Am I a nobody?

[NewYorkDoctors]

Every med student does. That's the sexy s***. It's what TV taught us to think medicine was. Med school and residency training in most specialties prioritize the emergent and acute care clinical experiences over the far more common (and probably more impactful) non-emergent and chronic care that makes up the bulk of healthcare.

A dozen years in and I'll take a clinic full of simple 99213s all day every day.

yes count that easy money rolling on in agreed.

years ago in my residency I also like inpatient better because I was "not the sole provider." I never needed to have the final say on things. I could juts show up to a rapid response order Lasix put on BiPAp send for CXR draw some labs tell primary team and then pat myself on the back . I had a set of tasks to do and then I was done with it.

however, this form of "limited responsibility" that med students and residents (to an extent) have is only available during training. hospital attendings have no such luxury of 'limited responsibilities." There is a reason why hospitalist medicine burns out after a while (unless it's one of those unicorn jobs...)

once a patient was discharged or transferred to "lower level of care" (i.e. MICu step down or transfer to the attending only service - which means wait for placement), I would pat myself on the back

so yes there is that appeal for the trainees


in outpatient clinics one can never really be "done" with a patient persay

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[DarkBluMage]

I always appreciate your input. My dislike for outpatient primary care comes from working several years in an outpatient clinic setting and it was something that I feel I would not like as a physician. My rotations on FM out patient as well as IM outpatient clinic (both in residency programs) solidified that I do not like outpatient primary care. Maybe providing primary care (as a cardio or heme/onc) is different and may suit me better but the FM/IM outpatient stuff did not suit me at all. I also love being in the hospital. I have a sense of calmness while there. Who knows. We will see after my next surgery rotation whether I choose to take the IM or surgery route.

I get what you’re saying. I also hate clinic

 

[dozitgetchahi]

Every med student does. That's the sexy s***. It's what TV taught us to think medicine was. Med school and residency training in most specialties prioritize the emergent and acute care clinical experiences over the far more common (and probably more impactful) non-emergent and chronic care that makes up the bulk of healthcare.

A dozen years in and I'll take a clinic full of simple 99213s all day every day.

Fully agree.

Trust me, the “high acuity”/emergent/etc care is a lot less sexy the longer you get into this profession. A lot of people over the years have been really surprised, for instance, when I’ve told them I’d basically rather be dead than be a surgeon - “wait, really!?” It’s like everyone thinks that all doctors live for that. Not really.

I think we do a disservice to trainees in the way we present certain types of healthcare to them.

 

[Calizboosted76]

Fully agree.

Trust me, the “high acuity”/emergent/etc care is a lot less sexy the longer you get into this profession. A lot of people over the years have been really surprised, for instance, when I’ve told them I’d basically rather be dead than be a surgeon - “wait, really!?” It’s like everyone thinks that all doctors live for that. Not really.

I think we do a disservice to trainees in the way we present certain types of healthcare to them.

I dont know that I like the exciting stuff because its "sexy". I am a very social, loud, and intense person. This paired with other aspects of my personality makes higher acuity situations just feel right to me.

 

[dozitgetchahi]

I dont know that I like the exciting stuff because its "sexy". I am a very social, loud, and intense person. This paired with other aspects of my personality makes higher acuity situations just feel right to me.

But can you do them for 40 years, day in/day out, even with the circadian rhythm disruption and exhaustion?

That’s the question.

 

[Calizboosted76]

But can you do them for 40 years, day in/day out, even with the circadian rhythm disruption and exhaustion?

That’s the question.

But does anyone really know the answer to that question when choosing their specialty? I am not saying that I will always dislike outpatient PC. I guess that is the trouble with choosing a specialty, finding one where I can have my high acuity when I a young and if I need to slow down be able to switch outpatient. Really making PCCM sound more and more like my cup of tea.

