How much does PA school miss out on medical school

[AnatomyGrey12]

You see your own office staff every day but you talk to living patients throughout your day in primary care where as surgery youre working with anatomy of a sleeping patient except for consults

The more you post the more I think you have literally no understanding of how medicine is run or how it works.

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[atomheart]

If things stay as they are now with respect to midlevels, it wouldn't be too bad. The concern is that they're rapidly increasing their numbers relative to physicians and are increasingly demanding - and achieving - expanded scope of practice. I don't encourage anyone to obsess over midlevels, but ignoring them altogether doesn't seem wise either.

I agree. Which is why I became a member of my state's organization for my specialty. The legal power creep is appalling, and it has become prohibitively expensive to fund PACs.

I actually believe a more logical solution would involve specialty-specific agreements between physicians and mid-levels rather than power brokering at institutions or legislatures. Obviously there are the old and entrenched who stand against this...

So what's your next step? I'm not going to sacrifice professionalism for this.

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[Atom612]

I agree. Which is why I became a member of my state's organization for my specialty. The legal power creep is appalling, and it has become prohibitively expensive to fund PACs.

I actually believe a more logical solution would involve specialty-specific agreements between physicians and mid-levels rather than power brokering at institutions or legislatures. Obviously there are the old and entrenched who stand against this...

So what's your next step? I'm not going to sacrifice professionalism for this.

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But aren't something like 40% of USMD graduates and ~>80%? of DO graduates going into primary care? So you're solution is for the specialists to work out something with the midlevels to stave off encroachment, leaving the majority of DOs and a large chunk of USMDs to fight a losing battle in primary care? Don't you think we'd have more bargaining power collectively as physicians rather than each specialty looking out for themselves?

 

[AnatomyGrey12]

But aren't something like 40% of USMD graduates and ~>80%? of DO graduates going into primary care?

No it's like ~30% and ~60% respectively I believe. I do agree with your point overall, I don't think the idea presented is very good.

 

[atomheart]

But aren't something like 40% of USMD graduates and ~>80%? of DO graduates going into primary care? So you're solution is for the specialists to work out something with the midlevels to stave off encroachment, leaving the majority of DOs and a large chunk of USMDs to fight a losing battle in primary care? Don't you think we'd have more bargaining power collectively as physicians rather than each specialty looking out for themselves?

What is your next step? Physicians collectively have only ever looked out for individual specialties and not the whole profession. There has always been tension between specialties, and that won't change. Do primary care physicians care about CRNAs or PAs in the ED? Not in my experience. It's really easy to say something like collective power, but I don't see that working out in practice.

I don't know how you took what I said and turned it into primary care vs others. Primary care has the biggest out from midlevels with direct pay. Yet almost all of my primary care preceptors loved NPs or did not view them as a large threat to primary care. This is not an option for anesthesiologists and emergency physicians. Every practice in every specialty has a different relationship with them.

I really want to know what your next step is if you disagree. Are you going to help fund PACs for decades before realizing their organizations will never stop? How much of your own money have you put on the table?

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[857770]

FNP_Blix: just in case you are still reading, here is a quote that sort of describes what we are trying to tell you when we say that it doesn't matter whether or not an NP has RN experience:

"Similarly with nursing and being a doctor. Things might not "seem" all that different when you're just watching the day to day stuff, going on rounds, giving medications, doing procedures, etc. But behind what you see is an entire world with tremendous differences, philosophies or ways of thinking, making decisions, working up a patient, formulating management plans, and much much much more." - Bashwell

Other than that, this is my last post to you in this thread.

 

[DO2015CA]

Yeah of course Im going to give it time and see how the rotation goes but I still dont think my mind will change. You see your own office staff every day but you talk to living patients throughout your day in primary care where as surgery youre working with anatomy of a sleeping patient except for consults. And its competitive to even enter into.

Not quite how surgery works. Yes your patients will be asleep while working cases but I’ve noticed during rotations there are tons of times I’m interacting with patients. Either before surgery, their families’ after the surgery, when they are in their rooms during rounds, and during office hours for follow up.

That being said, primary care is a cool gig that I enjoy so that’s where I’ll be going. I just want you to not limit yourself before you even take boards.

 

[xffan624]

Is anyone considering doing Direct Primary Care? I am thinking about doing it a few years after residency. No midlevels, no insurance. But of course I am not sure yet.

