Doctor Nurse (NOCTOR) Shopping at Costco

[caption id="attachment_736" align="aligncenter" width="600" caption=""Oh no she didn't!""][/caption]

 Just when you think you have seen it all folks.   Mad props to "DREDAY" over on the SDN forums for capturing this pic at a recent trip to the local Costco (who verified that this was indeed a doctor nurse from the labeling on the white coat).   They say a picture says a thousand words.  I think it says a million.  Still wondering why I finally had enough?  The bastardization of American healthcare marches on.

Goodbye Medicine

"I find I'm so excited I can barely sit still, or hold a thought in my head. I think it's the excitement only a free man can feel. A free man at the start of a long journey who's conclusion is uncertain. I hope I can make it across the border. I hope to see my friend, and shake his hand. I hope the Pacific is as blue as it has been in my dreams. I hope."

 

http://www.youtube.com/watch?v=YInN9mc9vXA

 

One for the Emergency Medicine Docs

Nothing like a good Xtranormal video to portray a day in the life of an ER doc.  So funny because it is so damn true!  The original version that garnered over 1 million views was pulled down but here is an equally entertaining remix.  Enjoy!

Scariest Graph Ever

“Until recently, I thought that there would never again be an opportunity to be involved with an industry as socially destructive and morally bankrupt as the subprime mortgage industry. I was wrong. The for-profit education industry has proven equal to the task.” -Steve Eisman (renowned hedge fund manager who called the housing market collapse)


I have been preaching for almost two years now how the student loan crisis is shaping up to be one of the most catastrophic financial disasters to lay assault on this country. And it is. Education in America has been hijacked by a cartel of banking thugs and administrative wolves cloaked in sheepskin all in cahoots with the US govt. Though the media has SLOWLY been picking up on this issue, our govt continues to sleep behind the wheel (surprising?). I have done quite a bit of research on this very topic and have quite frankly been blown away by all the disgusting corruption and greed that goes on behind the curtain. Everything from former for profit college lobbyists now working at the Dept of Education to recruiters drumming up warm bodies at homeless shelters to the University of Phoenix's impressive 4% graduation rate for online students is enough to make my head spin in utter disbelief.
Today in France the youth are protesting in droves after the govt proposed raising the retirement age from 60 to 62. I can only imagine how they would react to our student loan situation! We should be in the streets going ApeSh!t over this. Check out the graph above and see for yourself how this bubble is inflating beyond belief. It makes the recent housing bubble seem like a mere blip! Scary graph indeed!!!

YAY! 4 Year Family Medicine Residency

Gunner Jumps for Joy at Thought of 4 Year Family Practice Residency

I thought this was a joke but then I realized that April Fool's Day was over 2 months ago!

Wanting Out

I was honored to have been invited to write a guest post over on EarlyRetirementExtreme where I talked more about my desires of "Wanting Out" of Medicine.   If you haven't already, I highly recommend you check out Jacob's blog and read more about his story of how he was able to retire at the age of 30.  It is also a great place to read comments from others who share a similar philosophy on living.   For my regular viewers here, I will repost my piece below:

"When I was first asked by Jacob to write a guest post, I was excited yet also a bit overwhelmed as to how to approach the task. After some thought, I’ve decided to focus more on what led me to where I am now rather than vent on and on about what is wrong with our broken American health care system. Anyhow, one blog entry would simply not be enough to do that topic any justice. I figured if anyone was interested in hearing about the crap I put up with on a daily basis they could always read more over on my blog, medicinesux.

With that said, to deny that any of these outside forces did not play a role in my growing disenchantment would be naive. Yet at the same time, a growing realization that built up from within me collided head on with what was happening to me on the outside. It is these internal feelings and how I came to learn of them that I would like to write more about here.