 

[Meerkatology]

I recently went to a 20 yr medical school reunion. Some classmates are assitant deans and department heads, high powered specialized specialists, and big wigs in their fields, and then there's me (lowly hospitalist- glorified resident - worker bee). I've never been the envious or jealous type, but it is interesting to see. Anyone else can relate and does it bother you? Don't get me wrong, I'm happy, I've had a good career so far and I've done well due to good financial habits etc.

wtf, i work a light night job for the last 10 years. definitely the best years of my life that i wouldn't trade for anything else let alone some hospital dean or what not that needs to deal with all the politics and ... people

imagine having to suck up to ur cooperate higher ups while trying keep the plebs like us from revolting - thats what the glorified leadership has turned into in the age of cooperate medicine . and do you really want to be doing things that have nothing to with the training u spent last 10 years obtaining?

just me tho

 

[Nocturnist]

I recently went to a 20 yr medical school reunion. Some classmates are assitant deans and department heads, high powered specialized specialists, and big wigs in their fields, and then there's me (lowly hospitalist- glorified resident - worker bee). I've never been the envious or jealous type, but it is interesting to see. Anyone else can relate and does it bother you? Don't get me wrong, I'm happy, I've had a good career so far and I've done well due to good financial habits etc.

There's a few big decision points along one's career in medicine:
Surgical vs non surgical?
Acute setting vs out patient?
Lastly, cog in the wheel vs corporate ladder/rat race.


The status symbol for boomers and Gen X'ers was material things and fancy titles. Regardless of how little time it left them to enjoy what they really cared about or how it was all financed on credit and they were actually broke.

The ultimate flex for millennials and younger gens is financial freedom and control over your time.

Happiness isn't a fancy title or how high powered your career is, it's the ability to do exactly what you want when you want on your terms.

Let them think anyone cares about their title while academia pays them in prestige.
Let them have their high powered careers that trap them working 60 hour weeks on the endless rate race.

I'll happily take my financial independence by my early 40s while my kids are still young.

 

[Splenda88]

Below is a post from the "physician community" in Facebook. Moderator can delete if not permitted.

"My husband are both medicine sub -specialists. He is GI and his call is very stressful and he covers a huge part of the state we live in. Obviously, he knew that his job would entail night and weekend call before he entered the speciality and seemed ok with it. Now he is three years out of fellowship and when he is on call our house is a cloud of toxicity and rage. Every time he gets called for a consult he is rude, defensive and ugly. The rest of the family walks on eggshells when he gets called in bc he is bound to throw a temper tantrum. I have talked to him many times about burnout, he often says to himself “I hate my life, I hate my job”. I often point out that consultants are calling for help and direction and that patients need him to (often) help save their lives. This does not seem to help. He is obviously burnt out and miserable and I don’t know what to do. We have a 6 month old baby that I don’t want to be around this. I don’t know what to do."


I think I am ok with my simple life. I am home today by 2:00 pm after watching an entire soccer game at work. I got some rest and now I am drinking cognac while watching the Super Bowl.

 

[NewYorkDoctors]

Below is a post from the "physician community" in Facebook. Moderator can delete if not permitted.

"My husband are both medicine sub -specialists. He is GI and his call is very stressful and he covers a huge part of the state we live in. Obviously, he knew that his job would entail night and weekend call before he entered the speciality and seemed ok with it. Now he is three years out of fellowship and when he is on call our house is a cloud of toxicity and rage. Every time he gets called for a consult he is rude, defensive and ugly. The rest of the family walks on eggshells when he gets called in bc he is bound to throw a temper tantrum. I have talked to him many times about burnout, he often says to himself “I hate my life, I hate my job”. I often point out that consultants are calling for help and direction and that patients need him to (often) help save their lives. This does not seem to help. He is obviously burnt out and miserable and I don’t know what to do. We have a 6 month old baby that I don’t want to be around this. I don’t know what to do."


I think I am ok with my simple life. I am home today by 2:00 pm after watching an entire soccer game at work. I got some rest and now I am drinking cognac while watching the Super Bowl.

see what a big difference owning the ASC / facility is?

