Med School/resident/attending thread

Discussion in 'The Mainboard' started by skeezy, Apr 27, 2015.

  1. Cousin Eddie

    Cousin Eddie Lookin for the place called Lee Ho Fook's
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    Starting med school in late July. But first.. a month in Europe and a month of golf and drinking at the pool.
     
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  2. Scott Van Pelt

    Scott Van Pelt President of the Hate Avery Johnson Fan Club
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    Enjoy amigo. Study hard the first two years and step won't be as bad as everybody makes it out to be. Also take time for yourself and enjoy life.

    There's my sage wisdom. Off to the bars
     
  3. TC

    TC Show me your portfolio, pussy
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    I learned a little bit about "CME" from lechnerd in the job time off thread the other day. This morning I read an article from someone very critical of the pharmaceutical marketing that goes on at these things and some other topics and was curious if any of yall had thoughts. Curious your thoughts on any of it but particularly the bolded about the "toxic culture" of medical school

    Lessons From a Professor’s 10-Year Fight to Rein In Pharmaceutical Promotion
    By Paul Basken JUNE 20, 2017




    [​IMG]

    In the cramped basement of a research building at Georgetown University, some 200 scientists and doctors assembled this past week to share homemade cookies, hear how opioids and other drugs are unsafely and overaggressively prescribed, and figure out what doctors, hospitals, universities, and others should do about the problem.


    It was the 10th annual conference of an educational project at Georgetown known as PharmedOut. The project began in 2006 with a $398,000 award from a $21-million grant program created by state attorneys general who had sued Warner Lambert, a drug company that had admitted to illegally marketing an epilepsy drug called Neurontin for various unapproved treatments.

    The project’s founder, Adriane J. Fugh-Berman, now an associate professor of pharmacology and physiology at Georgetown, devised it to teach physicians about the marketing practices of the pharmaceutical industry.

    The money from the state attorneys general ran out after two years. Now, Dr. Fugh-Berman struggles to run the operation on a shoestring. PharmedOut’s annual budget, of about $60,000, relies heavily on donations as the organization tries to be heard alongside a pharmaceutical industry with about $1 trillion in worldwide sales.

    The industry exercises much of its influence through continuing medical education (CME) programs — classes and seminars that doctors are required to attend to keep current in their fields, and that are almost exclusively provided with drug-company sponsorship.

    Reflecting on her milestone conference, Dr. Fugh-Berman discussed with The Chronicle the challenges she faces and the future she anticipates. The following transcript has been edited for length and clarity.

    Q. What’s the PharmedOut origin story?

    A. With the grant from the attorneys general, we’d call up hospitals and say, "We’d like to provide CME, and we can pay for lunch." And it turns out you can get into any hospital saying that. That’s how the pharmaceutical companies do it — no questions asked. And the one question we were asked, repeatedly, was, "What pharmaceutical company are you with?"

    My project manager was the one who had to make the calls, and it was making her mad, like she wasn’t explaining PharmedOut right. But she couldn’t explain it, because the culture was that providing luncheon seminars was what pharmaceutical companies did, and nobody else, so you must be a pharmaceutical company.

    I remember visiting cardiologists at Howard University and them thinking, "Oh, God, another drug-company lecture." And after a while their jaws started to drop a little bit, and some of them asked me, "How did you get in here?" And it was not a hostile question. It was just like, "Wow, how did you sneak in here?" And I said, "Your organizers thought I was from a pharmaceutical company. Plus, we paid for lunch."

    Q. Why is CME so hard to change?

    A. It used to be that hospitals funded their CME offices, and that may still be true. But in many or most cases, CME is supposed to bring in money to their organizations, and they do that by running CME funded by pharma. They charge the provider of the information.

    Q. How do you run PharmedOut on $60,000 a year?

    A. We substitute labor for money. Homemade cookies have become like a hallmark for the conference. That was totally a cost-saving thing. And people loved it so much because they had never been at a conference with homemade cookies.

    Q. What goes on the rest of the year?

    A. We do research and education. The trouble is, it’s taking me five years to publish studies. Most journals take pharmaceutical ads, and the journals that take pharmaceutical ads rarely publish our work.

    Q. What reasons do they give?

    A. They don’t give reasons; they just reject the article. A while agothe Annals of Internal Medicine published an article about how pharmaceutical ads were not accurate. Not ground-shaking news, but the journal lost a million dollars’ worth of funding and the editors were made to leave.

