Alex

Sure if they can do what I do intubate under distress, lines, chest tubes, resucítate a dead patient, biopsy a lung mass, hold a patient’s family hand, like I said, please bring him to me and I will hire him on the spot But until you have a robot that can do all that well, you are really just talking a bunch of bullshit right? Because I’m sure also that one day we will be able to teleport and ask Scotty to beam me up, but right now even the robot that’s supposed to vacuum my floor can work for shit, so until then and until they find who’s going to figure out who the patient are going to be able to sue when things go wrong, well, you’re just gonna have to keep your mouth shut

@AlexAlexicumd @DrSuneelDhand intensive care may be one of the last to go- but go it will

The medical specialties most likely to be replaced by AI next few years: 1. Primary care doctors 2. Radiologists 3. Dermatologists 4. Psychiatrists 5. Ophthalmologists Least likely: Surgeons (although it’s still on the horizon) Did I miss any?

She doesn’t care about any of it, all she posts is to get “clicks” and followers, it’s just easier to make money that way, She knows all those arguments, she speaks to a group of resented people, for lack of a better word, so they follow her, all that acting out during COVID, and in Methodist Hospital, to get herself in the MAGA clique I guess, now she got her self in legal trouble and needs money for the fight, it has nothing to do with reasoning or reality Just like in Germany in 1940, this group is at fault, just a way to capitalize on people’s problems and anger

I really feel for Mary. Must be exhausting going through ~6,800 residency programs, stalking their websites and social media, zooming into intern photos, and playing “spot the nationality” just to build a narrative. That’s not research, that’s selective outrage with WiFi. And calling it “IMGs stealing spots”? That’s not data, that’s fiction dressed up as analysis.

She doesn’t care about any of it, all she posts is to get “clicks” and followers, it’s just easier to make money that way, She knows all those arguments, she speaks to a group of resented people, for lack of a better word, so they follow her, all that acting out during COVID, and in Methodist Hospital, to get herself in the MAGA clique I guess, now she got her self in legal trouble and needs money for the fight, it has nothing to do with reasoning or reality Just like in Germany in 1940, this group is at fault, just a way to capitalize on people’s problems and anger

This is not rocket science. None of these are the “most” competitive, and US MDs can’t fill half of all offered spots. Why are you still yapping? You went to medical school? Someone lied to you about the competitive specialties

Accelerometers are only useful in speed of movement not muscle effort, so exercises like abs, weights, yoga, pilates etc don’t move the wearable “needle” if they combine HR measurements in their interpretation algorithms may be more useful. Now I think the principle that fast short intervals moving is better than slow continuous so far holds, however combining or using, alternative methods of exercise, like yoga, Tai Chi, Pilates, calisthenics, needs to be compared with aerobics

Intensity of exercise vs volume of physical activity made a difference for lower risks of 8 diseases and all-cause mortality among 96,000 @uk_biobank participants, especially noted for immune-mediated (IMID). VPA-vigorous physical activity academic.oup.com/eurheartj/adva…

apple.news/A03mwj42CSgGST… America’s population has traditionally grown because there were more births each year than deaths. But that trend has ended in many places, due to the long decline in the fertility rate, an aging population and death rates that haven’t returned to prepandemic levels. “The new data show that two-thirds of the nation’s 3,100 counties—representing 28% of the U.S. population—had more deaths than births. As recently as 2019, fewer than half of counties—representing just 19% of the population—saw more funerals than baby showers.

@bryan_johnson One day down, another 360,000 days to go for another 100 years

Morning routine finished. Every single day. Today: > light in eyes + hair cap > breath work > protein + sups > strength 30 min > rucking 30 min > stretching 15 min > dry sauna > breakfast My favorite part of the day. It never get's old.

Sorry here Saint Vincent Hospital's Internal Medicine Residency Program in Worcester, Massachusetts (a community teaching hospital affiliated with UMass Chan Medical School) has a very high proportion of **International Medical Graduates (IMGs)**—often 90%+ in recent classes, with the specific incoming group highlighted in the post being overwhelmingly from Indian medical schools.19 ### Why So Few (or No) U.S. MD/DO Graduates? Several structural and practical factors explain this pattern, based on how the U.S. residency Match works and program characteristics: 1. **Internal Medicine Is Less Competitive for U.S. Seniors** U.S. MD and DO graduates overwhelmingly prefer higher-paying, lifestyle-oriented, or procedurally focused specialties (e.g., dermatology, orthopedics, radiology, ophthalmology, cardiology subspecialties). Internal medicine—especially at community (non-university flagship) programs—often ranks lower in their preferences. Nationally, IMGs fill a large share of categorical Internal Medicine positions (around 30-45% in recent Matches, with non-U.S. IMGs alone taking over 30% in some years). Many U.S. grads who do enter IM aim for competitive fellowships afterward or university-based programs with stronger research/reputation signals.55 2. **Program Type and Location** Saint Vincent is a **community-based program** rather than a top-tier academic one. These programs historically rely more on IMGs because: - They may offer heavier service loads, less research emphasis, or locations perceived as less desirable by many U.S. grads (Worcester is a mid-sized city, not Boston or a major coastal hub). - "IMG-friendly" is a known category for such programs—data trackers classify it as high-IMG (51-100%). University programs tend to fill almost entirely with U.S. MD/DO grads from strong home institutions.18 - Once a program develops a reputation for training many IMGs, it can create a self-reinforcing cycle: U.S. applicants may self-select away, assuming it's not their target. 3. **Application and Ranking Dynamics** The NRMP Match is applicant-driven but program-controlled in ranking. Programs receive thousands of applications and rank candidates based on: - USMLE Step scores (Step 2 CK especially post-pass/fail Step 1), letters of recommendation, U.S. clinical experience (USCE), and perceived "fit." - Visa sponsorship: The program explicitly sponsors J-1 visas and requires ECFMG certification for internationals. Many IMGs from India (which produces tens of thousands of doctors annually) apply aggressively to U.S. programs, often with solid Step scores from a highly competitive domestic selection process in India. - U.S. grads with lower Step scores, fewer connections, or no strong "signals" (e.g., away rotations at the program) may get ranked lower or not at all. There is no legal requirement to prioritize U.S. grads beyond the fact that they generally match at much higher rates overall (~93-99% for U.S. seniors vs. ~56-73% for IMGs depending on citizenship). Programs cannot easily "fill with Americans" if those applicants do not rank the program highly (or at all). If U.S. applicants prefer other spots, the program fills from its rank list—which can skew heavily IMG if that's who interviewed strongl

