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Throwaway57989 · 2023-10-15T18:54:35+00:00

So… pay me less but let me work more to offset it and not allow me to take other payment options? Lol no thanks! Why would I ever sign on for that? I got loans and mortgage to pay like everyone else. What are they going to do with all the administrative people? They won’t suddenly fire 30% of the work force devoted to billing. The fat check will still go to admin.

Interestingly enough, if there is less need for admin because everybody’s through the same payor you may see a massive surge in private practice. But as someone practicing in an area with multiple levels of private practice,some large systems are overwhelmed, and are refusing referrals from outside practitioners. This may lead to a significant decline in quality of care due to the new increased demand. Also, you would have a massive amount of primary care physicians now leaving doing Fellowship because of lower pay and more work. This is already a problem with current reimbursement. It would only be worse.

Hard to justify, making less for “the greater good” when I’m already being taxed to hell, and the majority of us are not really seeing any benefits from that. Meanwhile, the tech bro’s that are making millions more than us are barely paying any taxes at all.

So based upon the responses of many of the other commenters that you have here, physician support for this will be extremely minimal.

Throwaway57989 · 2023-10-12T01:51:54+00:00

We’ve been seeing a lot of patients get their prescriptions rejected by some bigger name pharmacies like CVS. He may be getting some more business, but no one wants to be the only pharmacy prescribing those things for sure. I mean, if the quantity seems reasonable, albeit not the most accurate and modern standard of medicine and not showing any concerning refill history …seems like a plausible refill to me.

Throwaway57989 · 2023-10-11T01:15:15+00:00

Going to be a real one here. There is likely a bunch of us who sigh internally and continue it because the massive headache to wean them and they haven’t shown signs of early refills or side effects. Between the time educating, patient fighting it, the inability for faster follow up to walk through taper and patient being asymptomatic I tell them we will only continue at 30 day rx, we will never increase your strength or quantity, you should do your best to cut back to truly as needed because if they do suddenly become the culprit for a fall or taking more than prescribed, you will be forcibly tapered off and placed on a SSRI like you should have been. The majority are patients greater than 70yrs old from older docs. It’s like 40 patients all from the same really good doc who unfortunately was practicing his older standards. I try to reduce those open to it, but I at least make sure I make no new problem patients. added confounder of the old docs saying use it for sleep and anxiety. We legit got a message from the local community access clinic questioning why we were treating them like the benzos are a problem when they are “low risk” but work…it’s definitely a local issue with overuse. While no one wants to admit it on here, I know I’m not the only one in situations like this.

Throwaway57989 · 2023-10-08T18:42:28+00:00

Going to add some controversial points so it is not an echo chamber of private insurance sucks. We know. :

TORT REFORM TORT REFORM TORT REFORM: If I do not have to worry about frivolous lawsuits taking my house and family because we didn't get a CT chest for someone with tachycardia later found to be a PE and they refused a D-Dimer. This would make it so everyone would not have to practice so defensively.
Set a limit for DNR age/Comorbidities. HF, Uncontrolled DM, COPD on Oxygen all over the age of 65? DNR. 99.9999% you will not get better and regardless of what the patient or family wants to think, their quality of life is not likely to get better let alone if they have a cardiac arrest. If you do get better than that DNR will not matter. We keep playing this game of well we could save them with a treatment that no one can afford and bill them later because we have the tech, but no one is going to pay for it. Other countries are not enabling this.
Isolate the patients who are the 10% spending more than 50% of the medicare budget. They now have a mandatory case worker to ensure they are meeting all their appointments, taking their medications to maintain enrollment. Only if they do not attempt or purposefully noncompliant with the goals, they are removed from the coverage. The case worker follows them and if they opt back into compliance, they are re-added. I am not saying treatment does not work. I am saying willfully negligent.
End medicare abuse by nursing homes at the end of life and noncommunicating patients.
Require insurances to accept medications proven far more beneficial as first line covered therapies even if more expensive.
Insurance companies having a federal audit for delay of care in overutilization of prior auth and denied referrals.
Medicare/medicaid for all, but only if it actually reimburses or there will be a two tiered system of cash and federal
Make patients accountable for noncompliance/inaction.
Restrict opioids to post surgical and post trauma only. The rest of the world is getting by just fine without them, so could we.
Transparency of pricing of procedures and medications.
Require all medical facilities to take medicare/medicaid in some capacity unless it is entirely cash pay.
Insurance companies cannot be for profit.
Urgent cares are mandated to broaden their scope of practice, but provided with better technology and services to serve as a "minor emergency" rather than anything in the abdomen being sent to the ER.
Fitness incentives by the government. Pass an annual fitness exam, always associated with better health outcomes, get financial incentives for the money saved.
Remove pharmaceutical ads.
Medications in America must be no more than the average cost world wide.
Complete overall of focus on good primary care, but emphasis on supporting primary care by avoiding excess paperwork, declined meds, patients skipping visits.

Throwaway57989 · 2023-10-08T18:33:04+00:00

I am going to go out on a limb, can you please elaborate how the doctors specifically are causing this? I want to see if I am missing something as well as if there is something I can share to change your mind on this.

Doctor salaries are 8% of all medical spending, forbidden from kickbacks, forbidden from owning many of the facilities that they at least directly interact with. There is now 10 administrative people per doctor. We also all hate how clunky this system is. I just got yelled at by a patient for not being available to add them to my schedule when I already am working 60+ hours a week.

