Line Monkey MD

I wrote this because the conversation around physician workforce shortages keeps circling the wrong target. Telling future doctors to commit to 20 to 25 years of full-time clinical practice sounds noble until you look at what the path actually costs. Medical school is not free. Training is not light. The years are expensive in money, time, family life, health, and opportunity. If society wants a service commitment, then society can fund the education and make that agreement clear before someone signs up. Until then, a medical degree belongs to the person who earned it. Physicians are already screened for discipline, endurance, delayed gratification, and the ability to survive a long academic obstacle course with a stethoscope waiting at the finish line. The better question here - that keeps getting ignored - is why so many capable, committed physicians eventually feel pushed toward the exits. If we want doctors to stay, we need to build a profession they can afford to enter, survive, and stay in.

@SalaryDr I feel like all your programming and this entire concept of “salary” pertains to employment with large healthcare systems. Private practice is still alive. You should focus some content on this.

After 200+ physician salary submissions on salaryDr, the single biggest predictor of total comp isn't specialty. It's the contract. A thread on the 5 contract terms that quietly decide your decade 🧵

Today marks four years since we lost my brother - a physician, away on a locums assignment. It was around 9:15 AM PST on May 21, 2022 when we last spoke. I was on my way to the gym, it felt like just another Saturday. That conversation lives with me every day. What I wouldn't give for just one more. His passing changed how I see everything. I found myself paying closer attention to what other physicians were carrying, the quiet struggles. For a while, I felt hopeful. There was real momentum building around physician wellness, and it felt like something was finally shifting. But the needle is moving in the wrong direction. Burnout rates remain at historic highs. Physicians are leaving clinical medicine faster than we can replace them. The administrative burden - prior authorizations, documentation, clunky EMRs, breaking the glass on a patient there to see YOU, continues to consume the hours that should be spent on patients, or on rest, or on simply being human. Mental health stigma in medicine hasn't gone away; if anything, the fear of career consequences keeps too many physicians suffering in silence. And we lost more colleagues to suicide this year than we should ever accept as normal. I don't have all the answers. But I know this - we have to figure it out, and we are running out of time before the profession is just a shell of itself.

@DrDadBuilder Wow very busy. Congratulations!

1 month into private practice. Half-day clinic. 19 patients. Still helping build the office between shifts. A lot of long days, late nights, and uncertainty went into this decision. Seeing patients support what we’re building makes it all worth it. Best professional move I’ve made. #Urology #PrivatePractice #MedTwitter #Pennsylvania

@kurt13warner How do you know you have inflammation around your knees?

Need some help! I’m in the best shape of my life… I’m as lean as I’ve ever been… but I have some inflammation around my knees that’s driving me crazy & no matter what I’ve tried: diet, vitamins/supplements or exercise, I can’t shake it! Any experts out there that have some ideas to help???

linemonkeymd.com/why-irs-are-un… @SIRspecialists @OEISociety

@RadiologyBiz @Medscape @MStempniak you’re killing us with these headlines.

Radiologists No. 1 among physician specialists with $5M or more in net worth: @Medscape. ow.ly/z76K50YP20B

@AndrewCallenMD @CURadiology @UCSFimaging Soonmee is the best!

Ran across the street today to hug my former residency PD, Soonmee Cha, right before her Grand Rounds at @CURadiology today. She’s a world-class @UCSFimaging brain tumor expert who has stayed deeply committed to residency training in a way that’s honestly rare. She expects excellence, but more importantly, quietly demonstrates it every day, even in the smallest things. She’ll show up on day one having memorized every resident’s name, their family, and their story. And somehow still asks about all of it years later. She’s the kind of person who will go to bat for a resident at 3am, and then show up the next morning like nothing happened. Hard to explain how much that kind of presence shapes people. If you trained under her, you know. #Soonmee

@noahkaufmanmd Congratulations! I hope you are able to refer your patient with a compression fracture to someone skilled in vertebral augmentation. One of the most satisfying procedures I perform. #irad

KaufCare DAY 4

🔎 For the first time in 14 years, Medicare is ready to end the status quo. CMS just included a request for information on allowing physician-led hospitals to expand to make the TEAM model excel, and PHA President Carlos Cardenas, MD, is calling it what it is: a landmark moment. Physicians hold the highest level of training in the healthcare system, and it’s time they’re allowed to put that expertise to work in operating hospitals. Our nation’s seniors deserve the best care possible, and that comes from physician-led healthcare. Stay tuned for more from PHA and dozens of other healthcare stakeholders who are ready to enhance our nation’s healthcare system.

