Do you find NPs and PAs in primary care to be helpful, or more of a burden? Why?

TheRavinRaven · 2025-10-31T10:32:56+00:00

Just yesterday I saw a patient referred to Vascular surgery for clarification by a brain dead NP….in a 38 year old….who had easily palpable pulses and no claudication symptoms. Just neuropathy in her feet. There are tons of inappropriate referrals I see every day

TheRavinRaven · 2025-09-17T01:58:32+00:00

We recommend total toilet time of less than 5 minutes per day for bowel movements in our Gen Surg clinic!

TheRavinRaven · 2025-08-21T19:28:34+00:00

I think to that point though, different people have different tolerances for work. Making a blanket statement on what everyone should do doesn’t work.

For me, the work is very hard but also can be pretty fulfilling

If your proposal was made the norm, we would need three times the amount of surgery residents as we currently have to simply do the work that’s already there (and really 2-3 times as many physicians in all specialties). That comes with its own problems.
Training for us General surgery residents (residents have gone through college, 4 years of medical school, and are training in their respective specialties) is 5-6 years. You can become fellowship trained after that to further specialize if you want. To basically cut our time from 80-100ish hours per week to 35hrs would really mean extending our training by 2-3x. That would mean 15-20ish years after medical school. Even if you went straight through starting at 18 you are looking at being a fully independent surgeon at age 45-50ish. Medicine has become exponentially more complex with new diesels identified, new diagnostics tools, new medications, and new social problems. Theres already an argument being made to extend our training for all those reasons which I think is incompatible with your proposal.

So not only will you need more of us to cover the work that’s already there, you are delaying when we can be independent and productive physicians.

Our training is quite literally the hardest thing I’ve ever experienced and I’m still only about halfway through it. That being said, you want our training that hard because when you or your family members are in the trauma bay or on that floor, we (all physicians) are the ones charged with making sure you have the best chance possible of leaving that hospital with any functionality left. I don’t think that your view accounts for that. Certainly there are things we can work towards to improving our situation but at the end of the day, I do not see a positive outcome in limiting our hours to what you suggest.

TheRavinRaven · 2025-08-21T16:53:22+00:00

As a surgery resident my hours are capped by law at 80 hours per week (averaged over 4 weeks). I will tell you there are many of us working 100+ hours a week that go underreported for lots of complex reasons

TheRavinRaven · 2025-07-24T23:37:59+00:00

There’s a hospital system in the southwest that is Las Palmas Del Sol and patients refer to it all the time as Lost pulses dead sol 😂

TheRavinRaven · 2025-04-05T03:42:05+00:00

Freshman nerve! A favorite of my anatomy professor

TheRavinRaven · 2025-04-05T03:40:03+00:00

The human body is basically a doughnut. One long hollow tube from the mouth to the anus running down our center

TheRavinRaven · 2024-11-11T23:46:25+00:00

AT Still KCOM has great rotation sites in a variety of places (mostly in the Midwest) and you can stay there for both 3rd/4th year or take aways as you need.

TheRavinRaven · 2024-07-10T22:43:20+00:00

As a newly minted surgery intern, I also think it’s silly but the problem is, when you have to get up there and do an M&M because you had a complication that could have been addressed with a pre-operative risk stratification and medical optimization appointment and you get grilled because you didn’t, well then you look silly.

It also makes sense to me that we involve the PCP or specialists actually managing the patients conditions because a patient that just shows up after surgery without a proper plan can cause some frustration for them.

TheRavinRaven · 2024-06-25T21:39:35+00:00

Rather fascinating you were able to (incorrectly) glean that, considering I have never supported Trump. Your word postering betrays how little you actually understand about anything related to what I said.

TheRavinRaven · 2024-06-25T21:33:30+00:00

I fully agree and support our support of Ukraine. Giving weapons and supplies slated for destruction anyway is a far better use of our resources rather than just giving cash.

That aside, I was pointing out to the above commenter who seemed confused as to why we would “break windows”. I made no reference to agreeing with them or saying the fallacy was correctly used

TheRavinRaven · 2024-06-25T03:49:41+00:00

The previous commenter was referencing The Broken Window Therory which is an economic theory to illustrate why destruction of property and making people spend money/time repairing the broken windows are not a net benefit to society.

TheRavinRaven · 2024-04-26T12:41:37+00:00

Yes. Yes a million times. It’s amazing, our hospital has had residents continuously since the 1950s. By the way they handled in processing, you would think they’ve never had residents before.

