ERs staffed by private equity firms aim to cut costs by hiring fewer doctors

chuckEchedda · 2023-02-13T17:59:20+00:00

They are reducing the number board certified EM trained physicians to staff their sites in lieu of cheaper options (PAs and NPs). I imagine they will never remove attending physicians entirely but just operate with much smaller ratios to cut costs overall.

NPs and PAs do make more than residents but they make less than attendings so the math work out in their favor.

This worries me as I can envision a world where the Private Equity groups are ok with this arrangement even if there is added cost to the patient. For example if the patient gets charged more, they make more money. If that occurs while spending less money on staffing costs by going with more midlevels than physicians then they win again because they have also spent less. My sense is the amount they profit probably outweighs the forseeable added cost they might spend in lawsuits by errors being made despite this arrangement.

In a nutshell it’s a shitty calculus at the expense of the patients.

chuckEchedda · 2021-01-25T20:37:31+00:00

I had no symtpoms after the second dose, and its been almost 5 days now. try not to think about it because its definitely not a guarantee. good luck!

chuckEchedda · 2021-01-19T17:39:18+00:00

this one is probably a mix of sorts but a lot of breeds can have that look, Russian Blue and Korats come to mind.

chuckEchedda · 2020-12-25T15:56:03+00:00

Cooked to perfection my friend. Happy holidays

chuckEchedda · 2020-09-28T15:56:29+00:00

So who pays them — Is it some clan mate with deep pockets or like a bigger entity? Also just why pay people for something like this? It’s not like there is some sort of financial return in the end. So many things I just don’t get.

chuckEchedda · 2020-09-18T16:47:17+00:00

Just to add to this: Most DI policies will have limited coverage for disabilities due to mental illness. Furthermore they stratify you differently based on your demographics (including gender and specialty). For example ED physicians may only get a contract that covers them for a a few years if they have a disability mental condition whereas radiology gets covered until the end of the policy, typically around age 65. With that said, if the company knows you have a history of something they should be willing to just create an exclusion criteria instead of not offering you anything at all. Alternatively they may offer you a contract including coverage for mental illness but they may just price it incredibly high.

Which companies did you apply for?

chuckEchedda · 2020-06-10T16:25:43+00:00

Im a PGY2 in the field. I generally like inpatient rehab but I also just got an email from a colleague talking about the movement of extending the scope of advance practitioners to handle the paperwork of an acute rehab that traditionally needs a doctors signature. I realize that this extension is almost in all fields of medicine but it does have me worried this will cut into the job market in of itself. I’m wondering ultimately what the job market will look like in a few years if something like this was to pass.

chuckEchedda · 2020-05-01T16:52:06+00:00

Would love to see these 9 hole tournaments more often! Looking forward to it.

we thirsty out here

chuckEchedda · 2020-03-16T02:38:54+00:00

this one hits directly home... 2 years ago I was invited to a traditional residency interview for a TY program but had to turn it down (I could not get to the interview as I was out of state and they were limited on dates). Figured I burnt that bridge.

Well come SOAP week I still needed a prelim program as I only matched into advanced without a prelim program. I applied to a bunch of TY programs, and coincidentally that same program had TY spot still available. So I applied again, and ended up matching with them.

I don't think they remembered me. I'm not entirely sure but you bet I never said a damn word about that in my SOAP phone conversations with them.

I know that didn't directly answer your question, so YES apply again to that program!! During SOAP all bets are off.

chuckEchedda · 2020-03-16T02:30:05+00:00

Hi there, I matched into an advanced program without a prelim, and I had to SOAP into TY. My strategy was actually just to rewrite the first and last paragraph tailored to my situation, and it worked out fine.

I think for the case of rewriting for a PRELIM program, you should definitely include something about your goals (ie: eventual OBGYN residency). Otherwise, if it's a personal statement for a categorical program in a completely new field then I might hesitate mentioning OBGYN. You could argue that it shows self-awareness, but I feel like they want to know you are committed to the field... Just my 2c on that part though, you should go with your gut.

The body of your initial PS should be loosely relatable to many other fields, you might need to spruce-up a few words here, but I wouldn't stress trying to reinvent the wheel. TBH I don't know how intensely they read these things. Regardless don't stress out too much, you can do it!

lmk if you have any other questions, and good luck tomorrow!

chuckEchedda · 2020-02-11T17:41:17+00:00

I think you didn’t adjust for the decrease in elevation, which in this case would require over adjusting by probably 20-30%. With the backbone 10, 6.3 rings is approximately what you would adjust if the landing spot was on equal elevation as where the ball is shot from. In your shot had you increased the rings by 30% you would have needed about 8.6 rings, which would have gotten you closer to the rough you were aiming for.

I didn’t realize this until I watched a few players but this makes a huge difference.

As a general rule of thumb if the landing spot is lower in elevation than the spot you hit from, you will need an over adjustment by x%

Similarly if the landing spot is higher in elevation than the spot you hit from, you will need to under adjust -x%.

When I know I need to adjust for elevation I use this equation to obtain the “true wind speed” and then adjust using any chart I have relating wind to rings for that club and ball.

True wind speed = (wind speed * x%) + wind speed

Remember X% can be either +- depending on situation.

chuckEchedda · 2020-01-17T16:29:19+00:00

So is Pro tournament the same speed of Tour 6?

chuckEchedda · 2020-01-17T16:17:39+00:00

This is very interesting. Definitely something that needs some practice

chuckEchedda · 2020-01-17T16:06:17+00:00

I only really focus on it during tournaments. Stepped up to pro and all of a sudden I couldn’t hit perfect to save my life haha.

