Mohamed Gaffoor

Now as a "mid-career" peds intensivist I find myself often repeating the same axioms/directives to my residents. I put these 16 rules up on the unit. For my #PedsICU friends, what rules do you use? some rules wouldn't fit in 1 tweet. #MedTwitter A🧵

@CloseToHomeMD Welcome back! I'm barely on here. I hope you are doing well. Still at the same job from when I started after finishing at @PICUFellows_UMD at @MaimoHealth I've been the division chief for the last 15 years. I hope you are doing well!

Well, it has been FOREVER since I posted here on X. Actually, I have never posted on X, only on Twitter. So, had to go through all sorts of trouble to prove I was actually me. Yup. It's me. Hope all my buds are doing well. Would love to hear from you.

Physician conversion factors: 2000: $36.6173 2003: $36.7856 2006: $37.8975 2009: $36.0666 2012: $34.0376 2015: $35.7547 2018: $35.9996 2021: $34.8931 2024: $32.7442 UHC stock up 8,556% Insurance premiums up 342% Inflation up 86% Physician pay down 10% We should keep cutting physician pay so families have more money in their pockets through reduced costs and reduced premiums based on the last 25 years of experience.

@mommimaya @safelydoingless Once you're intubated all bets are off and I tell parents to expect a 1-2 week duration of intubation. I'm more referring to the mildly to moderately critically ill kid who gets admitted on HFNC and ends up later on BiPAP/NIV who is super worried. #PedsICU

@PICUMD @safelydoingless I find the opposite. Families who arrive to the PICU having been told the illness will peak on days 3-5 are panicked when their child is still intubated on day 7 or if they worsen on day 6. Even if it were to provide reassurance it would be false reassurance for inpatients.

Bronchiolitis season has started! If you haven't read @safelydoingless article on day of illness and continue to teach and tell families day of illness matters please read. publications.aap.org/pediatrics/art…

@emily_fri Trained in the early aughts. No attendings in house for residency or fellowship. Now as attending we do leave overnight. I think you just learn to titrate how much responsibility you give residents and do a lot of contingency planning before you leave.

I did ICU as a resident with no in house attending or fellow. Attending on call at home, procedural support from other services. As a fellow I had in house attending, usually pretty hands off except tubes/bronchs. Now I supervise residents overnight in house and can’t imagine

@WCInvestor @doximity Absolutely true. Aside from PICU, NICU, Cards peds subs paid less than generalists. PICU/NICU/Cards all make less than our adult counterparts. Big reason for this is medicaid vs. medicare. jamanetwork.com/journals/jamap…

According to the @Doximity 2023 Physician Compensation Report, the lowest earning specialties tend to be in pediatrics & primary care. Pediatric subspecialties may be the only fields that often make less than their parent specialty.  Have you found this to be true? Why?

@MSharifpourMD @PVlisides For #PedsICU you'd need a yellow 24g in there.

The perfect t-shirt does not exis… Courtesy of @PVlisides

@WendyHassonMD @DrTanyaAltmann While I think cash only concierge critical care is not feasible, it would be nice to see greater proliferation of private practice critical care models like the adults have.

@DrTanyaAltmann Unfortunately the number of cash only concierge PICUS in the states is zero. But very happy for my medicine colleagues who found a path to autonomy!

I can think of no other field besides medicine where you are expected to provide a service despite being verbally abused for 12 hrs by the family receiving that service…. And then be expected to come back again in another 12. #MedTwitter

@ThePICULife I'm "senior" but still get told no. Unfortunately from a pure cost/benefit ratio anything for kids tends to have high costs. I feel like there's a challenge to working in non FS CH environments. It would be curious to know what the ask is?

Balanced take looking back at #covid19 from #PedsICU docs

@ThePICULife Not PICU specific but uptodate is probably the easiest way to get CME.

@VForPeds Graduated in 2006 from @UMMC we had 24 hour call.

Hi #PedsICU ! Does your fellowship program use night float or 24hr call?

R31/32/38: albuterol/steroids/HTS. I feel like for MOST bronchiolitics using these modalities do not help. However, for a select subgroup they may be useful. This is where we earn our keep as doctors in knowing when to use them. (9/9)

R25: Whenever possible (i.e. if I can find a mask that fits) I'm using full face BiPAP vs a nasal prong interface. It just works better and does not leak. (8/9)

I think the key to guidelines is to recognize when you do not need to follow them. #PedsICU Here's my take on some of the specific recs. A 🧵 (1/9): R1: really dependent on the level of your floor monitoring. Cont SpO2? CR monitoring?