My work hours suck also on paper and I am literally always on the computer , the EMR, the cloud at all waking hours of my life.
I just can only work this way with current technology. I cannot imaging how this went on back in the day of paper charts and those pink billing scantron sheets to mail in

Moreover I get all the money I work for. So I am fine with it. No RVUs. what flavor are those anyway? can I eat those?


anyway if that GI doctor owned the ASC, I am sure he would be find it easier. end of the day all physicians should strive to be independent and affiliated with the hospital systems. never ever be their employee unless they can give you a sweet deal like some hospitalist jobs are.

 

[chessknt]

see what a big difference owning the ASC / facility is?

My work hours suck also on paper and I am literally always on the computer , the EMR, the cloud at all waking hours of my life.
I just can only work this way with current technology. I cannot imaging how this went on back in the day of paper charts and those pink billing scantron sheets to mail in

Moreover I get all the money I work for. So I am fine with it. No RVUs. what flavor are those anyway? can I eat those?


anyway if that GI doctor owned the ASC, I am sure he would be find it easier. end of the day all physicians should strive to be independent and affiliated with the hospital systems. never ever be their employee unless they can give you a sweet deal like some hospitalist jobs are.

Exactly. If he owned the ASC hed be making 4-5k per scope, do 15 of those a day and he could retire in a year.

 

[dozitgetchahi]

Below is a post from the "physician community" in Facebook. Moderator can delete if not permitted.

"My husband are both medicine sub -specialists. He is GI and his call is very stressful and he covers a huge part of the state we live in. Obviously, he knew that his job would entail night and weekend call before he entered the speciality and seemed ok with it. Now he is three years out of fellowship and when he is on call our house is a cloud of toxicity and rage. Every time he gets called for a consult he is rude, defensive and ugly. The rest of the family walks on eggshells when he gets called in bc he is bound to throw a temper tantrum. I have talked to him many times about burnout, he often says to himself “I hate my life, I hate my job”. I often point out that consultants are calling for help and direction and that patients need him to (often) help save their lives. This does not seem to help. He is obviously burnt out and miserable and I don’t know what to do. We have a 6 month old baby that I don’t want to be around this. I don’t know what to do."


I think I am ok with my simple life. I am home today by 2:00 pm after watching an entire soccer game at work. I got some rest and now I am drinking cognac while watching the Super Bowl.

Exactly.

I knew I wanted a “bankers hours specialty” early on. I would probably be as miserable as the person in the story if I was being called in at all hours of the night all the time.

The answer for the guy in the story is simple: you need to switch jobs. Find a GI job with minimal call and/or outpatient only hours (they exist) or bail out of GI and do hospitalist work etc

 

[Calizboosted76]

Okay @Splenda88 I get it. I should be a hospitalist.

 

[Splenda88]

Exactly.

I knew I wanted a “bankers hours specialty” early on. I would probably be as miserable as the person in the story if I was being called in at all hours of the night all the time.

The answer for the guy in the story is simple: you need to switch jobs. Find a GI job with minimal call and/or outpatient only hours (they exist) or bail out of GI and do hospitalist work etc

I can sympathize with this individual. A nurse paging (or texting) me 3 times in a span of 1 hr usually irritates me.. Can't imagine getting calls at night for trivial things

While GI calls might be crazy, my guess is things are probably worse for general card because of high sensitive troponin.

 

[NewYorkDoctors]

I can sympathize with this individual. A nurse paging (or texting) me 3 times in span of 1 hr usually irritate me.. Can't imagine getting calls at night for trivial things

While GI calls might be crazy, my guess is things are probably worse for general card because of high sensitive troponin.

as well as the patients who "feel palpitations ai yi yi" or the patients who purchased a self monitoring rhythm strip like the Kardia devices and email / call the cardiologist with every single normal sinus rhythm but i have palpitations complaints throughout the day and night.

if I have PCP patients who do this and email me nonstop with every single NSR rhythm strip "but i feel palpitations..." i can imagine cardiologists feel this at a greater frequency

 

[Splenda88]

Okay @Splenda88 I get it. I should be a hospitalist.

By the way, my job is probably average to below average in term of flexibility when it comes to hospital medicine.

A few of my former co-residents have jobs that are ridiculously flexible. These guys would show up to work at 8:00 am and out 12 noon-2pm every single day.

