Nontrads over 28 yo.. why not PA?

scurred09 said:

I was just wondering why the nontrads over 28 yo chooses to go MD/DO and PA? I want to know your story, your reason for pursuing MD/DO. Are you not worried about the opportunity cost of becoming a doc versus a PA? What is it about a PA that discourages you? Please share your thoughts, pros and cons of why you are so sure of MD/DO.. Thanks.

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People who want to be the ultimate decision maker and function with more autonomy and be their own boss won't really have to spend much time on this decision.

Breadth of learning

career options, flexibility, control over a practice

Shorter path through pre-reqs for those without science undergraduate degrees

MD is probably less competitive considering the number PA spots (full disclosure, I don't have stats to back that up)

I have two sisters who are PAs. They could both have easily gotten into medical school.

One wouldn't have the energy to be a doc. Health problems, family to raise, depression. She just wants a job.

The other isn't happy as a PA. 34 MCAT, but she had a kid. I seriously doubt she'd be any happier as a doc.

Me: no kids, no baggage (aside from my transcripts), and I've learned, the hard way, what I'm good at and what I value. In my previous career I thrived on 16 hour days, agonizing over the costs and impacts of big fat scary decisions, being in charge, knowing everything and everybody, working the system. I still want to do all that - I just want my work to go towards something I value. PA isn't that work.

I applied at 33. In my case I just wanted to take the option that I could learn the absolute most in. I think MD/DO is the route if your condition is similar to this....

scurred09 said:

I was just wondering why the nontrads over 28 yo chooses to go MD/DO and not PA? I want to know your story, your reason for pursuing MD/DO. Are you not worried about the opportunity cost of becoming a doc versus a PA? What is it about a PA that discourages you? Please share your thoughts, pros and cons of why you are so sure of MD/DO.. Thanks.

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Dude. I like being a doctor and being an Emergency Physician is kind of cool, especially because everybody watches ER and thinks it's just like that. But being a PA is so not cool. Medicine mostly blows and the thought of enduring the goat rodeo as anything other than a physician is appalling. I can think of a couple of hundred other things I'd rather have done than settle for being a mid-level. Talk about bitch-slapping your ambition and your potential.

melanoleuca said:

Dude. I like being a doctor and being an Emergency Physician is kind of cool, especially because everybody watches ER and thinks it's just like that. But being a PA is so not cool. Medicine mostly blows and the thought of enduring the goat rodeo as anything other than a physician is appalling. I can think of a couple of hundred other things I'd rather have done than settle for being a mid-level. Talk about bitch-slapping your ambition and your potential.

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you are the dumbest person to learn to type

not sure how goat bit** slapping got in here but..

in my ochem class, a way bright person (ie kicking my butt in ochem 2) was pursuing the PA path b/c...

wanted to have patient contact, as heavy as possible rather than "running the show" autonomy

wanted limited med mal exposure

wanted to get in the game quickly

able to be happy on a PA salary

versus me: experience running the show (a small office) and enjoying both the authority and the challenges

comfortable accepting legal responsibility if my team screws up

OK deferring starting work (in my thinking, "starting" means I'm a resident doing a job in 4 yrs, NOT when fully trained in 10 yrs)

current salary higher than PAs earn, and current loans/family responsibilities that require higher earnings..

just my .02

I'm not sure if I count. I was 27 when I started med school and I worked as a programmer in my previous life. My reasons are the same as the previous posters. I like the autonomy, being my own boss etc of being a physician over a PA. I figure if I didn't go through with it, I would forever be resenting myself, so there's a bit of feeding my own neurosis there.

As for cost-benefit of starting later.....I think I will eventually recoup the loss of my income but it is a very delayed gratification.

I guess ultimately, when I decided to go into medicine, I figured if I could do it, why not go for it? I have no kids or mortgage and I thought it was dumb to give up my medical dream on the 'hope' that I will find a husband and we'd have kids.

It's good to be asking these questions now.
I never really seriously looked at mid-level careers, but it's probably best that you do. If nothing else, it will make you be really clear about what you want as an end result.
The process to become a doc can be brutal at times. It will be the main focus of your life and that probably doesn't change too much even when you're out practicing (I can only guess about that part, and it depends what field you enter). For some people, this is not the right field to enter.

Mid-levels get to do some similar work, but without the same time commitments; either during training or in practice.
Yes, the don't have the same responsibility, education or salary, but there are trade-offs. They probably get to have a more balanced life. This is going to be a better fit for some.

