i do EP and other things. recovering mayo IM, CV, EP fellow. don’t take my advice. Sioux Falls EP.
Sioux Falls, SD
Joined January 2017
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not the real Chris Stanton retweeted
Given that our more civilized northern neighbors have figured out how to apportion scarce resources at zero cost to the public, I am shocked that Canada isn’t over-run by American medical tourists.
“I was just diagnosed with Cancer, I need to get to Canada” is not something I hear very often.
not the real Chris Stanton retweeted
Why the fuck am I watching the bengals blow an easy game instead of broncos vs chiefs? @NFL what the fuck is this?
not the real Chris Stanton retweeted
Honest question : in the absence of absolutely prohibitive risk factors, why would anyone try to stent this and not send straight to surgery?
Same as quality docs leaving major health systems. Everyone is a widget until they realize they aren’t.
It's confusing why a major multi billion dollar law firm is going bankrupt.
So I talked to a bunch of lawyer friends about why Weil could suddenly be insolvent.
Unintuitively, law firms are basically fixed-cost businesses. Revenue comes from a concentrated core group of rainmakers.
Those rainmakers carry the whole business, while the rest of the business basically drags ass. Junior partners are rainmakers-in-training--they can't yet bring in the huge load-bearing dollars.
Everyone else--associates, back office staff--comprises one gigantic fixed cost center. Not to mention basic overhead like offices, revolver interest (for cashflow timing needs), etc.
The problem with law firms in particular, as opposed to other advisory businesses like banking, consulting, accounting, is that the clients are inherently portable.
So any partner can take their team and clients and leave. Doing so deleverages the rest of the partnership, because a small number of partners carry most of the revenue while leaving behind fixed costs.
Once there's a crisis of confidence, it no longer makes sense for partners to stay, because they're now getting underpaid in profit share relative to their revenue potential.
If they were to leave for a megafirm like Kirkland, they'd be properly compensated for their earning potential instead of being saddled by rising fixed costs as a percent of revenue.
There's also not much IP or brand moat in a law firm. Clients follow partners, and the process of crafting exceptional judgment is mostly in partners' heads (versus for instance more regimented value delivery in consulting and banking, where there can be a branded firm process).
And lastly, the partners ARE the equity in the firm. Law firms have no terminal value, so when partners leave it's as if a huge chunk of the firm equity walks out the door.
tl;dr law firm bankruptcy is basically a crisis of partner confidence, and the resulting departure spiral saddles anyone remaining with the gigantic fixed overheads of running a billion-dollar business.
not the real Chris Stanton retweeted
Pay attention to the charity care section. Note that for profit entities provide twice as much charity care as nonprofits. @GeBaiDC’s JAMA study in 2021 estimated that nonprofit hospitals received $37.4B in tax benefits in 2021. A recent EY analysis commissioned by the AHA estimated total tax revenue benefit at $54.4B in 2022. So what exactly are taxpayers buying with the nonprofit hospital tax exemptions they have granted?
not the real Chris Stanton retweeted
This is untrue... The residency match rate for American medical graduates is near 98%, whereas for international medical graduates (IMGs) it's low 70% for American IMGs and mid 50% for non-American IMGs (foreign doctors).
The real problems worth highlighting are the following:
1. Americans need to go through college and an LCME accredited medical school to apply to residency. By then, most have accrued loans over $250,000 and some near $500,000 at a 6% interest rate
2. Over 50,000 American premed students try to get into med schools but 56% (and climbing) get rejected due to lack of available spots
3. Residency offers close to 42,000 training spots but we only graduate 23-28,000 doctors (MDs/DOs)
The cost of rejecting 56% of all American premed students is millions of dollars in accrued interest on students who are still 7-8 years away from making enough money and who still are likely to take hundreds of thousands of dollars in more debt.
Instead of amplifying tropes or targeting IMGs, what we need is not an AMA sponsored JAMA publication boasting about how we have 158 MD granting schools today, because we had 160 in 1910, over 100 years ago, but a serious conversation about how whether we should subsidize medical schools and facilitate accreditation.
Your kid needs 8 years and hundreds of thousands of dollars to become a resident doctor.
High School → 4 years college → 4 years medical school → Residency
Meanwhile, someone from India, Pakistan, or Sudan can finish a 5-year program after high school, come to US on H-1B/J-1 visa, and take the same residency.
High School → 5 years medical school → Residency
Why is it easier for them to become US doctors, and so much harder for our kids?
not the real Chris Stanton retweeted
Why do we require doctors to do MOC? It seems it’s all about paying money to the groups requiring this. What evidenced is there this improves patient care and decreases adverse events? At every turn, boards and societies keep adding one more thing we must do to practice.
