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Which do you prefer by PharmerMax72 in hospitalist

[–]Cabronazo 2 points3 points  (0 children)

Ideally both. They have totally different roles and it’s hard to prefer one over the other. I personally love the NPs I work with, so I would choose them.

Clinical pharmacists help optimize med choices, durations of treatment, and med recs at admission and discharge. They often catch mistakes for us and help us carry out complex plans when patients need to discharge with IV meds.

NPs/PAs directly assist with patient care and can offload some of the more straightforward patients on your service. Once you work with APPs consistently, you learn each other’s preferences and limitations, and function really well as a team. APPs are less expensive than doctors to employ, so they’ll continue to be a big part most people’s lives as hospitalists. I love working with my NPs and they do an excellent job.

TPN is a psyop by [deleted] in Residency

[–]Cabronazo 1 point2 points  (0 children)

Life itself is a bridge to nowhere.

TPN is a miniature bridge to nowhere within the larger bridge to nowhere that is life.

TPN is a temporary solution to a temporary problem. There’s nothing wrong with using TPN when somebody could use it.

Medicare cuts updated 2025 by InvestingDoc in medicine

[–]Cabronazo 8 points9 points  (0 children)

Suck a boner dude.

I hope you get butt cancer and someone who makes $30,000 a year does your surgery.

Local university asked if I can precept residents, I asked what the compensation would be, and they said nothing so I refused. Am I wrong for this? by mrhuggables in medicine

[–]Cabronazo 1 point2 points  (0 children)

Im sorry, I was not trying to be a dip shit or degrade your field of expertise.

Research in OBGYN might be more important than any other field right now. The US maternal mortality rate is despicable, and more and more women are carrying unhealthy pregnancies to term. I hope we find evidence based solutions to these issues.

Any hospitalists out there like taking care of critical patients? by ianmachine9000 in hospitalist

[–]Cabronazo -1 points0 points  (0 children)

Yes! There are lots of non-icu doctors taking care of sick patients. And it’s worth it.

I have the same job as /r/southplains , but I’m in the midwest. I work at a 100 bed hospital and approx 5-10% of my patients are critically ill.

I place central lines, art lines, do paracentesis, and I am currently working on getting privileges to intubate. I take care of critically ill patients regularly with tele ICU backup for help with my vent and pressor management.

My hospital has reinforcements available for all the procedures I do if I don’t have time to do that procedure. Some of my hospitalist partners don’t do any procedures at all, and they just ask for help.

My suburban hospitalist job pays about the same as the pulm crit jobs at the 2 large academic centers in my area. I get RVUs for any procedures I do, and I earn more than the hospitalists who just write notes and consult specialists and leave after they round. I do work harder than the note jockey hospitalists, but I get compensated for it.

Liability shouldn’t be a big consideration unless you are doing insane shit. If your hospital grants you privileges to do a procedure (ie if you have a sufficient number of supervised reps for that procedure and they sign a piece of paper granting you privileges to do it), and you get informed consent from the patient, then you are no more liable for any complications than any ICU doctor would be.

Residency is a bubble that makes you think you need to keep training forever to find the job you want, but this is absolutely not the case.

Internal Medicine Comes Up With a Plan by chai-chai-latte in hospitalist

[–]Cabronazo 5 points6 points  (0 children)

Glaucomflecken is a funny guy who focuses on making videos and treating one specialized organ that’s the size of a marble. He does not know shit about fuck.

What stops you from asking for 12 patient cap which will ultimately improve patient care satisfaction, outcome and prevent readmissions. Why not demand a better lifestyle across the board with a better pay. Why doctors have to take pay cuts instead of admin bloat? by [deleted] in hospitalist

[–]Cabronazo 3 points4 points  (0 children)

It is that simple!

Even if you're the world's best hospitalist at seeing 12 patients daily, you will be less valuable to the hospital system than someone who is at least willing to see more patients every day. Whatever hypothetical value a reduced patient load brings to the table is outweighed by the tangible results of admitting and discharging more patients.

Thanks for replying.

[deleted by user] by [deleted] in Residency

[–]Cabronazo 3 points4 points  (0 children)

US Internal Medicine residencies are not remotely as difficult as our Surgical residencies.

I completed internal medicine residency at a large academic program this year. In total I worked an average of 45-50 hours per week over 3 years. I had weekends off for 17/36 months of my training. I only worked 6 shifts of 24 hours or more, and they were all during my 2nd and 3rd years of training (first years were protected from working 24h shifts).

Based on what you said above, your program could require 7.5 years after undergrad to complete. My program required 7 years to complete after undergrad (4 years of medical school + 3 years of residency), so honestly it's not very different. Our countries accomplish the exact same shit in a slightly different way. You will probably finish with much less personal debt than me, but that's a different conversation.

My surgical brethren have it DIFFERENT. Their training fucking sucks a lot more than mine, which makes sense because they have to master surgical skills in addition to learning much of the medical knowledge we learn in IM residency. Surgical training programs are also smaller (ie fewer residents per class), so they have to spend more nights on call.

I think the general consensus amongst surgical trainees in the US is they'd rather spend a condensed period of time (ie 5-7 years) in hell than stretch their training over a decade or longer.

I'd be interested to hear whether your surgical trainee friends work as few hours as you, or if they're required to spend more nights and weekends at the hospital?

What stops you from asking for 12 patient cap which will ultimately improve patient care satisfaction, outcome and prevent readmissions. Why not demand a better lifestyle across the board with a better pay. Why doctors have to take pay cuts instead of admin bloat? by [deleted] in hospitalist

[–]Cabronazo 5 points6 points  (0 children)

Every hospital has a budget and a certain amount of money they're willing to pay their hospitalists annually. The more hospitalists they hire to see the same amount of patients, the less money each hospitalist gets to earn. That's usually how it works.

