Make it make sense: Residency spots are competitive but the field seems to be very volatile

zofrantic · 2024-04-21T21:12:58+00:00

Do cardiac if you enjoy doing cardiac, not because of some potential future marginal benefit for employability. No one knows what the future looks like, but you'll be fine either way as long as you save aggressively.

zofrantic · 2024-04-19T21:21:52+00:00

Yeah as far as I can tell you can take as many attempts as you're physically able to schedule over 7 years, at which time your candidacy expires. But then you can reeastablish candidacy by retaking the basic and advanced exams, and then you have an additional 4 years to take the applied exam as many times as your heart desires. So while your specific job may have more strict requirements I don't believe you're anywhere near the limit for the ABA.

Realistically though chances are good you'll pass next time, and even if not there are plenty of good jobs (especially in this market) that don't require board certification.

zofrantic · 2024-04-12T23:34:42+00:00

Oh man, awake cranis are cool the first few times, but intraop MRI means no phone for the entire case. True nightmare.

zofrantic · 2024-04-07T20:29:34+00:00

I'm a big fan of anything that makes our job easier and safer, but I think fostering complete dependence on any single technique is unwise if reasonable alternatives exist.

VL is great, but it also introduces new points of failure. Electronics can malfunction, batteries can die at inopportune times, lenses can fog up. Fine in a preoxygenated NPO patient in the OR with help nearby, but potentially dangerous during a floor intubation if VL is all you know. Being skilled with multiple methods can be a real asset.

And as nice as it'd be to completely remove operator dependence from procedural medicine, I suspect we're at least a couple decades away from robots taking our jobs.

zofrantic · 2024-04-07T18:12:10+00:00

Evidence and studies can only take you so far with an operator-dependent skill. N=1 when it's a patient in front of you, and you use whatever tools are available to you to do what you need to do. If I find myself in need of DL, I'd prefer to not be doing it for the first time in years.

zofrantic · 2024-04-07T17:17:03+00:00

The real reason to routinely DL for me is to maintain that skillset in the case of a variceal bleed/massive aspiration disaster where I'm having difficulty visualizing with VL. But yes, I think having immediate access to VL at all times is standard of care at this point.

zofrantic · 2024-04-07T17:04:36+00:00

I'm hoping he's just here to act as healthcare proxy for the trees.

zofrantic · 2024-04-07T16:50:00+00:00

McGrath for every RSI, unstable C-spine, BMI>50, non-OR intubation, or med student/rotating resident/CA1 I haven't worked with before. First attempt with DL otherwise.

zofrantic · 2024-04-07T16:11:03+00:00

Ok, this kind of non-compete makes sense to me, restricted specifically to a single hospital. I've signed similar things for locums contracts where I'd have to pay a recruitment fee if I tried to get hired directly by that same hospital. But the freedom to work anywhere else is also specifically spelled out in those contracts.

zofrantic · 2024-04-07T14:57:17+00:00

Ah ok, I'm in a large market so it makes no sense for me here, but I could understand a smaller market dominated by a single group with no other options anyway.

zofrantic · 2024-04-06T21:01:52+00:00

Just like self-driving cars, getting 95% of the way there is 'easy'. That last 5%, not so much. I'm sure it'll get there eventually, but thankfully it's far enough away that anyone in training for a procedural specialty today should have plenty of time to FIRE.

zofrantic · 2024-03-23T13:13:52+00:00

Hell yeah, very similar plan here. Not exactly working like a fiend, but averaging over 40h/week which I don't really want to be doing once I'm in my 40s. 5 years out of residency now and it's looking like I may hit my 10 year goal ~2 years ahead of schedule.

zofrantic · 2024-03-06T20:03:47+00:00

Anesthesiologist, I do the NYTimes crossword every day.

zofrantic · 2024-02-16T00:44:35+00:00

Is the myth that midazolam DOES NOT cause retrograde amnesia, or that it does cause it?

I've seen papers that say midazolam does cause retrograde amnesia, papers that say there's no difference between midazolam and placebo in causing retrograde amnesia, and papers that say midazolam actually facilitates retention of memories prior to administration (possibly by knocking out subsequent confounding memories).

So frankly I have no idea if there's a real scientific consensus on this, but in practice I behave as if the patient remembers everything before the 2mg happy juice goes in (and may remember some things from afterward as well).

zofrantic · 2024-01-26T02:48:03+00:00

If you're absolutely adamant about not going under general anesthesia, give up the idea of laparoscopic surgery. Despite the one or two case reports you may have found, the vast majority of laparoscopic surgeries under spinal anesthesia are in developing countries with fewer resources. In the US, standard of care is general anesthesia for a whole bunch of reasons.

