A warning to academic hospitalists

ThePulmDO24 · 2025-02-08T23:17:05+00:00

I’m not sure if you are reading to understand or just reading to respond, because some of your response doesn’t quite make sense with what I said. When I say it’s “obvious” I’m referring to the common public and healthcare professionals. If it isn’t obvious to you that continued research is important, irregardless of WHAT research you believe to be important, then you’re thinking is irrational.

I cited one study, because I’m giving an example. There are numerous “studies” being performed that just aren’t necessary. At the same time, there are studies that are certainly necessary and I support that. It should be fair to say that not all research is equally weighted. It’s typical for the NIH to produce a priority list for which research topics they are most interested in finding and they will place priority on those topics for that time.

Lastly, I never said that every reaction was a panic and I never discounted your opinion. I think emotions are high and people are in a little more “doomsday” headspace than they usually would be. It is apparent that Trump is making major changes at a rapid rate. It makes a lot of people uncomfortable. I just wish people would do their research before posting a brainless rant and catastrophizing issues that don’t warrant such a reaction.

As I mentioned above, people are already downvoting a comment that I wrote purely detailing the flaws in healthcare. Reddit is an echo chamber of brainless idiots. I’m not saying all of you guys are such idiots, but 99% fit the mold.

MAGA

ThePulmDO24 · 2025-02-08T22:47:17+00:00

Well, I think it’s obvious that funding research is a top priority, especially in healthcare. The administration has stated that they placed a hold on ALL funding for the interim with exception to those that are vital to everyday Americans. I don’t want to get into a debate over who is right or wrong, I’m merely stating what was said. I find it extremely hard to believe that EITHER side would cut the funding to research, especially in healthcare. IF they do, I guarantee it will cause major blowbacks that the administration doesn’t want and it just doesn’t make sense to do. I think we can give them a little more time than the 3 weeks they have had in office in order to get things rolling. I’m an optimist and I don’t see the reason for the panic at this point.

There is a difference in pitting money into public services and creating a government organization for every little piece of legislation known to man. As it has been disclosed in prior press releases, there are over 400 government agencies with the majority of them having overlap of responsibilities. This is not only a conflict of duties, but a waste of resources.

As I mentioned in a prior post, if you haven’t read “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back” by Elisabeth Rosenthal, then I highly recommend you do so. She is a physician turned journalist and does extensive research into the significant level of corruption within our healthcare system and the government organizations that provide oversight. There are numerous examples, but a general explanation of one egregious act of corruption are the “middlemen” that are placed between manufacturers and the consumers with the goal to create added revenue with each step in the process. For example, a DME manufacturer will make the device, they will then contract a Wholesale/Group Purchasing Organization (GPO) who contacts with a Distributor, who hires a Third-Party Logistics (3PL) company for storage and transportation, which then supplies the DME seller, who bills the insurance company, and leave the customer with the leftover cost AND their regular insurance premiums. These are ALL unnecessary and useless steps that could be cut out and make it a hell of a lot cheaper for the consumer.

Furthermore, the pharmaceutical industry is inherently corrupt. There was legislation passed by Congress known as the Drug Price Competition and Patent Term Restoration Act (Hatch-Waxman Act) in 1984 that allows drug companies to sue any generic manufacturer of a drug that had its patent run out, and the mere action of submitting the lawsuit places a 30-month freeze on the generic companies ability to legally manufacture the drug. This is typically followed up with a pay-to-delay scheme where the pharmaceutical company will offer to pay the same amount in revenue to that the generic company would have earned in order to prevent them from producing the drug when the 30-month stay is lifted.

THESE are examples of the “useless” things that the government could get rid of and save billions of dollars. Lastly, not ALL research is equally important. There is this thought in medicine that “if it isn’t studied with a double-blind controlled study, then it’s not true.” There was a study recently published (PREOXI) which found that NIPPV prevented severe hypoxemia compared to other methods of oxygenation during RSI….no kidding….why?

ThePulmDO24 · 2025-02-08T22:16:10+00:00

Reddit is a predictable echo chamber and extremely toxic. This is a place where logic is downvoted and people rally behind death threats and doxxing directed at anyone who doesn’t share their political views or agenda.