Honestly, this process has beaten me up a little and there are times when I wished I looked a little more closely at some other options. In the end, I don't think most of those would have been a good fit. I like being the "expert" in my field. That's what I was in my previous field and I don't think I would be comfortable in another role.

jojoshabadoo said:

you are the dumbest person to learn to type

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Why would you say that? Because you don't agree with me? The fact is that most (but not all) mid-levels are hired to do essentially nothing but scut work of which the medical profession is chock full. I'm talking about the boilerplate stuff, the forms, the paperwork, and the large amounts of medical energy devoted to billing and compliance.

Let's say, for example, you are an interventional cardiologist. Since your time is extremely valuable and you are mostly paid for procedures (heart caths), it makes a lot of sense to hire a PA to go down to the ED and crank out the mostly boilerplate Admission History and Physicals ("Patient is a 54-year-old man with exertional chest pain relieved by nitro blah blah blah...") required by Medicare, Medicaid, and Private insurance.

I know they fill your head with visions of sugar plums and fairies that somehow mid-levels are just like doctors except that they are more clinically oriented but, since the Goat Rodeo is primarily about money, you will be used (we are all used) in a way that maximizes the flow of money to whomever is your master. Mid-levels are lucrative because they can do the same paperwork as a physician for half the cost and nobody cares that "I'm just like a doctor except I didn't have to learn any of that useless stuff."

With this in mind, about the only thing the medical profession really has to offer is money and prestige. The rest of it is mostly a horrific slog from one ridiculous thing to another and, with this in mind, being a PA or an NP would be a consolation prize I could do without.

Amen.

I'll be 30 when I start med school next year. I agree with what many people said above. As a doctor, I would have professional autonomy and greater income potential while doing something I know I will enjoy. But everybody is different and every situation is different (as some people have already pointed out). In the end, only you can decide what will make you happy. If that means being a PA, then that's great too.

I'll be 31 on my second day of Orientation.... Happy Birthday to me eh?

Being a PA wasn't discouraging, but being a full-blown Physician... being an absolute expert in something... that's sexy to me (not in a shallow way, but in an intellectually stimulating, life fulfilling way).

I have nothing but respect and admiration for PAs, their jobs, and their lack of debt... It's just the lack of depth they have. Obviously, an experienced PA will have depth, but not the same as a physician post-residency, post-fellowship... (But they can also switch fields much more easily).

scurred09 said:

I was just wondering why the nontrads over 28 yo chooses to go MD/DO and not PA? I want to know your story, your reason for pursuing MD/DO. Are you not worried about the opportunity cost of becoming a doc versus a PA?

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For me, an attorney, going to PA school would be sort of like a doctor switching careers by going to paralegal school instead of law school. It seems like a step back.

I don't like the idea of treating patients without having the extensive knowledge base and clinical training of a physician. The increasing use of loosely supervised PAs for primary care is scary. In the legal field, paralegals cannot give legal advice. Period. I'm simply amazed that the medical profession allows PAs and other midlevels diagnose and treat illness, and prescribe medication.

I have been mentoring my nephew who is a college senior headed to PA school. Smart kid who would have been a lock for med school.

The kid already has a job lined up with the local dermatologist (who is admittedly a family friend). Anyway, my nephew will be 24 years old making a base of 100K with achievable incentives that could take his salary to 200K+. He will be seeing new medical consults independently, assisting on MOHS surgery, perfoming Botox and other cosmetic procedures, etc. He will be living large at the age of 24.

Being a PA is not a lesser profession by any means. It does not have to be grunt work and pencil pushing.

futureboy said:

For me, an attorney, going to PA school would be sort of like a doctor switching careers by going to paralegal school instead of law school. It seems like a step back.

I don't like the idea of treating patients without having the extensive knowledge base and clinical training of a physician. The increasing use of loosely supervised PAs for primary care is scary. In the legal field, paralegals cannot give legal advice. Period. I'm simply amazed that the medical profession allows PAs and other midlevels diagnose and treat illness, and prescribe medication.

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Nah, JD to PA is still a step up. (j/k)

jojoshabadoo said:

you are the dumbest person to learn to type

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Relax. Yes, Melanoleuca can be cynical and his posts are an acquired taste for some. However, whether you agree with him or not, his posts are usually thought provoking. His blunt style is a refreshing counterpoint to the "I want to be a doctor so I can help people" premeds.

Remember, he is a practicing physician, and most of us are not.

mboaz said:

Nah, JD to PA is still a step up. (j/k)

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I guess so, if they're making $200,000 per year in their first job...

