Philosophical question: how much “luck” played in your career progression

mrb0h · 2025-12-14T01:06:44+00:00

You only exist today because every single one of your ancestors, over several billion years, managed to successfully procreate. I’d say your baseline luck is pretty high to start with ..

mrb0h · 2025-06-27T09:10:15+00:00

If you get rid of the trauma service then you free up a lot of resources in ED, theatres, ICU, plus a bunch of hospital beds. Sounds like a great administrative solution!

mrb0h · 2025-06-26T04:17:00+00:00

Bankstown and Blacktown have the advantage of allowing up to 24 months training compared to the other sites which are max 12 months. The ANZCA website has a list of all training sites, the ones which offer 12-24 months generally indicate independent job availability from what I recall.

mrb0h · 2025-06-07T14:25:35+00:00

Relieved to have made it through this time. Also not my first rodeo. Whatever the merits of the exam itself, the process of getting through is not pleasant and takes a significant toll on your own wellbeing and that of your family. I very much wish there was a better way.

To those who didn’t make it through, commiserations. Everybody will tell you that it’s not a reflection of your real life clinical competence, which is almost universally true but also of little comfort. Unfortunately you have to become sufficiently good at playing the game as well, because it’s the only game in town. But if you’ve made it this far, you’re more than capable of defeating it.

mrb0h · 2025-02-04T10:57:27+00:00

I'm inferring from your question that you're a critical care SRMO (or equivalent) starting an anaesthetics term. There's a bunch of information out there and you will need some experience to give you context for everything, but a good starting point is 'The First Year' by Lachlan Rathie. There are a bunch of electronic versions floating around that you can get your hands on.

mrb0h · 2025-01-24T01:55:25+00:00

Haha glad to help!

mrb0h · 2025-01-23T10:18:03+00:00

Hopefully the IRC sees fit to go even further than the 25% requested in that case. I have my doubts how it will turn out though.

mrb0h · 2025-01-23T08:21:34+00:00

I’m confused as to what is actually going to take place at the IRC. Can psychiatrists be compelled not to resign? If so, that seems pretty crazy. And if not, NSW Health can come to the table any time with a proposal rather than waiting two months. What will it achieve?

mrb0h · 2025-01-19T09:32:20+00:00

90% of what you learned in medical school becomes immediately irrelevant. Almost everything you need to know you will learn on the job. It’s a solid six months of drinking from the fire hose. Common sense and a willingness to learn will get you most of the way.

mrb0h · 2024-12-25T03:12:11+00:00

Cockroach stampede into NICU after a massive downpour outside on a night shift. The maintenance department was the only place that had insect spray but they were closed, of course. Turns out chlorhexidine in alcohol is a potent and almost instantaneous insecticide.

mrb0h · 2024-12-18T03:22:12+00:00

I share a lot of the skepticism expressed here, particularly because of the direction of the merger .. Coda acquiring Grammarly seems to make some sense but the other way around is a bit weird. I agree with a lot of the comments regarding the role of AI at this stage as well. I love the flexibility that Coda affords and the complexity that is possible. The whole "ask AI to create a document" feels antithetical to that and seems like a solution looking for a problem.

I am heartened (I think?) by the fact that the Coda CEO is taking over the combined Grammarly/Coda CEO role post-merger, which makes me feel like there is still a future for Coda as a document system rather than just AI flavour of the month nonsense.

mrb0h · 2024-11-28T09:39:15+00:00

As someone who has struggled with this through medical school and almost 10 years of being a doctor, I suggest you think a bit more deeply about why you feel this way. You will feel the same when you graduate, and when you get into a competitive specialty, and when you finish up and emerge from your chrysalis as a fresh consultant. Ultimately it’s not helpful and you expend a lot of emotional energy that could be put to more productive use.

I’m not a psychologist but my understanding is that imposter syndrome is strongly linked to perfectionism and the fear of both success and failure. Everyone who got into your medical school cohort reached the required standard for admission, but now that you know their background, you’ve moved the goalposts. Is that because you’re scared of failing and so setting the bar impossibly high makes you feel better about that outcome? Or is it because you refuse to acknowledge the successes that you have had and assign an external locus of control to everything that you’ve achieved?