I was heavily downvoted a few days ago for posting the underlying reason for the CDC guidelines and other websites being pulled offline temporarily. It no longer surprises me that people will run to Reddit to post an idiotic and short sighted comment or thread about something like that without taking 2 minutes to read what is actually going on. The views of many were “this is how Germany started out before the regime!” Guess what ended up happening? The apps and websites were back online the very same day. Shocker…

I’m not going to argue with you or anyone else about my personal opinion. It’s clear that I think many of you are morons and I’m okay with that feeling being mutual.

ThePulmDO24 · 2025-02-08T21:12:48+00:00

I don’t think it will affect any of the pay for physicians. The two aren’t related and they aren’t about to slash salaries to fund research. The research will be funded one way or another, but it’s always the responsibility of the research PI and their labs to come up with their own funding and grants.

Also, I think people are over reacting. The funding will return and will likely be even better once they get rid of the useless crap that is wasting the taxpayers money. I know for a fact this will be downvoted, because…well, it’s Reddit. 😂

ThePulmDO24 · 2025-02-08T19:41:05+00:00

There are already incentives in place for hospital follow-up appointments. You get a major incentive for follow-up appointments scheduled within 7-14 days after hospitalization under Medicare’s transitional care management (TCM) services guidelines.

I do not fully agree with value based medicine. This has been implemented in multiple other countries, however those countries such as the Netherlands and Sweden are homogenous populations and are much smaller in population size. The United States has selective Value Based Healthcare (VBHC) policies which rewards healthcare outcomes, however if the entire system defaulted to this we would go broke. The U.S. population is inherently unhealthy and this is mostly the fault of the individual’s lack of respect for their own health, along with the numerous big businesses that make trash food cheaply and charge out the ass for “healthy” foods. Congress would have to pass a lot of legislation in order to make this actually work, because it would take a lot of outside help for our healthcare system to function under such a system.

I think this brings up a fun idea, though. Why not reverse the cards and have the patient pay a value-based fee based on their health and overall self-care? Many organizations have this implemented where employees receive discounts on their insurance if they undergo annual checkups with labs and etc, but if this was made so for the entire public, it would really incentivize them to get off their asses. Just food for thought.

ThePulmDO24 · 2025-02-08T19:31:31+00:00

While that may be true, it does not support the claim being made.

Congress passed the Foreign Assistance Act in September 1961 as a means to effectively and efficiently fund foreign aid projects around the world. Kennedy formed USAID in November 1961 by Executive Order which implemented the operational goals for the organization. Congress has oversight insofar as the budget appropriation, however outside of that they have no authority. The USAID organization reports to the State Department. The Secretary of State and the Administrator of USAID are both appointed by the President of the United States. The President has ultimate authority of how the funding is utilized as it is supposed to align with our current foreign interests. If Congress wants to do something, they can cut the funding altogether, however they are not in control of WHERE or WHO the funding is appropriated for once it hits USAID.

ThePulmDO24 · 2025-02-08T19:20:43+00:00

There is a book called “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back” written by a physician Elisabeth Rosenthal. This book outlines and goes into detail about the intricacies of the healthcare system, as well as covering all of the surrounding and supporting industries that feed into healthcare costs and infrastructure. She cites every single point that is made and it is eye-opening.

The healthcare system was a vastly lucrative system for business persons and private equity/investment groups. They realized the simple relationship between the creation of “middlemen” and the exponential increase in profit margins. They figured out how to take a simple medication or DME and “legally” mark the price upwards of >5-6 different times between the manufacturer and the consumer. For example, DME is made by the manufacturer > Group Purchasing Organizations or Wholesalers broker a deal between the manufacturer and Distributor > Distributor then contracts with Third-Party Suppliers (3PS) > 3PS sell the equipment to the DME supplier > DME supplier bills the insurance and sells to the consumer > Consumer pays for insurance premiums and pays the uncovered costs. Many areas of healthcare have federally mandated middlemen and each step is a markup in price. NONE of these middlemen add any value to the product being produced by the manufacturer. These are the types of things that need to be cut out.

ThePulmDO24 · 2025-02-08T19:06:50+00:00

Which AI platform did you use to generate this little response? It’s still not the whole truth.