Here’s an internal medicine program in Massachusetts putting India first. 25 of 26 of residents are from foreign countries. 22 of 25 are from India. India has a severe physician shortage - why are they sending their talent to America?

@MaryBowdenMD Here’s Groks analysis

Not really, healthcare in small towns has been bought by private equity companies and hospitals is a local monopoly, if you’re a specialist and don’t work for them, they will put you out of business, make it impossible to get hospital privileges, block referrals, and if you work for them and want to leave them and stay on your own, well, they won’t let you. It’s easier in larger cities because they offer a larger number of alternatives of both employers and ability to join or start private practice groups

Every doctor knows we could double our income by going out to rural areas. We joke about it, talk about quitting the grind of the city to go be rich in rural Missouri or Wisconsin. No one actually does it

@Michaeldudufudu I just find it curious that you describe your self as being religious, believing in God, I imagine Jesus as well, you radiate so much love, humanity and compassion! What can I say

How do Indian immigrants make my life better as an American?

@robbystarbuck x.com/alexalexicumd/…

This is an untenable ratio. American students must be prioritized for medical residencies or we’re going to have a real problem in the future.

@jdcmedlock x.com/alexalexicumd/…

Between medicaid cuts and restricting the immigrant doctors who actually serve rural areas, I've never seen a political movement so laser focused on killing their most loyal voters.

Match Day 2026: Is Family Medicine Half-Full or Half-Empty? medscape.com/viewarticle/ma…

But I don’t understand the issue here, is it their race?, place of birth?, the medical school they graduated from? What makes this such a scandalous problem exactly, so if US citizens graduate from a foreign country that’s ok? What about a foreign born person graduating from an US medical school? Or a Pakistani descent born in the US and graduates from an US medical school? To your point of view what is acceptable and is not, who has the moral right in your eyes to provide medical care to US citizens? Please explain so there’s accurate communication

This is an example of what wrong in our world today. A doctor shares factual information about a disturbing trend in our country. Another doctor-with hurt feelings-cried “racist” because there is no other argument. We will never correct the sad state of our world until facts > feelings!

@vandamme1297708 @MaryBowdenMD The education system here in the US is different than South America and Europe

Here’s an internal medicine residency program in Texas where all 13 residents are foreigners. Six of the thirteen are from Pakistan.

@vandamme1297708 @MaryBowdenMD Everyone in my school, and that’s the standard curriculum

You’re talking out of ignorance, the need for 8 years in the US is because the US high school education is so poor, basically elementary school, compared to most other countries, they catch up during college, high schools elsewhere give you math, physics, chemistry, statistics, biology, and the degree they get is bachelor degrees, that’s why in the US some private schools provide international baccalaureate degrees, so US med schools are basically 5 years, the other 3 years of pre med are just catch up, that’s why when IMG take the US medical exams, USMLA, FLEX, etc they’re so easy for IMG’s to pass. Furthermore most of primary care providers in the USA and some specialty care is provided by nurse practitioners and physicians assistants, LOL! with very little education and NO residency or fellowship, a joke, where’s your bleeding heart for that? And by ANY standard that you use to measure the quality of medical care in the US, well, that’s is just embarrassing! Compared with the rest of the world, just look it up, the US just spends more money and pay more money in healthcare like in anything else, that what attracts foreign medical doctors, this is driven by the pharmaceutical companies, insurance companies, hospitals, and their lobbying, the US does something for a million dollars that everywhere else is done for a thousand and for no better outcome, no improvement in life expectancy or quality of life and worse access to healthcare The US healthcare is broken and you blame it on IMG’s that sounds like Germany in the 1940’s

@AlexAlexicumd @MaryBowdenMD Foreign countries are minting MD schools. However U.S. accreditation limits new openings. While U.S. students grind through 8 years of post-high school study plus years of research and service, most international peers enter medical school at 18 and graduate in just 5 years.