Sarah Hecht, MD

@CanesDavid @OpenAI Big upgrade! When do we get surgical animations?

Inage generation got a big upgrade from @OpenAI Finally handles anatomy better (not quite perfect yet) Try your own and share them in comments.

Big loss for the pediatric transplant world - an exceptional surgeon and teacher, and a mensch. feldmanmortuary.com/tribute/detail…

This is massively misleading to bundle physician fees and hospital fees together… Literally, physicians are paid “professional fees” and hospitals are paid “facility fees”, the latter of which is many multiples what the physicians are paid. Case in point: A 99285, which is the highest complexity ER visit, professional fee (to the physician) is 4.00 workRVUs, or $134 by the current Medicare conversion factor ($33.88/RVU). The Medicare conversion factor has been cut year over year. In contrast, the facility fee to the hospital is on average $1800, and has increased 531% over the past 17 years… We are literally fractions of the cost.

1-8 are about working less 9-10 are financial 11 and 12 suggest it’s a problem with the doctor Love your feed but I think this misses the point. Working less isn’t supported by data - there are specialties with more hours and low burnout and vice versa Financial distress- yes. Point well taken. But you’re missing 80% of what causes burnout in the first place Best research comes out of the Stanford model of professional fulfillment. 20% is resilience, 80% is about the culture and workplace efficiency at your job If I made a list, it would focus on finding the right fit in the place you work, fixing wrinkles in systems and processes to get your work done. ✅

"I regret that I have but one NO vote to give to my county" The county just passed its FY 2025 budget by a 4-1 vote. As the lone NO vote, cast with love for my community, belief in the potential of our County, and effort to move our County into action, here are my talking points: I want all of my supporters and constituents to know that I am still pushing urgent action at Multnomah County. I am still standing up any way I can, for real people and real progress. After all I’ve been saying and doing the past few years, it should be no surprise that I begin today by observing that Multnomah County is badly flailing without a plan. The budget approved by this board is proof that once again we have failed to make the fundamental choices necessary to drive change or to measure the results of our ever-increasing investments. Given the absence of an actual plan, the budget should be the closest thing we have to a clear mapping of priorities. But far from establishing focus, this budget obscures it. It hides investments of hundreds of millions of dollars beneath a bunch of mediocre rhetoric and buzzwords. It contains hundreds of pages, each describing another program that doesn’t tie into a larger purpose, plan or vision.  So-called “performance indicators” do not correlate in any way with actual performance, so we can’t learn over time whether we’re investing in a way that tells us if what we’re doing works, or how we might achieve better results. There is no data to tell us where we’ve been or to shine a light on where we are going, so next year we won’t know if we got anywhere.  Of course that assumes anyone in county leadership is responsible for following up to see if we did or didn’t do what we said. Each year it’s like a brand new game of charades, and the public - especially those who are most vulnerable, marginalized and disenfranchised- lose. The real tragedy is that our actions – or rather, inactions –  impact real human beings every day. PLANS are supposed to come before budgets. And no credible plan has ever been presented to this board by county leadership. For any of the core work of the county in mental health, addictions, corrections, public health, or housing.  Politically, this is a game. Morally, it’s shameful. I’ve realized that business at the county is not about smart plans or policies. In fact, it feels like county leadership is more dedicated to avoiding blame than making a difference.  This is the final budget in my 8 years of service. I’m leaving with a degree of sadness and outrage I never would have thought possible when I first ran for office. Because when I started I naively thought failure would be a matter of not having enough funding to reach our goals and help those most vulnerable. But the truth is much more pernicious. I’ve realized that we’re swimming - or more accurately, drowning - in money. What we’re lacking are a vision, goals, and a plan to get there. We have more money In Multnomah County than we can effectively waste, and given the history of waste at the county, that’s a hell of an indictment.  What’s worse are the excuses I hear. The wallowing in a mixture of arrogance and self-pity as we tell ourselves that we of course can’t do better until we solve the social issues of our times. That it’s other jurisdictions’ fault. That the problems have taken decades to develop and so we need infinite time to respond. That we somehow STILL don’t have enough money.  That’s all bullshit. If we actually planned in advance what we should do with hundreds of millions of dollars per year dedicated to street homelessness - we could have transformed this community, and saved countless lives already. The people who sent us here, and the people struggling on the street right now ALL deserve so much better!  What I see in the sad excuse for a budget are the missed opportunities that should plague ALL of us as we go to bed tonight with a roof over our heads. If this budget is not a prism from which we can see progress, it should at least be a mirror through which we see our failure. I want to say directly to all the service providers and volunteers out there doing the front line work every day - this budget represents the failure of the county as a government, not the failure of the people the county employs. There are an incredible number of people out there today as I speak dedicated to helping others and they are amazing human beings. They are being failed by their leadership who has yet to be leadership-coached enough to understand that we have an obligation to outline and implement a coherent plan, not to try to obscure accountability and hide failure. After eight years, in the end I can only say this: I regret only that I have but one NO vote to give to my county.

