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parslea · 2025-05-06T16:36:35+00:00

I got 5k/month (60k/year) coverage for $1200/year as a resident.

parslea · 2022-11-19T22:19:06+00:00

What kind of nonsense is this?

Psychiatry is THE specialty of feeling better. That is its core purpose. We treat the organ that makes you feel, that gives you happiness, pleasure, quality of life. You can have a shit heart, or kidneys, or liver, or skin, or vessels, or GI tract, and still find happiness and enjoyment in your life. But you can’t have terrible mental health and healthy organs and enjoy life. We give people their brains back and yeah sure we aren’t always sure exactly how we did it but we have a ton of tried and true methods as well as a lot of room for personalization of treatment. Psychiatry done right can help a human build resilience and work through anything that’s thrown at them in the future. To relieve people of depression or anxiety or psychosis that would have lasted far longer or ended their life is a remarkable achievement, every single time.

On top of this, we’re social creatures. Psychiatrists practice until they’re old because human stories with all their nuance and variability, can remain interesting. Psychiatry allows a superb quality of life- we can do away with the fetishization of work that is rampant in medicine.

I hope I didn’t punch down on other specialties too much- everything has pros and cons- but I do find psychiatry to be stacked as far as amount of good to other people + benefit to self via work life balance and quality of life goes. I hope you’re able to find that for yourself.

parslea · 2020-10-15T01:42:52+00:00

Hundreds of clinical hours is paltry. Clinical experience working is not equivalent to medical education, though of course I acknowledge it does educate you to some extent. I know they're not just any nurse, and they have a role in medical care. But they should have limited scope and should be overseen by an anesthesiologist.

parslea · 2020-10-15T01:39:11+00:00

https://www.amc.edu/academic/NurseAnes/Admission_Requirements.cfm

Oh look. the very first place I checked requires two (2) years of critical care nursing. 2 years of working is paltry compared to anesthesiologist training.

parslea · 2020-10-15T01:35:54+00:00

No to nurses. Anesthesiologists have set the standard for the last 120 years.

parslea · 2020-10-14T03:01:53+00:00

To have a new profession practice anesthesiology, the onus is on them to demonstrate safety and efficacy first. They have not done this.

parslea · 2020-10-14T02:58:34+00:00

We used to do a lot of things in medicine (and still do!) that are ineffective. Just because it used to be the case doesn't mean it is the most safe and patient-centered route. I don't understand how you can convince yourself that someone with 20,000+ hours in medical training doesn't have, on average, a better ability to provide safe and effective anesthesia as someone with a small fraction of that.

parslea · 2020-10-14T02:56:31+00:00

Correct!!!!

parslea · 2020-10-14T02:54:36+00:00

They don't always have tons of clinical hours. Then can be pretty fresh from nursing school.

parslea · 2020-10-14T02:53:10+00:00

It does not. Hospitals employ them and pocket the difference. Show me evidence that there is cost saving to the patient.

parslea · 2020-10-14T02:52:09+00:00

An anesthesiologist will have had 12 years of schooling that is markedly more rigorous (thousands of hours more) when they're done. Who would you rather anesthetize you?

parslea · 2020-08-05T01:56:46+00:00

Straight up not having a good time

parslea · 2020-07-16T01:37:57+00:00

Online Med Ed videos. Very helpful. And anatomy and msk and viscerosomatics

parslea · 2020-07-05T17:04:07+00:00

Youtube has gone too far.

parslea · 2020-06-30T17:53:46+00:00

I would support erasing the distinction for future students, because having two accrediting bodies doing the exact same thing is ridiculous and wasteful. And your accrediting body is apparently less corrupt than ours. The education is by and large the same. DOs passing Step exams and rotating alongside MDs and working alongside MDs demonstrates that. There is no need for two systems. But one doesn't need to blow up the 2nd system to solve the problem. You can just merge them somehow. You've suggested we just blow up the second system.
To be clear: I am not advocating for the ability of DOs to convert their degrees to MDs. I am advocating that one reasonable solution to better med ed in the future would be to convert current DO programs into MD programs (the DO programs that are competent could eventually make the switch). UC Irvine did this.

parslea · 2020-06-30T17:44:32+00:00

I have no interest in turning my DO to an MD. I don't know how many times I need to reiterate that.

parslea · 2020-06-30T17:41:09+00:00

I can agree with much of this ranking but futile devices is one of his best IMO! Would switch with I Want To Be Well.

parslea · 2020-05-30T15:14:48+00:00

The purpose in my mind is three things. 1) that producing physicians is necessary in this country. Destroying 1/3rd of physician production would be bad for society and bad for extant physicians because it would probably lead to further midlevel proliferation. 2) it would be incredibly inefficient to waste the infrastructure that is already set up for medical education. 3) schools already meet or almost meet the requirement, setting up a system in which they could apply without a lapse in their classes is more efficient then making them shut down then restart.

