NinerNiner999

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After reading the "this job's bad for you" posting, I notice a large disparity between the younger posters on this board, and those of us who have been here through medical school, residency, and now several years into the "real world".

Perhaps it's time to create a new subforum for Attendings, and focused on real-world issues. It would be nice if only those with attending status for 2+ years could post (but all others could view).

We have a very tough job, and only those of us who are in the trenches really understand how tough it is going to become.

Thoughts?
 

RustedFox

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I think its a great idea - how will you verify "attending" status, though? I can be wrong here, but it seems to me like anyone can just change their status at anytime (heck, in one month's time, I'm going to upgrade my own to 'attending').
 

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The first step is to be verified as a physician on SDN. You can use an institutional email if you're still a resident. I linked them to my state licenses, which was proof enough.

The second thing would be for the moderator to vet whomever would be listed as an attending. It's like the "practicing physician's" forum (which is functionally dead, dried up, and blowing away in the wind). If someone said "I'm an attending!", but refused to offer up any type of identification, they would be like a defunct leprechaun (i.e., out of luck).

Then again, someone could do step 2 without step one, but, since being verified as a doc gets you all the bennies of donation without paying any money, there's little reason not to do it.
 

DrMom

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Not a bad thought. I'll pass the request on to the moderators.
 

sylvanthus

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Ehh I think it'd turn into a dead forum in a month or two. The EM forum doesn't get too many new posts on a daily basis to begin with, even with us horrible young medical students who haven't been out in the "real world" actively posting. With an even fewer number of people (just attendings) in a separate forum, that forum will likely die off very quickly.
 

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I think it's a great idea. I'm a new attending still in the junior faculty phase but it's always good to hear issues that our colleagues discuss and it's great to have advice / stories from more experienced attendings. We all know in our own work settings we talk about everything from clinical frustrations to investments / ideas for entrepreneurship (spelling?) etc. I don't think the forum would dry up, there're enough attendings who visit and are active on this forum, at least this ED one. And it'd be a nice place to separate out from the other posts, majority of which are "how to get in" and residency reviews.
 

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I'll offer a little dissent.

For reference: I am an attending only a bit out of residency.

I don't see why an attending-only forum is needed. I just don't see how 'junior' opinions limit 'seasoned' input. In fact, I feel like it gets the old folks out of their rocking chairs.

Please explain the advantage of an attending-forum.

HH
 

RustedFox

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Good points, HH - I think the intent is to get rid of thread hijacking and to save time by not having to address the "wide-eyed and unrealistically idealistic" comments that pop-up inevitably.
 

fiznat

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A forum where medical students can listen but not speak? Sounds a little elitist. What is the problem that this idea is trying to fix? Are posts from medical students disruptive in some way?
 

RustedFox

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Its not that students are disruptive, its that they often don't get the bigger picture, and sometimes like to take snipe-shots at things to prove an attitude or point that may not be relevant for debate.
 

Arcan57

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A forum where medical students can listen but not speak? Sounds a little elitist. What is the problem that this idea is trying to fix? Are posts from medical students disruptive in some way?
It leads to some thread hijacking, especially when we're talking plainly about the challenges of EM outside of academia. I don't know if an attending forum is strictly needed, but I do think this forum acts as a support forum for some of the longer time posters. And there can be some pretty significant interruptions in conversations about real-world issues because of med students and (mostly junior) residents talking out of their rectums about how we should think and feel. The level of cynicism and bitterness I feel on a daily basis would be horribly inappropriate for a med student, yet my world view is Pollyanna-ish compared to Birdstrike or GV.

Doing this job changes you, and I don't think anyone that's not an attending has a feeling for how lonely and stressful the job is out in the community. The last day of residency is a the end of an era, and most of you will be going out to jobs where the change in level of support is unfathomable. Even in shops with double (or more) coverage, you're not sitting around and chatting with the other docs. I can go HOURS without seeing one of my partners, and usually it's to hand the phone over because we both needed the same consultant.

It's knowing that as a new doc you can get fired at any time, even for doing the right thing, if someone who brings enough money into the hospital gets pissed off. It's the stress of circadian changes when you have more in your life to worry about then when the surf is up or what the weather outside is like.

