So...how are you holding up?

[bashir]

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This is my standard greeting right now for someone whom I have good reason to presume is struggling mightily with events of the last few weeks. Sometimes people say "fine" and sometimes they take the opening to share a bit about what they're experiencing and how they're coping with it so far.

I'll go first. I had been waiting for the other shoe to drop in terms of when I would start to be personally affected by the spate of executive orders, rather than living primarily in terror of what is happening to others more vulnerable than myself. I'm in academia, so the instatement of the 15% ceiling on F&A for NIH grants kind of did it for me. A federal judge ordered an injunction yesterday that is supposed to put a pause on its implementation, but so far there hasn't been any indication that the Trump administration intends to pay any attention to what the courts say about anything. A full-on constitutional crisis seems to be inevitable and intentional. Not a bug but a feature.

I really really love my job. It's getting hard to imagine that there's a world where my university isn't drastically affected by the unlawful takeover of governmental institutions in a way that will ruin the good thing I have going here. And that makes me really sad, from a purely self-interested lens. It's also hard to give space to those feelings when they feel so small and petty in comparison to what seems an awful lot like the crumbling of democracy around us.

Anyway, feel free to share what you're experiencing if you like. All I can think to do is call my representatives daily (check out 5calls.org) and try to lean into the communities I am grateful to have in my life, including this forum.

A New Kind of Crisis for American Universities

The ivory tower has been breached.

www.theatlantic.com

 

[Merovinge]

I am very disheartened to see all the issues befalling our incredible Universities (which is honestly the best asset the US has). From all the researcher's that have poured their entire life into incredible domain expertise that improves all of our lives. To the amazing doctors taking huge pay cuts to train the next generation of doctors and take care of those that society has cast aside. The systematic devaluation of public service, of healers, and of experts is absolutely going to tear at the fabric of society.

I am drawn to psychiatry and the pediatric age range because protecting those who can't protect themselves is my ultimate idea of a day well lived. To see so many people want to strip away the little dignity and care our most vulnerable have so that Bezo's can have 3 helipads on his yacht instead of 2 is... tough, to say the least. I work and have worked with so many children who rely on federal funding to have their mental health and educational needs met and I cannot imagine the fallout from cutting that funding down the road (other than to say that I'm buying calls on crime rates 10 years down the road).

I will continue protecting my patients, my friends, and my family and go on living a very cushy life. But I do see the rising specter and it's shadow is rapidly expanding.

 

[Sushirolls]

Trump isn't perfect. There are things here and there I disagree with, but a majority are a positive.
First time in years I wake up each morning excited to see the news and read what positive changes are being started.
I breath lighter every day. But I am fully cognizant that it may only be a 4 year reprieve.

I hope for deeper, greater changes by the current administration, and congressional laws to support them so they can survive beyond the administration.

After experiencing as a youth the indoctrination of public schools, the massively left leaning bias of public universities, the disconnect that student loans should be paid for by tax payers, to accomplish basket weaving with a minor in social justice warrior protest, I'm appalled. I know conservative professors who stay silent and hide due to the torrent of liberal academia. Academia has transitioned from being an institution of repute, to hold sacred knowledge, its discovery, and its dissemination, to being transactional. How can we move the bodies thru to keep the tuition flowing? Even at the graduate level. How can we indoctrinate the youth to be our next political activists? That is disgusting, and I will shed no tears for any future razing of this institution.

Any of the pains we might experience in the next 4 years, and hopefully there will be more, has the real potential to stave off the collapse of America and its previous trajectory for rebirth as socialist scat scape.

So to the OP query, how am I holding up? I feel hope, and a bit more hope for my kids and future grandkids.

 

[lobstar]

I'm holding up well in the sense that I just know this thread is going to be fun to read until it's closed...popcorn time

 

[Sushirolls]

It shouldn't be closed. People should be capable of answering the OP prompt and not attacking others personally. I understand the feelings of frustration and angst others may be having now. I felt them for a few decades. Many people do and will have real things that impact them to gripe about. I anticipate I too will have things that make me flabbergasted. But if this administration does things right... we should all be equally disgruntled by the end.

 

[Ironspy]

My family fled a dictatorship when I was a child. This constitutional crisis and slide into dictatorship is highly concerning beyond my job in academia.

 

[Monocles]

Trump isn't perfect. There are things here and there I disagree with, but a majority are a positive.
First time in years I wake up each morning excited to see the news and read what positive changes are being started.
I breath lighter every day. But I am fully cognizant that it may only be a 4 year reprieve.

I hope for deeper, greater changes by the current administration, and congressional laws to support them so they can survive beyond the administration.

After experiencing as a youth the indoctrination of public schools, the massively left leaning bias of public universities, the disconnect that student loans should be paid for by tax payers, to accomplish basket weaving with a minor in social justice warrior protest, I'm appalled. I know conservative professors who stay silent and hide due to the torrent of liberal academia. Academia has transitioned from being an institution of repute, to hold sacred knowledge, its discovery, and its dissemination, to being transactional. How can we move the bodies thru to keep the tuition flowing? Even at the graduate level. How can we indoctrinate the youth to be our next political activists? That is disgusting, and I will shed no tears for any future razing of this institution.

Any of the pains we might experience in the next 4 years, and hopefully there will be more, has the real potential to stave off the collapse of America and its previous trajectory for rebirth as socialist scat scape.

