Menu

Dilaudidopenia

Home Dilaudidopenia Replies Created

Avatar
Message me
You have new message! Dilaudidopenia

Forum Replies Created

  • Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 202
    Joined: 05/22/2016

    Just the other day I found out that a nurse that I know from our hospital is getting an NP degree.  She has about 10 years experience already.  I asked her if it has been hard securing rotations and she told me that it was not for her because of her experience she could draw on the physicians that worked with her on the floors.  She did say without prompting that her classmates with no experience are having a much more difficult time.

    Click to expand…

    No self respecting physician should be allowing any of these people to rotate with them.

    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 202
    Joined: 05/22/2016

    The Preferred is a great card.  Very versatile.  My wife and I both got one in residency.  When I became an attending, I then got a Reserve.  Been raking in the points through locums.

    in reply to: Which credit card? #237303 Reply
    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 202
    Joined: 05/22/2016

    I would not sign for 3 years.

    You are not “guaranteeing” anything by signing for 3 yrs, except being beholden to paying back a signing bonus. PE = CMG = 90 day without cause termination clause which can often be accelerated.  So you can sign for a billion dollars an hour and then they put you on notice and say you can either now work for ten dollars an hour or you can get lost.

    Signing for 140 / mo over 120 / mo just gives them more power.  Sign for less, let them have holes in the schedule, which you can then fill for negotiated shift bonuses.

    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 202
    Joined: 05/22/2016

    You can’t do the study because it would be unethical to randomize patients to NP (and really any midlevel, PA too) care.

    I’m telling you.  I’ll get a midlevel presentation in the ED.  They will stop presenting after the physical exam, the way an MS1 first learning how to do an H&P would:

    “OK. So what’s your differential?”

    “Maybe like a virus or pneumonia?”

    “What about x,y,z?” –> This is followed by a blank stare, as one or more of x,y, or z they haven’t even heard of.

    “Ok so what do you want to do?”

    “I dunno. Labs I guess.”

    “…..ok, I’ll go see the patient.”

    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 202
    Joined: 05/22/2016

    The “right way” is medical school and a residency.

    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 202
    Joined: 05/22/2016

    And then when they come to the ED they need another 6 months of orientation lolllllllll

    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 202
    Joined: 05/22/2016

    Similar thing happened to me.

    I learned about hip replacements online.  Read the textbook chapter and everything.  But then no orthopedic surgeon would precept me!  What gives?!?!?!!?

    There’s this prevailing attitude that Primary Care is somehow less important, easier, of lower value, or doesn’t require expertise.  As anecdotally observed from all the nonsense “referrals” I get in the ED from midlevels in this setting (outpatient office, UC, ECF), this is certainly not the case.

    In the past 2 weeks:

    -Laceration sent from UC.  “Too complicated for us to fix.”  Was a starter lac that I would have an MS3 repair.

    -Sent to ED for INR check for resolved epistaxis

    -Sent to ED from ECF for sub-acute humerus fx in a hospice patient

    They add no value, probably increase costs with all their testing and “referrals,” and are outright dangerous.

    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 202
    Joined: 05/22/2016

    @panscan – yes that, and perhaps even scarier, in states where independent practice has not taken root, if they are in a busy ED, there is really no time to supervise them, making them effectively independent.

    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 202
    Joined: 05/22/2016

    NP education is garbage.  I see the results of it in the ED everyday.  It’s downright dangerous.  They don’t “assist” me in any form of the word.  They create more work for me.  Somehow a PGY-4 EM resident has to be under the preview of an attending and make 65k but an NP fresh out can be quasi independent and make upwards of 100k.  Bull.

    Physicians as a whole should be refusing these “opportunities” globally.  If they can’t complete their rotations, they can’t practice.

    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 202
    Joined: 05/22/2016

    Yup.  Been going on for a long time.  They and the insurance industry have killed private practice EM.

    in reply to: Private equity is taking over derm #233443 Reply
    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 202
    Joined: 05/22/2016
    People need to stop giving advice of “don’t do PSLF” based on their personal politics and whining. You’re giving people bad advice. 