    If you had a diverse group of advertisers, you wouldn’t be so beholden. If you pissed off one faction, you’d still have someone else to fall back on. But they don’t.

    Q. Why not? Money is money.

    A. I think it’s just because it’s easy. Whenever we talk to doctors, people run up to us and say, "How can you have a meeting without pharma funding?" It seems like a stupid question to me. If you are trying to do a conference without pharma funding, you have to do more work. You have to make the cookies, or you have to get other exhibitors.

    Q. What’s your biggest win?

    A. Fewer doctors seeing drug representatives, and tighter policies at academic medical centers. My initial idea with PharmedOut was that we would first write things in the medical literature and then for consumers. And I never had to get to that second part because there was so much interest in what we wrote for the medical literature.

    Q. Biggest disappointment?

    A. The fact that we haven’t been able to get external funding, despite the fact that we’ve tried. No one could possibly do more with less, but I could do more with more.

    Q. What do you expect in PharmedOut’s next decade?

    A. I’m hoping that 10 years from now there will be no pharmaceutical company or medical-device manufacturer or biotech manufacturer funding any medical education. CME is not regulated by the FDA, because they say it’s education. And we’re saying, No, it’s promotion — it is all promotion, every bit of it. It may be hard to see.

    There have been surveys of doctors on whether they see industry bias in teaching modules, and 95 percent of them say no. But they’re not trained to detect bias. I have trained students to detect marketing in industry-funded modules. We’re the only group doing this. It’s the kind of thing that’s easy for writers and English majors and people in the humanities. Doctors and scientists can’t tell the difference between persuasive writing and — I don’t know — words on a page.

    Q. Carl Elliott, the University of Minnesota bioethics professor, gave a presentation at PharmedOut. He showed that some of the worst offenders in terms of promoting unwarranted and unsafe drugs later got promoted to top positions, often heading professional societies. How is that?

    A. Normal is what you’re used to. And doctors and trainees in medicine, we live in a bubble that has different standards than people in the general public have.

    Q. Not better standards?

    A. No, definitely worse.

    Q. But they’re doctors. They go into it for the purpose of helping people.

    A. Carl Elliott and I have a competition, which I am winning, on how many people we can talk out of medical school, which both of us considered a soul-destroying experience. It takes normal, idealistic young men and women, and it makes them bitter. The training is horrible, people are horrible to you, and you lose compassion, sometimes permanently.

    The first two years, in most schools, you’re just learning sciences. But when you get in a clinical setting, there’s totally a culture of abuse. It’s like a hazing situation, where you go through it and then you feel like you’re different and superhuman and part of this exclusive club, and you now get the license to abuse other people, other underlings. And patients ... forget it.


    Q. How do we stop that? It almost sounds as if everyone who is a doctor now, you’d have to fire and start over. What do you do?

    A. Cultures are very slow to change. The other thing about medical education in the clinical years is you’re basically encouraged to lie or make up answers if you don’t know the answer.

    Q. How is that?

    A. There’s a process called pimping, where you keep asking someone questions until they can’t answer them anymore. I’ve been asked things like "What’s the brand name of this drug?" "OK, what’s the brand name in Britain?" "Which half of the molecule is this drug attached to?" You can always ask somebody one more question.

    It generally happens during daily rounds. You pick on the lowest-ranking people, and you ask somebody questions until they can’t answer them anymore, and then you’re abusive to them for not knowing anymore.

    You’re expected to know every single thing on your patients. You’re expected to be able to rattle off lab results, that kind of thing. I remember as an intern confiding to someone, "I find it very difficult to memorize 40 different lab results on every patient." And she said, "Well, why are you doing that? If they’re normal, just make up the numbers." I said, "Oh, is that what people do?"

    - See more at: http://www.chronicle.com/article/Le...qat=1&elqCampaignId=6082#sthash.RfwMdUMC.dpuf
     
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  4. TC

    TC Show me your portfolio, pussy
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  5. Scott Van Pelt

    Scott Van Pelt President of the Hate Avery Johnson Fan Club
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    Obviously I haven't been through the second two years, but from what I've heard the culture of abuse has been greatly minimized at our school. There's still some asshole residents that fuck your life up for a couple of weeks, but the longest you're paired with any resident on a rotations is 2 weeks, and most upper levels students I've talked to have loved the 3rd year and said it has actually made them want to be a doctor again vs the hell that is years one and two. I can understand feeling there's a culture of abuse, and I'm certain that it is still prevalent at some institutions, but I think it's been minimized quite a bit over the last decade, especially since they're so gung-ho about enforcing hours restrictions.

