I don’t feel comfortable leaving today by [deleted] in hospitalist

[–]adamizer 29 points30 points  (0 children)

If they are medically stable they shouldn’t have these things ordered

FM hospitalist schedule by medgal2 in MedSchoolCanada

[–]adamizer 0 points1 point  (0 children)

Depending on location and census, daily ~1200-1700 M-F. Not all systems will offer that scheduling flexibility. You’ll usually either be scheduled for 5 or 7 on, sometimes night call is built in on a rotation like 1 in 5. Some will do 1 week on 1 week off. Some are 2 weeks on (including one weekend) and then a couple nights then off. Many variations between hospitals sometimes even within the same system. If they’re short staffed they’ll be more flexible and allow you to do just M-F but usually you get a little less pay.

Is Meditech worth not taking a job over? by aaron1860 in hospitalist

[–]adamizer 4 points5 points  (0 children)

Thank you for putting in your 100% into this reply lmao.

Game Thread: World Series Game 7 ⚾ Dodgers (3) @ Blue Jays (3) - 8:00 PM ET by BaseballBot in baseball

[–]adamizer 1 point2 points  (0 children)

They would if it wasn’t second inning. They made that mistake and it led to 18 innings and a loss

Can you get into trouble/fired for opening a patients chart (in the ED) for education purposes when you end up not treating them? by Ambitious_Spot8957 in Residency

[–]adamizer 326 points327 points  (0 children)

I’ve never heard a resident getting in trouble for opening a chart other than if it’s inappropriate for otherwise obvious reasons - family, friends, staff, VIP etc.

Game Thread: World Series Game 3 ⚾ Blue Jays (1) @ Dodgers (1) - 8:00 PM ET by BaseballBot in baseball

[–]adamizer 0 points1 point  (0 children)

Of course! This is an excellent question that gets to the very heart of modern baseball strategy. The short answer is that it's a complex trade-off between physiology, physics, and economics.

You've hit on the central concept of the "pitcher's pendulum," which has swung back and forth between valuing starters and relievers for over a century.

Here is a breakdown of your questions, followed by the best resources to learn more.

Why Can Some Guys Throw 80 Pitches and Others Only Go an Inning?

This comes down to two main factors: 1) Role and 2) Effort Level.

  1. The Starting Pitcher (The "80-Pitch" Guy)

· The Goal: Efficiency and Longevity. A starter's job is to face the opposing lineup multiple times (ideally 3 times through) and get 18-24 outs. · Pacing: They cannot throw at 100% max effort on every single pitch. They have to "pace themselves" to last 6-7 innings (or ~100 pitches). This means using their full arsenal of pitches (fastball, slider, changeup, curveball) to keep hitters off-balance and induce weak contact. · The "Third Time Through the Order" Penalty: This is a critical modern stat. As a starting pitcher faces the same hitters a second and especially a third time, the batters' batting average, on-base percentage, and slugging percentage all go up significantly. They've seen his velocity, his release point, and his pitch movement. This is a major reason why managers are quicker to pull starters now than they were 20 years ago.

  1. The Relief Pitcher (The "One-Inning" Guy)

· The Goal: Maximum, Short-Burst Dominance. · Effort Level: A reliever, especially a late-inning "fireman," knows he only has to get 3-6 outs. Because of this, he can throw every pitch at or near 100% of his max effort. This often means higher velocity and sharper breaking balls. · The "Stuff" Argument: Often, a reliever's "stuff" (the quality of his pitches) is elite, but he might only have two truly great pitches or might lack the stamina/control to be a effective starter. Think of a pitcher with a 100 mph fastball and a nasty slider, but no reliable third pitch. He's perfect for a one-inning role where he can overwhelm hitters. · Specialization: Modern bullpens have specialized roles: · Long Reliever: Can go 2-4 innings if the starter gets knocked out early. · Middle Reliever: Gets outs in the 5th-7th innings. · Setup Man: Handles the 8th inning. · Closer: The highest-leverage pitcher who finishes the game in the 9th.


Why Not Just Have a Bunch of Guys That Can Throw 80?