 

[Calizboosted76]

By the way, my job is probably average to below average in term of flexibility when it comes to hospital medicine.

A few of my former co-residents have jobs that are ridiculously flexible. These guys would show up to work at 8:00 am and out 12 noon-2pm every single day.

That’s how it is when I rotated through inpatient IM. Wildly flexible makes it seem like you could go two full time job with there schedules and still have quality time for family.

 

[Splenda88]

That’s how it is when I rotated through inpatient IM. Wildly flexible makes it seem like you could go two full time job with there schedules and still have quality time for family.

I don't know about another FT job, but one can definitely have another PT job while having a 'normal' life.

The people who are saying they can't see themselves being a hospitalist are mostly saying it because of prestige...

 

[TooMuchResearch]

I can sympathize with this individual. A nurse paging (or texting) me 3 times in a span of 1 hr usually irritates me.. Can't imagine getting calls at night for trivial things

While GI calls might be crazy, my guess is things are probably worse for general card because of high sensitive troponin.

We had high sensitivity troponin put upon us. We (ED) don't like them and the cardiologists continue to tell us they're not sure what to do with the results, but no one seems to be interested in getting rid of them. They've increased ED length of stay on discharged patients and haven't seemed to decrease chest pain admission rates.

 

[Meerkatology]

We had high sensitivity troponin put upon us. We (ED) don't like them and the cardiologists continue to tell us they're not sure what to do with the results, but no one seems to be interested in getting rid of them. They've increased ED length of stay on discharged patients and haven't seemed to decrease chest pain admission rates.

isnt HS trop just on a different scale, like u just divide it by 3000 or whatever to get the old trop number. does it affect clinical practice?
went from negative being <0.01 to <30 or whatever. im not aware, is HS trop cutoff more sensitive or something, do u end up with many more positive trop with hs?

 

[TennCare]

Below is a post from the "physician community" in Facebook. Moderator can delete if not permitted.

"My husband are both medicine sub -specialists. He is GI and his call is very stressful and he covers a huge part of the state we live in. Obviously, he knew that his job would entail night and weekend call before he entered the speciality and seemed ok with it. Now he is three years out of fellowship and when he is on call our house is a cloud of toxicity and rage. Every time he gets called for a consult he is rude, defensive and ugly. The rest of the family walks on eggshells when he gets called in bc he is bound to throw a temper tantrum. I have talked to him many times about burnout, he often says to himself “I hate my life, I hate my job”. I often point out that consultants are calling for help and direction and that patients need him to (often) help save their lives. This does not seem to help. He is obviously burnt out and miserable and I don’t know what to do. We have a 6 month old baby that I don’t want to be around this. I don’t know what to do."


I think I am ok with my simple life. I am home today by 2:00 pm after watching an entire soccer game at work. I got some rest and now I am drinking cognac while watching the Super Bowl.

I love this. Was it Man U Villa?

 

[timpview]

isnt HS trop just on a different scale, like u just divide it by 3000 or whatever to get the old trop number. does it affect clinical practice?
went from negative being <0.01 to <30 or whatever. im not aware, is HS trop cutoff more sensitive or something, do u end up with many more positive trop with hs?

More sensitive.

But yea they’re a pain. It just freaks everyone out not just because more are “elevated” often due to non acute coronary syndrome causes, but also because those that are elevated are scarier to people..

A Trop of 0.2 sounds pretty harmless. But his HS Trop of 200 freaks everyone out.

 

[Meerkatology]

More sensitive.

But yea they’re a pain. It just freaks everyone out not just because more are “elevated” often due to non acute coronary syndrome causes, but also because those that are elevated are scarier to people..

A Trop of 0.2 sounds pretty harmless. But his HS Trop of 200 freaks everyone out.

hmm well i just think of the number as how many times the upper limit of its normal

and i can't imagine cardiologist not know what to do with them? i mean they are cardiologists

 

[greatnt249]

hmm well i just think of the number as how many times the upper limit of its normal

and i can't imagine cardiologist not know what to do with them? i mean they are cardiologists

Think of it as analogous to what the rheumatologist thinks every time a borderline elevated rheumatoid factor or ANA consult floats their way. We don't "not know" what to do with them; we struggle knowing what to do with them when that's the only piece of information that is "abnormal" (or abnormal in a myriad of other significant lab abnormalities) about the patient with an extremely vague presentation, especially when the ordering providers seem to have this sense that ACS is the only conceivable reason that the troponin could be abnormal.