I worked with a primary care doctor who switched her successful independent practice to a DPC model in medical school. She lost a lot of patients and definitely took a financial hit, but she was happier at the end of it. Practice is still going as far as I can tell.

 

[857770]

I think DPC can get expensive for some patients. They have to purchase insurance in case of emergencies and hospital stays; there are small costs for labs, imaging, and medications, which all add up.

 

[deafdealer]

Equal players? Are we going to a casino or practicing medicine, cause if we aren't in Vegas at the slots, DNP is nowhere near DO/MD. Lol, I am shocked you haven't been banned yet for trolling. As a former nurse, I am surprised when I run into the attitudes of my colleagues in graduate nursing programs. Have we really dumbed down nursing to the point where people aren't even remotely cogniscent of what they don't know and are not recieving for training? Posts like yours, especially in other threads make me believe so. Did you really learn nothing from [B]@Mad Jack[/B]'s quiz that you failed terribly?

Its not an us versus them issue, its a scope of training and practice. I didn't believe it before, but now I can see now that it is indeed the nurses, graduate level and wannabe advanced, pushing the tribe mentality. You feel disrespected? Its cause you say ignorant things, like a DNP is equivalent to a Medical degree.

Funny, I expressed that same sentiment in nursing school (that a DNP is like an MD cause of nurse experience/length of training etc) over a decade ago, and my advanced practice faculty corrected me real fast. I guess with the proliferation of nursing schools like bunnies, they just leave that part out now. Combined with hyperagressive recruits who want to 'skip' straight to advanced practice and expect to be treated like doctors without doing the time or training and you get what we have.

As someone with more experience than the average FNP grad, now that I am in medical school, I see just how little my years of critical care nursing help build the knowledge base needed to practice medicine (and I was certified!). Nurses have a surface understanding of pathology, can't work up a differential worth a lick, and are generally trained to recognize 'crashing' and trying to prevent it over everything else. A nurses job, while very important, does not train to be a physician, and people who push that kind of nonsense are promoting malpractice and patient harm.

If you wanted to claim DNP = PA, I agree depending on the background and especially the school. But DNP = MD/DO, no way. Just because politicians say you can do something (independent practice) doesn't mean that you are actually competent to do so.

What is this in reference to?

 

[BorntobeDO?]

What is this in reference to?

This: Should physicians let NP/PA take over primary care and anesthesia?

There are two large threads in Topics on Healthcare that FNP_Blix is all over. You would have thought after the beatdown he received over the above, he would stop, but it is evident that he cares much more about practice rights than good practice.

 

[pedem20178]

An NP was trying to challenge me about my treatment plan. Not to be cocky or anything like that but I recommended that you should do a rectal exam when a patient complains of bleeding from the stool and he didn't want to do it. When the attending agreed with rectal he was trying his hardest I guess to take me down. But yes, there is a significant gap between what a PA/NP knows v med student/resident/doc. It's not that we are superior, but we do have more schooling so we know better in a lot of cases. I really don't like it, for example when a PA prescribes zithromax for a common cold. It's just not what you should do.

Okay, I appreciate your opinion and I completely disagree. Answer my previous question.

 

[xffan624]

I think DPC can get expensive for some patients. They have to purchase insurance in case of emergencies and hospital stays; there are small costs for labs, imaging, and medications, which all add up.

The practice I worked at, had whole sale costs for labs, imaging, and meds for patients who paid the membership fees. These prices were vastly cheaper than what is normally charged at face value to the insurance companies (ie. a CBC was like $2, a BMP $1, etc.). It's not for everyone, but for some people it probably made financial sense for them and they got better care to boot.

 

[CaptainJackSparrow83]

Sorry to awaken a salty thread but does anyone know if PA school will be significantly easier than medical school should I chose to quit?

 

[AlbinoHawk DO]

Sorry to awaken a salty thread but does anyone know if PA school will be significantly easier than medical school should I chose to quit?

Depends on your definition of "significantly easier," but if you've gone through at least one semester of med school, you will definitely feel it is easier.

