You see a ton of people on r/residency and R/medicine talking about mid-levels. No one talks about mid-levels and ophthalmology. What are your thoughts?
Edit: I am a student interested in ophthalmology
I was reading a different post here and caught this comment. For your viewing pleasure:
> I must commend you for your post on midlevel at the residency subreddit, for your candid and honesty, and courage. but as i have found out, it's a lost cause. someone once told me that you can explain the most complex issue to someone that's open minded but you can't explain the simplest concept to someone that has already made up his mind.
> i have been practicing vascular surgery at so cal permanente group for over 7 years. while there is occasional friction, our physicians have the utmost respect for our midlevels, most of which are highly competent. i comment on the subreddit hoping i would help someone and provide some perspectives, something i wish i had when i was their age, but what i have found were overwhelming arrogance, the i-am-a-medical-student-but-i-know-more-than-you-do attitude. people have been making comments on things they have zero experience with as if they were experts.
> the vitriol on the subreddit against the midlevels is astounding. but do know, most of them are losers in the medical world. those people that are so obsessed with "titles" and the "pecking order" are in fact the "lowest" in the medical world. they are not surgeons or specialists. they are FM and EM, who, pound for pound, make the most mistakes and have the least knowledge on any given topic. frequently i get a better and more accurate referral from PA's and NP's than FM's and EM's. their skills sets are so low that they worry they'd be replaced. surgeons never have to worry about that, ever.
> give it up. move on. they're idiots that will never get it and most of them are gonna be terrible doctors because of their ignorance and arrogance.
>best.
I find it extremely ironic that this vascular surgeon is casting everyone against midlevel scope creep as 'arrogant' while his comment drips with the superiority of being a surgeon. It's also pretty obvious that these sorts of doctors would throw us 'losers' to the trash to protect their profits.
I have a premed friend (not premed myself), and I'm worried about them. Long story short, they don't really want to become a physician, but they're premed just because it's the only "respectable profession" they believe they can work as given that they went to a "shitty undergrad". I obviously think this is wrong, but they truly believe that the job will be fine despite all the struggles. However, I'm also concerned over scope creep and all the fun corporate bullshit that is killing medicine. Any advice?
I get Doctor’s are legitimately busy and can’t spend countless hours themselves trying to convince politicians and hospital admin that scope creep is a problem and unsafe for patience.
But they’re also not at a salary level that they can’t collectively buy out lobbying groups to advocate against SC and don’t have to be directly involved in any of it. Am I naive af for thinking this?
Is mid-level scope creep as a big of a concern in Australia as it is in the US?
I'm interested in md/phd but all of the posts about scope creep online are making me nervous. Is it as bad as people are saying/is there a solution? Is it too early to worry about this?
We have a number of projects that often go on much longer than expected due to client delays (delays in communication, feedback, deliverables, etc.)
During these delays, the details of a task or feature gets fuzzy and often forgotten by the time the client is ready to resume the project. When they do come back, ready to go, the scope changes and all of a sudden we're working on something we never really agreed to and are putting in extra (unpaid) work in the effort of keeping the project moving forward.
I feel like this often leads to stress for my team, the client, and ultimately hurts our bottom line and ability to grow.
For each new project we try to scope out the work to the best of our ability but like all creative projects, it's tough to nail down exact details in the beginning phases of a project.
What business practices or systems do you have in place to prevent this from happening with your clients?
For context I’m Canadian- I’d love to hear others‘ thoughts. There was a Pre-Med Forum from 2020 that also discussed this here.
Ok maybe I’m just naïve, but this idea of scope creep from midlevels and even the absurdity of how PAs/NPs etc essentially pay their way through is foreign to me. Getting an NP from what I understand in Canada is still a fairly long process and although have been helpful in filling in family physician shortages in isolated areas (Vancouver Island, the northern territories, etc) they don’t do much specialist procedures as those patients are generally flown to larger centres.
Given the amount of training that especially specialist physicians go through how can a midlevels with a fraction of the training be given so many procedural privileges?? The pharmacology knowledge needed for anesthesia is insane, do CRNAs do this?