There's a reason it's not called "high-specificity troponin."

 

[Meerkatology]

Think of it as analogous to what the rheumatologist thinks every time a borderline elevated rheumatoid factor or ANA consult floats their way. We don't "not know" what to do with them; we struggle knowing what to do with them when that's the only piece of information that is "abnormal" (or abnormal in a myriad of other significant lab abnormalities) about the patient with an extremely vague presentation, especially when the ordering providers seem to have this sense that ACS is the only conceivable reason that the troponin could be abnormal.

There's a reason it's not called "high-specificity troponin."

you have a point there.

as a hospitalist i am on the receiving end of ERs ordering a troponin on everyone and their mother who accompanied them to the ER to be seen for their cough. it is certainly ordered in way more patients than indicated.

 

[rokshana]

Below is a post from the "physician community" in Facebook. Moderator can delete if not permitted.

"My husband are both medicine sub -specialists. He is GI and his call is very stressful and he covers a huge part of the state we live in. Obviously, he knew that his job would entail night and weekend call before he entered the speciality and seemed ok with it. Now he is three years out of fellowship and when he is on call our house is a cloud of toxicity and rage. Every time he gets called for a consult he is rude, defensive and ugly. The rest of the family walks on eggshells when he gets called in bc he is bound to throw a temper tantrum. I have talked to him many times about burnout, he often says to himself “I hate my life, I hate my job”. I often point out that consultants are calling for help and direction and that patients need him to (often) help save their lives. This does not seem to help. He is obviously burnt out and miserable and I don’t know what to do. We have a 6 month old baby that I don’t want to be around this. I don’t know what to do."


I think I am ok with my simple life. I am home today by 2:00 pm after watching an entire soccer game at work. I got some rest and now I am drinking cognac while watching the Super Bowl.

Saw that post and frankly that spouse has other issues…my brother is GI, and his job is pretty chill…he’s usually home by 5p every day and weekend call 1:6 weeks…

 

[Splenda88]

I love this. Was it Man U Villa?

Yes.

I was happy with the outcome. Villa had better chances but you gotta convert them.

 

[Splenda88]

Saw that post and frankly that spouse has other issues…my brother is GI, and his job is pretty chill…he’s usually home by 5p every day and weekend call 1:6 weeks…

Yeah... GI does not seem to be as bad as general card.

 

[anonperson]

Below is a post from the "physician community" in Facebook. Moderator can delete if not permitted.

"My husband are both medicine sub -specialists. He is GI and his call is very stressful and he covers a huge part of the state we live in. Obviously, he knew that his job would entail night and weekend call before he entered the speciality and seemed ok with it. Now he is three years out of fellowship and when he is on call our house is a cloud of toxicity and rage. Every time he gets called for a consult he is rude, defensive and ugly. The rest of the family walks on eggshells when he gets called in bc he is bound to throw a temper tantrum. I have talked to him many times about burnout, he often says to himself “I hate my life, I hate my job”. I often point out that consultants are calling for help and direction and that patients need him to (often) help save their lives. This does not seem to help. He is obviously burnt out and miserable and I don’t know what to do. We have a 6 month old baby that I don’t want to be around this. I don’t know what to do."


I think I am ok with my simple life. I am home today by 2:00 pm after watching an entire soccer game at work. I got some rest and now I am drinking cognac while watching the Super Bowl.

Guy sounds like a doofus.

He's probably getting paid pretty well since he's covering the large portion of whatever state he's in. Probably the sticks but he signed up for it.

If he hates his job and life so much, just change jobs. It's not hard. He's GI. Jobs are plentiful and they're always extremely well paid.

All the GI docs I know seemed pretty happy.