So to the OP query, how am I holding up? I feel hope, and a bit more hope for my kids and future grandkids.

Whoa, I feel like we live in alternate parallel universes. I'm at the point where I am actively avoiding news or social media of any kind due to pessimism exhaustion.

I'm at the point where I am considering holding off early retirement (was previously projected to be around 2027/28) in case I need to leverage my physician credentials and flee to New Zealand or something given the political and social climate.

Of course, I recognise that being in academia and Boston, I probably live in a very insular environment and my view is shaped by peers who have fairly similar but isolated views.

 

[FatherPsychiatry]

I'm at the point where I am considering holding off early retirement (was previously projected to be around 2027/28) in case I need to leverage my physician credentials and flee to New Zealand or something given the political and social climate.

Oh boy. I pulled up my deleted/archived emails because I remember getting some locums offer for New Zealand. Looks like it was from early November 2024, offering $950 NZ per day (comes out to about $537 USD) for 8 hours a day of work. I thought that was a very low compensation, but wondering if now they could offer less and they'll have a huge set of applicants to draw from.

 

[lobstar]

Oh boy. I pulled up my deleted/archived emails because I remember getting some locums offer for New Zealand. Looks like it was from early November 2024, offering $950 NZ per day (comes out to about $537 USD) for 8 hours a day of work. I thought that was a very low compensation, but wondering if now they could offer less and they'll have a huge set of applicants to draw from.

Wow, that would be a steal for them getting US docs at that rate.

That's the crux of the matter though--is the US so bad that some of us are prepared to go from 250-400k down to 110k or so? I highly doubt it. As bad as the US may or may not be, there's not much in the way of alternative options unfortunately.

 

[TexasPhysician]

Oh boy. I pulled up my deleted/archived emails because I remember getting some locums offer for New Zealand. Looks like it was from early November 2024, offering $950 NZ per day (comes out to about $537 USD) for 8 hours a day of work. I thought that was a very low compensation, but wondering if now they could offer less and they'll have a huge set of applicants to draw from.

There hasn’t been a huge outflow of physicians. This “crisis” occurs every 4 years. Half of the country panics and considers fleeing for a period of time. A family physician I know escaped to NZ about 4 years ago and is returning. He took a 50% pay cut to go there. He reports overall enjoying the experience, but the 50% pay cut was hard to handle. I’m not sure how taxes work for US citizens in other countries, but most I’ve researched have higher taxes than USA. A psychiatrist I know that did another country moved back about 3 years ago and took a non-clinical job. He was disappointed that the alternate country was not a better clinical situation and has had enough of clinic for now.

I feel generally mixed so far. I wouldn’t say that things have gone very well over the last 5-6 years. We’ve dug a hole. Inflation has really hurt almost everyone. It hurts with staff retention as everyone wants a raise to keep up or exceed inflation. That doesn’t work in our field. We suffer which often leads to staff turnover and lower quality care. I don’t think there is an easy fix. I’m expecting things to get worse before they get better.

Maybe our profession biases us, but I feel the dissatisfaction in America is escalating over the last 10+ years. Big changes are needed, but can they be strategic enough to not cause significant harm? That’s rhetorical as I don’t believe anyone here has that answer.

 

[bashir]

Trump isn't perfect. There are things here and there I disagree with, but a majority are a positive.
First time in years I wake up each morning excited to see the news and read what positive changes are being started.
I breath lighter every day. But I am fully cognizant that it may only be a 4 year reprieve.

I hope for deeper, greater changes by the current administration, and congressional laws to support them so they can survive beyond the administration.

After experiencing as a youth the indoctrination of public schools, the massively left leaning bias of public universities, the disconnect that student loans should be paid for by tax payers, to accomplish basket weaving with a minor in social justice warrior protest, I'm appalled. I know conservative professors who stay silent and hide due to the torrent of liberal academia. Academia has transitioned from being an institution of repute, to hold sacred knowledge, its discovery, and its dissemination, to being transactional. How can we move the bodies thru to keep the tuition flowing? Even at the graduate level. How can we indoctrinate the youth to be our next political activists? That is disgusting, and I will shed no tears for any future razing of this institution.

Any of the pains we might experience in the next 4 years, and hopefully there will be more, has the real potential to stave off the collapse of America and its previous trajectory for rebirth as socialist scat scape.

So to the OP query, how am I holding up? I feel hope, and a bit more hope for my kids and future grandkids.

I am a liberal. But I actually think there is a lot of validity to your criticisms here of academia. And I also agree with you about the possibility of civil dialogue in the forum between people who disagree. We are psychiatrists; if we can't talk to people with beliefs we fundamentally disagree with we are in the wrong field.

One of my biggest worries is that the Trump administration actually has the power to enact many of the policies it is ramming through via executive order, in lawful ways, if they chose to act lawfully. After all, they control both houses of Congress and the Supreme Court. And yet, it appears that they are intent on denying the legitimacy of other branches of government and simply refusing to accept limitations on the power of the executive branch. It's not just about the policies per se (which are abhorrent to me, but I can accept and understand that other people feel differently about), it's about the power grab. Reasonable people can disagree about policy, but I'm having a really hard time understanding how anyone who believes in democracy can not be concerned about the process. I am wondering if you can help me understand why this doesn't concern you?

 

[TexasPhysician]

I am a liberal. But I actually think there is a lot of validity to your criticisms here of academia. And I also agree with you about the possibility of civil dialogue in the forum between people who disagree. We are psychiatrists; if we can't talk to people with beliefs we fundamentally disagree with we are in the wrong field.

