Physician compensation versus lifestyle balance (a composite index by Marit that accounts for weekly hours, long shift or after-hours work, call burden, and vacation weeks) by major specialty

Who else works in a system where you’ve become the regional dumping ground for everything? Complicated surgeries, weekend disasters, surgical complications, biopsies and every procedure smaller facilities supposedly can’t do or simply don’t want to do. We’re essentially the pop off valve for the entire region. In radiology that includes MSK ultrasound, lung biopsies, MRI patients with pacemakers and anything else that’s difficult, time consuming or unprofitable. And yes I’m talking to you smaller hospitals that cherry pick your work and private equity radiology groups that read outpatient imaging nonstop while dumping the difficult work on full service radiology groups. And we all know how it works. Your hospital system benefits from these patients and collects the downstream revenue and technical fees while radiology does the grunt work. Meanwhile the outpatient MRI group down the street cherry picks profitable studies right under your nose and laughs at you on Saturday afternoon while you’re taking call and they’re calling you a sucker. This has been going on for decades. I’m sure many know the drill. I’d love to hear how others have successfully pushed back against this and stopped being the default destination for everyone else’s unwanted work.

Why is Tom Holland here less well dressed than the King of Spain? This is a very good question. I will give you my perspective. The King is wearing a bespoke suit made for him by a bespoke tailor. Bespoke means the garment was made from scratch. In this case, a tailor measured the King's body and then used those measurements to produce a custom pattern (the term pattern refers to the garment's architectural blueprint). The garment was then made through an series of three iterative fittings — basted, forward, and final — each stage bringing the garment closer to its final form. Tom Holland here is wearing a suit from Boss, the premium label of Hugo Boss. The garment here is made using a pattern that the designer and their team developed using a mix of things: an idea of their target market, their idea of style (often influenced by trends), and a fit model (someone who professionally tries clothes on so the designer can see whether something fits). Tom Holland was not involved in any of these stages. Celebrities often wear things at big events due to a series of backdoor business deals. Sometimes it's as simple as a brand giving them something free to wear. Sometimes they are paid. Sometimes they are working with a stylist who has an agreement with a brand. The key thing is that these are business relationships motivated by profit (the brand is trying to make money through publicity). This is where Holland comes in. Once the suit arrives to him, it's adjusted much like something you'd have adjusted at a local tailor. But since the garment is already made, you can only do so much. In this case, the trousers are too slim for his legs, so they crumple below the knee. The jacket is also a bit too short, but dedicated followers of fashion often tell me, "this is the style." (Or, as the French say, à la mode). More importantly, as the suit travels down this production path — from the designer's head into Holland's hands — it becomes increasingly removed from people with technical skills. True, the alterations tailor is skilled, but they are limited in terms of what they can do. The stylist is not skilled in a technical sense; they are hired to buy clothes and put them on a body. This isn't to say stylists don't have skills or that they're necessarily bad. Indeed, I think Colman Domingo is among the best-dressed men alive today. Much of his style — although not all — can be chalked up to the fact that he works with some very talented stylists. But on average, stylists' work is often less convincing than costume designers'. Why so? In my opinion, it's because costume designers are often more technically skilled. The same is true for the King of Spain. There's no distance between him and the technically skilled person who made this garment — the bespoke tailor is literally laying their hands on his body. No profit motive exists beyond paying the tailor to produce a garment. The tailor's only motivation in this sense is to produce the best garment they can. In the other instance, the development of ready-to-wear systems has produced a network of intricate profit motives. Here, the brand tries to create desire in consumers by putting its clothes on a famous person. But the garment isn't created specifically for that person — and it follows "la mode." It also travels a path that puts Holland further and further away from the technical people involved in production. Of course, this is not to say that you will get an equally good outcome by going to a bespoke tailor, as not all bespoke tailors are so skilled. It's also worth noting that many people who are not technically skilled masquerade as tailors. For instance, it's common for business people and salespeople to run made-to-measure shops, where they drape a tailor's measuring tape around their neck. They may even describe their business as "bespoke." But they are not actual tailors, as they don't have any technical skills (they neither cut nor sew). Instead, they send your measurements to a distant factory, where someone who never sees you makes the garment. Thus, the same problem arises. I'm answering this question partly because I've been thinking about this issue in relation to AI. I suspect AI will do things comparable to the Industrial Revolution: lower production costs and, thus, increase how much you can consume. But I also suspect that it will lead to some deskilling. If you can generate an illustration with a prompt, there's no reason to spend decades learning how to draw by hand. Perhaps sometime in the future, someone will ask why one drawing looks so much worse than another, and someone will give an explanation similar to what you've read here about tailoring. There are fewer technically skilled people involved in the image you see on the right.

Every hospital merger is announced with the same promise: "This will improve access." Somehow, after twenty-five years of consolidation... prices went up, independent physicians disappeared, patients have fewer choices, and we're still talking about improving access. At some point, we should probably judge the slogan by the results.

I may be wrong but a big factor in the doctor substitution rife in the UK is the idea of flat hierarchies 1/

Many young cardiac surgeons think that most acute dissections need a total arch and all AVRs need a “root enlargement” unless they can get a Ross. That is the direct result of grandstanding “giants” in national meetings, often with very detrimental outcomes for patients.

graphs just hit harder in 1940