Ughh, Hard to believe it's been a week already, my workout plans entail swimming four days weekly, but today was my LONG swim day.
4500 meters. 3 miles. almost 2 hours in the pool...
I'm a tired boy.
Started with a 500m warmup....just to get loose, slow and easy. Then, ramped it up with intervals of 50m hard, 100 easy. After that, did a pyramid starting with 25 on 10 seconds, then up to 200m, and back down. After which, did some "total immersion" drills, and kickboarded for a little while. then 2000m continuous at a moderate to intense pace, and then 200 meter cool down.
Now I have to go run a short 3 miles today too.....Going to sleep well tonight.
Tuesday, January 6, 2009
Primary Care Shortages...
We've talked about MLP utilization, we've discussed hospital bed shortages....but now I think we need to talk about one of the biggest hurdles/problems in american medicine today.
We've discussed various issues with healthcare here, and recently I have been talking about the problems with simply enacting or instituting nationalized healthcare....NOTE, I am not saying that we should not eventually do this, as it is probably eventually needed, BUT, we need to do this slowly.....
Keep in mind that it took TEN years for Japan to re-work their healthcare system and provide nationalized healthcare.....TEN YEARS. And their society is much smaller and more homogenous. Recent estimates I've seen have suggested that it will take close to 20 years for a nationalized health plan to truly be implemented and function well. And it must be a multi faceted approach that addresses other problems as well.
Here's one:
http://www.usatoday.com/news/health/2008-11-18-doctor-shortage_N.htm
Primary care doctors in the United States feel overworked and nearly half plan to either cut back on how many patients they see or quit medicine entirely, according to a survey released on Tuesday.
And 60 percent of 12,000 general practice physicians found they would not recommend medicine as a career.
Eleven percent said they plan to retire and 13 percent said they plan to seek a job that removes them from active patient care. Twenty percent said they will cut back on patients seen and 10 percent plan to move to part-time work.
Now, imagine adding an additional 49 million patients to this system???
And add to that, that a recent survey of 1200 medical students indicated that only, ONLY 2% were planning on entering primary care......2%....we need that to be closer to 30%, at least.
Thoughts?
We've discussed various issues with healthcare here, and recently I have been talking about the problems with simply enacting or instituting nationalized healthcare....NOTE, I am not saying that we should not eventually do this, as it is probably eventually needed, BUT, we need to do this slowly.....
Keep in mind that it took TEN years for Japan to re-work their healthcare system and provide nationalized healthcare.....TEN YEARS. And their society is much smaller and more homogenous. Recent estimates I've seen have suggested that it will take close to 20 years for a nationalized health plan to truly be implemented and function well. And it must be a multi faceted approach that addresses other problems as well.
Here's one:
http://www.usatoday.com/news/health/2008-11-18-doctor-shortage_N.htm
Primary care doctors in the United States feel overworked and nearly half plan to either cut back on how many patients they see or quit medicine entirely, according to a survey released on Tuesday.
And 60 percent of 12,000 general practice physicians found they would not recommend medicine as a career.
Eleven percent said they plan to retire and 13 percent said they plan to seek a job that removes them from active patient care. Twenty percent said they will cut back on patients seen and 10 percent plan to move to part-time work.
Now, imagine adding an additional 49 million patients to this system???
And add to that, that a recent survey of 1200 medical students indicated that only, ONLY 2% were planning on entering primary care......2%....we need that to be closer to 30%, at least.
Thoughts?
Monday, January 5, 2009
American College of Clinicians...NP and PA
So I got my renewal reminder for the ACC in the mail today. The ACC for those of you not familiar, was created a few years back by a group of NP's and PA's (Bob Blumm among them, whom I know from the Academy) in order to foster a more collaborative atmosphere and to encourage a partnership between the two groups. I think their aims are admirable, so I usually send in my check.
It reminds me however, how often I am asked to explain the differences between the two, both at policy meetings, and by patients and even MD's (who should know this)
I will start by saying that I hold no personal grudge against NP's, hell, I supervise two of them in our group.
There are however, some substantial differences between the two.
Educational Degree:
PA's Master's level for the most part, there are still some baccalaureate programs remaining, and I believe one or two certificate programs.