One of my biggest worries is that the Trump administration actually has the power to enact many of the policies it is ramming through via executive order, in lawful ways, if they chose to act lawfully. After all, they control both houses of Congress and the Supreme Court. And yet, it appears that they are intent on denying the legitimacy of other branches of government and simply refusing to accept limitations on the power of the executive branch. It's not just about the policies per se (which are abhorrent to me, but I can accept and understand that other people feel differently about), it's about the power grab. Reasonable people can disagree about policy, but I'm having a really hard time understanding how anyone who believes in democracy can not be concerned about the process. I am wondering if you can help me understand why this doesn't concern you?

I’m more of a Libertarian swing vote. Most of your words are charged with a clear bias. I’d argue that most Americans are concerned about future policies (legal or not). Most want things to get better by whatever means. Most Americans can’t translate our own laws to tell you if something was legal or not. You are worrying about hypotheticals. Many Americans were equally concerned by the poor decisions of Biden, cognitive state, and the abundance of pardons granted.

This country would do a lot better if we could quit judging the other party and unite on best strategies and end goals. Instead both parties choose more extreme options to vote on and ram differences at each other.

The end result is that we can’t have nice things. Like the last 12+ years, we have an opportunity to build together and see the value in each other for a better next election.

 

[Sushirolls]

... I am wondering if you can help me understand why this doesn't concern you?

Very tempting to respond to that question.

But for the sake of your original post I'll avoid so as not to detract and hopefully keep the original intent flowing. The other issue is time, it would take hours to type up a point-by-point play and breakdown of the issues. But really, to answer that question with full gusto, an evening ear marked for dinner and lots of soju bottles is the best approach.

 

[calvnandhobbs68]

I’m more of a Libertarian swing vote. Most of your words are charged with a clear bias. I’d argue that most Americans are concerned about future policies (legal or not). Most want things to get better by whatever means. Most Americans can’t translate our own laws to tell you if something was legal or not. You are worrying about hypotheticals. Many Americans were equally concerned by the poor decisions of Biden, cognitive state, and the abundance of pardons granted.

This country would do a lot better if we could quit judging the other party and unite on best strategies and end goals. Instead both parties choose more extreme options to vote on and ram differences at each other.

The end result is that we can’t have nice things. Like the last 12+ years, we have an opportunity to build together and see the value in each other for a better next election.

Yeah yeah the "holier than thou independent" talk. We're getting a little past the "guys let's all just get along". I would take a real hard think about what the statement "most want things to get better by whatever means" actually represents in terms of "getting better" and "whatever means".

What I will say is all the "unprecedented" stuff becomes "precedented" when it happens. So, if we continue to have free and fair elections, eventually the other side is back in power and everything that's happening right now becomes free game for any other party. That certainly goes for all sides of the political spectrum.

 

[TexasPhysician]

Yeah yeah the "holier than thou independent" talk. We're getting a little past the "guys let's all just get along". I would take a real hard think about what the statement "most want things to get better by whatever means" actually represents in terms of "getting better" and "whatever means".

What I will say is all the "unprecedented" stuff becomes "precedented" when it happens. So, if we continue to have free and fair elections, eventually the other side is back in power and everything that's happening right now becomes free game for any other party. That certainly goes for all sides of the political spectrum.

That is a lot of quotes.

 

[calvnandhobbs68]

That is a lot of quotes.

 

[J ROD]

Having worked in government and experience the administrative state and how they "operate" behind the scenes and the amount of mismanagement of our taxes, I do not care what party "cleans it up". I just want to decrease the debt and not waste our taxes so we do not have to pay more taxes. I just want to pay lower taxes and have what I pay go to things that are needed. Just run things more business like and accountable. I think we all can agree we should know what our taxes are paying for and want to pay less in taxes and keep more money for ourselves.

 

[bashir]

Very tempting to respond to that question.

But for the sake of your original post I'll avoid so as not to detract and hopefully keep the original intent flowing. The other issue is time, it would take hours to type up a point-by-point play and breakdown of the issues. But really, to answer that question with full gusto, an evening ear marked for dinner and lots of soju bottles is the best approach.

I agree these types of discussions are best had in person, and sometimes the time it takes to type out a well thought out response that captures one's nuanced views on complicated topics doesn't seem worth investing, just to talk to strangers on the internet. That said, curiosity compels me to ask if you are essentially of the "the ends justify any and all means" camp? Or rather it's that you disagree with my characterization of Trump's unlawful seizure of power. If Trump starts openly flouting court orders (many argue that this is already happening and that the constitutional crisis is upon us, but it will become clearer one way or another in the coming weeks), would that still be ok, or would your opinion change at that point?

 

[calvnandhobbs68]

Guys I totally agree way too much excess spending in the government we need to start cutting back.

It’s all a scam and you ain’t in on it.

State Dept. Plans $400 Million Purchase of Armored Tesla Cybertrucks

The department plans to buy armored Tesla vehicles. Elon Musk, who is leading efforts to cut government spending, has won more than $13 billion in government contracts in the past five years.

www.nytimes.com

 

[bashir]

"It's all a scam and you ain't in on it" says more in 10 words than the last 10 think pieces I have read.

