Are there still lifestyle specialties besides derm?

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So France is killing babies left and right and Botswana is trying to save them all? But then if they weren't trying to save babies and letting them die, wouldn't the mortality rate be higher?
Seriously? Very prematureally babies are not counted as live births in many countries.

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So France is killing babies left and right and Botswana is trying to save them all? But then if they weren't trying to save babies and letting them die, wouldn't the mortality rate be higher? You do realize that effort to save a baby doesn't matter if the baby dies.

Not if you don't count them!

Many of those countries take a Mulligan.

You're in medicine, you should learn not to gobble up everything you're spoonfed. Doubly so if it happens to agree with your preconceived agenda/rhetoric.
 
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Is the US #1 for amount of people who shouldn't be having children who are having children?
 
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I'm not sure that most pediatricians favor single payer. In many states Medicaid reimbursement is low. The odds are that single payer would result in universally low payments. Some places like FQHCs get better reimbursement but how long will it last?

Regarding ACA, that resulted in many patients with insurance but essentially no coverage due to ridiculous deductibles. Essentially they are self pay so they don't want to come in or only want immunizations for example.


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I'm not sure that most pediatricians favor single payer. In many states Medicaid reimbursement is low. The odds are that single payer would result in universally low payments. Some places like FQHCs get better reimbursement but how long will it last?

Regarding ACA, that resulted in many patients with insurance but essentially no coverage due to ridiculous deductibles. Essentially they are self pay so they don't want to come in or only want immunizations for example.


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I make that statement only from pediatricians I know, ones working in a academic tertiary care center serving all comers. I don't know private practice pediatricians serving affluent areas. I imagine their opinion is different though.
 
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Is that seriously all you got out of that?

She quotes one article and concludes :
The poor infant mortality rate is used as a slogan to increase market share and profits for midwifery among Western, white, well off women, the demographic most likely to choose midwifery services. The victims of high US infant mortality are left to fend for themselves.

It is hard to take that seriously and objectively
 
She quotes one article and concludes :
The poor infant mortality rate is used as a slogan to increase market share and profits for midwifery among Western, white, well off women, the demographic most likely to choose midwifery services. The victims of high US infant mortality are left to fend for themselves.

It is hard to take that seriously and objectively
Jesus Christ.

Let's look at a quote from the article she's actually reviewing, shall we?

In other words, as I’ve written countless times over the years, direct comparisons of national infant mortality rates are invalid because the US includes very premature babies born alive, while many other countries do not. Since the highest death rates are in very premature babies, failure to include them makes other countries’ infant mortality rates look far better than they really are.

How did Oster et al. address this problem?

… We combine US natality micro-data with similar data from Finland, which has one of the lowest infant mortality rates in the world, and Austria, which has similar infant mortality to much of continental Europe. We first provide a detailed accounting of the US IMR disadvantage, quantifying the importance of differential reporting, conditions at birth (that is, birth weight and gestational age), neonatal mortality (deaths in the first month), and postneonatal mortality (deaths in months 1 to 12)… Second, we provide new evidence on the demographic composition of the US IMR disadvantage.

What did they find?

… Differential reporting of births near the threshold of viability can explain up to 40% of the US infant mortality disadvantage. Worse conditions at birth account for 75% of the remaining gap relative to Finland, but only 30% relative to Austria. Most striking, the US has similar neonatal mortality but a substantial disadvantage in postneonatal mortality. This postneonatal mortality disadvantage is driven almost exclusively by excess inequality in the US: infants born to white, college-educated, married US mothers have similar mortality to advantaged women in Europe. Our results suggest that high mortality in less advantaged groups in the postneonatal period is an important contributor to the US infant mortality disadvantage
 
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Jesus Christ.

Let's look at a quote from the article she's actually reviewing, shall we?

In other words, as I’ve written countless times over the years, direct comparisons of national infant mortality rates are invalid because the US includes very premature babies born alive, while many other countries do not. Since the highest death rates are in very premature babies, failure to include them makes other countries’ infant mortality rates look far better than they really are.

How did Oster et al. address this problem?

