StormKnight

Thanks. I almost had that burnt out of my memory. Almost

Yes you did. *waves back* It was hot! (the club. I am open to debate.)

Welcome!

Like I want a snack... *runs*

Like this should surprise anyone... though I can concentrate on a couple of things simultaneously. Your Attention Span is Long You're attention span is amazingly long. You can concentrate well, and your mind doesn't stray easily. Even if you have a mundane task to complete, you can get it done easily. Because you don't get distracted, you accomplish more than most people. Your self discipline is your greatest strength. You can will yourself to do almost anything. All you have to do is put your mind to it. How's Your Attention Span? Blogthings: Cheaper Than a Therapist

Ice, Ice Baby....what a raping of a Queen song. *flashes back to when this was played at Orpheus in Baltimore*

Still.

good grief, I must be below people's radars

Drop prepping to head out.

like I am waiting for the other shoe to drop.

Night on Bald Mountain Modest Mussorgsky The full version: This group gets the feel of it right. The slow start acclerandos (happens twice in the full version,) are supposed convey a sense of desperation of the damned souls. This group hits it on the head. And the Fantasia version for you Disney fans: http://www.youtube.com/watch?v=f9KoJWlivL0 Where they cut a few of my favorite passages out. One of my favorite things to play as a violinist.

Happy Birthday!

A bit bored.

It is that, and personality and desire of the student, as I discuss below. The specialties that are considered primary care providers are: -Internal Medicine -Family Medicine -Pediatrics -Obstetrics-Gynecology Now to look at Match statistics. "The Match" is the lottery/application process all medical students have to go through to get a residency in the US. The medical student designates specialty and program in the places they want to be based on the program quality and personal requirements. (e.g. wanting to do Family Medicine in Cooperstown, NY, because family lives close; Anesthesiology in Florida, because the program is the best, etc.) The programs are ranked (e.g. program A is number 1 choice, program B is number 2, etc.,) which becomes the student's lottery ticket, as it were. One Tuesday in March, after concentrating on traveling to interviews, networking, etc for most of the fourth year, they see what program picked them on their list. If no program they selected took them, they have the rest of the week to find a position to do something. This is a lot of phone calls, faxing, e-mails, etc. in something called "The Scramble." Some get the specialty the want, others just get the intern year and try again the Match during their intern year. It is stressful, competitive, and occasionally heart-wrenching. I bring this up to accent how much the above specialties are almost a give-me to get into, not because of the number of programs or positions, but competition isn't there for them. A bit is because of the student's experience in those rotations. My experiences as a third year student (where we get exposed to the speicalties,) have consistently been that the residents and the attending physicians are absolutely miserable because of the malpractice, longer hours (well beyond the 80-hour work week limit residents have to adhere to,) and fighting insurance companies. Also, the personality of the student draws them to certain specialties. I was attracted to surgery because of the intense work, the manual skill, and still practicing medicine (i.e., I dig bright lights and cold steel, and I am not phased by blood, guts and messy trauma.) Anesthesiology had the same level of attraction because it was still bright lights and cold steel (needles,) but there was an academic side in the fact they have to handle patient medical conditions if they manifest under anesthesia, and a geek side because of all the gadgets we have to use, like monitors, anesthesia machines, etc. If things had went the way I planned, I would have been in the service as one of those two specialties, in the mud and muck of a remote hospital, away from the civilian salaries that go with these specialties, for most of my working career (I was planning to be a lifer in the service.) What I would earn wouldn't have mattered. If anyone could see me working in the two specialties, I almost glow with both personal enjoyment and spiritual contentment, as if the job nourishes the soul. As I told one vascular surgeon I worked with being that amped, "There are some of us who, well, enjoy their job just a bit more than the rest of us." To which, he replied, "Some of us need our medications adjusted." Everyone notices it: nursing, attendings, even the patients. The primary care positions attract a certain personality that is now becoming more and more rare in the student makeup. And those that thought about it, think twice after seeing how miserable most are in those rotations. I could walk into most of the primary care specialties, but it is a major personality clash. My nature is much more of a hands-on approach, and I would do poorly as a resident and an attending in primary care (as I did as a student.) Below are the numbers of programs, positions offered by all the programs, amount of US med school graduates that chose it/got a position, and the percentage that was filled by US students in the Match from this year. Link to the PDF of the statistics here.: -Internal Medcine: 376 programs, 4922 positions, 2632 students chose it, for fill percentage of 53.5% -Family Practice: 453 programs, 2535 positions, 1071 students chose it, for a fill percentage of 42.2% -Pediatrics: 208 programs, 2392 positions, 1682 students chose it, for a fill percentage of 70.3% -Obstetrics/Gynecology: 245 programs, 1185 positions, 879 students chose it, for a fill percentage of 74.2% Just to show my favorite speicalties: -General Surgery: 239 programs, 1065 positions, 824 students chose it, for a fill percentage of 77.4% And it is going back up after a lull, as general surgeons do more and more work -Anesthesiology: 93 programs, 733 positions, 612 students chose it, for a fill percentage of 83.5% Gone up in recent years due to lifestyle. So, it is a combination of both what Reaper has stated about liability, and low wages (average for the primary care specialties is just at $100,000 or so, minus what they have for overhead, etc.) and the fact that the students are not getting a good impression of the specialties, and are not attracted to the specialties.