We certainly have our issues here too not going to deny that- just interesting to see how many problems there are w the current structure in the US.
Just a brand new intern. Was in the room to d/c a patient and advise follow up with his GI doc when his wife said he sees a PA who “only checks his vitals” and hasn’t been coming up with a plan for her husband to get better. I told her that she can always ask and should ask for a physician (I told her MD or DO only) instead of a PA. She said she didn’t know that, and she thanked me. I explained to her the difference between physician vs PA training and that while PAs are valuable in healthcare, a physician may be more qualified to take care of her husbands condition.
It starts with educating one patient at a time. Hopefully he can finally get the proper care he needs, and I hope to not see him back again in the hospital.
His wife also went on to say I’m “such a good doctor,” for offering to message her husbands PCP to try to set up an earlier appointment for follow up, as they were having difficulty arranging an appointment. It’s certainly a weird feeling to have someone say that, especially so early on in my training when I have so much more to learn and feel like I’m a burden on seniors and attendings by asking so many questions. Reflecting on that experience made me realize that patients perceive how “good” a doctor is based off how much compassion and attention is given to the patient and their caregivers. Yes we have the brains but we also have the hearts to do what’s best for our patients.
When you try to flesh out a setting and portray a living world beyond what the main character sees, but things keep expanding beyond what you planned. Do yout try to rein it in, or see where it leads you? Do you draw a strict line before you start?
I just wanna say im pretty new to the franchise my first exposure with the ff franchise was with crisis core and right now I'm playing the ff 13 trilogy as my first mainline ff games and while playing the games (ff13 and 13-2) it's obvious that there were a lot of developmental issue gameplay wise it didn't seem like there were any issues except for customization options which are almost non-existence.
With things like Vanille taking up much of narrative and driving the plot while not being the main character, fang having almost non existence character development (while every other character goes through one) i don't know whether Lightning returns had any development issue.
Another game is FF15 which started as an entirely different game only 6 years later for development to be restarted.
And what's with developing expensive and highly technical game engines being abandoned and some of the game engines even slowing down development of major games like FF13 the crystal tools engine was developed and implemented with no longer than two years later another engine Luminous engine being developed as well wouldn't this be bad for budgetary reasons or the fact that your organization now has to support two engines? Or about the internal co-operate politics that seem to be affecting square?
And in terms of scope creep why spend did FF15 really need to take more than six years to be developed drawing a parallel this is what got Kojima booted of off Konami as MGSV was too much of a scope creep.
and it's not like these projects are a failure FF13 sold 6 million units and FF15 as sold nearly 9 million units as of 2019
My main question is why is there so much internal co-operate politics and mismanagement at square last semester we learnt about Systems development and we were heavily warned about scope creep is it normal at triple A game development or maybe im just reaching?
I've started to come across this problem in a new workplace.
A ticket I worked on for example, said to add X feature to page A, B, C and D.
I add the feature to A, B, C, and D like the ticket asked, but our QA Tester comments on the ticket to say the feature on page E and F doesn't work - pages which I didn't go near.
On another ticket, I was asked to add image upload validation on the client side so people couldn't upload anything other than certain filetypes. I added that, but the QA Tester comments and says the uploaded object only appears after a page refresh, which was a completely separate bug.
Am I correct to reply to these comments and say "Ok, noted - but these are outside the scope of this ticket so can you raise a new one for these?"
I just feel that if every ticket has this sort of back and forth, it will take longer to get fixes into our codebase and everything will just grow arms and legs, because our list of bugs is extensive to say the least. I also find it super annoying that after I've fixed something specific I'll be told that I haven't fixed it because some other part is broken.
Hi! I have this client I found here in Reddit. She’s very nice and we have good relationship.
She trusts me a lot of I have their bank info and business CC details.
