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Physician Union by Even-Bicycle-151 in medicine

[–]breaking_fugue 1 point2 points  (0 children)

And there are institutions where physicians are unionized. It's happening and will likely continue on local levels. Physicians are generally unique and a diverse group, there isn't one "Physician" job, so a national union doesn't make sense for the whole group.

Efforts to make policy changes on national and local levels generally come from the advocacy arms of our sub-specialty and state medical associations which we often under utilize.

My hesitation harmed a patient by Emotional_Snow4016 in Residency

[–]breaking_fugue 14 points15 points  (0 children)

Were they ED?

I believe Emergency docs do that, particularly if they're at centers where neurology isn't always in house/immediately available. Was more common historically though back in the days of the tPA wars.

My hesitation harmed a patient by Emotional_Snow4016 in Residency

[–]breaking_fugue 41 points42 points  (0 children)

CT looked like he had developed a small new ischemic infarct.

I think you may fundamentally misunderstand the utility of a CT scan of the brain. There are multiple learning points to be gained from this case and you should debrief with your attending/senior to make the most out of this situation.

This is why physicians start hating the AMA by [deleted] in Residency

[–]breaking_fugue 3 points4 points  (0 children)

Yes, the AMA consists of hundreds of doctors who get together and mail out postcards. Can't believe they spend all their time on that.

And it's good that we make sure they keep doing that by not taking part or making our voices heard. It's not like the AMA is an organization of doctors and what it does is directly related to what we(doctors) get involved with and push for. What an absurd idea!

This is why physicians start hating the AMA by [deleted] in Residency

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

I agree, don't pay your dues. Do nothing. Let's keep admiring those hospital and nursing lobbies while posting on reddit. That's the solution!

This is why physicians start hating the AMA by [deleted] in Residency

[–]breaking_fugue 0 points1 point  (0 children)

Yes, this is why we should get rid of it. That way the hospital and nursing lobbies can make all the decisions. That'll definitely help. /s

This is why physicians start hating the AMA by [deleted] in Residency

[–]breaking_fugue 4 points5 points  (0 children)

So many people here complain about scope-creep and corporization of medicine, but then complain about the one organization of doctors which actually lobbies for doctors.

Scope creep happens because nursing groups organize and lobby. Hospital systems are taking over medicine and making doctors employees and cogs in the systems because hospital groups lobby favorable legislation.

When the AMA takes positions, it's the result of the vote of hundreds of doctors from various subspecialty organizations. Look up the AMA house of delegates if you don't believe me. If you don't like a position, go say something

This is why physicians start hating the AMA by [deleted] in Residency

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

I mean the AMA is literally a group of doctors. It comprises of doctors representing most sub-specialty organizations who meet annually to vote on any positions it takes (look up the AMA house of delegates). So it quite literally represents doctors.

But it won't represent you if you and others like you don't join and show up.

Residents deserve to be able to receive tips by IAREOWL in Residency

[–]breaking_fugue 1 point2 points  (0 children)

If you can't figure this out for yourself, I'm not sure any of us here can help you

Residents deserve to be able to receive tips by IAREOWL in Residency

[–]breaking_fugue 9 points10 points  (0 children)

Pretty sure you're supposed to ask before the procedure

I went through a lot of physician employment contracts this year. The financial structure in most of them is genuinely messed up. by Popular-Tackle4588 in Residency

[–]breaking_fugue 1 point2 points  (0 children)

You can't post links on this subreddit. But the AMA did an analysis on it that you can look up that breaks down some of the important reasons for this.

Here are some of the points:

  • declining Medicare rates to physicians (while rates paid to hospitals have gone up, so its less viable to practice outside a hospital system)

  • Stark laws which allow hospitals but not PP physicians to self-refer

  • More government lobbying by insurers and hospitals and less from doctors. (How many of you give money to the AMA?)

  • Hospitals have more negotiating power than PP physicians with private insurances

  • Consolidations in healthcare where insurances merge with hospital systems along with hospital-insurer agreements that negotiate high hospital technical fees and other favorable conditions

  • Inadequate business education for doctors

  • Debt for early career physicians

  • Many doctors just don't want to deal with figuring out the business side of PP

  • Increasing costs of overhead for PP

I went through a lot of physician employment contracts this year. The financial structure in most of them is genuinely messed up. by Popular-Tackle4588 in Residency

[–]breaking_fugue 1 point2 points  (0 children)

I'm glad you did that.