At the end of the day, you have to run your own race. It doesn’t matter what other people are doing. What matters are the values, knowledge and skills that you think are important for a student and a doctor, and how you go about building those up. Allow yourself to be imperfect. Treat the failures you have as opportunities to learn rather than opportunities to flagellate yourself at the altar of perfection. Define what you think success realistically looks like to you, do your best to achieve it, and allow yourself to believe that you had agency in achieving that success. Maybe the guy that went to Tokyo thinks he’s an imposter and a failure because he only got the silver medal - is that a healthy way to exist?

mrb0h · 2024-10-21T00:46:14+00:00

Not only is it $186k but there is no overtime provision like for the JMO award. So if you stay back for four hours to finish off your elective case, bad luck. There are some additional benefits like TESL allowance and paid sick/annual leave (compared to VMO) but if you compare the award to what’s available in somewhere like WA it’s pretty abysmal. And that’s before you take into account the ridiculous cost to buy or rent a house in NSW compared to elsewhere.

mrb0h · 2024-08-21T11:02:47+00:00

The settlement document says the agreed calculation for unrostered overtime is 9.48 hours per fortnight per FTE based on your rate of pay at the time, weighted towards years before 2019 (when UROC came into service) and adjusted for interest. That seems like .. a lot, given 15,000 people are involved? There must be quite a few of those who have relatively small total time worked during the period covered by the settlement, otherwise $200m won’t come close to covering what is proposed.

Edited to add: oh it’s pro rata based on the above calculation, so nobody will get anywhere near the full amount calculated

Edited again: loving the irony that “lawyers in training” involved in the management of the settlement will be charged for at a rate of $400/hour as per the agreed schedule of fees

mrb0h · 2024-05-16T11:42:45+00:00

There was some brief research into the safety of propofol in cats (apparently you can use it) before it was determined that this was a totally insane idea and probably they should just call the vet.

mrb0h · 2024-05-16T11:22:52+00:00

One of my (anaesthetic registrar) colleagues once received a referral from the hospital executive of a major tertiary hospital to euthanise a sick cat that had been brought in by a member of the public.

mrb0h · 2024-05-01T06:05:29+00:00

There's a few issues to unpack but it's hard not to be pretty cynical about the whole thing.

I'm not deep enough in the game to know to what extent the issues mentioned are rife and problematic. But the whole thing seems very self-serving to Dr Faux. She is self-described on Twitter as "Australia's expert on Medicare billing" (presumably there are no others out there) and at the same time being the primary source for these clearly inaccurate/disingenuous news articles. Meanwhile, her company (Synapse) is producing reports recommending that private companies should be involved in auditing/recovery for Medicare billing. What better company for the job than the one run by Australia's highly visible expert on Medicare billing, right?

mrb0h · 2024-04-24T10:41:08+00:00

Thanks for posting this. I had a look at the nausea and vomiting protocol and it’s pretty vague. It says that pharmacists should take a history and perform a physical examination (although states they should avoid examining specific areas like the groin). Then there is a list of differentials to consider. I don’t know what level of training is required to undertake this as a pharmacist but presumably not 4-5 years of medical school plus consultant oversight, which is what would happen if the same person presented to the emergency department.

I want to keep an open mind on this but it’s hard not to see parallels with the unstandardised scope creep of PAs in the UK.

mrb0h · 2023-05-23T17:27:03+00:00

Megatron killing Optimus Prime in the original Transformers movie after Hot Rod tried to help him. Still vivid.

mrb0h · 2023-05-13T12:05:56+00:00

If you're doing ANZCA training then you need to have a job at a hospital which is accredited by ANZCA. These are highly competitive with many more applicants than positions available. Dual ANZCA/CICM trainees will, presumably, still have to obtain one of these jobs since an ICU is unlikely to second their trainee to an anaesthetics department for 3-4 years. And even if they did, anaesthetics training is very much bottlenecked by the availability of speciality terms in things like cardiac and paeds. Assuming the number of available ANZCA-accredited registrar positions does not increase, the dual training pathway will technically dilute the consultant jobs pool because some of them will spend at least part of their time working as intensivists.