The societies collect the money, so it wouldn’t be in their interests to stop or eliminate this. Hospitals and state boards police doctors. What it takes to become a board certified orthopedic surgeon is no small task. Once earned,shouldn’t have to keep doing pointless busywork. We are required to do CME annually. Just one more reason doctors burn out.
not the real Chris Stanton retweeted
As I study my @ACCinTouch CMP modules after working as an EP for > 30 yrs, its clear the “gotcha” psychology of the questions and later surveys of their value to me are designed more to perpetuate MOC and to reinforce learned helplessness of US physicians than to improve pt care.
not the real Chris Stanton retweeted
Have you a similar case where the PPI–TCL didn’t add up.
I had already been in the LA for PVI, but the LA activation histogram didn’t cover the full TCL of this tachycardia. In the RA, the activation sequence looked like typical flutter—despite the confusing PPI.
CTI line terminated the tachycardia.
The published tracing in this animation illustrates one reason the PPI can mislead us:
TCL: 270 ms
Pacing CL: 200 ms
PPI: 380 ms
A PPI–TCL of 110 ms, yet the pacing site is within the CTI.
The learning point: pacing too fast can introduce local delay and prolong the PPI. In this published example, repeat pacing at 250 ms at the same site produced a PPI nearly identical to TCL. The pacing rate matters.
EGM: Ellenbogen KA, ed. Essential Concepts of Electrophysiology and Pacing through Case Studies.
Supporting study: Vollmann et al. JACC. 2012;59:819–824.
doi.org/10.1016/j.jacc.2011.…
#EPeeps #AIinEP #Visualize_EGMs
not the real Chris Stanton retweeted
A research paper written by authors from the American Board of Medicine claims its products saves society money. At the same time they take 110 million dollars a year from doctors.
Also JAMA IM is a garbage journal and I'm embarrassed to have published in it.
Medicare patients of general internists with higher Longitudinal Knowledge Assessment scores were significantly less likely to receive low-value services, underscoring the role of physician knowledge in reducing unnecessary care. ja.ma/4rhxtat
not the real Chris Stanton retweeted
Look at the comments. Astonishing how disliked the AMA is by physicians and the public.
This is a good time to support CMS’s effort to dissociate the AMA from professional billing by physicians.
Nobody wants them involved
This comes from someone who was a huge supporter of the AMA until, like so many before me, got completely screwed over by them.
not the real Chris Stanton retweeted
Just remember that state and federal politicians block and prevent new medical facilities from being built and then hold hearings about why healthcare is expensive.
They think you’re stupid. Politicians in every state block new hospitals, new ERs, and new places to have safe surgery. Then they cry about affordable and accessible care while asking for your vote.
I used to look up to these people. Now I listen to them recite party-written talking points they cannot defend.
In what world does less supply produce lower prices?
We imported Soviet economic planning, added American flag lapel pins, and called it healthcare policy.”
not the real Chris Stanton retweeted
If you’re a medical student, junior resident, or just new to a procedure, you might not get to do it.
But you can always be the person who sets it up.
Knowing how to prepare a procedure efficiently (equipment, positioning, workflow, anticipation), is an underrated procedural skill that differentiates good from great proceduralists.
not the real Chris Stanton retweeted
I’ll say it again - US physicians took the National Boards. Physicians should have a National License
not the real Chris Stanton retweeted
This is remarkably close to why I left.
Hospital leadership gave me a front-row seat, and eventually I realized the emperor wasn’t wearing any clothes.
Huge buildings. Endless bureaucracy. Constant claims that there was never enough money. Decisions that made little sense to the physicians actually doing the work.
Ownership doesn’t guarantee good decisions.
It just means I’m no longer forced to live with someone else’s bad ones.
not the real Chris Stanton retweeted
EVERY state needs this! And every hospital needs to follow their lead. 👇 👏👏👏
Important development in the national @ABMSCert MOC discussion: the Florida Board of Medicine has approved @nbpasadvocacy as a recognizing agency: "Once the final order is issued, physicians who hold qualifying NBPAS certification will be permitted to identify and advertise themselves as board certified in Florida."
flmedical.org/florida/Florid… @FloridaMedical
not the real Chris Stanton retweeted
Important development in the national @ABMSCert MOC discussion: the Florida Board of Medicine has approved @nbpasadvocacy as a recognizing agency: "Once the final order is issued, physicians who hold qualifying NBPAS certification will be permitted to identify and advertise themselves as board certified in Florida."
flmedical.org/florida/Florid… @FloridaMedical
not the real Chris Stanton retweeted
One of the best measures of an informed doctor: they never shock w less than maximal energy.
Don’t let your friends use less than maximum energy
The largest randomized AF DCCV trial to date shows excellent safety and efficacy with either 200J RBW or 360J BTE shocks. @AndrewNguyen_DO @atwater_brett @ISHVnews ahajrnls.org/4bVOKj2