NP's Master's mandated now, however, the NP leadership has now mandated that the Doctor of Nursing Practice degree (DNP) be the entry level degree for the profession.
Educational Structure:
PA's Based on the medical model. All schools must meet stringent criteria, and be accredited by the APAP. There is ALWAYS one full didactic year, followed by one full clinical year. We are told that we get the "meat" of medical school, essentially the 2nd and 3rd years. As I have not been to medical school, I cannot qualify this statement.
NP's All over the place, there is no nationally based criteria for NP school structure, and many have a mix of didactic and clinical hours, but do not seem to follow any pattern, hence there are sometimes serious questions regarding their educational model.
Board Examinations/CME:
PA's Licensed by the state medical board, we have to fulfill the same requirements as the MD's....50 hours of CME every year, and we have to take our boards over again EVERY six years. Most MD specialties require boards to be taken every x number of years, most are every ten.
NP's Licensed by the board of nursing, they have to fulfill the minimum CEU requirements for their state. They take a state based NP board exam only once. They do not ever have to take their boards again, and as their board exam is state based, there is wide variability on the testing that actually takes place.
Practice:
PA's Generally, although not always, much better at procedural medicine, and much better at acute care (ICU's, ER's, Surgical specialties).
NP's Generally, although not always, much better at preventative medicine, and patient counseling, as well as geriatric nursing home care.
Bottom line is, there are differences between us, it is important to recognize these, but also to work together.
I do have a problem with the NP pursuit of the DNP degree as their entry level degree, as they are creating a potential legal minefield for themselves. I have 3 friends who are PA's that have PhD degrees as well, and not a SINGLE one of them will identify themselves as "Doctor" to patients. They don't even have the PhD listed on their clinical nametags, as it is simply NOT worth the potential confusion. I know that I am finishing my Doctoral degree now, and I will follow their example. I can see everything being fine for the NP's until something goes wrong. Which it will, when you practice medicine, as an NP, PA, MD, DO, CRNA, CNM, etc.etc., if you practice long enough, you will have complications and/or bad outcomes. It's just a statiscal reality, and I can see a defense attorney having a FIELD day with the DNP degree. "So, (snidely) DR, was the patient aware that you do not in fact, have an MD?....before you answer that, WHERE did you go to medical school? Where did you complete your residency....DR?, I mean you are ABSOLUTELY SURE that the patient was aware that you are not, in fact, an MD? How could they be so sure, I mean after all, you call yourself a DR, you are treating the patient, are you not?"
And that would likely end badly. So, to any NP that reads this, it is not a slam, merely a concern. I would like to see us both flourish........
(PS.......you should have to re-board too.....dammit)
It reminds me however, how often I am asked to explain the differences between the two, both at policy meetings, and by patients and even MD's (who should know this)
I will start by saying that I hold no personal grudge against NP's, hell, I supervise two of them in our group.
There are however, some substantial differences between the two.
Educational Degree:
PA's Master's level for the most part, there are still some baccalaureate programs remaining, and I believe one or two certificate programs.
NP's Master's mandated now, however, the NP leadership has now mandated that the Doctor of Nursing Practice degree (DNP) be the entry level degree for the profession.
Educational Structure:
PA's Based on the medical model. All schools must meet stringent criteria, and be accredited by the APAP. There is ALWAYS one full didactic year, followed by one full clinical year. We are told that we get the "meat" of medical school, essentially the 2nd and 3rd years. As I have not been to medical school, I cannot qualify this statement.
NP's All over the place, there is no nationally based criteria for NP school structure, and many have a mix of didactic and clinical hours, but do not seem to follow any pattern, hence there are sometimes serious questions regarding their educational model.
Board Examinations/CME:
PA's Licensed by the state medical board, we have to fulfill the same requirements as the MD's....50 hours of CME every year, and we have to take our boards over again EVERY six years. Most MD specialties require boards to be taken every x number of years, most are every ten.
NP's Licensed by the board of nursing, they have to fulfill the minimum CEU requirements for their state. They take a state based NP board exam only once. They do not ever have to take their boards again, and as their board exam is state based, there is wide variability on the testing that actually takes place.
Practice:
PA's Generally, although not always, much better at procedural medicine, and much better at acute care (ICU's, ER's, Surgical specialties).