Think of PA as students that just do step 2 studying and nothing more. We have to study for step 2 while spending most of our day at the clinic/hospital and will likely only get 1 month of dedicated time. A PA student will have one entire year of watered down step 2 material where they don't spend a single minute in clinic. Then their next year comes and they add the second half of the watered down step 2 while doing rotations. Then they take their board exam which has to be made for students that are generally weaker in knowledge and science. In other words, we'll have a 209 step 2 passing score for our boards and their equivalent is if they told us to just get a 150 and it doesn't matter if you hit 280. This is why they easily become protocol pushers and cannot think of the more complex or in depth aspects of disease.

 

[AlbinoHawk DO]

Eh, I enjoy being an NP. Can practice independently in primary care where I'm at and pretty much practice in any specialty I choose. As a physician, you get confined to one area. Though, I've thought about applying someday to do general surgery. I would like to do that.

If the goal was to practice each specialty at the capacity of a nurse practitioner, then any med student that has completed 3rd year could easily do it. If the goal is to practice at the level of a physician, then you need to finish medical school and at minimum residency in that field. As a physician you get to be "confined" as being a true expert in a particular field.

 

[AlbinoHawk DO]

I'm working with a concierge physician this month. I will say I'm learning more about medical business than practice. Don't underestimate how much risk and footwork it takes to be your own boss. My preceptor still has two side jobs to pay the overhead. There's a reason more physicians are just choosing employment.

Also, your patients must purchase at least some insurance for the model to work, so unless you're charitable, this only works for middle and upper class folks. The more prestigious specialties will continue to feed on insurance from your referrals.

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This is true if your goal is to be a solo practitioner only. The early days will be very hard. However, you can still choose a partner track where you earn well and work toward your business expertise. Downside is you never have your clinic solo, but for many people, they would enjoy being around colleagues.

 

[AlbinoHawk DO]

totally irrelevant, but any field in medicine is "very repetitive". if you do primary care, you will see hypertension and diabetes everyday. ruling out general surgery because of this reason is asinine.

I agree with this fully. Once you begin to rotate you can easily say every specialty is repetitive

FM = Hypertension + Diabetes
Neuro = Stroke + Headache
Psych = Anxiety + Depression
Surgery = Lap Chole
Peds = URI
and so on...

Thing is people that haven't rotated easily get fooled by the idea that technically primary care can do anything. Reality is you will have a good basis of knowledge for many diseases but not necessarily the in depth and up to date information to treat the more "zebra" or complicated aspects of even things like depression or headaches. On top of that, it would be very stupid for any FM to start prescribing 3rd or 4th line therapy to things like depression because the patient hasn't responded to previous therapies. That's a guaranteed way to get sued into oblivion.

 

[Chibucks15]

This: Should physicians let NP/PA take over primary care and anesthesia?

There are two large threads in Topics on Healthcare that FNP_Blix is all over. You would have thought after the beatdown he received over the above, he would stop, but it is evident that he cares much more about practice rights than good practice.

I mean he's super important in the world of anonymous internet forums...I wonder if he walks around whatever 'practice' he has by himself and just entertains the masses with his stories of valor against the big bad physicians and medical students

 

[atomheart]

This is true if your goal is to be a solo practitioner only. The early days will be very hard. However, you can still choose a partner track where you earn well and work toward your business expertise. Downside is you never have your clinic solo, but for many people, they would enjoy being around colleagues.

Patient ownership is complicated with partnerships. There will almost certainly be a non-compete on a partnership track.

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[857770]

An NP was trying to challenge me about my treatment plan. Not to be cocky or anything like that but I recommended that you should do a rectal exam when a patient complains of bleeding from the stool and he didn't want to do it. When the attending agreed with rectal he was trying his hardest I guess to take me down. But yes, there is a significant gap between what a PA/NP knows v med student/resident/doc. It's not that we are superior, but we do have more schooling so we know better in a lot of cases. I really don't like it, for example when a PA prescribes zithromax for a common cold. It's just not what you should do.

OMG! I hope he is not an independent provider. If not, I hope his SP fired him by now. Dangerous to say the least. His ego is more important to him than patient care.

 

[CaptainJackSparrow83]

Depends on your definition of "significantly easier," but if you've gone through at least one semester of med school, you will definitely feel it is easier.

Think of PA as students that just do step 2 studying and nothing more. We have to study for step 2 while spending most of our day at the clinic/hospital and will likely only get 1 month of dedicated time. A PA student will have one entire year of watered down step 2 material where they don't spend a single minute in clinic. Then their next year comes and they add the second half of the watered down step 2 while doing rotations. Then they take their board exam which has to be made for students that are generally weaker in knowledge and science. In other words, we'll have a 209 step 2 passing score for our boards and their equivalent is if they told us to just get a 150 and it doesn't matter if you hit 280. This is why they easily become protocol pushers and cannot think of the more complex or in depth aspects of disease.

