The problem comparing 24 hour stores to medicine is that you don't really care who checks you out. Most people like to choose their doctor. Nearly all of them like to choose their surgeon.
new ACGME regulations for interns starting next July which limits you to 16 hours in-hospital and rules for "strategic napping."
Man, am I glad I got through before that crap started up. Those guys will never leave the hospital.
For those who don't understand: Under the old rules, interns (first year out of med school) could work up to 24 hours straight on new patients, and then an additional 6 hours of seeing old patients and handing off patients to the on-call team. They were on call every third or fourth night. Under the new rules, they can only spend 16 hours on duty before a mandatory 6 hour rest. Sounds great, right? The problem then becomes: how do I provide coverage for the hospital? The answer, I'm pretty sure, will be: one intern on days, 6:30 AM - 7:30 PM, and one on nights, 6:30 PM - 7:30 AM, six days a week, with two other interns brought in on Saturday to provide weekend coverage. It's only 78 hours, so you stay under the 80 hour limit, but it utterly and completely wrecks your life.
getting a page at midnight because the nurse thought the patient needed "butt paste."
My favorite was the midnight page from the floor nurse who said that I needed to fix a patient's consent for surgery the next morning (why on earth she thought that couldn't be done down in the OR holding area, I have no idea, but whatever). When I go to investigate (because she needed to see me up there to get this fixed!), it turns out that the patient is scheduled for a colostomy, but the consent says enterostomy. (For the non-medical, it turns out that the patient is scheduled to receive a square, but the consent authorizes a rectangle. Never mind that the one is a subset of the other.) Got to grin and bear it, too, since fighting back only gets you woken up all night long in revenge. It was a great moment in reminding me why I'm an anesthesiologist, not a surgeon.
You don't have people checking the schedules to fly only with Captain Jones, or have their television delivered only by Dave the driver. Surgeons are not interchangeable.
Harder than you think. On-call duties don't just include doing surgery. I'm an anesthesiologist, not a surgeon, but I did play one for a month as an intern, so I may be able to give you a bit of an idea how things work.
The way to reduce call is to increase the number of people in your group. Larger group = less frequent call. HOWEVER, larger group = larger number of patients admitted to multiple hospitals to care for overnight, and less familiarity with those patients. If you're in a 3-man group, and you're on call every third night, you'll get to know your partners' sicker patients better. If it's a 10-man group? You'll rarely see the same patient twice, and there will be a lot more of them. In the 3-man group, you'll have a manageable list of patients, and given the number of things that happen in an average night, you'll probably get a bit of rest. The bigger the list of patients, though, the more likely you are to get called about something during the middle of the night. Maybe the primary surgeon forgot to write an order for Tylenol for the patient; maybe the patient is constipated and wants something for it (an astonishingly common complaint); maybe they want a sleeping pill. Doesn't matter; you've got to take a call and deal with it.
Furthermore, surgeries are scheduled by days of the week - you will have (e.g.) one room on Mondays, two rooms on Tuesdays, and one room on Friday afternoons. Regardless of what night you're on call, that's when you can operate. Since surgeons only make money when they operate, there is an enormous incentive not to miss an operative day. Since the hospital only makes money from ORs that are in use, if you don't use your operative time you'll lose it. Cancelling a day of surgeries has enormous costs - you already have a nurse anesthetist, a scrub tech, a circulating nurse, and housekeeping personnel scheduled to work there. Do you send them home early, effectively docking their pay for something that isn't their fault? Or do you pay them to do nothing?
The AMA doesn't control medical school admissions, and the number of medical students admitted has zero influence on the number of practicing physicians in the United States. The number of practicing physicians in the US is determined by residency slots, which are controlled by the ACGME and funded by CMS.
I know you hate doctors, but please try to get it right.
The most important determinant of your physician's skills is the residency and fellowship (s)he did. Contrary to popular belief, highly academic centers do not always produce the best clinicians, because their focus is much more on generating research. Now, they're definitely very smart guys, and in some fields of medicine that's all there is. But in an interventional field, things get hairy. In particular, the collection of a few individuals can make an otherwise obscure place a powerhouse. In my field, anesthesiology, one of the best residencies in the country is at the University of Alabama-Birmingham.