NP's Generally, although not always, much better at preventative medicine, and patient counseling, as well as geriatric nursing home care.
Bottom line is, there are differences between us, it is important to recognize these, but also to work together.
I do have a problem with the NP pursuit of the DNP degree as their entry level degree, as they are creating a potential legal minefield for themselves. I have 3 friends who are PA's that have PhD degrees as well, and not a SINGLE one of them will identify themselves as "Doctor" to patients. They don't even have the PhD listed on their clinical nametags, as it is simply NOT worth the potential confusion. I know that I am finishing my Doctoral degree now, and I will follow their example. I can see everything being fine for the NP's until something goes wrong. Which it will, when you practice medicine, as an NP, PA, MD, DO, CRNA, CNM, etc.etc., if you practice long enough, you will have complications and/or bad outcomes. It's just a statiscal reality, and I can see a defense attorney having a FIELD day with the DNP degree. "So, (snidely) DR, was the patient aware that you do not in fact, have an MD?....before you answer that, WHERE did you go to medical school? Where did you complete your residency....DR?, I mean you are ABSOLUTELY SURE that the patient was aware that you are not, in fact, an MD? How could they be so sure, I mean after all, you call yourself a DR, you are treating the patient, are you not?"
And that would likely end badly. So, to any NP that reads this, it is not a slam, merely a concern. I would like to see us both flourish........
(PS.......you should have to re-board too.....dammit)
This is just sickening.....
I have a two and half year old daughter....this just breaks my heart. There are some truly evil people in this world, and this must be one of them. I mean, he hasn't ever seen the kid, finds out he needs to pay child support, and then kills him....an innocent little child. This is the kinda guy that I would LOVE to have alone in a room for a few hours...show him the true meaning of the word PAIN......
http://news.yahoo.com/s/ap/20090104/ap_on_re_us/new_orleans_child_killed_6
http://news.yahoo.com/s/ap/20090104/ap_on_re_us/new_orleans_child_killed_6
Dusty Guitar
Ahhh...looked at some of my old beauties last night. Haven't picked up any of them for some time. I actually played guitar for what seems like forever, I started as a teenager, and then alternated between bartending gigs, and playing in heavy metal bands to pay my way through undergrad. Haven't heard a song in a LONG time that made me want to play again..but then I heard this song:
Well, sat down to learn to play it, and right away, I knew he was playing in a different tuning. SO I started with a drop D....then tried DADGAD......but NO.....he's playing it in a DROP C......dayyyumm. Took me about an 2 hours to figure it all out, but a good hour of that was changing the strings (locking tremolo) and then figuring out the tuning. Definitely like this tune.....
Well, sat down to learn to play it, and right away, I knew he was playing in a different tuning. SO I started with a drop D....then tried DADGAD......but NO.....he's playing it in a DROP C......dayyyumm. Took me about an 2 hours to figure it all out, but a good hour of that was changing the strings (locking tremolo) and then figuring out the tuning. Definitely like this tune.....
Sunday, January 4, 2009
Hospital Bed Shortages
I thought perhaps a discussion of the availability of hospital beds and, secondarily, resources, might be apropos this evening. This is extremely important in light of discussion of 47 million uninsured americans beginning to use health resources if and when "Universal Healthcare" becomes a reality. Most people in this country are not aware of the bed shortages, and difficulty finding placement that occur daily. Most people operate under the assumption that if you are very ill, you can present to your hospital, and be admitted for further care there. Well, not necessarily.