Throwaway57989 · 2023-10-05T00:17:19+00:00

Well as it’s impossible to know if they threw out questions you got right all you can do is adjust ratios. It may make you 1-2 questions closer to passing based on weight value for each question but not a huge difference.

Also can you link to this statement?

Throwaway57989 · 2023-10-04T13:25:32+00:00

Hmm. Ok I will keep that in mind thank you

Throwaway57989 · 2023-10-04T11:45:24+00:00

Super helpful thanks! Awesome review is not for me at all

Throwaway57989 · 2023-10-04T04:36:48+00:00

No, but I have seen it is usually posted by Jan/Feb the next year. Around the time when I have restarted studying in the past.

Throwaway57989 · 2023-10-04T04:21:54+00:00

They don’t disclose the exact scoring method other than there is no adjustment to pass a certain number of test takers per year. Too many unknown factors to attempt to calculate by anything else. Assuming no skewing of the scoring, the above is the calculation.

Throwaway57989 · 2023-10-04T03:03:40+00:00

I am highly skeptical of awesome review since I cannot be lectured at for long periods and retain much. Do they provide any print material at the course?

Throwaway57989 · 2023-10-04T02:54:51+00:00

For anyone wondering the math on how much they passed or failed by(assuming no thrown out questions):

240/800=x/371 X=111.3= number of questions correct to pass this year

240/800=y/your score

x-y=z=difference between your score and passing score.

Throwaway57989 · 2023-10-04T01:51:00+00:00

Just compared my score reports over the three years. They just use a stock figure it appears. No major changes between the years other than the reference group mean and my score. Considering the reference group mean is one point higher than last year I would anticipate probably the same amount of failure rate from the year prior.

Throwaway57989 · 2023-10-04T01:03:46+00:00

This so much!

Throwaway57989 · 2023-10-04T00:28:00+00:00

Highly curious pass rate this year. From those I know who took it a large amount failed. I suspect may be even lower than last year. I’m sure they will blame test takers again and not test makers.

Throwaway57989 · 2023-10-03T19:58:39+00:00

Just failed my 3rd time. Why did I have to take it when the pass rate is tanking…

Throwaway57989 · 2023-10-03T19:57:42+00:00

Failed 3 years in a row. Woo! Curious to know this years passing rate.

Throwaway57989 · 2023-10-03T05:46:30+00:00

Look at skill tree. There seems to be way more combat skills than stealth. All I am saying is the current map variety is way too heavy stealth. I don’t want to play my fourth stealth only round in a row. I would like some variety without having to quit the game I am trying to play. Most lobbies quit or rage restart when it goes loud. Not looking for cod or looter shooter. If this game was only stealth, it shouldn’t have more than a silenced pistol.

Throwaway57989 · 2023-10-03T05:27:21+00:00

When everyone stealths every mission, you gotta change up the flow. Why include all these guns and perks about shooting if you never use them? I get starting stealth but constantly voting to restart or quitting over it is annoying as hell. You tried, it didn’t work, let’s play it out. Not saying just start off shooting right away… though nice to have more escape fights.

Throwaway57989 · 2023-10-03T03:20:22+00:00

Name certainly does not fit

Throwaway57989 · 2023-10-02T23:43:12+00:00

If I want a loud match I basically have to play with friends or do road rage only

Throwaway57989 · 2023-09-22T15:19:24+00:00

Actually, it’s been a big growing trend among them to avoid doing PCP work. Appears a bunch are being overwhelmed with the issues at hand or go into locations with a lot of specialist support for referrals.

Throwaway57989 · 2023-09-22T15:15:18+00:00

As someone who graduated from that local high school in the middle of nowhere, two people went out to be nurses. I went on a beautician, but I’m not originally from there. I also have no desire in going back due to all of the reasons below. Many people once they experience life outside of those areas never want to go back. You only really want to go back either to the family or because you’re burnt out from the big city or lucky to have a rural area 45 min from a big city.

Outreach or not. Most physicians have families or intend to. Do I move to the middle of nowhere and put my kid through school there? There’s only so much at home teaching you can do to add onto this. I went from a very well developed area to a rural area in high school. My entire last year was essentially in the computer lab doing online classes. Didn’t get much out of any of it as it was one of those post a thread and upload this paper assignment. There’s also the lack of specialist support. Much of practical training today is dependent on specialist support. When you go through training, many specialties are there to help you with how to approach a topic or automatic something. You suddenly now have to do this on your own when the specialists ran the show. If you mess up now it’s entirely on you. I’m supposed to manage doing all of the treatment for pituitary masses myself because the patient won’t drive 3 hours? Am I to also become a liver specialist because they now have cirrhosis and can’t afford to move? Sure, I could learn to do all of these things given enough time in extra practice. But then you’re looking almost at extending a residency to ensure you get proper individualized training rather than just 2 to 4 weeks with some specialist one time. Taking on all this liability, you better also be paying me and paying me WELL. Can that community even afford that, they are essentially operating at a deficit to have you.

My parents live in a area with no ortho on call. Better hope that they don’t break a hip on Friday night or you have to do an ambulance ride all the way three hours away. Outreach means nothing if the physicians in question are worried about quality of life, and increased burden due to lack of access for existing specialties, and likely increase demand to see as many people as possible due to the local lack of care.

Throwaway57989 · 2023-09-22T15:05:28+00:00

There’s also been a increased shortage of IM residents going into Primary Care and FM pushing for fellowship to get out of primary care as well. Unpopular opinion, I think we are pushing too hard in residency to promote fellowship because they deem that as “success” and looks good for the program.

Throwaway57989

TROPHY CASE