    I know that's fairly anecdotal but that's the rumblings I've heard from students in my program.

    Also I think attendings that pride themselves on talking pre-med students out of medicine are massive douchebags.
     
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  6. RonBurgundy

    RonBurgundy Well-Known Member

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  7. TC

    TC Show me your portfolio, pussy
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    Yeah, I realized the article was old. Figured if things had changed they would be for the worse. Has there been improvement in this regard? FYI I pulled the link for this article out of the first one I posted which is a new article
     
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  8. Name P. Redacted

    Name P. Redacted I have no money and I'm also gay
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    From my second hand knowledge there's less "hazing" but still plenty of verbal abuse, sexism and harassment from patients and residents.
     
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  9. Scott Van Pelt

    Scott Van Pelt President of the Hate Avery Johnson Fan Club
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    Wouldn't know about the sexism (feels good to be a male :smug:), but the verbal abuse from patients won't ever change. Our school has an anonymous reporting system for abuse by residents, though I'm not sure how much it's utilized or if it's even effective.
     
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  10. RonBurgundy

    RonBurgundy Well-Known Member

    Idk about details of journals, just speaking in generalities.

    For me med school was hard and stressful but I didn't think it made me bitter or a worse person or anything like that. Residency wasn't that bad once you got into the routine imo. I'm not burned out, I treat students I have that rotate with me well, and my staff are generally happy and pleasant to be around
     
  11. lechnerd

    lechnerd They say Monaco is a sunny place for shady people
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    Med school is toxic and residency even more so.

    The problem with docs is we are the best in the world at taking tests. We have been conditioned since an early age to make the best grades possible. Give us a book tell us we will be tested on it and nobody will do that job better. And then at the end we get a grade, a nice objective way to evaluate our performance and compare how we did to our peers. Quickly we learn how cut throat the game is, the cream rises to the top and your scores rapidly begin to define you.

    When I first took the MCAT I scored in the bottom 10%. I was a toxic leper. Nobody wanted anything to do with me. I went from ignorance about the test to expert as quickly as I could and later scored in the top 10%. I was the belle of the ball. I didn't somehow turn into a different person though, I just figured how to take the test which is half the battle.

    The scores and grades obsession was only getting started though. Med school and residency are an onslaught of judging and one-upmanship. Complicating matters are the socially awkward personas of the matriculants themselves. While most of us were out partying and developing social skills in HS and college the doctors-to-be had their heads buried in a book. This is why most of them are so painful to be around. And their competitive nature isn't easily turned off after they finish residency. They just find other ways to do so...get a big house, fancy car and flash their money. This is why building the narrative of Shock Linwood was so easy.

    With regards to CME it's become a huge racket. So many for-profit companies have emerged in the last 5-10 years. And think about it, there is free money just waiting for the taking. Most employers offer $3-6,000/yr or more in CME money. I've seen some offer $12,500/yr. And the requirements for use are pretty loose at best. Most docs use it for a vacation (you'll find there are not too many CME events in Waco or Topeka) and you can find multiple conferences every weekend in Vegas or Hawaii for example. The new brazen CME's are offering gift cards (Amazon, apple, Best Buy, etc) in exchange for buying access to their online CME questions and articles. It's basically a defacto way of converting your CME money into currency.
     
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  12. Name P. Redacted

    Name P. Redacted I have no money and I'm also gay
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    It's pretty amazing how often people think my fiancée is going to be a nurse when I say she's in med school.
     
  13. RonBurgundy

    RonBurgundy Well-Known Member

    This doesn't represent my experience at all, but obviously everyone has/had different experiences and journeys.
     
  14. lechnerd

    lechnerd They say Monaco is a sunny place for shady people
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    Pics?
     
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  15. Name P. Redacted

    Name P. Redacted I have no money and I'm also gay
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    You'd get to see them if you had accepted my offer to Shock to be Facebook friends
     
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  16. wes tegg

    wes tegg I'm a Guy's guy, guys.
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    Any of y'all in ortho? If so, I'd appreciate the help on this. I've got the following MRI report and need to know whether there's anything about this that would make it more likely caused by trauma than by degeneration. The relevant history is that you've got a 55 year female regular smoker who was bumped by a car in a parking lot and fell onto a slightly elevated sidewalk (and potentially a trashcan on that sidewalk, but it's hard to tell).