… We combine US natality micro-data with similar data from Finland, which has one of the lowest infant mortality rates in the world, and Austria, which has similar infant mortality to much of continental Europe. We first provide a detailed accounting of the US IMR disadvantage, quantifying the importance of differential reporting, conditions at birth (that is, birth weight and gestational age), neonatal mortality (deaths in the first month), and postneonatal mortality (deaths in months 1 to 12)… Second, we provide new evidence on the demographic composition of the US IMR disadvantage.

What did they find?

… Differential reporting of births near the threshold of viability can explain up to 40% of the US infant mortality disadvantage. Worse conditions at birth account for 75% of the remaining gap relative to Finland, but only 30% relative to Austria. Most striking, the US has similar neonatal mortality but a substantial disadvantage in postneonatal mortality. This postneonatal mortality disadvantage is driven almost exclusively by excess inequality in the US: infants born to white, college-educated, married US mothers have similar mortality to advantaged women in Europe. Our results suggest that high mortality in less advantaged groups in the postneonatal period is an important contributor to the US infant mortality disadvantage

Here is the actual abstract

"US has similar neonatal (<1 month) mortality but higher postneonatal (1-12 months) mortality."

http://www.ncbi.nlm.nih.gov/m/pubmed/27158418/

I suggest you read Figure 2 and Figure 7 of the paper too.

Essentially the article says that while the infant mortality rate maybe less than previously reported, the US mortality rate is still higher than in Austria and Finland because we stink at taking care of poor people. I'm not sure how the article helps your point that infant mortality rates are useless data, but I do agree, the actual article speaks the truth.
 
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And Im fed up with people who disparage anyone who doesnt share their romanticized notions of medicine..Not all of us had physician parents. Its not an idealistic fairy tale world for everyone...when you grow up poor, its impossible to look past the financial aspect of your career ambitions. Im not saying im doing medicine for the money, but im not ashamed to admit that thats a major factor. Its a means of huge social mobility for people like me, whose parents worked as janitors...the fact of the matter is that im going to be making at least 5x what either of my parents made. Of course i think about that. I want to have the means to care for them and pay them back for the sacrifices they made for me, to allow them to experience some of the things they could never afford for themselves...and to give my children the things that I never got to experience in my own childhood. That doesnt mean I care less about my future patients. I can and will care just as much as any other physician out there. As long as youre practicing good, evidence-based medicine and producing good outcomes, who really cares what your incentive is??? Im sick of this martyrdom culture. There should be no shame in wanting a nice lifestyle if you work for it and earn it.

No one cares. Stop with the inferiority complex.


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I make that statement only from pediatricians I know, ones working in a academic tertiary care center serving all comers. I don't know private practice pediatricians serving affluent areas. I imagine their opinion is different though.

Are you compensated based on RVUs or straight salary or in another way?


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Do you have a quota of RVU's, below which you would get reprimanded/penalized?

Maybe, don't know. I would assume if you didn't meet a benchmark RVU you would be reprimanded during annual performance review, but I've never gotten below 80% benchmark. I know the bonuses start at 60% benchmark for one's FTE though.
 
Maybe, don't know. I would assume if you didn't meet a benchmark RVU you would be reprimanded during annual performance review, but I've never gotten below 80% benchmark. I know the bonuses start at 60% benchmark for one's FTE though.

What RVU number is your benchmark if you don't mind revealing?


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Well, I'm a physician-scientist and have a lower FTE based on salary from the NIH, but 50% is around 2,000, 95% is close to 5,500, but that is for a 0.3 FTE.

Is yours a procedure based specially?


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Well, I'm a physician-scientist and have a lower FTE based on salary from the NIH, but 50% is around 2,000, 95% is close to 5,500, but that is for a 0.3 FTE.

Is that work or total RVU?


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wRVU only, but we don't get other RVUs. I wish they counted other academic RVUs, but I doubt they ever will.

Does your contract have a dollar paid per RVU or more of a revenue share based on levels of RVUs?


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No. Salary based on FTE and fringe benefits.

