Farewell AMA - Pulm/CC fellow

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EDIT Nov 2018: I'm reviving this thread in "celebration" of my 10-year anniversary as an SDN member. I feel like what I can uniquely contribute now is advice on the beginnings of pursuing a career in academic medicine. But happy to answer any and all questions of course.

I'd again like to give a shout out to the physicians who post on this site without whom SDN would be useless. I see some new usernames who are providing some fantastic insight and advice!


Most of the original post from May 2017 (heavily edited to be a lot less...belligerent):

For those of you who don't really know I'm a pulmonary and critical care fellow. Recently graduated from IM residency. Went to a state med school.

What most people know me for is my outspoken views, particularly on DO issues, and for tussles during my almost 9 years on SDN with @gutonc, @Goro and other prominent members.

What you may not know is that I first came to SDN in 2006 as a pre-med to ask about a very significant IA and was told "you're screwed." Now, 11 years later I'm a physician and have quietly tried to educate the SDN community.

I would also like to give a shout out to the physician members of this site without whom this website would be completely useless. To name a few: @SouthernSurgeon, @whoknows2012, @Psai, @ThoracicGuy, @gyngyn, and @gutonc. Keep up the good work. EDIT: how could I forget @jdh71!

Ask away.

-MeatTornado/SkinMD

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What is an IA
 
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So some IM fellowships are competitive (allergy immuno, heme onc, cardio, etc) or so I've been told. What makes one resident more competitive than another, since there are no grades or test scores? Or do they reference back to your medical school records? Is it basically LORs and research done as a resident?
 
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But...why?

Mostly this:

I just discovered this thread today.
I have - separately but in parallel to this situation - also been contemplating quitting SDN. SDN has never valued it's most valuable members (physicians at any phase of training or practice) but now they've taken it to the point of blatant disrespect. Despite being extremely busy we contribute our experience to this forum with no compensation and that's fine, I'm not asking for money. But as a physician who's been an active member for 9 years it's disheartening to see premed and med student "moderators" talk down to me because someone has given them some manufactured power/responsibility. It's not like I'm some rando pretending to be a doctor. You guys actually verified it. If you think a senior member has erred a senior moderator should contact them to point it out and discuss it like adults. On a forum where all members are inherently not on the same level and some contributions *should be* valued more highly than others, the "rules" can't and shouldn't be applied blindly.

It no longer seems like a good way to spend my time. I also feel like I've made enough of an impact and from now on what I can offer is outweighed by the aggravation of moderators and certain other members.

If you're asking why I'm on probation it's because I named a certain member's residency program which apparently is "against the rules" even though he's mentioned it numerous times on SDN.

What is an IA

institutional action
 
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So some IM fellowships are competitive (allergy immuno, heme onc, cardio, etc) or so I've been told. What makes one resident more competitive than another, since there are no grades or test scores? Or do they reference back to your medical school records? Is it basically LORs and research done as a resident?

The residency program you attend is very important. University program > community program. But even within university programs, reputation matters.
Besides this research, LORs, PD letter (basically how you performed in residency) are all extremely important
You do have to submit your med school info and fellowships will put varying weight on your MSPE and med school grades. I know for a fact that at least some will look at it though.
 
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When did you make the decision that pulmonary and critical care was right for you?

Did you go into medical school with a semblance of an idea that IM->Pulm was your direction?


Sent from my SM-G930V using SDN mobile
 
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My time on SDN has run its course, punctuated by recently being put on probation, thus I have decided to leave this website. I have always wanted to do an AMA thread so may as well have it be my final significant contribution to this site.

For those of you who don't really know I'm a pulmonary and critical care fellow. Recently graduated from IM residency. Went to a state med school.

What most people know me for is my outspoken views, particularly on DO issues, and for tussles during my almost 9 years on SDN with @gutonc, @Goro and other prominent members.

What you may not know is that I first came to SDN in 2006 as a pre-med to ask about a very significant IA and was told "you're screwed." Now, 11 years later I'm a physician and have quietly tried to educate the SDN community, despite @LizzyM's insistence, that you can come back from an IA. I have had dozens of members PM me about their IAs (a testament to the search function) and I've been more than happy to be very open, honest, and candid with them.

