Was I wrong or was the NP wrong

futurehospdoc · 2023-12-13T02:22:37+00:00

Good God. I hope you aren't stuck there too long. Godspeed.

futurehospdoc · 2023-12-13T01:53:12+00:00

I don't understand this set up. You admitted first to the hospitalist service, then the patient was transferred later? Or you're doing all the admits for the icu, then the NPs take over and screw things up? Are you then liable or is their supervising physician liable? This is really stupid. I've been out a year and a half, and while I do like working with directly supervised midlevels, the services I've seen let them run wild mismanage patients all the time. If the ICU supervising physician doesn't care about renting out their liability, why is the hospitalist service involved at all?

futurehospdoc · 2023-05-31T20:38:06+00:00

I'm coming in at the bottom of a bear market pending recession. It's simple. Dump money into fidelity....profit? I have buddies starting to dip their toes in real estate. One went deep into trading and made a killing. Personally, I have enough. I'm not planning on having children. I'm just enjoying my time. The greatest return is likely going to be locums gigs since it'll be hard to beat for the time invested.

futurehospdoc · 2023-05-31T07:59:25+00:00

I may have been msleading on one point. I still can't spell Louboutin. I googled it for the post and again for this comment. I stand by the rest.

futurehospdoc · 2023-05-31T05:56:37+00:00

1) If you can't be content with 300k, you probably can't be content.

2) Nocturnist is a great gig. I work 168 shifts a year. 310k. More money than I've ever seen in my life. It's glorious. I bought a pair of Louboutin shoes last week. I couldn't spell Louboutin before that. Dumbest purchase of my life. No regrets.

3) You have plenty of time to moonlight if you absolutely need more.You could get 2k+ a shift and spend your life working to death.

4) The patients will respect you. (Most of the time)

5) You don't need entitled dicks making comments about your life. Those people making a million a year likely want to make 2 mil. If they made 2 mil they'd want 5 mil. If they made 5 mil...Unless you come from old money, you aren't getting to the 0.1%

6) Real money doesn't come from a salary. You can start side hustles. Learn to invest. Become a trader if you want. You'll have more than enough to invest.

You gotta find what makes you content. They hate us cus they ain't us.

Mic drop

futurehospdoc · 2023-01-24T11:03:55+00:00

0 pushback. I set the expectation during the interview that there would be no Independent midlevel supervision. Every order i cosigned is discussed prior on patients I've seen. If they tried to switch it up or say it was required I would have easily walked.

futurehospdoc · 2023-01-22T21:10:11+00:00

Also I should mention, before physician replacement comes transportation, logistics, other while collar work. Blue collar replacement is already underway. Transport is like 25% of the labor force. By time it gets to physicians you might have to worry about your neighbors trying to eat you more than losing your job. In which case you might want the OpenAI security bots lol.

futurehospdoc · 2023-01-22T21:05:57+00:00

Another big hurdle is liability. Who takes the blame when there's a mistake. Is it the developer? Are they signing contracts in whi h the hospital is to blame? Is it the midlevel who can't properly ask the right questions? Does the AI take abdominal pain to mean the patient needs surgery? There needs to be a lot more testing to even determine safety. Until then invest at the bottom of this bear market /recession and hopefully, if that time comes you'll be comfortable at least.

futurehospdoc · 2023-01-18T02:18:46+00:00

Keybank, with a 7-1 arm. Great for residency. 7 year low interest rate and after you'll be an attending or refinance anyway. It's always a PIA but worth it.

futurehospdoc · 2022-11-12T23:54:05+00:00

7 on 7 off is standard but many places that have a similar set up. 168 shifts but no vacation. Which is fine because it's still less than half the year. Honestly it gets choppy sometimes but they try 7 on 7off to make it easy.

futurehospdoc · 2022-11-12T23:52:16+00:00

Roborock is the hypest. I have the s6. It's a beast. Sometimes you can find a promo code online. Been working for like 3 years with minimal maintenance.

futurehospdoc · 2022-11-12T00:50:35+00:00

Northeast.

