Ajay Choudhri

@ajgunnmd @UKYRadiology @cityofbhamal @uabmedicine @UKYMedicine @thefibroidlady @CheriCanon @UABRadiology @uab_ir @SIO_Central @SIRspecialists @danbrownIO Amazing. Congratulations. I've enjoyed watching you carry the flag. Continue the great work

My family and I are excited about this next chapter in our journey working with a dedicated and talented group of individuals @UKYRadiology! Thank you for trusting me with this role! Without a doubt, we will miss friends in @cityofbhamal & @uabmedicine! tinyurl.com/3p5s8946

@BelannF @TheFIREorg Merit is great but if it's close, the nod goes to the majority. We get it

The main criteria should be merit when hiring people regardless of the color of their skin - gender - etc and no one can mandate Patriotism - a person is either Patriotic or they are not - It helps when a person wants what's best for the country which means they are Patriotic. Being a "Patriot" is not a bad thing if you love America.

The University of California system announced today it will remove “stand-alone diversity statements” from its hiring process to avoid evaluating applicants on issues outside their expertise. As FIRE has long argued, requiring applicants to pledge allegiance to a specific interpretation of DEI too often becomes an ideological litmus test, stifling debate on inherently politicized concepts. This is an important shift in practice for much of the UC system. Its most prestigious campus, Berkeley, used diversity statements to eliminate over 670 candidates from a pool of 893 in 2018. While faculty should not have to endorse DEI, it would be equally bad to mandate they affirm values like “patriotism” or “capitalism,” or to demonstrate opposition to DEI initiatives. Focusing on candidate qualifications over ideological commitments is a massive step forward for one of America’s premier public university systems. Universities are charged with fostering the free exchange of ideas and producing knowledge. For that to happen, faculty must be judged on their academic merit, not on whether they align with popular sentiment. FIRE will continue to monitor academic freedom and the rights of faculty members to express themselves across all of the system's campuses.

@Doc_Freedom1776 @residencyreview That option has flown the coop. You can't compete with integrated hospital systems or big PE firm backed practices. Independent practice accepting insurance is a crap shoot.

@residencyreview Admins are fucking self-serving dirtbags. Young doctors, do whatever you can to not be employed by a hospital system or a private practice group owned by private equity! They are all fucking leeches that will abuse you. BE YOUR OWN BOSS!!

Hospital admin will be making $1 million a year, pushing back compensation on primary care physicians working 50 hours a week, making $220,000/year.

@DocDifferently I don't know a single private neurosurgeon who doesn't get compensated for call. Once that precedent is set, it should be for all practitioners. It can be baked into your total comp as long as it's itemized in the contract. Assigning value to it is the first step

A doctor at my hospital took 24 hr call for free for years because he “didn’t need the money.” Now the hospital (w/ billion dollar annual revenue) now refuses to pay doctors for 24 hr call. Working for free/cheap hurts all of us. Be in it for the money.

@shycollie @drdanchoi Any doctor that drops out part time male or female is a drag on the workforce. Train more physicians. My experience of 25 years of hiring and managing is that current graduates want to work less. So if that's the case, train more physicians

@drdanchoi We’re wasting scarce valuable resources training women to be doctors so that they can either drop out of the workforce or go strictly part time

@shycollie @drdanchoi There is alot of dissatisfaction and grumbling amongst male surgeons and physicians about that. I think we have to really plan the workforce better if we want to balance the needs of male and female physicians. Increase the absolute number of physicians so both can have the same

@TippetRing @drdanchoi Too long for X for sure but your points are well taken. Our diagnostic radiology practice is now shift based and you just clock in and clock out. I call it "clocking for the man" just an endless hamster wheel of cases 24/7 Rads don't deal with HUGE chart and admin burden

@drdanchoi Not sure what specialities (a few) have better hours than a rad onc to be honest. I don't see any radiation oncologists in the building on any weekend. As long as there are other options especially in pharmoncology where there is a gold rush. there will be brain drain.

@LexLiberty123 @DutchRojas Ok so your statement actually concerns screening colonscopy for cancer. Colonoscopy has many other indications and is used for many other disease states

@11Blade @DutchRojas drmcdougall.com/misc/2010nl/au… gold standard to refuse

𝐇𝐨𝐰 𝐥𝐨𝐧𝐠 𝐰𝐢𝐥𝐥 𝐭𝐡𝐞 𝐠𝐫𝐢𝐟𝐭 𝐜𝐨𝐧𝐭𝐢𝐧𝐮𝐞? Colonoscopy with Biopsy (CPT 45380) •HOPD Facility Fee: $1,607 •ASC Facility Fee: $930 •Overpayment Per Procedure: $677 •Annual Medicare Overpayment: $4.47 billion Colonoscopies are routine. They don’t require hospital-level care. Yet the government shovels nearly $4.5 billion in unnecessary payments to health systems every year. @CMSgov why not use ColonoscopyAssist.com like I do for our patients? I get a better price than you in the entire of the United States. Stop the steal! 🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸 𝐌𝐞𝐝𝐢𝐜𝐚𝐫𝐞 𝐩𝐚𝐲𝐬 𝐡𝐞𝐚𝐥𝐭𝐡 𝐬𝐲𝐬𝐭𝐞𝐦𝐬 𝐦𝐨𝐫𝐞 𝐭𝐡𝐚𝐧 𝐀𝐒𝐂𝐬 𝐟𝐨𝐫 𝐭𝐡𝐞 𝐬𝐚𝐦𝐞 𝐩𝐫𝐨𝐜𝐞𝐝𝐮𝐫𝐞 𝐜𝐨𝐬𝐭𝐢𝐧𝐠 𝐭𝐚𝐱𝐩𝐚𝐲𝐞𝐫𝐬 𝐛𝐢𝐥𝐥𝐢𝐨𝐧𝐬.