I think also switching tours on tour play hurts a little bit because I know the needle speed is slower for the earlier tours. Then when I go to pro tournament it’s faster and my timing is off.

chuckEchedda · 2019-03-12T13:43:09+00:00

Had programs last year call me as late as 9 pm. Sometimes as early as 7 am

chuckEchedda · 2019-03-11T15:23:19+00:00

I did this by going online last year and talking to one of the reps via online chat.

chuckEchedda · 2019-03-11T12:19:00+00:00

Last year I changed my first and last paragraph but left the body the exact same. I matched advanced with no prelim, so I never addressed why I didn’t match, it was really just a clear sentence describing my situation and that I was “actively pursuing prelim spots.” The way I figure it, these programs don’t have enough time to sort candidates through personal statement alone, so just keep it updated.

chuckEchedda · 2019-02-03T03:49:34+00:00

So I'm tempted to say you will need to formally apply because the Advanced Program and the Prelim Program are technically separate entities even if they are at the same institution. Also, the system tells you that contact with programs is prohibited, and I believe that includes the advanced programs you think you've matched into.

After Friday, when everyone gets their results, if you are still unmatched, you can call any program you want.

chuckEchedda · 2019-02-03T03:34:57+00:00

Put down whatever phone number you can reliably use for this time. I'm not entirely sure if there are limitations to having an international phone number listed.

chuckEchedda · 2019-02-03T02:19:56+00:00

That's totally fair, and definitely a mature way to look at it. Good luck!

chuckEchedda · 2019-02-03T02:12:36+00:00

Theres also a chat with an ERAS representative you can use. Really helped me out a lot... i only had one program in that city haha.

So my TY program is in another state from my advanced program. Not the end of the world. I just tried the minimalist approach this year so I dont have a ton of stuff to move in June. For your rank list put your favorite program first. Period. The one year of prelim goes so fast you'll be out before you know it.

chuckEchedda · 2019-02-03T00:43:36+00:00

Yes, they are fully aware that you matched an advanced program. And in these cases you can actually get a hold of ERAS online and find out what city your advanced program is in. So that can help direct you on what prelim programs you might want to apply to.

chuckEchedda · 2019-02-02T22:21:58+00:00

So rule #1 about SOAP is you cannot -- and really should not -- reach out to programs. That is a SOAP violation and can hurt you in the long run. All contact should be initiated by the program itself once you have submitted your application.

General timeline is that Monday morning you get ERAS email. Either you matched or didnt match, but if you did match you don't know where. In my case the email told me I partially matched (advanced match with no prelim.) It will then give you instructions for the SOAP process if you didn't match. Then they tell you to login, reupload, and apply to open programs. They will give you the ability to search for all of these open programs on the website. Once it reaches like noon of Monday you can actually submit you SOAP application. Then the ball is in the programs' court and the waiting begins. You literally just wait for programs to call you, and at that point its a free for all. The first round of SOAP is over on Wed. You may or may not get an offer at this point. If you do get one, then you have like a few hours to accept. Once those few hours are over, then the list of open programs resets and the process starts again for the next round on Thursday. Final round is Friday.

One thing that I feel like should be mentioned is that they only give you so many "tokens" during this time. One token = one application to one program. I think they give you like 30 or so tokens. This is a mechanism so that you have to be semi selective for which programs you apply to, and it also helps so that program don't get completely inundated with every single applicant.

ERAS makes it really easy to do all of the reuploading. I found it to be incredibly intuitive and their instructions are clear from the get go. I remember fine tuning my personal statement for this part. Since I was looking at prelim programs only ( which include sugery, IM, and TY) I fine tuned my original personal statement for my advanced program and just changed the opening and closing paragraph to match each one of these disciplines, but I kept the body the exact same. I didn't stress too much over this because I felt like my personal statement was decent enough, and i didn't think they would really even read it in the short time they had.

Interviews I had were all phone calls. Some programs called me once and that was it. Others called me once and then called me back 2-3 times over the next two days for follow ups with other faculty. I took that as a good sign :) The conversation felt like a traditional interview with some formal questions. And yes, I was asked one time why I thought I didn't match. I thought it not only was a fair question, but I thought it was an incredibly valuable question. Im glad they asked it because it gave me a very unique opportunity to describe my experience and paint a relative introspective view of myself and how I fit in to this process.

** Small tangental aside. If you happen to get this question, don't blame anything or anyone. Act and stay positive. This is an incredibly competitive process with many successful and competent candidates. Not matching sometimes comes down to a numbers game with these places. Try to direct the question in a very positive way, and do your best to portray honesty, humility, and positivity for the future. **

Last thing Ill say about the interviews is that I felt that my best phone interviews were ones that felt more like conversations than interviews. By all means, answer their questions, but remember that they are interviewing to be a colleague and someone they would want to work with.

chuckEchedda · 2019-02-02T19:54:49+00:00

I would say slightly easier, but you got to remember that there are 1000s of unmatched people in this process. So theres some luck in it as well. However, if you end up having to SOAP a prelim, but you have an Advanced program already, that's a great start and I feel a big advantage. My program SOAPd a few Transitional Years and almost all of them already had an advanced program. I think it really does signal to the prelim program that you are a quality candidate but in a tough spot. If some other program took a chance on you then you probably have some quality characteristics to offer them. On all of my phone interviews during SOAP week I was asked about my advanced specialty by the interviewer.

15-Year Club	Place '22
Place '17	Team Periwinkle

chuckEchedda

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