So...how are you holding up?

[comp1]

Given that specialty boards are private, very profitable "non-profits," they most certainly will not be told to stop CME requirements. I also seriously doubt that our new HHS will do anything whatsoever about CME requirements from anybody.

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[bGMx]

Can't wait to see SushiRolls expand on the greatness of the Make America Healthy Again Executive Order, Section 5 (iii): assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, stimulants, and weight-loss drugs. 😆

 

[Merovinge]

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"

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.

I'm very confused, the latest Republican budget proposal adds 4 trillion to the debt. The amount of corporate and top 0.1% tax cuts dwarf even the unrealistic proposed cost reductions. The economy has consistently done worse under Republican presidential power over the past centaury.

"From 1926 to 2023, we have had a Republican president for 47 years, and a Democratic president for 51 years. The difference in returns between the parties is pretty stark. The average annual return for the S&P 500 index when we had a Republican President was 9.32%. When we had a Democratic President, the S&P 500 average 14.78% per year. That’s a premium of 5.5% per year on average. To put it mildly, this is a really big difference."

Are Republicans or Democrats Better for the Stock Market?

Is there anything in historical data that can help us sort out which candidate, Trump or Biden, is going to be better for the stock market?

retirementresearcher.com

 

[Sushirolls]

In my earliest post on this thread, I have hope, but wouldn't be surprised if not much changes. But how do you eat an elephant? one bite at a time. Got to start some where, even if its the low lying fruit. I'm willing to have hope for greater reductions, but yes, evidence is on your side, nothing will change.

 

[Monocles]

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"

This is actually quite terrifying as someone who has visited countries that would have been considered "developing" during those eras. Sushi I want to ask if you have ever been outside the US or developed countries where food safety for citizens is a societal norm that can be taken for granted.

To give an example, I briefly visited China in the late 2000s where there were two major food related scandals. One was a baby formula company which added melamine (a chemical used in plastics manufacturing) to baby powder as filler to pad profits. The issue is that tens of thousands of babies got sick and hospitalised w/ kidney injuries regardless of family political influence or socioeconomic status. It was so bad and caused societal outrage that some of the company heads were executed. A second example is the use of "gutter oil", essentially restaurants and food suppliers collecting and reusing restaurant waste oil, or even skimming oil from the sewers and reusing it in foods. Again hundreds of arrests were made and heads literally rolled for this one.

 

[Monocles]

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 think some concern is warranted even when looking at the situation from a purely self-interested financial perspective. One of the reasons why the US economy has historically been the top of the world is that investors around the world have faith in the US government and our law-based institutions. A gradual erosion or dismantling of such institutions will adversely affect markets and your portfolio in the long run. This is before we even consider risks of internal or broader geopolitical instability due to Trump policies..

 

[Sushirolls]

This is actually quite terrifying as someone who has visited countries that would have been considered "developing" during those eras. Sushi I want to ask if you have ever been outside the US or developed countries where food safety for citizens is a societal norm that can be taken for granted.

To give an example, I briefly visited China in the late 2000s where there were two major food related scandals. One was a baby formula company which added melamine (a chemical used in plastics manufacturing) to baby powder as filler to pad profits. The issue is that tens of thousands of babies got sick and hospitalised w/ kidney injuries regardless of family political influence or socioeconomic status. It was so bad and caused societal outrage that some of the company heads were executed. A second example is the use of "gutter oil", essentially restaurants and food suppliers collecting and reusing restaurant waste oil, or even skimming oil from the sewers and reusing it in foods. Again hundreds of arrests were made and heads literally rolled for this one.

Oh, yes, I have traveled to places and have had my fare share of GI issues. China culturally has an element of expected/accepted scamming.

That is less so in the US. And a balance can be struck. US is over regulated to now everything is processed. And restaurants or venders that want to do locally organic sourced may run into bureaucracy barriers. That shouldn't be the case. US is one end of the extreme, China is the other.

We could find a middle ground to say this size company or product scale gets full regulatory weight of USDA. Under this size, free pass.

To give you an example in America, there is a carve out for chickens and rabbits. You can raise chickens up to 20,000 in your backyard. Butcher it, then go to a hotel/restaurant/person etc and sell direct to consumer. Now some counties have department of health laws at level of state that impact the ability to butcher/sell to consumers. But if you try doing that with a goat? a cow? a pig? you legally cannot butcher the animal yourself in your backyard or farm or homestead and sell to direct to consumer. You can butcher for yourself to eat, but can't sell it. That is wrong. You have to involve a 3rd party. A USDA exempt butcher (no veterinarian onsite watching carcass role by). But if you want to go to your local farmers market and sell your back yard pig in various cuts (bacon, ribs, shoulder)... you can't. It has to go to the USDA inspected butcher (huge places, with veterinarian on site) and they booked out more than a year by the large companies and the $ to open such a facility is well into the millions. Small farmers suffer the same plight as us in Medicine. You need to be small niche, or Big Box. There just isn't any middle ground wiggle room - these practices get bought up by PE. That is wrong. Oh, and the USDA inspected butchers, also spray the meat down with nitrites...