I would also like to give a shout out to the physician members of this site without whom this website would be completely useless. To name a few: @SouthernSurgeon, @whoknows2012, @Psai, @ThoracicGuy, @gyngyn, and @gutonc. Keep up the good work.

Ask away.

-MeatTornado/SkinMD

Very glad that your very serious IA was not a death sentence. Not all IAs are but some can be.
 
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Sorry to see you go @MeatTornado . You are an essential member to the forums and I learned a lot from reading your posts and discussions with your contemporaries. I always very strongly believe that residents, fellows, attendings and faculty make up the core of the forums and it's because of them and their sage advice I joined SDN in the first place. So it is really unfortunate and disheartening to see one of the essential members leaving the forums.

Regardless, it's your decision in the end. Good luck in your future endeavors!
 
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What led you to Pulm/CCM versus the other specialties of IM? How is the lifestyle as an attending compared to GI/Cards/HemeOnc? I hear pulm works a lot of hours but is that just on a week on week off basis or do you generally take jobs working every week?
 
When did you make the decision that pulmonary and critical care was right for you?

Did you go into medical school with a semblance of an idea that IM->Pulm was your direction?


Sent from my SM-G930V using SDN mobile

After my MICU rotation intern year. I wanted to do EM or anesthesia when I started med school but quickly realized that both were poor choices. EM you see so much low acuity stuff and are going 110% the whole shift while being hounded by non-MD administrators to "move the meat" and anesthesia I felt you were mostly just doing very formulaic and routine things not to mention there is little "doing" anymore and lots of supervising.

What led you to Pulm/CCM versus the other specialties of IM? How is the lifestyle as an attending compared to GI/Cards/HemeOnc? I hear pulm works a lot of hours but is that just on a week on week off basis or do you generally take jobs working every week?

Partly because it's a moderately competitive specialty. I was done with the rat race and hyper-competitiveness. Also I prefer sick patients and find the lungs interesting. The lifestyle as an attending varies widely, particularly because it's a hybrid specialty. Critical care is shift work but intense. Pulm is outpatient +/- consults in the hospital. So it really depends on the balance you want to strike between the two. Obviously CC makes more $$$. As with the other three specialties you mentioned YMMV based on how you want to tailor your career and how much $$$ you want to make.
 
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My time on SDN has run its course, punctuated by recently being put on probation, thus I have decided to leave this website. I have always wanted to do an AMA thread so may as well have it be my final significant contribution to this site.

For those of you who don't really know I'm a pulmonary and critical care fellow. Recently graduated from IM residency. Went to a state med school.

What most people know me for is my outspoken views, particularly on DO issues, and for tussles during my almost 9 years on SDN with @gutonc, @Goro and other prominent members.

What you may not know is that I first came to SDN in 2006 as a pre-med to ask about a very significant IA and was told "you're screwed." Now, 11 years later I'm a physician and have quietly tried to educate the SDN community, despite @LizzyM's insistence, that you can come back from an IA. I have had dozens of members PM me about their IAs (a testament to the search function) and I've been more than happy to be very open, honest, and candid with them.

I would also like to give a shout out to the physician members of this site without whom this website would be completely useless. To name a few: @SouthernSurgeon, @whoknows2012, @Psai, @ThoracicGuy, @gyngyn, and @gutonc. Keep up the good work.

Ask away.

-MeatTornado/SkinMD
Any sage like advice for incoming MS1 about how to navigate medical school. Looking back now what did you think you did right and if you could go back what would you change ?
 
Any sage like advice for incoming MS1 about how to navigate medical school. Looking back now what did you think you did right and if you could go back what would you change ?

Pre-clinical grades definitely matter - they are averaged into your class rank which can be extremely important depending on what specialty you're applying to.
The most important thing is to learn how to learn in med school. It basically took me until halfway through second year to finally get it right. Big picture. Do lots of practice questions. Focus on the details later.
Decide on a specialty early, it gives you a big leg up.
 
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Some small questions. What is the best way to study for preclinical years? Would you recommend studying lectures and board materials in both MS1 and MS2? Or is sticking with only lectures and doing well on class exams a better idea since setting up foundation is critical?

I realize this may be school specific but would like to know your thoughts. Thanks!
 
