Rob Gray🧢

✋ & Microsurgeon. Mayo Clinic, Rush & Brown. “I treat it like it’s my own hand” Opinions my own & this isn’t medical advice

[Orthobullets @orthobullets]

Here is a new case by Dr. Deana Mercer and the University of New Mexico @UNM.

SEGMENTAL METACARPAL FRACTURE FROM GSW IN 45M

How would you manage this #orthotwitter?

Vote on this case for CME: https://t.co/Vh0v1xqDXT

[Rob Gray🧢 @robgraymd]

Dutch is coming for it today!

[Dutch Rojas @DutchRojas]

You’re worried about the debt.

Fine.
Name the line item.

It’s healthcare.
It has always been healthcare.

The federal government does not buy healthcare like a market.

It buys healthcare like a Soviet planning committee with lobbyists.

CMS sets prices.
Congress creates carveouts.

HHS writes rules nobody understands.

Then every trade association in Washington shows up to turn one sentence into a billion-dollar reimbursement advantage.

Friends on Ways and Means?
Congratulations. You found margin.

Protected category?
Congratulations.
You found a moat.

Special payment model?
Congratulations. You found a taxpayer-funded annuity.

Everyone wants to argue about Medicaid fraud in California or Minneapolis because it makes for a clean villain.

The real villain is bigger.

It is the entire healthcare bureaucracy pretending central planning becomes moral because the acronym is federal.

Medicare and Medicaid keep growing faster than the economy.

Healthcare already consumes roughly a third of federal spending.

Zero out foreign aid.
Zero out culture-war nonsense.
Zero out half the things cable news screams about.

The debt still wins because the machine keeps writing healthcare checks nobody priced in a real market.

This is why every serious debt conversation eventually ends in healthcare.

Not tanks.
Not Iran.

Not some DEI grant your uncle found on Facebook.

Healthcare.

The deficit is a hospital bill with a flag on it.

[Rob Gray🧢 @robgraymd]

You remember the early days! The U was like drinking from a firehose so going off q3 Level 0 trauma was a big part. Then what I detail above. Lots of gym. And a lot of blind faith. But the compounding effect really holds up. You just have to make it through the toe region of the curve to the inflection point.

[Rob Gray🧢 @robgraymd]

The first step is honestly just getting good. It takes forever to feel like you’ve attained mastery and high-level mastery takes longer. I’d say five years before you really feel like you are good at the job and then another three or four before you can figure out how good you’ll be.

The other part is the money. It takes you so long to really make a solid dent in paying off school loans, saving for a mortgage, and starting to put down money towards retirement and college funds. Even when you're doing everything right, the numbers on the screen just don't go up nearly as fast as you think they should. Keep your head down and keep doing it. Then, when you look back in two years, the numbers will be much higher than you thought.

At this same point, your efficiency has grown. You've gotten better. Your practice is expanding, and so the salary goes up too. It is a virtuous cycle. As your improvement in skill leads to an improvement in your financial situation, which certainly makes you happier, that also makes you a better doctor.

Beware what I call the kill zone. Years 5 to 8 are particularly brutal. You've gotten good enough that you don't feel scared anymore, but none of these good things I mentioned have started to take off yet. The rest of your life up to this point, you've had a major change every 1 to 4 years. You start to realize there is nothing new and no one is coming to save you.

At this point, there are also often small children at home and/or parents are getting sicker. This is when burnout really strikes and people start making horrible life decisions.

In addition to the above, the biggest other changes in my happiness have honestly been using an AI scribe and going to the gym seven days a week before I start my workday. I am now happier, healthier, and better than I ever thought I could be.

Hang in there and DM me if you need.

[Rob Gray🧢 @robgraymd]

@FiSurgi I say 1/3, 1/3, 1/3, but yes, that’s the general advice.

[SurgiFi @FiSurgi]

Let me reintroduce myself.

I was homeless as a kid. Lived in cars, shelters, on couches. Today I'm a robotic surgeon. But here's what nobody tells you: I became a doctor and was still broke. This is everything poverty never taught me about money — and how I figured it out.

The first time I felt truly helpless, I was a kid watching my mom have a seizure in the middle of the street. I couldn't do a thing. That feeling never left me.

So I made a promise: never be that powerless again. Naval Academy. Then med school. Then surgery. I learned to operate using robots. On paper, I'd made it.

Here's the part that makes no sense: Starting as a brand-new attending, I was a practicing physician and still broke. Barely keeping my head above water. What people don't understand is that a big income doesn't undo what growing up with nothing teaches you about money.

Nobody ever taught me how money actually works. Not in the shelters, not in school, not in medicine. So I taught myself. The hard way. Made every mistake on the list.