Why is it okay, to butcher chickens to a certain quantity and sell direct to consumer but not other animals? Chickens are more prone for bacterial issues than other animals.

So a small farmer trying to make ends meat (see the pun?) has a tough time getting their animals to market. And face tough decisions of which route to go.

 

[Merovinge]

I think some concern is warranted even when looking at the situation from a purely self-interested financial perspective. One of the reasons why the US economy has historically been the top of the world is that investors around the world have faith in the US government and our law-based institutions. A gradual erosion or dismantling of such institutions will adversely affect markets and your portfolio in the long run. This is before we even consider risks of internal or broader geopolitical instability due to Trump policies..

100%. The reason for the current US Market dominance is very simple. Our incredible universities, tons of venture capital money/risk capital/willingness to take risks, relatively less regulation than Europe while more regulation than 3rd world countries such that people have developed faith in our institutions but also allowing rapid innovation. There are additional considerations like our natural resources, having friendly neighbors and oceans as boarders, keeping WW2 off our soil, and our ability to attract multicultural top talent (related to all the above).

Markets hate instability and unknown. I have major bones to pick with both Democrat and Republican leadership/policy, but both have historically backed neoliberal globalization which has been the fuel to our economic fire for 4+ decades. Neoliberal globalization, like nitrous into a car, needs additional brakes to help handle the dramatic thrust and we have failed spectacularly at that. I shudder to think how much less suffering would be in the world if we simply praised individuals for their lifetime tax payment awards, instead of a nebulous "job creation", and had sensical graduated tax rates for individuals while eliminating the tax loopholes that the 0.01% use.

 

[shoomer]

Wondering how everyone is feeling about the RFK announcement today regarding psych meds...

 

[TexasPhysician]

Wondering how everyone is feeling about the RFK announcement today regarding psych meds...

Currently it is a lot about nothing. I too would like to evaluate the risks/benefits of family docs, NP’s, and prescribing psychologists regarding their abilities to manage psych meds in various populations. Will they actually do anything or just posture?

 

[shoomer]

Currently it is a lot about nothing. I too would like to evaluate the risks/benefits of family docs, NP’s, and prescribing psychologists regarding their abilities to manage psych meds in various populations. Will they actually do anything or just posture?

Agreed that that's where I would take an approach to reforming the current system. But it's an area of uncertainty with what this will mean in practice. The fact that RFK was appointed to his position with a very clear agenda and a growing anti-science/medicine sentiment in this country makes me think they might really try to change something (for the worse). But big pharma will have something to say about that so who knows.

 

[Lunzio]

Currently it is a lot about nothing. I too would like to evaluate the risks/benefits of family docs, NP’s, and prescribing psychologists regarding their abilities to manage psych meds in various populations. Will they actually do anything or just posture?

The repercussions of even posturing are still enough to cause a large ripple effect. See Autism and vaccine concerns for reference. Never in my wildest dreams would I hope they simply "posture" on this issue as a child & adolescent psychiatrist.

 

[calvnandhobbs68]

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!

Physician libertarians have always been interesting to me considering you directly benefit from a profession with one of the most guild-like systems still in existence...which is a direct result of the federal and state regulatory structure surrounding that guild. I would hope you don't have any problem at all with NPs or PAs having independent practice as long as we cut all regulation around medical school accreditation and residency requirements. We could go back to the backyard medical schools of the 1910s, maybe do some combo chiropractic/med school 2 for 1s.

The whole reason why physicians are paid so much in the first place is because of 1) Wage controls implemented by the federal government during WWII causing drastically increased expansion of private health insurance as an employment benefit and 2) Medicare/Medicaid being created.

 

[claypigeon]

Wondering how everyone is feeling about the RFK announcement today regarding psych meds...

At least on my social media feeds, 2024’s Hims and hers compounded semaglutide ads have replaced 2023’s mindbloom at home compounded ketamine ads which replaced 2022’s done and cerebral’s NP driven adderall / eating too much cake =adhd ads which replaced 2020’s hims and hers ssri and propranolol ads which replaced pre 2020 get Roman’s viagra and cialis ads.

