Sucks to be on Medicare!

Unless congress can get their acts together and do something fast, Monday is going to be a very bad time to be a medicare patient! On Monday, a 21.2% cut in physician reimbursements will go into effect. There are already plenty doctors out there who don't take medicare or who are decreasing the number of patients they have on Medicare. But, if this goes into effect, it's going to be very bad. The AMA is already telling physicians how to help their patients find new doctors and physicians have already asked for handouts they can give to patients that they drop. When this happens, Medicare patients are going to be forced to go to clinics where it's hard to get appointments, you wait forever, and you get less attention. And please do not think that this is because doctors are greedy. Rather, it's because doctors are already not getting paid enough money, particularly in primary care (especially considering the quarter million dollars of debt you come out of med school with). If they have to take this cut, many will not be able to even remain profitable.

Situations like this are exactly why there is going to be an enormous shortage of primary care physicians in the future, and patient care is going to suffer for it. And, this is exactly why US healthcare could not ever survive with a nationalized government healthcare plan. The government already cannot manage the much smaller medicare program...the last thing they need it control over anything else! Once again, thank you Massachusetts!!

Update: so it looks as though this will wind up not really being a problem. Apparently the vote today had to be unanimous, so it didn't pass because one guy insisted on voting against it (there are some other things tucked in there, of course, that he didn't agree with). However, it will be able to have a real vote on Tuesday, where it will almost certainly pass, and things should carry on with little to no interruption. Good news for doctors, as well as people on COBRA or unemployment (other areas touched by this bill). Still, Washington really needs to get their collective heads out of their asses

One more day!!

Of internal medicine, that is! I have neurology clinic in the morning, followed by studying in the afternoon, before a 5-8PM lecture. Wasn't that sweet of them to schedule us an evening lecture the last day of the rotation, and the night before the shelf exam? Oh well...I'm determined not to be mad or frustrated anymore, since it's the last day!!

On Monday, I begin surgery...which I've been impatiently awaiting for years! My surgery student team was changed around a little so that now, I'll be with one person from AUC and two people who are in IM with me. Fortunately, they're both people I get along with well, so it should work out well. There are twelve people in my group, so we have overnight call every 12 days. Guess who was assigned overnight call on monday (the first day)!? Yes...me! I'm probably the only person who's actually excited to stay over and be kept awake in surgery though. Have I mentioned I'm excited? I just hope I'm still excited 3 months from now!

getting excited

In a week from Monday, I'll finally start my surgery core! After about a year of being VERY jealous of a certain blogger that my page links to, it's finally nearly my turn! I've already found out my team (blue team) and the people I'll be working with. So far, I've heard good things about my team of resident, and the other students I'll be with seem pretty decent too. Fortunately, none of them are interested in surgery, so hopefully they won't be fighting me for cases. It'll just make their lives easier if they don't! OK...just kidding....sort of! ;)

In the mean time, I only have one more week left of internal medicine. Although I have not enjoyed any part of my time in IM, it has gone by very quickly. It's double the length of my previous cores, but it seems about the same length. However, maybe it's that extra time which has made me so ready to move on. I did go out to dinner with a few of the other students last night though, and that was a good way to begin to end this rotation. We wound up at Joss Sushi Cafe in Baltimore, and it was every bit as wonderful as the Annapolis original. It's bigger and a bit nicer than the one in Annapolis, but the food is identical.

For today, I think I'm off to the firehouse...something I've been neglecting lately.

SNOW!!

So since I last wrote, we have had insane amounts of snow in Baltimore!! We had about two feet this past weekend, and then about another foot yesterday! Yesterday, I was one of the only cars in Baltimore that was out the entire time, while shuttling around hospital employees. I borrowed my dad's Denali, pushed through snow that really no one should have tried to drive through, and got over 30 employees to and from work, from 5AM to about 1:30 AM! I can tell you one thing for sure...if you are looking for a car that's good in the snow, that is it. More than once, I drove through well over a foot of snow, that no plow had thought to touch, and had snow drifts that were even deeper. I was exhausted by the time it was done, but it was pretty enjoyable. I would have rather slept in, but I know that I would be upset if I came into work and couldn't get home, or couldn't get any relief after being in the hospital overnight already! The people all seemed very appreciative, so it was worth it.

For the next couple weeks, I'm going to have an awful lot of studying to do, with the subject exam coming up immediately after I finish this rotation. Fortunately, I'll be in CCU / MAO for the next two weeks, so should give me much more time than I would have had on the floor. I still cannot wait to start surgery in just over 2 weeks! I'm planning on being chronically tired for 3 months, but I hope I like it as much as I think I will.

I know, i know, i know

I've been absent for a while, again, and I'm sorry!! I really do mean to post, and I'm not exactly sure why I haven't. I think it's because when I stop for a while, I feel like I have a lot to catch up on, and I'd rather just write about what I'm thinking in the moment, than what I was thinking many moments ago. And, the longer I procrastinate, the worst it gets. It's a vicious spiral!!

So what's going on this moment? Well...I've only got 1.5 more weeks left on the floor in IM!!!! That makes me extraordinarily happy. I am not going into psychiatry or peds, but there is a far better chance that I'll do those than go into anything requiring an IM residency. And that's unfortunate, because there are some interesting fellowships out there, I just could not stand doing 3 years of IM first. In fact, I couldn't even go into a specialty that required a one year IM prelim year. Maybe it's better at other hospitals, but from what I've seen at my current hospital, no way in hell. However, I am going to reserve my review of the rotation until I've actually finished it and gotten my grade...things can change in 3.5 weeks.

Speaking of 3.5 weeks, I really have to kick up the studying for the NBME subject exam, which I have to take immediately following the rotation. Very fortunately for me, I end this rotation with two weeks in the cardiac care unit (CCU) and clinics, both of which are far less time consuming than the floor, and will give me lots of time to study. Scheduling is the one thing that's actually worked out very well for me this rotation.

I'm beginning to get very jealous when I see the surgery students walking around every day. I cannot wait to do surgery next month! Come on, March!!