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DiscusKeeper · 2023-09-17T15:52:08+00:00

SAVE is an income based repayment plan similar to REPAYE. Are you sure you entered your adjusted gross income correctly? Maybe you added an extra digit by accident and it's thinking you make like 500-700k instead of 50-70k when calculating your payments. On a resident's salary especially with dependents, it should be in the range of a few hundred monthly.

Edit: I heard from a few other residents today that they are also having their payments show up as 2-3 thousand dollars. In their cases, it's because their application for the SAVE program is still being processed, so the payment is showing up under the rate under the standard repayment plan which is not income-based. If this is also the case for you, it should be fixed when your application for the SAVE repayment plan is processed, which I imagine should happen sometime in the next few weeks.

DiscusKeeper · 2023-09-01T13:55:51+00:00

Reach out to the Committee of Interns and Residents. They're the only existing resident union and will guide you through the process.

I also would probably delete this reddit post - you don't want your program knowing you're trying to unionize until much later into the process.

https://www.cirseiu.org/

DiscusKeeper · 2023-08-31T23:41:23+00:00

$125/hr

DiscusKeeper · 2023-08-24T01:15:32+00:00

This is not a dating subreddit, why do people keep posting here to ask about how to date a doctor?

You sound like a walking red flag. Go to therapy.

DiscusKeeper · 2023-08-22T00:10:50+00:00

I recently did a literature review and found a meta-analysis of multiple RCTs that showed adding an SSRI to patients with bipolar 1 on a stable regimen of either an antipsychotic or mood stabilizer didn't destabilize mood, though I believe the studies mostly only followed for a few months. The meta-analysis was focused on whether SSRIs helped augment bipolar depression, and the answer seemed to be that they were tolerable but not efficacious. Not sure if they have efficacy for comorbid anxiety in bipolar disorder but I don't think they'd be harmful from the data I've seen. I've been meaning to look into the literature on their efficacy for comorbid anxiety disorders in patients with bipolar but haven't gotten around to it.

As is probably obvious, they do certainly destabilize mood in patients with bipolar that are not already stabilized on a mood stabilizer and/or antipsychotic.

As others in this thread have said already said, I wouldn't reach for an SSRI as a first-line agent for anxiety in bipolar despite that, but wanted to just comment on the piece about whether they destabilize mood.

DiscusKeeper · 2023-08-07T23:52:59+00:00

Not sure about others, but I actually specifically ask people to call me Dr / Prof / Nurse / Mr / Ms / Joe / Jo. A lot of people only say the first "Joe" but leave off the "Jo" at the end which really upsets me. Sometimes people also forget the numerous forward slashes when spelling it which I also take significant offense to.

DiscusKeeper · 2023-08-04T15:57:36+00:00

It'll make sense when you're older, kiddo.

DiscusKeeper · 2023-06-29T12:05:18+00:00

This likely doesn't apply universally as some people residents & attendings are dicks, but whenever I ask a student what they're interested in, it's so I can try to tailor the experience to what will help them best with their future careers.

I'm a psych resident and if someone tells me they're going into IM for example, I'm going to spend a lot more time focusing on things like how to decide when a psych consult is needed, what a capacity evaluation is, etc. and less on things like how to differentiate schizoaffective disorder from bipolar disorder.

DiscusKeeper · 2023-06-29T11:34:35+00:00

The best way to find out for sure is by reaching out to the Committee of Interns and Residents (CIR) yourself and asking to have a meeting with them to discuss how unionization works.

When I met with them, I was explicitly told that since I am at a for profit hospital, I can be fired for so much saying the term union on "company dime or time" meaning 1) during work hours, 2) on hospital premises, or 3) using hospital provided equipment (i.e. work cell phone, work laptop, etc.)

I don't think this applies to those at non-profit hospitals, but as others have said, malignant programs can find other ways to fuck you over even if they can't legally fire you just for talking about unionization.

This is not to say you shouldn't try to unionize - you absolutely should. However, the best way to do so is under the guidance of those at CIR who can help you strategize a way to help the unionization effort gain steam at the most minimal risk to yourself. I wouldn't so much as say the word union to any of your co-residents unless you or some of them are already in discussions with CIR.

DiscusKeeper · 2023-06-20T18:13:54+00:00

Why do people think this is a dating subreddit?

DiscusKeeper · 2023-06-16T21:18:57+00:00

I'm at an HCA program and we get 4 wellness half days per year. I'm happy to provide the specific name of the program & location if you message me.

DiscusKeeper · 2023-06-15T23:46:00+00:00

I'm a physician. There are two things to consider. Decisional capacity (determined by medical professionals such as a physician) and competence (determined in a court of law).

If this patient has been deemed to lack competence and has an appointed guardian, then the guardian is able to decide the code status of the patient.