like things need to get done.

Mail reading and B5 watching.

maybe go to sleep.

This was an article that is given to me as a speech on my first day of medical school to drive home the competitiveness and the OCD ad nauseum that physicians need to work under. 99 percent is not enough By Michael Pinto May 19, 2000 When lives are at risk, being one percent wrong is all wrong Every safety, health, or environmental professional deals with situations which illustrate a broader point. One project recently drove home for me a reminder of how little room there is for error in a field where lives are at risk. This particular project was a complicated asbestos abatement. The renovation work was well underway before testing revealed that fireproofing sprayed on the structural members of the building contained asbestos. Our organization was brought in to do testing, develop an emergency action plan, and perform the necessary industrial hygiene monitoring. Ninety-nine percent right Despite the emergency nature of the work, requests from several occupants to save contaminated items, and investigations by two state regulatory agencies, the abatement crew did a great job isolating the area, decontaminating vital equipment and records, removing the accessible fireproofing, and cleaning the entire area. Their performance through 99 percent of the project was exemplary, particularly given the time pressures that developed during the emergency response (construction schedule, displaced occupants, etc.). One percent wrong After completing a detailed visual inspection to ensure that all of the accessible asbestos had been removed from the work area, the contractor was left to spray an encapsulant on all exposed surfaces and inside wall cavities that potentially hid inaccessible asbestos debris. Unfortunately, the encapsulant, a paint-like material, was applied poorly, resulting in obvious drips, runs, and sags on some of the wall surfaces. This mistake resulted in some costly repairs after the asbestos abatement crew left the site. More importantly, it left the building owner with a perception that the entire project was not performed in a professional manner. When I failed to persuade the building owner that the mistaken last step was an aberration from the performance through the majority of the project, I understood that 90 percent, or 95 percent, or even 99 percent correct in this case was not good enough. Fortunately, in this instance, the error occurred at a stage in the project where the health or safety of individuals was not jeopardized. This margin for error is not present, however, in many other situations faced by safety, health, or environmental professionals. A gas meter, which measures the air prior to entry into a confined space, that is calibrated and operated properly 99 percent of the time could still result in a fatality upon the 100th entry. Accepting a standard of 99 percent error-free performance would mean that 466,750 annual takeoffs and landings of commercial airplanes in the United States could end in tragedy. A light curtain on a power press that operates 99 percent properly means that a worker averaging 200 pieces an hour has 16 chances during every work day to lose a hand or finger. A laboratory that analyzes 99 percent of its samples correctly could cause hundreds of companies to exceed their discharge permits each year, resulting in increased health risks and millions of dollars in citations. The safety trainer who teaches individuals how to utilize fall protection equipment correctly 99 percent of the time seriously jeopardizes twenty workers on a large construction crew. The examples of situations in our industry where 99 percent correct is just not good enough are endless. Safety, health, and environmental activities are a perfect fit for a system of total quality management. The consequence of allowing our standards to slip in response to monetary or business pressures is the real possibility of loss of life or limb. And don't be fooled into thinking that standards won't slip. Ask any professional who has been called in to turn a program around how easy it is to fall into the cycle of mediocrity, and how difficult it is to convince people to set their sights higher. Chuck Swindoll explained in his book, "The Finishing Touch," that if goals are not set high, excellent is soon reduced to acceptable, which then slips to adequate, which, before long, settles at mediocre. It is clear, the lesson is all around us. When you step into the arena of safety, health, and environmental activities, the only acceptable goal is 100 percent.

