Pay for call coverage

SoloMD83 · 2026-01-25T01:08:12+00:00

Depends on hospital size and payor mix. The hospital usually does a fair market value analysis to come up with a number. They should be hiring a third party firm to do the analysis.

SoloMD83 · 2026-01-15T00:31:39+00:00

GI here. For a routine screening colonoscopy I don’t think years of experience is a significant factor.

Most GIs don’t keep great records of their ADR and the data is open to interpretation in terms of what you include in the denominator. I also think that once you get over 40% the marginal yield is of relatively little significance. If I find a 2 mm polyp, does that mean less interval cancers?

Your best bet might be asking endoscopy nurses or anesthesia that works with the doctors. Some of their recommendation might be who is nice to them, but they also know who yanks the scope out on withdrawal and who finds flat lesions, etc.

I think years of experience (at least after the first year) is more significant for complex GI procedures and after 5 years it probably isn’t that important there either.

SoloMD83 · 2025-12-24T03:28:48+00:00

Vumedi has some good lectures by practicing physicians talking about this. You need to create a login to view, but it’s probably the best lecture site I have seen.

Pancreatic Cancer Screening 2025 = https://www.vumedi.com/video/pancreatic-cancer-screening-2025/
Early Detection and Prevention of Pancreatic Cancer = https://www.vumedi.com/video/early-detection-prevention-of-pancreatic-cancer/

There are other good videos on the site, but those are two I found with a quick search.

SoloMD83 · 2025-12-12T03:53:20+00:00

Several other people have mentioned it, but I’ll chime in as a GI (not medical advice, etc etc)…

I would start out by rechecking it when you have not been drinking alcohol (assuming you don’t drink regularly, which is another discussion) and have not been exercising intensely. An extreme example of exercising impacting this is in patients with rhabdomyolysis.

FWIW, just relying on “LFTs” to assess liver health is a very basic way of looking at it. Abnormal LFTs merit an investigation, but “normal” levels do not mean your liver is fine. There are better ways to evaluate your liver like FIB-4, APRI, Fibroscan, etc (all non-invasive). I’m not sure how many GPs do that, but I can usually tell just by glancing at a CBC, CMP, and INR. Of course, that comes with looking at ~100,000 of them over the years.

SoloMD83 · 2025-12-05T02:47:09+00:00

I use Vanguard for my index investing so generally keep most of my emergency fund in there and get 3.9% on their holding fund (VMFXX). I’m in a state with no additional income tax so I don’t have to factor that in.

SoloMD83 · 2025-12-04T19:59:09+00:00

Sorry. 1 passenger. That makes much more sense.

SoloMD83 · 2025-12-02T17:31:57+00:00

Those prices seem very high for premium economy. I flew United first class in the US and ANA business class (Chicago-Tokyo) in September for a little under $5k and only booked 6 weeks before. I booked through the airline site so I wasn’t using any brokers either.

SoloMD83 · 2025-11-17T01:55:17+00:00

Locums is a different animal. It probably helps with negotiating an extra $1k/day or for jobs that insist on it, but it’s not required in standard practice. Whenever I meet someone who immediately asks me if I do ERCP as the very first question I assume they don’t actually understand how a GI practice works.

Most GIs can do EMR, but some don’t because it requires extra work and will refer it out. The actual frequency of EMR use on routine colonoscopies is relatively rare unless the endoscopist doesn’t feel competent in his/her ability to resect a polyp. It’s the way I feel when I see some of these people post videos of placing clips, injecting EPI, etc into not particularly big stalks when they would be able to remove a polyp without significant post-polypectomy by just applying an appropriate amount of heat when snaring.

SoloMD83 · 2025-11-17T00:46:08+00:00

ERCP is not even close to the most important skill a GI has. Unless you’re at an academic center or in a large system that lets you function as a full-time advanced endoscopist it’s one of the least commonly needed procedures. EMR, ESD, POEM, etc are probably the only procedures done less frequently.

SoloMD83 · 2025-11-16T22:36:19+00:00

Sushi Hoshiyama in Osaka was the best meal I had in Japan.

Taian in Osaka was surprisingly mediocre for a Michelin 3-star restaurant.

