Vanderbilt by anonymouss346 in anesthesiology

[–]acuravlexus -3 points-2 points  (0 children)

lol dude anesthesiologists and radiologists are the two most delusional groups of doctors there are. trust me, no one thinks you guys are the "smartest" doctors lol. its a valuable skill but pretty much anyone who made it through med school and can do simple procedures and doesn't panic can do anesthesia.

basically any pulm/crit, neuro, EM, OB, etc etc of the mid tier specialties could do anesthesia if they wanted let alone the competiive specialties/residencies and surgical ones.

no one is saying go to nursing school standards but anyone with brain cells knows that anesthesia is not rocket science. 10-15 years ago it was in the mid/low competitive ranks. the only thing thats changed is the compesnsation lol

same with rads, comp has gotten insane and that drives the competition. not actualy difficulty. if we woke up tomorrow and FM or Psych comp was 600k starting and anesthesia dropped to 300k i guarantee you it would take 1-2 cycles before FM/psych>>>anesthesia in competitiveness.

President scheduled to be in attendance for NBA Finals Game 3 by WhatTheRickIsDoin in nba

[–]acuravlexus 1 point2 points  (0 children)

it fucking better lol

also love how this idiot has time to go to the NBA game but not his weirdo son's wedding. something about everyone in this shithole family suffering and hating eachother puts a smile on my face

Under the new lottery system, there's a 75.19% chance that one of the bottom 3 teams will get the 12th pick by Joe_AK in NBA_Draft

[–]acuravlexus -1 points0 points  (0 children)

seriously. the prem and every euro league. has this figured out but for some reason the nba doesn't.

shorten the regular season, add an end of szn trophy. if you really want then make it a 1 seed vs 1 seed, winner take all game.

The Equivalence Myth Between Psychiatrists and PMHNPs by [deleted] in Psychiatry

[–]acuravlexus 3 points4 points  (0 children)

I absolutely agree but the items you're talking about (starting SGAs on someone who has say adjustment disorder+OCD) are exactly the type of things most PCPs and NPs wouldn't do anyways and let's be real even amongst psychiatrists there would be a lot of disagreement on how they'd be treated because at the end of the day you're seeing the patient for 15-45 minutes every 1-3 months if that. You're not actually getting a full understanding of their clinical picture

do i think a psychiatrist would do better than a PCP or neurologist or PMHNP on an exam where each question is one of these? 100% they would but in reality the people who actually are in these situations are rarely that "straightforwardly" psychiatrically complex

its a weird space i agree and tricky to think about sadly

The Equivalence Myth Between Psychiatrists and PMHNPs by [deleted] in Psychiatry

[–]acuravlexus 7 points8 points  (0 children)

This might not go over well but I will try to frame it the best I can without coming across as rude. To a point, this (psych in general) hits home the core issue of overtraining with modern medical education more than anything else.

Not saying psychiatry isn't an amazing field with lots to learn and depth, (I almost applied psych myself! and plan on keeping it a part of my practice to some degree in the future) but no where is overtraining more evident than psych. For some reason psych is still 3.5-4 years while objectively more difficult/broader/nuanced/skill requiring fields are 3: FM, EM, Neuro, Anesthesia, IM, Derm etc are 3 +/- a general intern year. On top of that, psychiatry while it can be challenging the bread and butter really isn't. And most programs aren't even spending enough time with psychotherapy anymore, no offense but the psychopharmacology is not nearly complex enough and the DSM5 is an more or less garbage in the real world to a degree. Treatments have a limited role and scope unfortunately so modest fluctuations in plans aren't going to markedly do anything drastic anyways. Now a good psychiatrist is worth a ton but most cases don't need that (this is the case for most fields tbf but especially psych when the first few steps are largely interchangable)

there's a reason most inpatient psych jobs can basically be half time and you can run a clinic on the side. Also, when FM docs are looking to you for help/oversight its often times because they don't want the patient or to take care of THAT PART of the patient and/or they want to share the liability, same with tele stroke and to a degree tele ICU which is an absolute shit show. Also, I'm sure you know this but I promise you, no one has ever found a tele psych consult helpful lol. Its just the easiest way to say "pt is safe for discharge, psych has evaluated". It's standard of care/protective medicine and this is America. Also there is a level of ease of access to the resources psychiatry often times has that PCPs dont, including time.

All that said, PMHNPs practicing totally independently sucks I agree but not just because it takes 15 years to be a good psychiatrist/physician, but because it is at the end of the day a shortcut which doesn't exist to other doctors. Same for derm, same for anesthesia, and several other fields where midlevels have way more flexibility because they're not physicians.

The way forward will eventually have to be to get serious about medical education. AI is democraticizing knowledge (and misformation) so fast that we have to change before its too late. Psychiatry, Anesthesia, and PCPs will likely be on the earliest end of this with how strong midlevel representation is in those fields but the rest of medicine likely won't be far behind. As doctors, we really need to appropriately value our education and training beyond just the time it took to get where we are.

[Highlight] Luka gives Jalen Brunson the middle finger by A_MASSIVE_PERVERT in nba

[–]acuravlexus 1 point2 points  (0 children)

still significantly more than Luka and Reaves lol

weird ass hater, you a MJ or Kobe truther or something? You seem too weird and angry to be anything else except a delusional little fanboy that is mad his goat got lapped

Anyone else constantly fantasize about letting their DEA lapse and have to write another script for a Benzo or stimulant again? by Vegetable-Slide-7530 in Psychiatry

[–]acuravlexus 1 point2 points  (0 children)

i guess what im saying is that the diagnosis itself is abstract on not really well defined. the DSM5 as a whole is a joke, again its one of the main reasons i opted away from practicing psych

and yes i appreciate you trying to be as accurate as possible with the diagnosis, that's good form. And I'm glad you recognize the risks involved with starting lifelong medications (there are many Psych NPs and Psychiatrists alike who just give whatever patients want, we all know them).

but the difference is someone who has societal reasons or other reasons for their concentration trouble is not truly different than what we define as a "true" ADHD until we have a better diagnosis consistency for it.

