Doctors going broke

[کیش]

I work as a Pharmacist assistant, and I don't see why you need all that schooling if most of the drugs prescribed are Narcotics and controlled substances.

I feel guilty stacking a bottle with 180 Vicodin pills.

Not to mention that close to all female patients pop Aprazolam (Xanax) like vitamins.

Or every child gets fed Adderall, for their ADD

[faye]

better you feel guilty than tempted, lol.

[کیش]

better you feel guilty than tempted, lol.

Sometimes just sometimes cracked medications just slips past the dumbster and into my pockets.

I'm kidding, or am I

[Laila]

I work as a Pharmacist assistant, and I don't see why you need all that schooling if most of the drugs prescribed are Narcotics and controlled substances.

I feel guilty stacking a bottle with 180 Vicodin pills.

Not to mention that close to all female patients pop Aprazolam (Xanax) like vitamins.

Or every child gets fed Adderall, for their ADD

what is the difference between a pharmacist technician and assistant?

[کیش]

what is the difference between a pharmacist technician and assistant?

Pharmacist assistant is just a fancy word for Pharmacist bytch. Do this, do that; count this count that; mix this mix that; clean garbage.

[Laila]

lol but is the pay good?

[کیش]

I guess it makes a good PT job. I get about $10 an hr, under the table.

On the positive note: I learned alot about drugs and generics.

[BarakzaiAbdali]

Thx for the article. I saw this on CNN the other day. I think it raises a few important points but conclusions derived from it are far from final.

I think the key phrase in the article centers around the business savvy or lack thereof displayed by many physicians. This can be for various reasons.

I recall as a resident, I had a superb attending who was a nephrologist. This guy still did resident level work (in terms of how much he subjected himself to) as a middle aged attending. He loved to teach at the bedside and that was his MO. Most of all, he provided services pro bono to many inner city advanced diabetic patients on the verge of renal failure. His practice collapsed due to the weight of his pro bono work. At the end of the day, he landed on his feet as he took on a hospitalist position at the main academic center and subsequently at the veterans association with a similar salary command.

That is sort of what the article leaves out in terms of ease of transitioning out of private practice back into in local hospital or academic center. Its something that is happening at the national level due to the reasons stated by the article. I think its good for academic centers because they are recovering a lot of talent... and it may end up being good for the government and the patient populations pocket book.

The other issue is that this sort of belt tightening was bound to happen. I dont remember much from oncology, but I do recall that the mortality and morbidity benefit of some chemotherapeutics were still under investigation. If you are an oncologist trying to get reimbursed for accessing cutting edge chemotherapeutics for your patient, and they dont have a liquid tumor where your approach is likely to be curative... you may have to think again in this upcoming enviroment where medicare and medicaid are going to be paying a lot more attention to what they want to reimburse or not based on evidence based practice. I think that Ron Paul was harping on this inevitable boom and bust cycle that would occur and is on the process of initiating, due to the design of our healthcare system.

Regarding lifestyle, I think thats much more nuanced than the article or the discussion above lets on as well.

For instance, my kid sister is applying to opthalmology right now. She is 25. He lifestyle as a trainee for the intern year can be rigorous or not, depending on what she applies as an intern for. Many smart folks do a rather easy internship called the transitional year that is basically like a 5th year of medical school, and then they step into a dermatology or optho residency that entails taking call once a month, which is not shabby at all. At the end of the day, they will be 29-30 years old commanding a salary initiating in the mid $200,000 with potential to climb the ladder at a fast pace and rapidly pay off loans.

Generally, the demanding residency fields with q 4 days call cycles are internal medicine and surgery and their subspecialties. The latter is much more rigorous with fewer elective rotations for obvious reasons (surgeons need to get hands on experience). So certainly, the input and output ratios may not be optimal in such setups.

I personally think females across the world should do whatever they choose in terms of fields they want to enter. However, I do understand that females that adhere to traditional lifestyles across cultures, even amongst the Americans, gravitate towards derm, family prac, or optho or radiology for obvious biological reasons. I respect that and teach that folks should take a look at what they want to do in life and make sure that all their ducks are in a row. If a girl wants to have a big family and still be the Caesar of Cardiothoracic Surgery... she may have to make a crucial decision and make a choice between the two. The field is much more accomodating now towards women having children while training (2 of my colleagues had babies recently and are being treated extremely well... but that doesnt compensate for the performance gap in that males may not take paternity leave and can rebound quickly back to work). In such a circumstance, working hard during medical school and entering a high paying and competitive, yet easy work schedule speciality (radiology, radiation oncology, etc) or PA schooling for females is not a bad idea at all. The same goes for a traditional male that wants to live the 9 to 5 life.