 

[trophyhusband]

Having worked in government and experience the administrative state and how they "operate" behind the scenes and the amount of mismanagement of our taxes, I do not care what party "cleans it up". I just want to decrease the debt and not waste our taxes so we do not have to pay more taxes. I just want to pay lower taxes and have what I pay go to things that are needed. Just run things more business like and accountable. I think we all can agree we should know what our taxes are paying for and want to pay less in taxes and keep more money for ourselves.

Cut debt and pay less in taxes... oh lordy.

Total revenues for the US gov are $4.4T and expenditures are $6.1T. Of that $6.1T non-defense discretionary spending is $917B... so you could cut the entirety of what we think of as goverment in its non-military form and you'd still be adding to the debt each year. You could then cut all military spending $805B and you'd just barely start reducing the debt.

This is all performative political theater. You'd need to start cutting SS, Medicare and Medicaid to really make a difference but if you start cutting the last two guess who's incomes you're going to really start decimating... physicians.

Commercial insurance (insurance through employers) will start going through the roof because the hospitals will have to get their money from somewhere. So employers will stop dropping their benefit plans or employees won't be able to afford them. Then all doctors will start trying to go cash pay and I doubt the high rates being charged now by Psychiatrists will be sustainable.

So in the end they won't really cut much actual spending. It'll be cutting around the edges of the tiniest bits of overall Federal spending and cuts to the programs that people really need. They'll cut taxes and the deficits will balloon and you'll pay more in interest as rates rise and more in inflation as tariffs and the money they keep shoving into the system drives costs up on everything.

Edit: Should have noted that this is 2023 dollars. It's probably more for 2024.

 

[Sushirolls]

And they've already started to turn their eye towards the defense budget. Which is good.

And seldom spoken about is the US defense budget has allowed countries like Canada and most of Europe to avoid investment in their own military complex because of the US alliances. This has allowed these countries to dump more money in socialist endeavors, which then leads to the left in the US having envy "see they can do that, why can't we?" I'm supportive of pulling back defense protection for the rest of the world to force them to reconcile their budget's as we starting to do with ours.

 

[trophyhusband]

And they've already started to turn their eye towards the defense budget. Which is good.

And seldom spoken about is the US defense budget has allowed countries like Canada and most of Europe to avoid investment in their own military complex because of the US alliances. This has allowed these countries to dump more money in socialist endeavors, which then leads to the left in the US having envy "see they can do that, why can't we?" I'm supportive of pulling back defense protection for the rest of the world to force them to reconcile their budget's as we starting to do with ours.

Prediction, they make more small cuts that they hail as finally taking on the cutting of defense spending. But then end up spending billions upon billions more on AI and whatever hairbrained weapons system SpaceX/Elon/Tesla come up with and you end up with more spending in the end.

They'll also somehow spend more but protect less and less of the world as well.

 

[Sushirolls]

I agree these types of discussions are best had in person, and sometimes the time it takes to type out a well thought out response that captures one's nuanced views on complicated topics doesn't seem worth investing, just to talk to strangers on the internet. That said, curiosity compels me to ask if you are essentially of the "the ends justify any and all means" camp? Or rather it's that you disagree with my characterization of Trump's unlawful seizure of power. If Trump starts openly flouting court orders (many argue that this is already happening and that the constitutional crisis is upon us, but it will become clearer one way or another in the coming weeks), would that still be ok, or would your opinion change at that point?

There is no constitutional crisis. It's just the latest rebirth of "threat to democracy" or Trump is a dictator or Trump is a Nazi etc. After the buzz words lose their hype and click bait status, a new term is developed to feed the fervor of the left media apparatus. It's the flavor of the season, like iPhone #62.

The gaslighting from the left is non stop. The progression of the left is the greatest threat to democracy. One only needs to look at the uni-party system of California to see that as its showing the earliest stages of its death. Contrast to say Idaho, which is actively pushing bills thru to lower property taxes give refunds etc to their residents. Or the recent growth seen in FL or TX.

Expanding on @trophyhusband the budget and debt must be reigned in. One can reference the history of Greece and the austerity measures placed on it. We have the warning signs now of BRICS and the true declarations of countries that are not our friends, and not our allies. And when the day comes to pass that the economy collapses from debt, it will be worse than what Greece experienced and there won't be any countries coming to help us out, because much of the world will also be reeling in economic crisis too, and there won't be any way to buy (inflation) one's way out of it. During those economic blights - substance use, Suicides, child abuse, crime, mental health crises - will all be amplified as America doesn't have its historic religious/agricultural/resilient roots to lean into. We can see the grand canyon, are just starting to peer off the over the edge, and the imperfect Trump administration is sadly our best chance at pulling us away from the edge.

 

[Sushirolls]

Prediction, they make more small cuts that they hail as finally taking on the cutting of defense spending. But then end up spending billions upon billions more on AI and whatever hairbrained weapons system SpaceX/Elon/Tesla come up with and you end up with more spending in the end.

They'll also somehow spend more but protect less and less of the world as well.

Probably right.

But conversely, when was the last time an administration openly said we need to really review what's being spent, and what's money going towards? The USMC lives on shoestring budget yet does the majority of pounding in conflicts. Hegseth pointed that out and that shows insight, and means there is a chance to look wisely at the other branches. I'm suspecting nothing of consequence will change, but I am cautiously optimistic with this administration. At least the scat show of previous has come to end. We will tread water for 4 more years, or just maybe be better off. And Ukraine is the latest test laboratory to understand how things need to be changed for military readiness and the new emphasis/need for drones; lots of them.