I had an employed job that required 5 in house 24 hour calls a month. It was physically tiring and then admin wanted to cut pay. I gave notice and had a new job lined up (no call ) so I could start working with no interruption.

My quality of life is 100% improved.

If the job sucks, just find a new one. As a physician, most specialties have this luxury.

 

[NotAProgDirector]

More sensitive.

But yea they’re a pain. It just freaks everyone out not just because more are “elevated” often due to non acute coronary syndrome causes, but also because those that are elevated are scarier to people..

A Trop of 0.2 sounds pretty harmless. But his HS Trop of 200 freaks everyone out.

As mentioned here, HS troponins are 1000x the units of regular troponins. So an old 0.2 is the same as 200.

The key when you switch is to develop a protocol to use them. In the ED, we draw two of them 1 hour apart. If there is less than an increase of 7 between the two, regardless of the absolute level, it is theoretically negative for ACS. But you have to believe!

 

[Nocturnist]

As mentioned here, HS troponins are 1000x the units of regular troponins. So an old 0.2 is the same as 200.

The key when you switch is to develop a protocol to use them. In the ED, we draw two of them 1 hour apart. If there is less than an increase of 7 between the two, regardless of the absolute level, it is theoretically negative for ACS. But you have to believe!

Yup. We have a 1 hour and 3 hour delta protocol at my shop (I think it's 5 and 7, respectively).

Despite which, half the time the ED still gets a third one even when they're negative just to be extra sure- then admits for provocative testing when the third one's negative too.

 

[timpview]

hmm well i just think of the number as how many times the upper limit of its normal

and i can't imagine cardiologist not know what to do with them? i mean they are cardiologists

Has nothing to do with the cardiologist knowing what to do with them… it’s the fact that the ER doc or the NP hospitalist at 2 in the morning doesn’t know what to do with it

 

[Meerkatology]

it’s the fact that the ER doc or the NP hospitalist at 2 in the morning doesn’t know what to do with it

sure they do, they order it on everyone and call you for admission when its not normal

 

[goldsummer]

1 - The type of personalities that go to those are the ones that enjoy a bit of showing off their success. I bet a few ppl that you were jealous of went home feeling the same cause they didnt achieve what so and so did.
2 - For me, I dont wanna be known, I dont want clout, I just wanna do a good job and help as many as i can while setting up my life the way i want in the meant time. Its ok not to shoot for the most prestigious thing
3- no youre not

 

[DarkBluMage]

1 - The type of personalities that go to those are the ones that enjoy a bit of showing off their success. I bet a few ppl that you were jealous of went home feeling the same cause they didnt achieve what so and so did.
2 - For me, I dont wanna be known, I dont want clout, I just wanna do a good job and help as many as i can while setting up my life the way i want in the meant time. Its ok not to shoot for the most prestigious thing
3- no youre not

So people aren’t allowed to catch up with old classmates? Lmbo seems like people can’t even reminisce these days without getting labeled as a show off.

 

[Elixir6]

Below is a post from the "physician community" in Facebook. Moderator can delete if not permitted.

"My husband are both medicine sub -specialists. He is GI and his call is very stressful and he covers a huge part of the state we live in. Obviously, he knew that his job would entail night and weekend call before he entered the speciality and seemed ok with it. Now he is three years out of fellowship and when he is on call our house is a cloud of toxicity and rage. Every time he gets called for a consult he is rude, defensive and ugly. The rest of the family walks on eggshells when he gets called in bc he is bound to throw a temper tantrum. I have talked to him many times about burnout, he often says to himself “I hate my life, I hate my job”. I often point out that consultants are calling for help and direction and that patients need him to (often) help save their lives. This does not seem to help. He is obviously burnt out and miserable and I don’t know what to do. We have a 6 month old baby that I don’t want to be around this. I don’t know what to do."


I think I am ok with my simple life. I am home today by 2:00 pm after watching an entire soccer game at work. I got some rest and now I am drinking cognac while watching the Super Bowl.