I just don't understand the question. PA is not the same thing as physician, and why 28 as an arbitrary age after which you should toddle along in your current career towards dementia??

I don't want to be a mid-level anything. That's why not PA. And I too look at the start of my career as residency. Maybe even M3/M4. It's just like an entry level position in other kinds of careers. Your pay sucks and your hours blow and your learning curve makes you cry. And other people ask you insulting questions that you have no idea how to answer.

futureboy said:

Relax. Yes, Melanoleuca can be cynical and his posts are an acquired taste for some. However, whether you agree with him or not, his posts are usually thought provoking. His blunt style is a refreshing counterpoint to the "I want to be a doctor so I can help people" premeds.

Remember, he is a practicing physician, and most of us are not.

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Four more weeks and 15 shifts, Baby!

And then I am free at last, free at last.

And I want to give a "shout out" to any of you in the Shreveport area where I will be working.

jojoshabadoo said:

you are the dumbest person to learn to type

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Hey, for a dumb person I type a lot:

www.studentdoctor.net/pandabearmd

Yeah, and you have mad verbal skeeeeelz for an engineer.

CuriousKat said:

Smart kid who would have been a lock for med school...

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Is anyone really a "lock for medical school" these days? Even 4.0 students get rejections.

CuriousKat said:

He will be seeing new medical consults independently.

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Non-physicians dispensing medical advice without supervision. Great.

CuriousKat said:

Being a PA is not a lesser profession by any means.

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Compared to the physician, it is.

just depends on what you want to do...if you become a pa you will always be a pa or midlevel...unless you go back to school....if i went back now i would go to MD because getting a pa with my pharmacy degree would be side stepping to me...but i generally like my job now and have no scut work etc...i just round with the surgeons....make up better ways to do stuff...and do research and publish....the pa/np looks pretty stressed out usually and i liken them to an intern on most services...they are there to get the note in the chart before we round....there are a few around though that think they are better than the attending (usually the nps) and i know several midlevels who are going back to med school now because they just were not satisfied...i think about it but then i look at the student loans i have and cringe

Compared to the physician, it is.[/QUOTE]

So says the person who is not yet in med school and is minimum 7 years from BC

for me it is at least two things.
1) I don't like not being the boss.
2) I don't believe that PAs are viewed the same way as Physicians. If I go to see the "doctor" and I am seen by a PA instead, I feel slighted even if i get good care. I feel like a physician type person and I desire to be viewed that way.

futureboy said:

Relax. Yes, Melanoleuca can be cynical and his posts are an acquired taste for some. However, whether you agree with him or not, his posts are usually thought provoking. His blunt style is a refreshing counterpoint to the "I want to be a doctor so I can help people" premeds.

Remember, he is a practicing physician, and most of us are not.

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I agree. I want realistic answers.

A lot of people become cops because they "want to help people." There are countless jobs where you can do that, and some of those also appeal to me while many don't. I became a cop because I thought it would be a **** load of fun. It was. I lived it, and now I want to move on to the next and last thing on my list - being a doctor. I've accomplished everything else I set out to do. I'll get in somewhere, and I'll make it through the process eventually despite all the hoops one has to jump through. I've had enough experiences in life to know my limitations, and neither medicine nor admissions committees aren't them. I question it a lot, and have thoughts of PA'ing around, but it's what I keep wanting to do despite the fact that I have a bad*** job. A lot of what I do now leaves me grinning ear to ear when no one is looking, and if I'm ready to give that up, as I am, then heck yeah I'm cut out for med school.

njbmd said:

I was a research scientist (Ph.D in Biochemistry) before medical school with rank of Assistant Professor in a tenure track. I enjoyed the intellectual work of research and teaching in an exciting environment. I applied to medical school (six schools) at age 45 thinking that I probably wouldn't get in but I would give it a shot and see what happened. I got into all six and received a full-ride scholarship. Now, I am a physician/research scientist/professor with a great job back in my tenure-track position with more options. I have no debt, part owner of my own plane, have my own estate (90 acres), writing most of healthcare policy in my state and loving every second of what I do. PA just would not have worked for me.

