Private doctor office visit- 99213- $91.85 Hospital-employed doctor across the hall, same building, same visit, including facility fee- 99213- $191.12 This incentivizes hospitals to employ doctors. Consumers pay double. Hire the competition, get paid twice as much.

SpineJack is excellent for anatomic reduction in subacute junctional fractures, but the rules of adequate VB cement apply: side to side, top to bottom. Even after 12cc, lower L1 was still bare. 2.5 more cc via inferior endplate extrapedicular access finished the job.

I wrote this because the conversation around physician workforce shortages keeps circling the wrong target. Telling future doctors to commit to 20 to 25 years of full-time clinical practice sounds noble until you look at what the path actually costs. Medical school is not free. Training is not light. The years are expensive in money, time, family life, health, and opportunity. If society wants a service commitment, then society can fund the education and make that agreement clear before someone signs up. Until then, a medical degree belongs to the person who earned it. Physicians are already screened for discipline, endurance, delayed gratification, and the ability to survive a long academic obstacle course with a stethoscope waiting at the finish line. The better question here - that keeps getting ignored - is why so many capable, committed physicians eventually feel pushed toward the exits. If we want doctors to stay, we need to build a profession they can afford to enter, survive, and stay in.

Today marks four years since we lost my brother - a physician, away on a locums assignment. It was around 9:15 AM PST on May 21, 2022 when we last spoke. I was on my way to the gym, it felt like just another Saturday. That conversation lives with me every day. What I wouldn't give for just one more. His passing changed how I see everything. I found myself paying closer attention to what other physicians were carrying, the quiet struggles. For a while, I felt hopeful. There was real momentum building around physician wellness, and it felt like something was finally shifting. But the needle is moving in the wrong direction. Burnout rates remain at historic highs. Physicians are leaving clinical medicine faster than we can replace them. The administrative burden - prior authorizations, documentation, clunky EMRs, breaking the glass on a patient there to see YOU, continues to consume the hours that should be spent on patients, or on rest, or on simply being human. Mental health stigma in medicine hasn't gone away; if anything, the fear of career consequences keeps too many physicians suffering in silence. And we lost more colleagues to suicide this year than we should ever accept as normal. I don't have all the answers. But I know this - we have to figure it out, and we are running out of time before the profession is just a shell of itself.

linemonkeymd.com/why-irs-are… @SIRspecialists @OEISociety

🔎 For the first time in 14 years, Medicare is ready to end the status quo. CMS just included a request for information on allowing physician-led hospitals to expand to make the TEAM model excel, and PHA President Carlos Cardenas, MD, is calling it what it is: a landmark moment. Physicians hold the highest level of training in the healthcare system, and it’s time they’re allowed to put that expertise to work in operating hospitals. Our nation’s seniors deserve the best care possible, and that comes from physician-led healthcare. Stay tuned for more from PHA and dozens of other healthcare stakeholders who are ready to enhance our nation’s healthcare system.

Nice review, KP.

Incredible! Hope all turned out well! @SIRspecialists @SIR_ECS @SIRRFS Check out the schedule ! @_backtable #Irad @keithppereira ..we were talking about this not too long ago!

linemonkeymd.com/independent… Greetings from #SIR26TOR. Great to connect with friends and colleagues. Have some thoughts on my mind and wanted to share them. Let’s ask the tough questions and get to work creating a better future for IR. @SIRspecialists

The opacity you're describing is deeply baked into how hospitals operate financially. The chargemaster system - that massive internal price list hospitals use - is designed to be opaque. Charges bear little relationship to actual costs, and the gap has been widening for decades. A hospital's full accounting would reveal just how detached their billing is from what care actually costs to deliver. The consultant spending you're flagging is a real pattern. Revenue cycle consultants and chargemaster specialists are now standard fixtures in hospital administration, and their entire job is optimizing how charges are set to maximize reimbursement across Medicare, Medicaid, and private insurers. It's a cost that feeds itself - spend on consultants, inflate charges, trigger higher supplemental payments, justify the consultant spend. The reason full accounting rarely gets published isn't just reluctance. It's that the numbers would make the strategy visible. When a hospital's operating costs represent only 30 cents of every dollar charged, that's not inefficiency - that's a deliberate gap maintained for financial leverage in negotiations and payment calculations. Wrote a long piece on exactly this, tracing why the ratio between what hospitals spend and what they charge has been cut in half since 2000, and what it reveals about the incentive structure underneath. onhealthcare.tech/p/the-econ…

Celebrating #DoctorsDay! Congratulations to Dr Thomas Tullius (NM) on his new role as Vice Chair of @SIRspecialists Small & Rural Practice Committee—advancing access where it’s needed most! #RuralHealth #AccessToCare #SIR26TOR

A radiologist who spends 20 minutes producing an accurate, thorough, & actionable report is considered slow. A hospital that runs 14 committees to approve a hodgepodge of overpriced AI widgets that generate alarm fatigue & additional cognitive burden is considered innovative.

It’s time for the greatest show on earth. I am speaking at OEIS 13th Annual National Scientific Meeting. Please check out my talk if you're attending the event! @OEISociety

"We are not ‘burned out.’ We have been gaslit." 🛑 After 15 years of training and $300,000 in debt, Dr. Corina Fratila just published a blistering, unfiltered essay about why she is ready to drop her stethoscope faster than Big Pharma drops accountability. She argues that doctors are no longer allowed to be healers. They have been forced into becoming "glorified data-entry monkeys in a Kafkaesque insurance labyrinth," spending their days begging insurance companies for permission to save lives and timing their own bathroom breaks. Her shockingly honest comparison of modern medicine to a vastly different (and highly controversial) profession is breaking the internet today. It is raw, it is darkly hilarious, and it is a heartbreaking look at what is really happening behind the clinic doors. "Every day feels like a hostage negotiation between your soul and your malpractice insurance. The system isn't broken. It is working exactly as designed. For profit. Not for people." Healthcare workers and patients: Is Dr. Fratila right? Drop a 💯 in the comments if you feel this, or tag someone who needs to see the truth. 🗣️ Link to the full article in the comments below! 👇

20 years ago, 90% of cardiologists were independent. Today? Most are hospital-employed. This thread is about what we lost — and why it matters to you as a patient 🧵

Don’t let #PAD get in the way of #PAE. In this case, bulky calcified atherosclerotic plaque causes critical ostial-proximal stenosis of the right internal pudendal artery (viewed in LAO). Crossed with a 5 Fr TC-BNK catheter & 014” Prowater wire. Type 4 prostatic artery. #IRad

Looking good!

Does anyone not use AI to create their social media posts anymore? Insert emoji, insert dash etc. med students, residents, attendings…please stop. It’s so obvious. Use your brain.

The real reform agenda is five items: •Repeal the physician-owned hospital ban •Eliminate Certificate of Need laws •Enforce site-neutral payments •Condition nonprofit tax exemptions on actual community benefit •Separate insurer-PBM-physician conglomerates This bill does one of five and calls it a revolution. Do all of it, or admit the rest is theater. buff.ly/k2aHceS