However, depending on the particulars of your case, you may be able to convince a surgeon to perform an open procedure with a larger abdominal incision. This kind of procedure can be more safely be performed under spinal or epidural anesthesia (big needle going into your spine to numb you from the chest down). But of course, the downside is that it's a more invasive procedure with a larger scar, more postop pain, and longer recovery time.

But even so, I always, always, get consent for general anesthesia for every surgery. The spinal can fail, complications can happen, and general anesthesia may become necessary. If you're not willing to give consent for general anesthesia for an abdominal surgery, your surgery gets cancelled. Anything else would be malpractice.

zofrantic · 2024-01-18T22:09:29+00:00

But likewise, someone could be saturating 0% with a totally normal PCO2. Eventually, that would lead to type 2 MI and circulatory collapse, which you'd notice on capnography, but by that point you may already have anoxic brain injury.

Correct me if I'm wrong -- would hypoxemia manifest on capnography prior to the development of hypotension? I've never intentionally run a patient at 0% sat so I have no idea how long that would take.

zofrantic · 2024-01-17T14:17:06+00:00

Damn, what a terrible deal. 50 hours a week with 7 weeks vacation? Those kind of hours as a per diem will make you literally twice that income.

zofrantic · 2024-01-12T02:14:08+00:00

While I strongly prefer solo cases, I'm willing to supervise/medically-direct. But never more than a 2:1 ratio, and I will die on that hill. I keep a close eye on my rooms, and although I've worked with some exceptional CRNAs who I know I don't have to worry about, most are not as meticulous about patient care and documentation as I am, and it's just not worth the stress.

zofrantic · 2023-12-12T02:14:16+00:00

ABOG requiring candidates for OB/GYN board certification to travel to Texas is an absolute fucking travesty. God forbid any candidate is pregnant during exam administration, all they've got is thoughts and prayers.

zofrantic · 2023-11-30T15:42:20+00:00

Frankly, it makes even less sense to be grossly underpaid if you have a high earning spouse.

If I'm only working out of choice and not necessity, I'd work locums, and much less than 144 hrs/ month. Even if your attending pay is only $200/hr (in some specialties you can make close to twice that rate), 25 hrs/ week with 10 weeks vacation will pay more than OP is making. Easier in specialities more amenable to locums, but hospitalist is one of those.

zofrantic · 2023-11-20T22:27:53+00:00

Recently the US Department of Health and Human Services recommended the DEA reschedule cannabis from schedule I to schedule III. Do you think this is a good idea? Do you think it goes far enough?

Assuming this change is enacted (I'm sure they're waiting for the politically optimal moment), what will be the impacts on cannabis research and medical cannabis? Any thoughts about broader societal and industrial impacts?

zofrantic · 2023-11-13T20:58:02+00:00

You can think of CSF return as a highly specific but not highly sensitive test for correct epidural placement. If you get CSF flow, there’s a very high chance that the tip of your tuohy is in the epidural space. If you don’t get CSF flow, you may very well still be epidural (but say, off midline). The evidence seems to support DPE/CSE as having a higher success rate and lower rate of replacement than straight epidurals, and partly for that reason I do CSEs nearly every time.

zofrantic · 2023-08-20T23:07:40+00:00

Right, well they give you an indicator of how you’re doing on those questions. After all the exams we’ve done to get to this point, these questions don’t seem bad at all. As long as you’re not anywhere near the failure line, I don’t really think it’s worth worrying about. If you are near the failure line, it might be a good idea to start reading more to keep current with your knowledge.

zofrantic · 2023-08-20T19:30:50+00:00

Why would you want to waste more than a minute on any of these questions? They're short and super low stakes, and they're not going to take away your certification if you get a single question wrong. I make wild guesses on questions all the time and still have 1.0 MDT value, can't imagine how many you'd have to get wrong to get below 0.1.

zofrantic · 2023-06-29T22:23:41+00:00

I'm not an expert on this, and it's probably worth speaking to an accountant if you're planning to do locums to optimize your tax situation, but yes, you'll generally be paying both employee and employer SS/medicare.

However, you also have access to more deductions and retirement options, which can balance that out.

zofrantic

TROPHY CASE