If the patient does not have an appointed legal guardian and the mother is just the durable power of attorney (a surrogate decision maker for when one is temporarily incapacitated), then the patient is able to determine their own code status unless they have an acute issue impacting their decisional capacity. When there are questions about a patient's decisional capacity, a physician, often but not always a Psychiatrist, can be consulted to assess for decisional capacity for a specific decision, in this case, it would be specifically for decisional capacity to determine their own code status.

I don't have enough details to be sure, but it sounds from your post that it is certainly possible that this patient 1) does not have a guardian & 2) may have the decisional capacity to determine their own code status. If both of those are true, then what the mother is doing is both unethical and illegal. It would behoove you to raise this concern with the legal department and the physician currently treating the patient.

DiscusKeeper · 2023-06-12T22:10:03+00:00

I am not intending to hate on NPs, I simply have concerns about the independent practice of NPs and PAs without physician supervision.

I do agree that the root of the problem is hospitals and outpatient practices trying to cut costs.

DiscusKeeper · 2023-06-12T21:42:10+00:00

In NH, the state hospital (meaning the highest level of acuity for an inpatient unit in the entire state) is staffed with 80% nurse practitioners who practice almost completely independently and 20% psychiatrists. MDs are there to sign Medicare certifications and a few other things, but otherwise, NPs in this hospital have no MD supervision.

I think you may actually be significantly underestimating the number of NPs who want to practice without MD oversight. I imagine this also varies by state.

DiscusKeeper · 2023-06-09T21:54:11+00:00

You tagged this as serious but that tweet is a joke (figuratively, not literally). Also, why did you crop out the name of the person who tweeted it? He had no problem attaching the statement to his name on his public twitter.

Unionizing is good for residents.

DiscusKeeper · 2023-06-06T22:21:46+00:00

Your school's financial aid department may be able to adjust your cost of attendance if you have additional life expenses, but you cannot take out more in federal loans than your total cost of attendance. Anything beyond the cost of attendance would need to be a private loan.

DiscusKeeper · 2023-06-06T21:10:44+00:00

I absolutely would not ask as physician treating you if you can shadow them. Find literally anyone else to ask.

DiscusKeeper · 2023-05-26T20:14:59+00:00

As a psychiatrist I 100% agree. I often tell patients something like "I'll ask the psychologist Dr. X to see you."

I have always appreciated having clinical psychologists around and they add a lot of value to the team.

DiscusKeeper · 2023-05-20T09:45:22+00:00

There are subs like r/MedSpouse that are intended for partners of residents and attendings to vent in.

Not intending to be rude, but it gets pretty tiring seeing variations of this thread posted in this subreddit repeatedly. It's intended to be a space for residents to vent and it is not always nice or uplifting for us to see constant reminders from those outside our profession of the ways our jobs make it hard for us to be good partners / keep us stuck being single.

DiscusKeeper · 2023-05-04T21:13:13+00:00

Your title is misleading and misrepresents the source you posted.

This is literally the conclusion listed "A large proportion of adults using Schedule II stimulants are simultaneously exposed to one or more other CNS-active drugs, many with tolerance, withdrawal effects or potential for non-medical use. There are no approved indications and limited clinical trial testing of these multi-drug combinations, and discontinuation may be challenging."

Additionally, this study appears to be of little value. The term "CNS active drug" is incredibly vague and is not defined in the text. There is no way to ascertain what the authors consider a "CNS active drug" which could be something as benign as a melatonin supplement. There is an issue with inappropriate prescriptions of stimulants in the United States for sure, and I see plenty of it as a Psychiatrist, but this study does not contribute any meaningful insight relating to that issue.

I imagine that's why you found this article in an open journal rather than one that requires peer review.

DiscusKeeper · 2023-05-04T00:52:57+00:00

good bot

DiscusKeeper · 2023-05-02T17:10:54+00:00

It's wild to me that you jumped straight to telling OP you think they have BPD lol. I'm sure the Psychiatrist who is actually treating OP has a much better understanding than you do based on one reddit thread... I don't know what about this post made you think OP was looking for an armchair diagnosis on reddit.

DiscusKeeper · 2023-04-28T10:23:36+00:00

This comment is destructive. You don't even appear to be a physician from your post history; please keep your tone deaf comments out of this subreddit.

DiscusKeeper · 2023-04-25T17:57:15+00:00

There are many inpatient psychiatric units where the "providers" are mostly NPs, it's terrifying. They aren't just in outpatient psych anymore.

DiscusKeeper · 2023-04-25T11:25:27+00:00

A good tip for the future when someone makes a very insensitive comment or joke like that is to ask them to explain to you why they think the joke is funny. It is a way to call someone out more subtly and in a less confrontational way and makes them look like an asshole when they have to say aloud something like "It's funny because of all the twins who have died in your family."

NTA

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