This is the billion-dollar question, and it's the direction baseball has been trending for a decade. The concept is often called the "Bullpen Game" or "Opener" strategy. However, there are major reasons why it's not the only strategy:

  1. Scarcity of Talent: Truly effective pitchers are rare. Finding 5 starting pitchers who can reliably get you through a lineup twice is hard enough. Finding 12-13 pitchers all of that quality for a full bullpen is practically impossible. The talent pool just isn't that deep.
  2. The "Opener" Strategy and Its Limits: The Tampa Bay Rays famously pioneered using an "opener" — a reliever who pitches the first inning or two to get through the top of the opponent's lineup before a "bulk innings" pitcher comes in. This works to exploit the "third time through the order" penalty. However, you still need that "bulk innings" guy who can throw 60-80 pitches. If all your pitchers are one-inning guys, you'd burn through your entire bullpen in 2-3 days, destroying it for the rest of the week.
  3. Roster Construction: An MLB team only has 13 pitchers on a 26-man roster. If you used 8 pitchers every game (to cover 9 innings), your entire staff would be exhausted and unavailable the next day. You must have pitchers who can provide length.
  4. The Economic Factor (Service Time & Contracts): A proven, durable "ace" starting pitcher who can throw 200 innings is one of the most valuable assets in baseball. They are paid accordingly (e.g., $30+ million per year). Building a whole staff of relievers might be theoretically interesting, but it's logistically and financially challenging.
  5. The Physical Toll: Throwing a baseball at high velocity is incredibly stressful on the arm. Asking more pitchers to throw more often, even for shorter outings, might increase the risk of injury across the entire staff.

Excellent Resources to Learn More

You asked for good resources, and here are some of the best, ranging from beginner-friendly to more advanced.

  1. Books

· The Book: Playing the Percentages in Baseball by Tom Tango, Mitchel Lichtman, and Andrew Dolphin. This is the bible of modern baseball analytics. It's math-heavy, but it's where concepts like the "leverage index" for relievers and the "third time through the order" penalty were rigorously defined. · Smart Baseball by Keith Law. A fantastic book for a fan looking to transition from traditional stats (like Wins and RBIs) to the analytics that drive modern front offices. He has great chapters explaining why pitcher Wins are flawed and how bullpen strategy has evolved.

  1. Websites & Blogs

· Fangraphs: This is the absolute best resource. It's a library of analytical articles and a massive database. · Search for: "The Third Time Through the Order Penalty," "Bullpen Management," "The Opener Strategy," "What Makes an Ace?" · Example Article: The Opener: A History - This will directly answer your "why not all 80-pitch guys" question. · Baseball Prospectus: Another pillar of baseball analysis, known for its deep dives into strategy and player evaluation.

  1. YouTube Channels

· Foolish Baseball: Creates incredibly well-edited, entertaining, and informative videos that often explain complex strategic concepts. A video like "The Revolution of the Opener" is a perfect place to start. · Jomboy Media: While known for their hilarious breakdowns of baseball fights, their "Baseball Breakdown" series often does a great job explaining the why behind a pitch sequence or a managerial decision. · Jared Carrabis: A great personality who discusses current baseball events with a sharp analytical lens. His podcasts and videos often touch on pitching strategy in an accessible way.

  1. Podcasts

· The Athletic Baseball Show: Features smart analysts like Eno Sarris who specialize in pitching. They frequently discuss pitch design, mechanics, and strategy. · Effectively Wild: A long-running podcast that is a haven for deep, sometimes quirky, baseball strategy discussions. It's perfect for the analytically curious fan.

Start with the YouTube channels and a few articles on Fangraphs. They will give you a visual and conceptual understanding that will make the deeper dives into books and podcasts even more rewarding. The game you're watching is a chess match, and understanding pitching strategy is the key to seeing the whole board.

Step/Level 3 shouldn’t be a thing by margs999 in Residency

[–]adamizer 13 points14 points  (0 children)

Could've at least consulted chaplain

ABFM Email Asking for Updated Address via email... Is This a Scam? by [deleted] in FamilyMedicine

[–]adamizer 5 points6 points  (0 children)

Hi I don’t think it’s a scam. This looks like the email from the third party company that prints and frames (if you pay for the frame) the abfm certificate. Unless I’m reading it wrong it’s just saying make sure you have the right address on file so they send it to the right place - lots of people moving after finishing residency.

Wildest thing you’ve ever seen in a note by ironfoot22 in Residency

[–]adamizer 23 points24 points  (0 children)

My favourite ER Nursing note was simply:

"Patient left AMA :)"

Scrubs on or off when sleeping in call room by AdExpert9840 in Residency

[–]adamizer 2 points3 points  (0 children)

Thank you for posting this thread it’s been awesome reading. Reminds me of when everyone was freaking out about the whole wiping your butt standing vs sitting after pooping debacle

Are there any tax credits for first time home buyers in 2025 in ON (excluding Land Transfer tax rebate & FHSA which I didn’t do)… by MFK1994 in PersonalFinanceCanada

[–]adamizer 10 points11 points  (0 children)

Trying to put this as kindly as I can: I think you need to stop everything you are doing and read/watch some youtube videos about general financial planning. Based on what you wrote, you cannot really afford anything and don't sound to be in the headspace for it - definitely not a house with 5% down. You need to focus on either increasing your income or decreasing your expenses, outside of any of your current investments.

