Alexander Smith

@Cephii1 @jeremykauffman Unclear why people think IQ is a big thing in medicine. Yes there is a requisite level of intelligence required, and the smarter the better, but most of what is required is work ethic and persistence. Most with IQ>120 would probably be bored stiff within a week of med school.

2 year undergrad, 1 year high school, 1 year med school could be removed. Med studentts are paying (not getting paid). Residents get paid enough to barely survive and not enough to have kids. Median doctor salary is still weak now when you count the hours and 3-6 years of below min wage. No improvement with inflation in 20 years. Corporations and insurance took most of the margins. Most humans lack the IQ and intellectual curiosity and personality and work ethic to do the job well. 120 is not a “common” IQ. People fantasize about what the human IQ pool really looks like. In many jobs, people are not bothered 24/7 and in places people don’t want to live. Many docs work 50-75% of weekends and holidays. Suicide rates are also high. At current pay rates, talented people are considering other options.

A 120 IQ teenager could be trained to be a doctor in under 4 years, but the median doctor salary is $227,000 This is the real conversation about healthcare we should be having

Welcome home everyone!

@bjcohenmd @EiranGorodeski @AHajduczok @HFSA @ACCinTouch @AHAScience Must be in the conversation about integrated training pathways. Institutions are looking for advanced imagers. Why should we not read CMR for cardiomyopathy, PET for post-transplant CAV screening, PET for sarcoid, TEE for TEER, etc? These are our patients, let’s own their care.

@EiranGorodeski @AHajduczok @HFSA @ACCinTouch @AHAScience Is the career path too limiting in scope? Perhaps add multi modality imaging to the mix?

More bad news for Advanced Heart Failure and Transplant Cardiology #NRMP match: Of 75 programs participating in match n=21 (28%) filled. Of 127 positions offered, n=61 (48%) filled. There will only be n=61 AHFTC trainees in the US in 2025-2026 academic year. #ShrinkingWorkforce

@adriansarli @ebtapper Chaotic good.

@ebtapper I just order a prn for a systolic sufficiently high that it wont be used.

Little discussed fact: Choosing to not “treat” high blood pressure makes you look like a wacko to the nurses and CRNAs/anesthesiologists in the real world where I practice It requires lots of time, explanation, being present, and even documentation of your rationale

@OGdukeneurosurg Probably massive DVT based on swelling. Analgesia. IV heparin bolus. Doppler to confirm. Fourth order is case request for thrombectomy.

First three orders in chart after seeing this patient?

@EM_RESUS ECPR available? TNK successful?

Here's a video I made breaking down this Cardiac Arrest Echo that was recorded during CPR #FOAMed

@buckeye_sanjay Are we still heroes if we are snarling?

@DaytonaDon3 @nascarman_rr Nah, MX5 cup is pretty much full contact. Watch some old races next time you’re bored, it’s a great series.

@nascarman_rr Do they penalize contact like the bumping/touching at the 15/16 second mark?

Sports car racing needs more ovals, Miatas at Martinsville is sick youtube.com/live/SiRwqZTnj…

@pulmtoilet CI? Lactate clear? Filling pressures normal? If not under-supported/ underdiuresed and truly just SVR problem, would be reticent to use prolonged nipride if there is AKI. Either cardene or ramp loading of PO hydralazine starting at 10q8h, can escalate at each dose if tolerated

@AWSmith__ already in; pressures found during RHC which led to IABP placement

Cards crit friends-->Sky high SVR from cardiogenic shock in chronic HF and worsening renal failure , trying to augment afterload to get pt to advanced therapies and assuage renal failure, etc do you reach for: Cardene, nitro, or nipride? My limited gestalt is to reach for cardene for these situations but am told guidelines rec nipride. I looked up the guidelines, and they do not in fact rec nipride dont try to riz me up with some mumbo jumbo either @AZviman @CardioNerds @goodmra1 @malvarez_md @FSotoMD @icu_ct @IM_Crit_ @ThinkingCC @MaxHockstein @LeivaOrly @AndrewHigginsMD @nickmmark @CritCareTime @RyanTedfordMD

@buckeye_sanjay When you figure it out let me know and I’ll do it for IV diltiazem.

@atflorio Looks great.

@ShariqShamimMD Considering the other visible work on the heart, I can nearly assure an elevated heart score. Whose ED is sending this home without any testing?

We are told “In era of high sensitivity troponin, unstable angina doesn’t exist and its safe to discharge from ER if HS troponin negative.”Here is an anatomy in patient with “atypical CP with negative HS troponin X3”.

@Mike_M_Klotz WV looks a bit like Road Atlanta innit?

QOTD: the outline of which state would make the best racecourse?

Now accepting applications for the #Match2025! Join our team in Cardiology, Advanced Heart Failure & Transplant, or Interventional Cardiology. We offer a collaborative learning environment under the guidance of highly experienced physicians. Apply in #ERAS now! #CardioTwitter 🫀

@poison_com @slucy @ogbonigwe1 Where are you sourcing that there is a decline in interest? I’m telling you there isn’t, and that competitiveness is continuously rising.

My partner is sending me slides from orientation at her new job and it's all like - No more than 80 hours per week! - 4 days guaranteed off per month! - Shifts are capped at 28 hours!

@poison_com @slucy @ogbonigwe1 Re: quality, some are probably not qualified for what they applied for. Many are. Are some smart people choosing not to be a doctor? Sure. More than before? Idk, maybe. But there is plenty of demand and unless something changed, the average GPA and MCAT score rises year on year.

@poison_com @slucy @ogbonigwe1 Thousands of medical school applicants don’t get in each year. Hundreds of doctors graduating from US med schools who apply but don’t get a residency each year. Thousands of US citizens in non-US med schools+foreign medical graduates who apply but don’t get a residency each year.

@jl35wilsonMD SCAI E plus sounds like EDP is through the roof. Offload with VAD first. There isn’t a line for door to balloon metrics on death certificates.

Traffic jam in Le Mans...😅 #LeMans24 #WEC