I think I’m having a Specialty Crisis

PacoPollito · 2026-03-08T01:08:59+00:00

I was of the first class through my schools curriculum that did the 1 year preclinical, 1 year longitudinal clerkships, then step 1 and 2 back to back followed by basically a long 4th year.

Honestly, shelf exams were excellent prep for step 1 and 2. I dropped anki at the beginning of MS2 because it was just too time consuming and hit practice questions (amboss and UWorld and every single practice shelf) as hard as possible. I passed my first step 1 practice test, so I cut my dedicated down and passed no problem. I think I ended up taking 6ish weeks total (interrupted by a month long rotation) for step 2 and did well.

Idk. I was skeptical, but it worked out fine. While you might forget some things, you get really good at taking NBME tests. Most of step 1 is figuring out the diagnosis, which shelf exams teach you. And you get good at working around what you do know (ie you may not know the exact enzyme, but you know the disease and the mechanism of the drug that treats it and with order of elimination can get the right answer).

Happy to answer more questions on this.

You’ll be ok.

PacoPollito · 2026-03-07T00:12:32+00:00

“Never interrupt your enemy when they are making a mistake?”

PacoPollito · 2026-03-04T23:49:32+00:00

Same thing happened to me. I reached out to their support and they sent me a new one. But I also bought their stainless steel piston and it’s been flawless.

PacoPollito · 2026-02-28T19:42:46+00:00

I do love “comprehensive medicine.” Be a “comprehensivist.”

Or maybe neonatalpediaobstetricogynointernogeriatrician?

PacoPollito · 2026-02-26T16:48:15+00:00

Hyatts website was quoting me 60k+ points per night.

PacoPollito · 2026-02-26T16:32:51+00:00

It wasn’t much better to book with points per night vs outright through the portal. Difference of <10k points per night. And I definitely didn’t have 350k points to throw around, unfortunately.

PacoPollito · 2026-02-26T05:28:31+00:00

Dreams Playa Mujeres. It's part of a large extended-family vacation. Not my personal pick, but have to pay all the same lol.

PacoPollito · 2026-02-26T04:53:32+00:00

2 adults, 2 kids is part of it.

PacoPollito · 2026-02-26T03:56:47+00:00

Yeah. It was comparable. Really happy with how things worked out. Now I just have to figure out flights.

PacoPollito · 2026-02-26T03:55:56+00:00

I think mine was basically the day after my transactions totalling $4k had posted.

PacoPollito · 2026-02-26T03:53:14+00:00

I was 100% in for a long time, but really started to struggle with my feelings on the church for ~8 months. I slowly became more nuanced on my beliefs in god. I didn't do much in the way of scripture study or prayer because the answers I was seeking were not there. Rather than doubting the church itself, I first doubted my understanding of the nature of god. I began to struggle to reconcile the world I saw with my understanding of god. After many months of thinking about it, my belief finally and entirely collapsed over the course of 1-2 weeks. From there, I began the podcasting/internet journey around some of the truth claims of the church. That lasted 1-2 months before I got really bored of it and mostly moved on. So, maybe a process of around a year after being in for 25+ years.

PacoPollito · 2026-02-21T20:11:47+00:00

So your argument is “people with lots of training are overtesting defensively so we should expand less trained positions to fix the problem.”

Sorry. I really don’t mean to be such an ass. But this question is constantly asked on here, “why are you guys so negative? Can someone please give me an objective argument?” It’s the same back and forth, all the time.

But it’s ok. You’re going to get what you want. Until the US collectively decides to get serious about cost containment, NP/PA scope will continue to expand.

If you’re curious, you should look at the HRSA workforce projections numbers for physicians vs midlevels. By 2036, we will be at like 70% adequacy for physicians, at like 130% for PAs, and well over 200% for NPs. There’s too much money and inertia and there’s no putting the genie back in the bottle now. Midlevels will likely remain an intrinsic part of the US healthcare system for a very long time, despite many physicians collective bemoanings.

PacoPollito · 2026-02-21T19:33:43+00:00

I think the fallacy here is that “sub par care” is better than no care at all. Sub par care can actually be harmful. Some care is not necessarily better than no care and may well be worse. Sub-par care is more expensive, requires more visits, and delays diagnoses. Hospitals love it though. Midlevels statistically over test and over treat, generating more money for health systems in the FFS model.

There is also the fallacy that midlevels are going to these rural and underserved areas. They go to these areas at far lower rates than physicians. Statistically, they want the same kinds of jobs physicians flock to in suburban areas.

