Vik Khamare

@BubbaBooey @DrewSav I never used the word malpractice. I just said that he didn’t have the appropriate work up when he started having a cough and getting a “shot” of steroids is not appropriate for treatment

@KhamareVik @DrewSav So Vik, since you know all of the details leading up to Kyle’s death and the malpractice this PA committed, let’s hear it

When I go to a doctor's office I should be able to a board certified physician, not a physician's assistant or a nurse practitioner. They may be good people that are good at their jobs but they do not have the robust education and training of an MD.

@NextOwlsCoach @doc_rudman I doubt it. But a normal lung exam would not exclude pneumonia. He needed vitals including temp, BP, and pulse ox. Also, needed a CXR with worsening cough at the very least.

@KhamareVik @doc_rudman No chest xray... did a physician listen to his lungs??

I think I would request an autopsy. Sepsis is definitely in the differential, but to progress this rapidly in a healthy young athlete? Unless he was immunocompromised, on prednisone, or suffering from some chronic medical problems, sepsis really wouldn’t be at the top of my list.

@AndrewS051314 @doc_rudman That’s entirely possibly as well including post viral superimposed bacterial pneumonia. From what I read and not actually treating him, it seems by the day 911 was called he was in ARDS by that point from some infection.

@KhamareVik @doc_rudman Not entirely true. Pneumonia is caused by an infectious agent. It can lead to sepsis and ARDS. Bacterial PNA can set in after a viral URI which is what sounds like happened here

@LangmanVince He wasn’t seeing a doctor it was a physician assistant

This is horrible! How did his doctors miss this?

@RepGregMurphy I did my residency at ECU in internal medicine and now I am a Hospitalist. I work nowhere near full time. The question is you want me to work full time and quit at 48 or work my current schedule well into my 60s? I chose longevity and spending time with my family over burnout!

Unless our Medical Schools do a better job of screening admission candidates, we won’t have any Doctors. If you don’t want to practice FULL time for at least 20-25 years, pick another profession.

@jcbmd @RepGregMurphy Exactly! He was a practicing urologist where I did my IM residency at ECU. He left practice for politics ands now preaches this garbage!

@RepGregMurphy Says the guy who left clinical practice to be a politician and helps perpetuate the broken system. Instead of criticizing admissions why don’t you pass meaningful legislation that helps fix some of the issues driving physicians out of medicine?

@matt_gottshall @bryanhasling I am a member at a club near Charlotte, NC. Two physician couple. I play a ton and we have two kids.Next year is a 20k assessment for course improvements. We live way below our means so it’s not a concern financially. Many members leaving. Live below your means!

@bryanhasling That’s a wrap! I’d love to hear peoples thoughts on this, and happy to answer any and all questions - I’m an open book! The beauty of X, I’m just here to share info and educate and do my best to help out someone else who may face this decision in their own life 🙌🏼

As a golf fanatic, I knew I always wanted to join a country club, which I did in 2022 But the perception of a club always bothered me, as did the lack of cost transparency Inspired by a convo with my friend @bryanhasling , let’s talk about all of the things you need to know:

@FrommyFromm @SpineNeuro So true! I had a CT surgeon consult IR for a chest tube removal for a patient on my service…watching season 1 of the Pitt and nothing like reality.

@SpineNeuro 1. Obesity 2. Many IM/ED docs no longer do procedures (at tertiary centers at least, very dependent on where they practice). Central lines, PICCs, paras, thoras, chest tubes, bone marrow bx are almost exclusively done by rads/IR nowadays. Unless it’s The Pitt lol

@LaGrecca333 I am a physician. When I trained, I did 30 hour call during general surgery. I lived at the hospital. Now, residents gets breaks at night. They miss out on critical learning. I am thankful for the training I have received because helped me developed all the skills necessary today

I had a conversation with a doctor that trains residents. She said she doesn’t know how the medical system can stay the same because these young people don’t want to put in the long hours necessary. She said that doctors expect “work life balance” and that wasn’t a concept when she was up and coming. I wonder if other doctors are noticing the same issue?

@lukecombs Daytona 499!

Held back 5 copies of my new album The Way I Am on vinyl and CD to autograph and give away to y’all! Like and repost this photo, then comment your favorite song from the album and I’ll pick random winners!

@WCInvestor This is a great quote. I think I learned after 10 years of practice, that money is a tool and that time is precious with our two boys. Dual physician couple, all student debt paid and now just work PRN as a Hospitalist. I enjoy work so much more now and I can spend time with kids

"You don't want 'He spent 40 hours a week in the OR' on your tombstone. You don't want that on your tombstone. You have to ask yourself, what are my kids going to say about me at my eulogy, or are they even going to want to speak at my eulogy?" - Bill Bernstein Have you learned that money is not the most important thing in your life? How did or will you know when what you have is enough?

