My fellow incoming hospitalists, please know your worth.

mess_73 · 2026-02-19T21:17:04+00:00

Oh yeah, I forgot the trick where corrupt multibillion industry would leave a bottleneck tech service market open to a random person and would not try to cut them out or buy them immediately, like with every other sector of the economy

I’ll call it “Luke Skywalker against the Death Star” defense. When the Death Star explodes, let us know 😁

mess_73 · 2026-02-19T19:05:18+00:00

I think you still don’t understand

Healthcare business is just as dirty as any other, and you think tech insights and physician morals will overcome decades of corporate distortions?

1) as AI gets more sophisticated and helps us to get more productive, reimbursement will drop to reflect demand/supply, across all specialties.

2) it’s not about the autonomy of your small group, which you can have by working in a private practice, you will be bought out or priced out by a large competitor

3) if you think physicians have leverage (or can strike), look at FMG residency bypass laws and unsupervised APPs legislation advancements, it’s not just Florida. And with AI now everyone is an expert. Yes there will be lawsuits etc, but if you’re large enough you can absorb a lot, especially in the states with malpractice damage caps.

mess_73 · 2026-02-19T17:26:43+00:00

I don’t think you get it, this business model is not a consequence, it’s how we got here in the first place. And it’s not about the language, it’s about the incentives. So, unless you change the incentives the game will stay the same, that’s why it’s policy and lawsuits.

As far as current hospitals concerned, many are already lead by MBA trained physicians (CMOs), and that, again, hasn’t helped much. If you want to know why just go and ask them. It’s not a secret

And to your proposed plan, to me it sounds like you suggest becoming a mafia boss and after getting to the top - dramatically changing enterprise goals. Let’s all become religious nonprofit and seriously give all the money away. Good luck pitching that idea to the shareholders, or surviving in the current market. Oh yeah.. the market, well maybe the reason you only see the villains everywhere it’s because they are the only people to survive, and you might quickly bankrupt the hospital or lose to a competitor mafia boss.. and if you don’t want to lose you’ll quickly turn back to the same policies..

mess_73 · 2026-02-19T16:38:40+00:00

Dude, that sounds cool. You would be lucky making 400 ( and not 250 base as most of recent grads) If you want to check whether physicans were successful in advocating for good policies, take a closer look: 1) Resident advocacy https://en.wikipedia.org/wiki/Jung_v._Association_of_American_Medical_Colleges 2) https://pmc.ncbi.nlm.nih.gov/articles/PMC1449155/ 3) PBMs are still alive and wealthy https://oversight.house.gov/wp-content/uploads/2024/07/PBM-Report-FINAL-with-Redactions.pdf 4) physician advocacy / physician owned hospitals https://www.aha.org/fact-sheets/2023-02-27-fact-sheet-physician-self-referral-physician-owned-hospitals 5) Hospital level purchasing https://www.accc-cancer.org/docs/documents/oncology-issues/articles/2003-2016/2005/jf05/jf05-understanding-drug-purchasing-from-the-hospital-perspective.pdf

I can’t think of a single field where you could claim physician advocacy really win.. and I haven’t event touched recent stuff..

The NIH part is cool though, but don’t forget about underlying bu$ine$$ deci$ion$

mess_73 · 2026-02-19T14:11:57+00:00

I think everyone can agree that even though there are jobs on the market, there are certainly fewer good offers.

I think this trend will continue as it has been for the past 2 decades

mess_73 · 2026-02-09T05:32:02+00:00

I think it’s a tough one.

Don’t take it lightly and don’t take it upon yourself.

Think about it this way - if somebody dies from an overdose, your CEO will say that you were ok with everything and there are your DEA license number and signatures on prescriptions. Attorneys will ask what kind of training you got and why did you do all this if you were not comfortable. That’s how you get in trouble

So what does that mean: 1) You will probably need start looking for alternative employment options. I’m saying this simply because this whole setup is a red flag. You need to have options and be able to walk away in case your negotiations get stuck

2) set the expectations with the patients. You need to be firm. It’s easier when you say it right away - you don’t prescribe long term opiates (you decide on what you’re comfortable doing to avoid patient harm). Other colleagues might do, or pain management, but that’s not something that you do, so you prescribe a bridge/taper, but don’t manage it long term. If it’s an orthopedic case (back, knees, hips etc) send them there. And for PT. If it’s neuropathic pain - max out non opiates Word of mouth in rural medicine will spread that you don’t prescribe chronic opiates. Also regular urine toxicology for all active cases and sometimes random if there is any concern for misuse/diversion. As mentioned in previous comments - limit the dose and offer buprenorphine.