http://content.healthaffairs.org/cgi/content/full/22/6/40
"After nearly two decades of concern about excess inpatient capacity in U.S. hospitals, the business media and some industry observers are beginning to suggest that some hospitals are near their capacity limits in providing patient care.1 Concerns have arisen especially about emergency services and the increased frequency with which hospitals have gone on emergency department (ED) diversion (requesting that ambulances bypass their EDs) in recent years.2 Some studies suggest that ED diversion might be the most obvious sign of more widespread capacity problems in certain hospitals. In particular, some hospitals may go on diversion because their ED is crowded with patients who are boarded there because regular floor and intensive care unit (ICU) beds are full.3
These issues have generated discussion in public and private policy circles largely because of impending demographic changes as the baby-boom generation enters retirement and needs more health care. Should the United States now be considering increased investment in hospital capacity? The Health Care Advisory Board recently suggested that based on a moderate-growth scenario, hospital in-patient days will rise 3.5 percent each year through 2010, which implies the need to increase inpatient bed capacity by 40 percent.4 Also, a 2003 study of the Chicago health market, commissioned by its local hospital association, suggested that 4,500 more beds (approximately a 20 percent increase) would be needed there by 2020.5"
And
"Number of hospitals. These data suggest a consistent downward trend in the number of hospitals from 1975 to 2001. The number of staffed hospital beds also declined between 1985 and 2000, with a small increase in 2001. The number of hospitals declined 14.4 percent from 1985 to 2001, as a result of hospital closures and mergers. The decline in staffed hospital beds between 1985 and 2001 was about 17.5 percent, the result not only of closures and mergers but also of hospitals’ decisions to downsize bed complements or their difficulties keeping beds staffed because of labor shortages.
Hospital use. In relation to hospital use, between 1975 and 1980 admissions rose about 11 percent, and average length-of-stay was stable. This likely influenced the hospital bed expansion observed in this period. After 1980, though, inpatient admissions declined 14.4 percent, as did average length of hospital stay (14.5 percent).
Several factors were instrumental to these changes, including advances in medical technology that expanded the types of procedures that could be provided in an outpatient setting. Further, the introduction of the Medicare prospective payment system (PPS) also contributed, given its payment incentives that encouraged reductions in inpatient lengths-of-stay and a shift of some care to outpatient settings.9 Finally, managed care was a strong force between 1980 and 1995, and health maintenance organizations (HMOs) in particular focused on utilization management to reduce unnecessary hospitalizations and hospital days.10
Some of these trends took an interesting turn after 1995 (Exhibit 1). Most notably, hospital admissions rose 9.4 percent from 1995 to 2001. Despite a decline in average length-of-stay of 0.8 days over this period, average hospital occupancy rates rose to 64.4 percent in 2001. Meanwhile, the growth in outpatient visits continued unabated, rising about 30 percent between 1995 and 2001."
Also, Massachusetts looked at this, and found this:
--------------------------------------------------------------------------------
"http://www.mass.gov/Eeohhs2/docs/dph/quality/healthcare/ad_emergency_dept_analysis.doc
This study found that the most significant driver of ED diversions in the two hospitals studied is the lack of sufficient inpatient capacity. This is supported both by observational data and by stochastic modeling. Capacity shortfalls may result from either an absolute lack of staffed hospital beds, a periodic bed shortage revealed during peaks of demand, or a combination of the two."
Just wondering what others thoughts might, or might not be.
http://content.healthaffairs.org/cgi/content/full/22/6/40
"After nearly two decades of concern about excess inpatient capacity in U.S. hospitals, the business media and some industry observers are beginning to suggest that some hospitals are near their capacity limits in providing patient care.1 Concerns have arisen especially about emergency services and the increased frequency with which hospitals have gone on emergency department (ED) diversion (requesting that ambulances bypass their EDs) in recent years.2 Some studies suggest that ED diversion might be the most obvious sign of more widespread capacity problems in certain hospitals. In particular, some hospitals may go on diversion because their ED is crowded with patients who are boarded there because regular floor and intensive care unit (ICU) beds are full.3
These issues have generated discussion in public and private policy circles largely because of impending demographic changes as the baby-boom generation enters retirement and needs more health care. Should the United States now be considering increased investment in hospital capacity? The Health Care Advisory Board recently suggested that based on a moderate-growth scenario, hospital in-patient days will rise 3.5 percent each year through 2010, which implies the need to increase inpatient bed capacity by 40 percent.4 Also, a 2003 study of the Chicago health market, commissioned by its local hospital association, suggested that 4,500 more beds (approximately a 20 percent increase) would be needed there by 2020.5"
And
"Number of hospitals. These data suggest a consistent downward trend in the number of hospitals from 1975 to 2001. The number of staffed hospital beds also declined between 1985 and 2000, with a small increase in 2001. The number of hospitals declined 14.4 percent from 1985 to 2001, as a result of hospital closures and mergers. The decline in staffed hospital beds between 1985 and 2001 was about 17.5 percent, the result not only of closures and mergers but also of hospitals’ decisions to downsize bed complements or their difficulties keeping beds staffed because of labor shortages.