@DrBruggeman As a Hospitalist, noncompetes make no sense. Inpatient doctors do not bring their patients with them to different area hospitals. The only way I have figured out how to make this profession work for me, is to work on a PRN basis and not have a noncompete.

Telling physicians to stay independent while leaving in place every structural barrier to independence is not a policy. It is a wish. Right now a physician who wants to leave a hospital employment arrangement faces a gauntlet that has nothing to do with clinical competence or patient demand. It has to do with contracts, regulations, and a practice environment that has been systematically engineered to make independence difficult. Start with noncompetes. Most employed physicians signed agreements prohibiting practice within a defined radius for one to three years after departure. The practical effect is not inconvenience. It is forced displacement from the patient panel they built, the referral relationships they developed, and the community where their family lives. A surgeon who trained in San Antonio and then joined a hospital system should be able to leave that system and continue practicing in San Antonio. The Texas legislature thankfully advanced noncompete reform that would restore meaningful mobility to the physician workforce for new contracts (old contracts are grandfathered). That bill should become a national model. Federal preemption of physician noncompetes should be a companion provision to any site-neutral reform package. Then there is the question of where to practice. An independent proceduralist needs access to an ASC or hospital to supplement income (recall that ASCs and hospitals see inflationary increases but doctors don’t), but in roughly 35 states, Certificate of Need laws require regulatory approval before a new facility can be licensed. This process is slow, expensive, and routinely captured by incumbent hospital systems that sit on the review committees. CON laws were sold as cost-containment tools. They function as incumbent protection statutes. The FTC and DOJ have said so explicitly. CON repeal is not peripheral to this conversation. It is a prerequisite. Then there is Stark. The physician self-referral prohibition makes investment in ASCs and ancillary facilities legally complex for physicians who participate in Medicare fee-for-service. If we want physicians to own the alternative care settings that benefit from site-neutral payment reform, we need a safe harbor that makes that investment clean. A targeted fix: any service line subjected to and surviving prior authorization review should be exempt from Stark self-referral scrutiny. The insurer has already adjudicated medical necessity. The self-referral concern is analytically weaker when clinical appropriateness has been externally confirmed. This is the pathway for unlocking competition in the hospital market. None of these reforms alone solves the problem. Together with site-neutral payment equalization they begin to construct an environment where independence is not just theoretically possible but financially rational. That is the standard we should be measuring against: not whether a physician can technically go independent, but whether doing so makes as much sense as taking a buyout offer. Right now it does not. Every one of these barriers is a reason why. Tomorrow I will show you exactly what happens when we fix the hospital side of this equation without fixing the rest. It already happened in Oregon.

@HeathVeuleman As an American born and trained physician, this is absolutely true. It’s a hard market right now doing Locums/PRN Hospitalist work. Most employed spots are filled by H1b/foreign physicians that accept cheaper salaries and worse treatment. They are cheaper but not better!

Just a reminder to physicians: J1 and H1B doctors cost less. That’s it. There’s nothing to moralize. And how are employed physicians paid? On averages collected by the MGMA. Every time a new J1 and H1B is hired, your future earnings are diluted. Vaya con dios!

@WCInvestor I am about 10 years out of residency. I have only owned two cars my whole life, both Hondas. At this point though, it’s time to enjoy myself a bit and get what I want, likely a BMW. Both wife (PM&R) and myself (IM) student loans are done and we have saved plenty thanks to WCI!

The real key to keeping costs down when it comes to a car is keeping it a long time, whether bought brand new, close to new, or a decade old. Buy new for 20 years. Buy 4 years old and keep for 16 years. Buy 10 years old and keep for 10 years. All probably works out pretty similarly. It matters most early on. Hopefully within 10 years WCIers can just drive whatever they want and not have to care . How long do you keep your cars? How do you prefer to buy them?

@thegarybrecka I have the flu, so homemade chicken soup with bone broth and gluten free pasta

Drop a picture of your lunch... curious what you guys are having👇🏻👇🏻

@coookwithchris I just put in my first order with Dutch meadow farms. They just built a butcher shop walking distance to my house that only sells grain fed beef so I will take my business elsewhere. Thanks for the recommendation!

GM When the farm has traditional Amish baked goods you take advantage🤤 Coffee cake made with real butter and organic flour

@KornFerryTour @BahamasKFTour Let’s go Taylor Dickson! Rooting for you from Gastonia, NC and Gaston Country Club!

Taylor DIckson from the bunker! 🔥 His lead is now three (!) with two holes to play @BahamasKFTour. 📺 Golf Channel

@KornFerryTour @BahamasKFTour @PGATOUR Let’s go Taylor! Rooting for you!

Co-leader Taylor Dickson made THREE eagles in the second round @BahamasKFTour at Atlantis Paradise Island 😮🏝️ Dickson lost his @PGATOUR card last fall but is fired up to chase a return ⬇️