At my mother's funeral, I promised her I'd save as many people as I could. In the OR, I do it one at a time. This is how I save the rest — by handing you what I had to learn on my own.

So that's the deal here: money, life, and success for people who started with nothing. No shame for where you are. No guru act. If that's you — follow along. We're just getting started.

[Sahil Bloom @SahilBloom]

Life advice nobody told you: Violent consistency is the only path to achieve what you want.

It's not going to be pretty. It's not going to draw oohs and aahs from the crowd. Because it looks messy in the days. It's getting out of bed when you don't want to. It's sitting down at your desk when you're tired. It's pounding your head into a wall one more time. It's ugly. It's unimpressive. But it works.

Quantity is a necessary precursor to quality. You cannot create once and hope for it to be perfect. You have to create a lot. Every single day.

I recently came across a story in Art & Fear that I love:

A ceramics teacher split a class into two groups. One would be graded on the quantity of their output, the other would be graded on the quality of their output. On the final day, the first group would have their total output of pots weighed, while the second group would have one pot judged.

When grading day arrived, something fascinating happened:

"The works of highest quality were all produced by the group being graded for quantity. It seems that while the 'quantity' group was busily churning out piles of work—and learning from their mistakes—the 'quality' group had sat theorizing about perfection, and in the end had little more to show for their efforts than grandiose theories and a pile of dead clay."

Quality is a byproduct of quantity. Violent consistency. That's the real recipe.

[Rob Gray🧢 @robgraymd]

@FiSurgi Tyre. Please.

[Rob Gray🧢 @robgraymd]

@ENPDoc @CE_HandSurg

[Heath Veuleman @HeathVeuleman]

Want to know the most valuable asset on a hospital’s campus or within an entire health system?

A physician’s signature.

The irony is that everyone knows it except the physician.

[Rob Gray🧢 @robgraymd]

This took me too long to understand. But it is the basis of all achievement

[High Performance Founder @hpfounder]

If you want to achieve any goal, you can't be the same person. Every new result you want to create has to come with a change in identity. Goals are just an upgraded version of your current self. Before setting any goal must ask who you must be to attain it, then go be that person.

[Rob Gray🧢 @robgraymd]

@FiSurgi You can never hear the truth too often.

[Orthobullets @orthobullets]

Here is a clip from our latest episode of CoinFlips & Controversies, “Subacute Elbow Terrible Triad Fracture-Dislocation in 60F.”

Watch Drs. Hoekzema & Makowski, discuss “Using Intraoperative Fluoroscopy Instead of Staged Reduction for Chronic Elbow Dislocation."

Click here to learn more and watch their full webinar on Orthobullets: https://t.co/OWr7ybZrKr

#orthotwitter

[Tyler Olson, EA @olsonplanner]

I can't repeat this often enough.

Doctors can have anything they want, just not everything they want.

[Josh Chambers @JoshChambers]

"Talent is god given, be humble.

Fame is man given, be grateful.

Conceit is self given, be careful."

-John Wooden

[Rob Gray🧢 @robgraymd]

This. Work can be a burden but it should be a gift.

[Elizabeth Yin 💛 @dunkhippo33]

I went to my uncle's funeral this weekend. He had a great life.

He was a fairly well-known researcher and his work had been cited over 450k times.

The most profound thing to me is even though he died in his mid-80s, my cousin found his laptop open to a word file with text for his next book that he was working on.

To be so excited about your work until the day you die is incredible and something he would’ve wished for everyone.

[Rob Gray🧢 @robgraymd]

@morrisonMSK Yikes! Epidural hematoma w this one or no?

[Orthobullets @orthobullets]

Here is a clip from our latest episode of CoinFlips & Controversies, “Subacute Elbow Terrible Triad Fracture-Dislocation in 60F.”

Watch Drs. Hoekzema & @robgraymd, discuss “Managing Chronic Elbow Dislocation with Instability, Fracture Fragments, and Nerve Risk."

Click here to learn more and watch their full webinar on Orthobullets: https://t.co/mgMASR9aif

#orthotwitter

[Sahil Bloom @SahilBloom]

Nobody told you this about success: Rent is due every single day. A lot of people seem to think that after you make it you can coast in the idyllic land of success. This is wrong. Every single day, you have to fight to earn your seat at the table. And that fight gets more intense as you have more success. You have more to lose. More mouths to feed. More people counting on you. More expectations. There's an old saying that I love: Every morning in the savannah, the gazelle wakes up and knows it must outrun the lion or be killed. The lion wakes up and knows it must outrun the gazelle or starve. Whether you're the gazelle or the lion, when you wake up in the morning, you'd better start running. Rent is due daily. Pay it with pride.