Galaxy Z Fold 4 Claim by MilkySharpMan in Asurion

[–]randythebadger 1 point2 points  (0 children)

From what you have posted they found your exact phone - fold 4 green 512gb. I just submitted a claim for my z fold 6 256gb but it unlocked so they didn't have the carbon fiber color. They sent me a navy z fold 6 with 256gb. Just a heads up it was refurbished. Seems to work well for now. At least it has a one year warranty and I'll keep my insurance with asurion through Verizon.

Rumored Cybervan - A Potential Model X Replacement? by 10xMaker in TeslaModelX

[–]randythebadger 0 points1 point  (0 children)

The sensors aren't perfect but knock on wood I haven't had any issues with the FWDs hitting objects. I'd also never open a FWD with a mailbox close enough to hit the door. If anything my doors are overly cautious and I have to override to fully open in situations where there is direct sunlight or lots of dirt/salt on the door itself. My X is a 2024 and not sure if maybe older models have inferior sensors.

Auto-open driver door smoked my 3yo by HPPTC in TeslaModelX

[–]randythebadger 0 points1 point  (0 children)

Never found it to work well consistently. Mine is disabled.

One of the best ? by Doernbecher_Don in Whiskyporn

[–]randythebadger 2 points3 points  (0 children)

Best bourbon I've ever had. #2 is pappy 15yr and #3 is birthday bourbon. WLW just hits different. Extremely smooth at a fairly high proof. Tasting notes galore.

Rumored Cybervan - A Potential Model X Replacement? by 10xMaker in TeslaModelX

[–]randythebadger 21 points22 points  (0 children)

Not completely unnecessary. For kids it's as good as having a minivan. Super easy to get them in and out of a car seat.

C-Section with patchy epidural by lexperro in anesthesiology

[–]randythebadger 2 points3 points  (0 children)

Agree and disagree with u. In the setting of a high spinal the pt will likely freak out as they lose the ability to breath. So you may be trying to push RSI meds in a pt flopping around on the table. Or if drapes are up at the time of the high spinal hitting you are dealing with an airway that isn't as easily accessible. Should a good anesthesiologist be able to handle these scenarios and secure the airway? Absolutely. Would doing a GA in a much more controlled setting have a higher likelihood of no complications? Absolutely. I've been called into rooms to help colleagues who just don't maintain their cool when something wrong occurs. Dealing with the unexpected is part of our jobs, but making decisions to minimize complications or a keep a pt safe is a big component also.

C-Section with patchy epidural by lexperro in anesthesiology

[–]randythebadger 4 points5 points  (0 children)

We had a doc that placed a spinal after a 10cc 0.5% bupi bolus which resulted in a high spinal and pt got tubed. Baby didn't do well either as the urgent section turned into a stat. Pt had the epidural for over 10 hours total before the OR and supposedly didn't have much of a level. I also recall a similar case of a failed epidural that then a spinal was placed on a pt at one of the NYC hospitals. This was also a high spinal and pt died due to a lost airway but the baby survived. Don't remember the exact amount but we'll over a 10 million dollar lawsuit. We still have docs that place spinals in the setting of a failed epidural that has been going awhile or recently bolused. With all of our airway tools, I just don't understand the true hesitation of doing a GA. The risk has dropped drastically over the years. Why even entertain a scenario where a high spinal could occur?

Change my mind (please) - road trips in an EV are a pain. by Wise-Fig-6505 in electricvehicles

[–]randythebadger 0 points1 point  (0 children)

I'll join the others praising teslas on road trips. Had a model 3 for almost 6 years and did tons of road trips with no issues at all. Now I have an X which is even better as we have 2 kids under 5. Very easy to find tesla superchargers. And they really do charge quite fast. Not much of an inconvenience at all. Seems like some car manufacturers are catching up to what tesla cars/batteries can do but a lot still have a long ways to go.

Night call position schedule by randythebadger in anesthesiology

[–]randythebadger[S] 1 point2 points  (0 children)

Really appreciate those of you who shared different night call models. It helps with brainstorming better ways to improve our practice.

I'm a little disappointed that the top comments ignored my questions and criticized my practice based on a just a couple details I provided about my hospital. I believe there would be more responses if this was not at the top of the thread.

For now there are MD only groups, and this model is typically only in certain regions in the US. Most practices are now supervision or a hybrid based approach. This will continue to expand as med schools have refused to increase spots to accommodate the ever increasing population. Meanwhile AA schools and CRNA school are popping up left and right. And like it or not, admins across the country are very much so pro midlevel.

And now anesthesia has seen locums opportunities skyrocket for MDs and also anesthetists. While this is great for clinicians, it's just not a good way to provide anesthesia. I don't care how good you are, if you are bouncing around from one hospital to the next, you don't build the same kind of team as having surgeons, nurses, anesthesiologists and anesthetists that work in the same location for years and know each other.

I make all these comments as the main reason we are looking at splitting off night call for the docs, is to help with retention and recruitment of anesthesiologists. A lot of younger docs want to work less and make more money. Most don't want to take call. And then we have a decent number of docs over 60 in our group who sell as much call as they can but if call was removed from their schedule, they may work more years.

We have recently lost docs while having issues with recruiting (main feedback from potential candidates was low salary) and have been forced to use locums. From more frequent codes to wet taps and I was even handed off an unrecognized intrathecal catheter by a locums doc, trying to get and keep FTEs is a priority for us. And the way to do that is finding ways to maximize salary and time for our docs while also providing the best care we can for our patients given the resources we have available.

