Boston you're my home!

Boston Chinatown - the only historic Chinatown in New England. It's probably third behind San Francisco and New York in terms of Chinatowns in the US. Lots of good food here!




The Roman Catholic Mission Church in the Mission Hill area of Boston. You can't miss it! It's real name is The Basilica of Our Lady of Perpetual Help.

The NEIDL (National Emerging Infectious Diseases Laboratories) in front of the Boston skyline at night.

Watching people taking a ride on the Swan Boats in Boston Public Garden (the first botanical garden in the United States). It's a legacy dating back to the 1970s. I haven't had the pleasure yet.

The Episcopalian Trinity Church in Copley Square was completed in 1877. It looks "interesting" from the outside. I was told it's known for its stained glass but on the day I went to visit the guide could not convince me to part with $6 to look inside. I wonder if the Church knows that they have such un-enthusiastic employees/volunteers (I don't know which). My internet search revealed that it is one of the "Ten Most Significant Buildings in the United States" as determined by the American Institute of Architects. It's also a "National Historic Landmark".

The tall glass skyscraper nearby is the John Hancock Tower or "The Hancock". It's the tallest sksycraper in New England and was completed in the mid 1970s.

Below is a picture I took while riding the (yellow) duck tour as we passed by The Hancock. I love how the Trinity Church is reflected in the glass.

Also in Copley Square/Back Bay is the Boston Public Library (est. 1848), the first public library in the United States. It's huge! Nearby is the Old South Church another Historic Landmark. It's a Congregational church that boasts former members such as Benjamin Franklin, Phylis Wheatley, and Samuel Adams.

Interestingly, the Back Bay area of Boston is landfill!

An underground mural at the Park Street T station. It's one of the oldest subway stations in the United States.

The Old State House is one of the historic landmarks on the Freedom Trail. It's the oldest surviving public building in Boston (built 1713) and the seat of the first elected legislature in the New World. At around 1pm on 7/18/1776 Colonel Crafts proclaimed the Declaration of Independence from this balcony.

I may have been standing at (or within feets)of the site of the Boston Massacre of 1770 when I took this picture.

Below, the burial ground for the victims of the Boston Massacre.

There are lot of interesting cemetaries in Boston if that is your thing.

Park Street Church (near the Park Street T station) is an Evangelical church that is celebrating its bicentennial this year. It's also a historic landmark. "America" (the "my country tis of thee song") was first sung here in 1831. In addition, William Lloyd Garrison, a famous abolitionist, gave his first anti-slavery speech here in 1829.

The Boston Common is the oldest public park in the United States (1634). This monument is from the Park Street & Tremont corner of the park.

Kilroy was here! I wonder if the DUKW I was on when I took the Duck Tour was an original World War II vehicle. I want to say it was.

The Museum of Science as seen from the Charles River. It's a wonderful museum but what I like the most about its history is that after World War II the Society of the museum negotiated a 99-year lease of the land that spans the Charles River (now known as Science Park). Result? The museum currently pays ONE DOLLAR annually for the use of the land. What a deal! They better be saving up their monies for when the lease is up!

One question. Who lives here (along Charles River)?!

Boston skyline as seen from the Charles River. I have to say that the best part of the DUCK tour is the ~30 minutes that we spend in the water versus the land part (too much Boston traffic). The Charles River is my dividing line between Boston and Cambridge. It exits into the Atlantic Ocean. In addition to the Museum of Science, and the ?condos above, other buildings along the shore of the river are MIT, BU, Brandeis, and Harvard.

Another view from the river. This is the Leonard P. Zakim Bunker Hill Memorial Bridge aka Zakim bridge or Bunker Hill bridge! Completed in 2003, it is the world's widest cable-stayed bridge. I don't take it often, but when I do I want to stop and marvel for a bit, especially if I take it at night. At night it's lit up so beautifully, which only makes one wonder how much electricity is being wasted.

Finally, the current State House. Built in 1788, this "new State House" sits atop Beacon Hill on land once owned by John Hancock (first governor of Massachusetts and known for his rather large signature on the United States Declaration of Independence.

The dome is covered with 23 karat gold to prevent leaks. That's funny I say. Only gold on roofs can prevent leaks? I understand that the original roof was a leaky wooden one, but really gold? Well it got its first gold plating in 1874, then in 1947 after the World War II. Apparently during WWII, this beacon of Boston was plated gray so that enemy ships in the Boston harbor couldn't see it to use it as a target. The gold re-plating is supposed to be done every thirty years or so and I beleive the last time was in 1997.