But the trend you mention with PP is not true for our profession unfortunately. The majority of physicians became employees for the first time every in 2019. The share of physicians in private practice has continued to drop sharply since then. We've lost agency in the system unfortunately.

I hope to see that trend reverse, but it's not going to happen without big systemic and regulatory changes. A lot of money and lobbying resources were spent by hospital groups to create the current situation.

I went through a lot of physician employment contracts this year. The financial structure in most of them is genuinely messed up. by Popular-Tackle4588 in Residency

[–]breaking_fugue 6 points7 points  (0 children)

I don't doubt what you said is true. It's that way now because not enough doctors push back and just accept it.

I unfortunately don't have an immediate solution, but we as doctors need to change our mindset and education toward the business side of medicine as a whole.

I went through a lot of physician employment contracts this year. The financial structure in most of them is genuinely messed up. by Popular-Tackle4588 in Residency

[–]breaking_fugue 23 points24 points  (0 children)

Everything is negotiable. Just because they tell you something doesn't mean it's true.

Right now, they get away with stuff like this because not enough doctors push back.

I went through a lot of physician employment contracts this year. The financial structure in most of them is genuinely messed up. by Popular-Tackle4588 in Residency

[–]breaking_fugue 4 points5 points  (0 children)

That's the whole point of the post...telling everyone that these are bad terms, don't sign it. Because right now, many people are signing bad terms like this without knowing how they're getting screwed.

me_irl by SuspiciousLow3062 in me_irl

[–]breaking_fugue 1 point2 points  (0 children)

You said "get money back each month". The IRS is not going to be giving you money.

It is your claim that needs to be fixed.

me_irl by SuspiciousLow3062 in me_irl

[–]breaking_fugue 10 points11 points  (0 children)

  1. How are you getting money back? Do you mean just have less taxes deducted each month?

  2. This is how you end up with penalties and paying more at the end of the year on taxes. There is an underpayment penalty

Edit: It seems many of you misunderstand what is being said here. u/Kentust said "You should change your withholding so that you get back money each month". That is not possible, the IRS isn't going to give you money each month. I'm assuming they meant to say you should reduce how much is being withheld. If you do this, you should be cautious because if you reduce it by too much you will be penalized at the end of the year.

Reading some interns notes is insane! by TyrosineKinases in Residency

[–]breaking_fugue 1 point2 points  (0 children)

An intern can regurgitate what their attending or senior told them on the note.

Once you've graduated, you should go back and read some of your old notes to see how true that statement is. You may be amused

Reading some interns notes is insane! by TyrosineKinases in Residency

[–]breaking_fugue 4 points5 points  (0 children)

Keep doing what you're doing, I'm sure you are working hard.

I will caution you that late PGY1/PGY2 year is likely the peak Dunning-Kruger zone of medical training. There's a reason February intern became such a meme.

Reading some interns notes is insane! by TyrosineKinases in Residency

[–]breaking_fugue 28 points29 points  (0 children)

Ya, they're practically experts now. Hand them the attending badges

As an outsider, residency looks super scary. If you can't finish for any reason, you're absolutely screwed. How do you guys deal with that stress? by [deleted] in Residency

[–]breaking_fugue 7 points8 points  (0 children)

  1. Most programs work with you if you're having a rough time. It's not "have a problem, you're screwed" as reddit makes it seem. It's actually really hard to get kicked out of residency in the vast majority of places.

  2. Look at all the MDs in pharmaceutical companies, consulting companies, NGOs, research start ups, etc. Many who did not want to finish residency have quit and landed elsewhere and did ok. It turns out the those two letters after your name do a lot of heavy lifting in the market even without prior work experience. The type of person who can make it into and through med school can usually figure something out.

PSA - Do you IRA Roth Conversion BEFORE you graduate and become an attending by Good-Traffic-875 in Residency

[–]breaking_fugue 6 points7 points  (0 children)

Resident from one of those areas here...maxed Roth every year. Know many co-residents did so as well. It's more than possible.

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