Daniel McDevitt MD FACS FSVS

@BrentAWilliams2 Channeling my late father. For every complex problem there is always a simple solution that is completely wrong.

This would require an insane amount of authoritarianism and health care rationing to achieve:

@igor_muzevic @DutchRojas @CharlesLutzMD Sounds like pimple popping is the way to go!

@dtmcdevitt @DutchRojas @CharlesLutzMD You get 40 bucks per hour. Doesn’t matter if you do a baby heart transplant or if you squeeze a pimple. Same pay.

A surgeon I know recently operated on a man's spine. Saved his mobility. Saved his career. Saved his marriage, probably. The surgeon's take-home on that case, after the facility fee, anesthesia, device costs, payer discounts, and overhead, was $1,840. The health system collected $64,000. Ask yourself who the system thinks did the work.

@igor_muzevic @DutchRojas @CharlesLutzMD Not even remotely reasonable given the nature of the procedure.

@dtmcdevitt @DutchRojas @CharlesLutzMD In Slovenia surgeon would get 80 bucks.

@DaveDavids34746 @DutchRojas @CharlesLutzMD Somebody owes me some money.

@dtmcdevitt @DutchRojas @CharlesLutzMD Not sure how accurate this site is but you might try wiping your tears with some of that 600k

My malpractice premium alone was $140,000 PER YEAR. That’s just one component of overhead. The liability is daunting for this specialty. There is no way to do what we do cheaply. There are certain things like varicose veins that are doable for cash, but most things we do just aren’t affordable for most people.

Yeah we have Smith surgical center here in Denver and I know vascular guys are definitely involved on spine cases etc. But I hear you, we need a new system. Locums is better than nothing brother. At least you can maximize tax strategies that way. Seems like as a society we could’ve built a much better medical system that was somehow not tied to the money system.

@DaveDavids34746 @DutchRojas @CharlesLutzMD It’s not all it’s cracked up to be.

@dtmcdevitt @DutchRojas @CharlesLutzMD Must be rough living on a surgeons salary

Medicare reimbursement is determined by the federal government via an agency abbreviated as CMS. Value units are assigned to a code that identifies a procedure. The value units are multiplied by the conversion factor. The conversion factor today is less than it was in 1992. The value units are the same. Based on inflation alone, we’ve had a 60% loss of reimbursement over the last 30 years. Yes. We’ve complained, lobbied, etc but to no avail.

@dtmcdevitt @DutchRojas @CharlesLutzMD do you fight the lobbying insurance companies push? do you fight them at all? or have you just put up with it your entire career?

@noahkaufmanmd @DutchRojas @CharlesLutzMD I’m out now. I do locums only. Direct care model is awesome but challenging for vascular surgery.

@dtmcdevitt @DutchRojas @CharlesLutzMD Go direct. Get out now.

@farkomd Looks like we peaked 40 years ago. Who knew?

It’s losing its luster

Doctors to admins> You know nothing about what we do. You need to let us handle patient care. Admins to doctors> Shut up and click the boxes in the EMR we tell you to. You need to see X number of patients per hour. Make sure you attest to the billing codes we give you. No call pay. We will assign your work hours. Remember you have a restrictive covenant. Make sure you complete all the training modules we send you. You must show up to medical staff meetings where we pretend you vote on things. Doctors to admins> Ok. Sadly, the history is the exact opposite of your post.

Physicians are not resistant to change. We are resistant to being changed by people who have never taken care of a patient.

My great great grandfather was part of the “Forlorn Hope” that charged the Confederate fortifications at Vicksburg. He was one of the few survivors who was rescued from under the pile of dead a few days later. He was awarded the Congressional Medal of Honor for his gallantry. His photo is the one I use as my avatar on this site. The photo is me on the very hill he tried to scale.