my $0.02 Malpractice cases and suits are only 2% of what is currently spent on healthcare. The effects of tort reform are discussed in this article, too. What makes it such a talking point is the dramatic press and the high payouts of the few high cost cases, the doctor's name being dragged through the mud by media, and the malpractice insurance companies take that as a chance to stratify certain specialties risk rates. It is also the easiest to understand for most lay people, as it is most publicized, and most seen. It also does hit doctors hard, as the insurance can take up to 70% of the salary of a doctor. 2% of $2.5 TRILLION in cost annually ($50 BILLION by my math,) paid by the 700,000 practicing doctors in the country currently is a hell of a lot of money per physician ($71,428.57.) *on soapbox for malpractice* Personally, I would be happy to keep ahead of malpractice (up to 50% of what is billed in my specialty,) and modest living. Most primary care doctors (internal medicine doctors, family practice, OB-GYN, and pediatrics,) the malpractice is a large portion of what they take in, (up to 70%.) Also, unlike a hospital type (surgeons, anesthesiologists, etc,) they have overhead to pay for as well. Example, say a primary care doctor bills $100.00 USD per patient visit: $50.00 can be malpractice (OB-GYN have it bad, it can be as high as 70%, see below.) $25-30.00 is overhead and office staff salary (receptionist, nurse, coder, equipment, etc.) $10-15.00 is those student loans (up to $200,000 and higher if you are typical and don't have parents that are affluent paying your way (maybe 1-2% of my graduating class at most.) This is basically a house loan with higher interest rates.) $2.00 for continuing medical education (CME.) Every doctor graduated since 1998 have to re-certify every ten years in their specialty, requiring them to keep latest knowledge up to date. The remaining $3-8.00 of the visit is theirs. Subject to taxes. Time wise, for every 15 minute appointment, there is at least that much in paperwork/insurance negotiating. When considering it as an hourly wage, can be as low as minimum wage for doctors in some areas. When the mentality that 80 hours a week (maximum allowable for residents to work,) is being a wuss (as some old schoolers call the residents,) most practicing primary care doctors work well beyond that. Remember, this is average breakdown. Usually the doctor takes a pay cut to maintain malpractice. Insurance doesn't pay the full 100; usually it is 50 or 60, and takes months to get from the companies. So cuts have to be made somewhere. OB-GYN doctors have it really bad. Not only do they have the highest percentage of malpractice lawsuits, but they are liable the longest. If they are an obstetrician, (actually delivering babies and working with pregnant women,) they have to keep records of every one of those kids they deliver for a period not less than 21 years, in case of something during delivery caused physical problems down the road. And a suit can happen anytime. These reasons are the cause of obstetric doctors closing up shop, and most are concentrating only on gynecologic (i.e. cancers, dysmenorrhea,) issues. They are considered primary care providers, and as such their compensation is less from insurance companies. So you women out there wondering why you can't find obstetric care, these are the reasons. I will say that I am looking within no less than 4 years after entering practice that my malpractice rates will be up to 50% of the average salary, and that is regardless of whether or not I even *have* a lawsuit against me. If I do get sued, even if it is thrown out, that percentage will go up instantly, and possibly beyond 50%. And as for nurse practicioners and physician assistants: The reason they are cheaper to use is because they don't have to worry about high rate malpractice insurance. The reason they don't have to carry as much malpractice is that, in the end, a physician has to review and sign off on their assessment and treatment of patients. In the end, the physician is the final target of the lawsuits. So, more providers working under a doctor, the more chance for liability a doctor has. And while both NP's and PA's are sued, it is to a much lesser extent than the doctor they work under. If released from the sign off of a doctor on their charts as is sometimes discussed, their malpractice will also rise to the same level as doctors, as they will take on the full liability, and become less cost effective. While I do believe in tort reform, and should be part of reform in general since it attacks the providers, it is not the alpha-omega of it all. *steps off pedestal* About insurance companies/companies: We are also talking about insurance companies, entities that exist to make money and a profit for the stock holders. WellPoint (NYSE: WLP) is the parent company of Blue Cross Blue Shield in several states, and is openly traded. As we have seen in the meltdown in banks and Wall Street issues, without enforcing ethics by a set of laws, the company is akin to a primal animal, which the brain (employees/CEOs) is worried about one thing: its own survival, by eliminating competition (i.e. pack mentality (forming monopolies/mergers,) or consuming (buying) them,) and nourishing themselves ("feeding" off of money they take in, as it were.) As a biologist, I have seen animals who have access to food unlimited keep eating until full, and keep the rest away from their cage mates. It could be inferred that greed is a basal survival instinct. For those into Sagan and "Dragons of Eden," this is of the limic (reptilian) system in the brain. Now, if we apply the idea that of people regressing in large organizations/large groups to the lowest thought/instinct, it could be construed it could only be inferred that the entity/animal that is a large company will regress to a survival instinct; greed. Without a higher level (like the cerebrum in the brain model,) to control it (e.g. laws,) that greed goes out of control. To summarize my thoughts: Insurance companies are out to make money by any way they see fit, and they act on the reptilian brain. Without something in place, whether law or government competition to give it reasoning skills (i.e. a cerebrum to hold the reptilian brain in check,) to control it, it will run out of control and be greedy. If allowed to cross state lines to provide insurance, smaller, local companies will be absorbed by larger companies, leading to fewer options for insurance fewer and fewer companies are out to offer insurance, forming a cartel of a few large companies that will set prices (OPEC, anyone?) For solutions? I am not sure. However, I don't believe it lies in a private entity that has the greed/mentality of a primitive animal.

