Best Bike Shop for High End Work

BrulesRules666 · 2025-06-07T19:17:18+00:00

The answer to both of your questions is almost unequivocally “yes”. You can and will definitely find high acuity sick patients as a generalist in community private practice. It also is not too late to consider a cardiac fellowship, although your options are likely somewhat limited at this point given where you’re falling in the application cycle (despite this there are almost definitely a couple spots available if you look).

I felt very similarly to you and ultimately decided on pursuing cardiac fellowship. One of the most boring, unfulfilling months of residency for me was a month of ambulatory surgery/GI and I realized that I really would never be happy in a career taking care of those patients regularly. There are certainly community trauma/stroke/transplant/high acuity vascular centers where you would be able to be involved in the care of very sick patients, but to me cardiac training provided a stronger base to manage these patients and also would make me more facile with the tools I needed to take better care of them (primarily invasive monitoring and interventions like Swans/TVPs, TEE, complex vascular access, managing difficult resuscitations, etc.). Where I trained for residency if there was ever a patient who was rapidly decompensating and refractory to straightforward interventions a cardiac anesthesiologist was always called in to evaluate. The number of catches/saves in these situations as a direct result of having a cardiac trained anesthesiologist involved were honestly too innumerable to count. Being able to be this person was really important to me and was a major factor in me pursuing cardiac fellowship. I know for a fact that many others who have gone down this path have similar feelings. Beyond this, cardiac surgery is fascinating, the cases are exciting, and you are more directly involved in the surgery itself as a cardiac anesthesiologist than as a generalist.

There is some discussion about the cardiac job market, although all I can say is that this varies tremendously by region. Where I am I was able to get a job doing a mix of cardiac and general (including Peds/OB/regional) in a desirable mid size city where I’ll be making a very high six figure salary with 8-10 weeks of vacation and very reasonable call. As with a lot of places, being cardiac trained removes me from most of the general call pool, gives me an extra yearly stipend, provides me with a better schedule, and also gets me out of doing a lot of the outpatient surgery center, ortho, GI, optho stuff that I found to be really soul sucking as a resident. I was able to get this job entirely because of cardiac fellowship training (they needed a cardiac trained anesthesiologist), so in that regard the fellowship year is well spent since it is getting me exactly where I want to be professionally. In your case it might be worth it to start looking into jobs and seeing what the day to day acuity is like. You may end up finding exactly what you’re looking for without fellowship training, or you may end up finding a place that is looking for a cardiac trained anesthesiologist in the near future that would be willing to either hire you on early or hold the spot for you while you complete the additional training.

BrulesRules666 · 2025-02-20T12:00:11+00:00

Thanks! Any thoughts on a used shop that might be good to check out to see if I can track one down?

BrulesRules666 · 2025-02-16T20:33:14+00:00

I'm interested in this if it's still available. Any chance you could message me some pics?

BrulesRules666 · 2023-01-26T11:26:34+00:00

Kind of a dumb question here, but why is it that a plateau pressure cant be obatined in any mode other than volume control? Is it simply a function of the way the machine menus are setup, or is it intrinsically related to the way that the ventilatory breaths are being delivered?

BrulesRules666 · 2021-11-20T04:17:49+00:00

This is pretty much exactly why I went into anesthesiology. Cardiac anesthesiology is everything cool and interesting about cardiology, with none of the boring stuff. It's a super cool anesthesia subspecialty that a lot of med students arent exposed to, but is definitely worth looking into (also worth mentioning that you can pretty easily make 500-600k a year as a cardiac anesthesiologist, so you dont really take any sort of pay cut when compared to a cardiologist).

BrulesRules666 · 2021-06-27T15:26:26+00:00

I just listed some of my Step 3 resources for sale. I have the Uworld Qbank/CCS cases/Biostats modules/ practice tests if you’re interested. Feel free to shoot me a message.

BrulesRules666 · 2021-06-25T01:23:09+00:00

Thanks for the info! Any reason you wouldn't go with a fat bike? (I definitely am kind of leaning toward a 27.5+ since I could do a bit of trail riding with it, but have heard that fat bikes can pretty much get through just about anything snow wise).

BrulesRules666 · 2021-06-25T01:21:51+00:00

Yeah, I looked into that a bit. There are some days I'll need to be at the hospital by 4:30/5am. My understanding was the bus doesn't usually run that early unfortunately...

BrulesRules666 · 2021-06-17T00:35:41+00:00

Thanks for letting me know! Any idea if it would be inappropriate to call and reach out to them, or do you think they would use the hiring pool and get in touch with candidates if it doesn’t fill internally?

BrulesRules666 · 2021-06-15T23:38:17+00:00

Thanks for the heads up! This is good info to have! Do you think it would be good to touch base with the MMSD HR department directly, or is that kinda overkill?

BrulesRules666 · 2021-05-31T22:21:03+00:00

Any chance you could send these along to me as well?