    Findings: There are degenerative changes at the AC joint with thickening of the joint capsule. The glenohumeral joint has a small effusion. The biceps and subscapularis tendons are intact. The labrum is unremarkable. The supraspinatus tendon shows slender complete tears near its attachment on the greater tuberosity of the humerus with tendinopathy. The infraspinatus shows mild tendinopathy without tear. There are subchondral cysts along the glenoid. No fractures or contusions are noted. There is mild sub-deltoid bursitis.

    Opinion: Slender tears of the supraspiinatus tendon near its intersection with tendinopathy. Tendinopathy of the infraspinatus without tear. Mild sub-deltoid bursitis.

    TIA.
     
  17. AlternativeFactsRule

    AlternativeFactsRule Mmm ... Coconuts
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    Don't you have paid experts you can call?
     
  18. wes tegg

    wes tegg I'm a Guy's guy, guys.
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    Yeah, but I'd rather hear from somebody impartial before I paid one to say what I need him to say.
     
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  19. Leeroy Jenkins!

    Leeroy Jenkins! At least I have chicken
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    She's 55, those tears were already there (esp depending on the patient's line of work) based on age but you you can't prove it wasn't from the bump based on this static snapshot.
     
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  20. wes tegg

    wes tegg I'm a Guy's guy, guys.
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    Thanks. :respek: Fortunately for me, I don't have to prove it wasn't. They have to prove it was. She's a CNA at a nursing home, FWIW. So, she does do a lot of lifting and moving patients.
     
  21. lunchbox

    lunchbox ...
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    Been in orientation, so i have been busy, but monday is my first official day of being an intern. Yay.
     
  22. Scott Van Pelt

    Scott Van Pelt President of the Hate Avery Johnson Fan Club
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    Congrats. What field?
     
  23. lunchbox

    lunchbox ...
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    Internal
     
  24. skeezy

    skeezy what is this? meowschwitz
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    Finishing up mine. It's crazy to see how you change from July to June. buckle up
     
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  25. Leeroy Jenkins!

    Leeroy Jenkins! At least I have chicken
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    Get back to work and take your beating 'tern!
     
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  26. killrbee7

    killrbee7 EMAGin' and Swaggin'
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    Those findings were 99.9% likely to have already been there.
     
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  27. Leeroy Jenkins!

    Leeroy Jenkins! At least I have chicken
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    I'm sitting for my ortho boards in a month. Residency and medicine in general has been a ride of ups and downs but i'll say it as, there's good people and there's assholes in every aspect of business. Everyone is always trying to make a buck anywhere they can; this is becoming more evident in medicine, the more and more pennies are pinched.
     
  28. Lyrtch

    Lyrtch My second favorite meat is hamburger
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    wifes going into third year IM

    job search is on

    its nuts
     
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  29. Can I Spliff it

    Can I Spliff it Is Butterbean okay?
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    Tell me about MD/PhD's. Is there a lot of wiggle room with the PhD's, like doing a Bioengineering/Biophysics track, or are they limited to stuff like immunology?
     
  30. AlternativeFactsRule

    AlternativeFactsRule Mmm ... Coconuts
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    I would only recommend getting an MD if you wanted to actually practice medicine.
     
  31. Leeroy Jenkins!

    Leeroy Jenkins! At least I have chicken
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    You can do whatever you want
     
  32. Can I Spliff it

    Can I Spliff it Is Butterbean okay?
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    What if my goal is to fast track to a head biotech development position? It is my (poor) understanding that non-MDs coming up are stonewalled?

    That is both awesome and very frightening.
     
  33. AlternativeFactsRule

    AlternativeFactsRule Mmm ... Coconuts
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    I have no idea about that, but I wouldn't consider getting an MD to be any kind of fast track. It's also an incredibly expensive investment. Most of what you learn about being a doctor happens during your residency which is another long time commitment with deferral of decent compensation. If the biotech development is the type of tech that's going to be used by fellowship trained physicians, that's a further commitment. It's a lot of work, a lot of time, and a lot of deferred income for an outcome that's in no way guaranteed.
     
  34. Can I Spliff it

    Can I Spliff it Is Butterbean okay?
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    Are MD/PhDs not fully funded? I thought that was their allure
     
  35. Leeroy Jenkins!

    Leeroy Jenkins! At least I have chicken
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    They are, paid for by NIH
     
  36. lechnerd

    lechnerd They say Monaco is a sunny place for shady people
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    I used to think this but there are tons of non-traditional jobs for MDs that I never knew existed.

    One company tried to recruit me to become an expert witness for them as an MD. They were a consulting firm that big law firms would use and employed a ton of engineers, MD's, geologists, etc. and they did a whole host of functions. It paid incredibly well but required too much travel for someone with a family.