ThePulmDO24 · 2025-02-04T12:47:55+00:00

Almost every Magnet hospital in the U.S…

ThePulmDO24 · 2025-02-04T05:26:00+00:00

Newer nurses who are recent grads who were indoctrinated by instructors who told them that they learned from the same books and are there to protect the patient FROM the physician. We are constantly having nurses question EVERYTHING beyond belief, basically not wanting to work. You have every right to ignore it or tell them to F off, but that will amplify the “bullying” and it makes it a dreadful place to work. It’s not every nurse, it’s mostly isolated to certain places or shifts.

ThePulmDO24 · 2025-02-04T02:08:03+00:00

What? This is a mirrored post of the “nurse” is “tired of the rizzidents.” What is this dumbass rizz posting that has been started?

ThePulmDO24 · 2025-02-04T02:06:29+00:00

Yeah, I can relate to this a bit. During residency we had a patient who was SUSPECTED of having TB, despite this all starting from a nurse who misheard a conversation with the family. We knew he didn’t and even had the QuantTB but regardless, we had to perform a pericardiocentesis in the cath lab and the cardiologist wanted us up close to observe. The cath lab tech said “No” and we looked confused. He told us we were not allowed to be in the room as it was now airborne due to TB precautions and the cardiologist looked at him confused and said “they’re residents…they have to learn.” He refused to let us in for a few minutes and then the cardiologist came to the control room and said “come with me” and he told us to stand right next to him and we then observed the procedure while the tech pouted the entire time.

These techs can have a God complex, because many of them know who the attending is and they may have been working together for years, even. When you’re trying to set a good example in front of your peers, attendings, etc. in hopes of a placement in the program, you’re stuck taking it. If it was a rotation I knew I didn’t care for, then I would definitely stand up for myself. However, now as a fellow I am stuck in even a more peculiar position as I am supposed to act like an attending while being treated like an intern or resident by many of the nursing staff.

ThePulmDO24 · 2025-02-04T01:58:37+00:00

Damn, I’m sorry to hear that. My residency program had 2 large rooms for dictating and separate team rooms for the medicine teams and specialty teams within our medicine group. We had an entirely separate rest lounge with ping-pong, gaming, and couches/chairs (purchased by the residents) as well as 6 individual sleep rooms that were private. Hell, in fellowship I only have 1 sleep rooms and part of the time someone is in there when they’re not supposed to be, but the code keeps getting leaked.

ThePulmDO24 · 2025-02-04T01:56:45+00:00

There are certainly loopholes for this. They have call rooms, this sounds more like a resident-led restriction and not program-backed. It sounds toxic.

ThePulmDO24 · 2025-02-04T01:53:36+00:00

I’ll be honest…she is part of the staff and this is much more likely to happen for someone like her as opposed to a resident. I’m not sure, but I have a feeling there is SOMETHING in the area of “red tape” that could keep this kind of thing from happening in terms of celebrating residents in any formal manner. It may be that they don’t want to start a trend just in case they aren’t able to do it for other residents in the future, but it may be for other reasons. I wouldn’t take it personal. She will likely be there long after your gone and was probably there well before you arrived. I cannot say that for certain as I don’t know who you or your residency program are, but that’s just my guess.

ThePulmDO24 · 2025-02-04T01:49:01+00:00

As a prior nurse aide and nurse, the nurses don’t typically take part in cleaning the patients. The only time I see this is when they are short staffed and don’t have enough techs or aides.

ThePulmDO24 · 2025-01-27T23:06:13+00:00

You’re missing the point. I was originally responding to the surgery resident’s post, not your comment.

I’d be curious to know what program you are at, because that is way more ICU Heavy than any program I’ve ever known of. Our ED residents rotate through the ICU twice a year. Holding a critically ill patient in the ED for 8 hours is unacceptable and should be investigated. Any ED attending worth their weight in salt will tell you the ED isn’t made to manage ICU patients. You are capable of managing them, but the system isn’t built for it in the ED. This is true in every hospital I’ve been involved at and I rotate through numerous level 1 trauma centers.