For some of the new attendings, it's taking jobs (for a variety of reasons) that pay way less then they thought they would be paid. It's understanding the impulse to just want to pay off your debt ASAP and be out of clinical medicine. It's figuring out why that's not what you're doing, or how other attendings rationalize their approach to a specialty that is toxic. The losses outnumber the wins on most days, and if you string enough shifts together you're not the same person at the end. We recover and bounce back and learn to value the rare wins out of proportion to their frequency. For most EM docs, there's a point where the recovery stops being complete and we start staying in the red. This requires some sort of change, either in our own coping mechanisms or our external environment. If you've never stared at a stranger's name and a chief complaint on a tracking board and HATED them without having even seen them, you're a better and different person then I am. And while I'd like to think you have some secret figured out, I can't help feel that you haven't seen what I've seen.
 
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John146

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Attending only forum doesn't offend me at all. Not sure why med students are getting upset...

Plus, as others have stated, the forum will flame out in a few months.
 

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I think its a bad idea, good in theory, but bad for the mission of this board....

The first issue is that there is more than just EM on this board; should SDN make an 'attending' subform for Anes, FM, Surgery, etc... I think the answer is 'no' as it will water down the posts and cause even more false information in the 'student' threads as the Attendings will mainly post in their subforum.

Read the name of this site: Student Doctor Network. Attendings are not students, although I would agree they are an INVALUABLE tool to this network.

Sounds like I am one of the few attendings, albeit it a newer one, that is completely against this. It will be interesting to see what the folks in charge do.... I just thinks its completely against their business model.

I come here to see the interactions of those above me that have been doing this much longer, but I love the uniqueness of a medical student chiming right in to a conversation or a resident doing the same. Sometimes they need some direction, and sometime they are not really open to appropiate direction, but oh well.. thats just part of it.
 

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I'm against a subforum. I've been reading this forum for a long time (holy crap! almost 9 years!), and I feel like having the salty perspectives of attendings did much to balance the "Sunshine and Puppy Dogs" posting of less experienced people over the years.

Perhaps we as a community can do more to ignore off topic postings within threads that might cause derailment.

Plus, I think the interaction works well for both sides of the student/resident/junior attending/senior attending spectrum: less experienced people get to see how their colleagues further down the line feel about a problem or the specialty. And the more experienced folks can see where they were and perhaps realize that something (either the job or within themselves) needs to change, as Arcan was referring to.

Or whatever. But I do think that this board would plummet in usefulness if I never dealt with medical student stuff. And I say this as someone who is about 3 weeks from being an attending.

Peace
 

leorl

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This requires some sort of change, either in our own coping mechanisms or our external environment. If you've never stared at a stranger's name and a chief complaint on a tracking board and HATED them without having even seen them, you're a better and different person then I am. And while I'd like to think you have some secret figured out, I can't help feel that you haven't seen what I've seen.
ha ha! I thought I was the only one. Fortunately I'm now at a place where this feeling doesn't come up so much, but I definitely remember it. :thumbup:
 

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I enjoy having the perspective of attendings and seeing their experiences ahead of time. I think it's one of the most important things about this board: providing some realistic expectations of what the job is like.
 

DrMom

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There is a private forum within anesthesia and it has not flamed out nor have the attendings stopped posting in the main anesthesia forum.
 

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I've noticed, as an attending, that I post here less often than I used to. Not because I've stopped coming, but because my attending perspective isn't relevant to many of the aforementioned posts.
But, I still post about many things, and would continue to do so in a subforum as well as in the main forum.
 

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I'm relatively cool to the the idea. My main reason is that I think that the students/residents get something important out of reading the discussions. You can graduate residency and have never heard of Press Ganey. But if you read this forum you've heard of it. That's a big deal. I think we need to just ignore and resist the hijack type posts. One great thing about the EM forum is that those posts here are at least heart felt if misguided. We don't get as much abject snarkiness as the other fora.

That said if there is enough interest I will pursue it.
 

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I'm against the idea. Some of the most valuable discussions I see are when people who are naive get educated by people who aren't.

The losses outnumber the wins on most days, and if you string enough shifts together you're not the same person at the end. We recover and bounce back and learn to value the rare wins out of proportion to their frequency. For most EM docs, there's a point where the recovery stops being complete and we start staying in the red. This requires some sort of change, either in our own coping mechanisms or our external environment. If you've never stared at a stranger's name and a chief complaint on a tracking board and HATED them without having even seen them, you're a better and different person then I am. And while I'd like to think you have some secret figured out, I can't help feel that you haven't seen what I've seen.
This is so spot on. The mental abuse we endure from bosses, administration, colleagues, nurses and patients is unbelievable.