Sadly, China was becoming less of a military concern and just a trading nuisance with their thefts and shady reports of their economy. But with Xi in office looking to tech enforce the future longevity of the communist party and expand and dominate like their good ol' empire days, here the world goes yet again with an aggressive nation ramping up for expansion...

And yes, the US arms race for AI sadly also is imperative. A nasty adversary AI from China that shatters individual citizen bank accounts, commercial banking, electric grids, traffic cameras, internet, and we are thrust into the dark ages. 3 days no food (most people don't have much food in their pantries) or 3 days no heat or no water and people are statistically picking up weapons and the throats of their neighbors. To think China can't or won't do such a thing is foolish. Their political party came into power by killing several hundred million of their own people. They've already taken over Tibet [where's the liberal protests here? I remember as a kid seeing the protests. Not cool anymore? Free Tibet doesn't get crowds?]. They have their muslim population in work camps. Previous 20 years we ignored the arms race in front of us with Xi in office, and now we have to hit the gas pedal Cold War style, yet again.

 

[littlefred]

I am flabbergasted by how this conversation expands my knowledge of psychiatry and politics.

Looking forward to more discussion.
Thanks to all.

 

[trophyhusband]

Probably right.

But conversely, when was the last time an administration openly said we need to really review what's being spent, and what's money going towards? The USMC lives on shoestring budget yet does the majority of pounding in conflicts. Hegseth pointed that out and that shows insight, and means there is a chance to look wisely at the other branches. I'm suspecting nothing of consequence will change, but I am cautiously optimistic with this administration. At least the scat show of previous has come to end. We will tread water for 4 more years, or just maybe be better off. And Ukraine is the latest test laboratory to understand how things need to be changed for military readiness and the new emphasis/need for drones; lots of them.

Sadly, China was becoming less of a military concern and just a trading nuisance with their thefts and shady reports of their economy. But with Xi in office looking to tech enforce the future longevity of the communist party and expand and dominate like their good ol' empire days, here the world goes yet again with an aggressive nation ramping up for expansion...

And yes, the US arms race for AI sadly also is imperative. A nasty adversary AI from China that shatters individual citizen bank accounts, commercial banking, electric grids, traffic cameras, internet, and we are thrust into the dark ages. 3 days no food (most people don't have much food in their pantries) or 3 days no heat or no water and people are statistically picking up weapons and the throats of their neighbors. To think China can't or won't do such a thing is foolish. Their political party came into power by killing several hundred million of their own people. They've already taken over Tibet [where's the liberal protests here? I remember as a kid seeing the protests. Not cool anymore? Free Tibet doesn't get crowds?]. They have their muslim population in work camps. Previous 20 years we ignored the arms race in front of us with Xi in office, and now we have to hit the gas pedal Cold War style, yet again.

BRAC under Clinton was the last major try at cuts probably. I actually lead the team that moved the USMC's finance group from Kansas City to Cleveland under the Navy's main financial office due to BRAC. So I'm well aware of how the USMC gets treated budgetarily.

My prediction for the cuts that they actually make to the military are getting rid of the VA (they've already discussed it and it fits with their goal of selling off goverment real estate assets) and pissing off our allies abroad so much that they have to start closing military bases. They'll tout those as cuts and then spend 10× as much elsewhere.

Who knows maybe they'll stop being a voluntary force to cut back on personnel costs... go back to the draft or forced obligation for 18 to 20-somethings like some other countries do with their young people.

 

[Sushirolls]

The VA needs to go.
It should just be a private insurance company. But one that pays more than medicare rates.

I'm mixed on the obligatory service. That's a long topic there. Lots of pros, lots of cons. That is its own multipage thread just on that topic.

But I do believe with the new emphasis and importance of drones, there will be a reduced human force over the next few years/decades as that takes shape.

 

[trophyhusband]

The VA needs to go.
It should just be a private insurance company. But one that pays more than medicare rates.

I'm mixed on the obligatory service. That's a long topic there. Lots of pros, lots of cons. That is its own multipage thread just on that topic.

But I do believe with the new emphasis and importance of drones, there will be a reduced human force over the next few years/decades as that takes shape.

Tricare rates at best if they even pay for anything at all. I wouldn't be surprised if they just say you're on your own after service or force the states to deal with it via whatever block grant thing they turn Medicaid into.

 

[Sushirolls]

The laws stemming from Civil War, Lincoln era, require veteran medical care. That would be a very difficult slash. Lot's of other budget targets way higher on the list before considering that.

 

[trophyhusband]

The laws stemming from Civil War, Lincoln era, require veteran medical care. That would be a very difficult slash. Lot's of other budget targets way higher on the list before considering that.

I'm not assuming they actually care about laws anymore. We'll see. Hope they do.

 

[comp1]

The VA, in every system wide clinical study I've ever seen, provides care that is cheaper and more clinically effective than that provided in a local community even while having a significantly sicker and lower socioeconomic baseline population. There are specific VAs that have specific issues with specific specialties (as with any specific hospital, although the VA is more likely to make national news). However, turning the largest single provider of healthcare in the world into just another payor does not seem in any way likely to be cost or clinically effective. Quite the opposite, we need to expand the VA model, and the sheer amount of oversight the VA undergoes, dramatically throughout the country for larger populations of people to both reduce cost and improve overall health.