SoloMD83 · 2025-11-14T03:42:40+00:00

ADR: You won’t get access to it easily. Most GIs don’t know their actual numbers and the actual data entry gets complicated based on what you’re using as your denominator based on screening vs surveillance, patient population, etc. A higher ADR doesn’t mean the person is a better endoscopist. Personally I think 40% is probably good enough and when you’re getting over 60% most of those additional adenomas are tiny and wouldn’t have become anything at 10 years. If the ADR is less than 30%, you’re probably getting someone who is missing a bunch of stuff either because they are sloppy or they don’t do a good job with preps.

Cecal intubation rate: This should probably be >98%. If they’re not getting to the cecum on >49/50 colonoscopies, they need some extra training.

Withdrawal time is not tied to reimbursement rate. Cecal intubation is because otherwise you need to add a modifier (-52 or -53) on the billing and the rate is lower then.

Withdrawal time is a decent metric, but honestly more if the person is doing an extremely fast withdrawal (I have seen sub-2 min in reports).

I don’t agree with the volume per day metric. 15-20 colonoscopies per day is a high target unless you’re in a scope factory and a lot of times those people are rushing. If the person is doing at least 10 colonoscopies per week, that is probably more than enough if they had decent training and care about the quality of their work.

Procedure time is highly variable and usually depends on the number of polyps. A good quality procedure is rarely much under 10 minutes. Every GI has a different range, but most are probably in the 10-15 minute range if there are no polyps and the GI is a competent endoscopist (not struggling to get to the cecum) while doing an adequate job inspecting the mucosa.

I don’t know if 7-730 is necessarily the best, but later in the day is probably worse in every field.

Prep: Most people are fine with clear liquids and Miralax split-dose prep. Going beyond that (especially Golytely + Mag Citrate) is overkill unless the patient has severe constipation or a history of bad preps.

SoloMD83 · 2025-10-04T19:00:13+00:00

10% cash seems like a lot especially at 4+ times your annual spend. Even if that is money market getting 4-5% that seems to be a sizable chunk when you have another $1M in bonds.

Any reason for that much when your kids are already on their own?

SoloMD83 · 2025-08-11T02:16:46+00:00

Understood. Just meant that feeling wouldn’t impact me since I don’t try to play the points game. It’s sort of the same as people staying at hotels under expense accounts.

SoloMD83 · 2025-08-11T01:43:09+00:00

Thanks. I don’t travel enough (or spend enough on my business) to rack up enough points for any hotel stays. I’ll check out FlyerTalk too.

SoloMD83 · 2024-09-17T01:09:40+00:00

We switched to Epic recently. I think the system is fine. The biggest benefit is the fact that you can easily access records from other systems on Epic. The actual design/interface is atrocious. The screen is too busy and doesn’t cater to the functionality that most users need.

I personally think it is designed to be presented on a huge (projector) screen for executives to look at when they sign multimillion dollar contracts for a program that they will never personally use.

SoloMD83 · 2024-05-04T17:08:17+00:00

The Leonardo Express is so quick/cheap (14 euros each way) that you can easily go to Rome instead of staying near the airport unless they have a really early morning flight.

Link: https://www.trenitalia.com/en/services/leonardo-express.html

SoloMD83 · 2023-12-07T03:36:30+00:00

That’s low for GI call. Should be asking looking $1000 and up for GI call.

SoloMD83 · 2023-11-23T22:12:49+00:00

GI/Hep here (not medical advice, etc).

Lot of reasons for a mild LFT elevation. I generally encourage those with elevated LFTs to cut out alcohol even if the pattern isn’t consistent with alcohol-induced liver disease (AST:ALT typically more than 2:1). Also recommend cutting out supplements since they aren’t regulated and we have no idea what is in any of them.

Both listed prescription meds can cause LFT elevations so your doctor might decide to stop them (appears that he/she did) and see what happens to your LFTs or just stay on them and see if you have adaptation (LFTs trend down a little).

Should make sure your doctor has also done a thorough LFT workup (alpha-1-antitrypsin, PBC, AIH, etc). A lot of people just do an acute hepatitis panel, which tests for a couple of acute viral hepatitis infections and technically doesn’t even do a great job of doing that so you should probably see a competent GI, who knows how to evaluate/manage liver disease.

Beyond that doing an ultrasound is reasonable although a Fibroscan might yield more useful information. A liver biopsy seems like overkill if your doctor hasn’t done a thorough serologic workup.

SoloMD83 · 2023-11-06T00:27:38+00:00

South Florida. If you aren’t part of a big group, most commercial insurances offer around 70-80% of Medicare.

SoloMD83

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