It is hard to say whether I would’ve found out about the concept of voluntary simplicity if it weren’t for the fact that my career in medicine came to tax my soul to no end. I’ve always compared my journey in medicine up until now to that of a marriage gone terribly wrong. So bad in fact, that I am about to file for a divorce. I thought I had found a diamond, but instead I picked up a rock. I had the best of intentions going in and in the beginning everything was going quite well, but with the passage of time things started to slowly come apart. For as long as I can remember, I always vowed to myself that I would choose a career where I could help people and make a difference in the lives of others. I also had a knack for science and did all the prerequisite health care volunteer work from working in a nursing home to joining the university EMS squad. So, I was quite excited to apply to med school. The first two years of med school where one learns the meat and potatoes of medicine in the classroom were interesting (the honeymoon phase). I always loved learning new things especially when it involved the human body. However, upon entering the clinical rotations in third year, I began to get a taste of the ugly side of medicine. And in residency I was getting fed it with a shovel. And as an attending, it is the same BS but now you bear all the responsibility when the shit hits the fan. (Here is where I would start going on an explosive tirade but I will refrain.) I began to realize that 30 more years in medicine was simply not going to happen. I needed an out, but how to go about it???

For starters, I started my blog about halfway through my residency. It was a way for me to get out my frustrations and stay sane. After working 12 or gasp…24-30 hr shifts at the hospital, I would also come home and spend my evenings online diligently seeking out more information to plan my escape from medicine. It is around this time that I learned the concept of “Early retirement” for the first time. It was like a lightening bolt went off in my head. I remember thinking to myself that this was it! This was my answer to finding my freedom. Hearing of stories of how others were able to do this on early retirement forums and blogs such as Jacob’s opened my eyes like never before. Only if I had known about this pathway a decade earlier, I could’ve spared myself so much grief! Yet I don’t think I would’ve ever found it if it wasn’t for the fork that I took in the woods when I decided to go to med school.

I had always been a frugal person but like everyone else I had my splurges. I knew in order to make this early retirement thing work out, I had to put the plan in ultra drive. I immediately called up the building management the following week to tell them that I would not be renewing my lease which was soon to be up. Two months later, I moved two blocks over to a tiny walk up studio which effectively cut my rent in half for the remaining two years of my residency. I hired some guy with a van on craigslist to move my belongings for 150 bucks. Well worth it since I had no car living in the city (I walked to the hospital) and didn’t have much time either since I was a busy resident. After moving in, I felt so much “lighter” living in a smaller place which completely fit my needs. After seeing how quickly I could save money, even given my meager resident salary, I became hooked. Every dollar saved meant I was that much closer to getting out for good. I went as far as sitting in my underwear when it was 90F degrees out so I didn’t have to turn on the A/C! Yes, I wanted out that bad. LOL

So here I am, about nine months out from finishing residency. The days are as painful as ever and I am exceedingly close to pulling the plug for good. The fancy car, McMansion, and latest toys and gadgets no longer mean anything to me like they once did. Money is like a drug. If you let it consume you, it can really take over your life. Sacrificing my time and freedom to become enslaved to a career that has sucked me dry is simply not worth it. I have found an inner peace that I would never have achieved if I were somehow able to remain in medicine. I believe that knowing when you have enough and appreciating what you have without killing yourself for it is the key to finding this serenity.

Some people outside of medicine may think I am insane for walking away at this point. My response is F them. Until one walks a day in my shoes they cannot really judge. Interestingly, many fellow physicians would leave in a heartbeat but have bogged themselves down with mortgages and other debts and are trapped. The golden handcuffs of being a doctor can be a terrible thing. I’d rather have my hand amputated than have those things put on me. I wish I had the tolerance to stay longer but I simply don’t have it in me much longer. I am long past my expiration date as it is. During this whole process, I learned that I need to live for myself first. I really don’t give a damn anymore what society esteems, from how much money we make to what jobs we hold. I just want to be free."

A Nurse May Soon Be Your Doctor

 



"28 states are considering expanding the authority of nurse practitioners"

"And if they hold a doctorate, they want to be called "Doctor."

"Medicare, which sets the pace for payments by private insurance, pays nurse practitioners 85 percent of what it pays doctors"

"The health care overhaul law gave nurse midwives, a type of advanced practice nurse, a Medicare raise to 100 percent of what obstetrician-gynecologists make — and that may be just the beginning."

"The American Nurses Association hopes the 100 percent Medicare parity for nurse midwives will be extended to other nurses with advanced degrees."

"I don't think patients are ever confused. People are not stupid," said Linda Roemer, a nurse practitioner in Sedona, Ariz., who uses "Dr. Roemer" as part of her e-mail address. "

And my response to all this:  "Why even bother going to medical school anymore?"