 

[FlowRate]

The VA, in every system wide clinical study I've ever seen, provides care that is cheaper and more clinically effective than that provided in a local community even while having a significantly sicker and lower socioeconomic baseline population. There are specific VAs that have specific issues with specific specialties (as with any specific hospital, although the VA is more likely to make national news). However, turning the largest single provider of healthcare in the world into just another payor does not seem in any way likely to be cost or clinically effective. Quite the opposite, we need to expand the VA model, and the sheer amount of oversight the VA undergoes, dramatically throughout the country for larger populations of people to both reduce cost and improve overall health.

Not sure if Kaiser has similar published evidence for cost effectiveness (there is a reason the model is so popular/successful, especially in California), but I really think integrated systems with incentives that are aligned toward cost effectiveness and clinical quality are the ideal middle ground for patients and physicians.

 

[clozareal]

For me, things seem mostly the same in terms of patients coming to me, my income, and my investments. The NIH grant thing doesn't affect me directly as I'm in private practice.

I have more anxiety about what all the government changes will mean for society and for me as a taxpayer, but I'm trying to focus on decisions I have more direct control over. I recognize this is a privilege that not all Americans have.

 

[docloufan]

The VA needs to go.
It should just be a private insurance company. But one that pays more than medicare rates.

I'm mixed on the obligatory service. That's a long topic there. Lots of pros, lots of cons. That is its own multipage thread just on that topic.

But I do believe with the new emphasis and importance of drones, there will be a reduced human force over the next few years/decades as that takes shape.

The VA, in every system wide clinical study I've ever seen, provides care that is cheaper and more clinically effective than that provided in a local community even while having a significantly sicker and lower socioeconomic baseline population. There are specific VAs that have specific issues with specific specialties (as with any specific hospital, although the VA is more likely to make national news). However, turning the largest single provider of healthcare in the world into just another payor does not seem in any way likely to be cost or clinically effective. Quite the opposite, we need to expand the VA model, and the sheer amount of oversight the VA undergoes, dramatically throughout the country for larger populations of people to both reduce cost and improve overall health.

I don't know, man? I disagree with everything these fools say most of the time, such as: "After experiencing as a youth the indoctrination of public schools, the massively left leaning bias of public universities" (puke, ya weirdo), but this particular is position is actually right and just... in my opinion.

No "job" or "career" itself should dictate one's right to privileged health care services. No one man is more deserving than another. It's a caste system.... and it's wrong/immoral. Period.

Social determinants of health behavior are just conspiracies...of NIH funded psychiatry and public health researchers effort for 30 years, yea?

 

[OldPsychDoc]

Trump isn't perfect. There are things here and there I disagree with, but a majority are a positive.
First time in years I wake up each morning excited to see the news and read what positive changes are being started.
I breath lighter every day. But I am fully cognizant that it may only be a 4 year reprieve.

I hope for deeper, greater changes by the current administration, and congressional laws to support them so they can survive beyond the administration.

After experiencing as a youth the indoctrination of public schools, the massively left leaning bias of public universities, the disconnect that student loans should be paid for by tax payers, to accomplish basket weaving with a minor in social justice warrior protest, I'm appalled. I know conservative professors who stay silent and hide due to the torrent of liberal academia. Academia has transitioned from being an institution of repute, to hold sacred knowledge, its discovery, and its dissemination, to being transactional. How can we move the bodies thru to keep the tuition flowing? Even at the graduate level. How can we indoctrinate the youth to be our next political activists? That is disgusting, and I will shed no tears for any future razing of this institution.

Any of the pains we might experience in the next 4 years, and hopefully there will be more, has the real potential to stave off the collapse of America and its previous trajectory for rebirth as socialist scat scape.

So to the OP query, how am I holding up? I feel hope, and a bit more hope for my kids and future grandkids.

You don't take care of actual real psychiatric patients, do you?
Because anyone working with SPMI patients and who has any passing acquaintance social determinants of health is not feeling hopeful at all, least of all for the kids and grandkids.

 

[FatherPsychiatry]

So what you all are saying is... it really wasn't about the price of eggs, was it?

 

[Stagg737]

"It's all a scam and you ain't in on it" says more in 10 words than the last 10 think pieces I have read.

That's pretty much true of every government since, forever? Just depends on what the hustle actually is, how obvious it is as a scam, and how much people are willing to buy the crap being spoon fed to them. Anyone thinking that our highest politicians truly prioritize the people over their party and personal ideology outside of acute crises perceived as threats to the nation (like COVID or 9/11) are either naive or delusional.

We are where we're at because our two main political parties have been ineffective at what they've said they would do and lost the confidence of the people. If that weren't the case Trump wouldn't have been able to overrun the GOP and beat a helpless democratic party into the ground.

You don't take care of actual real psychiatric patients, do you?
Because anyone working with SPMI patients and who has any passing acquaintance social determinants of health is not feeling hopeful at all, least of all for the kids and grandkids.

Realistically, if SPMI or the typical academic patients are what you're referring to, then probably 80-90% of private practice docs don't take care of "real psychiatric patients". So really only applicable to a small number of us anyway.

While research at academic centers will likely take a hit, what has been done or is in the works to cut funding to CMHCs or academic clinics? If the argument to academic clinics is that they're dependent on that funding to function, seems like a mismanagement of funds within the academic centers. Unless the concern is regarding future policies that could be implemented through changes to CMS policy, in which case we'll just have to wait and see.

