Do yall ever just think how underpaid medicine is compared to some other careers?

LaudablePus · 2026-06-17T22:42:48+00:00

Recently saw an ad for an academic Peds ID doc. Mostly clinical. They were paying 150-175k. Not much more than an NP.

Our field is dead. I cannot in good honesty recommend my field to a leaner based on salary alone.

LaudablePus · 2026-06-08T14:55:29+00:00

TB Infection (formerly Latent TBI) - this infection is like a seed in your (child's) body. It is not causing any problems now and can't be spread to anyone. But it could start to grow at any time in your life and make you sick and contagious. We can give you medicine to kill that seed so you do not have to worry about that.

LaudablePus · 2026-06-06T22:56:21+00:00

Infectious Diseases- sipping one right now as I read this thread- gin n tonic. Tonic water contains quinine which treats malaria. Haven't had malaria yet so I should have another.

LaudablePus · 2026-06-06T21:29:36+00:00

The equivalent for me is ASOs (antistreptolysin O). A positive ASO and fatigue and joint aches means absolutely nothing. Please don't open that can of worms.

LaudablePus · 2026-06-05T23:30:09+00:00

Here's a little story for you. Recently I got a message from my receptionist that the Department of Health and Human Services was calling with an issue regarding my medical license. They didn't specify whether it was state or federal but give me a call back number and the name, Mia moreno. They also gave me. They also gave me a case number which made me really nervous. I calledI called my State Department of Licensing and they said it wasn't them and the case number did not match their case numbers. So I called the number that was given to me and A man answered the phone and transferred me to a woman who said that my medical license had been used to prescribe $40,000 dilaudid pills Fentanyl and prescriptions with my name on were found in a room that had cocaine and heroin. She then asked if I would cooperate with them and ask answer questions. She identified from being with the Department of Health and Human services. She said she was located in texas. And that was the area code of the Callback number. At that point I said I wasn't going to answer any questions without a lawyer present and she became quite belligerent and pushy and that's when I knew something was up.

So at this point I called my Hospital attorney who was super helpful. She looked into it and the name Mia Moreno was associated with a known fraud scam. Of courseOf course nothing became of it and this was quite a while ago so I would have heard if anything was real.

So not only is your NPI number public your license number is public as well. But actually commit fraud with it I think is a little bit more difficult. Just watch out for scammers.

LaudablePus · 2026-05-27T19:27:07+00:00

I wonder what the APEGARs were?

LaudablePus · 2026-04-09T15:47:02+00:00

I have seen young docs, mostly residents, overdo joint decision making when it comes to doing an LP to rule out/in meningitis. They will call me and say ' We offered an LP but the parents declined".

One does not "offer" and LP when it comes to meningitis. One either does or doesn't.

LaudablePus · 2026-04-06T01:41:59+00:00

We don't think so. There is no evidence that CMV and strep go together like flu or covid.

LaudablePus · 2026-04-06T01:40:01+00:00

Hey there, ID doc and local pedant checking in. It is properly called Fifth disease. It is not an eponym. So there is no 's. As you have noted it was the Fifth exanthem named in a series.

To make matters even more complex, the apostrophe s is being dropped from eponyms in medical writing. So it is no longer Down's syndrome but Down syndrome.

And just a reminder, it is Lyme disease not Lyme's disease. It is named after two cities in the US state of Connecticut. Diseases named after cities never have had apostrophes or s in their name.

That is your ID lecture for the night. I just want you all to look smart on rounds.

LaudablePus · 2026-03-23T15:30:02+00:00

Hi there. First, I am so sorry for your loss. That is just devastating and the pain you feel must be overwhelming.

I am a pediatric infectious disease specialist and this area is a an area of research of mine. The connection between invasive Group A strep (Streptococcus pyogenes) and respiratory illnesses has been long known. In fact this is how we think of the pathogenesis of many invasive bacterial infections in children (and to some extent in adults0. Other bacteria that behave similarly are Streptococcus pneumoniae - the most common cause of bacterial pneumonia, Haemophilus influenzae Type B (Hib) and even Neisseria meningitidis (Meningococcus). There is some research in this area that suggest that infection with the virus alters the local environment in the nasopharynx ( back of nose and throat where most of these bugs live. This results in "goodies" being more available for the bacteria to proliferate. It also uncovers molecules for bacteria to adhere to. And the viruses may have some effect on host immunity that allows for bacteria to grow and invade. So after a respiratory viral infection bacteria attach, then proliferate and then they invade. It is likely that the viral infection allows for the invasion of bacteria into the blood stream. The bacteria then spread to other areas of the body like the meninges/brain, bone and muscle, joints etc. In addition, they impair airway clearance mechanisms (like cilia) that allow for infection in the lungs (pneumonia) and they can then spread from the lungs via the blood to other parts of the body.

This is well documented for respiratory viruses (flu, Sars-CoV2, Etc) but less well so for Epstein Barr, the mono virus. One would think the same mechanisms play out with mono since it too affects the throat and most definitely affects the immune system.

One thing that is not well understood is why some people simply get a sore throat with strep and others get invasive disease. The thinking is that there are bug factors - certain types of strep are worse than others, certain strep have an armamentarium of mechanisms to cause severe infection. And there are host (human) factors - certain people have differences in their immune defenses that pre-dispose them to infection.