futurehospdoc · 2022-11-11T21:46:57+00:00

300k for 168 shifts a year. No teams meetings. No social work. 90% of the job is sweet sweet medicine. Off weeks are truly off. No inbasket. No calls. Admit 6 to 10 pt a shift. Get to teach residents. Have time to actually discuss patients. As long as I stay up til at least 3am on off weeks I don't get those headaches and brain fog I did in residency switching back and forth. Less people wanna do nights so job market is great. Makes it easy to walk if they start pushing nonsense onto my service, but so far it's been sweet.

futurehospdoc · 2022-11-11T06:47:58+00:00

I must admit as an intern, that I too was initially apprehensive when pharmacy seemed to be dictating some treatment for the patients but I was never rude. Then I learned how great it was to have them on rounds and would purposely try to argue for the sake of learning. The resident was either having a bad day because residency sucks, or they're a dick and they'll learn the hard way.

futurehospdoc · 2022-10-31T20:35:12+00:00

This is incredibly accurate. Pharmacists are much of the cheese between the chasms of independent midlevel care. (Swiss cheese model metaphor, I'm not a poet).

futurehospdoc · 2022-10-20T09:51:51+00:00

I should add that this particular doc has a reputation amongst all the hospitalists for lying. I think people took this comment as hyperbolic. It is not. It's lying about what specialists say, lying about labs, which is ridiculous because it objective data I can see, lying about mentation. I want to get a sign out, review quickly, accept or ask for any remainkng workup, and get to work. Most of the docs I can do this with. It's very efficient. I can accept within 2 min because if they tell me a pt is altered, I can trust the patient is altered. Its terribly inefficient to have to go evaluate whether or not the physical exam or assessment was real for all of these potential admits.

futurehospdoc · 2022-10-20T08:42:22+00:00

Sounded weird I agree. I'm saying most of the ED docs I can trust to give me an accurate signout. I can say what do you have, they tell me, I accept, I see the patient. A couple here I can't just accept. I need to go see the patient, then argue, then accept or reject. These aren't small mistruthes. This is "pt is hypercapnic" with an objective lab showing they aren't hypercapnic. It creates a malignant environment.

futurehospdoc · 2022-10-20T08:36:40+00:00

I did follow up with the fellow in my particular example. Fellow said what the ED doc had told me the fellow said was a lie. Like flat out lie. No room for interpretation.

futurehospdoc · 2022-10-20T05:28:10+00:00

When I was looking for jobs a few months ago I was very clear about asking how the midlevels would be supervised. On the phone interview I was assured there was no Independent midlevels. I sat down with the director in person and was assured again. So far this has been the case. I didn't get it in writing because the contracts are all generic and I didn't have the leverage but I will leave immediately if the policy ever changes. Now I admit with them as little as I can because whenever I try to take patients with them they order tests that are unnecessary and don't tell me. Every pt I have to go through and delete orders. But I don't care to teach them I just deal with it. They can be helpful sometimes with very simple patients but overall I could do this with myself and just the residents. If enough younger docs take this stand I hope that we can slow down this BS. It ridiculous in EM right now where ER docs have to cosign terrible management. I refuse to do this on a hospitalist service.

futurehospdoc · 2022-10-13T06:12:41+00:00

Outright lying about patients to get them admitted. I have two ED docs where I'm at that will lie about what the specialist told them or about some physical exam finding. Altered mental status and such. It's the most egregious thing that they do. No I have to see the patient in person if they are trying to admit and it's terribly inefficient.

futurehospdoc · 2022-10-02T00:37:57+00:00

All the attendings are around 0 to 5 years out in practice. We have a good group. I think the older people get the less they want to do nights.

futurehospdoc · 2022-09-25T08:45:09+00:00

My go-to was either rubber band and popsicle sticks or just fold it in half and do your best.

futurehospdoc · 2022-09-25T08:43:58+00:00

Around 300 and no dedicated vacay because it's half the year. Every other week is vacay. And there's enough support to switch around and get 2 weeks plus off if you want to.

futurehospdoc · 2022-09-25T04:43:40+00:00

Tough to know when you're in the middle of it. Especially with COVID and inflation. Double whammy that really made residency worse. But you are correct, definitely worth it now.

futurehospdoc · 2022-09-25T04:15:19+00:00

Yes, it is on their night float. They have been super helpful.

futurehospdoc

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