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Thanks for a well thought out unbiased answer. The trashtalking that goes on around here about the the midlevels just gets me riled up. I am so tired of those who see us as less than. I am an NP and proud to be so. I am however premed because I desire more authority and knowledge. But make no mistake NP's/PA's are not idiots for goodness sakes! I have a master's degree in nursing with a required 500 plus clinical hours in the NP program and a prior histiory 10 years as a nurse which helped me tremendously. I care a lot about my patients and see that they get the very best care possible. Come on people!!! ...and I might add that my day is not filled writing H&P's or doing grunt work either. I work in a family practice clinic and see 30-40 patients a day along side the docs and have done so for 3 years. Not one of my patients have suffered negligence or detrimental effects as a result of having seen me.

Don't you think it's unreasonable to assume that in three years of treating patients not one has had a detrimental effect as a result of seeing you?

I assume that in medicine, as in any other profession, that I will make mistakes, overlook things etc. Now, generally, these mistakes are small and not very serious, but they are there.

I'm gonna agree with Sindadel on both counts - there's nothing magical about 28 or any other age, and PA isn't really Dr-lite. Opportunity cost is making the choice between two desirable but mutually exclusive choices, and where that line falls is completely individual based on your desires and situation.

My actual decision making process wasn't particularly interesting - I was going to have to switch careers to be happy, would require training for any of the fields I thought were enticing, and medicine was the best balance between $$ cost and enjoying how I was using my brain. I used to fall 100% on the risk averse side of the equation, but over time my values shifted a bit away from financial stability and more towards job satisfaction. For many people the flat reality is that pursuit of a satisfying life entails assuming some risk and I really envy the people for whom that isn't true.

southerngrl said:

Thanks for a well thought out unbiased answer. The trashtalking that goes on around here about the the midlevels just gets me riled up. I am so tired of those who see us as less than. I am an NP and proud to be so. I am however premed because I desire more authority and knowledge. But make no mistake NP's/PA's are not idiots for goodness sakes! I have a master's degree in nursing with a required 500 plus clinical hours in the NP program and a prior histiory 10 years as a nurse which helped me tremendously. I care a lot about my patients and see that they get the very best care possible. Come on people!!! ...and I might add that my day is not filled writing H&P's or doing grunt work either. I work in a family practice clinic and see 30-40 patients a day along side the docs and have done so for 3 years. Not one of my patients have suffered negligence or detrimental effects as a result of having seen me.

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There is no trash talk. The truth is that most of American Goat Rodeodery is ridiculous and unnecessary and consequently most of any "providers" job is also ridiculous and unnecessary. Since a mid-level can handle most of the ridiculous and unnecessary work, they are more economical than physicians and the highly artificial market that is medicine responds accordingly.

Let's say you see 30-40 patients a day. How many of them really need to be seen or have medical problems for which you can do anything more than whip a little placebo medicine on them or fill out some forms? No need to bull**** me by the way, I did a year of family practice and most of the patients I saw during clinic had sublimely ridiculous or extremely minor complaints that needed no therapy whatsoever except what used to be common sense.

Even in the Emergency Department where I currently work, a place you would think would have mostly sick patients the majority are ridiculous and some criminally so.

southerngrl said:

Thanks for a well thought out unbiased answer. The trashtalking that goes on around here about the the midlevels just gets me riled up. I am so tired of those who see us as less than. I am an NP and proud to be so. I am however premed because I desire more authority and knowledge. But make no mistake NP's/PA's are not idiots for goodness sakes! I have a master's degree in nursing with a required 500 plus clinical hours in the NP program and a prior histiory 10 years as a nurse which helped me tremendously. I care a lot about my patients and see that they get the very best care possible. Come on people!!! ...and I might add that my day is not filled writing H&P's or doing grunt work either. I work in a family practice clinic and see 30-40 patients a day along side the docs and have done so for 3 years. Not one of my patients have suffered negligence or detrimental effects as a result of having seen me.

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500 clinical hours is nothing. An internal medicine resident on the day he graduates probably has 15,000 clinical hours or 30 times what you have.

Just giving you a little perspective.

As for being a nurse...that's cool. I like and respect nurses but a nursing degree and 500 clinical hours just makes you a nurse with 500 clinical hours.

sindadel said:

Don't you think it's unreasonable to assume that in three years of treating patients not one has had a detrimental effect as a result of seeing you?

I assume that in medicine, as in any other profession, that I will make mistakes, overlook things etc. Now, generally, these mistakes are small and not very serious, but they are there.

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I did not say I did not make mistakes. I said that none of the patients I have seen have suffered from seeing an NP vs an MD. I am not going to debate NP vs MD with you are anybody else. I think there is room for both. That's all...

melanoleuca said:

500 clinical hours is nothing. An internal medicine resident on the day he graduates probably has 15,000 clinical hours or 30 times what you have.

