Ben White

The Mean World

06.27.23 // Miscellany

From Humankind: A Hopeful History by Rutger Bregman:

“Imagine for a moment that a new drug comes on the market. It’s super-addictive, and in no time everyone’s hooked. Scientists investigate and soon conclude that the drug causes, I quote, ‘a misperception of risk, anxiety, lower mood levels, learned helplessness, contempt and hostility towards others, and desensitization’……That drug is the news.”

Over the last several decades, extreme poverty, victims of war, child mortality, crime, famine, child labour, deaths in natural disasters and the number of plane crashes have all plummeted. We’re living in the richest, safest, healthiest era ever. So why don’t we realise this? It’s simple. Because the news is about the exceptional, and the more exceptional an event is – be it a terrorist attack, violent uprising, or natural disaster – the bigger its newsworthiness.”

The “mean world” theory: we fall prey to the synergistic effect of availability bias and negativity bias, making us believe the world is more dangerous and violent and scary than it really is. It’s a potent source of misunderstanding about how the world works, our place within it, and the general happiness of humankind.

The power of the news in shaping your mood and feelings is much more potent now than it used to be, not just because you spend more time on social media than you ever did consuming network television or the newpaper in years past, but because the algorithmic targeting of your attention allows companies to feed you content that engages you, even if that content isn’t good for you. Rare events that cause your outrage are singled out to be given to you in regular doses to keep your attention and maximize your engagement. That’s why a quick check of your Facebook feed turns into a 20-minute slog, leaving you drained and frustrated.

On top of that, individual content creators, journalists, and influencers suffer from audience capture, where a feedback loop of positive reactions from their audience to their most extreme or hot-button content creates a feedback loop resulting in the creation of evermore egregious content. Even a billionaire like Elon Musk was unable to resist wasting his fortune to buy Twitter because he enjoyed feeding the trolls so much.

The Medical Student Research Arms Race

06.22.23 // Medicine

From “Research Fever—An Ever More Prominent Trend in the Residency Match”:

Insanity.

I have zero doubt that this incredible trend reflects a whole bunch of meaningless CV-fluffing that only further detracts from the mission of graduating good doctors.

I also wonder how much the bigger numbers in ERAS even impact individual success. Yes, studies have demonstrated that matched applicants on average have a greater number of research experiences than unmatched applicants, but how much can we attribute to the research and how much is just confounding correlation?

Other research has suggested that putting up big numbers during training doesn’t ultimately reflect those who go on to do research over the long term. It’s mostly brownie points and free trips.

At this point, we’d probably be better off with a residency lottery.

Ultralearning Radiology

06.20.23 // Radiology

The science of learning has become a lot more popular over the past few years than when I was a student. Contemporary medical students utilize spaced repetition algorithms for their Anki flashcard decks, enjoy high-quality question banks, watch videos at 2x speed, and drill with picture-based mnemonic tools like Sketchy Medical. These techniques have minimal overlap with the medical school I started fifteen years ago (in-person lectures, books, repeat).

A lot of the most compelling educational literature forming the basis for our current conception of optimal learning is well-summarized in the book Make it Stick (the big three being [1] spaced repetition, [2] retrieval practice, and [3] interleaving). A less academic and more casual book repackaging of this evidence-based approach is Ultralearning by Scott Young. I wrote about it back in 2020 in this post about the transfer problem.

We can summarize Young’s key components of “ultra” learning as Directness, Drill, Retrieval, Feedback, Retention, Intuition, and Experimentation.

This post is meant to prompt you to do the work of meta-learning: learning about learning, trying to figure out the best ways to learn the art and science of practicing radiology.
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The pull of these forces left many doctors anguished and distraught, caught between the Hippocratic oath and “the realities of making a profit from people at their sickest and most vulnerable.”

Not only are clinicians feeling betrayed by their leadership,” she says, “but when they allow these barriers to get in the way, they are part of the betrayal. They’re the instruments of betrayal.”