It's Official. The agenda for the May 2024 AMA CPT® Editorial Panel Meeting includes a proposal to establish CPT codes for prior authorization + appeal of wrongful denials. ama-assn.org/system/files/c… #PriorAuthCPT #WrongfulDenialAppealCPT 1/15

Oregon HB 4130 not only limits corporate ownership in medical practices, it outlaws non-compete and non-disparagement clauses from employment contracts, a favorite tactic among private equity firms

Wonderful Resident Ski Day at Mt. Hood Meadows @OHSUurology @OHSUUroRes The weather tested our grit, but fun times were had. Thanks to all our residents for their hard work!!

In basket coverage on vacation reduces burnout @JAMA_current jamanetwork.com/journals/jaman…

Dr. Brian Duty, a surgeon and urologist at Oregon Health & Science University, announced his candidacy today for the Democratic nomination in House District 33. wweek.com/news/2024/01/1…

If government were full of Brian Dutys we’d be in good shape - pragmatic, supremely competent, honest, and listens more than he talks. Looking forward to having him as my representative.

First year uro oncology fellow numbers. Looking for current PGY4 RALPs 105 R Nx 38 R PNx 52 R NUx 9 R Adrenal 3. R rc 4 Open Cys IC 64 Cys Neobladder 27 Cys Pouch 3 Ileal ureters 4 RPLND 14 2 robotic Open Nx 25 total, 11 thrombus Inguinal LND 8 Rc reimplants 13 @SUO_YUO

@olive_liz @candacegranberg Agree - any industry in which the question is “what I can do for you?” and not “what can you do for me?” Also highly recommend team sports.

Nothing prepared me for a career in medicine better than my job as a server in a restaurant. @candacegranberg

@TheVinodLab Congratulations, this is incredible work. Perhaps a premature question - any chance the phase 2 trial is starting soon and will include an arm for patients who received neoadjuvant chemo? 🤞🏼

Unrolled thread threadreaderapp.com/thread/1656334…

1. ENTER #mRNAvaccines for #pancreaticcancer! Long-term #PDAC survivor story PART3. "Do #PDACs REALLY have vaccine neoantigens (NAs)"? (aren’t they lowly mutated?) If each patient = own NAs, how do you vaccinate? Maybe mRNA? But how? @Nature nature.com/articles/s4158… 👇🏽 [1/32]

Real hope! Bravo, @TheVinodLab

@BogdanaSchmidt @UtahUrology I was up there Saturday and Sunday - the snow was still unbelievable 🤯🎿🤩

Too bad @UtahUrology graduation is in June

@SFUPA1 @zaontz @McMasterU @LuisHPBraga @ESPUorg @SFAR_ORG @ADARPEF1 Let’s compromise - pudendal blocks? It’s our standard block @OHSUDoernbecher and we’re huge fans!

@zaontz @McMasterU @LuisHPBraga @ESPUorg @SFAR_ORG @ADARPEF1 Perhaps we should stratify the results with the experience of the pediatric urologists. Or build up a multi institutional international RCT

#ESPU23 #clashstudy ⁦@McMasterU⁩ ⁦@LuisHPBraga⁩ concludes that #caudalblock may increase #complications after #hypospadias repair - we need more #pediatricanesthesiologists during ⁦@ESPUorg⁩ meeting! #collaboration ⁦@SFAR_ORG⁩ ⁦@ADARPEF1⁩

Join us this Thursday, March 23rd at 12:15 CST via @VUMChealth live stream, link can be found 👉🏽 news.vumc.org/2023/03/14/mar… HUGE thanks to @UroCancerMD @benhopark @urogeek and @VUMCchildren @VUMChealth leadership for their support in making this happen! 🙏🏽

@RyanWerntzMD @CaseySeidemanMD Benefit >>> risk

Do we really need to pex the other testicle for to torsion cases? @SarahHechtMD @CaseySeidemanMD

@CaseySeidemanMD Aww, shucks ❄️🐰

Get yourself fantastic human colleague friends like @SarahHechtMD who rescue you from the ice and whisk you the airport so you can fly to Singapore!