The AMA represents, at best, about 20% of American physicians. It does not, despite what you read on the Internet, limit the number of doctors that practice in the US. The limitation is entirely under the control of CMS (the Centers for Medicare and Medicaid Services) who fund residency positions, and the ACGME, who approve the residency programs and tell them how many positions they may have.
one really doesn't have any good way of knowing if they're up to it.
Although a few turkeys make it through now and again, certification by the American Board of Anesthesiology is a pretty good starting point. Approximately 10% of graduates of American medical schools fail the written exam the first time, and about 30% of American medical school graduates fail the oral exam the first time. It was definitely one of the most stressful hours of my life...
I was thinking of this and similar. You're right, the courts have ruled that they can only be "administrative" stops, but that's not what's happening out there, and I haven't seen an agency get slapped yet.
You're not under arrest, but you're not free to go, either. You have been detained. His statement that it was the Homeland Gestapo suggests that he was within 100 mi of the border, which means that the courts have agreed to treat any stop within that territory as being equivalent to a search at the border, so the authorities can search anything they like without reservation.
That is in fact how things work, but it's a far cry from how it should be. A state that can force you to be stabbed with a needle merely because a police officer states that he thinks you have the scent of alcohol on your breath - without any other evidence of impaired driving - is a police state.
Well, there's google.it, for starters. Not sure if any EU laws/regulations would come into play, but if they do it's a sure bet that Google isn't interested in writing off Europe.
No, I'm claiming that the 0's didn't exist as a decade. The people living through them mostly thought of 1 AD as 754 AUC. Even assuming Christian year numbering, there was no year 0. Still, 1813-1823 is a decade, even though it doesn't coincide with "the 1820s" as a matter of course.
Nonsense. Millennia numbered that way might be more proper - there was no year zero - but there was a year 2000, and the aughts ended on January 1, 2010. We're in the teens now.
You don't need a machine to process Kodachrome, so long as you have the chemicals. If something really phenomenal showed up, you could have the chemicals synthesized and do the processing by hand.
Corollary: how many people to the left of center would have accepted as a positive thing a regulation put forth by the Bush administration's FCC (but opposed by both of the Democratic commissioners) that claimed to be "ensuring net neutrality"?
The Obama administration has done a terrible job explaining itself here. We all know that we want the rules to say "Comcast can't charge Google for carrying YouTube videos, or charge its customers for access to Facebook". But that's a very difficult regulation to craft properly. It is not insane to be suspicious when your political opponents, using a government commission that has a questionable authority to regulate the thing to begin with rather than Congress, start throwing out rules.
I'm not sure where you get that idea. From here, median household income in 1950 was $3200, while average was $4200. Do you think you could get a new car in 1950 for $200? (A quick Google suggests that $1600-$2000 is more like it.)
Wow, whoever downmodded me, I feel sorry for your family. If you feel the need to nail multiple people, don't get married. If you're married and tired of her, get the divorce before you start banging someone else.
what happens in a Michigan divorce is that property is divided equally between "the parties", regardless of who filed, what caused the divorce, or either party's behavior during the marriage.
The question is how you choose the teams to play. Take a look at the two top 25 lists on this page. Notice that while they contain mostly the same teams, the order does vary a bit. The many historic conferences (see here vary quite a bit in difficulty - and since a large part of your schedule necessarily consists of in-conference teams, the difficulty of the schedule can vary quite a lot. For example, 6 of the 12 teams in the Southeastern Conference and 5 of 12 in the Big 12 are in the top 25; only 1 of 12 in Conference USA is. Going strictly by win/loss record doesn't account for this.
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The problem comparing 24 hour stores to medicine is that you don't really care who checks you out. Most people like to choose their doctor. Nearly all of them like to choose their surgeon.
new ACGME regulations for interns starting next July which limits you to 16 hours in-hospital and rules for "strategic napping."
Man, am I glad I got through before that crap started up. Those guys will never leave the hospital.