I realize that what jobs come down to is one question: Is this career going to provide me a way to feed my family, provide them shelter/food, and stability.

The general qualm I recently developed with our growing cadre of PAs is their inability to see that a hospital generally functions of the largesse of its trainees and workers. Its been that way since the British led the way.

Here is a solid example: We got hit with 20 admissions to the ICU a few weeks ago. We have 3 young girls who are PAs and we have 4 residents. The whole team generally functions on a 12 hour cycle (7 a to 7 p). With the resident staff, there are caps of admissions as well as with the PA staff. Theoretically residents can take 6 admissions a piece and PAs take 2 admissions a piece. When, on a crazy day, the burden increases, what you are bound to see is that the resident staff steps forward and, in a military like fashion, will agree to take additional patients beyond their negotiated patient caps (the numbers you can hold on a panel). 1 of the PAs is very good about this and understand that rules in a hospital are generally there to guide care... but that when the time comes... if there is a great demand, these rules have to be compromised so that the system can serve patients safely and efficeintly. The other 2 PAs are extremely negative and will have had relatively easy admissions that I pass to them and become combative when asked to take on an additional 1 or 2 patients. Its problematic because 2 patients that are even very sick require about 5 hours tops. Sometimes there are 2 PAs per a cap so that between them, they harbor 2 patients with a break down of 1 patient per PA. So then the excessive burden falls on the MD and the PA generally sits there from about 12 pm to 7 pm doing absolutely nothing. I had to ream one and literally scream her out of the unit when I walked up behind one of them after they had refused an additional patient, after discharging 1 earlier in the day (meaning they had an open spot) because she was reading about Kate Middleton's latest problems as opposed to doing her work. Basically, when 5 pm hits, if a sick patient rolls in and I see my team overwhelmed, I dont care if I am a higher level trainee, I get in there and put on my gloves and we get to work central lining and arterial lining that patient. That ethic is extremely important as a patient provider irrespective of whether you are a psychiatrist, ED doctor, cardiothoracic surgeon, or any level of provider. On other wards, when i consult, I noted this trend... residents will have accomplished all the orders in a timely fashion and will stay late to ensure that my recommendations are adhered to. On the other hand, I have had to repeatedly escalate above the PA to her supervising physician, across the hospital to make sure that such work gets done in a timely fashion.

I recall, just the other day, I got called to the floor because a PA was concerned her patient was sick and needed to be admitted ot a higher level of care. I got there and a code cart was by the patient's bedside... and the guy had been sitting there on the ward all night without any laboratory values being sent on him... without any studies validating her concerns being done... I asked her a series of questions about her patient (the maxim is, know thine patient) and she could not give me an explicit reason of why my team had to be consulted versus a critical care team and what her concerns where specifically. She proceeded to become upset when her supervising physician apologised for her (meaning that he understood the consult and directionality of referral were completely inappropriate.).

Now in contrast, there are some PA s who have been in the field about 20 or so years and they are very capable and have come to recognize patterns of sickness and are dependable when they want to admit someone to a higher level of care.

The question for me really is: do we need to increase the physician work force and have PAs serve in the capacity of a primary care role, which doesnt create the quandries above.... or do we have to address the standard of care being taught to PAs in schooling (i.e. patient care comes first, second, and third).

Back to the issue about doctors not being business men: This may very well be true in the American market. In fact, there are many loan forgiveness programs that are available for physicians willing to work in underserved areas... but what I see is that my colleagues are intent upon going to Boston, LA, or the saturated market areas and not taking advantage of those offers. One Khybar grad I met along the way told me how dumb he thought my American born colleagues were in that he was taking advantage of such an offer in rural Ohio to get better immigration perks and that his pay was great. And these programs abound. I get offer after offer for great states like Montana, Oklahoma, and Texas that entails serving a rural population and they hire head hunters to get people to notice these positions.

The other reason I continue to advocate for medicine is that its still rather troubling to me to see the status of Afghans when compared to the rest of the immigrant populations. I was in the masjid for Friday prayer the other day and it hurt greatly (bitter sweet) to hear that APNA (A Pakistani physicians organization) was running a refugee clinic in associated with Indian physicians as well. I long for the day where all 10 Pashtuns in the mosque can serve their own populations. At work, the Iranians run the division, and mind you, its not like the Iranians are any better with their language skills than Afghan Americans.

I always say that immigrant populations like the Jews from Eastern Europe, serve a great model. These folks understood that you have to drive your generations into professional level education at the PhD, MD, JD, MBA levels. Thats exactly why every other name of program directors is a -stein or an -ov. The Chinese long ago understood this paradigm and drove their children into professional and technological fields to the point that when you look at Yale Medical School's roster... every other face is an Asian one.