Nice review, KP.

@SalaryDr Few things actually: 1. Understand/eliminate/mitigate non-compete 2. Understand vesting schedule for retirement funds. 3. Pay as it relates to call frequency/burden. Really 1 but 2 was a big deal too. 3 was a surprise when a partner left and had to do call for same pay.

What's the one thing you wish someone had told you before you signed your first physician contract?

@averagemoneymd Congratulations. Do not do that. Keep paying off the mortgage AND investing.

Our taxable brokerage now exceeds our 3.75% mortgage (currently $488k) for the first time ever. Should I sell it all and go mortgage free????

@averagemoneymd I think this is fantastic. Great move.

Last month, we received a family gift of $260,000. We debated a lot and ultimately decided for a few reasons to drop it all on our 3.75% mortgage. Our mortgage went from $750k --> $490k We recognize we could have made much more investing, but it felt secure to take a little risk off the table. Mortgage calculator shows this will save us $285k in interest. We then recasted our mortgage and our payment dropped from ~$3,800 to ~$2,400. A little bit closer to freedom.

@MiraMalavia @Jonas__Kruse @VISLAMDSCAIP @KPVISLA @Subhash_Gutti @ashleylambaMD @brittanyj_b Modern Dotter. VIR=Vatakencherry

Every SIR, Dr. V sightings just hit ✨different ✨ #VIRad #SIR2026 #irad #sir26tor @VISLAMDSCAIP @KPVISLA #mentor

@KyleCooperMD @LLUHealth @SIRspecialists @SIR_ECS @SIRRFS @LLUMedSchool @LLUHPhysicians @SidKulkarni3 @LLUMedCenter @LLUChildrens Great seeing you!

Honestly the best SIR I have ever had, with an absolutely awesome @LLUHealth IR crew to share the experience with. I am so lucky to have found my home with this hospital and this society. Best specialty in medicine!! @SIRspecialists @SIR_ECS @SIRRFS @LLUMedSchool @LLUHPhysicians

Incredible! Hope all turned out well! @SIRspecialists @SIR_ECS @SIRRFS Check out the schedule ! @_backtable #Irad @keithppereira ..we were talking about this not too long ago!

@leileiyu_ @SIRspecialists Thanks for attending! Hope it was helpful.

@linemonkeymd @SIRspecialists Great to see you in person for the ECS OBL talk!

linemonkeymd.com/independent-ir… Greetings from #SIR26TOR. Great to connect with friends and colleagues. Have some thoughts on my mind and wanted to share them. Let’s ask the tough questions and get to work creating a better future for IR. @SIRspecialists

The opacity you're describing is deeply baked into how hospitals operate financially. The chargemaster system - that massive internal price list hospitals use - is designed to be opaque. Charges bear little relationship to actual costs, and the gap has been widening for decades. A hospital's full accounting would reveal just how detached their billing is from what care actually costs to deliver. The consultant spending you're flagging is a real pattern. Revenue cycle consultants and chargemaster specialists are now standard fixtures in hospital administration, and their entire job is optimizing how charges are set to maximize reimbursement across Medicare, Medicaid, and private insurers. It's a cost that feeds itself - spend on consultants, inflate charges, trigger higher supplemental payments, justify the consultant spend. The reason full accounting rarely gets published isn't just reluctance. It's that the numbers would make the strategy visible. When a hospital's operating costs represent only 30 cents of every dollar charged, that's not inefficiency - that's a deliberate gap maintained for financial leverage in negotiations and payment calculations. Wrote a long piece on exactly this, tracing why the ratio between what hospitals spend and what they charge has been cut in half since 2000, and what it reveals about the incentive structure underneath. onhealthcare.tech/p/the-economic…