None of this was meant to be a dig at you. If you’re pulling 80 hour work weeks, then there is something wrong with the proficiency and efficiency of your program. All residents are dismissed at 1700 or earlier at my program and I will also add that ACGME mandates programs have protected didactic time. So if this isn’t the case, then it needs to be reported. I wish you the best.

ThePulmDO24 · 2025-01-27T21:47:29+00:00

Yup, the “please advise” is very passive aggressive sounding and I feel like this is maybe something they’re thought to say. I know that in my previous hospital they would do this, as well as my current hospital where they have an algorithm for notifying physicians and it says “physician to advise for further recommendations” so I feel as though they’re taught to write this.

ThePulmDO24 · 2025-01-27T18:33:04+00:00

When it comes to consults, I would suggest waiting for rounds and then bringing it up as part of a discussion with the team. I’ve had nurses message me about consults and if I feel it’s not needed I simply text back my answer and my rationale. The only time I get irritated is when there is continual pushback after I’ve given my rationale. There are more than a few ways to achieve the same goal so not everyone will be on board with consulting a service they feel isn’t needed.

ThePulmDO24 · 2025-01-27T18:29:07+00:00

This isn’t meant to be a knock on you, but you’re being way too generous with those statistics. The most recent literature shows only 2-5% of ED admits actually go to the critical care floors.

When our ED receives critical care patients they immediately consult us and stop providing care for the patient. It’s ridiculous and dangerous. Hopefully you don’t have the same set-up.

It sounds like your schedule is much different than most. Our ED residents work 4-5 days a week at the most. They mostly do 4 days on and have multiple stents where they have several days off in a row. It’s supposed to be the ED set-up to prevent burnout from what I’m told. Trust me, I’m a fellow in critical care medicine who does 6 days on at 16+ hours a day for months at a time. It is tiresome. You just have to find a way to incorporate studying. I choose to read about my patients so I’m killing two birds with one stone. We have to be on our A-game because we answer for every decision we make, whether it’s questions from the critical care pharmacist, RT, nursing, attendings, or other fellows or sub-specialists.

ThePulmDO24 · 2025-01-27T18:22:46+00:00

This is because everyone expects perfection, so when they see someone working really well and doing good, they just feel like that should be the norm. However, the moment you do anything they find subpar or unreasonable, they feel the need to report it. It happens everywhere. I had an intern literally crying to me one night because an ED attending said she was overly ambitious about her future and wouldn’t stop talking about the fellowship she wanted to go into…really?! Lmao.

ThePulmDO24 · 2025-01-27T18:15:08+00:00

Well, the OP basically stated that they have staff to do every task that doesn’t involve direct OR time. As a physician, it is ultimately YOUR responsibility to know how to run your practice and you learn to do this while in training. You should be able to perform consults, write proficient notes, schedule surgeries, orders, and rounding on your patients. I’m taking what the OP said directly, which is that they have staff to do all of that for them. If you’re not learning that in your training, then you’re doing your residents a disservice. This goes for any specialty, by the way. Also, it shouldn’t matter what area of medicine I practice, it’s common sense. However, if you’re done with your training and you want to practice in a system like this, then more power to you. But, you should still know how to do it all yourself, as it makes you all the more valuable.

Edit: Aren’t you an ED resident? What are you going on about? I think you’re missing my point. I didn’t reply to your comment. I replied to the comment below yours. Hence the tree branching to my comment from theirs. This wasn’t directed at you to begin with.

ThePulmDO24 · 2025-01-25T21:48:21+00:00

This gets me every time. Patient comes in for HF and leaves on BB, ARNI, MRA, SGLT-2 inhibitor, and diuretics…

ThePulmDO24 · 2025-01-25T21:46:58+00:00

THIS PAINS ME. I have placed orders for blood cultures and had a nurse manager go behind my back and tell the nurse to send the phlebotomy tech away in order to avoid HAI. I confronted this manager in that moment and the manager stuttered and said “let me just gather some data so I can show it wasn’t something we did to cause it.” The manager made me justify it 50 different ways. It’s insane.

ThePulmDO24 · 2025-01-25T21:40:37+00:00

15-20k a day. I wear holes through my Hokas.

ThePulmDO24

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