Sorry to get into the weeds there. I was planning to do the peds anesthesia/PICU track after peds, though had military obligation first. Problem then was the boards kept tacking on time needed to be triple boarded so decided to stay in general peds. Compensation is great but very high production based. With current position payor mix doesn't matter, but in private practice it did, though the overhead was far less than hospital based employed.

Single payor is very reminiscent of military medicine which was low pay and no real incentives or option to be a high producer. Now with MACRA coming looks like thing may change drastically eventually, but who knows?
 
Sorry to get into the weeds there. I was planning to do the peds anesthesia/PICU track after peds, though had military obligation first. Problem then was the boards kept tacking on time needed to be triple boarded so decided to stay in general peds. Compensation is great but very high production based. With current position payor mix doesn't matter, but in private practice it did, though the overhead was far less than hospital based employed.

Single payor is very reminiscent of military medicine which was low pay and no real incentives or option to be a high producer. Now with MACRA coming looks like thing may change drastically eventually, but who knows?

There are incentives in academics to be a high producer, but there is little penalty for being a poor producer, at least from what I've seen. That being said, the incentives aren't much (ie, I publish and get grants, but get no RVUs for it, in fact I lose wRVUs relative to my colleagues) so you have to do what makes you happy and makes it enjoyable to come to work everyday.

As far MACRA, yeah we'll see.
 
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I'm not sure that most pediatricians favor single payer. In many states Medicaid reimbursement is low. The odds are that single payer would result in universally low payments. Some places like FQHCs get better reimbursement but how long will it last?

Regarding ACA, that resulted in many patients with insurance but essentially no coverage due to ridiculous deductibles. Essentially they are self pay so they don't want to come in or only want immunizations for example.


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So those patients now still come to the ED as their only option, and most of the care remains without reimbursement, but at least the patient only gets billed the negotiated rate so that's better, right?
 
So those patients now still come to the ED as their only option, and most of the care remains without reimbursement, but at least the patient only gets billed the negotiated rate so that's better, right?

The ones I'm talking about avoid the ER and healthcare in general because they have sometimes deductibles close to $10k. Some call wanting meds without being seen. But the proponents of Obamacare call them "insured" even though effectively they have insufficient coverage.


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Here is the actual abstract

"US has similar neonatal (<1 month) mortality but higher postneonatal (1-12 months) mortality."

http://www.ncbi.nlm.nih.gov/m/pubmed/27158418/

I suggest you read Figure 2 and Figure 7 of the paper too.

Essentially the article says that while the infant mortality rate maybe less than previously reported, the US mortality rate is still higher than in Austria and Finland because we stink at taking care of poor people. I'm not sure how the article helps your point that infant mortality rates are useless data, but I do agree, the actual article speaks the truth.
OK good, we're making progress.

Interestingly, it seems our rate of premature births is almost entirely responsible for our high infant mortality (if you correct for that, our mortality rate drops to 4/1000), combine that with the 40% improvement by standardizing the definition of "live birth" and we're right up there with the best in the world.

So then, let's look at premature births. If you look at the most common risk factors that for (no partner support, age <18, smoking, substance abuse, low education level) those are absolutely issues more commonly seen in poor people. However, I'm not sure how medicine is supposed to fix those (if you meant America as a whole when you said "we stink at taking care of poor people" and not the medical system then we're in agreement and you can ignore the rest of this). In order of my list: I'm not sure what doctors/nurses/midwives can do to make fathers stick around. Same with teen pregnancy, other than advocating for better sex ed which many physicians do. Same with smoking and substance abuse - I actually try fairly hard to get my patients to stop smoking and it rarely takes, sometimes it does and we absolutely should keep trying but I think the better route is the New York approach of stupidly high cigarette taxes. Low education level correlates with teen pregnancy (and then subsequent pregnancies by said teen moms) and that seems outside the realm of medicine.
 
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(if you meant America as a whole when you said "we stink at taking care of poor people" and not the medical system then we're in agreement and you can ignore the rest of this).