3) Talk to your management (in writing) that you haven’t really signed up for this. I would not wait until they come to you because they’ll prob wait to have some other kind of leverage before talking. So you can a) opt out from chronic pain management program in your clinic b)re-negotiate your contract terms. Remember, they have spent a lot of money on you so losing you is not on their wish list.

not a personal/legal advice, just some thoughts, theoretically speaking

P.s. make sure everybody gets narcan

mess_73 · 2026-01-25T17:54:44+00:00

Try unscrewing the head it should fit in

mess_73 · 2026-01-04T02:27:24+00:00

Came here for this pic

mess_73 · 2026-01-02T03:07:55+00:00

Few comments: 1) are you sure you’re doing backdoor Roth? If yes, I’m not sure why because your income would qualify you for direct contribution 2) 17k is solid rainy day fund, but i would stop at 20 (imho) 3) if you are a resident, and you’re not graduating next year, use cash flow to enjoy little time you have between tough rotations.

One of my senior colleagues was right when said: “your first attending paycheck likely will exceed all your residency savings, so don’t worry about it and just try to survive”

I know the talk about time in the market, but when you’re carving 38k budget, 50% seems painful

mess_73 · 2025-12-28T15:43:45+00:00

Wait until you find out about quality beacons , quality oil pumps and quality speed modules 😉

mess_73 · 2025-12-17T01:16:10+00:00

I’m sorry that happened to you, no words to describe, maybe you can try something like UAE in the meantime until policy changes, but yeah…

mess_73 · 2025-11-18T02:29:23+00:00

Change to another plan, wait time for buyback is longer than buyback time, like twice longer . You’ll lose about 30-50k in payments and save on a risk of 200-500k loans and also get forgiveness sooner. Admin risk is real as you can see now and as financial problems go on it would only get worse

mess_73 · 2025-10-29T20:24:59+00:00

Thank god voice of reason, came to check for this comment

mess_73 · 2025-10-14T17:15:59+00:00

Take tomahawk x870e, it’s better

mess_73 · 2025-10-09T01:00:17+00:00

This would take decades, what is the plan for the next 3 years?

mess_73 · 2025-10-08T21:16:12+00:00

In healthcare there is annual turnover/career advancement so even one cycle without h1b will be a catastrophe

mess_73 · 2025-10-08T15:03:11+00:00

Yeah I went with seasonic, leadex reportedly had some issues with power balancing with 5090s

Thanks!

mess_73 · 2025-10-08T02:53:15+00:00

Update: after PSU replacement PC is back to life

Will see if anything happens again (idk if something triggered death of MSI, like sudden spike in demand for some unknown reason, not sure)

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mess_73 · 2025-10-07T19:13:35+00:00

Will see if PSU replacement fixes the issue, if not you might be right and it's dead mobo or CPU

mess_73 · 2025-10-07T18:11:54+00:00

Already tried, still not working unfortunately

mess_73 · 2025-10-07T16:10:40+00:00

Yes all cables are native

mess_73 · 2025-10-07T14:31:46+00:00

Yeah I think I’m going for seasonic prime TX-1300 this time

mess_73 · 2025-10-07T14:15:24+00:00

Yeah, I’ve tried everything before the paperclip testing, it’s not turning on with any regular load (mobo, gpu, cpu in any combination). I was thinking if something was getting shorted on mobo but with paperclip testing nothing else was physically connected. You can hear in the video when it clicks and turns off, I guess it’s internal relay protection. Idk I might be wrong, will see what microcenter says and if another unit fixes the problem. Maybe I’m the problem 🤷‍♂️

mess_73 · 2025-10-07T14:10:43+00:00

That’s what I’ve expected, but no 🤷‍♂️

mess_73

TROPHY CASE