    One of my good friends finished Med school and got his MBA while in Med school. He never went to residency and went straight into work for Aetna and now is the COO of a new biomedical startup. Never practiced medicine.

    I have many MD friends that are in utilization review and are happy.

    I have one friend who only works part time and he supervises 4 mid-levels who are doing their own thing but they can't operate without supervision so they pay him to be their medical supervisor. He reviews about 5-10% of their electronic charts and occasionally stops in to say hello.

    Plenty of non-practicing options.
     
  37. Can I Spliff it

    Can I Spliff it Is Butterbean okay?
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    Can you PM me this company name? I know someone with a geology degree that is looking to try something new
     
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  38. Leeroy Jenkins!

    Leeroy Jenkins! At least I have chicken
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    Thats the dream.
     
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  39. lechnerd

    lechnerd They say Monaco is a sunny place for shady people
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    Give me a sec, I'll see if I can find it.
     
  40. Can I Spliff it

    Can I Spliff it Is Butterbean okay?
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  41. skeezy

    skeezy what is this? meowschwitz
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    Met our new ones yesterday. I'm going to make one cry. So excited
     
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  42. hudson

    hudson Oh, you know...stuff.
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    Interestingly enough, I get mistaken for a patients doctor a significant portion of the time just because I'm a guy in scrubs in their hospital room.
     
  43. clemsonvianj

    clemsonvianj Well-Known Member

    most of the time I want to murder the idiots who give me sign out.

    "um, eh, uh, this is a 60 year old male who apparently, um, uh, had a bypass...oh, uh, actually it was tamponade. so on Thursday, she was, um, not doing well so we got consulted."

    like I can't fucking read how old they are and what they're here for you stupid fucks. tell me what we are doing in one sentence and what I need to watch out for. don't give me a fucking soliloquy where you go back and forth between the patient being male and female five times while not telling me any useful information.
     
  44. skeezy

    skeezy what is this? meowschwitz
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    long signouts make me irrationally angry
     
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  45. skeezy

    skeezy what is this? meowschwitz
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    hes cried 3 times :3
     
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  46. lechnerd

    lechnerd They say Monaco is a sunny place for shady people
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    Good article on the death of the primary care physician:



    I think we’ve been headed to extinction for a while but these new big company mergers will signal the burying of our casket.

    There is a small town west of San Antonio and at least one person from one family, the Meyers, have been the town doc for over 100 years. The oldest Meyer had a horse and buggy and no clinic. He would ride house to house with his small black bag, deliver babies, perform surgeries, everything. A few months ago the local hospital essentially forced them out and the Meyers are now practicing way outside of town.

    Here is a neat article mainly about the youngest, Dr Emily Meyer, but touches some on the family history.

    https://news.uthscsa.edu/meyers-make-sure-there-is-always-a-doctor-in-hondos-house/

    The article is nearly 15 years old so it’s before the family was forced out of town.
     
    #397 lechnerd, Apr 8, 2018
    Last edited: Apr 8, 2018
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  47. RonBurgundy

    RonBurgundy Well-Known Member

    This issue isn’t big corporations or technology or anything inherently wrong with primary care, it’s that fee for service values shitty, brainless wasteful medicine like people coming in for uris being valued as much as people getting their diabetes and hypertension managed.

    So of course some company is going to come in and build an UC or virtual visit app platform to steal those easy, shitty appts and take business away from regular pcp visits. That’s capitalism in a fee for service world.
     
    #398 RonBurgundy, Apr 8, 2018
    Last edited: Apr 8, 2018
  48. lechnerd

    lechnerd They say Monaco is a sunny place for shady people
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    There’s more than one reason.

    When I mentioned big companies/mergers I’m referring to the power that comes from strength in numbers. Very few primary care docs are out on their own these days. When you negotiate rates as a single provider you get close to break-even reimbursement rates from the insurance companies. Whereas the larger corporations have more leverage when it comes to negotiating rates. At that point primary care becomes whatever the corporation wants it to be. And if that large corporation is a hospital (NY Times said they now have nearly 1/2 of the entire primary scene) none of what they create is geared towards preventive care. The more emergent and acute medicine becomes the better they can feed their MRI’s, their surgical centers, their ER’s, etc.
     
  49. Cousin Eddie

    Cousin Eddie Lookin for the place called Lee Ho Fook's
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    2nd year starts tomorrow :chan:
     
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