Some small questions. What is the best way to study for preclinical years? Would you recommend studying lectures and board materials in both MS1 and MS2? Or is sticking with only lectures and doing well on class exams a better idea since setting up foundation is critical?

I realize this may be school specific but would like to know your thoughts. Thanks!

Boards studying should be review. You can't review what you haven't learned. I would recommend starting around January of your second year. Until the learn the material as it's taught and focus on doing well in classes. That's how I did it and ended up with a ~250 even though I didn't do particularly well with regards to grades (slightly above average). The review books and questions are only a snapshot. Step 1 will have many questions that you'll only be able to answer if you took the time to study for your classes and are nowhere to be found in the review books/questions.
Don't be one of those people who complains that the doctoring class is a waste of time. It's why you're in med school. If you think you're going to show up on day one of 3rd year and be a wizard on the wards without practicing on a whole bunch of standardized patients first you're wrong and need to check your ego.
 
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I've actually been rattling around intensivist in my head for a while now. Luckily all the things I'm interested in go through IM so I at least have a direction.

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I already know your thoughts on getting into an IM residency, DO or otherwise, so...

What are your thoughts on how to be the best IM resident you can be, wherever you land?

What should someone be doing during IM residency if they're interested in pulm/pulm crit?

Any tips on deciding critical care vs pulm crit?

I sometimes think you're a little too pessimistic, but I do truly appreciate your candor and will be sorry to see you go. Thanks for your contributions to the site.
 
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....critical care

you can even do it as a stand-alone 2-year fellowship after IM

So do you think in general, people who are interested in the "real emergencies" (i.e. time-sensitive, life threatening pathology) part of EM would find CC more stimulating?
 
Mostly this:



It no longer seems like a good way to spend my time. I also feel like I've made enough of an impact and from now on what I can offer is outweighed by the aggravation of moderators and certain other members.

If you're asking why I'm on probation it's because I named a certain member's residency program which apparently is "against the rules" even though he's mentioned it numerous times on SDN.



institutional action

Oh I know exactly who you're talking about. The guy whose program is so amazing and top tier they needed a guy who was rejected by literally any other program in the country.

I've been contemplating a move off of sdn too because the overbearing moderation. The constant whining from everyone is getting toxic.

Thanks for the shout out bro, you'll be missed.
 
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I already know your thoughts on getting into an IM residency, DO or otherwise, so...

What are your thoughts on how to be the best IM resident you can be, wherever you land?

What should someone be doing during IM residency if they're interested in pulm/pulm crit?

Any tips on deciding critical care vs pulm crit?

I sometimes think you're a little too pessimistic, but I do truly appreciate your candor and will be sorry to see you go. Thanks for your contributions to the site.

Pulm or crit care alone are very rare....there are only a handful of programs in the country. The vast majority are pulm/cc and it's only an extra year (3 vs 2) to do both. Gives you more career options. I didn't know anyone who was contemplating doing CC only. In fact I didn't know that was an option until I was in fellowship.

IM residency - show up, do your work, be someone that your co-residents look up to as a steady hand who is dependable. Don't ruffle feathers - whether it's nurses, attendings, NPs, etc. And of course read and have an inquisitive mind. If something about a patient doesn't feel right make sure you constantly expand your differential. Teach the med students - it's part of your job. The amount of research you do will depend heavily on your career plans...I did a lot and it payed off but to each his own.

So do you think in general, people who are interested in the "real emergencies" (i.e. time-sensitive, life threatening pathology) part of EM would find CC more stimulating?

Well it's a different kind of "emergency". Rarely will anyone roll into the micu totally crashing or seconds away from dying. That will certainly happen when they've already been there but things are much more controlled and less chaotic. Your scope of practice is also more limited....no gun shuts, trauma, etc etc. More thinking rather than reactionary doing that you get in EM. Your job is to fix the patient and not just stabilize them. You also get to follow the patient for a period of time in the MICU and see their care through rather than pass them along. Be forewarned though that the "emergencies" account for maybe 10-20% of your practice in EM. The US medical system is broken and as an ED doc you are on the front lines of the disaster.

Oh I know exactly who you're talking about. The guy whose program is so amazing and top tier they needed a guy who was rejected by literally any other program in the country.

