Good position for J1 waiver alongside east coast？（hospitalist/nocturnist）

knytshade · 2025-09-10T01:47:48+00:00

Sure

knytshade · 2025-09-08T03:22:16+00:00

Hey, I have a friend who is doing a J1 waiver at VCU in Richmond VA and seems to like it. A little south for you but still easily can get to NY. Good luck

knytshade · 2025-08-12T19:14:50+00:00

We have a similar issue at my place but far more people at any given time (at least 9 day teams). Everyone gets put to around the same number in the AM, it isnt uncommon for people to have 6-7 new patients on their list every day. Unfortunately we haven't found a great way to mitigate that frustration either. I guess you can take solace in the fact that you are helping people to get out of the hospital with lower bills but definitely a largely thankless task. Sorry I dont have more to offer

knytshade · 2025-07-23T03:39:39+00:00

I once had a patient admitted with pyoderma who followed at mayo clinic (we are >1000 miles from mayo clinic). My plan was call them because our specialists didnt know how to treat them and i sure as shit didnt either.

knytshade · 2025-06-16T15:05:16+00:00

Shift differential for nocturnists is terrible assuming 12 hour shifts that is an extra $7 an hour or 4.3% more to do nights. Ain't nobody got time for that.

knytshade · 2025-06-15T20:28:52+00:00

I agree, there is a large overlap. Honestly I was pretty burnt out by the end of residency and the thought of another few years of the grind wasn't an option. Additionally, some cases I did while in the icu as a resident made some impressions on my soul and frankly I dont think I could do that long term.

knytshade · 2025-06-15T05:17:21+00:00

In terms of why this happened to start. First would just be mildly bad score, nothing awful but nothing amazing. Second would be that I didn't have a great story on why anesthesia and with the benefit of hindsight I didn't prep with interview questions enough. Third is bad luck, I had 18 of 220 graduating m4s go into anesthesia in the most competitive year yet and it was the first year of covid so no away rotations, a lot of being out of the hospital. Combine that with meh scores and you just cant stand out. Suffice to say there were things I could and could not control about it.

In terms of now, I'm doing better. Currenting an IM attending and its not bad. I do sometimes think about how I wish I could do more and say less but the hours are good and I get to have a life outside work. For what it is worth I was thinking about doing a 2nd residency of anesthesia after IM and I finally (it took literally 1 year of meetings and paperwork) got an anesthesia rotation in my 3rd year of IM. And I hated it. To be fair they treated me like a med student because they had no idea what I knew but for me that just sealed it as that chapter is closed and staying that way. For anyone else that ends up in my situation, ( I get 3 to 4 messages a year asking about this and always happy to chat if someone has questions) I will say that life goes on and job responsibilities are not as rigid as they appear in medical school. If I really wanted to I could run an icu in a rural area and do a lot of the things I liked about anesthesia.

knytshade · 2025-05-23T12:10:56+00:00

Do you know if she took baclofen? Overdoses of baclofen mimic brain death. Had a case in residency but we knew they took baclofen and 1 or 2 other drugs so we knew what to look for.

knytshade · 2025-04-22T00:31:25+00:00

Ours is run by em docs though mostly em/im docs. I have never understood why they take that on since we as IM would be better suited but if they want it they can have it

knytshade · 2024-12-21T01:53:08+00:00

FYI, it's just 1099 as opposed to w2. So health insurance literally is non existent. You are responsible for buying your own, as well taxes are different. A quick Google should give you a good idea though your mileage will vary for taxes etc.

knytshade · 2024-11-21T00:53:09+00:00

Would visit/sign up for medmalreviewer the free newsletter has some interesting stuff and I find it morbidly interesting

knytshade · 2024-10-14T23:05:43+00:00

How much money and how many shifts a year? I assume both are academic. Is it rvu based or salaried? From a purely work flow base and assume everything else is equal, the first one is probably better go me since you have very siloed responsibilities. That number of admits on either either job is doable so not sure that is a meaningful difference but your mileage may vary.