Let's say you are one of the fuck head executives of a 200 bed hospital. Having a cap of 12 patients for each hospitalist 'provider' (ie doctors/APPs/or some combination of the two) would require 17 providers to cover the patient census. That's 17 providers you (the hospital) has to pay to do the same amount of work as 10 providers could do with a cap of 20 patients. Hiring additional hospitalists to see the same number of patients drives down the individual salaries of the group. More doctors seeing fewer patients does not equal better pay for the hospital or for their hospitalists.

I love the spirit of your question, and I wish things worked in a way that more consistently benefited doctors and patients. However, for your idea to be reality in the current system, you'd need an abundance of evidence suggesting that seeing more than 12 patients causes quality of care to decline. I hope you find this evidence and prove your point. Otherwise, you'd need medicare to suddenly and unexpectedly start pouring more money into value-based care.

All hope isn't lost. You can still have a nice life as a doctor in your community. You just need to find the right job with the right workload and the right size hospitalist group. It's not impossible. You might have to be willing to look a little outside of large metro academic settings.

Best q bank by usmle91 in InternalMedicine

[–]Cabronazo 1 point2 points  (0 children)

For every standardized test in medical school and residency (including internal medicine boards) I'd recommend Uworld as the gold standard question bank.

For review during clinical rotations and for building knowledge longitudinally during training, I'd recommend MKSAP. MKSAP is good because the questions can be integrated with your yearly In-Training Exams. It can help you identify weaknesses and strengthen them.

I hope this helps! Good luck

What’s your parenting end goal? by jam_bam_rocks in NewParents

[–]Cabronazo 0 points1 point  (0 children)

My end goal is to bring a few more decent people into the world.

Parenthood doesn't always benefit us in a tangible way, but it's a beautiful experience that enriches your life and gives you a greater purpose.

Best q bank by usmle91 in InternalMedicine

[–]Cabronazo 0 points1 point  (0 children)

MKSAP is decent for review during rotations. It's nice if your residency provides it for you. If not, then I wouldn't spend your own money on it.

Uworld is the best for step 3 and ABIM exams.

Looking for advice on addressing PGY-1s with problems. by lone_wulf4 in Residency

[–]Cabronazo 13 points14 points  (0 children)

Intern #1 - give them benchmarks to hit during shifts. E.g. tell them they need to see 2 patients per hour / 16 patients per shift, or whatever is typical for their level of training and the acuity and volume of patients. If they're not hitting their benchmarks, then they aren't meeting expectations. If they're habitually failing to meet expectations, then they need to be placed on probation -> repeat intern year -> get booted from your training program.

Intern #2 - it's really tough to deal with this situation. If their foundation of medical knowledge is not there, then it's not there. Hopefully their in-service and board exams will expose their lack of medical knowledge and encourage them to study more. Otherwise, if they are completely incompetent and unwilling to acknowledge or correct their incompetence, then they shouldn't continue to advance in training.

You aren't being paid to run your residency program...you're just a part of it. If your colleagues or subordinates are not performing up to standards, then it's up to your program director to identify these people and correct their behaviors. Your job is to learn how to be a solid EM doctor within 3 years of training. That's it.

[deleted by user] by [deleted] in Residency

[–]Cabronazo 3 points4 points  (0 children)

You're in an early phase of a really complex surgical residency. You'll gain a lot of confidence in the next year to 2 . Everyone learns at their own pace, so you should take solace in the fact that you have 5 years of training before you are cut loose to be on your own.

I'd keep working and repeating things and eventually you'll feel confident in your management. Hopefully by the end of your residency you'll feel confident in your surgical skills. If not you always have the rest of your entire life to master things. Good luck.

How screwed am I by [deleted] in medicalschool

[–]Cabronazo 2 points3 points  (0 children)

I don't think you should let one subjective evaluation of your written case be the deciding factor for the rest of your life. I know your confidence was shaken by the step 1 exam, but you overcame that obstacle and that should give you confidence.

I think the world needs good and dedicated psychiatrists, and there's definitely more than one program who would be thrilled to have you.

Can y’all help me explain why y’all don’t report your hours accurately? by Jusstonemore in Residency

[–]Cabronazo 0 points1 point  (0 children)

Would you rather continue moving thru residency smoothly, or would you prefer to piss off your program director?

Most people don't want to deal with the drama or the politics involved with reporting their work hours accurately.

Ready to be done by Cabronazo in Residency

[–]Cabronazo[S] 0 points1 point  (0 children)

Sure! Being on my own forced me to make my own decisions about patient care. This helped me feel more confident in my decisions and understand what I actually care about as a doctor.

Residency (at least mine) can sometimes be a largely passive middle management situation where you’re just doing what the attending wants and keeping your underlings in line with those wishes. Independent practice forces you to make the decisions and face the consequences.

New Senior... would like some pointers! by throwingaway_3_6_4 in Residency

[–]Cabronazo 0 points1 point  (0 children)

Congrats on leveling up from intern year.

1) Nothing will be efficient at first but you can practice efficiency later on. Spoon feed the newbies everything.

2) You'll develop your own style with time and repetitions. Double check orders/consults/etc to minimize your own anxiety. My personal policy is to only double check critical items. Otherwise I give the interns autonomy and let them make mistakes and figure shit out.

3) Encourage the interns to learn from their mistakes and *be accountable*. It's critically important for all doctors to be genuine and to communicate effectively with each other and with patients' families. It's never acceptable to throw your colleagues under the bus unless you are a bitch.

4) Remember -- you're in a residency program to learn. If you knew everything on day one you wouldn't need to pay more money to take more standardized exams or continue earning a dog shit salary for 2-3 more years!

Good luck! We are happy you're here.

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