I apologize if the dates for any of the above are slightly off but think we all understand the theme. Better to go after DTC advertisements but I hope this XO helps put a stop to whatever 2025 ads we’d otherwise be getting. Our meds have lots of legitimate risks and monitoring requirements and if this helps more people consider therapy or other non medication options, I think that’s a win as long as the report balances this with the large benefits of these meds. I’ve seen enough ssri induced hyponatremia cases I dont think you should be able to get them from online pill mills.

 

[Sushirolls]

Agreed that that's where I would take an approach to reforming the current system. But it's an area of uncertainty with what this will mean in practice. The fact that RFK was appointed to his position with a very clear agenda and a growing anti-science/medicine sentiment in this country makes me think they might really try to change something (for the worse). But big pharma will have something to say about that so who knows.

This is a notable result of what unfolded from years of covid restrictions.
People are pissed off from Covid actions and how it was handled.
People are more receptive to razing things to the ground after how Covid was mandated on people. RFK is part of the reconciliation to make sure it doesn't happen again, and there very likely will be ripples and consequences from RFK actions.

But these are the consequences we have when people say, you must wear this mask. You must get this vaccine. You must lose your job. You can't see your loved one die in the hospital. And lied to... again... this virus wasn't Chinese... if you say so you are a racist. And so many other things that happened during covid.

I completely understand the sentiment people have for Release the Kennedy Kraken.

 

[Sushirolls]

Bureaucracy, rules, laws, restrictions, etc.

Just today I strolled into the local national forest office. Had some questions about specific resource harvesting and associated permits I had been wanting to know.

One question was about the timber auctions for logging, and if they do any tiny 1 or 2 acre auctions geared toward a micro forestry operation. Something like a single owner/operated business that thrives with low overhead of minimal equipment capital needs - a niche logger. The guy was like oh, yeah, we used to do those things back in the day. Was fantastic and described the utility for certain forest conditions that I didn't even think about where they were able to apply such small auctions towards certain forestry goals. But then he sighed, and started to list off the insurance, liability, bonds, and slew of other things that essentially stopped the practice and left them with only large tract big timber auctions. So, yet again, the bloat of government strangling economic endeavors. Not hard to look around most any corner to find this problem.

 

[Liquid8]

Can't wait to see SushiRolls expand on the greatness of the Make America Healthy Again Executive Order, Section 5 (iii): assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, stimulants, and weight-loss drugs. 😆

Benzos and ketamine for everyone!

 

[esob]

Where I'm at, everyone already gets unlimited benzos and ketamine from the NP-run pill mills.

 

[lol.psych]

How? Not well. **** this ****, I’m disgusted and disappointed, and I’m mad that my tax dollars aren’t going to be used for the greater good, but for tax cuts for oligarchs.

 

[sloop]

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.

I have some libertarian tendencies but overall consider myself a progressive in the tradition of Theodore Roosevelt. What you say about the kids and grandkids really resonates with me and is a theme for how I feel about the current climate right now.

I believe in the market, but ultimately believe that the tremendous energy of capitalism needs to be channeled so that it is subservient to the human needs of real people. Government is often the only effective means for correcting market failures or social problems that are inadequately addressed by market forces. Science and academia are not well-supported by free-market dynamics alone. It is not like commercially viable scientific pursuits just spring out of the ether. They are based on foundational discoveries that often would, at the outset of the inquiry, be viewed as too risky or conjectural for a private company to back. We need government to support the advancing vanguard of scientific progress so that industry can then build on those discoveries.

Similarly, a variety of social and economic forces have conspired against recent and future generations and these demand real solutions. I am a millennial, and I constantly hear older generations complain about how we do not have the work ethic of prior generations. My retort is that we have been systematically killing the American Dream and it is crazy to expect people to play the same game with different rules. Thankfully as a physician I feel somewhat insulated from much of this, but many of my generation can’t afford a house and it’s doubtful they ever will. As impressionable teenagers, most were told that the recipe for success involved going to college which would qualify them for decent jobs, but the jobs never came for many and they were saddled with massive amounts of student loan debt. The private sector pensions that some prior generations enjoyed have all but gone away entirely. Young people are paying into a social security system that, at its current trajectory, is of unclear long-term viability. Bootstraps don’t work here. It is unclear what future the average young person today can aspire to. It is not helpful when people who already own a house and a substantial 401(k) talk about how great everything is because their assets are appreciating and then tell young people with nothing, and for whom much of this is largely unobtainable, that they’re on their own.

We seem to have decided that the interests of a few extraordinarily wealthy people are more important than a system which is fair, provides opportunity for advancement, and supports the basic needs of ordinary people.