60 HR Work Weeks Coming?

As if working 80 hrs a week was even remotely sane to begin with. If this ever comes to fruition, it will be way beyond overdue. 

Read the comments section from the Washington Post article below for some interesting perspectives. Who would've thought that the lay public would rather not be treated by a resident who has been up all night? Check out the good clashing going on between the old timer physicians and the younger crop of docs who are viewed as "lacking commitment". One of these geezers even threatened to recommend his hospital stop taking residents if this were to go through

60 HR Work Weeks Coming?

One of the major complaints being voiced is that the hours of clinical training will no longer be sufficient. Though I believe this has some merit, I also see sour grapes from those who want to continue the hazing process and also from admin who will be losing their cheap slave labor. Too bad.  I've worked numerous 30 hr shifts myself as a resident and I'd rather not see anyone else coming up behind me forced to endure the same just because I suffered.   This wildly abusive system needs to be taken out of service once and for all. So what to do to make up for these lost hours?   I would chop off the fourth year of med school (which would also save a whole year of egregious tuition costs on a fairly useless year) and transform it into a mandated internship for EVERYONE no matter what specialty they eventually pursue. This infusion of 20K extra bodies would also help cover the increased hours that would need to be covered. This internship would be done at the hospitals your med school is affiliated with so there would be no applying. During this internship you would than apply to your respective residencies. Of course, med schools and hospitals would pitch a fit over this proposal since they would be out our student loan money.

Introducing the "MOPING" Specialties

Many of us have heard of the acronym, ROAD.   The saying goes that anyone fortunate enough to have landed a residency in one of these specialties is well on their way to the "road" to happiness.  Though each of these fields have their own particular issues, they are known for affording better lifestyles with lower hours and better pay.  For those of you not in the know, ROAD stands for:

R-  Radiology

O- Opthalmology

A- Anesthesiology

D- Dermatology

May I now introduce to you, MOPING.  Those who choose one of these specialties risk finding themselves indeed "moping" in the future.  Don't say now that you haven't been warned! 

M-  Medicine (Family) (need to know a lot about everything and get paid crap; "noctors" intruding on the field)

O-  Ob/Gyn  (wildly erratic hours, malpractice rates that would leave you breathless)

P- Pediatrics (lowest paid specialty; crazy parents)

I- Internal Medicine (sucks so bad no explanation needed, only hope out is doing a second residency....I mean fellowship)

N- Neurosurgery (brutal 7 year residency with brutal hours; essentially sacrificing your life for a higher calling)

G- General Surgery (demanding 5 year long residency, some very malignant personalities to deal with, your mechanic gets paid more to fix your car than the surgeon who removes your appendix)

"I'm a Medicare Doc- Here's What I Make"

  

      Every year, physicans across the United States tremble at the thought of having their medicare/medicaid reimbursements slashed.  However for the first time, the guillotine began to fall on  March 1st.    This deadline came and went without reversing these cuts (there has now been another temporary extension till the end of the month from what I undersand).  If we have come this close to getting the axe, it is only a matter of time before these devastating cuts go through for good.  Check out this must read article from today's CNNMoney and you will easily see how damaging this situation will be.   Because fixed costs (office rent, payroll, malpractice insurance, medical supplies, etc.) do not decrease in tandem with medicare reimbursement, a 21% drop in Medicare pay means the physician will be losing A LOT MORE.   For example, say a practice nets 500K a year but pays out 350K for overhead costs. That leaves 150K net pay. But with a 21% drop in reimbursement from Medicare (and I am making the valid assumption that private HMO's will similarly follow these cuts), the gross revenue from your practice is now down to 400K leaving you with a whopping 50K a year in pay!  Good luck paying back your 250K student loan debt on that while working like a racehorse 60 hrs a week not being able to take a vacation!  As you can clearly see, one must magnify every percentage drop in reimbursement many times over to see the damaging end result.

