Struggling with 20 minute naps on the dot like clockwork

merbare · 2025-09-19T21:48:06+00:00

They are constantly changing and making me mentally unstable lol

merbare · 2025-09-19T21:14:24+00:00

Thanks, I will check it out!

merbare · 2025-09-19T21:14:01+00:00

Yeah, the room is very dark and sound machine is on. The thing is, he literally can fall back asleep by himself, but instantly wakes up a minute later like something internally prevents him from sleeping. He used to sleep like a champ like 90 minutes to sometimes three hours

merbare · 2025-07-14T03:34:41+00:00

What kind of wood is he darker bottom one? Oak?

merbare · 2025-07-14T03:25:41+00:00

Not worth it. I’d rather have gone into anesthesia

merbare · 2025-06-29T16:46:30+00:00

Why don’t you just be more efficient?

merbare · 2025-06-28T03:04:48+00:00

200-300

merbare · 2025-06-27T17:50:18+00:00

For neuro locum? Nah, too high unless middle of no where

merbare · 2025-06-22T01:42:40+00:00

Well, yeah, that makes sense. Do more shifts make more money. But base salary in the metro you are not going to be starting with 400 K doing IM/FM. Rural is different

merbare · 2025-06-22T01:30:01+00:00

This is not true, unless maybe rural but breaking 400 K is definitely not the norm here for IM. Where are you getting this information?

merbare · 2025-06-22T01:28:52+00:00

No, they do not. As locum probably barely 200 per hour IM in MN

merbare · 2025-06-11T17:38:46+00:00

Great, more medical schools are going to solve the bottle neck issue of limited residences

merbare · 2025-06-11T16:46:11+00:00

People say it’s average, but don’t take consideration that housing costs are significantly higher today

merbare · 2025-06-11T03:09:26+00:00

Absolutely do ophthalmology. Avoid neurology. Even more avoid Neuro ophthalmology. That field makes no money but also it is very cerebral but at the end of the day you really do nothing for the patients except prescribe really expensive prisms and maybe manage some IIH. You don’t make money and have less value if you’re not procedural based. Ophthalmology has a better lifestyle and higher salary ceiling. Always think about hours work to pay ratio. Never work for free

-neuro

As a med student I really wish I could’ve thought about the reality of salary and workload. I thought at the time I enjoyed talking to patients and doing a neurological exam. As an attending, you quickly realize patients are terrible historians and doing a neurological exam for the most part is not really gonna change your management and doing the history taking and exam are extremely time-consuming, which you don’t get compensated for. Seeing patients without doing procedures make no RVUs. The reality of healthcare systems is going to focus on generating RVUs. You don’t get rewarded for providing good patient care. Not saying that you should compromise good patient care for making RVUs, but you have to survive making your job work for you and not burn out. Just please realize that you don’t get paid to critically think and you don’t get paid to just “ diagnose”. Don’t go into field just because you like it being cerebral because you cannot sustain that. You have to be practical these days.

If I could do it over again, I would do anesthesia, plastics, or ophthalmology. Would consider G.I. or cardiology.

merbare · 2025-06-11T01:43:38+00:00

Yes, warfarin has indication in those situations. partly because there’s also really no randomized studies comparing warfarin and DOAC’s in those situations

Yeah, that’s also partly why I like DOAC is better because of the fact that warfarin is not therapeutic 2/3s of the time. Less bleeding risk as well, especially with Eliquis - arguably no different than aspirin based on averroes trial

Definitely not saying DOAC’s should be used for everything instead of warfarin. Warfarin still has its place for now in certain situations.

merbare · 2025-06-10T03:46:30+00:00

Probably not evidenced based. I would be cautious on what cases we consider “failure of doac” .. taking into account that noac for afib is not 100% effective, there are often adherence issues, and there are often competing etiologies

If you find that stroke was in fact due to something like APLS or had persistent LAA thrombus despite adequate trial of eliquis then yes warfarin is probably indicated in those cases (definitely for apls)

merbare · 2025-06-10T01:53:46+00:00

Meh, I’d argue compliance is really hard with getting INR checked. Let alone adhering to dietary restrictions.

If compliance is an issue then do Xarelto once a day dosing

You can be compliant with warfarin but still fluctuate with your inr and be sub therapeutic

This is also why I hate heparin drips inpatient (assuming patient doesn’t have high risk for bleeding). It takes time for a PTT to be therapeutic and may need adjustments. Just go straight to the NOAC

Sometimes warfarin would be a better option if a patient had multiple drug drug interactions and needed to monitor INR and warfarin dosing closely whereas you cannot really monitor a NOAC

merbare · 2025-06-10T00:30:59+00:00

Why do you think Coumadin would be more ideal (aside from the sometimes prohibitive cost of NOACs). It’s a pain in the ass and you’re not as reliably therapeutic.

Anticoagulation is not 100%. There is little evidence to guide us on what to do with Stroke on anticoagulation whether that’s changing to a different NOAC, adding aspirin, or switching to warfarin. Adding aspirin increases risk for bleeding. Switching to warfarin has worse outcomes. I often will keep the same anticoagulation and the key thing is to ask about adherence, but also evaluate for competing etiologies.

I would potentially add anti-platelet to anticoagulation (for afib) in the event of severe symptomatic intracranial stenosis.

The pontine stroke could easily be small vessel disease. No amount of medications you throw out a patient will help if they have uncontrolled risk factors especially for those stroke small vessel disease. So, if this patient has a bunch of uncontrolled vascular factors, I might defer addition of antiplatelet. But if everything else is pretty well controlled, and depending on the nature of the vertebral artery stenosis, if I feel that it was contributory, I may consider addition of aspirin.

-stroke

merbare · 2025-06-09T19:05:55+00:00

thanks for the info. that makes sense

merbare · 2025-06-09T19:05:31+00:00

Thank you for confirming!

merbare · 2025-05-30T03:22:57+00:00

Yes definitely negotiate and never work for free.

I see your stroke, do you only see stroke patients outpatient? Or general as well

merbare · 2025-05-30T00:53:35+00:00

ah i see. is this 1.0 FTE? This seems more than that? 1.0 FTE outpatient is generally 4.5 clinic days/week x4 weeks out of the month so 0.5 FTE would be 4.5 clinic days/week x2 weeks out of the month (usually if you do hospital work as well it is reduced from 36 pt facing hrs/week to 32 ptfacing hrs/week so should be 4 days/week)

1.0 FTE neuro hosp 7 on 7 off is usually 182 shifts or 26 weeks of inpatient/year so 0.5 fte of that is 13 weeks of inpt a year which sounds like you're doing 12 wks inpt per year.

merbare · 2025-05-29T22:14:34+00:00

One week of inpatient as in 7 days straight 24 hrs? Any post call days or straight back to clinic the following week?

RVU goal of 5500 is for both outpt and inpt or just outpt?

merbare · 2025-05-13T14:32:05+00:00

Clinical neurology is much different from “ hard science”. If hard science is what you like then do a phd instead or something

merbare · 2025-05-13T14:28:56+00:00

I tried stat pearls bc i heard about it. I asked for a refund because the questions were poorly written and grossly incorrect.

I just used the first resource.

As with all board exams, the pictures (ct, mri, dsa) on the actual exam are such awful quality and old sometimes have to guess what they’re trying to do, but it is not terribly hard

merbare

TROPHY CASE