Just giving you a little perspective.

As for being a nurse...that's cool. I like and respect nurses but a nursing degree and 500 clinical hours just makes you a nurse with 500 clinical hours.

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I am not trying to compare my litte pittance of 500 clinical hours to what med students cover at all. Just letting you know that NP's are trained and have some experience. I worked hard to get where I am today. I don't need you or anyone else's blessing on what I do. Please resist the urge to respond to my last reply to this post. I joined SDN to engage in positive and meaningful discussion about the journey to becoming a physician. I will reserve posting in discussions with others who are positive as well.
Peace out!

I started medical school at 30. I already had a BS and MS in biology. I decided I was going to go on for a Phd in Bio or on to an MD.

For me it was (1) I want to know the science behind everything, I am not content with a midlevel degree of knowledge and (2) I already had the pre-reqs for med school completed so all I had to do was take the MCAT and shadow, for a PA I would have had to spend at least a year getting clinical work experience, etc (I don't know if all PA programs require that but the ones I looked into around me all did). So it was actually quicker for me to go MD. Oh, and (3) would be the autonomy.

southerngrl said:

I am not trying to compare my litte pittance of 500 clinical hours to what med students cover at all. Just letting you know that NP's are trained and have some experience. I worked hard to get where I am today. I don't need you or anyone else's blessing on what I do. Please resist the urge to respond to my last reply to this post. I joined SDN to engage in positive and meaningful discussion about the journey to becoming a physician. I will reserve posting in discussions with others who are positive as well.
Peace out!

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Why does everything have to be positive to be meaningful? Actually, the negative is probably more or as important as the positive.

southerngrl said:

I did not say I did not make mistakes. I said that none of the patients I have seen have suffered from seeing an NP vs an MD. I am not going to debate NP vs MD with you are anybody else. I think there is room for both. That's all...

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You see, you don't get it. Most of clinical medicine is done at such a low level or is so trivial that it doesn't matter what you do as long as you don't get too ridiculous about it. In other words, I could work at a clinic giving out generic drugs for generic medical conditions or placebos for most of what I saw and the risk to my patients would be almost nothing. Likewise in the Emergency Department most of the patients could go home with no interventions and no lab tests or studies and they would be perfectly fine except for their chronic and largely self-inflicted diseases. We make a big show of working people up but it is mostly sound and fury, the ones who are really sick are usually obvious and the ones who aren't, except that patients lie, usually are too.

melanoleuca said:

You see, you don't get it. Most of clinical medicine is done at such a low level or is so trivial that it doesn't matter what you do as long as you don't get too ridiculous about it. In other words, I could work at a clinic giving out generic drugs for generic medical conditions or placebos for most of what I saw and the risk to my patients would be almost nothing. Likewise in the Emergency Department most of the patients could go home with no interventions and no lab tests or studies and they would be perfectly fine except for their chronic and largely self-inflicted diseases. We make a big show of working people up but it is mostly sound and fury, the ones who are really sick are usually obvious and the ones who aren't, except that patients lie, usually are too.

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That's some real ****.

Man, who says Tupac is dead. I think he's just an ED physician now.

I mean. I get back stage a lot. But is rare to see the Russian acrobatic tapeze royalty smoking cigarettes with the tent crew. I often wondered how the majority of you stay in character so hard. How you cope with the central paradox of it. ? And then go on with the drum major routine.

Nasrudin said:

That's some real ****.

Man, who says Tupac is dead. I think he's just an ED physician now.

I mean. I get back stage a lot. But is rare to see the Russian acrobatic tapeze royalty smoking cigarettes with the tent crew. I often wondered how the majority of you stay in character so hard. How you cope with the central paradox of it. ? And then go on with the drum major routine.

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[tangent]
Check this out if you have not already, it's a classic & it's all about said paradox.
[/tangent]

I speak literate-yet-funky Californian, and Nas is always onto something, so let me translate.

Nasrudin said:

That's some real ****.

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"Thank you for not blowing smoke up our heinies."

Nasrudin said:

Man, who says Tupac is dead. I think he's just an ED physician now.

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// this part I'm not sure I understand, unless it means we keep hearing from Panda even though he's using a different alias now

Nasrudin said:

I mean. I get back stage a lot. But is rare to see the Russian acrobatic tapeze royalty smoking cigarettes with the tent crew.

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"There are 150,000 premeds on SDN, and ~5 practicing physicians, so to us, you're a rock star and we don't really know how to handle it."