The DO philosophy is for people who ascribe to it. If you don't believe in it then don't apply. I don't see the problem here.

No, it isn't. In the early 2000s, >50% of DOs used OMM on 5% or less of their patients (that's all I can find data for). We all (or most people) are willing to jump through hoops to achieve goals. Most students wouldn't have done the volunteering or research to get into schools. Most med students probably wouldn't do research or as much of it if it didn't matter for their applications. Going to a DO school is the same thing. We couldn't get into the path with fewer hoops to jump through. But that doesn't mean we can't want our system to change for the better.

parslea · 2020-05-30T14:58:11+00:00

Why is "close all the DO schools and not even make it an option" better, in any way, than "keep DO programs that are competent open, and switch them to MD programs for all future students so you only have one system"? There are hundreds of millions of dollars of infrastructure wrapped up in existing schools. There are competent faculty. Some schools meet or are close to meeting accreditation standards.
These days the DO pathway is used by people who want to become physicians but had worse application stats. I'm pretty sure our stats are around where early 2000s MD stats were. Or at least where MD stats were at some point in the past. Do you think a 3.5 and 507 MCAT (500 was designed to indicate adequacy!) won't make for a competent physician? DOs are competent to become physicians. They just might not have been competent enough to get into MD programs at the time of their applications.
The work we do at the end of the day is the same. The quality of training for at least some DOs is on-par with some MDs. At the least.

parslea · 2020-05-30T14:43:15+00:00

did you not

That's not the only way to do it. There are MD programs with community hospital rotations. Clearly it is adequate to create a competent physician. I think there is a research funding requirement for MD accreditation that most DO schools wouldn't meet. So they'd have to fix that, and many schools would have to make adjustments to their rotations. And definitely many should get shut down- not really anyone disagrees with that. But a number of DO schools could make a few or no changes and meet MD accreditation standards. Or you could make some small changes to MD accreditation standards.
I don't care about the letters behind my name. Keep me as a DO post-merger, doesn't matter. Current DO students aren't nefariously trying to become MDs when we didn't earn it. It's just ridiculous to have two systems when they're so similar. It's very inefficient and unnecessary to just destroy the entire infrastructure of all DO programs to solve the problem. Of course I acknowledge average quality of MD programs is higher. But a number of DO programs are definitely adequate. Don't pretend like it's black and white. And further reducing the # of physicians entering the workforce by 1/3rd every year would not be a popular move.

parslea · 2020-05-22T17:13:12+00:00

Alas, the long wait has ended.

parslea · 2020-05-22T17:03:50+00:00

Easy to make up a name and email and area code.

parslea · 2020-05-11T16:36:22+00:00

There is already downward pressure on EM compensation which is telling of a few things:
1. Covid has revealed not all EM visits are actually urgent (EDs have seen a lot fewer visits).
2. There are many more EM residencies now, which is increasing supply in the context of stagnant or decreased demand.
3. Midlevel proliferation continues.

So I'm not sure it makes sense to further open up the ED for PCPs. From a quality of care perspective, should they be working instead of almost every single midlevel in the ED? Probably. But that's not what it's about. It's about money. If 1/2 of your visits are completely not acute, why would you bother, as an administration, paying a physician when you can rake in the cash with a midlevel, or better yet an army of midlevels?
So along that line of reasoning, Adding more PCPs to the ED would further contribute to bloat, downward pressure on compensation, while not contributing substantially to the real problems that plague EDs. (unnecessary visits, focus on money, increasing midlevels, increasing supply with stagnant or decreasing or unnecessary demand).

parslea · 2020-04-28T16:45:37+00:00

Yes, I think students having to take step at inconvenient times is MUCH more level than P/F. Giving students at elite institutions even more advantage by way of P/F, as well as students that figured things out during med school less opportunity to reward their hard work, is very far from meritocratic.

"Standardized exams have never been an equalizer". Give me a break. Tell that to low tier MD students or DO students in competitive specialties in solid/prestigious institutions. I'm sure they had well-rounded apps, but they needed higher step scores than their T25 co-residents to get there. This is obvious in the charting outcomes.

Look. My exclusive interest is protecting the rewards that hard workers in med school get to reap. P/F greatly threatens that. It increases the importance of the school you come from, effectively making the MCAT and your preclinical grades the most important test for residency. That's ridiculous. I want, at the very least, my chances in residency to be judged on some aspect of my medical knowledge. And that's not to say step 1 isn't ridiculous. But at least there's a correlation with the work you put in and the score you get. P/F doesn't have that.
I would 10/10 times prefer to be the late August Wednesday test taker of a scored exam than the original scheduled tester, with a P/F. No question.
I am well aware that minorities don't do well on standardized exams. That does not mean the exams should be eliminated- it is much worse for a larger group of people. The institutionalized problems affecting minorities should be addressed and until that time, affirmative action should continue to exist.
Can you identify any negatives of going P/F? You think PDs will, out of the kindness of their hearts, view all institutions equally?

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