From “The Moral Crisis of America’s Doctors.”

// 06.15.23

RadPartners’ Debtholders Are Lawyering Up

06.12.23 // Radiology

In Bloomberg Law, “Radiology Partners’s Lenders Seek Counsel as Debt Wall Looms“:

Some lenders to Radiology Partners are consulting with lawyers at Gibson Dunn & Crutcher to explore its options ahead of looming debt maturities, according to people with knowledge of the situation.

The ad hoc group holds more than 50% of Radiology’s term loan, said the people, who asked not to be identified because the matter is private.

Radiology Partners, a group of radiology practices, has a $440 million revolver due in November 2024, which will become current in about six months. It then has a $1.6 billion term loan and $800 million of secured notes maturing in July 2025.

Not “private” enough that they could resist the chance to try to turn the screws on RP publically.

This is, of course, hot on the heels of the recent S&P downgrade, cashflow problems, and United lawsuit on a background of recent PE bankruptcies including Envision.

Graduating medical students: if you haven’t already begun, it’s around time to consolidate your federal student loans. The benefits are discussed in this chapter from my (free) book. While you’re at it, you should also probably read the whole thing.

// 06.11.23

June is DI Month

06.10.23 // Finance

Trainees: It’s never too early, but if you haven’t looked into getting disability insurance yet, you should especially get some quotes in June before leaving your institution after finishing residency/fellowship.

If you know where you’ll be next month, a good agent will be able to compare your available institutional discounts from each location and make sure you get the best deal. My own policy was cheaper with discounts from my training institution.

The folks at LeverageRx and Pattern can get you quotes for the right kind of policy (own-occupation, non-cancellable, guaranteed-renewable) from the reputable companies quickly. You should always get a few sources of quotes to comparison shop too; insurance is expensive, and you’ll be holding this policy for a long time.

You may ultimately decide not to pull the trigger, but it helps to know your options in order to make the right decision for you (and your family).

((Those are affiliate links. Using them helps support my writing without cost. The information is always free; all agents get paid by the insurance companies and not the individual.))

Confidence in RadPartners Continues to Fall

06.08.23 // Radiology

As reported by Radiology Business, S&P has downgraded Rad Partners’ credit rating from B- to CCC+ (from vulnerable to speculative/junk)

The full descriptions of those ratings are here:

An obligation rated ‘B’ is more vulnerable to nonpayment than obligations rated ‘BB’, but the obligor currently has the capacity to meet its financial commitment on the obligation. Adverse business, financial, or economic conditions will likely impair the obligor’s capacity or willingness to meet its financial commitment on the obligation.

An obligation rated ‘CCC’ is currently vulnerable to nonpayment, and is dependent upon favorable business, financial, and economic conditions for the obligor to meet its financial commitment on the obligation. In the event of adverse business, financial, or economic conditions, the obligor is not likely to have the capacity to meet its financial commitment on the obligation.

As in, S&P doesn’t really believe RP can meet its debt obligations unless “favorable” conditions arise. I’ve reported on RP’s financial/PR problems before, including delays in profit-sharing just last week.

There was a great line referenced in the RBJ article that I’m not sure was intended as written or just an amazing Freudian slip (emphasis mine):

“That said, we also understand Radiology Partners’ cost saving initiatives, increased focus on organic growth rather than acquisitions, continued efforts to manage labor market conditions and ability to increase subsidies from providers, will eventually improve profitability and credit metrics,” analysts noted.

Assuredly RP is trying to get subsidies from its hospital contracts, but I suppose in many ways they are also keen on extracting subsidies from their radiologists as well.

Perhaps the recent management resignations (including the Senior VP of Finance and VP of Human Resources so far) are no coincidence either:

S&P said its downgrade also reflects RP’s corporate decision-making, which “prioritizes the interests of the controlling owners, in line with our view of the majority of rated entities owned by private-equity sponsors.”

You can read S&P’s announcement here.