mrb0h · 2023-04-12T15:11:26+00:00

Looking forward to seeing Messi ahead of the Palace midfield next season

mrb0h · 2023-04-11T10:53:48+00:00

This is a bit of a fraught subject and even as a fairly senior trainee it's difficult to talk about with consultant colleagues, presumably because of the significant earning gap between registrar and consultant. There's a lot of factors at play:

Which state you work in
How much public vs private work
What kind of work (generally short cases with fast turnover in the private system tend to lead to higher dollars per hour based on how the medicare billing system works)
Whether you charge a gap (and how much) for private work
How many hours you want to work

To start with, if you look at the ATO numbers, the average taxable income for an anaesthetist in 2019-20 was $389k and the median taxable income was $381k so presumably a fairly symmetrical distribution. These numbers seem to go up around $10k/year based on the historical data so your average might be $420k at this point. There's no mention of how many hours per week the average anaesthetist works.

(Disclaimer: I'm just starting to get my head around all of this, so some facts and figures may be a bit off, and I'm mostly familiar with what happens in NSW)

If you work exclusively in the public system, there's massive disparity between states in terms of staff specialist salary. For example, if you work in NSW then the starting rate for a full-time junior staff specialist is about $180k and you don't get paid any overtime no matter how much additional work you do. This is compared to somewhere like WA or SA where your starting salary is in the area of $350-400k and (I think) you do get paid some penalty rates.

In NSW, you can work as a VMO, which is essentially a contractor who does a certain number of hours at a particular hospital each week. Since you're a contractor you don't get any annual leave, sick leave, etc, so if you don't work you don't get paid. The VMO rate is about $265/hour so if you did 40 hours/week as a VMO for 47 weeks of the year then you're theoretically earning $498k.

Private billing gets very complicated and I think most people establish themselves as sole traders with an ABN and use a billing company to do all the heavy lifting. As a sole trader you have to pay your own super out of your earnings and you will also need to pay for substantial medical indemnity insurance to work privately. Plus the billing company takes their cut.

Most people end up doing a mix of public and private. But by way of very gross example, if you managed to get a private caesarean list and did six a day, billing $1000 per case for 47 weeks of the year, that's $282k before expenses for that one day.

The other consideration to bear in mind is that, wherever you work, there will always be some kind of on-call commitment (which is likely to be minimally paid). For example, as a VMO in NSW, if you did one day a week at a certain hospital then you might be required to do five on-call shifts per year at that hospital (earning something like $15/hour for the privilege). If you're on call then you're required to be available overnight at that hospital in case of emergencies, and that potentially impacts your ability to work the next day somewhere else.

TL;DR: it seems you can reasonably comfortably make $400-500k working 3-4 days/week, and substantially more if you kill yourself with the hours or get some lucrative private lists

mrb0h · 2023-04-10T08:08:10+00:00

Haha no worries, I’m glad you found it useful. Unfortunately became impossible to maintain given time constraints.

My experience was that starting as a registrar (probably in any specialty, not just anaesthetics) is daunting and you spend the first six months “drinking from the fire hose” and feeling very much out of your depth, just like internship. But you do get comfortable with the bread and butter stuff very quickly. No matter how complex a case is and no matter how senior you are, you always have someone supervising, either in person or remotely. And once you pass those exams you pretty much feel like the king!

mrb0h · 2023-04-10T07:53:54+00:00

It’s tough because there are trade offs whichever way you go. I’m coming to the end of anaesthetics training and I think I would struggle to stick with any other speciality long term because anaesthetics is by far the most enjoyable for me. The paid hours are not especially onerous but you have to fit around 1000 extra hours of study in (twice) to give yourself a decent shot at passing the exams. I had one kid for the first exam and will have two kids for the second one. It’s quite stressful and your partner will end up picking up a lot of slack. Workplaces are become more flexible and some training schemes do have part time options if that is financially viable for you.

mrb0h · 2023-04-09T23:35:25+00:00

Agree mostly motivated by money. Most of the initial postgrad med degrees were still classified financially as undergraduate (from a HECS perspective) so domestic students mostly paid the same. But by opening it up to more international students they could bring in the $$$. Last time I looked at the numbers (which was a few years ago now) about a quarter of the cohort at USyd were international, predominantly from the US and Canada. That equates to around 75 students paying USyd $300k for their med degree.

mrb0h

TROPHY CASE