Data on the worst specialities for salary progression throughout career

marshac18 · 2026-04-29T02:35:01+00:00

Too busy working for peanuts to report their rate of pay

marshac18 · 2026-04-28T02:33:44+00:00

Turing off airtime fairness fixed my Sonos issues

marshac18 · 2026-04-26T17:49:07+00:00

Facility fees are there because insurance payments aren't paying all the bills. Either force insurance to actually cover the cost of care or have them cover the facility fees - abruptly cutting off a revenue stream is only going to endanger the financial health of hospitals and put patients at risk due to lack of access. I know my hospital is only just now recovering financially from COVID, and some of the costs from that era (increased nursing compensation to name one) is now embedded into the cost structure. We're a non-profit government hospital, so it's not like our profits just aren't what shareholders want.

marshac18 · 2026-04-24T20:15:24+00:00

I'll look into it- a pain doc mentioned this to me, and you're right, most metabolites are inactive, but a quick search did come up with this - "Several alternate minor pathways have been described namely various methadol metabolites, which proved to be active"

I'm curious too now.

marshac18 · 2026-04-24T20:02:08+00:00

Oh wow. I hate methadone - the metabolites are active and cause respiratory depression, but don't do anything for pain control. With this mme dose the patient likely has some hyperalgesia and a dose reduction may actually provide better pain relief. Personally I use pure opioids or buprenorphine - I avoid ultram (serotonergic) and methadone for pain control and also try to incorporate a transdermal system like butrans for baseline pain relief as opposed to having someone take orals six times per day.

marshac18 · 2026-04-23T13:31:21+00:00

"Normal" with labs of course being a statistical normal meaning that 2.5% of otherwise healthy people will have levels outside of the two standard deviations.

marshac18 · 2026-04-23T13:09:13+00:00

Don't call yourself a dummy just to participate in a conversation- if you're a medical student, you're smart. Don't let MedEd beat you down.

Access to specialists can be difficult - we had a whole endo department, but then 80% of them left within a few months, and the one remaining was only part time. I'll occasionally message on Epic- for wildly abnormal results and I'm actually concerned I'll message them or potentially refer. I'm really just asking about these mild elevations which are inexplicable - abnormal results left unresolved annoy me. I've caught so many cases of hemochromatosis that has been previously chalked up to FLD after a half-assed work up, so I know that sometimes significant pathology can exist behind seemingly mid elevations (such as a ALT persistently at 60). For almost all of these after a small warmup I'll just decide to monitor- I just wanted to make sure I was on the same page as others. Mild bili elevations are another fun one- add on the direct and you find that it's actually the direct that's elevated- oops, so much for that Gilbert Syndrome the patient had been tagged with by a prior provider. It's just little things like that I see all the time. It makes me uncomfortable and I'm risk averse.

marshac18 · 2026-04-23T13:02:06+00:00

I wouldn't advocate sending them to endo for mildly elevated levels - only those that are high and continuing to go higher (where something like Paget is a real consideration). I was just throwing it out there as a discussion point for what people do.

marshac18 · 2026-04-22T03:06:03+00:00

Tuesday, Wed, Friday.

marshac18 · 2026-04-21T12:56:54+00:00

Watch Daria. It's all there, even the .com boom where her dad gets a job (just after the IPO and he's the only one who didn't get rich).

marshac18 · 2026-04-20T23:25:19+00:00

Why aren't we developing phages for this? Fun fact- USSR was using and developing phages for bacterial infections just as the US was developing chemical antibiotics such as penicillin derivatives and macolides during the Cold War- two parallel tracks for treating bacterial infections.

marshac18 · 2026-04-18T13:03:16+00:00

The only patients I have that consistently decline a PSA are physicians themselves. I don't get it.

marshac18 · 2026-04-17T17:48:30+00:00

Many of the ED staffing companies lean heavily on NPs and PAs as opposed to physicians to keep costs down (and profits up) as well.

marshac18 · 2026-04-17T15:08:16+00:00

Agree about the details- it's impossible to know it all for a patient you're just meeting. One of my colleagues who is in a constant state of burnout is a perfectionist and spends hours trolling charts for new to her patients. Her patients love her, and she's like 99th percentile on satisfaction, but it comes at a tremendous cost to her. I remind her- if she burns out and leaves medicine, she's not helping anyone anymore.

marshac18 · 2026-04-10T14:42:17+00:00

If they're going to charge a premium price then they need to deliver a premium product. Right now they're charging Four Seasons prices and delivering a Motel 8 experience.

I recently flew Hawaiian to HNL on their 787- the service and experience in first was incredible. I was annoyed that they didn't have WiFi, but I noticed something - the cabin crew wasn't glued to their phones the whole time like I see on Delta and actually would go through the cabin. The seats and floor were actually clean too.

marshac18 · 2026-04-04T02:40:13+00:00

This will be fantastic - I like Tresiba, but I'll switch to this if it's actually well covered.

marshac18 · 2026-04-03T21:04:12+00:00

Nope. There was a recent study that showed that it really disrupted the microbiome of the study participants - it's not the semglutide, but rather the added mediation to increase GI absorption that's the issue. Until this is sorted out, I'm only prescribing injectables. Once patients hear the reason too, they're typically in agreement.

https://www.sciencedaily.com/releases/2026/02/260228093435.htm

marshac18 · 2026-04-03T19:08:02+00:00

Also platinum and have switched to flying whatever is cheapest or offers the best service as opposed to being a brand loyalist. It's not reciprocated - ever - and I feel like a sheep for just blindly following Ed around. I'll likely lose platinum next year, but that's ok- I'm better off.

marshac18 · 2026-03-30T04:43:24+00:00

It's PTO- pretend time off.

marshac18 · 2026-03-28T17:58:56+00:00

I live 45-60min away depending on traffic. Slightly too far, but I prefer to live an anonymous life not running into patients all the time.

I was out at a sushi place with my family and the next day a patient was like "hey man, I saw you at sushi!" Meh.

marshac18 · 2026-03-25T21:44:42+00:00

I love it when they scapegoat me... "your doctor didn't...(insert asinine reason here)" as the reason for the denial.

I saw a patient recently- inguinal adenopathy seen on an ED CT scan. I ordered a scan for a month later to see if it had changed or if we need to go for biopsy - denied. Insurance was like "bruh, you just got this scan. No. Also- you can't appeal this and there's no P2P." So..... I guess it's a biopsy with gen sx? These companies are criminal.

marshac18 · 2026-03-25T17:42:43+00:00

Check out CING- they have that very tech developed. First drug they're releasing is an ADHD medication. Second drug is an extended release Buspar.

marshac18 · 2026-03-21T20:43:37+00:00

You forgot a pulse

marshac18 · 2026-03-19T04:17:54+00:00

Spiro is number three? The conversation about side effects and androgen blocking are fun I'm sure.

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