It’s been awhile since I’ve posted, and I’ve been getting emails asking if I’m still around. I’m here, but I’ve really taken a hiatus from the whole medical school thing recently. Now that I’ve been out of the game for awhile, it’s getting tougher and tougher to post shit about medical school.

I’ve recently taken on a new client in a revenue-sharing agreement, and I’ve been working hard at that. I’m currently reading a book on personal finance that kicks all kinds of ass, and should be required reading if you’re of high-school age or above. I think I’ll write more about that book in near future, but right now I’m kicking back and pulling in the $$$ doing what I love.

I’m not disappearing forever, but I’ll definitely be posting less in the future. Just giving you guys a heads up, but I love what I do and when I’m doing it, it’s like a vacation.

Updates soon (hopefully).

Hoover

Popularity: 1% [?]

Ahh, July 1st.

It came around so fast, just a mere two months of sleeping in and traveling since you walked across that stage with your medical degree in hand. Today’s a new day. Today begins the ritualistic flogging of new interns across the nation.

Waking up at 7am used to seem early, but now it will be considered late.  Weekends will now simply be another work day of another work week. Pimping will take on a whole other meaning now that you have to grin and bear it. Personalities that you thought never existed will be encountered every minute of your existence. While once sacred in your mind, medicine will — at some point — be something that you hate, even for a brief moment.

With the sound of a beeping pager going off somewhere in the background, we welcome you to Hell.

We’re glad you’re here.

Popularity: 7% [?]

A recent story in the New York Times talks about some of the reasons physicians are frustrated with medical practice today. I’ve outlined some of the more concerning reasons below. Please, for your own well-being, consider these before you dig yourself too deep into the medical school hole.

1. Loss of Autonomy
“I’d write a prescription,” he told me,” and then insurance companies would put restrictions on almost every medication. I’d get a call: ‘Drug not covered. Write a different prescription or get preauthorization.’ If I ordered an M.R.I., I’d have to explain to a clerk why I wanted to do the test. I felt handcuffed. It was a big, big headache.”

2. Payment Denials
“Thirty percent of my hospital admissions are being denied. There’s a 45-day limit on the appeal. You don’t bill in time, you lose everything.”

3. “Informed” Patients
“Stories of patients armed with medical knowledge gleaned from the Internet demanding antibiotics for viral illnesses or M.R.I. scans for routine symptoms are rife in doctors’ lounges.”

4. Malpractice
“Malpractice worries also remain at the forefront of many physicians’ minds, compounded by increasing liability premiums that have forced many into early retirement.”

5. Decreased Realized Income
“Doctors are working harder and faster to maintain income, even as staff salaries and costs of living continue to increase. Some have resorted to selling herbs and vitamins retail out of their offices to make up for decreasing revenue. Others are limiting their practices just to patients who can pay out of pocket.”

6. Declining Reimbursements
“A 10.6 percent cut in Medicare payments to physicians is scheduled to take effect on July 1. Further cuts are planned in coming years. Many doctors have told lawmakers that if the cuts go through, they will stop seeing Medicare patients. But reimbursement cuts are only a small part of doctors’ woes today.”

7. Naive Pre-Meds
“I was naïve, Saeed Siddiqui said. When I was a resident I thought it was enough to take good care of patients. But the real world is totally different.”

The practice of medicine has made its way over the hill. Don’t say I didn’t warn ya.

All quotes taken from the original article.

Popularity: 8% [?]

I’m not a fan of socialized medicine. I firmly believe that health care is a privilege and not a right. Many people — including uninformed pre-meds with high hopes of saving the world — think socialized medicine is the best thing since sliced bread.

Doing some reading today, I came across a reply to an article on $8 per gallon gasoline. Here’s what this person had to say, emphasis mine:

“You have never lived in a country with social medicine. I have and it does not work. It took me six months to find a doctor in Canada… everyone’s shining example of a great social health care success story. I was told by their social medicine govt office to call all of the doctors in the phone book and I might get lucky. I tried to get my knee repaired (ACL reconstruction) however, the waiting line was too long ( 15 months) so I went to the states and had it done in two weeks. I was in England and hurt my knee and could not get a doctor to prescribe pain medication nor get me crutches to walk. Montreal has five major hospitals all with CAT Scan Machines…4 out of 5 broken and the fifth with out of date software. Keep in mind social medicine is not medical care on demand, they prioritize and categorize, my age, health and whether the surgery or care is needed. What you don’t hear is the number of Canadian citizens that come to the states to get medical care that they cannot get in Canada. Additionally, the average monthly tax rate in Canada of my peers was close to 50%.”

Does this sound like a great system to you? People need to wake up and realize that socialized health care is not equivalent to easily-accessible, cheap (or free) medical care on demand. This is just one of probably many examples of why it doesn’t really work.

Popularity: 11% [?]

The Committee on Optimizing Graduate Medical Trainee Hours and Work Schedules from the Institute of Medicine in Washington, DC is making their final report in nine months and recommend decreasing maximum work hours from 80 to 56 per week. That’s the inside word, anyway.

All I can say is about f’ing time.

It looks like strong support for the care of patients as well as the care of those providing that care is fueling this fire, and I believe the old-schools are probably shaking in their boots right now. This rule change looks to be garnering quite a bit of support.

Additionally, training programs consistently violating the rules as if they’re part of some game probably have a lot to do with the proposed rule changes as well:

Furthermore, we know that despite rules being put in place in 2003 to govern resident work schedules that the culture and traditions remain very strong. What we need are some levers—maybe even some financial levers—to make it easier for people to do the right thing.

Like I said in a post way back — it’s all about the Benjamins. On one hand this could mean yanking funding and even hefty fines (i.e. hundreds of thousands to millions) for training programs that don’t play nice this time around. On the other hand, “levers” could also mean an increase in funding to those programs who are rule-abiding citizens. Either way, it’s about f’ing time.

The primary task of this committee will be to focus on four areas:

• Synthesis of the current evidence base on graduate medical trainees hours and works schedules and their impact on safety.
• Identification and development of strategies, practices, interventions, and tools that can be used to implement reasonable work hours.
• Analysis of both the potential benefits and harms of updating work hours and schedules.
• Short- and long-term recommendations for action by various stakeholders and interim strategies and policies for implementing these recommendations.

According to the thread at SDN, the only problem yet to be tackled is length of training. But, it’s a big one.

I’d say that many people are willing to put up with the extra-long work hours in order to be done with an Internal Medicine residency (for example) in three years. However, there are undoubtedly countless others who would prefer to live a more “normal” state of being and extend training by a year or two.

I guess it really all boils down to how much you really want it, but I see this coming out into the light sooner rather than later. No matter how you slice it, “only” 80 hours per week is the biggest joke I’ve seen in a long damn time.

Popularity: 15% [?]