    Click to expand…

    What if the decision to not go PSLF is based on finances? For many of the jobs (yes, not all) that qualify for PSLF, you’re likely looking at a significant pay cut over what you could make in private practice. It doesn’t make sense to take a significant pay cut with the hopes of having your loans paid off when you could make more and pay them off on your own and still come out much further ahead. That’s not bad advice. Besides, we don’t know if telling people to take PSLF is good or bad advice until they get to the end.

    Click to expand…

    Well yes, of course.  Why would you be an academic orthopod and make 350K when you can be PP and make 600K+ (if you’re not interested in academics) just to get 200K of loans forgiven after 10 years?

    It’s just that for my wife, her earning potential is low either way (not sure PP in her field really even exists) that continuing to go for PSLF isn’t that hard of a decision.

    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 202
    Joined: 05/22/2016

    My state (PA) is issuing REAL IDs.  I went through to process of getting pre-approved so that when they started issuing them, you could opt in for it.  Well, a couple of weeks ago, they started.  Only they want to charge for it too.  60 bucks or something.  Nahhhhhh, I’ll just bring my passport.

    in reply to: flying with drivers license/public service message #233426 Reply
    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 202
    Joined: 05/22/2016
    Splash Refinancing Bonus
    It is extremely unlikely that even if the government changes the program that those already making qualifying payments will not be grandfathered in.  Whenever the federal govt has made changes to the loan system, this has been the case. 

    Click to expand…

    A lot of people say this but what information backs this up?  Can you cite an example of where something like this was grandfathered in.

    I mean it makes sense and it would be nice if it was but I would not hang my hat on it.

     

    Look at the people who bought 2-3 million dollar homes who cannot write off their full interest payments now.

    Homes with large property taxes that are capped at 10K

    You can argue that this only affects the rich but I would say if they change PSLF it will likely affect the “rich”

    Click to expand…

    PSLF with side fund makes the most sense – not blindly paying off the loan because of what MIGHT happen in the future.

    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 202
    Joined: 05/22/2016

    People need to stop giving advice of “don’t do PSLF” based on their personal politics and whining.  You’re giving people bad advice.

    The reason you see all these click bait articles about not being approved for PSLF is that people can’t be bothered to follow directions.  You have to transfer your loans to FedLoan, be in a qualifying repayment plan (standard, IBR, PAYE, RePAYE), not be in deferment, be in a qualifying job working 30 hrs / week or more, not consolidate (as it resets the payment counter), not make extra payments on top of your scheduled payments (as that messes up the next month’s payment qualifying), stay in qualifying job until PSLF is processed.

    It’s a good idea to have your employer certify your employment status yearly so that you can accurately track your payments.

    It is extremely unlikely that even if the government changes the program that those already making qualifying payments will not be grandfathered in.  Whenever the federal govt has made changes to the loan system, this has been the case.  This is not me making up information – this is the expert opinion of a WCI recommended loan consultant who has former congressional lobbying experience and has contacts on capitol hill. Every 2-3 yrs there’s a big rabblerabblerabble about PSLF and then it dies down.

    OP, you need to think about the relative financial opportunities of 501c3 vs non 501c3.  If you’re not overly interested in academics and you are in a well paying specialty, you may consider refinancing and paying off.  Beware that just because you might be a hospital employee, the hospital may NOT be 501c3. Or, you might work at a 501c3 hospital, but really you’re an employee of a massive multi specialty physician group that is not 501c3.  Personally, I wouldn’t want to limit myself to only 501c3 opportunities, especially if I knew I wasn’t gung ho on the academic thing.

    In our situation:

    -I am non-academic EM, making good money, I refinanced x 2 (once in residency and once when I signed my contract – RePAYE wasn’t a thing then) and then rapidly paid off < 2 yrs after residency graduation

    -My wife is in a low paying specialty and will always be tied to academics.  Therefore, we have kept her in the federal system, going for PSLF.

    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 202
    Joined: 05/22/2016

    In the ER, I have rules:

    -No IV benadryl

    -No outpatient narcotics without a diagnosis

    -Maximum 3 day supply (5mg PO oxycodone x 10ish)

Notifications Mark all as read  |  Clear