Legitimately curious on people's takes on this.

 

[comp1]

Halving the overhead percentage for NIH research grants will affect everything that an academic medical facility does. It's not efficient or even possible to silo money used in that way. It's why it's called overhead and not specifically directed to the PI.

 

[docloufan]

So what you all are saying is... it really wasn't about the price of eggs, was it

It's allegiance to.... nonsense. There is no core belief. That ended long ago.

 

[SaiyanSammy]

I mean, not great. You have Elon Musk literally doing a nazi salute on stage and giving a speech to the AfD that they should be proud of all parts of their German heritage. All the while he has rehired someone onto DOGE who is openly a white supremacist (Marko Elez) because he is the "best man for the job" despite the fact that he is unqualified... all the while Elon and Trump's policy is to dismantle DEI efforts which are intended to force equity into systems where racial discrimination both openly and secretly exists. They're destroying DEI and intentionally placing white supremacists into such roles.

All the while Trump supporters (both the ignorant ones and the racist ones) try to gaslight people into believing racism no longer exists and DEI programs aren't needed.

This is obviously just going to lead to another civil rights movement, if not a genocide, somewhere down the line.

Or maybe I'm just misunderstanding their intentions and really Trump, Elon, and his supporters are doing God's work through the oppression of less civilized peoples who need to be controlled.

 

[calvnandhobbs68]

Realistically, if SPMI or the typical academic patients are what you're referring to, then probably 80-90% of private practice docs don't take care of "real psychiatric patients". So really only applicable to a small number of us anyway.

While research at academic centers will likely take a hit, what has been done or is in the works to cut funding to CMHCs or academic clinics? If the argument to academic clinics is that they're dependent on that funding to function, seems like a mismanagement of funds within the academic centers. Unless the concern is regarding future policies that could be implemented through changes to CMS policy, in which case we'll just have to wait and see.

Legitimately curious on people's takes on this.

There's a high chance of some level of Medicaid funding cut coming down the line. It's likely to be part of how GOP pays for extending tax cuts cause we know from both parties end SS and Medicare are untouchable. Who votes? Old people. Who doesn't vote? Poor people and kids.

Eliminating the Medicaid Expansion Federal Match Rate: State-by-State Estimates | KFF

This analysis examines the potential impacts on states and Medicaid enrollees of eliminating the 90% federal match rate for the Affordable Care Act (ACA) expansion. Eliminating the federal match rate for adults in the Medicaid expansion could reduce Medicaid spending by nearly one-fifth ($1.9...

www.kff.org

Also, you may not know this but lots of kids even if they don't have medicaid as primary have supplemental medicaid for stuff their private insurance won't cover. Medicaid ends up funding things like case managers, intensive home based therapies, in school therapy services. So yeah, lots of potential for pain here.

 

[2025DandW]

It is scary because we are moving backwards rather than forwards. The USA will not be great with the current moves of the government. I believe Trump and Musk just want to make money and keep their money. I do not see the government savings trickling down to the masses believe the bottom 50% will be involved in a race to the bottom as private companies take over where the government left off. Just look at where the privatization of medicine and prisons have gotten us. The corporations have gotten ever richer and the people ever poorer. How can we remain great without research? Do you believe the private sector will just step in to fill the void. If so, at what cost will they do so? We already lament about big pharma , but these are typically corporations that have shareholders expecting ever growing results. Don’t get me started on our isolationism, which will likely have dire consequences. I understand the angst at giving money to other countries when there is need here. But, the goodwill generated by USAID is so important when you look at the other actors that will fill the void we will be leaving. Also, it is inhumane to let $500 million of food rot in ports. I hope I am wrong, but I don’t believe much if any good will come from the direction we are moving.

 

[2025DandW]

Also, they talk about merit, but you’re going to tell me RFK was the best person they could find for HHS? There are other suspect additions to Trump’s cabinet. Trump himself was a nepo baby. They are not looking for the best.
They are looking for people that will brown nose Trump. RFK is planning on purging the Health Department. I know some brilliant people that work there, and I am sure will be let go. Who do they think they are going to attract? It definitely won’t be the best. To just willy nilly fire people is stupidity at its best in my opinion. Maybe Musk has plans to replace people with AI.

 

[Dantes]

A lot thoughts, but in terms of the medical world...RFK gets appointed, some states no longer promoting vaccination and trying to extradite doctors for abortions, NIH money gets cut suddenly with no real transition period, Medicare, Medicaid, reimbursement, and education probably next on the chopping block. Meanwhile insurance companies can continue to run unfettered. It doesn't feel like trimming waste as much as it does setting everything on fire. Probably part of the Peter Thiel and Russell Vought playbook.

 

[OldPsychDoc]

It is scary because we are moving backwards rather than forwards. The USA will not be great with the current moves of the government. I believe Trump and Musk just want to make money and keep their money. ...

Ya think?

Also, they talk about merit, but you’re going to tell me RFK was the best person they could find for HHS? There are other suspect additions to Trump’s cabinet. Trump himself was a nepo baby. They are not looking for the best.
They are looking for people that will brown nose Trump. RFK is planning on purging the Health Department. I know some brilliant people that work there, and I am sure will be let go. Who do they think they are going to attract? It definitely won’t be the best. To just willy nilly fire people is stupidity at its best in my opinion. Maybe Musk has plans to replace people with AI.

