@AhmadRehanKhan @jbcarmody Due to market distribution. And this has happened in every other country
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Rangarajan Purushothaman
1.2K posts
Rangarajan Purushothaman
@rangapurushoth
Interventional Radiologist
Katılım Temmuz 2010
693 Takip Edilen312 Takipçiler
@AhmadRehanKhan @jbcarmody available post grad seats in their countries. So it's not out of the norm for students to choose a speciality based on job prospects. If someone graduates with little to no debt at young age, and if only available jobs are say rural primary care it will fill
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𝗔 𝗠𝗨𝗦𝗧 𝗦𝗲𝗲:
Must-watch under 3 minutes.
Amid the noise and bias blaming IMGs and immigrants for “stealing” residency spots, Dr. @jbcarmody cuts through the misinformation with facts and clarity.
Straight to the point. Agenda dismantled.
Matamoras, PA 🇺🇸 English
@SadiqNaveed Agree with being the sane voice, but the rationale behind the whole thread is completely flawed as you know @jbcarmody especially assuming that current gap filled by IMGs only out of passion.
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Thank you, Dr Carmody for being a rationale and sane voice in the room.
Bryan Carmody@jbcarmody
Sigh. Hate to spoil the party, but… We really DON'T want a system in which the number of U.S. medical graduates equals the number of residency positions - and the reasons why should be obvious if you think about the practicalities and second-order effects. (🧵)
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@t_intheleadcoat @smbracewell @ChengaziMD been using an inflated Fogarty with a little bit of Benson wire to lead, balloon just follows direction of flow and also doesn't get caught in the chordae
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@smbracewell @laronecampbell @ChengaziMD @hkmccullough @IRtmke @AustinBourgeois @tarheeldylan You are too kind!
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Nice illustration!
Keep them coming Austin!
Adding one more to the collection, a recent one. Courtesy @laronecampbell
Austin Bourgeois@AustinBourgeois
Overview of our equipment and technique for accessing the PA for PE thrombectomy. @SDhandMD @t_intheleadcoat @keithppereira @TheRealDoctorOs @_backtable
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@shycollie @SpineNeuro Lavishly reimbursed? It's still about 5-6 total RVUs, 150-200 dollars
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@SpineNeuro Money.
It’s very simple, same for bone marrow biopsy, paracentesis etc..
These procedures are lavishly reimbursed in IR, poorly or not at all in inpt/outpt medicine.
No doctor should waste 45 minutes doing these procedures when they’re done by one click of the mouse in IR
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Why did lumbar puncture go from being a med student procedure (bc it is extremely low risk) to a procedure that can only be done by an interventional radiologist?
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@ChengaziMD @ReneLizola @DrJayMohan @t_intheleadcoat @TheRealDoctorOs @AustinBourgeois @JayMathewsMD @kmadass @roblookstein @PERTConsortium @drochohan @DonGarbettMD @linemonkeymd @ChengaziMD AlphaVac works really well in tough angles - easier to manipulate sheath and aspiration catheter from main PA into right lower without having wire at all.
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Older and adult sized
Getting into RPA was a struggle, I use longer sheath but that was a hindrance here - chose 80cm flash for aspiration force but had to switch to 100 to have enough length beyond long sheath to make selection
Got up fine but even with lunderwuist not enough support to make angle with shorter catheter, with longer catheter and staccato movement I got catheter up, then sheath over it to secure access.
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In the spirit of chronic clot (@DrJayMohan) - just pulled out the largest chronic PE I’ve encountered.
Tough situation w/ peds patient, malignancy and prolonged hospitalization with delayed diagnosis.
PA angle also very difficult to deal with.
Well compensated but symptomatic with chest pressure improving immediately.
AC wasn’t going to touch this, guarded prognosis overall but I’d argue better out than in
Controversial? What are your thoughts?
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@ChengaziMD @AustinBourgeois Do you get your AT/PT access supine before starting with the IJ access?
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@AustinBourgeois I usually park an element sheath in lower IVC, can access AT or PT and floss. Usually I don’t take aspiration to ankle, but will instill some lyric or flush some alone forward while aspirating from prop to promote clearing them out
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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
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@DrDiGiorgio @m_ozdemir_MD none of my co complained of hours, everyone wanted more complex case volume. There are cases i encounter not frequently, and volume dilution as staff will make me lose my skills. No neurosurgeon is going to be happy just doing middle of night cases without complex elective cases
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Training should teach one how to function on sleep deprivation. I don't want neurosurgeons encountering true fatigue for the first time as an attending.
There's not much room to expand training without sacrificing quality, either. You're not going to be able to double the workforce.
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This is part of the job.
The alternative to a tired neurosurgeon isn't a rested neurosurgeon, it's no neurosurgeon.
HustleBitch@HustleBitch_
🚨 HE WENT TO BED - THEN SPENT ALL NIGHT TRYING TO SAVE A PARALYZED STRANGER A neurosurgeon turns on the camera at 9:30 PM. He was already in bed. Half asleep. Then the call comes in. A patient just arrived paralyzed at a Level One trauma center. Coffee. Uber. Silence. By 11:30 PM, he’s making the incision. The case drags on for five straight hours. One wrong move and the damage is permanent. At 6:00 AM, he walks out exhausted. The surgery worked. The patient is doing well. But the night isn’t over. He’s still on call. Still writing notes in the back of an Uber. Still expected to function like nothing happened. Just a man trading his night so someone else gets a lifetime. While you slept… this happened. Would you trust your life to someone running on zero sleep - or does this reveal how broken the system really is?