        My advice to any high school student that happens to come across this blog is to THINK TWICE BEFORE GOING DOWN THE LONG ROAD TO BECOMING A PHYSICIAN!  Unless your conviction is as strong as that of Mother Theresa's and you are willing to take on a vow of poverty, you really should consider doing anything else that you may have the slightest thread of interest in.  If you love art, become an artist.   If you enjoy children, teach kindergarten.  If you like cars, become a mechanic.   Besides, you will probably wind up making the same or even more in these careers down the road without any of the debt.  Medicine has gotten worse for sure but I am outright frightened to see what the landscape will be like in another 10 years.  You see the arrow at the top of this posting?  That is exactly where we continue to be heading with NO RELIEF in sight.  Ask yourself this.  Will tuitions ever decrease?   Will medicare and HMO's ever increase their reimbursements?   Does the US govt get anything done nowadays to better the lives of their citizens aside from endless quarreling?  No, no, and no....point made, case closed.

Bronx Woman Gets $60 MILLION for VAGINA Injury

        Actually, the labia to be more precise.  According to this article 60,000,000 US Dollars (Yes, MILLION) were awarded by a Bronx jury to Ms. Alison Hugh this week after she sustained an injury to the involved private after going for a cosmetic thigh lift procedure. 

        If this particlar case does not scream TORT REFORM, quite frankly I don't know what does.  You would think for 60 million that she lost 2 arms, 2 legs, an ear, and an eyeball.  This is even above and beyond brain damaged baby territory.  Here we have a clear cut example of how runaway juries can dole out valuable healthcare dollars like monopoly money and why ambulance chasing lawyers are so eager to play the healthcare lotto.  What I find even more shocking than the jury award is the fact that I would never have known about this case if it weren't for the above lone article.  Apparently, exorbitant malpractice awards have become so matter of fact that they rarely even make the headlines anymore.  Meanwhile, healthcare costs continue to rally upwards as physicians pay ever mounting malpractice premiums and order more needless tests to rule out that needle in a haystack.   In the end, we all wind up paying for this woman's almighty precious labia.

Millionaire Gives Away ALL His Money

        Check out this story of Austrian millionaire, Karl Rabeder, who is giving away every penny he ever earned in his lifetime. Mr. Rabeder states that "My idea is to have nothing left. Absolutely nothing." He plans on raffling off his £1.4 million villa in the Alps and £613,000 farmhouse in Provence and giving all the proceeds to charities in Latin America. He will then downgrade to a simpler existence by moving into a "small wooden hut in the mountains" or a "small bedsit in Innsbruck". I was particularly struck by his following comment, "More and more I heard the words: 'Stop what you are doing now – all this luxury and consumerism – and start your real life. I had the feeling I was working as a slave for things that I did not wish for or need." I have the feeling that there are lot of people doing the same thing."
        I must say that this story really hit home with me. Like so many other Americans, I confess to being bound to the gravely mistaken belief that by working oneself to the bone one is able to accumulate wealth and happiness will ensue. However, after toiling away in a career that continues to shred me apart from the inside out, I realize more and more how trading one's valuable time in exchange for money to buy STUFF is one BUM deal. This becomes even more apparent when you find yourself working 60-70 stressful hrs a week in a job that you don't particularly enjoy. Part of the reason why I have become so tight with money is because I realize how painful it is to make. Is that Mocha Frappuccino really worth the one hour of torture I had to endure in the hospital? Let's take it up a notch. Can I make do with a perfectly reliable Honda Accord versus BMW saving me 20K which will spare me 10 hours of hospital waterboard torture per week for a whole year? Let's go even further. If I am willing to embrace simple living, could I possibly transition from a highly toxic career to one with less hours that is infinitely more enjoyable? Or perhaps even, if I can keep my expenses low enough could I even retire for good? Not possible you say? Well here's one guy who has done it at the early age of 31 www.earlyretirementextreme.com
        I often wonder why it is that we lust after things made by man while what God has given us is not fully appreciated. No amount of money can buy a walk along the beach on a cool crisp September morning while the sun begins to peak over the horizon or the experience of trying to find the Big Dipper with your kids as you lay on the grass in the backyard gazing in awe at the darkness of the night sky. However, you would be too busy at work to even take notice of such things. Happiness is right before you but you don't have time or the clarity of mind to see it. Society commends us for working like slavehorses so we can buy "things" to show off to others or to give us a quick fix to feel better about ourselves. I, on the other hand, now see this way of living as outright asinine. Instead, I'll take having the freedom to do whatever I please with my time.  Now that's priceless!

Pic of the Year!