I got called in when one of my colleagues called in "deathly sick" and I had just completed a night shift. I was running on 3 hours of sleep. I wished my colleague would come to the ER and check in just so I would hate them less, so that they could prove to me that my sleep deprivation was less imparing than their illness. What other specialty or job has this degree of rigidity in scheduling? Surgeons can cancel cases. PCPs can reschedule visits, but the damned ER just keeps on staying open and recieving the constant onslaught of patients.

Unless you have consistenly experienced shift work for a couple of years, you don't understand the effects of sleep deprivation. Sleep deprivation is something more painful than hunger or thirst. It takes much longer to recover from as well. We've all come back from an all day hike, a couple liters down on fluids, and feeling parched. An hour later and a few cups of water, you're all fixed. Not so with sleep.

It is hard to be compassionate when the job costs so much to you and when the average patient totally takes your efforts for granted. It is hard not to be @#!*% off when 50% of your care is unreimbursed, and the remaining 50% is 1/3 documentation foisted on us by CMS, or required by the gods of medicolegal insanity. So, only 1/3 of our efforts are reimbursed actual patient care.
 

WilcoWorld

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I'm against the idea. Some of the most valuable discussions I see are when people who are naive get educated by people who aren't.



This is so spot on. The mental abuse we endure from bosses, administration, colleagues, nurses and patients is unbelievable.

I got called in when one of my colleagues called in "deathly sick" and I had just completed a night shift. I was running on 3 hours of sleep. I wished my colleague would come to the ER and check in just so I would hate them less, so that they could prove to me that my sleep deprivation was less imparing than their illness. What other specialty or job has this degree of rigidity in scheduling? Surgeons can cancel cases. PCPs can reschedule visits, but the damned ER just keeps on staying open and recieving the constant onslaught of patients.

Unless you have consistenly experienced shift work for a couple of years, you don't understand the effects of sleep deprivation. Sleep deprivation is something more painful than hunger or thirst. It takes much longer to recover from as well. We've all come back from an all day hike, a couple liters down on fluids, and feeling parched. An hour later and a few cups of water, you're all fixed. Not so with sleep.

It is hard to be compassionate when the job costs so much to you and when the average patient totally takes your efforts for granted. It is hard not to be @#!*% off when 50% of your care is unreimbursed, and the remaining 50% is 1/3 documentation foisted on us by CMS, or required by the gods of medicolegal insanity. So, only 1/3 of our efforts are reimbursed actual patient care.
See, even attendings hijack threads.

Just playin' J - you know I love ya.
 

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While I can appreciate the sentiment of the OP, I have serious concerns with limiting student access to input on forums for a website called "Student Doctor Network."

As an aside, I have often wondered why the SDN forums do not allow thumbs up/likes for posts. I feel like this may alleviate some of the problem as posters would be able to identify more useful posts from the more experienced persons such as attendings, meanwhile useful input from students/residents would not be stifled.
 
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NEATOMD

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ah, that's why it would be a SUB-forum and not the main EM forum ;)
I think that you are missing my point.
Do this simple exercise:
1.) Go to any page in the forums you have access to. 2.) Scroll all the way to the top. 3.) Read that logo there at the top left. 4.) Get it?

No?

Okay. 5.) Now go to any forum on this website you have access to. 6.) Read the hypertext link in your address bar. It probably starts like this: http://forums.studentdoctor.net/

Get it now? :idea:

So, in essence, it doesn't matter how many, sub, sub forums you make. Limiting access in any way by students seems (to me, at least) to conflict with the purpose of the website in general.
 

fiznat

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I'm still not seeing an argument that couldn't be answered equally well by effective (community or otherwise) moderation of posts. If thread hijacking is a problem, why can't we just handle the issue like every other forum- through peer pressure and by having our mods take care of it?

I also don't like the attitude that the attendings have nothing to gain from student input. Some might scoff at our wide eyed enthusiasm, but others might welcome the reminder of what it felt like to be excited about this field. It seems some (though certainly not all) are in desperate need of that.
 

RustedFox

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PFFFFFFTTTT.....


HERE'S where someone should make the sub-(forum)-argument that we're all "students" at any stage of development, be they "high-school... pre-health... medical...resident...attending...curmudgeon"... and make some sort of "circle of life" argument...

Bottom line - they're (we're?) trying to get something going. This set is going to be without the pedantic "look at me and what I've learned and what you've forgotten but-isn't-relevant" set. Whether its home-base is here or at whatever.com doesn't matter. Might as well be here for everyone else (those of us who are still in "larvae" form) to observe.