For those who don't understand: Under the old rules, interns (first year out of med school) could work up to 24 hours straight on new patients, and then an additional 6 hours of seeing old patients and handing off patients to the on-call team. They were on call every third or fourth night. Under the new rules, they can only spend 16 hours on duty before a mandatory 6 hour rest. Sounds great, right? The problem then becomes: how do I provide coverage for the hospital? The answer, I'm pretty sure, will be: one intern on days, 6:30 AM - 7:30 PM, and one on nights, 6:30 PM - 7:30 AM, six days a week, with two other interns brought in on Saturday to provide weekend coverage. It's only 78 hours, so you stay under the 80 hour limit, but it utterly and completely wrecks your life.
getting a page at midnight because the nurse thought the patient needed "butt paste."
My favorite was the midnight page from the floor nurse who said that I needed to fix a patient's consent for surgery the next morning (why on earth she thought that couldn't be done down in the OR holding area, I have no idea, but whatever). When I go to investigate (because she needed to see me up there to get this fixed!), it turns out that the patient is scheduled for a colostomy, but the consent says enterostomy. (For the non-medical, it turns out that the patient is scheduled to receive a square, but the consent authorizes a rectangle. Never mind that the one is a subset of the other.) Got to grin and bear it, too, since fighting back only gets you woken up all night long in revenge. It was a great moment in reminding me why I'm an anesthesiologist, not a surgeon.
You don't have people checking the schedules to fly only with Captain Jones, or have their television delivered only by Dave the driver. Surgeons are not interchangeable.
Harder than you think. On-call duties don't just include doing surgery. I'm an anesthesiologist, not a surgeon, but I did play one for a month as an intern, so I may be able to give you a bit of an idea how things work.
The way to reduce call is to increase the number of people in your group. Larger group = less frequent call. HOWEVER, larger group = larger number of patients admitted to multiple hospitals to care for overnight, and less familiarity with those patients. If you're in a 3-man group, and you're on call every third night, you'll get to know your partners' sicker patients better. If it's a 10-man group? You'll rarely see the same patient twice, and there will be a lot more of them. In the 3-man group, you'll have a manageable list of patients, and given the number of things that happen in an average night, you'll probably get a bit of rest. The bigger the list of patients, though, the more likely you are to get called about something during the middle of the night. Maybe the primary surgeon forgot to write an order for Tylenol for the patient; maybe the patient is constipated and wants something for it (an astonishingly common complaint); maybe they want a sleeping pill. Doesn't matter; you've got to take a call and deal with it.
Furthermore, surgeries are scheduled by days of the week - you will have (e.g.) one room on Mondays, two rooms on Tuesdays, and one room on Friday afternoons. Regardless of what night you're on call, that's when you can operate. Since surgeons only make money when they operate, there is an enormous incentive not to miss an operative day. Since the hospital only makes money from ORs that are in use, if you don't use your operative time you'll lose it. Cancelling a day of surgeries has enormous costs - you already have a nurse anesthetist, a scrub tech, a circulating nurse, and housekeeping personnel scheduled to work there. Do you send them home early, effectively docking their pay for something that isn't their fault? Or do you pay them to do nothing?
The AMA doesn't control medical school admissions, and the number of medical students admitted has zero influence on the number of practicing physicians in the United States. The number of practicing physicians in the US is determined by residency slots, which are controlled by the ACGME and funded by CMS.
I know you hate doctors, but please try to get it right.
The most important determinant of your physician's skills is the residency and fellowship (s)he did. Contrary to popular belief, highly academic centers do not always produce the best clinicians, because their focus is much more on generating research. Now, they're definitely very smart guys, and in some fields of medicine that's all there is. But in an interventional field, things get hairy. In particular, the collection of a few individuals can make an otherwise obscure place a powerhouse. In my field, anesthesiology, one of the best residencies in the country is at the University of Alabama-Birmingham.
wouldn't be able to clock as many over time hours
AHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHHAHAHAHAHAHAHAHAHAHAAAAAAAAAAAAAAAAAA!!!!!!!!!!!!!!!!!!!!!