This sounds unusual. GI call is really not that bad. As a fellow I would cover 3 hospitals at night, (one over 1000s beds, 400 beds and another was a VA, so like 80 beds) and I didn't get called this much. Many annoying calls from outpatients about bowel prep. You rarely have to go in as most things can wait till the morning. I'm not sure how many hospitals this guy is covering, but it can't be that big because you can't practice GI and have to drive 1 hr one way to one hospital and then 2 hours the other way to another hospital, so this must be a small North East state like Vermont.

The posters approach is absolutely correct in terms of framing things that the consulting physician and patient need your help. Just give them a plan and scope in AM 8 or 9/10 times. This physician is seriously burnt out.

 

[glorifiedresident]

i don't know if he's burnt out or just a loser. maybe both.

 

[HemeOncHopeful19]

Saw that post and frankly that spouse has other issues…my brother is GI, and his job is pretty chill…he’s usually home by 5p every day and weekend call 1:6 weeks…

I was gonna post similarly I have a family member in GI and they rarely go in overnight... that person's spouse took a crap job

Edit: Just like the GI fellow above lol they joke that they could reduce their call volume in half by changing the answering machine message to say "yes. yes you do need to finish the whole prep, if you have any other questions please remain on the line..."

 

[TexasMed22]

I was gonna post similarly I have a family member in GI and they rarely go in overnight... that person's spouse took a crap job

Edit: Just like the GI fellow above lol they joke that they could reduce their call volume in half by changing the answering machine message to say "yes. yes you do need to finish the whole prep, if you have any other questions please remain on the line..."

Out of curiosity, how many times a year do you think they have to physically go in overnight?

 

[HemeOncHopeful19]

Out of curiosity, how many times a year do you think they have to physically go in overnight?

10 or less, community hospital couple hundred beds, make high 6 figures but they do work hard for it on a day to day basis. Will ask next time I talk to them and edit this post if I remember

 

[Splenda88]

Heme onc is the way to go these days.

These guys/gals in our cancer center are making 600-800k/yr working 4 1/2 days a week. We (hospitalist) admit their almost dead patients and most of the times, we are the ones initiating goal of care discussion with them and their families.

 

[TexasMed22]

Heme onc is the way to go these days.

These guys/gals in our cancer center are making 600-800k/yr working 4 1/2 days a week. We (hospitalist) admit their almost dead patients and most of the times, we are the ones initiating goal of care discussion with them and their families.

yea onc is one of the best gigs in medicine right now, slightly behind derm and rads

 

[sloh]

Heme onc is the way to go these days.

These guys/gals in our cancer center are making 600-800k/yr working 4 1/2 days a week. We (hospitalist) admit their almost dead patients and most of the times, we are the ones initiating goal of care discussion with them and their families.

The gravy train may not last forever.

How ‘White Bagging’ Affects Patients, Physicians and 340B Funding

Having specialty pharmacies fill prescriptions may lower costs, but critics of the practice see safety issues and other drawbacks.

www.managedhealthcareexecutive.com

“White bagging can also affect provider reimbursement, and some critics say much of the criticism from providers is, to some degree, animated by the fact that white bagging means they lose out on the markup that comes with buy-and-bill. Lausten says that with white bagging, “we’re managing the order and dose, making sure it’s drawn up correctly in USP (United States Pharmacopoeial Convention) sterile product rooms, which are expensive to operate and maintain. We get no reimbursement for drawing them up.”

The white bagging also affects the 340B program, Lausten says. The federal 340B program means providers can get drugs at discounted prices if a substantial fraction of their patients have low incomes, are uninsured, or both. “Those (drug) savings pay for unfunded programs we provide at our hospital,” he says. “When the drug comes through the specialty pharmacy, those 340B savings go away.” But 340B program has plenty of critics, who say it has been distorted by health systems for financial gain.”

 

[TexasMed22]

The gravy train may not last forever.

How ‘White Bagging’ Affects Patients, Physicians and 340B Funding

Having specialty pharmacies fill prescriptions may lower costs, but critics of the practice see safety issues and other drawbacks.

www.managedhealthcareexecutive.com

“White bagging can also affect provider reimbursement, and some critics say much of the criticism from providers is, to some degree, animated by the fact that white bagging means they lose out on the markup that comes with buy-and-bill. Lausten says that with white bagging, “we’re managing the order and dose, making sure it’s drawn up correctly in USP (United States Pharmacopoeial Convention) sterile product rooms, which are expensive to operate and maintain. We get no reimbursement for drawing them up.”