She’s handling multiple business (consulting) pero puro start up so konti lang clients
Part time lang ako 3-4hours $500/mo
(I’m employed full time simultaneous ko ginagawa or after my shift)
Tasks ko: Daily Handling of Email Inquiries -Rental business (3-5 emails lang a day minsan wala pa)
Creating Lease Agreement - once a month
Managing Ads ng rental (once in a while)
Daily Handling of email inquiries - painting services and remodeling business (3-5 emails lang din)
Research - check prices, find me the list of etc keme
Quickbooks - both rental and painting services
Taxes - kunin ung mga requirements at isend sa Accountant
Order items - order nito, order ng ganyan
Answer ng survey twice a month
Magbayad ng CC bill once a month
Graphic design - gawa ng flyers once in a while
At ibang errands pa like next week nagpapatulong sya mag set up ng LLC para sa friend niya
Walang time tracker kaya gusto ko kasi anytime ko pwede magawa May times na walang ginagawa at tulog lang ako
Pero pag sinamahan mo ng quickbooks kain oras talaga dahil magulo QBO nila kaya feeling ko nag eexceed ako ng 4hrs pero i think moving forward hindi na kasi inayos ko na
Sapat ba yung $500/mo PT? Actually last month $400/mo lang ako tinaasan niya ng $100 dahil sa QBO.
Should I just say na, I think I’m working for more than 6hrs a day. Can we make it $700? Or can you increase my rates just this month since dami mong pinalinis na QBO at naghandle ako ng taxes?
Thanks guys!
Hello!
I'm really curious if anyone could help me out. A client reached out to me about add on work that would be pretty quick for me to do after already paying and being happy with what I already made. The way they're talking about it though it doesn't sound like they want to pay me so I'm wondering how I can slip in a quote without being abrasive about it. It's something I could do for a relatively small fee, like probably $100. I just don't know how to open up that conversation
I'm in IM and got a 30~ minute presentation on any medicine topic I choose. Is it possible to educate my co-residents along with some attendings on scope creep(mid-levels, whatever you want to call them) without stepping on any toes? I'm looking at ways to do it, but it seems any way you cut it, it seems adverserial. Even having a slide comparison the education level I know might step on some toes.
There's been so much development on scope creep ever since COVID, I feel like it's a reasonable topic. Feels bad that I don't feel comfortable doing this and I don't want this to be the hill I die on in my residency lol. Any thoughts?
Maybe this is a better fit for r/Freelance or something, but here goes nothing.
I've had a professional creative role since 2015 at three different places, and I can't get a serious raise, and my job description almost never covers all of my responsibilities. These aren't scummy places, but I've definitely tried to stick with small businesses with less than 100 employees -- usually less than 10.
Because of this, I am usually the whole graphics "department", which hasn't been a problem directly, but I'm finding I that I struggle to find peers in a similar situation as me, and being the only creative, I can't exactly hash it out with the team.
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So here's a look at my most recent employment:
Job Title: Digital Designer
Schedule: M-F 8-5, variable based on projects/workload, occasional travel req. for equipment/software training, trade shows, events, etc.
Description:
- Assist Customer with logo creation, design modifications, & digital proofing.
- Prepare artwork files as needed for production
- Create Digital graphics & content for email marketing, announcement, social media, print, etc.
- Assist with website updates & other marketing needs.
- Capture & edit photo/video content as needed for social, website, etc.
Benefits:
- Health Insurance, company pays 1/2 of HMO group rate
- Retirement IRA 3% match
- 1 week PTO, vacation/sick, etc.
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Which, this is fine, and its right at my region's median household income (even though I've been making about that same amount since 2015). On paper that sounds like a nice mix. HOWEVER, the owners of the business also have two other businesses that they have me do work for, so my ACTUAL job duties so far have been:
--------------------------------------------
Original Company I interviewed with/work at:
- Create new/seasonal/event-related retail designs with ideation, design modification, and digital proofing.
- Assist Customers with logo creation, design modification, and digital proofing.
- Prepare artwork & internal production files as needed for production
- Update and maintain a consistent brand system across all platforms
- Strategize, research, and implement schedule for daily social media, bi-weekly blog content, and 3/mo email marketing content
- Create digital graphics and content for email marketing announc
Some details changed to protect phi.