Hospital use. In relation to hospital use, between 1975 and 1980 admissions rose about 11 percent, and average length-of-stay was stable. This likely influenced the hospital bed expansion observed in this period. After 1980, though, inpatient admissions declined 14.4 percent, as did average length of hospital stay (14.5 percent).
Several factors were instrumental to these changes, including advances in medical technology that expanded the types of procedures that could be provided in an outpatient setting. Further, the introduction of the Medicare prospective payment system (PPS) also contributed, given its payment incentives that encouraged reductions in inpatient lengths-of-stay and a shift of some care to outpatient settings.9 Finally, managed care was a strong force between 1980 and 1995, and health maintenance organizations (HMOs) in particular focused on utilization management to reduce unnecessary hospitalizations and hospital days.10
Some of these trends took an interesting turn after 1995 (Exhibit 1). Most notably, hospital admissions rose 9.4 percent from 1995 to 2001. Despite a decline in average length-of-stay of 0.8 days over this period, average hospital occupancy rates rose to 64.4 percent in 2001. Meanwhile, the growth in outpatient visits continued unabated, rising about 30 percent between 1995 and 2001."
Also, Massachusetts looked at this, and found this:
--------------------------------------------------------------------------------
"http://www.mass.gov/Eeohhs2/docs/dph/quality/healthcare/ad_emergency_dept_analysis.doc
This study found that the most significant driver of ED diversions in the two hospitals studied is the lack of sufficient inpatient capacity. This is supported both by observational data and by stochastic modeling. Capacity shortfalls may result from either an absolute lack of staffed hospital beds, a periodic bed shortage revealed during peaks of demand, or a combination of the two."
Just wondering what others thoughts might, or might not be.
Saturday, January 3, 2009
What a shift....
Wow. Moonlighting at another hospital today....what can I say...money talks.
This hospital is a smaller community hospital in one of our rural towns. There is one physician on at all times, and between the hours of 12p to 12a, there is a PA on to help with flow during peak hours.
Today was incredibly busy, saw a great many patients, and some were pretty sick. One of which was a very debilitated old man who came in with a shortened, externally rotated lower extremity which was very obviously a hip fracture. He lived on his own, and had become increasingly confused over the past several months. I think that he must have fractured his hip the night before, as he was still wearing the same clothes from the previous day according to his family, and had an elevated creatinine. Along with a concomitant UTI. Can we say admission. It was a good femoral neck fracture with significant displacement. He'll be having surgery soon....
Also saw a patient who ended up being pretty sick. Had a an elderly female patient who had a syncopal event present primarily for evaluation of her shoulder, as she had fallen on her left side and sustained abrasions as well as pain and swelling at the sternoclavicular border. No SOB, No CP, No neurologic changes. Had some episodic dizziness after recovering from the syncopal event, but felt fine now with no pain outside of her clavicle. I explained to both her, and her family, that the clavicle pain and swelling was one thing, but more concerning was this isolated syncopal event. We needed to rule out more sinister causes for this. EKG demonstrated A-Fib, which the patient did NOT have a history of, exam demonstrated some skin tears, abrasions, and the above mentioned clavicle swelling and pain. Neuro exam was carefully done, and was benign. I ordered a head CT, and this demonstrated an acute SAH with bleeding in to the sylvian fissure and temporal lobe. I explained the significance of this to the family, and the need for urgent neurosurgical consultation. The nurse at this point, comes up to me concerned about his BP which was 95/55. I laughed and said that was perfect. I explained to her, that at this point, I would prefer a slight hypotension, as long as she was perfusing well.
Anyway, add to that, the diverticulitis patient, the 2 year old that needed periorbital suturing, the two chest wall traumas (non penetrating)...and this PA is done tired.
Now I have to go deal with a drug seeker......yay....(rolls eyes)
This hospital is a smaller community hospital in one of our rural towns. There is one physician on at all times, and between the hours of 12p to 12a, there is a PA on to help with flow during peak hours.