Im confused, so they dont really learn anything about step 1 material/basic sciences?

 

[AlbinoHawk DO]

Im confused, so they dont really learn anything about step 1 material/basic sciences?

You have to keep in mind that step 2 is not entirely a new test. You have already learned about MRSA, osteoporosis, preeclampsia, etc. What step 2 tries is take you to the next step of managing the patient including testing and treatment. They basically learn for the first time what osteoporosis is but not the scientific basis behind it, just presentation and management

 

[57A]

You have to keep in mind that step 2 is not entirely a new test. You have already learned about MRSA, osteoporosis, preeclampsia, etc. What step 2 tries is take you to the next step of managing the patient including testing and treatment. They basically learn for the first time what osteoporosis is but not the scientific basis behind it, just presentation and management

I thought PAs learned at least some science behind diseases and disorders. So do they pretty much just respond to protocols?

 

[CaptainJackSparrow83]

I thought PAs learned at least some science behind diseases and disorders. So do they pretty much just respond to protocols?

Im sure they learn the basics, this makes me wonder, how useless are our basic sciences. Almost every resident and physician tells me they dont use over 40% of what they learned in the basic sciences. But I suspect that percentage may be higher.

 

[CaptainJackSparrow83]

You have to keep in mind that step 2 is not entirely a new test. You have already learned about MRSA, osteoporosis, preeclampsia, etc. What step 2 tries is take you to the next step of managing the patient including testing and treatment. They basically learn for the first time what osteoporosis is but not the scientific basis behind it, just presentation and management

So basically. If I dropped out today, (I am at a DO school), I go to PA school starting next fall, I finish 2 years of schooling, and start off making about 100 k a year for life? Why dont more people do this?

 

[AnatomyGrey12]

So basically. If I dropped out today, (I am at a DO school), I go to PA school starting next fall, I finish 2 years of schooling, and start off making about 100 k a year for life? Why dont more people do this?

Well, I mean, lots of people DO do this...... PA school is competitive to get into, not like medical school but it's still competitive. Did you literally do no research about any of this when you were thinking about applying?

 

[AlbinoHawk DO]

So basically. If I dropped out today, (I am at a DO school), I go to PA school starting next fall, I finish 2 years of schooling, and start off making about 100 k a year for life? Why dont more people do this?

I have never heard of a PA school that didn't fill their seats with qualified applicants. Thing is you never want to get to be 40+ and have a 26 year old tell you what to do while calling you "Jack" and you have to call them "doctor."

 

[DubbiDoctor]

Well, I mean, lots of people DO do this...... PA school is competitive to get into, not like medical school but it's still competitive. Did you literally do no research about any of this when you were thinking about applying?

Yeah, these are really choices to make before matriculating. If you're already in DO school, I'd suggest sticking with it, and doing a FP or IM residency (unless some other field captures your interest).

 

[DubbiDoctor]

I have never heard of a PA school that didn't fill their seats with qualified applicants. Thing is you never want to get to be 40+ and have a 26 year old tell you what to do while calling you "Jack" and you have to call them "doctor."

In primary care, PAs have a lot of independence. So it wouldn't be too bad. You'd still be managing your own set of patients, with minimal consultation.

 

[CaptainJackSparrow83]

I have never heard of a PA school that didn't fill their seats with qualified applicants. Thing is you never want to get to be 40+ and have a 26 year old tell you what to do while calling you "Jack" and you have to call them "doctor."

This is just about the only reason I havent dropped out and switched to nursing with the aim of becoming a crna or a PA. Respect. as far as a career it sounds like a pretty solid deal.

 

[AlbinoHawk DO]

This is just about the only reason I havent dropped out and switched to nursing with the aim of becoming a crna or a PA. Respect. as far as a career it sounds like a pretty solid deal.

One would hope you'd also be in it because you like to have the expertise and a greater income, but to each their own. If you really are only in it for the "respect," maybe you would ultimately be happy sacrificing the title and going to a state where you practice independently.

