Keith

a TSA officer will visually inspect your lobster

Disagree that MD shortage is due to lack of training spots. Burned out physicians trying to leave clinical practice is truly at an all time high. Key is to look at why attending physicians after all those grueling years of training (med school, residency, fellowship) are trying to exit clinical practice after reaching “the promised land.” You’ve finally made it! All those late nights as a pre-med, sacrifices made away from friends and family in residency, tens of thousands of patient care hours spent to hone your craft and expertise. Finally getting to practice clinically as an attending is supposed to be the light at the end of tunnel. Another issue is that most graduating physicians are choosing to become employed instead of entering private practice (not by choice necessarily. most physician jobs available today are employed positions post ACA driven massive healthcare consolidation and death of private practice) which imo can be exacerbating MD shortage. Incentives of employed physicians vs private practice physicians can be very different. Employed physicians are evaluated on RVU/productivity KPIs and work hours usually designed to be more predictable, similar to shift work. Patient referrals “belong” to a health system and physicians are more so representing a corporate entity’s brand. Patients referrals as an employed physician are basically guaranteed as health systems have bought up most PCP practices in a community. But in private practice, referrals are never guaranteed and much harder to come by. Your reputation, availability, ability to take care of patients, and affability determine your survival in private practice. You’re more incentivized to be on 24/7 and you never say no to a ER consult or to any referring physician who wants to send you a patient. “Thank you for the interesting consult!” always. When 80% of physicians used to be in private practice working for themselves and building up their own brand & reputation in a community, the impact of any MD shortage in past may have been more blunted. To see young attendings trying to leave clinical medicine is one of many symptoms of a sick and broken healthcare system that has been overrun by corporate medicine. Medicine is a profession with physicians at their best and patients benefiting most when physicians maintain their autonomy. Restoring physician independence through restoration of physician access to capital and physician viability will do much to cure MD shortage.

I am no longer injecting my son's blood. I've upgraded to something else: total plasma exchange. Steps: 1. Take out all blood from body 2. Separate plasma from blood 3. Replace plasma with 5% albumin & IVIG Here's my bag of plasma. Who wants it? 🧵