On this day in 1863, Union and Confederate soldiers stopped killing each other for two and a half hours, walked out into the field between their lines, traded coffee for tobacco, sat down together to bury bodies that had been rotting in the Mississippi sun for three days, and then went back to their trenches and resumed killing each other. The place was Vicksburg. Three days earlier, on May 22, Ulysses S. Grant had ordered a massive frontal assault on the Confederate fortifications ringing the city. He believed the garrison was demoralized and one hard push would crack it. He was wrong. The attack went in across open ground into prepared trenches, ditches, and tangles of abatis. In a few hours of fighting, the Union army lost more than 3,000 men killed and wounded. Many of them fell within fifty yards of the Confederate works. A few got inside the works and died there. When the smoke cleared, the wounded were still out there. For one day, then two, then three, they lay in the Mississippi May heat. Some were dead. Many were not. Confederate and Union sharpshooters made it suicide to crawl out and retrieve them. The temperature climbed past ninety. The smell rose up over both armies and settled into the trenches and would not leave. Grant refused to ask for a truce. To formally request one would be an admission that his army had been beaten on the 22nd, and Grant did not like admitting that. He held out for three full days while his own men breathed in the corpses of their friends. On the morning of May 25, he finally sent a note across the lines to John C. Pemberton, the Confederate commander inside Vicksburg, proposing a two-and-a-half-hour cease-fire to bury the dead. Pemberton, who had been waiting for exactly this letter, agreed within the hour. He had refrained from suggesting it himself because he did not want to seem to be showing weakness, or worse, doing a favor for the enemy whose corpses were stinking up his front yard. The note crossed under a white flag at noon. The cease-fire was set for 6 p.m. At 6, the firing stopped. White flags went up along the entire siege line. Burial details climbed out of both sets of trenches and walked toward each other across ground that had been a killing zone an hour earlier. They started digging shallow graves where the men had fallen, side by side. And then something stranger happened. The fighting men, on both sides, came out too. They had been shooting at each other for a week from holes a hundred yards apart. Some had served in the same prewar U.S. Army regiments. Some had been at West Point together. Grant and Pemberton themselves had been classmates. On the Missouri and Tennessee sides of the line especially, some of these men had grown up in the same towns and gone to the same churches. They sat down on the grass between the trenches and talked. Confederates traded tobacco for Union coffee. They swapped newspapers. They asked after mutual friends. Officers found old classmates now wearing the wrong color uniform and shook hands and stood there in the evening light catching up on three years of war. A few yards away, the burial parties were still shoveling. When the cease-fire neared its end, the buglers sounded recall. Men stood up, brushed off their pants, shook hands again, and walked back to their own trenches. The white flags came down. At 8:30 p.m. the firing started again. Vicksburg held out for another 40 days. Grant never ordered another assault. He let hunger finish what bullets could not. On July 4, 1863, one day after Lee was beaten at Gettysburg, Pemberton surrendered the city and 29,000 men. The Mississippi River was now a Union highway. The Confederacy was cut in half. The war's outcome was no longer in serious doubt. But for two and a half hours on a May evening in 1863, the men actually doing the killing put their rifles down, found their old friends in the enemy's uniforms, and remembered they were one country.

@DocLibertarian Hindsight is undefeated.

Dying from pneumonia is not “always preventable.” A bad cough can turn into life threatening pneumonia in hours. Most coughing does not even need treatment in healthy people. This is why lawyers get rich on the backs of doctors who couldn’t predict the future.

Good point. They would be much more useful as a cloud-based database that is constantly updated by the various users. Imagine logging into someone’s record from anywhere independent of the particular facility you were at. When an elderly parent is visiting from another city and runs into trouble, you’d have instant access to all available information from previous medical encounters. But that’s not what happened as you know. Good ideas often fall prey to business models, legislation, and unintended consequences. EHRs suck much worse than they should. Templated information in EHRs is pretty worthless. Actual notes written by physicians are still useful.

@dtmcdevitt When are hospital-based EHRs going to be useful for physicians?

How do you know AI will do a much better job than doctors? The AI databases and algorithms are proprietary, and each one is different. The studies are done by the AI companies, are for a short time period, and are on a small group of patients. The AI companies have spent a fortune on their models and will always claim they work well. What about the hallucinations of AI? Do you expect AI to monitor its own shortcomings? AI is trained on the usual and will miss an unusual presentation.

@ScottAtlas_IT It was the Milgram experiment repeated outside the lab. Same results.

And THE exposure that: "guaranteed" freedoms are an illusion; overwhelming majority of people are weak; govt officials are truly dumb; ppl have an insatiable need to control others; and an immoral willingness to destroy the poor and even your own children to save yourself.

@dandinohill Politics is a blood sport. If you’re not in it to win it, you’re gonna get steamrolled.

How did a country of 300 million mostly honest, hardworking people end up with so many leaders who are corrupt?

@Legoat1322222 @DrCorriel Government money always comes with strings. There’s no end to political manipulation.

@DrCorriel As long as the loans are federal and indirectly subsidized, they have the right to do so.

With respect, if the government isn’t paying for the education needed to earn this degree, coupled with the fact that it costs more than some make in a lifetime, I don’t think anyone can tell people what to do with their degrees, or how long to practice with them. If this were a system where there was a service exchange (ie an entity covers that cost and time commitment), that would be a different story and society would be in a place to make demands. How about we clean up the system of the corruption that lies within, inclusive of insurance company abuse and manipulation of the physician, and then we see who leaves and who stays?

@notaproviderMD These programs are simply public bribery to ensure political power.

This is one of the problems I have with entitlement programs. We can find endless reasons to add qualifying expenses. This is how we ended up with “Learing” and fake hospice centers. In this case, I believe we should help our seniors with medical care, but where do you draw the line on what constitutes medical care?

@JonathanTurley It’s amusing to think that the Founders would never learn from their mistakes. That’s why they made it possible for future generations to correct obvious errors.

I strongly disagree with the push for a constitutional amendment to bar foreign-born legislators. foxnews.com/politics/mace-… While I have suggested the possible tinyurl.com/f86u4tce, I cannot think of anything more antithetical to our founding than barring foreign-born citizens from Congress. As a nation of immigrants, it is a reaffirmation of our heritage to have these citizens serve in government...