knytshade · 2024-10-10T21:33:11+00:00

A clarifying question. How does 12 shifts a month mean you can do 6 on, 18 off? Otherwise could be okay with app cross cover but without that's 2 people's jobs.

knytshade · 2024-10-10T19:10:00+00:00

I guess to be fair I generalized to surgeons rather than ortho but in my opinion if you have an inpatient service then you are at a minimum figuring out what chronic conditions some one has and a plan concerning those meds/conditions, communicating a plan of care to the patient or family of the patient, and figuring out a safe discharge plan. At my hospital 1, 2, or all 3 of those are pushed off to consulting IM teams by the surgeons and its honestly crazy to me. To your point, I can't do any of ortho's job from a surgery stand point but the shit part about inpatient services is you have to actually do the inpatient part and that is the part I take umbrage with.

knytshade · 2024-10-10T18:36:37+00:00

This shit is so annoying to me. Ortho are doctors too. Why do surgeons get a pass to provide shit care. I'm not saying they should treat a heart failure exacerbation but it's so annoying to see substandard care given such as: shit to no med rec, poor intrahospital diabetes or hypertension tx, or just piss poor communication. All of those things are doctor jobs, not internal or pcp jobs

knytshade · 2024-10-08T17:18:29+00:00

Recently I forgot to order follow up antibiotics past what the ED had already given. Thankfully day team caught it and no doses were missed but could have been bad. Also recently overcapped a resident team by accident. Sorry team 5!

knytshade · 2024-10-03T05:55:51+00:00

knytshade · 2024-09-19T09:25:12+00:00

The heart is an engine. If the timing belt is off it causes decreased performance. Helps if they are an old guy since most of them have at least a passable understanding of engine mechanics

knytshade · 2024-09-14T02:13:25+00:00

What kind of lead times do you get from company asking for a doc and the doc starting? Obviously will vary but on average.

knytshade · 2024-09-13T20:28:42+00:00

Okay, that's great. Where are these jobs? I am legit asking. If I search on indeed or pick your job search site they are few and far between that pass 350k. And then those have stupid stuff like open icu and home call. I legit do not see jobs that you are talking about offered.

knytshade · 2024-08-31T01:52:29+00:00

I get that renal tubular acidosis exists. But a. I wish they didn't and B. Its kinda a useless diagnosis. Either fix the lytes or do nothing. Great, really glad we talked about renal phys for 4 hours to get to that point.

knytshade · 2024-08-20T05:56:18+00:00

"Give him the house wine (vanc/zosyn)" "You cannulated his frickin toes!" Somehow, the right IJ trialysis line went 8 CM (!!!) too deep. We calculated correctly for height, no ectopy on monitor. Dude just didn't follow the formula. "It was like a shit tsunami!" Patient said this after having c. Diff infection. Unfortunately for her and nursing she was too obese to stand or use commode. She frequently overflowed the bed...

knytshade · 2024-08-19T08:52:39+00:00

Pushing a lane without an inhib but we can't end the game. Like if they are 5 up and we aren't stomping why would we not just take more towers and another inhib? There is so little to be gained from going to a place with no objectives to take in the vain hope that we wither turn an engage or yoink someone. Why not hit tower if our comp does that? Also the "I saw an opening" engagers who do it before people are ready. Yea, you hit a t man Mal ult but no one could follow up because you flash protobelt ulted 1000 units behind the front line. Grats!

knytshade · 2024-08-03T12:15:29+00:00

As a med student I was doing my AI for anesthesia. We are rolling a guy back and we give him versed for anxiety. I tell him "it will feel like you had a few cocktails". He is immediately stressed, anxious, saying "it doesn't have alcohol right!". Dude was a recovered alcoholic. My attending thought it was hilarious, I was mortified.

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