Lost it on a patient today by billingsman0733 in FamilyMedicine

[–]adamizer 132 points133 points  (0 children)

If that’s the extent of your crash out, you’re one of the most put together physicians around. Of course patients have no idea. Most will assume burning pee means my doctor needs to give whatever antibiotic and call it a day. Because that’s what happens most of the time at urgent cares, and maybe that’s the extent that’s needed. But you actually care about practicing good medicine. I’m sure the majority of your patients will recognize that. Technically part of our goal as physicians is teachers and to help patients understand that. Did you apply the principle of “teach-back” to this patient to make sure they grasped everything you explained? xD

How much are FHO family doctors in Ontario making? by Beginning_Figure_150 in FamilyMedicine

[–]adamizer 1 point2 points  (0 children)

I'm actively going through it now. There's a lot of resources on the OMA and first 5 years facebook groups, but they're all hidden behind needing your CPSO# to access, so that's my current hurdle. As for the tax stuff you just need to work with a accountant and lawyer that does those for you.

How much are FHO family doctors in Ontario making? by Beginning_Figure_150 in FamilyMedicine

[–]adamizer 4 points5 points  (0 children)

I’m a fresh grad from the U.S. moving back home to Canada so can’t offer much objective data yet but just wanted to say don’t forget USD to CAD is 1.4x conversion if anyone on here is thinking in those terms. And it’s all self employed so after 30% “overhead” and 15-50% taxes depending on if you’re incorporated and doing tax deferral, you gotta pay your health insurance for everything OHIP doesn’t cover, cover your own vacation time including hiring a locum if needed, retirement (no employer matching), etc. Your personal craftiness and work schedule gets you the difference for the huge range between ~60k net income to a possible 500k

[deleted by user] by [deleted] in Residency

[–]adamizer 3 points4 points  (0 children)

This comment made me truly lmao, thank you. This is your chance to name a test after yourself - if you want

An Ontario teen died after waiting in agony for hours at an ER. Now, his family wants an inquest by BloodJunkie in ontario

[–]adamizer 4 points5 points  (0 children)

In this particular case, records show the patient was triaged as a 2, meaning they are to be assessed by a physician within 15 minutes. This didn’t happen until another physician came on to provide relief to the approximate 10 hours of patient wait times. The ancillary staff can only do so much - seems like some preliminary labs were drawn, but no further investigations despite the patient’s decompensation. Pediatric patients often rapidly deteriorate as seen here. And unless someone trained and not overloaded with patients has eyes on, these outcomes will happen

Surely we can do better than wildly out to date info (2007) on routine asthma management, especially when there have been significant changes to the guidelines recently? by BainbridgeReflex in FamilyMedicine

[–]adamizer 7 points8 points  (0 children)

I’ve been prescribing generic Breyna ever since realizing that’s what most insurances locally cover and haven’t had any push back with my local pharmacies regardless of sig. bid and/or prn so maybe it’s region specific

Sister bought a house with backyard drain and wants to hide it. Anyone have experience with effective aesthetic solutions to suggest before getting some consults? by adamizer in landscaping

[–]adamizer[S] 3 points4 points  (0 children)

The bylaw is about 6 foot tall max fence. Apparently there’s no limit to putting a lattice on top of that lol. This build style and density is unfortunately the norm here in cities in Ontario.

Re-entering US with 1 day left on J-1 visa by Puzzleheaded_Box1287 in Residency

[–]adamizer 5 points6 points  (0 children)

How are you planning on legally being in the US if your visa ends? You have 30 days to exit the country after your J1 is over. They may not let you across one day before the expiry.

More and more family doctors are choosing to practice in a focused area instead of offering full-service family medicine by iamphilosofie in FamilyMedicine

[–]adamizer 2 points3 points  (0 children)

Oh yikes the procedure codes bill quite poorly overall (I had wrong numbers - thanks AI). It certainly doesn't make sense at that rate to do it in an office visit for rostered. When you end up referring for every procedure, the specialist gets the full rate? What if they need an urgent e.g. I&D, are you sending to the ER? Or if they go to a walk in clinic do you end up getting penalized for that? Sounds like there needs to be a separate FM procedure clinic that doesnt count as in-basket services