@Third_i_Prophet @DutchRojas I am not disagreeing with your inefficiency argument, ASC are tasked with doing one thing and doing it well. They save the system money You want to move those surgeries out of HOPD, find a way for the hospitals to make money on being a hospital otherwise they close. That's it.

@11Blade @DutchRojas You ignored the main point that hospitals are half as efficient as ASCs, and hospitals' incentive structure is why they are inefficient and costly. No hospital should be paid higher rates for any procedure that is approved for ASC.

If the American People Only Knew… Same Surgery, Same Surgeon, Medicare Pays 2x More To Health Systems for No Reason The government claims to care about efficiency. Yet Medicare pays significantly more when a procedure is performed in a health system, owned outpatient department instead of an ASC, even though the care is the same, the outcomes are the same, and the only difference is who profits. @waysandmeans @GOPDoctors @doge

@abl57 @DutchRojas All new ASC in NJ require hospital co-owner ship. Hospital wins some revenue, doctor owners get better rates. Healthcare system loses by paying higher rates. Hospital co-opted a cheaper healthcare delivery method

@DutchRojas 1. 95% of the time I agree w ur takes. Re ASC’s the majority of them are now 51-49’hosp/MD partnerships so the entity can bill using “hospital” rates. In those cases the ASC’s are not cheaper. Ur info is always good so I’m just trying to add helpful context.

𝐌𝐞𝐝𝐢𝐜𝐚𝐫𝐞 𝐩𝐚𝐲𝐬 𝐡𝐞𝐚𝐥𝐭𝐡 𝐬𝐲𝐬𝐭𝐞𝐦𝐬 𝐦𝐨𝐫𝐞 𝐭𝐡𝐚𝐧 𝐀𝐒𝐂𝐬 𝐟𝐨𝐫 𝐭𝐡𝐞 𝐬𝐚𝐦𝐞 𝐩𝐫𝐨𝐜𝐞𝐝𝐮𝐫𝐞 𝐜𝐨𝐬𝐭𝐢𝐧𝐠 𝐭𝐚𝐱𝐩𝐚𝐲𝐞𝐫𝐬 𝐛𝐢𝐥𝐥𝐢𝐨𝐧𝐬. Cataract Surgery (CPT 66984) •HOPD Facility Fee: $3,235 •ASC Facility Fee: $1,917 •Overpayment Per Surgery: $1,318 •Annual Medicare Overpayment: $5.27 billion Cataract surgery is the single most common outpatient procedure in the U.S., with over 4 million performed annually. Medicare would save over $5 billion per year simply by applying the ASC rate to all cataract surgeries. #healthcare @cmsgov @doge @waysandmeans @GOPDoctors

@vrabecj @DutchRojas The OBS argument is even stronger. OBS gets even less than ASC which is less than HOPD In NJ, you cannot get a certificate for OBS any more unless co-owned with a hospital. @DutchRojas keep up the good work and add OBS reimbursement in your analysis

@DutchRojas I don't think very many cataract surgeries are done at hospital. You are assuming 4 million done at hospital, thus saving 5 billion? But the majority are not. Am I wrong here?

@LexLiberty123 @DutchRojas I'm intrigued with your statement. Seems very absolute "noone should get a colonoscopy" - what does it mean? Other alternatives? Blood tests? Cologuard? Virtual colonoscopy with CT? What about Crohn's dz, colitis? Please elaborate.

@DutchRojas No one should get a colonoscopy. Risk benefit non existent. Other solutions with less risk to make yourself a cancer business customer

@DutchRojas @Third_i_Prophet This all is in the lens of low risk, high profit easier surgery. You have to raise DRG, ICU and inpatient care reimbursement for hospitals to provide difficult care like chronic disease, ICU care so they can wean themselves off surgery. Operating an ASC is easier than a hospital

@Third_i_Prophet 🔥🔥🔥🔥🔥🔥🔥

@KprasMD @shamitsdesai The discrepancy between OBL, ASC and hospital outpatient rates is insane. Kudos to those who make OBL reimbursement work.

@11Blade @shamitsdesai Yeah. Honestly reimbursement goes down every year, costs go up. Your ability to earn a return that outpaces inflation or some risk free rate is challenged. Investing in this has to be out of interest/passion. If things don’t change - it’ll be hard to find good ir work.

Epidemic for IR who feel they were sold a bag of false goods and leaving field in droves. History of head in the sand and panels of self interested people w/o a clue discussing PP issues. Lack of pragmatic forward thinking, akin to PAD fate- the easy road won’t win here.

@KprasMD @shamitsdesai Good IR work requires a build it and they will come mentality, with the easy easy DR escape valve, we will only have pockets of strength

@11Blade @shamitsdesai Doesn’t need to be right? Honestly I think for most people DR beats bad IR work, and good IR work/clinic beats both right? Just need to be flexible and make the future/job that you want.

@jeffreystirlin5 @shamitsdesai Very high for IR'S over 50 who lost the PAD turf wars and tired of the dumpster tricks at the hospital. Most of my residency class who were IR's (5) all read DR now instead of IR except for me. I still read DR as my BATNA

@shamitsdesai What is the attrition rate like in IR ?

@KprasMD @shamitsdesai We have a collision here. There are folks that want 100% IR jobs, then there are obl folks who want to DR, then there the OG's who did DR and IR. Identity? I don't believe there will be one in a decade unless AI destroys DR.

@shamitsdesai I recommend part time tele and working in an Obl for people who want to do fulfilling IR cases.

@SRajesh_IR Nice work. Support like friends is always helpful.

Parallel guidewire anchoring technique for cannulating a blocked TIPS stent.