Yup....THAT guy. Apparently scrambling is the new matching.
 
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B...bb...bbbutt...its Ivy League

tumblr_nl5nvlVztw1qfm4ivo2_400.gif
 
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Very glad that your very serious IA was not a death sentence. Not all IAs are but some can be.

OMG wasssssssup broseph. Can you do a WAMC residency style for me.
 
How long will it take the pain of my Step 1 to go away? Will I ever be normal again? Will I ever be able to date a girl that looks like this:
Gabriella Wilde - IMDb

Honestly, all I want in life in a smoking hot wife, a Tesla Model S, and a home in Tuscany.
 
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Good luck Meat.
While I didn't always agree with you I loved the fact that you respected factual arguments and used them yourself. Everyone has their biases but I always felt like the discourse you engaged in, while occasionally confrontational, was based on facts and logic. This is a tenet I fear we have lost in the world, and certainly on SDN.
And on a personal note, spending 3 years dodging osteopathic propaganda and seeing my classmates and friends suffer because of the lies I'm glad someone cares enough to try and push through the farce.
Hope attending life treats you well.
 
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Oh I know exactly who you're talking about. The guy whose program is so amazing and top tier they needed a guy who was rejected by literally any other program in the country.

I've been contemplating a move off of sdn too because the overbearing moderation. The constant whining from everyone is getting toxic.

Thanks for the shout out bro, you'll be missed.
...are you serious? It makes me livid that I know exactly who you're talking about.
 
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My time on SDN has run its course, punctuated by recently being put on probation, thus I have decided to leave this website. I have always wanted to do an AMA thread so may as well have it be my final significant contribution to this site.

For those of you who don't really know I'm a pulmonary and critical care fellow. Recently graduated from IM residency. Went to a state med school.

What most people know me for is my outspoken views, particularly on DO issues, and for tussles during my almost 9 years on SDN with @gutonc, @Goro and other prominent members.

What you may not know is that I first came to SDN in 2006 as a pre-med to ask about a very significant IA and was told "you're screwed." Now, 11 years later I'm a physician and have quietly tried to educate the SDN community, despite @LizzyM's insistence, that you can come back from an IA. I have had dozens of members PM me about their IAs (a testament to the search function) and I've been more than happy to be very open, honest, and candid with them.

I would also like to give a shout out to the physician members of this site without whom this website would be completely useless. To name a few: @SouthernSurgeon, @whoknows2012, @Psai, @ThoracicGuy, @gyngyn, and @gutonc. Keep up the good work.

Ask away.

-MeatTornado/SkinMD

Probation is being handed out like free condoms at planned parenthood these days. Its losing its disciplinarian value.

When I see someone on probation, first thing that comes to mind is 'which mod did they piss off,' not 'gosh what did they do to deserve that.'

The purple glow is coming to symbolize martyrdom.

So long @MeatTornado
 
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University program > community program
Longtime lurker on SDN, made a profile about a year ago and became a somewhat active member of the community-- I appreciate your insight regarding matching and I wanted to ask in your opinion if University Program> Community program always holds true? I've been fortunate enough to get into a US MD school and I was wondering that if one has aspirations to enter a IM sub-specialty would attending a notable community IM program like California Pacific Medical Center be a better program for competitive fellowship opportunities than some University programs given that CPMC and other "Communiversity Hospitals" do fairly well in fellowship placements or should one always strive to enter University programs if competitive fellowships is their final career destination?

Thanks again man, I hope attending life treats you well --it saddens me to see really experienced members leave the forums because it's people like you and other residents/med-students/fellows/faculty that help us premeds navigate through medical school. Especially those of us with no family members who are physicians who use this forum as a guide. Thank you again, I truly appreciate the SDN community--all of you.
 
Especially those of us with no family members who are physicians who use this forum as a guide. Thank you again, I truly appreciate the SDN community--all of you.

My father dropped out of high school and my mother went back to college around the same time I did, so I feel ya man. I'm a long time lurker and I really looked up to the big honchos of these forums, all of whom were essentially my only source of guidance from UG, to post-bacc, to now.

There was actually a response MeatTornado made in a thread a while back that inadvertently changed the trajectory of my life (thanks butterfly effect). It was sobering and a little bitter, but necessary.
 