Nasrudin said:

I often wondered how the majority of you stay in character so hard. How you cope with the central paradox of it. ? And then go on with the drum major routine.

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"Knowing what you know, particularly the futility of it all, how do you keep going back day after day, how do you maintain professionalism?"

(Am I close, Nas?)

DrMidlife said:

I speak literate-yet-funky Californian, and Nas is always onto something, so let me translate.

"Thank you for not blowing smoke up our heinies."

// this part I'm not sure I understand, unless it means we keep hearing from Panda even though he's using a different alias now

"There are 150,000 premeds on SDN, and ~5 practicing physicians, so to us, you're a rock star and we don't really know how to handle it."

"Knowing what you know, particularly the futility of it all, how do you keep going back day after day, how do you maintain professionalism?"

(Am I close, Nas?)

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Ma'am you do confer your dignity on me with a grace I believe I do not deserve. Why I have developed such a proclivity for nonsense I could not say.

Mr. Panda represents to me someone on the inside who is not afraid of puncturing the elaborate mythology that surrounds doctoring.

The tent crew is me and all the other cockroaches who have much less stake in seeing the thing go up in flames. Except for that we have been rendered, institutionally, unemployable by these harsher, less hospitable firms that roam this economy raping and pillaging *****s everywhere. We too fall in line.

And still. The hilarity of it all. And the grotesque futility. How does one rally the troops against such existential threats. ?

Perhaps a picture is more succint.

I'm waiting with a patient for the CT technician.

This woman has been turfed back in forth from some over run public home to the ED several times recently all in various states of rotting to death in her own piss.

So as I am caressing her hair. I'm not thinking hold on ma'am Dr. so-n-so will make it alright. I'm thinking. We all pass like strangers through this gray abyss. Under the dull hiss of fluorescent lights. The sound of roughly drawn breaths. I'm thinkin ma'am if you're gonna go now's a good a time as any, cause these people are bound to get medieval on your @ss out of bureaucratic imperative.

So if the sole chance of executing some thought process of clinical acumen on a small but measurably improvable problem. Then get me some of that. Uncut. The PA gig is all stomped on. In the drug trafficking sense.

I was a PA for 6 yrs before starting med school. I will be starting 3rd year in 2 weeks (with a little thing called Step I to get thru 1st).
Here is my take on the cost:benefit, etc.
My salary as a PA: ~85,000 plus benefits.

So, subtract 4yrs of that cut in half (I am lucky that I still get half my salary by continuing to work-I guess it's luck or just crazy). That is a 170,000 lost there. Add to that the approx 400,000 debt I am incurring.

That is a total loss of about 600,000.

I try not to think about the financial loss, otherwise, I could not say it was worth it. I think about all the reasons it is worth it.
I will be a doctor, what I have really always wanted to be. I will have autonomy and more control over my career. And, as someone who was a PA, I can say that I did not fully realize all that I DID NOT know until I went to medical school.
The shear volume we undertake as med students is amazing. This is why the buck stops with us most times, because we have the depth of knowledge.

I fully respect PA's and hope to continue to work in partnership in the future. I just realized that for me, I would never be fully content.

Good luck to everyone, no matter what path you chose.

Nasrudin said:

Perhaps a picture is more succint.

I'm waiting with a patient for the CT technician.

This woman has been turfed back in forth from some over run public home to the ED several times recently all in various states of rotting to death in her own piss.

So as I am caressing her hair. I'm not thinking hold on ma'am Dr. so-n-so will make it alright. I'm thinking. We all pass like strangers through this gray abyss. Under the dull hiss of fluorescent lights. The sound of roughly drawn breaths. I'm thinkin ma'am if you're gonna go now's a good a time as any, cause these people are bound to get medieval on your @ss out of bureaucratic imperative.

So if the sole chance of executing some thought process of clinical acumen on a small but measurably improvable problem. Then get me some of that. Uncut. The PA gig is all stomped on. In the drug trafficking sense.

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Dude, you have got to guest-author on my blog. That elegantly captures the ridiculousness of the Goat Rodeo. Let me at least use this as a part of my next article.

melanoleuca said:

Dude, you have got to guest-author on my blog. That elegantly captures the ridiculousness of the Goat Rodeo. Let me at least use this as a part of my next article.

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I thought so too, Nasrudin can sometimes really eloquently summarize the ridiculousness of the healthcare system. It sounds like something out of "House of God" when he wrote that paragraph.