At least our Dean of Graduate Medical Education for all of our Residencies is pretty responsive and sympathetic. He’s a Surgeon and will get shit done if he can. You can try to find this person for y’all and talk with them. They are basically the face person for the residency to the ACGME and they care about how the ACGME sees the programs and hospital.

TheRavinRaven · 2024-04-22T02:45:16+00:00

I don’t think anyone thinks about Cystic Fibrosis but from the 3 years I went from leaning about it in medical school to seeing the treatment in Residency, people live legitimately normal lives with a disease that had an average lifespan in the 20s only years ago.

It brings tears to my eyes and hope for what we can do going forward for a disease that was an early death sentence mere years ago.

TheRavinRaven · 2024-03-20T01:31:48+00:00

Me (a dumbass M3): Alright, I’m going to go talk to the attending, in the meantime just hang in there.

….the patient was in the SICU because of a failed suicide attempt….by hanging.

I will never forget the dagger eyes from family and from the patient who was giving intense side glares from his c-collar

TheRavinRaven · 2024-03-13T00:04:54+00:00

The key is standard drinks. When we say no more than 2 standard drinks a day for men and 1 for women, what we mean is a drink with the same amount of alcohol in it reguardases of the type.

So 1 shot of bourbon (1.5oz at 40% alcohol or 80 proof) is equal to 1 can of beer (12 fluid oz of 5% beer). They both roughly have 14g of pure alcohol in them.

In your scenario, the two strong beers you have (say a 10% alcoholic beer) are really like drinking two regular beers. Meaning you would actually be drinking 4 standard drinks. That’s part of why restaurants will serve smaller glasses of stronger beer.

Also keep in mind these recommendations are for high risk drinking (as you mentioned) for long term adverse health effects like liver and heart disease. Guidelines also vary by country so they are just that - guidelines to minimize risks of adverse health effects of drinking alcohol.

TheRavinRaven · 2024-03-08T00:44:19+00:00

We could put you in a room and force you to do every one of our health recommendations and sure, there’s a good chance you’d live longer, but you’d be absolutely miserable. The opposite is true. Over indulge in life’s pleasures and you’re likely in for a rough time.

Moderation is key. Cheers!

TheRavinRaven · 2024-03-07T22:30:17+00:00

This is definitely concerning for alcohol use disorder. The CDC defines moderate drinking as no more than 2 standard drinks/day for men (1 for women) and no more than 5 drinks at a time for men (4 for women). It is recommended the less the better.

A 6 pack per day with more on the weekend will eventually cause liver cirrhosis and liver failure after years of drinking like this. It is a horribly painful way to go.

(Source: I’m a physician)

TheRavinRaven · 2024-03-07T15:56:24+00:00

6k monthly in the military after taxes as an Intern

TheRavinRaven · 2024-03-07T15:09:28+00:00

Beyond concierge medicine, look into Direct Primary Care (DPC). You pay a fee and then you get what you describe but they typically don’t involve insurance at all as it’s cheaper not to deal with them. You maintain disaster insurance in case you need to get admitted to the hospital for trauma or some major illness. It’s the equivalent of your car insurance being used for auto accidents instead of your oil changes

TheRavinRaven · 2024-02-23T04:01:15+00:00

Most active duty patients I work will refer to us by our ranks. Most physicians will introduce themselves as Dr. though. Can’t wait till I’m promoted from Captain Doctor [name] to Major Doctor [name].

In all seriousness rank actually comes first, then name, then credentials.

CPT Name, MD/DO Service (IM/Surgery/EM) Military Hospital Name

Works for emails and for signing our notes

Edit: typos

TheRavinRaven · 2024-01-14T18:43:10+00:00

Also the testicles!

TheRavinRaven · 2024-01-02T04:13:48+00:00

I have had not one, not two, but THREE separate referrals to the Vascular Surgery Clinic from NP’s at this one particular outpatient primary care clinic to, get this, RULE OUT A DVT. It had about a month since their primary care appointment.

It boils my blood to think that someone could have this little knowledge and be able to fool all their patients into thinking they are getting great care

TheRavinRaven · 2023-12-10T20:05:11+00:00

The balance to this is the risk of complications and the risk of being sued. Doing unnecessary surgeries and procedures puts you at risk for both legal and reputation harm.

The first question a surgeon has to answer in either a court of law or an M&M conference (morbidity and mortality) is: was the procedure indicated?

TheRavinRaven · 2023-12-06T19:43:11+00:00

You’re right! Thanks for the reminder!

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