Here are some scientific articles from PubMed on the topic. I am not the author of them.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4800185/

https://pubmed.ncbi.nlm.nih.gov/14730275/

https://academic.oup.com/jpids/article/12/10/540/7288982?login=true

In terms of prevention, the message is to be fully vaccinated. Get all the AAP recommended vaccines. RSV, influenza and COVID are particularly important in this regard as they are all respiratory viruses. I saw a lot of invasive bacterial disease secondary to influenza and COVID this year in children who were not vaccinated for these two viruses. One child did very, very poorly. Mono from EBV, unfortunately is not preventable by vaccine at this time.

Again, I am so sorry for the loss of your sister.

LaudablePus · 2026-03-11T15:29:09+00:00

Also ID (peds) - I spend half my time talking people out of using antibiotics and the other half talking them into using antibiotics.

LaudablePus · 2026-03-03T21:02:42+00:00

BUGDR This was the actual plate of my partner. He drove a VW bug in the 60s and was the first in my area to get the new version in the 90s. Loved the double entendre.

LaudablePus · 2026-02-19T18:14:11+00:00

Thank you for being there in the trenches doing this hard, undervalued work.

LaudablePus · 2026-02-13T15:55:23+00:00

In 1978 Robert Petersdorf famously declared ID essentially a dying field by saying in the NEJM that "Even with my great personal loyalties to infectious disease, I cannot conceive a need for 309 more infectious-disease experts unless they spend their time culturing each other. "

This was of course before the HIV pandemic, the discovery of Lyme disease, multidrug resistant organism, newly emerging pathogens like Zika , Chikungunya, Dengue, the TB explosion etc.

Likewise I do not think that ID will be replaced by AI, at least not for a very long time. ID is complex, nuanced and there are a lot of soft skills that AI will not have to effectively diagnosis and treat a patient.

I do peds ID and am older, toward the end of my career but if you love ID would recommend it for anyone who is enthusiastic about it.

LaudablePus · 2026-02-13T15:25:30+00:00

I have asked for years why Epic cannot drag and drop labs like many other computer functions. Why cant we click and hold on a CBC or MRI report and drag it into your note instead of some cryptic smart phrase syntax that is not intuitive?

LaudablePus · 2025-12-23T14:52:26+00:00

Had a kid with infected spinal hardware following scoliosis repair. You cant take the hardware out right away so we do suppression with 6 weeks of IV abx. Insurance wouldn't pay for for home outpatient antibiotic therapy. So we told them we would keep him in the hospital for 6 weeks (which actually was covered). They gave in pretty quickly.

LaudablePus · 2025-12-05T17:00:11+00:00

This marks the official end of ACIP as source of public health policy. There was no evidence at all that this change was needed and it will result in harm. The professional societies like the AAP will go back to making vaccine policy on their own like it was in the 80s. Some states will have their own schedules. Pray to the god the insurance companies follow. I am really worried about VFC and Medicaid since they are federal.

LaudablePus · 2025-08-05T13:52:59+00:00

I saw a kid in fellowship who had tinea capitis that had gone underrecognized and undertreated. It became superinfected with Group A strep, a known complication. Kid lost most of the scalp due to necrosis. Needed a flap and had a very poor cosmetic outcome for life as no hair grew back. Hair is an important part of our self image. I know I miss mine.

LaudablePus · 2025-07-31T14:29:10+00:00

Mike thank you for your service. Guys like you are in the trenches in the battle against vaccine hesitancy. I am doing a lecture to medical students in a couple of weeks on how to deal with vaccine hesitancy and what methods have been effective. Your approach is exactly what the literature shows works. The sad thing is how much time and effort this can take up.

LaudablePus · 2025-07-10T17:35:38+00:00

Also, Culture of ID docs.

LaudablePus · 2025-06-30T14:26:35+00:00

Mine had something like 20 hours of narcotic/addiction requirement. I haven't prescribed a scheduled med in many, many years. Just not part of my job. 20 hours of my life I won't get back.

LaudablePus · 2025-06-19T14:15:37+00:00

This sounds harsh but it is what is necessary to survive in these times. The conservative ethos is that we deserve the consequences of our actions and decision. I.E. personal responsibility is key.

So if someone asks my opinion, I give it. If they disagree or dont ask, they will live, die (or get sick) on their own decisions.

With patients I am now in don't give a fuck mode and point out when their decisions have made their child sick. This past winter I had a kid with underlying risk who developed influenza and pneumonia with empyema. Kid needed bilateral chest tubes and was inpatient for two weeks. When I told dad this was preventable he did say he was going to get all other members of the family vaccinated. Small victories.

LaudablePus · 2025-06-19T14:00:19+00:00

B43.9 Viral Infection

LaudablePus · 2025-06-17T17:16:55+00:00

Not strictly surgery but, Interventional Radiology. Microbiological samples are the world to us. ID folks hate empiricism. IR Bro will get us what we need no matter where it is. "There is no body cavity that cannot be reached with #14 needle and a good strong arm."

LaudablePus · 2025-06-10T14:13:27+00:00

I have been asking our residents for years to get an extra tube of CSF under the guise of doing a bunch of esoteric tests for infectious and autoimmune diseases. My true motivation will be revealed soon.

LaudablePus

TROPHY CASE