CRNA SMILING WHILE PATIENT CIRCLES THE TOILET



I nominate Coastie, from the SDN forums, a Pulitzer Prize for this find! The CRNA smiling without a care in the world while the patient's blood pressure reads 76/35 is ......well......uh.....(can anyone think of a word that encompasses the thoughts of shocking, hilarious, outrageous and disbelief all rolled in one?!)

CRNA Retires After 40 Years

If Air Travel Worked Like Health Care

IF AIR TRAVEL WORKED LIKE HEALTH CARE


there would be 757's falling out of the sky like dead flies (assuming they even made it off the ground). The crushing bureaucratic BS that medicine has morphed into this nation is enough to make oneself buy a one way ticket to the insane asylum. If you took all the paperwork that I wrote during my internship alone, I am sure it would easily top the 560,000 words in Leo Tolstoy's War and Peace. Makes going to work everyday just that much more pleasurable.

ER Resident Posts Cadaver on Facebook

and is now in SERIOUS hot water (now being investigated by state health dept and her ER residency at Stony Brook University Hospital on Long Island where she is a PGY2 is now on the line). The above photo which was taken by this resident of a fellow medical student (who could also find himself on the chopping block ...Thanks for the tag!) is apparently now going viral and can easily be found online with a simple google search. Now whenever this particular resident googles her name, hundreds of hits involving this incident will pop up for posterity! You know future employers are going to love that! I wouldn't be surprised if this story winds up on the front page of yahoo real soon. To those on the outside of medicine, this pic of a medical student giving two thumbs up in the presence of a cadaver could be erroneously seen as being as sensational as those involving the prison wardens of Abu Ghraib.



You can read more of the lurid details here 

Looks like one of her facebook "frenemies" turned her in. Reminds me of the story I posted sometime back about the chief surgical resident in Arizona who got expelled from residency after taking a pic of his patient's hot rod penis on his phone cam and was allegedly snitched out by one of the OR nurses (according to a source). In the cut throat world of medicine this does not surprise me in the least.

Why is photography even permitted in the gross anatomy lab in the first place with cadavers all over the place??? This is 2010 and we now live in the digital age. I'm sorry but this resident is so screwed. She would have been better off having a secret sex tape leaked involving her than this. Don't laugh. I am sure if given the choice she would agree with me and you would too!

MD Underground

Thanks to www.jdunderground.com and the suggestion of others in the medical community, I have been inspired to start the medical version- www.qfora.com/mdunderground/ .  Since medicine is going to hell in a handbasket, I strongly feel we need a forum of our own. The starting of this forum is even more imperative since SDN (Student Doctor Network) has been undergoing a recent Chinese crackdown where more vocal members have been threatened and outright banned for speaking the truth on the harsh realities of pursuing a career in medicine. Numerous threads have also been moved, locked, and outright shut down. I welcome you to the break away republic of  mdunderground where the truth shall finally prevail over censorship.  Please please please contribute to ensure it's success so we can get it off the ground!  Registering takes two seconds and you can be posting right away.