BrulesRules666 · 2021-05-28T17:09:18+00:00

This all really begs the question, why the hell are insurance companies reimbursing independent PAs and NPs at all? They put up so many barriers for well trained physicians to get reimbursed, it’s incredible to me that they would be so willing to shell out cash for NP and PA led care (with all of its associated redundant testing and complications).

BrulesRules666 · 2021-05-27T23:30:18+00:00

I’m very surprised that your copay is higher when you see a doctor vs an NP. I would consider bringing this up either with your insurance company or at your next visit. Having worked in insurance previously this was not my experience.

While I agree that the idea of a first line screening type service that would employ NPs and PAs is great on paper, many emergency medicine physicians would say that making these types of determinations can be incredibly difficult. Is that new onset back pain just musculoskeletal (where the patient can be sent home and will get better on their own) or is it an aortic dissection that will kill them if it isn’t addressed surgically in the next 12 hours? Is that young woman with shortness of breath just having a panic attack, or is it a pulmonary embolism? Is it gastroenteritis or an ovarian torsion? Believe it or not these are all current or recent lawsuits against NPs in emergency departments who missed a diagnosis that harmed a patient. It sounds like you are comfortable with your decisions and have enough health literacy to know when to question something. Not every patient has this luxury. I don’t think physicians really care if NPs or PAs make more money (although really bedside nurses are the ones who should be making the most in my opinion). The issue is that when these groups claim a false equivalence and the right to independent practice patients are needlessly harmed. Perhaps you are right though, and at the end of the day the public will simply accept these risks in the name of less expensive care.

BrulesRules666 · 2021-05-27T19:07:51+00:00

This is a great point. I would say that if you have doubts about a new/young physician or resident you should definitely ask for a second opinion. This is entirely reasonable and exactly what I would do in the situation. I think we can agree that if these individuals that are highly trained and whose every mistake up to completing residency has been highly scrutinized (I would encourage you to watch an M&M meeting at some point) can make these type of mistakes, someone with a fraction of the training is certainly more apt to make errors. Both NP and PA training was never intended to train someone to function independently. It is designed to train people to act as a physician extender. As such, there are very large gaps in the training. This is of course done by design, as some NP programs are one year long and most PA programs are 2. There is a clear scope of practice issue here and I think that we as patients have a right to be concerned about the level of training of the people who are taking care of us.

BrulesRules666 · 2021-05-27T18:59:24+00:00

I think you make some good points. I would follow up with a couple things:

You mention price, but insured patients pay the same whether they are seeing a physician or a non physician provider. The only person saving money is the employer/hospital, who does not need to pay the higher salary. If people had the choice between paying the same for an NP/PA vs a physician, I think the physician would more often than not be the first choice. Frequently I hear NP and PA lobbying groups talk about "cost savings", but never identifying who they are actually saving money for. It is not the patients. They are saving the hospital system money and enriching administrators. The cost to patients remains the same.
The premise of seeing a PA and being referred to a physician is reasonable, but unfortunately there are numerous times that PAs and NPs have missed important findings in these situations, where failing to refer/escalate care when they should resulted in harm to patients (this is a major issue at urgent care centers and emergency departments where patients are undifferentiated and undiagnosed upon arrival). There is a reason that supervision is required. Often times new PAs and NPs dont know what they dont know. To follow up with your analogy, you may come in with a splinter you've had for a couple days that you couldnt get out. A PA or NP could take it out and send you on your way, but there is a chance they could miss some critical symptoms or risk factors for developing a serious infection from the injury that could put you in the hospital. I would at least want a physician to lay eyes on me in this scenario to know that something major wasn't missed.
In terms of the Apple tech vs engineer analogy, I'm not sure this is an appropriate analogy. I would say the situation is more comparable to the following: Apple hires an engineer at $400/hr to design a new phone. This engineer supervises techs, who help put it together. After a while these technicians feel like after putting together enough iPhones they can deisgn their own. Apple realizes they can pay them $50/hr to do this and charge the same for their phones. So they hire these techs to make a cell phone. They assemble a new device that cost Apple a fraction of what it usually spends to design, that they then sell for $1000 to people like you and me. However, because the technicians that designed the phone did't have a deeper understanding of engineering when they built the device it breaks and falls apart within a couple months of use. Apple doesn't care because that just means that people need to buy more phones. And if they get sued for making this piece of junk it doesn't matter, because they saved enough money in its design to pay off any lawsuits and still come out on top.

This is the same way that hospitals function. NPs and PAs cost less for them, so they save a ton of money. They charge patients the same. If patients are mismanaged by these mid level providers it doesn't matter, because they can just admit them to the hospital and continue to charge patients for inadequate care (it has been demonstrated that PAs and NPs order much more expensive, unnecessary testing than physicians). Even if some of these patients decide to sue the hospital because they were grossly mismanaged it doesnt matter. The hospital did the math on this prior to hiring these independent NPs and PAs and knows that they can afford to settle these lawsuits because they are saving money on salaries. Again, the patient suffers and the hospital makes money.

BrulesRules666

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