Ready for a light nap.

You Are Glam Rock You are flamboyant, outgoing, and even a bit freaky. You are a natural entertainer. You like music that rocks hard and doesn't hold back. You appreciate inventive musicians. You are an unusual, eccentric person. You have some very interesting ideas about the world. You like songs that echo your offbeat views. It's hard for a song to be too weird for you to enjoy. What Kind of Rock Are You? Blogthings: We Have a Quiz for Almost Everything

Screen Name: Your Name is Red Your name tells people that you are powerful and intense. Your name makes people take you seriously. You stand out in a crowd and command attention. You can't blend in - and you would never try to or want to. People see you as a bit of a wild card. You're well known for being passionate, and you can be a bit dangerous at times. You inspire strong feelings in others. People either totally love you or totally despise you. There usually isn't much in between. What Color Is Your Name? The First Rule of Blogthings Is: You Don't Talk About Blogthings Real Name: Your Name is White Your name tells people that you have good intentions and a pure heart. You try to always speak the truth. You are happy to step back and let other people shine. You don't seek attention or acclaim. People see you as someone who is generous and ethical. You can be counted on to do the right thing. You are bright and clear headed. You can offer a fresh perspective, especially when other people are in a rut. What Color Is Your Name? Blogthings: We'll Tell You The Truth... Someone Has To!

Your Birthday is Silver You are the shy type. You get so lost in your own thoughts that you sometimes forget to interact with other people. You are clever and bright. You find learning and thinking to be very easy. What you find difficult is relationships. You have never been able to understand people. You find both friendships and love to be difficult. It's hard for you to communicate your needs, hopes, and fears effectively. What Color Is Your Birthday? Blogthings: Quizzes and Tests and Memes, Oh My!