Thoughts on Sicko

        Thanks to www.tiphero.com, I learned of a website where you can watch some of your favorite documentaries for free at freedocumentaries.org. Much to my pleasant surprise, Michael Moore's Sicko was one of the featured films on the front page. Being that I never got the chance to watch Sicko and had a dreary Sunday afternoon to kill some time, I thought this was the perfect opportunity to view this film. Let's just say that all my feelings of angst regarding our broken healthcare system have been reaffirmed.
        The gripping stories of typical Americans are real and their wrenching testimonies can not be discounted. Juxtaposing our system to those of Canada, the UK, France, and gasp ...Cuba, only accentuates the needless absurdity that ours has become. Only in America would a for profit model like this be ever be introduced in the first place. The HMO's are no different from the big banks in this country who have bought out Congress to further their own domination. They are an unnecessary parasite who have siphoned off billions of healthcare dollars that should've gone to the sick. Think of the number of cancer treatments, organ transplants, or preventive healthcare checkups that could be payed for by just one HMO CEO's salary? Before this whole health reform got underway, I could've told you that not in a million years would we have one govt run system. Seriously, what would happen to the HMO's? Did we honestly think that they would just disappear overnight without a fight? Instead, they are fighting tooth over nail to rid the govt option which is on it's death bed right now.
        There are many doctors who despise Obama's quest to reform healthcare. They feel that their salaries will plunge only further. Medicare and medicaid is run by government and their reimbursements are ABYSMAL. I fully understand this opposition. Some also don't trust our government since they have a history of bungling everything up. One only need to be reminded of the Katrina disaster to see this. So what is the solution??? Since American medicine has turned into one really bad game of Jenga, I believe that the whole system needs to be bulldozed and restarted from the ground up. Medical school tuitions need to be reset to zero and those with current student loan balances should have them forgiven. HMO's would be rid off the face of the earth for eternity. Salaries should be set at a level appropriate and commensurate for the level of training required to become a doctor  (meaning NO medicare pittance rates).  Tort reform would be mandated. 99 year olds would be allowed to die with dignity instead of languishing in ICU's at 10K a day because daughter Sally demands it. Taxes would obviously have to be raised (sorry millionaires, but you will just have to cut back a mansion or two so your fellow human beings can access the healthcare system) but this would benefit the country many times over.  Unfortunately, "healthcare reform" has turned into a ridiculous folly and is only spiraling further out of control into an ever worsening bureaucratic mess.
        There is no excuse for the wealthiest country on the planet to not be able to provide healthcare to it's own citizens. I am embarassed as an American and a physician to live in a country where greed trumps generosity like this. There is a heated debate whether having access to healthcare is a basic human right. I don't get this. It is simply the RIGHT thing as a society to do.

Defining Success

 

"What's money? A man is a success if he gets up and goes to bed and does everything he wants to in between" -Bob Dylan

 

     How do you measure success? By the amount of money in your bank account? the town you live in? the type of car you drive? the schools you attended? the places you've been? the title of your job? I would say no unequivocally to all of the above. Here's a story of one person that I crossed paths with in my life that illustrates why.
     Dr. Slaughter was a highly "successful" orthopedic surgeon on staff. He would crank through patients in the OR as if it was some Michigan automotive factory back in it's heydey. Time was money and money consumed his life more than he could ever bargain for. He thought very highly of himself for training at one of the premier surgery residency programs in the country (which he "name dropped" whenever the opportunity would (forcibly) arise) and made it well known that he lived in a million dollar house in a gated community. He also had two children and was already on trophy wife number two.
     However, Dr. Slaughter was a miserable pathetic man. He would yell at the nurses, curse out his residents, belittle the medical students, and always be complaining to the administration about something. He was an absolute nightmare to work with on so many levels. He was also having an affair with one of the scrub nurses which was widely known. His wife would call him on his cell phone and the conversations were always heated. His one son was in and out of drug rehab while the other was reportedly doing very well in prep school but their relationship was distant and strained.
     I just wanted to take a moment and personally thank Dr. Slaughter. If you ever happen to come across this post, thank you for being such an asshole and showing me everything NOT to do in my life. Thank you for proving that money truly does not bring happiness and success. Thank you for making me better realize that the quest for money and success can rob you blind of your soul and divert your attention from what REALLY matters in this world. Thank you Dr. Slaughter for giving my life more meaning.
     I will end with the following poem by Edwin Arlington Robinson that I read in the eighth grade. Though I would not classify Dr. Slaughter as "a gentleman from sole to crown", I still think it is most befitting on how success can only be measured from within.

Richard Cory

Whenever Richard Cory went down town,
We people on the pavement looked at him:
He was a gentleman from sole to crown,
Clean-favoured and imperially slim.

And he was always quietly arrayed,
And he was always human when he talked;
But still he fluttered pulses when he said,
"Good Morning!" and he glittered when he walked.

And he was rich, yes, richer than a king,
And admirably schooled in every grace:
In fine -- we thought that he was everything
To make us wish that we were in his place.

So on we worked and waited for the light,
And went without the meat and cursed the bread,
And Richard Cory, one calm summer night,
Went home and put a bullet in his head.

-Edwin Arlington Robinson

The Joys of Working in a Pain Clinic

Pain Medicine Anyone?


Medicinesux, of all the specialties in medicine which one do you dislike the most? PAIN MEDICINE - Hands down by a mile.....actually, make that a lightyear! Could you even imagine medicinesux in the above scenario??? I would've spontaneously combusted before she rattled off her third allergy. (video made by youtuber "crickethk")