpharmacologic therapies for acute and chronic pain.

Non-Opioid Pharmacologic and Nonpharmacologic Therapies

Principles for starting, continuing, and tapering opioids while minimizing risk of misuse and overdose.

Initiating and Monitoring Opioid Therapy Safely

Identifying opioid use disorder and initiating or facilitating evidence-based treatment.

Recognizing and Managing Opioid Use Disorder in Clinical Practice

How malpractice cases arise and progress, and what physicians should know about documentation, depositions, and testifying.

Malpractice, Litigation, and the Physician as Witness

Patterns of diagnostic error, communication failure, and system issues that drive malpractice litigation.

Common Malpractice Allegations and How They Arise

How notes, orders, and consent forms are interpreted in court and what constitutes defensible documentation.

Documentation, Informed Consent, and the Medical Record in Litigation

Practical steps physicians can take when they are deposed or consulted in legal cases.

Preparing for Depositions and Interactions with Counsel

Strategies for clear, credible testimony and maintaining composure in the courtroom.

Testifying at Trial and Maintaining Professionalism Under Pressure

Building a professional online presence and using web, search, and social media to attract and retain patients ethically.

Digital Reputation, Marketing, and Patient Acquisition

Core elements of an effective practice website and online profile that support patient trust and access.

Building a Patient-Centered Online Presence and Website

Using search optimization, online reviews, and social media to enhance visibility while protecting professional reputation.

Search, Reviews, and Social Media Strategies for Clinicians

Transforming digital interest into scheduled visits through clear calls to action and efficient workflows.

Converting Website Visitors and Inquiries Into Appointments

Understanding professional, legal, and payer constraints that apply to digital outreach and advertising.

Ethical and Regulatory Boundaries in Digital Marketing

Using high-quality documentation, patient communication, and team processes to lower clinical and legal risk.

Documentation, Communication, and Team-Based Care to Reduce Risk

Structuring notes and problem lists so they support patient care and defend clinical decisions.

High-Value Progress Notes and Problem Lists

Talking with patients about risks, benefits, and uncertainty in ways that foster understanding and shared decisions.

Risk-Reducing Conversations and Informed Consent

Designing systems to ensure abnormal results, referrals, and follow-up needs are tracked and addressed.

Closing the Loop on Tests, Referrals, and Follow-Up

Optimizing team roles and handoff practices to reduce errors and improve patient experience.

Leveraging Team-Based Care and Handoffs to Improve Safety

Medical Update: Clinical Practice, Practice Growth, and The Future of Care

This conference offers a practical, forward-looking update on the clinical, legal, financial, and operational challenges of modern medical practice. Learners will strengthen their approach to common outpatient conditions including hypertension, dyslipidemia, obesity, gastrointestinal disease, cancer screening, and sleep medicine, while also addressing the risks that shape contemporary care, such as opioid prescribing, malpractice exposure, litigation, documentation, communication, and digital reputation. Beyond clinical care, the program examines practice finance, fraud prevention, efficiency, burnout, asset protection, retirement planning, and the evolving technologies and care models that are reshaping the future of medicine.

A forward-looking day on practice finance, fraud prevention, burnout, and the emerging future of care models and technology.

Recognizing, preventing, and responding to financial fraud and embezzlement in clinical settings.

Fraud Prevention and Internal Controls in Medical Practices

How fraudulent billing, skimming, and embezzlement show up in day-to-day practice operations.

Recognizing Common Fraud and Embezzlement Schemes in Clinics

Core internal control concepts and simple safeguards physicians can implement with their teams.

Designing Basic Financial and Billing Controls

Using basic reports and periodic audits to monitor for fraud and compliance problems.

Monitoring Reports, Audits, and Red Flags

Steps to take when fraud is suspected and how to engage legal and financial advisors effectively.

Responding to Suspected Fraud and Working with Advisors

Improving visit flow, managing EHR and inbox demands, and building sustainable work patterns that prevent burnout.

Clinical Efficiency, Burnout, and Sustainable Practice

Tools for analyzing how time and effort are distributed across clinical tasks.

Diagnosing Inefficiency: Mapping the Clinical Workday

Optimizing visit structure, templates, and delegation to support efficient, high-quality care.

Visit Flow, Templates, and Team Roles

Strategies to control electronic health record burden and reduce spillover work into personal time.

Managing the EHR, Inbox, and After-Hours Work

Recognizing burnout and building individualized plans for resilience and boundary-setting.

Burnout Prevention, Boundaries, and Personal Sustainability Plans

Core concepts in protecting assets, building wealth, and planning for retirement across a medical career.

Asset Protection, Wealth, and Retirement Planning for Physicians

Clarifying financial goals and understanding assets, liabilities, and cash flow for clinicians.

Financial Goal Setting and the Physician Balance Sheet

Using legal entities, contracts, and insurance coverage to protect personal and professional assets.

La Romana

Available Conferences

Medical Update: Clinical Practice, Practice Growth, and The Future of Care

Medical Update: Clinical Practice, Practice Growth, and The Future of Care

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