Today was incredibly busy, saw a great many patients, and some were pretty sick. One of which was a very debilitated old man who came in with a shortened, externally rotated lower extremity which was very obviously a hip fracture. He lived on his own, and had become increasingly confused over the past several months. I think that he must have fractured his hip the night before, as he was still wearing the same clothes from the previous day according to his family, and had an elevated creatinine. Along with a concomitant UTI. Can we say admission. It was a good femoral neck fracture with significant displacement. He'll be having surgery soon....
Also saw a patient who ended up being pretty sick. Had a an elderly female patient who had a syncopal event present primarily for evaluation of her shoulder, as she had fallen on her left side and sustained abrasions as well as pain and swelling at the sternoclavicular border. No SOB, No CP, No neurologic changes. Had some episodic dizziness after recovering from the syncopal event, but felt fine now with no pain outside of her clavicle. I explained to both her, and her family, that the clavicle pain and swelling was one thing, but more concerning was this isolated syncopal event. We needed to rule out more sinister causes for this. EKG demonstrated A-Fib, which the patient did NOT have a history of, exam demonstrated some skin tears, abrasions, and the above mentioned clavicle swelling and pain. Neuro exam was carefully done, and was benign. I ordered a head CT, and this demonstrated an acute SAH with bleeding in to the sylvian fissure and temporal lobe. I explained the significance of this to the family, and the need for urgent neurosurgical consultation. The nurse at this point, comes up to me concerned about his BP which was 95/55. I laughed and said that was perfect. I explained to her, that at this point, I would prefer a slight hypotension, as long as she was perfusing well.
Anyway, add to that, the diverticulitis patient, the 2 year old that needed periorbital suturing, the two chest wall traumas (non penetrating)...and this PA is done tired.
Now I have to go deal with a drug seeker......yay....(rolls eyes)
Sunday, December 14, 2008
Long Day
29 patients, 12 hours.....extensive work ups. Cardioverted two patients, had one STEMI, and another that I had to intubate with the WORST parapharyngeal abcess I have seen in my entire career. Add to that a horrible intracerebral hemmorhage that was so bad there could be no possible recovery...guess who got to tell the family. You know, I've told countless patients over the years that they have some horrendous diagnosis such as metastatic cancer, and have had to tell families in the past that their loved one cannot, or could not be saved.....you'd think that at some point you get more comfortable with it, or develop some level of confidence with it.......but unfortunately.....you don't. It sucks....like BAD, everytime. Glad to be done with that shift...
On a study note, I am about to piss off most of our primary care department, and many of the primary care MD's are close friends. I'm wrapping up an access study that does not reflect kindly on them. Maybe I should wear a kevlar vest to work for a while. LOL.
My daughter is only 2 and half, and is starting to color coordinate EVERYTHING. Add to that, the fact that she is now judging every other kids outfit at daycare, and I think that I might be in some serious trouble down the road.......Ugh.
On a study note, I am about to piss off most of our primary care department, and many of the primary care MD's are close friends. I'm wrapping up an access study that does not reflect kindly on them. Maybe I should wear a kevlar vest to work for a while. LOL.
My daughter is only 2 and half, and is starting to color coordinate EVERYTHING. Add to that, the fact that she is now judging every other kids outfit at daycare, and I think that I might be in some serious trouble down the road.......Ugh.
Thursday, December 4, 2008
Haven't posted in a LONG time...
Like a year. It's been so busy. As of right now, I have two articles pending, another in the review process, I have a book chapter that is over due, and as an article reviewer for a prominent medical journal....well, I have three articles sitting here waiting for my input. My daughter is growing like crazy, we just took her to my mom's back on Buffham road to see the farm. She got to see Llamas, horses, and even got to ride a horse......guess who had to hear about riding horses THE WHOLE F*CKING PLANE RIDE HOME......ugh.....She is in the "WHY?" phase now, over, and over, and over again....."daddy why?...why?...why, daddy?"
Clinically work is going well, I am now on an institutional committee regarding state health policy, also starting on the Clinical and Scientific Affairs Council for the national Academy, and am beginning to work on my Doctoral of Health Sciences degree. I plan on completing it at the same institution that I finished my master's at. No, I don't sleep much. From a practice perspective, I am now in a supervisory role, and function equivalently to an Emergency Medicine physician. I rarely involve them with my patients, and they rarely ask about them, and they often (at least the younger ones) will consult me on Orthopedic and Neurologic problems. I am also lecturing to the residents, and medical students on TIA and Stroke management, as well as the management of complex sports injuries.