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585f2f9151f061c688d16ae694c676a6_memes-sweet-mother-of-god-mother-of-god-memes_400-274.jpeg


I often disagree with your posts, but absolutely love your willingness to bring about a healthy discussion. Your input will surely be missed.
 
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Can you give a TLDR for the advice you have for DO students? I'm talking about down to earth DO students that have a genuine interest in fields that aren't considered to be "competitive". Or DO students that are gunning for a University IM program but have a back up plan because they are aware that they will face discrimination.
 
How long will it take the pain of my Step 1 to go away? Will I ever be normal again? Will I ever be able to date a girl that looks like this:
Gabriella Wilde - IMDb

Honestly, all I want in life in a smoking hot wife, a Tesla Model S, and a home in Tuscany.

Studying for step 1 was the worst 4.5 weeks of my life. It fades with time like any other traumatic experience.
Dating hot girls is up to you. It's mostly about personality ;)

Longtime lurker on SDN, made a profile about a year ago and became a somewhat active member of the community-- I appreciate your insight regarding matching and I wanted to ask in your opinion if University Program> Community program always holds true? I've been fortunate enough to get into a US MD school and I was wondering that if one has aspirations to enter a IM sub-specialty would attending a notable community IM program like California Pacific Medical Center be a better program for competitive fellowship opportunities than some University programs given that CPMC and other "Communiversity Hospitals" do fairly well in fellowship placements or should one always strive to enter University programs if competitive fellowships is their final career destination?

Like any generalization there are of course exceptions but if you want to keep the most doors open University > Community. I don't really believe in this communiversity stuff ...university hospitals are buying up community hospitals left right and center. It's a meaningless distinction. That said there is a lot of regionality to this too. If you are a west coaster and you want to stay there forever you should aim to go to the best program you can in that geographic region. Not saying that you won't match from a community program, it'll just be more difficult and you'll have to be that much better.

There was actually a response MeatTornado made in a thread a while back that inadvertently changed the trajectory of my life (thanks butterfly effect). It was sobering and a little bitter, but necessary.

I'd really like to hear what that was. Feel free to PM me.
 
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Can you give a TLDR for the advice you have for DO students? I'm talking about down to earth DO students that have a genuine interest in fields that aren't considered to be "competitive". Or DO students that are gunning for a University IM program but have a back up plan because they are aware that they will face discrimination.

How can one summarize a thousand posts? haha
First of all I've spent lots of time admonishing folks for using the word "discrimination" to describe this. You weren't born a DO. It isn't a protected class. It is well within an employer/residency program/fellowship program's right to have a preference for one medical degree over another.

As long as you are aware of the general limitations you'll be fine. It always infuriates me when DO students (and "pre-DO" students ...if that's actually a thing) only listen to those who tell them "you can do any specialty as a DO" and interpret it completely incorrectly. The fact that 3 people a year matched into something shouldn't lead you to conclude "that'll be me some day"....rather you should say "wow that seems extremely improbable".

Geography is your friend as a DO when applying IM. Meaning look at university programs in undesirable places. For example my med school had several DO residents because it was in a less desirable location. If you want a less competitive IM sub-specialty: renal, ID, geriatrics you'll have no problem getting it regardless of which residency program you go to. You need to go into it though knowing that you may end up doing hospitalist or primary care. That's advice I would give to anyone, not just DOs.
 
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I've always appreciated your posts on here, especially your perspective on how DOs fare in academic IM. All the best and thanks for your help
 
How can one summarize a thousand posts? haha
First of all I've spent lots of time admonishing folks for using the word "discrimination" to describe this. You weren't born a DO. It isn't a protected class. It is well within an employer/residency program/fellowship program's right to have a preference for one medical degree over another.

As long as you are aware of the general limitations you'll be fine. It always infuriates me when DO students (and "pre-DO" students ...if that's actually a thing) only listen to those who tell them "you can do any specialty as a DO" and interpret it completely incorrectly. The fact that 3 people a year matched into something shouldn't lead you to conclude "that'll be me some day"....rather you should say "wow that seems extremely improbable".