Working a grueling night shift and I get a transfer call. An np from a nearby ED is sending over a teenage girl with a sudden drop in hb. Np casually states she's had some belly pain and vomiting over the past week. Np says she saw her a week ago for the same complaint and at that time she was just starting her period, and the NP checked some labs but sent her home. Today, she's white as a ghost and her hb had dropped more than 5 points. Oh and mom brought her back today since she spiked a fever. Turns out her symptoms weren't her period but hemorrhagic torsion with (now) necrotic ovary.
EM is doomed between unqualified APPs playing loose with people's lives and EM national leadership in bed with CMGs. And the government will turn a blind eye on a few casualties along the way in the name of cheaper HeAlthCaRe.
Where I work the whole point of scoping a project is to prevent scope creep. If a client changes what they want, it's a change request that is billed separately. There's of course room for changes and improvements within reason, but from what I've read on this sub it sounds like you're constantly adjusting the scope of the project based on what you learn. I'm wondering how you avoid having the client use this as an excuse to constantly ask for free changes and improvements. Some clients are very ill-intended.
Edit: thanks for the replies and sorry for the confusion. The question I meant to ask was how do you avoid scope creep in fixed fee modality contracts. It sounds like most of you work on a monthly or bi weekly time and materials modality where you just charge for whatever work the client requests and yeah, obviously in this case you dont care much about the scope because you get paid either way. However in fixed fee contracts if you're not careful you can end up working a lot of hours for free just to avoid ruining the relationship with the client and risking having them walk.
Being that I see very little pushback from them and 80% plus want to go be NPs one day, they are part if the overall issue.
They do their NP homework on duty, talk about wanting to go be "providers." Sure you have the rare nurse who does disgree, but very few are willing to speak out against anything negative a fellow nurse does.
GGG could have had such an easy ride[1] by not doing that (attempting to make POE and POE2 'one' game by bringing POE down to their vision of POE2) and just maintained POE after POE2 was released, carrying over players accounts (MTX) without existing POE characters.
[1] with the community, IMHO and development/project management specific as you have to steer two productions towards one and the same endpoint.
> Scope creep (also called requirement creep, or kitchen sink syndrome) in project management refers to changes, continuous or uncontrolled growth in a project’s scope, at any point after the project begins. This can occur when the scope of a project is not properly defined, documented, or controlled. It is generally considered harmful. It is related to but distinct from feature creep, because feature creep refers to features, and scope creep refers to the whole project.
With the most recent bills asking for similar reimbursement rates between midlevels and physicians as well as the push for midlevel independent practice, I think one drastic step we should take to protest is absolutely no more education of midlevels in any regard by physicians. No more lectures to PA and NP students, no more allowing them to shadow, no more allowing PA/NP students to be under the wing of a physician. No more.
Our education is valuable, costing on average $300,000 now. We’re giving our education to those who wish to replace us. What’s even more infuriating is that physicians are under the threat of “professionalism” and “not being a team player.” You know what else is not professional and not being a team player? Undermining the leader (ie physicians) and actively trying to replace them.
The buck stops with physicians. We need to value our education and bestow it upon medical students only. Let the blind lead the blind and show how midlevel curriculums don’t compare to a physician’s.
Scope creep puts us out of a job, sitting with massive loans and lost time. How does giving away your job help anyone ?
I’ve see Virtue signaling on Twitter and RL and I just don’t see what we gain from it. Will the $$$ for supervision/collaboration I can’t say that anymore because both groups are trying to get rid of it but does that money outweigh our salary .Does fluffing your CV mean that much to these people?
Preface: I'm an MD in a small private clinic. Around 4 yrs of residency but didn't finish one a 5-6 yr programs(s). One got shut down so many attendings resigned. So today a new PA hired on at my practice (I get paid per visit only) emails me saying she would like to learn addiction medicine from me. Haven't responded yet, but short answer: no way! Go to a big box place. I would not even teach/supervise a physician in that environment. I only come in when I have a patient. I work another job. It is very easy area of medicine to get screwed over/high risk. I gain nothing and have it all to lose if one unhappy PA patient posts a negative review on Google. Nope. I cannot adequately train a mid level or physician even in this type of practice.