Let's not make mountains out of molehills, folks. Make the attending-only forum happen. It will succeed or fail of its own accord, and a lesson will be learned, either way.
 

RustedFox

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CLARIFICATION: An attending-only forum serves the distinct purpose of "demystifying" those who haven't learned at the foot of the real world. If the attendings are talking about it... its probably important... if the attendings dismiss it, or ridicule it.... well... take heed.

I'll be the first individual to admit that when I was a MS-3/4, I championed things that I would slap myself now for even thinking of... and the reasons why are the same reasons that everyone eventually "figures out" for themselves along the way.

Wow.


Thanks, SDN.
 

fiznat

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CLARIFICATION: An attending-only forum serves the distinct purpose of "demystifying" those who haven't learned at the foot of the real world. If the attendings are talking about it... its probably important... if the attendings dismiss it, or ridicule it.... well... take heed.
Still not seeing how a special VIP forum for attendings serves this purpose while the current solution cannot. How does a private forum "demystify" anything at all? No opportunity for students to ask follow-up questions? No way to take part in a discussion? It sounds like you would like students to be seen and not heard, and to simply "listen to the adults talk" and hope to learn what we can. What can we expect will happen to this main EM forum? Dilution of attending input, and unnecessary posts about other posts in the hopes that someone might be able to answer a follow-up question. This will do more harm than good.

Again, I think you are underestimating the value of student input. Not all of us are straight out of college, and you might be surprised to find out that students come from a wide array of backgrounds, experiences, and perspectives from which you might actually benefit. I cant imagine that if you, sitting on the internet browsing an forum about EM, have been an attending for so long that you can't stand to answer a few questions from students now and then. Even if they do break up whatever massively important discussion you have going on at the moment.
 

RustedFox

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On one hand, I want to say - "Jeeebus, strong argument, man."

On the other, I want to say - "Blah-Blah-Blah-Diversity-Blah-Blah-Students-Blah-Feelgoodism-Blah...whatever."

When it comes down to it... I have to say - "you are right". Period.

The drag of it (between the MS-3s and the PGY-17s) exists because (we) play by different sets of rules. The PGY-17s don't wanna hear the "dumb" idealism of the MS-3s, but like to teach the things that really DO make a difference.

The bottom line here (as I painfully learned) is the almighty****ingdollar.

Sometimes, those who have already surrendered to it would rather not bother with those who would pointlessly rail against it.

It really comes down to the phenomenon of - "Hey, what do you think about MultiFart therapy and UnfoundedPatientConcernX? Hate it? Yeah, me too.... but you can't get away with not doing it because of ManagmentGroupABC and their metrics... How do we circumvent this?"

Meanwhile, the MS 3/4s are saying - "uhhhm... chest ultrasound and mediastium fuzzy-values can go a long way to proving that..... things that ManagementGroupABC doesn't give a fart about."


Greek salads sometimes have feta cheese. Get it ?
 
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Arcan57

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I'm still not seeing an argument that couldn't be answered equally well by effective (community or otherwise) moderation of posts. If thread hijacking is a problem, why can't we just handle the issue like every other forum- through peer pressure and by having our mods take care of it?

I also don't like the attitude that the attendings have nothing to gain from student input. Some might scoff at our wide eyed enthusiasm, but others might welcome the reminder of what it felt like to be excited about this field. It seems some (though certainly not all) are in desperate need of that.
Wide eyed idealism coming from a med student is not a balm to the soul. If you aren't excited about the field then why go into it. But I think a conversation about EM after the thrill is gone is useful. As you get better at something, it becomes less exciting. Yet the excitement is mentioned by almost everyone who is interested in EM. So what do you do when one of the main reasons you went into EM is gone? Because honestly most of us arent in jobs where we see something completely novel every day or even every week. This doesn't necessarily apply to me (my motivation for EM wasn't mainly adrenaline) but it is a big issue.
 

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Surprised there is so much back-lash. There is no evidence that having a private forum will dilute the posting, in fact there is evidence to the contrary over in the Anesthesia forums. Their private forum has been up for some time and that board hasn't withered up and died. Hell, the EM folks aren't even suggesting to restrict viewership like anesthesiology did.
 