Yes, I never intended to say that direct medical care was worse for people in lower SES, but the medical system as a whole (which I'm mostly talking about insurance) does a poor job of providing care. Physicians refuse Medicare patients not because they don't like the patients, but because the reimbursements aren't worth their effort, thus the insurance (or poor insurance) drives a lack of care and poorer outcomes. But these are all a reflection of a larger systemic issue. Healthcare is just one of many of the problems. But it also happens to be the one I'm most intimately involved, therefore I have the strongest opinion about.
 
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You don't know me or how hard I work/care, so don't make presumptions about that. I would honestly say that I work harder than the average student in my M1 class (and my grades lately are consistently above the class average, for the record)

I think it's foolish to be proud of being overworked. We should be striving to work smarter, not brutishly harder.

I owe you an apology. I'm sorry for the hostility of my initial post, and I don't like how other people are piling on. I'm glad your hard work is paying off. You've earned it.

But "I can be just as good" by working smarter still seems silly to me. At the margins--when you start talking about being better that good--everybody is already pretty damn smart. There are no shortcuts to success (as I'm sure you know, with how hard you're working now to get your high grades).

My point (not directed at you, just in general): we can't all be the best, and we need to find balance in life. I wish more medical students would realise this before feeling personally traumatised for getting an average Step 1 score or whatever (*cough* @failedatlife *cough*). It is what it is, and that doesn't mean you're a bad doctor or a lazy person. Realistic self-acceptance is key to a happy life IMHO. So is being okay with other people being better than you, especially if they consistently outwork you in devotion to craft (which is not just busy work or obsessing over useless details). That's true for any speciality, even the "lifestyle" ones.

Don't forget that a speciality is often a 30+ year commitment. Imagine how much the world has changed in the past 30 years. No "lifestyle" speciality will look the same in 10 years, let alone 30. Just ask radiology. My suggestion: pick what you love to do and let the rest sort itself out. I know it sounds pat, but ultimately what's in your circle of control?
 
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Yes, I never intended to say that direct medical care was worse for people in lower SES, but the medical system as a whole (which I'm mostly talking about insurance) does a poor job of providing care. Physicians refuse Medicare patients not because they don't like the patients, but because the reimbursements aren't worth their effort, thus the insurance (or poor insurance) drives a lack of care and poorer outcomes. But these are all a reflection of a larger systemic issue. Healthcare is just one of many of the problems. But it also happens to be the one I'm most intimately involved, therefore I have the strongest opinion about.
This might be a regional thing, but even that is changing. Lots of the private practice groups in my area have stopped seeing Medicare not because the reimbursements are bad (for outpatient they're not terrible) but because of the ever increasing mandates and regulations.

Now Medicaid is entirely reimbursement related (well, and patient population for us adult doctors) as even the pediatricians around here don't accept it.
 
I owe you an apology. I'm sorry for the hostility of my initial post. And I'm glad your hard work is paying off. You've earned it.

But "I can be just as good" by working smarter seems a little silly to me. At the margins--when you start talking about being better that good--everybody is already pretty damn smart. There are no shortcuts to success (as I'm sure you know, with how hard you're working now to get your high grades).

My point (not directed at you, just in general): we can't all be the best, and we need to find balance in life. I wish more medical students would realise this before feeling personally traumatised for getting an average Step 1 score or whatever (*cough* @failedatlife *cough*). It is what it is, and that doesn't mean you're a bad doctor or a lazy person. Realistic self-acceptance is key to a happy life IMHO. So is being okay with other people being better than you, especially if they consistently outwork you in devotion to craft (which is not just busy work or obsessing over useless details). That's true for any speciality, even the "lifestyle" ones.

Don't forget that a speciality is often a 30+ year commitment. Imagine how much the world has changed in the past 30 years. No "lifestyle" speciality will look the same in 10 years, let alone 30. Just ask radiology. My suggestion: pick what you love to do and let the rest sort itself out. I know it sounds pat, but ultimately what's in your circle of control?

Agree. If you chose a specialty based on lifestyle but don't really like it you'll have more job stress which defeats the purpose. Also if you like the field not all positions are the same so u may be able to find a position that checks the boxes even though it may not seem that way based solely on stats. I know pediatricians who have made over $450 with minimal call minimal if any weekends but the mantra here is u only can make $150.