This administration never meant to appoint the "best".
This is the culmination of a plan stretching back before the Reagan era to emphasize that "Government is the Problem", then hamstring and defund it wherever possible to prove that it couldn't work, and cut taxes on the richest of the rich so their power and influence could increase. It started as a backlash against the Civil Rights Act, and aided by co-opting conservative mass media through conglomerates like Fox and Sinclair Corp, they've pretty much succeeded in dumbing down the masses and establishing their billionaires' oligarchy now.
(Subscribe to blogs like Robert Reich's and Heather Cox Richardson's if you want well reasoned accounts from scholars with a long-term historical perspective.)
We had a pretty decent 248 year run, I guess...

 

[Merovinge]

A lot thoughts, but in terms of the medical world...RFK gets appointed, some states no longer promoting vaccination and trying to extradite doctors for abortions, NIH money gets cut suddenly with no real transition period, Medicare, Medicaid, reimbursement, and education probably next on the chopping block. Meanwhile insurance companies can continue to run unfettered. It doesn't feel like trimming waste as much as it does setting everything on fire. Probably part of the Peter Thiel and Russell Vought playbook.

Of course it is. You see the worse you make public institutions, the more you get to complain about them, privatize further and profit the "donations" from the corporations making the money. It's hilarious to see right-wingers complaining about the institutions they defund for being ineffectual. For the folks that think "all government is bad government" we might get a FAFO situation in the near future.

I certainly think we should take a look at where you can make efficiency gains in the government, and have no problem culling the bottom performers, but you do this in a measured and knowledge/expertise way, rather than just lighting it all on fire and seeing what is left after. Take a look at the Clinton administration for ways to actual generate improvement in governmental efficacy.

 

[Sushirolls]

My family fled a dictatorship when I was a child. This constitutional crisis and slide into dictatorship is highly concerning beyond my job in academia.

We most definitely are not sliding into a dictatorship. Such a slide always includes disarmament of citizens.
The only party seeking to disarm their citizens are the democrats. One needs to only look at WA, CA, IL, HI.
Trump recently put forth an EO tasking the AG to look for put stop to blue state lawfare against the 2nd amendment.
The 2nd amendment is the vanguard against dictatorship. And the current administration is the one trying to protect that.

I fled a blue state as a political refugee to a red state. The ills of democrats/left/progressives is the real path to dictatorship, and I am grateful every day I am out. But that was my home. The place I worked hard to return to. Only to watch it crumble in front of my eyes. Defund the police, crime not being prosecuted by DAs, cops no longer caring as society forsook them and legislative laws set them up for more civil lawsuits, drugs escalating, pedophiles being released and not charged, homeless people outside my office window camping and using the office building bathrooms personally, "common sense gun laws" stripping a right away but having no real effectual difference in desired crime reduction, taking away parental rights and permitting state seizure of children for gender changes, teaching kindergarten sex ed and including trans topics, the list goes on, and on.

But ultimately a big summary is this. Liberals see things they don't like and think, where can I run? Where can I flee? What about Canada? Europe? New Zealand?
Conservatives don't. They know there is no other America, they believe in America, and know its better to stay and strongly advocate, for their forever country. Every time I land back in the states from being abroad, I breathe a big sigh of relief. Thank heavens I'm home, land of the free.

 

[Sushirolls]

..... For the folks that think "all government is bad government" we might get a FAFO situation in the near future. ........

Yes! I do hope we continue to FA - I want to FO. Slash, slash. The government is not a help, not a savior. If a libertarian were a Pokemon, I would toss that ball out right now. Get 'em Libertarian!

We have so much bureaucracy, federal, state, and some places city/county. Too much. Even in my own private practice, a small business, I've put forth good faith effort to stay on top of every regulation, rule, etc but there's just too much. Its choking.

As standard of living plummets across western nations, the one thing that can be done, to encourage growth and vibrancy, is regulation reduction. Government shrinkage, that can allow people to survive and make incomes. We have ag/food laws, that say people can't drink raw milk. Personally I'm a fan of pasteurization, but I've also drank fresh from the cow, and dang that's good stuff. If people want to drink raw milk, let them. People should be free to be idiots. Too many rules, too many laws. Going back to my practice, I can only imagine what I'm missing, probably something. First year, some how I missed the requirement of paid time off for my employee, state required, and thankfully she knows it wasn't malacious. Quickly corrected that upon noticing. If someone wants to cook food in their home and sell it on the street as a pseudo-food truck? Let them. All those kitchen health department laws, just need to go away. People will quickly point out "I got sick here" "don't go here"

Here is a fresh article detailing the bureaucracy of USDA impacting a business because of a label on tallow.

For medicine, now we have the DEA mandating CME. States mandating CME. Board certs mandating CME. Teach students or residents, they mandate certain CME. No, just no, stop it ... all of you.

So to the government agencies, let's definitely slash, bring on the FAFO - better to do it now, than in 5-20 years when the economy collapses from debt. This is on our terms not a world wide crisis we have to react to then.

 

[OldPsychDoc]

Of course it is. You see the worse you make public institutions, the more you get to complain about them, privatize further and profit the "donations" from the corporations making the money. It's hilarious to see right-wingers complaining about the institutions they defund for being ineffectual. For the folks that think "all government is bad government" we might get a FAFO situation in the near future.

Already there--
https://www.reddit.com/r/LeopardsAteMyFace/