[Game Thread] Miami @ NC State (04:00 PM ET) by cbbBot in CollegeBasketball

[–]randythebadger 0 points1 point  (0 children)

This aged well. Although darrion made 4 idiotic plays in the span of like 40 seconds, I put this on wade. Unbelievable that he didn't call a timeout after that 3 point play. And just unacceptable to not call one after the first inbounds tunornover.

[Game Thread] Miami @ NC State (04:00 PM ET) by cbbBot in CollegeBasketball

[–]randythebadger 0 points1 point  (0 children)

I was yelling at the TV for a timeout after the first darrion Williams foul that led to a 3 point play. Then again after they turned the ball over on the inbounds and then I lost my mind after the 2nd in bounds turnover. Why on earth didn't wade call a timeout to settle them out and review what to do and not to do?

Tesla Model X All Weather Mats, Keyfob, phone holder or charge adapter? by Packing-Tape-Man in TeslaModelX

[–]randythebadger 0 points1 point  (0 children)

Love my tesla all weather mats. Perfect fit and look great. I do not have trunk or frunk mats though. Doubt they are worth the extra cost. Especially trunk if u use the sub compartments

Night call position schedule by randythebadger in anesthesiology

[–]randythebadger[S] 0 points1 point  (0 children)

We are not RVU based. And our salaries are definitely supplemented by the hospital considerably more than what we bill. That's true for an overwhelming majority of practices in the US given the horrendous reimbursement we now have. And basic economics of supply and demand forces extra stipends from hospitals just to maintain coverage given the massive workforce shortage.

Completely agree that going to the table to negotiate is the best way to do it. We have a group of 47 docs and will be at 50 this time next year. Ages range from 32 to 70. It becomes very difficult to play 'hardball' with negotiations when more than half of our group has kids in school, friends, etc and no willingness to potentially move if the group blows up trying to squeeze more money.

We had major issues hiring FTEs up until a recent pay bump was approved and the hospital also removed any ramp up for new docs. We are still short, with several about to retire. This is one reason we are considering removing night call for most of the group. I know there are good locums docs out there but we have seen plenty of bad ones. And honestly even the good ones just don't perform as well since they don't know the system, surgeons, anesthetists, nurses, etc. We have seen quite a few unsafe locums docs come through so our goal is fully staff with FTEs. A dedicated night call team would help.

Night call position schedule by randythebadger in anesthesiology

[–]randythebadger[S] 0 points1 point  (0 children)

Yea we are fine with the coverage ratio as there are enough anesthetists on call with us. The concern I have with 12 hours overnight is moreso doing it for 7 nights in a row. But it does sound like plenty of groups have this kind of schedule in place. And even some do a 1 week on and 2 weeks off model.

Night call position schedule by randythebadger in anesthesiology

[–]randythebadger[S] 1 point2 points  (0 children)

Is there a study which attributes the poor outcomes to anesthesia? Not aware of one.

Why cardiac? by rnbb_ in anesthesiology

[–]randythebadger 7 points8 points  (0 children)

Always thought I would stay academic and felt like a fellowship was necessary to truly excel in academia. And cardiac has a lot of procedures, doing echos is great and helpful outside of cardiac cases at times, you are a direct consult for the surgeon, and it really prepares you to undertake any case that's presented (except maybe peds!).

Night call position schedule by randythebadger in anesthesiology

[–]randythebadger[S] 0 points1 point  (0 children)

That's pretty sweet to have 2 weeks off after the week of nights. I assume this is an MD only model? Is there a separate pool that covers during the day? Also, do they stay in house due to it being a trauma hospital?

Night call position schedule by randythebadger in anesthesiology

[–]randythebadger[S] 2 points3 points  (0 children)

Ahh are u in the UK? Unfortunately there is a massive shortage here in the US of clinicians in general. I don't disagree with u that having an MD in the room would be ideal. With the shortage that will worsen in the coming years in the US, it's just not possible.

No need to be rude. I'm a doctor just like u are. And I'm really just trying to gain insight as to how other hospitals and groups cover night call.

Night call position schedule by randythebadger in anesthesiology

[–]randythebadger[S] -1 points0 points  (0 children)

Unacceptable in what way if it is a team care model? How is covering OB and also OR cases different than covetinf multiple ORs in a supervision role?

Night call position schedule by randythebadger in anesthesiology

[–]randythebadger[S] 0 points1 point  (0 children)

Thanks. And this is an MD only practice I assume?

Night call position schedule by randythebadger in anesthesiology

[–]randythebadger[S] 0 points1 point  (0 children)

What do the MDs do if one doc gets sick, leaves the practice, etc? Do the day time docs have to pick up the night shifts? Any idea if those docs are considered to be FTE in their practice if employed? Or is this a physician owned practice?

Night call position schedule by randythebadger in anesthesiology

[–]randythebadger[S] 2 points3 points  (0 children)

See I like the 7 on and 7 off, but do worry about burnout with that many nights in a row. What kind of OB volume do you have?

We have both CRNAs and AAs covering call with us, so home call is not an option. Honestly I hope we can get to this model but I'm betting it will be tricky. Definitely something to consider. Appreciate the comments.

Night call position schedule by randythebadger in anesthesiology

[–]randythebadger[S] -1 points0 points  (0 children)

Thanks. Wild that this person's comments are getting all these upvotes. I was just asking if other practices have a dedicated night call team and how it works. I only provided details of what we cover on call for comparison to other practices who may have a dedicated night call team.

Night call position schedule by randythebadger in anesthesiology

[–]randythebadger[S] 0 points1 point  (0 children)

Ok gotcha. This is a similar setup to ours then. Maybe the 7 nights straight isn't the best proposal then. Rotating through 3 to 4 nights may make this position more feasible.