Line Monkey MD

It’s time for the greatest show on earth. I am speaking at OEIS 13th Annual National Scientific Meeting. Please check out my talk if you're attending the event! @OEISociety

"We are not ‘burned out.’ We have been gaslit." 🛑 After 15 years of training and $300,000+ in debt, Dr. Corina Fratila just published a blistering, unfiltered essay about why she is ready to drop her stethoscope faster than Big Pharma drops accountability. She argues that doctors are no longer allowed to be healers. They have been forced into becoming "glorified data-entry monkeys in a Kafkaesque insurance labyrinth," spending their days begging insurance companies for permission to save lives and timing their own bathroom breaks. Her shockingly honest comparison of modern medicine to a vastly different (and highly controversial) profession is breaking the internet today. It is raw, it is darkly hilarious, and it is a heartbreaking look at what is really happening behind the clinic doors. "Every day feels like a hostage negotiation between your soul and your malpractice insurance. The system isn't broken. It is working exactly as designed. For profit. Not for people." Healthcare workers and patients: Is Dr. Fratila right? Drop a 💯 in the comments if you feel this, or tag someone who needs to see the truth. 🗣️ Link to the full article in the comments below! 👇

20 years ago, 90% of cardiologists were independent. Today? Most are hospital-employed. This thread is about what we lost — and why it matters to you as a patient 🧵

Don’t let #PAD get in the way of #PAE. In this case, bulky calcified atherosclerotic plaque causes critical ostial-proximal stenosis of the right internal pudendal artery (viewed in LAO). Crossed with a 5 Fr TC-BNK catheter & 014” Prowater wire. Type 4 prostatic artery. #IRad

@AustinBourgeois I take it out up front

@AustinBourgeois When in doubt, take it out

TIPS for massive upper GI bleed in unstable patient. How many out there are taking down shunts like these at the time of TIPS? Do you embolize before TIPS placement or after? Here we treated with 440cm coils and 1cc Obsidio. #iRad

@olsonplanner I know this scenario except mortgage at 6.99% not low rate. I’d still pay it off even with a lower rate! It’s not just math but it’s also things like cash flow, job optionality etc. once you have enough that you can “coast fire” then just pay off your liabilities if possible.

They’ve built a $3,000,000+ net worth They have a low mortgage rate & strong income So why do they want to pay it down? Because math isn’t the only variable From today’s new episode (listen on Apple or Spotify)

Looking good!

@AustinBourgeois @AHMalik_MD Hey this is a great idea. Very importent to clear potato help with calf/ankle edema.

I have a partner who has spent the last couple years refining a technique of posterior tibial vein access using large-bore devices for DVT intervention. Intent is to clear popliteal inflow. The method involves PTV access, 7mm balloon angioplasty of the PTV, 16Fr suction and/or clottriever through the pop and PTV. Then, as in the case shown, a separate access of the popliteal vein for treatment of the iliofemoral segment and stent placement. It seems arduous but this case took just shy of an hour. What are your thoughts? #iRad

@DocDifferently Wow I met 5 lawyers and been inside court rooms. All on the first case!

I’ve been an expert witness for 5 years and I’ve never seen the inside of a court room, been deposed, or met a lawyer in person. My experience has essentially been remote chart review and writing expert reports. I charge $600/hr for my pediatric expertise.

@olsonplanner Thanks, Tyler. Enjoyed interacting with you here. Good advice and hope people listen whether they’re paying customers or not. I will be making similar moves away from this platform but more to LinkedIn.