 

[CaptainJackSparrow83]

One would hope you'd also be in it because you like to have the expertise and a greater income, but to each their own. If you really are only in it for the "respect," maybe you would ultimately be happy sacrificing the title and going to a state where you practice independently.

Well im at the point where even respect doesnt matter much anymore to me. Anything above 100 k is pretty much okay with me.

 

[SurgDoc95]

Well im at the point where even respect doesnt matter much anymore to me. Anything above 100 k is pretty much okay with me.

That sounds good now, but you should think long term what’s going to be important to you. 100k before taxes only goes so far when you add in a spouse and children. Don’t make a rash decision based of quick earning potential since you are talking about the rest of your life. If you’re in med school stick it out, match fm or im and live comfortably with greater autonomy. Just my opinion!


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[AlbinoHawk DO]

That sounds good now, but you should think long term what’s going to be important to you. 100k before taxes only goes so far when you add in a spouse and children. Don’t make a rash decision based of quick earning potential since you are talking about the rest of your life. If you’re in med school stick it out, match fm or im and live comfortably with greater autonomy. Just my opinion!


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On the other hand the average 4 people household makes roughly 50k, so it's really about the lifestyle that you want and what sacrifices you want to make for it. There's no one size fits all.

 

[AlbinoHawk DO]

Well im at the point where even respect doesnt matter much anymore to me. Anything above 100 k is pretty much okay with me.

Then it's an option to explore. CRNA definitely makes more than 100k. I'd say 150k is about right. In some places it would require more work hours than others, but for the type of procedures they'd let CRNA do, chances of something really going south or having to do much during the surgery are almost none.

 

[AnatomyGrey12]

Then it's an option to explore. CRNA definitely makes more than 100k. I'd say 150k is about right. In some places it would require more work hours than others, but for the type of procedures they'd let CRNA do, chances of something really going south or having to do much during the surgery are almost none.

But for that poster CRNA (or any other midlevel devree honestly) makes literally no sense, they would have to go get a nursing degree, then have at minimum a year or two of critical care nursing experience before they could even apply to CRNA programs, and then they would have to do the CRNA program. Seeing as they have already started medical school it would be a lot easier, will take honestly about the same amount of time, give them more autonomy, and a much higher salary ceiling if they just finish med school and go into a short 3 year residency like FM, IM, or EM. It's not like they could just drop out and be a CRNA or PA in 2 years.

 

[857770]

CaptainJackSparrow: The thing is what if you find that you want to do surgery. PAs are involved in surgical cases, but the surgeon is really the operator.

 

[AnatomyGrey12]

CaptainJackSparrow: The thing is what if you find that you want to do surgery. PAs are involved in surgical cases, but the surgeon is really the operator.

Or anything mecially complex really

 

[CaptainJackSparrow83]

On the other hand the average 4 people household makes roughly 50k, so it's really about the lifestyle that you want and what sacrifices you want to make for it. There's no one size fits all.

Then it's an option to explore. CRNA definitely makes more than 100k. I'd say 150k is about right. In some places it would require more work hours than others, but for the type of procedures they'd let CRNA do, chances of something really going south or having to do much during the surgery are almost none.

CaptainJackSparrow: The thing is what if you find that you want to do surgery. PAs are involved in surgical cases, but the surgeon is really the operator.

Basically. My salary was about 70 k a year. I made about 30 dollars an hour logging data. 70 k was kind of a struggle, I was in the bay area though.

Surgery may be cool but at the same time I am beating myself to pass classes every day. I struggle with focused studying and I honestly don't think the pre reqs or the MCAT really equate to the mental torture a medical student has to put himself thru every day for at least 2 years. Im more over considering PA if something goes south.

Agreed with anatomy grey, crna is probably too long of a pathway for me to even get involved in, PA or another field would be the way to go.
My other field would probably be computer engineering making 85-120 k on average. But with PA I am not stuck to a desk, I can move to many many places , and theres a bit more job security.

 

[AnatomyGrey12]

PA or another field would be the way to go.

The issue with this is that PA school is decently competitive to get into, and the same stuff that got you into medical school won't work. You will most likely need to take the GRE, you will need to get tons of patient/clinical exposure hours as they require a lot more than medical school admissions. You would be looking at a year or more of prepping to apply. That's why I think the easiest route is to just get through med school and do a short residency

 

[Neopolymath]

Then it's an option to explore. CRNA definitely makes more than 100k. I'd say 150k is about right. In some places it would require more work hours than others, but for the type of procedures they'd let CRNA do, chances of something really going south or having to do much during the surgery are almost none.