A part of their reasoning, I believe, was that they understood that money makes the world go round, but that you need a cadre of professionals to ensure that your ethnic group gets a foot hold in this new nation. These generations in turn would go on to build the Technion in Israel and continue to enact cross fertilization of knowledge between the Americas and Israel.

The fact that APNA can go to Khybar and offer scholarships to Pakistani students makes me want to, in a friendly way, out compete them.

We have 4 Afghans that have gone through Yale now on Fulbright scholarships.... all of them the children of prominent folks back in Kabul and all of them opting to pursue degrees in economics. I get emails every few weeks from these folks about a dinner at such and such time and such and such place. It will be peak work time for their semester and these folks are keen on collecting us together to talk about some useless political matter.

Instead, Afghans in the states and Afghans in Kabul need to start emulating the jews, the asians, and the indo paks and start viciously competing for professional level positions.

Perhaps the other leg up that the actual professional degree may give you is that when things do become standarized in Afghanistan... they will likely follow the Arab state pattern of recruitment. At this juncture, to practice medicine in the near or far east, coming from the US, one must have the MD. So for those who want to leave the US and set up shop in their native country... I think the additional time suits that particular goal.

I do however agree with Admin Khan that the psychosocial impact of medicine training is something to consider. Its rigors are very boot camp like. Its like that for a reason: people dont schedule when they have their heart attack... it can occur at 5 pm on a sunny day or at 2.34 am on a winter storm evening. The pager will go off 100 times during your shift and 3/4 of those pages are irrelevent, but you are obligated to deal with each and every one of them in an efficient manner. Physicians have to learn to ensure the type A personality this breeds does not come home with you so that you do not treat your family like a medical team. Physicians also have to find ways to cope with stress related to the fact that you are testing and retesting every few years for recertification and these tests are neither easy, nor short. You are, essentially, a student for life.

[Ahmad Walid]

Nicely put Barakzai brother. You can't imagine the plans and dreams I have for Afghanistan if inshallah I get into Med. School and become a doctor. On the note about PAs, yes, we have lots of Afghans here that are training to be PAs. Only reason why I wouldn't consider PA, I hate having a boss telling me what to do. I believe PAs have to report their daily activities to their superior physician everyday and personally I don't like this. The way Barakzai brother explained, I can't understand why no one would want to be a doctor. I have had my difficulties with my first "real" science course (Ochem), but it is awesome because you can predict what will happen with certain reactions without having to literally perform it. And don't get me started on Biology, one thing I loved about my genetics (hated the genetics part) course was the part on how the DNA>RNA>Protein process works. It is absolutely amazing the perfection and the complexity of this process. I can't wait for Biochemistry and Microbiology in the fall. I don't think I could ever stop learning about the human body. And I don't understand why people think its a long time (8-10 years seems short to me). I can't believe how fast time is going for me in my undergrad. With each science course I am amazed at how complex the human body is and further it resembles the perfection of our creator.

I could do with student for life without the homework (1000 physics problems) for life.

Just my undergrad. opinion.

[retro]

I work as a Pharmacist assistant, and I don't see why you need all that schooling if most of the drugs prescribed are Narcotics and controlled substances.

I feel guilty stacking a bottle with 180 Vicodin pills.

Not to mention that close to all female patients pop Aprazolam (Xanax) like vitamins.

Or every child gets fed Adderall, for their ADD

Americans area nation of guinea pigs and have a pill for every conceivable ill. It's a wonder that half of them haven't all died of renal failure. As they pop mind altering drugs like smarties.

[Admin Khan]

Americans area nation of guinea pigs and have a pill for every conceivable ill. It's a wonder that half of them haven't all died of renal failure. As they pop mind altering drugs like smarties.

It's all business for them.

[faye]

actually, it is really lovely to see the love and enthusiasm of barakzai and ahmad. for their profession and studies. congratulations for finding a worthy niche you love, as a profession.

[emkhan]

actually, it is really lovely to see the love and enthusiasm of barakzai and ahmad. for their profession and studies. congratulations for finding a worthy niche you love, as a profession.

Faye faye, you never appreciated me for my enthusiasm and hard work towards my work. I am disappointed with you.

[faye]

i haven't heard you express any enthusiasm for where you are or what you are doing emkhan, only winging and moaning like a miserable ole woman, lol. you have to earn, dear.

[emkhan]

i haven't heard you express any enthusiasm for where you are or what you are doing emkhan, only winging and moaning like a miserable ole woman, lol. you have to earn, dear.

You will soon come to know what have I achieved but I know you hate me you never gonna appreciate.