As far as training, well, finally starting to ramp up again.....Rode a short 45 miles yesterday, and swam 3.5 miles today in the pool....Going to run a short 5-6 miles tomorrow. Might do some swim interval work as well.
Anyway, that's my life right now, I will endeavor to keep this more updated in the future.
Clinically work is going well, I am now on an institutional committee regarding state health policy, also starting on the Clinical and Scientific Affairs Council for the national Academy, and am beginning to work on my Doctoral of Health Sciences degree. I plan on completing it at the same institution that I finished my master's at. No, I don't sleep much. From a practice perspective, I am now in a supervisory role, and function equivalently to an Emergency Medicine physician. I rarely involve them with my patients, and they rarely ask about them, and they often (at least the younger ones) will consult me on Orthopedic and Neurologic problems. I am also lecturing to the residents, and medical students on TIA and Stroke management, as well as the management of complex sports injuries.
As far as training, well, finally starting to ramp up again.....Rode a short 45 miles yesterday, and swam 3.5 miles today in the pool....Going to run a short 5-6 miles tomorrow. Might do some swim interval work as well.
Anyway, that's my life right now, I will endeavor to keep this more updated in the future.
Tuesday, November 20, 2007
Sorry for the delay in posting
Was kinda burned out this past few months, and took some time off. Took my daughter to some swimming lessons which was essential, as she unfortunately has no fear of water. Working less nowadays too, which will allow me more time to train. I've got my race calendar set for the first part of the year. I will be racing the road race...the Oxbow Classic here, one of the most painful events I've ever done in mid april. 18 mile circuit race, with a monster hill. Closed to cars in the winter, as it is too steep, it is about a 1/3rd of a mile long, and has a gradient of between 19 and 20%. My HR approached 190 last time I did it, and when I reached the top of the hill, I saw the whole world spin and start to turn black, I fell off the bike and threw up twice....GREAT RACE. Can't wait to do that again.
Upcoming races will also include an Olympic length triathlon on June 27th, 1.5K swim, 40K bike, and 10K run. Hope to break 2:50. http://www.winmultisportevents.com/
After that doing a Half Ironman, Chisago, 1.2 mile swim, 56 mile bike, and 13.1 mile run. Can't wait for that, although, I will have to substantially increase my training this winter and into the spring. http://www.midwestsportsevents.com/events.php?EventID=4
I am also thinking about another Half Ironman later in the summer, and early in the fall.
My daughter is the light of my life, and I will try to post a pic here as well.
Today was a good workout:
Swim: 7 x100m in pyramid with crescendo/de-crescendo effort. 4 x50m workouts/drills.
then 500m continuous at slow steady pace. 3 beat breathing pattern.
Run: Colder, very windy today, so only ran 3 miles with 4:00/half mile pace alternating with 4:30/half mile pace as well.
Well, have to work in the ER tomorrow, and unfortunately on turkey day as well.
Here's a gratuitous pic of my little angel....
Upcoming races will also include an Olympic length triathlon on June 27th, 1.5K swim, 40K bike, and 10K run. Hope to break 2:50. http://www.winmultisportevents.com/
After that doing a Half Ironman, Chisago, 1.2 mile swim, 56 mile bike, and 13.1 mile run. Can't wait for that, although, I will have to substantially increase my training this winter and into the spring. http://www.midwestsportsevents.com/events.php?EventID=4
I am also thinking about another Half Ironman later in the summer, and early in the fall.
My daughter is the light of my life, and I will try to post a pic here as well.
Today was a good workout:
Swim: 7 x100m in pyramid with crescendo/de-crescendo effort. 4 x50m workouts/drills.
then 500m continuous at slow steady pace. 3 beat breathing pattern.
Run: Colder, very windy today, so only ran 3 miles with 4:00/half mile pace alternating with 4:30/half mile pace as well.
Well, have to work in the ER tomorrow, and unfortunately on turkey day as well.
Here's a gratuitous pic of my little angel....
Subscribe to:
Posts (Atom)