Geography is your friend as a DO when applying IM. Meaning look at university programs in undesirable places. For example my med school had several DO residents because it was in a less desirable location. If you want a less competitive IM sub-specialty: renal, ID, geriatrics you'll have no problem getting it regardless of which residency program you go to. You need to go into it though knowing that you may end up doing hospitalist or primary care. That's advice I would give to anyone, not just DOs.

Thanks for the advice.

Is hospitalist/primary care that bad? I know the pc answer is that "no its great primary care is awesome and we need the best and the brightest in that field". I don't agree with that BUT hospitalist/primary care also doesn't seem THAT bad to me. I shadowed primary care docs that have done cool procedures, see a wide variety of pts, make pretty good money (~200k), and work reasonable hours. In fact one of my favorite mentors was a semi retired IM doc that started an awesome free clinic where he was able to make a tremendous difference in a large Mid-west city. Even with the frustrations, it seems like a decent gig to me.

Out of curiosity if, in some horrible bizzaro world, you were an average DO what would you choose? psych?
 
Thanks meat, you're actually one of the reasons I ultimately decided DO over doing an SMP. I feel like you actually gave me an honest viewpoint into the limitations and allowed me to make a calculated decision off of that, ultimately with me realizing I am completely ok with the realities of that path. I feel like I know exactly what I'm getting into. It was nice to hear a voice of reason through the propaganda. You will be missed, good luck in your career!
 
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Your top 3 pointers for

1. Third year rotations

2. Dealing with the rampant passive-aggressiveness.

Thanks.

I agree, this site is easily butt-hurt about a lot of things.
 
Can you share what was the IA, and how you overcame it, if it indeed hindered your chances at application time? ie, were you ill advised over a pot possession or a DUI vs, say, theft or cheating?
 
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Really feel like I missed out on some kind of exciting verbal exchange here.

Sorry you're leaving. You'll be missed.
 
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You're definitely going to be missed. Agree this place's moderation has become ridiculous. They don't discuss anything or value that some members are long running. They get their little power trip and ban someone.
 
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You're definitely going to be missed. Agree this place's moderation has become ridiculous. They don't discuss anything or value that some members are long running. They get their little power trip and ban someone.

Last time I got banned it was because some pa was going around mouthing off about being a global health doc because they had some dcs degree that no one's ever heard of. Dude thinks he's some sort of Paul Farmer so I said no you're actually a pa in the middle of nowhere and this dr.mcdouchemod felt like banning me even though literally everyone else in the thread agreed with me. Of course the poster in question spams anti-physician rhetoric in their own pa forums. Our mod didn't even have the courtesy to tell me what the ban was for or how long. That was incredibly annoying.
 
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Adding to the chorus that you'll be sorely missed, MT. Best of luck to you in the future. Your voice on the forums was sorely needed. Hopefully someone steps up to fill those shoes.
 
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I will add to the chorus. I am new but as I wrap up applying to medical school. I am grateful for your view points on all sides of medicine and medical education, specifically the osteopathic medical schools. It helped provide to some very real truth that I needed to hear. So I am thankful for you on this forum. You helped me more than you know. So thank you.
 
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Last time I got banned it was because some pa was going around mouthing off about being a global health doc because they had some dcs degree that no one's ever heard of. Dude thinks he's some sort of Paul Farmer so I said no you're actually a pa in the middle of nowhere and this dr.mcdouchemod felt like banning me even though literally everyone else in the thread agreed with me. Of course the poster in question spams anti-physician rhetoric in their own pa forums. Our mod didn't even have the courtesy to tell me what the ban was for or how long. That was incredibly annoying.
rofl, hopefully that person is no longer a mod
 
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Last time I got banned it was because some pa was going around mouthing off about being a global health doc because they had some dcs degree that no one's ever heard of. Dude thinks he's some sort of Paul Farmer so I said no you're actually a pa in the middle of nowhere and this dr.mcdouchemod felt like banning me even though literally everyone else in the thread agreed with me. Of course the poster in question spams anti-physician rhetoric in their own pa forums. Our mod didn't even have the courtesy to tell me what the ban was for or how long. That was incredibly annoying.
Can I get a link to this PAul farmer incident.
 
I just want the deets on the SDN drama. What forum was it in? Allo? The ones I frequent don't seem to have this kind of drama routinely in them. I won't go into Pre-Allo b/c I value my mental health.
 
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