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I don't really see the point of an attending only forum. I agree it's annoying to see some medstudent jump into a conversation with 100% conviction and 0% experience, but when I see an obviously clueless comment, I usually just look at their training status and filter it appropriately if it says "med student/health student/premed/etc". I get a lot of value from reading comments from the more curmudgeonily attendings on here and I think, there is good educational value in getting smacked down by someone with more experience from time to time. As I go into my final year of residency, I'd hate to be excluded from hearing what Attendings are saying about my field.
 

fiznat

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Wide eyed idealism coming from a med student is not a balm to the soul. If you aren't excited about the field then why go into it. But I think a conversation about EM after the thrill is gone is useful. As you get better at something, it becomes less exciting. Yet the excitement is mentioned by almost everyone who is interested in EM. So what do you do when one of the main reasons you went into EM is gone? Because honestly most of us arent in jobs where we see something completely novel every day or even every week. This doesn't necessarily apply to me (my motivation for EM wasn't mainly adrenaline) but it is a big issue.

I donno man. While I am obviously not yet a physician, I was a paramedic for 10 years and I do know a little bit about burnout, the loss of excitement, and what it means to not have a "win" in a while. Still, one of the things that really kept me interested in my work in the face of all that was working with paramedic students, and training new-hires in the field. Even though I sometimes groaned at their idealistic attitudes, more often than not it was a shot in the arm, and a reminder of some of the core principles that kept me working with patients (not adrenaline either). Keeping myself involved with the new folks was difficult and annoying sometimes, but it always benefited me in the end. Maybe this isn't precisely apples to apples, but I can't imagine we're talking about different fruits entirely. Keeping yourself involved with trainees is almost always an eye-opening experience that offers challenge and stimulates self-reflection unlike any other process. Is physician training really all that different?
 

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Surprised there is so much back-lash. There is no evidence that having a private forum will dilute the posting, in fact there is evidence to the contrary over in the Anesthesia forums. Their private forum has been up for some time and that board hasn't withered up and died. Hell, the EM folks aren't even suggesting to restrict viewership like anesthesiology did.
Not the same. The anesthesiology private forum is not visible to those who are not authorized (which is not what is being discussed here). The same applies to the "Pain Rounds" physician only subforum in the pain medicine forum.
 

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IMy main reason is that I think that the students/residents get something important out of reading the discussions. You can graduate residency and have never heard of Press Ganey. But if you read this forum you've heard of it. That's a big deal.
We'll read if we can, even if we're not allowed to post. I've learned a great deal about the nitty-gritty of the practice of emergency medicine just by reading posts by attendings in this forum.
 

Arcan57

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I donno man. While I am obviously not yet a physician, I was a paramedic for 10 years and I do know a little bit about burnout, the loss of excitement, and what it means to not have a "win" in a while. Still, one of the things that really kept me interested in my work in the face of all that was working with paramedic students, and training new-hires in the field. Even though I sometimes groaned at their idealistic attitudes, more often than not it was a shot in the arm, and a reminder of some of the core principles that kept me working with patients (not adrenaline either). Keeping myself involved with the new folks was difficult and annoying sometimes, but it always benefited me in the end. Maybe this isn't precisely apples to apples, but I can't imagine we're talking about different fruits entirely. Keeping yourself involved with trainees is almost always an eye-opening experience that offers challenge and stimulates self-reflection unlike any other process. Is physician training really all that different?
No, physician training isn't all that different. And I think that most of the attendings are happy to answer questions, and that a lot of us are on here because we miss the interaction and teaching that was a constant feature in residency.

But for the first time in the years I've been on here, there is a core group of attending posters that started their SDN careers in residency or even med school. We've always had lone voices crying out in the wilderness (Apollyon, etc.) but now there are enough of us to have productive dialog about attending life. Yes, we could try and move en masse to Sermo but I like the posters on SDN better and a lot of us have been posting here for years. And I would miss being able to share some of the practical knowledge I've acquired as well as hearing some of the new stuff coming out (ECMO for pt's in cardiac arrest comes to mind and I'd like to know if anybody is doing this routinely).

As an attending there are specific concerns that make no sense to a resident in the same way that residents have concerns that make no sense to an M2 cramming for Step I. At some point the answers that come out of these discussions are going to be useful to you, but you may not have a whole lot of need/credibility to be part of the discussion.
 

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The anesthesiology forums puts me to sleep anyways...
:thumbup: I see what you did there...:thumbup:

Anyway, as a lowly pre-med who checks this forum frequently, I wouldn't be opposed to the idea. I mean, there is a closed forum dedicated to past/current chief residents. That doesn't seem to bother anyone.