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@DrDiGiorgio @m_ozdemir_MD Ppl outside procedural specialities don't understand how important training volumes are. The statement "just produce more NES" is pure hubris, as there are only a handful of complex cases to go around
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The new BEACON-HCC treatment recommendations, presented by @docamitgs at @HCCLIVEConf today are outstanding 👏.
Really nicely incorporates best available evidence in 2026 re: locoregional treatments, systemic therapies & tumor biology. @OncoAlert
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@aribindi @anish_koka their system really works well for them, because they don't care about being politically correct. They have tight control legal immigration, number of specialists vs primary care trained etc - so it's really easier for them to drastically switch policies that favour the nation
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@anish_koka I like the Singapore model a lot- but their rates of significant poverty is far lower. It's also very geographically concentrated- resulting in fierce competition by default, instead of the US reality of far-flung out communities where it's hard to get real competition.
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Singapore is not a bad model to follow!
Just making the point that part of America’s health policy problem is trying to solve every possible problem.
Singapore: Aren’t a citizen ? Buy private insurance or get it through your employer.
Emergency care : there are 30 some ambulances that operate to deliver care. If deemed not an emergency - you will pay for ambulance. After 2023, there is a triage process to determine emergency vs. non emergency. Ambulances won’t go out if determination is made that there is no emergency:
Care delivered in a govt. hospital is not free even to citizens — it is subsidized, so it’s at a lower rate than non-citizens.
There are 50 million non-U.S. citizens in the US, and everyone coming to an er gets care, illegal or not, if it’s an actual emergency or not. Anytime anyone tries to set up a system to make sure only those truly unable to work can get the Medicaid safety net program , or try to make sure Medicaid enrollees aren’t inappropriately also enrolled in some other insurance program, or god forbid make sure those here illegally don’t get on Medicaid — there’s a vocal group that will scream health care is a right and tell you what a bad person you are.
So while I would love some version of the Singapore health system here , the same people constantly screaming about no one having a good plan for healthcare will reject any plan that isn’t everyone being issued a card that signifies you have insurance.
Anish Koka, MD@anish_koka
Singapore is not a bad model , but 30% of their population are non citizens , non permanent residents that do not have access to their national healthcare program. Singapore total population is 6 million, so about 2 million are not covered by their national program.
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@aribindi @anish_koka most specialty care runs through the public hospitals — and the system is designed to ration resources carefully. Imaging, referrals, and specialist slots are tightly controlled to avoid unnecessary use
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@LighthouseDPC @anish_koka Nope - prices are comparable to the US, and probably closer to what u get with cash pay practices and scan centers in the US. They also do not do write offs easily - if u a non PR worker and end up with a bill you are expected to pay over time
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@anish_koka These non citizens have access to probably the most affordable healthcare system on the planet.
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Singapore is not a bad model , but 30% of their population are non citizens , non permanent residents that do not have access to their national healthcare program.
Singapore total population is 6 million, so about 2 million are not covered by their national program.
Humane Healthcare for All@LighthouseDPC
@JahangirAsgha10 Singapore has Universal Healthcare and is consistently ranked #1. It’s also the most affordable costing HALF of Canadas Healthcare system. They don’t want to talk about Singapore because it has a Robust Free Market Medical Care economy and a Catastrophic Only Health Insurance.
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Rangarajan Purushothaman retweetledi
Rangarajan Purushothaman retweetledi
Charlie Kirk is the kind of intellectual I wish I could be.
I’ve always been impressed with how he handled himself in a debate. He was quick, articulate, and logical. He never argued in bad faith or got emotional.
Even if you disagreed with everything he said, you should want more people like him on the left and the right.
Engaging in debate, allowing the marketplace of ideas to thrive is the only way we can move forward.
Thank you for what you did, @charliekirk11. The world is worse off with you gone.
Dutch Rojas@DutchRojas
I’ve always loved debate. I’ve always loved argument. May the best ideas win! And no one carried that spirit more than Charlie Kirk. He crisscrossed this country, defending free speech, championing free markets, and reminding young people that they have a purpose. The point of conversation is simple: challenge ideas. That’s how growth happens. But there’s a class of people who fear debate. They don’t want autonomy. They don’t want freedom. They wrap themselves in false virtue, while recoiling from open dialogue. From coffee shops in my hometown, to the pubs of Cambridge, to boardrooms in New York and San Francisco, the pattern repeats: a disdain for dialogue, a contempt for freedom, and a pretense of superiority. And now those same forces silenced Charlie Kirk. They couldn’t defeat his arguments, so they ended his life. A 31-year-old father of two, gone. Rest in peace, Charlie. My prayers are with your children, your family, and the movement you built.
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Young pt with testicular CA and PET avid precaval lymph node. Trans caval biopsy using TLAB with diagnostic samples #IRAD
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Rangarajan Purushothaman retweetledi
Our voices are being heard at the highest levels of government. This week, during a congressional committee hearing, Representative Lloyd Doggett and others made it clear: they’re listening.
Our stories are making a difference. Thank you to all who are stepping up. This will take a bipartisan effort, and we’re here for it. Let’s keep pushing for healthcare that truly serves the American people.
Watch the clip here:
youtu.be/jirlXiTrSOM?si…
YouTube
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@Etihad I’ve never experienced worse customer service than with Etihad Airlines. They canceled my return flight without any notification, leaving me to find out the day before my journey—with no options to rebook. Avoid Etihad at all costs!
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Rangarajan Purushothaman retweetledi
Day Two of #SIR24SLC is underway!
Check out our LinkedIn post for more info: linkedin.com/posts/rad-aid-…
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