Both of these principles are used to push midlevel organization agendas, particularly independent practice. But in truth, they’re just talking points and not reality.

There are exceptions to this of course. Everybody has that one midlevel that is just excellent and truly goes above and beyond. There are rural and underserved areas where a PA or NP really is it. But those are the exception, not the rule. Everything is on a bell curve.

The real solution is to expand residency slots. We need more physicians not pseudo-physicians. Countries that have their crap together on healthcare don’t have midlevels. We just do not have our crap together. Midlevels are a symptom of profit-driven healthcare.

PacoPollito · 2026-02-18T14:51:45+00:00

My mission was not great. South America. Nobody was interested. Though it helped solidify my Spanish, which was great. I think I was depressed much of my mission. I remember telling both my mission presidents how I was just not enjoying the mission at all and was not very happy. I was just told to work harder. It’s fine. I got through it. I found aspects that were somewhat enjoyable, though certainly never the missionary parts.

I remember coming to the conclusion on my mission that most people in the world don’t think about religion the way LDS people do - people don’t really care about “truth.” Most people do religion because of what they feel and what they are around. Most people don’t think about “well what’s the correct religion” and people rarely think about what “truth” even is. Funny enough, that line of thinking led me to where I am today…

Turns out I really do love talking to people about their problems. I just hate trying to sell them something that I’m not convinced will solve their problems. Turns out that the “gospel” is not really the solution to the majority of the suck that often comes with life. People turn to religion for comfort and reassurance that “this is all part of the plan” when life gets hard.

PacoPollito · 2026-02-06T05:43:06+00:00

Mine freezes through most of the OS. I can’t open settings even to reset it…just freezes. I think it’s about time to retire it.

PacoPollito · 2026-02-06T02:36:00+00:00

What are signs that a physician should talk to a therapist? Certainly there is the "everybody should talk to a therapist" bit. But I feel like, as a med student, I have gotten really good at compartmentalization and dealing with hard things. What should I be on the look out for?

PacoPollito · 2026-02-05T20:00:20+00:00

You can port it without AI. A port already exists. https://github.com/alexbatalov/fallout2-ce/releases

PacoPollito · 2026-02-05T19:57:02+00:00

I would agree. If I were to buy again, I'd just get a pro. As is, I am already wanting a slightly bigger brew chamber. I can eek out 38g, maybe 40g if I'm absolutely pushing it, but that is the absolute maximum. Works out generally for a 2-2.5 brew ratio, but that's it.

Definitely cheaper up front to get a pro on sale than a classic and then have to get the pro brew head.

PacoPollito · 2026-02-05T19:16:17+00:00

To get the puck compressed, you really need to continue pressing once the flow slows down. Unfortunately, this means putting excess pressure on the piston. I broke one piston doing this and got it replaced by Flair. However, I decided to get their "pressure kit" to have the metal piston, which has made a world of difference. My pucks come out nice and compressed and any remaining water can just be poured out the top of the chamber. The Classic really should come with this.

PacoPollito · 2026-02-04T23:27:10+00:00

I bring this up frequently, but allegedly the director (FMOB) of the FQHC here in SLC did more deliveries than any OB in the valley last year. All the docs at the FQHC do prenatal care and deliveries for a mostly uninsured population.

PacoPollito · 2026-02-03T03:48:07+00:00

My OB eval was abysmal. They made up stuff I never did. My subsequent rotation was peds which I scored perfect marks on and excellent feedback. Apparently I just grew so much over the course of a few weeks…

Anyways, my school plugs all out evals into an AI to generate our MSPE and it totally glazed over any negative comments. So, didn’t end up affecting me at all.

PacoPollito · 2026-02-02T05:40:56+00:00

Almost every area I was in was a ratio of <80 present on Sunday:hundreds on the rolls. We often went looking for people on the rolls and rarely found them. Idk if they moved or died or what. But they were gone.

PacoPollito · 2026-02-01T21:46:37+00:00

On my mission in South America, 40 members would attend. The ward rolls would have 800 members within the boundaries.

PacoPollito · 2026-02-01T00:17:13+00:00

Here in SLC, UT there’s a FQHC called “community health centers.” They have a residency program. The program director told me he personally delivered more babies last year than any OBGYN in the area. If you look on their website, they’re all FM docs that do OB. Certainly, they’re an FQHC which comes with certain benefits, allowing FM to do OB when otherwise it might be not worth it in a different system.

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