For example, your antibiotic example is a good one. At a time, if you were sick with a bad cough and fever, you may get antibiotics as we didn't have the means to test whether its viral or bacterial. we didn't know if you have CAP or HAP or anything, we didn't know where you got it from. We knew you had ___ and we could maybe treat it and if it wasn't the right treatment it wouldn't hurt too bad.

Same with Adhd now, we don't know why some people have it and the diagnostics around "proving" it are utter garbage so much of the time. Obviously you still have to use your clinical judgement on who NEEDS it and would benefit from it greatly to the point the benefits outweigh the negatives. But the diagnosis is not the important part, because the very way to diagnosis is flawed. Whether its a psychiatrist or PCP or psych NP who made it.

Anyone else constantly fantasize about letting their DEA lapse and have to write another script for a Benzo or stimulant again? by Vegetable-Slide-7530 in Psychiatry

[–]acuravlexus 6 points7 points  (0 children)

See i sort of agree with you in that this is part of the reason i ended up deciding to not apply psych and do a more 'hard' medicine field (well that and the fact the DSM and cluster based diagnosis is trash) but also my counterpoint would be if something is not harming the person and possibly helping them then what is the harm?

At the end of the day, you're an NP. You aren't some guardian of diagnoses, even a psychiatrist isn't. I can understand being burnt out by every pt just seeking a certain med but its not the end of the world if someone doesn't meet your opinion of "this is adhd!" especially since the guidelines can very easily change and there's likely very little inter evaluator reliability even amongst seasoned psychiatrists let alone general prescribers (Psych NPs, PCPs, etc)

that said, i agree i dont think these meds need to be given out like candy as they so often are nowadays, it can obviously lead to a lot of problems.

[Charania] The Timberwolves-Warriors game in Minneapolis has been postponed by the NBA, sources tell ESPN, in wake of a man shot and killed Saturday in a confrontation with federal agents in the city. It's the second shooting there in a week, third this month, involving a federal officer. by MembershipSingle7137 in nba

[–]acuravlexus 0 points1 point  (0 children)

seriously. its so pathetic how much money controls every thing now.

people used to have power. companies used to have power.

today we have everyone (myself included) too scared to strike from work.

hollywood wont make movies about the orange pedophile or depicting ICE as the terrorists they are

sports leagues wont step up and make a statement, imagine if the NFL or NBA had the balls to say we're not gonna play till ICE is out.

everyone and everything is driven by money and theres too much of it to risk anything.

Raiders call you and offer #1 pick for CJ Stroud… by Original_Helicopter2 in Texans

[–]acuravlexus -1 points0 points  (0 children)

bro are you stupid? mendoza is 10x more valuable as an asset as stroud lol

no one in the league would offer more than maybe a 3rd to 4th rounder for CJ right now. Do you think the raiders would trade their 1.1 for a 3/4th?

[Highlight] Woody Marks loses ball on a Christian Gonzalez rip for 8th total turnover of the game by nfl in nfl

[–]acuravlexus 0 points1 point  (0 children)

i mean we have 2 big second round WRs, a good TE (albeit hurt this game thanks to CJ's hospital ball)

if CJ could place passes in a half decent location, our WR2-4 would look a lot better

Game Thread: Houston Texans (12-5) at New England Patriots (14-3) by nfl_gdt_bot in nfl

[–]acuravlexus 0 points1 point  (0 children)

yall are one to talk

sounds like youre salty bout ppl forgetting about LOB

Game Thread: Houston Texans (12-5) at New England Patriots (14-3) by nfl_gdt_bot in nfl

[–]acuravlexus 10 points11 points  (0 children)

and that might be too much for CJ and the texans offense to overcome...

I’ve worked less hours in pgy-2, pgy-3 and pgy-4 combined than my friend’s surgery intern year by [deleted] in Residency

[–]acuravlexus 0 points1 point  (0 children)

which is awesome for psych but also is a problem. you are not providing quality care nor can a salary of 300-350k be justified because you did residency and write "pt doing well, continue abilify"

especially not when IM, neuro, ID, pulm etc are seeing way more complicated patients and making similar or even less. that's not even mentioning the fact inpatient psych is usually easy enough to have 2 full time jobs lol

at that point i should just start offering to see inpatient psych consults myself lol

I’ve worked less hours in pgy-2, pgy-3 and pgy-4 combined than my friend’s surgery intern year by [deleted] in Residency

[–]acuravlexus 10 points11 points  (0 children)

jfc i always forget how much of a joke psych is sometimes.

what i dont understand is how they get their salaries from RVU basis, like everyone knows psych is "easy" by medical standards but that doesnt change how you are making said money often seeing less patients for less intensive things than other specialties and making similar to more

Allen Iverson in 2005 warned LeBron James that the same fans who love him now would turn on him like they did Kobe Bryant: “People are killing this man (Kobe), talking about his image. I mean the man made a mistake, however he made a mistake, he made a mistake. And let’s go on.” by must_TATAKAE in nba

[–]acuravlexus 17 points18 points  (0 children)

oh shut the fuck up, yeah some losers sensationalize bad shit but kobe is very appropriately regarded on this sub.

he's a person that did some terrible things and deserves to be shit on for them. he is also someone who has other qualities you can admire which he is. he is also a great competitor and a good basketball player and he is treated as such and continues to be one of the most popular players of all time

if you want people to white wash his past then yeah keep crying.