The white bagging also affects the 340B program, Lausten says. The federal 340B program means providers can get drugs at discounted prices if a substantial fraction of their patients have low incomes, are uninsured, or both. “Those (drug) savings pay for unfunded programs we provide at our hospital,” he says. “When the drug comes through the specialty pharmacy, those 340B savings go away.” But 340B program has plenty of critics, who say it has been distorted by health systems for financial gain.”

ASCO is a strong lobby
"Since 2021, legislation to address payer-mandated white bagging has been introduced in 32 states. Arkansas and Louisiana became the first states to pass laws prohibiting the use of payer-mandated white bagging policies in 2021. Since then, North Dakota, Tennessee, and Vermont have enacted laws banning payer-mandated white bagging, while Minnesota, Texas, and Virginia have added guardrails around the practice.
In 2023, bills that would address payer-mandated white bagging were introduced in 23 states. Legislation in 10 of these states remains active and will carry over into the 2024 legislative session"

State of Play: White Bagging

Over the next few months, we'll be sharing summaries of state action on the Association for Clinical Oncology’s (ASCO) key advocacy priorities. This article examines recent action on white bagging.

society.asco.org

 

[sloh]

ASCO is a strong lobby
"Since 2021, legislation to address payer-mandated white bagging has been introduced in 32 states. Arkansas and Louisiana became the first states to pass laws prohibiting the use of payer-mandated white bagging policies in 2021. Since then, North Dakota, Tennessee, and Vermont have enacted laws banning payer-mandated white bagging, while Minnesota, Texas, and Virginia have added guardrails around the practice.
In 2023, bills that would address payer-mandated white bagging were introduced in 23 states. Legislation in 10 of these states remains active and will carry over into the 2024 legislative session"

State of Play: White Bagging

Over the next few months, we'll be sharing summaries of state action on the Association for Clinical Oncology’s (ASCO) key advocacy priorities. This article examines recent action on white bagging.

society.asco.org

Good share. Thanks!

 

[Splenda88]

The gravy train may not last forever.

How ‘White Bagging’ Affects Patients, Physicians and 340B Funding

Having specialty pharmacies fill prescriptions may lower costs, but critics of the practice see safety issues and other drawbacks.

www.managedhealthcareexecutive.com

“White bagging can also affect provider reimbursement, and some critics say much of the criticism from providers is, to some degree, animated by the fact that white bagging means they lose out on the markup that comes with buy-and-bill. Lausten says that with white bagging, “we’re managing the order and dose, making sure it’s drawn up correctly in USP (United States Pharmacopoeial Convention) sterile product rooms, which are expensive to operate and maintain. We get no reimbursement for drawing them up.”

The white bagging also affects the 340B program, Lausten says. The federal 340B program means providers can get drugs at discounted prices if a substantial fraction of their patients have low incomes, are uninsured, or both. “Those (drug) savings pay for unfunded programs we provide at our hospital,” he says. “When the drug comes through the specialty pharmacy, those 340B savings go away.” But 340B program has plenty of critics, who say it has been distorted by health systems for financial gain.”

I wonder how much of their salary is from "selling" chemo?

 

[sloh]

I wonder how much of their salary is from "selling" chemo?

Without chemo, the specialty would mostly be E&M. Think outpatient IM/FM income.

 

[aafisahar]

The better the test for troponins are, the worse of a test it is.

 

[aafisahar]

Without chemo, the specialty would mostly be E&M. Think outpatient IM/FM income.

meh not really, the hospital would subsidize their salary because cancer is a money maker.

Remember the entire hospital system is a loss leader (on their books) for the joints, cancer, and hearts. If that's all they could do, then that's what they would.

 

[HemeOncHopeful19]

Without chemo, the specialty would mostly be E&M. Think outpatient IM/FM income.

We probably order more outpatient imaging than any other IM specialty