Doctors - I won't be writing much here going forward. DMs are closed to new requests, though I'll check messages from existing conversations from time to time. Here's where I'll be focusing my public educational efforts: 1) Physician Cents (Podcast) 2) A Good Problem to Have (Podcast) 3) Tiktok 4) At attendings' homes where they host their trainees for a meal and a discussion about money with me. These have had such an impact, love playing this supportive role. 5) At a medical conference near you. In-person teaching opportunities like these are really fun and I will be doing more of them. 6) Semi-annual webinars - one in the spring and one in the fall. Next up is the Post-Match Financial Education Webinar, slated for April 10th. As for planning work: If you want to work with us at OlsonFP, you're welcome to inquire through our website. - Our next set of single sessions ($4k) with me will take place in August. - Ongoing planning service interviews are taken on a case by case basis. On a related note, I've determined we will grow the practice by hiring another tax pro so I won't be the only EA/CPA on staff. I'm looking forward to continuing to build the practice. Appreciate you all in medicine as you navigate your careers and make tough money decisions! Your work is SO important. My heart particularly continues to be with you med students and trainees - y'all work so hard in learning and training, ultimately for your patients - we are all in your debt. I'll keep doing my best to support you with what I have to give. - Tyler

@benwhitemd Agree. Permanently broken is the perfect way of describing it.

@linemonkeymd Broad social media feels permanently broken (not that it was good when it “worked” either).

Does anyone not use AI to create their social media posts anymore? Insert emoji, insert dash etc. med students, residents, attendings…please stop. It’s so obvious. Use your brain.

@t_intheleadcoat @kmadass @keithppereira @SDhandMD @JayMathewsMD @ChengaziMD @drvarshana @laronecampbell @SIRspecialists @baobui99 @JuliusChapiro @drcostantino1 @DrJayMohan @KprasMD Thank you 🙏 Someone with a brain.

@linemonkeymd @kmadass @keithppereira @SDhandMD @JayMathewsMD @ChengaziMD @drvarshana @laronecampbell @SIRspecialists @baobui99 @JuliusChapiro @drcostantino1 @DrJayMohan @KprasMD No AI was used in the making…😉

This filter left the body after 17 yrs! Double Hangman technique to the rescue! @kmadass @keithppereira @SDhandMD @JayMathewsMD @ChengaziMD @drvarshana @laronecampbell @SIRspecialists @baobui99 @JuliusChapiro @drcostantino1 @DrJayMohan @linemonkeymd @KprasMD

@DonGarbettMD Good question. Not sure but smells like BS!

@linemonkeymd What’s AI?

The real reform agenda is five items: •Repeal the physician-owned hospital ban •Eliminate Certificate of Need laws •Enforce site-neutral payments •Condition nonprofit tax exemptions on actual community benefit •Separate insurer-PBM-physician conglomerates This bill does one of five and calls it a revolution. Do all of it, or admit the rest is theater. buff.ly/k2aHceS

@ramposham @ChengaziMD @alroubaieMD @Cigna @SIRspecialists @OEISociety Only if RUC re-evaluates the 37243 code. Agree re comparison with PAE.

@linemonkeymd @ChengaziMD @alroubaieMD @Cigna @SIRspecialists @OEISociety If it’s under the same code as 37243… it will affect reimbursement for other embos too right? it is nowhere near as complex or effective as PAE….

I don’t know who reads this anymore, but am I the only one surprised @Cigna has approved GAE in addition to other MSK procedures as an approved treatment using CPT 37243? @SIRspecialists @OEISociety

@ChengaziMD @alroubaieMD @Cigna @SIRspecialists @OEISociety Same. These guidelines basically seem to have been written by someone who may have integrated single service IR OBLs in large orthopedic or GI practices…

@linemonkeymd @alroubaieMD @Cigna @SIRspecialists @OEISociety Interesting that in their guidelines the point for OA is made that it’s referred by an MSK specialist. My experience has been that many of this patients have already failed serial corticosteroids and/or RF ablation and this population is much more inconsistent in their response

@ChengaziMD @alroubaieMD @Cigna @SIRspecialists @OEISociety I agree 💯 I honestly struggle with GAE. Not sure who is the right candidate exactly. Need better predictive tools. Need more data. Some Pts do great and are super happy. Technically simple. Going the way of vein ablation it seems. High utilization low reimbursement.

Yeah there’s def still so many questions - should a preop MRI always be done to exclude marrow edema or severe meniscal degeneration? How much do these things impact outcomes. I believe the procedure is beneficial to some, but not all, I think the data will get there but before it does GAE may be overutilized