My wife is a CRNA (I know... the enemy) and I can tell you that a starting salary of 150k is average if anything for a new grad's first job. This field can make excellent money for the amount of work/training. I honestly think a lot of people in medical school should have strongly looked at AA or CRNA school. You can get jobs in every practice setting that either pay you 150k (at least) to work 36-40 hours per week and go home or do hearts/OB and call to add 50-75k to your base pay. And get 4-6 weeks of vacation to start. Hell, if you pick the right hospital you will be getting paid for 40 hrs but going home early because cases got done early for the day. There are plenty of issues, but the money is not one of them.

As far as what they do day-to-day, it's pretty obvious that most medical students have no idea how medical practice works outside of academic centers and anesthesia is no exception. Out West is different, but on the east coast a CRNA is sitting your aortic root surgery/doing CVLs/placing epidurals etc.

 

[Neopolymath]

But for that poster CRNA (or any other midlevel devree honestly) makes literally no sense, they would have to go get a nursing degree, then have at minimum a year or two of critical care nursing experience before they could even apply to CRNA programs, and then they would have to do the CRNA program. Seeing as they have already started medical school it would be a lot easier, will take honestly about the same amount of time, give them more autonomy, and a much higher salary ceiling if they just finish med school and go into a short 3 year residency like FM, IM, or EM. It's not like they could just drop out and be a CRNA or PA in 2 years.

This is why these people go to AA school instead of CRNA school these days. Cush job after 2.5 years post undergrad and no butt-wiping in the icu in between for about the same pay. They also take MCAT/medschool rejects

 

[CaptainJackSparrow83]

This is why these people go to AA school instead of CRNA school these days. Cush job after 2.5 years post undergrad and no butt-wiping in the icu in between for about the same pay. They also take MCAT/medschool rejects

What is aa school? Architecture school?

 

[Neopolymath]

What is aa school? Architecture school?

Anesthesia Assistant. More or less a PA of anesthesia. They do not work in all areas of the US (yet). It's a different route to get to essentially a CRNA position. I don't want to talk about the political discussion that comes up with CRNAs, but full disclosure there are some minor differences, but they wouldn't matter to you from what you have previously expressed. Same cush job with high pay and low hours, and not in primary care.

 

[AlbinoHawk DO]

But for that poster CRNA (or any other midlevel devree honestly) makes literally no sense, they would have to go get a nursing degree, then have at minimum a year or two of critical care nursing experience before they could even apply to CRNA programs, and then they would have to do the CRNA program. Seeing as they have already started medical school it would be a lot easier, will take honestly about the same amount of time, give them more autonomy, and a much higher salary ceiling if they just finish med school and go into a short 3 year residency like FM, IM, or EM. It's not like they could just drop out and be a CRNA or PA in 2 years.

I agree, but being a doctor takes hard work. They may have to spend more or equal total time, but it's lazier hours. It's like comparing being an hour at work vs an hour watching netflix.

 

[AlbinoHawk DO]

Basically. My salary was about 70 k a year. I made about 30 dollars an hour logging data. 70 k was kind of a struggle, I was in the bay area though.

So basically you were making the equivalent of 30k anywhere else

 

[AlbinoHawk DO]

The issue with this is that PA school is decently competitive to get into, and the same stuff that got you into medical school won't work. You will most likely need to take the GRE, you will need to get tons of patient/clinical exposure hours as they require a lot more than medical school admissions. You would be looking at a year or more of prepping to apply. That's why I think the easiest route is to just get through med school and do a short residency

If relocation is willing to be anywhere, there are programs in the south/midwest that will take PA with very little experience

 

[CaptainJackSparrow83]

So basically you were making the equivalent of 30k anywhere else

idk if I would say 30 k. Thats really rock bottom low. Im in the midwest at a DO school, and my rent is 800 for a 1 bedroom. 2 bedrooms in the bay area would be around 2000/month.

I would just split a 2 bedroom there and have more or less the same rent as here with a HUGE amount of disposable income vs 30 k. My food bill is almost 5 k annually. And no im not fat lol.

 

[857770]

Or anything mecially complex really

This. I forgot. People with very complicated medical problems.