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This might be a regional thing, but even that is changing. Lots of the private practice groups in my area have stopped seeing Medicare not because the reimbursements are bad (for outpatient they're not terrible) but because of the ever increasing mandates and regulations.

Now Medicaid is entirely reimbursement related (well, and patient population for us adult doctors) as even the pediatricians around here don't accept it.

Though I understand the financial disincentives from the providers standpoint, this really only contributes to the problem. Again, medicine is a mess, on many levels.
 
Though I understand the financial disincentives from the providers standpoint, this really only contributes to the problem. Again, medicine is a mess, on many levels.

We are physicians. Not providers. This is an allo/MD board and we are not midlevels. [many are medical students who will be physicians shortly and the point remains the same].

Have some respect for yourself and your profession. Don't let this subtle but damaging difference in language put forth by administrators creep into your psyche.
 
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We are physicians. Not providers. This is an allo/MD board and we are not midlevels. [many are medical students who will be physicians shortly and the point remains the same].

Have some respect for yourself and your profession. Don't let this subtle but damaging difference in language put forth by administrators creep into your psyche.

Ha. If you want to define yourself by a title, you are welcome to do so.

Oh, and I've met some great "mid-levels" and I've met some poor "physicians". Respect is earned on an individual basis, not a given or denied based on a title.
 
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Ha. If you want to define yourself by a title, you are welcome to do so.

Oh, and I've met some great "mid-levels" and I've met some poor "physicians". Respect is earned on an individual basis, not a given or denied based on a title.

Yeah yeah blah blah everyone loves to trot out the "hurr durr some doctors are not good and some midlevels are awesome" trope time and time again. That's not the point and the fact that you instantly reach for that is both predictable and concerning.

This discussion has been hashed out elsewhere, but suffice it to say you do yourself no favors to professionally neuter yourself with that language.
 
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Yeah yeah blah blah everyone loves to trot out the "hurr durr some doctors are not good and some midlevels are awesome" trope time and time again. That's not the point and the fact that you instantly reach for that is both predictable and concerning.

This discussion has been hashed out elsewhere, but suffice it to say you do yourself no favors to professionally neuter yourself with that language.

This is clearly important to you. That's fine. I'm sorry but it is not important to me.
 
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Psych is the bomb. Great hours as a resident (lots of moonlighting opps and the time to do it), gratifying and interesting work with disenfranchised patients, and amazing opps as an attending. It's very easy to work as much or as little as you want and IMHO, one of the only specialties where it's still affordable to go into pp with low overhead and malpractice. Procedures are becoming an increasingly normal part of practice and I don't see that changing (interventional psych fellowships do exist.) Dont be fooled by salary surveys; per hour, we do very well. You will always have a job anywhere because the need for us is so great.

I understand that what I do is not everyone's cup of tea, but it is a field that has a lot to offer with a lot of personal and professional potential.
 
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what psych procedures are there besides ECT? Not sure we have the same definition of procedure
 
what psych procedures are there besides ECT? Not sure we have the same definition of procedure

Apparently they are looking into deep brain stimulation and transcranial magnetic stimulation. Leave that to the neurosurgeons. Psychiatrists shouldn't even do an lp.
 
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You are a physician on a messaging board for physicians. Your disrespect for your peers is very bizarre.

Apparently they are looking into deep brain stimulation and transcranial magnetic stimulation. Leave that to the neurosurgeons. Psychiatrists shouldn't even do an lp.

There are interventional psychiatry fellowships. And psychiatrists can even get into pain, though it's tough.

Here's some more information.

http://forums.studentdoctor.net/threads/applying-for-fellowships.1195282/#post-18139170
 
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Apparently they are looking into deep brain stimulation and transcranial magnetic stimulation. Leave that to the neurosurgeons. Psychiatrists shouldn't even do an lp.
Somebody needs to program those stimulators and maintain them. And it's not going to be a neurosurgeon.
 
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