Daniel McDevitt MD FACS FSVS

They say laughter is the best medicine. Surgery works pretty good, too.

[Daniel McDevitt MD FACS FSVS @dtmcdevitt]

@SeabassSay @uroegg Yep. That’s the issue. Not enough of us around.

[Daniel McDevitt MD FACS FSVS @dtmcdevitt]

In my experience, it’s more typical for working dialysis patients to be younger. I think it’s great if they can do it.

But keeping up with all the problems these folks get as they age probably separates them from employment much younger than their colleagues who do not have ESRD.

I agree that you can’t just cut off benefits. They won’t survive. This is one of the most medically brittle cohort of patients.

[Daniel McDevitt MD FACS FSVS @dtmcdevitt]

@anish_koka It’s been very successful for consultants and payers, and that’s what counts.

Transferring risk to others and keeping the premium yourself is the best way……to make money.

[Daniel McDevitt MD FACS FSVS @dtmcdevitt]

@DutchRojas 10 more payments and this baby is mine!

You haven’t lived until you accept assignment.

[Dutch Rojas @DutchRojas]

My job is to make sure your surgery center never gets built.

Eleven years, and I have never lost.

The kid had it all lined up. Board-certified, two partners, a lease on a space where he could do the same procedures my client does across town. He showed up to the hearing with a slide deck and patient testimonials.

Adorable.

I did not bring a deck.

I brought one sentence.

“This facility is not necessary.”

That is the whole game.

In this town, you cannot pour a foundation until a board agrees the community “needs” the place. The people who get to argue that you are not needed are the incumbents who would lose the business.

My client gets a seat at the table where his own competition is approved or killed.

I have sat in that chair for eleven years.
I have never once said yes.

The kid drained himself dry to file.

The application alone is the moat: thick, slow, and expensive enough to stop most physicians before they ever reach a vote.

He cleared it anyway, which I respected, right up until I buried him in it.

We said “duplication of services.”
We said “protecting the safety net.”

Language that tested well in 1974 and continues to test well today.

The board tabled him for review.
Review became a year.

The year became a withdrawn lease, and three physicians quietly returned to working for the health system.

You want to know what we were actually protecting?

A physician down the street doing the same procedure for less. Medicare pays us more. Which means commercial pays more. I don’t share.

That is the threat.

Everything else on the record, the duplication, the waste, the safety net, we wrote for the transcript.

Patients kept paying more.

My client called it a win.

I bought a boat last spring.
I named her Certificate of Need.

[Daniel McDevitt MD FACS FSVS @dtmcdevitt]

@realdocspeaks Imagine a health system purchasing the debt of a physician in exchange for a multiyear commitment.

Indentured servitude at its finest!

[Daniel McDevitt MD FACS FSVS @dtmcdevitt]

This was so obvious early on. I would come home after clunking on shitty interfaces all day trying to write a note that made even a modicum of sense and see my kids playing Xbox with amazing graphics and everything set up for the most efficient use of a few buttons to accomplish complex tasks.

It was just frustrating technology. It still is.

[Daniel McDevitt MD FACS FSVS @dtmcdevitt]

The figures quoted in the original post are potentially doable but at the higher end and would be closer to full time work.

Specialities vary in terms of compensation but demand is high and coverage is critical in some locations. It’s interesting because you have the upper hand in the negotiations. If you don’t like the deal, you don’t go.

You can work when you want. Take off all the time you want.

Make sure you set up your company with professional legal and financial advice. There are financial advantages in having your own legal entity.

[Daniel McDevitt MD FACS FSVS @dtmcdevitt]

@DutchRojas FSD is a total game changer. It even makes long distance driving better.

People say they like driving themselves, but FSD makes you realize how much daily driving is just a boring chore.

Now I just relax and listen to The Doctors Lounge!

[Daniel McDevitt MD FACS FSVS @dtmcdevitt]

@JManthrow @CoffeeBlackMD Reality seems very much at odds with this.

[Daniel McDevitt MD FACS FSVS @dtmcdevitt]

I wanted to hate Epic but it’s actually tolerable in some ways. Most places have Dragon so you can dictate notes. Routine things can be templated pretty easily.

Locums requires the ability to adapt quickly to wherever you are. I’ve worked enough with most of the major EMRs to be comfortable using them. It’s an important skill if you’re going to work in a hospital.

[Daniel McDevitt MD FACS FSVS @dtmcdevitt]

@FiSurgi "Tipping" is mandatory now?

I don't think that word means what you think it means......

[Daniel McDevitt MD FACS FSVS @dtmcdevitt]

@CoffeeBlackMD I have heard it said elsewhere:

In the absence of effective law enforcement and a functioning justice system, every crime carries the potential for the death penalty.

We cannot live in a lawless society. Eventually, the people will take matters into their own hands.

[Daniel McDevitt MD FACS FSVS @dtmcdevitt]

@BladeDoc @DrNeilStone But but but but……there was a white cell in the UA!

Must be urosepsis!

[Daniel McDevitt MD FACS FSVS @dtmcdevitt]

@OckhamsRazor4 @CoffeeBlackMD Progressive policies had nowhere near the traction they have now.

[Daniel McDevitt MD FACS FSVS @dtmcdevitt]

@Jaberuski Who is checking?

Since the airport sits on the soil of the country you’re in, you were there.

[Daniel McDevitt MD FACS FSVS @dtmcdevitt]

@noahkaufmanmd @HeathVeuleman @DutchRojas I’ll say it again.

The margin IS the mission.