Good summary of current evidence about risk: there is no single rule of thumb. Instead: work to reduce your risk as best you can!

10/ I don’t know what the right answer is. But I do know that our current solution is broken. And that the right answer won’t come from people treating patients as profit-taking opportunities. Appreciate the civil conversation.

9/ It’s why I enroll my children in public education. It’s why I am comfortable drinking the water from my tap and buying the food I serve my family. The simple fact that a market is regulated or limited doesn’t immediately condemn it as substandard.

8/ Before you throw “Marxist” at me like a slur, I think the capitalist free market is a fine way to maximize wealth and outcomes in many other industries. I just disagree that the kind of capitalism you are suggesting here considers values vital to my profession.

7/ Agreed, our current system undervalues primary care and overvalues proceduralists. I agree that administrative growth in medicine is the biggest driver of cost, and clinicians relatively less. But shoving more profit motive is hard to see as a part of an effective solution.

6/ I don’t think M’care is perfect. It is hamstrung by an inability to negotiate Rx prices, leaving my pts without access to vital drugs. It is frustratingly bureaucratic. But I’ve never had to file a PA for a lifesaving care with M’care. Except with for-profit MA.

5/ I agree that there are plenty of private independent practices that provide excellent care. Contrasted with few to no examples I know of where a for profit hospital system does anything but siphon off profit and shunt expensive complicated patients to those Bishops you malign.

4/ To your specific point about not-for-profit systems reaping the benefits of our current setup: Those large health systems provide care for uninsured and underinsured. They absorb the most expensive care from private hospitals & payers unable or unwilling to provide/pay for it.

3/ This is not an ad hominem attack, but it belies a basic difference between your motive (“exiting” your entrepreneurial endeavors with as much profit as possible) and my motive (healing patients). This I suspect will preclude us from agreeing. Not at all discounting your voice

2/ The free market perverts and distorts the autonomy, beneficence, justice, and nonmaleficence that ethical care is built upon. The profit motive is incompatible with the principles of medicine, something I don’t expect to convince you of, not having cared for patients yourself?

I appreciate your willingness to engage with me, and to agree (partially) with several of my points. My suggestion that publicly funded insurance is superior to private for-profit insurance is borne of years listening to and caring for my pts who die b/c of for profit medicine

4/Increase upstream social services that focus on social drivers. All of this paid for by a wealth tax and/or more aggressive progressive income tax. At the end of the day, doctor salaries are <10% of expenditures. Look up Amdahl’s law! We should focus on the other 90%.

3/ We should be training twice as many PCPs and half as many specialists. We are upside down in our medical system and it’s no mystery why. Reduce administration, reduce high cost specialty care, reduce private sector perversion of medicine. Medicare for all.

2/ Unfortunately this is not true - private insurance companies cost more (eg: all of them), provide less care (eg : UHC) and ultimately are bad for patients and doctors. There shouldn’t be any private insurance companies.

1/ @MaxJordan_N Was raked over the coals for 2 basic truths: 1) high paid proceduralists are paid 5-10x as much as primary care w/o 5-10x the training or value. 2) Medicaid provides lifesaving care. @DrDiGiorgio was thinks vouchers or cash subsidies will cut it as a replacement.

Help RVA by helping elect @SpanbergerForVA

I don’t post much, but the first thing I thought when I saw this photo of Mars taken by a little lonely rover is: How nice it would be to be 140 million miles away from the slow decay we are all forced to watch every day.

But they're BOTH so OLD! Gandalf can barely remember his passwords and even forgot that people called him Gandalf (yikes), while Saruman betrayed the Free Peoples of middle-earth and led an insurrection that stormed Helm's Deep. You can see how they're equally bad choices.

Who knew Taylor Swift’s appeal extends to 2 year old babes at breakfast.

Percentage of pediatric and internal medicine specialty programs that filled in this week’s NRMP fellowship match.

I’m not sure I’ve seen any news outlet discussing that 8 million children lost a parent or caregiver during the pandemic. These two facts are related.