Seriously, you're killing me. We don't get paid for being there; we get paid for doing stuff. And we never get overtime.
The AMA represents, at best, about 20% of American physicians. It does not, despite what you read on the Internet, limit the number of doctors that practice in the US. The limitation is entirely under the control of CMS (the Centers for Medicare and Medicaid Services) who fund residency positions, and the ACGME, who approve the residency programs and tell them how many positions they may have.
one really doesn't have any good way of knowing if they're up to it.
Although a few turkeys make it through now and again, certification by the American Board of Anesthesiology is a pretty good starting point. Approximately 10% of graduates of American medical schools fail the written exam the first time, and about 30% of American medical school graduates fail the oral exam the first time. It was definitely one of the most stressful hours of my life...
I was thinking of this and similar. You're right, the courts have ruled that they can only be "administrative" stops, but that's not what's happening out there, and I haven't seen an agency get slapped yet.
You're not under arrest, but you're not free to go, either. You have been detained. His statement that it was the Homeland Gestapo suggests that he was within 100 mi of the border, which means that the courts have agreed to treat any stop within that territory as being equivalent to a search at the border, so the authorities can search anything they like without reservation.
That is in fact how things work, but it's a far cry from how it should be. A state that can force you to be stabbed with a needle merely because a police officer states that he thinks you have the scent of alcohol on your breath - without any other evidence of impaired driving - is a police state.
Well, there's google.it, for starters. Not sure if any EU laws/regulations would come into play, but if they do it's a sure bet that Google isn't interested in writing off Europe.
No, I'm claiming that the 0's didn't exist as a decade. The people living through them mostly thought of 1 AD as 754 AUC. Even assuming Christian year numbering, there was no year 0. Still, 1813-1823 is a decade, even though it doesn't coincide with "the 1820s" as a matter of course.
Nonsense. Millennia numbered that way might be more proper - there was no year zero - but there was a year 2000, and the aughts ended on January 1, 2010. We're in the teens now.
You don't need a machine to process Kodachrome, so long as you have the chemicals. If something really phenomenal showed up, you could have the chemicals synthesized and do the processing by hand.
I suppose I should have made an exception for those with pre-approved open marriages.
Corollary: how many people to the left of center would have accepted as a positive thing a regulation put forth by the Bush administration's FCC (but opposed by both of the Democratic commissioners) that claimed to be "ensuring net neutrality"?
The Obama administration has done a terrible job explaining itself here. We all know that we want the rules to say "Comcast can't charge Google for carrying YouTube videos, or charge its customers for access to Facebook". But that's a very difficult regulation to craft properly. It is not insane to be suspicious when your political opponents, using a government commission that has a questionable authority to regulate the thing to begin with rather than Congress, start throwing out rules.
(about 5% of gross pay)
I'm not sure where you get that idea. From here, median household income in 1950 was $3200, while average was $4200. Do you think you could get a new car in 1950 for $200? (A quick Google suggests that $1600-$2000 is more like it.)
You've never had a BMW fixed in the US, I see.
Or take it for a 30-minute spin on the weekends.
Wow, whoever downmodded me, I feel sorry for your family. If you feel the need to nail multiple people, don't get married. If you're married and tired of her, get the divorce before you start banging someone else.
what happens in a Michigan divorce is that property is divided equally between "the parties", regardless of who filed, what caused the divorce, or either party's behavior during the marriage.
wrong?
ex tried to raise this same charge against me
Reading her email, or fucking someone else? Because the latter should result in severe penalties.
The question is how you choose the teams to play. Take a look at the two top 25 lists on this page. Notice that while they contain mostly the same teams, the order does vary a bit. The many historic conferences (see here vary quite a bit in difficulty - and since a large part of your schedule necessarily consists of in-conference teams, the difficulty of the schedule can vary quite a lot. For example, 6 of the 12 teams in the Southeastern Conference and 5 of 12 in the Big 12 are in the top 25; only 1 of 12 in Conference USA is. Going strictly by win/loss record doesn't account for this.