The rash of doctor salary posts from WSJ Health Blog

First, WSJ reported on the starting salaries of physicians and now they are reporting on the trend of increasing signing bonuses given to physicians.

At first I was eager to learn how much physicians make (as I mentioned previously, medical students, residents, and fellows are often clueless about there future net-worth and either ballpark it too high or too low). Now I'm experiencing anger that "we" are still talking about doctors' income (note I didn't use the term salary), when we really should be looking at all aspects of health care industry when it comes to reform. Somebody has beef with physician salaries. I also feel that either I'm being lied to by WSJ or I've been hoodwinked, over and over again.

I just went through a job search this past year as a graduating fellow (why does WSJ use the term "rookie" - that was when I was an intern!). And although I know that infectious diseases is one of the lower paying medical specialities, I did not hear of base salary averages (not including benefits or productivity bonuses mind you) close to what is being reported. So, I must conclude that the report from Merritt Hawkins & Associates includes seasoned physicians not just "rookies", that it does not include those who remain in academia, and that there's a heavy bias from locations like McClellan, Texas, where the business of medicine thrives.

Otherwise, I've been seriously hoodwinked! No other explanation. If only these reports came out before I signed my contract...

Why is Gabon weeping?

I don't get it.

The longest serving African head of state, Omar Bongo Ondimba, who has served as thief of state, I mean head of state of Gabon for the past 41 years finally died last week presumably of cancer. My naive self thought that the people of Gabon could finallybegin to enjoy the riches of their country. How wrong I was.

Instead, they are "crying for their Papa". Why? And I quote: -

An estimated 400 families spend their days digging with bare hands through the valley of trash, skirting piles of medical waste from a nearby hospital including coils of tubing and bags of blood. They are looking for empty bottles to sell — and food to eat.

"If we find a piece of meat, we shake it off, take it home and give it to our wives to cook," said 41-year-old Crepin Edou, one of the scavengers who was born the year Bongo took office.

When asked about the president's massive wealth abroad, he shrugged. Overall, Bongo was a good ruler, he said, pointing out that unlike many other African countries, Gabon has never had a civil war.

"We may be poor," he said, "but at least I have the right to dig through the trash in peace without worrying about a bullet hitting me."

Seriously?! What on earth?! It reminds of women who feel that being raped by their husbands is the natural course of things. Ummm, no!

And what is with Sarkozy and other Western dignitaries being there? Are they mourning Bongo or is this something to do with his pillaged millions? Am I to expect that when a former Ghanaian president (or does it have to be the one in power?) dies that Queen Elizabeth would grace our shores? Here, something wants to scream "Nkrumah was different". But was he?

I'm obviously lacking in my knowledge of African politics, let alone Gabon. Suffice it to say that I'm seriously disturbed.

Other "get the hell out of here moments" while reading the article: -

• By 1985, Libreville held the world record for per capita champagne consumption.

• The first family owned 45 homes in France, including at least 14 in Paris and 11 on the French Riviera. And they boasted of 19 or more luxury cars, including a Bugatti sports model that cost the Republic of Gabon $1.5 million.

• While much of the country still has no paved roads, Bongo spent 14 years and an estimated $4 billion to build a train. He diverted its route at a cost of hundreds of millions of dollars to reach Franceville, the capital of his native province. Since its opening, the train has required a $60-million-a-year subsidy to stay running.

• Bongo asked Citibank to convert $1.6 million into cash for a single family trip in 1995 to New York.

• 8 percent of Gabon's budget — around $110 million — is set aside each year for discretionary use by the president's office

• Bank documents showed increasingly frenetic activity by his numerous children and grandchildren....Gabonese now worry the president's family will siphon off the country's remaining wealth, including money from the safe that takes up one wall of Bongo's former office.
  

Am I mad?!

"So why do doctors complain so much when they make so much money?"

That was one response to my post "WSJ: How much do rookie doctors make? The latest scorecard".

I of course cannot speak for all doctors. The MGMA survey reveals a wide range of median doctor starting salaries; from $132, 500 for a pediatrician to $605,000 for a neurosurgeon. I agree, I would be hard pressed to understand how a person making $605,000 cannot make ends meet even after the deferred gratification required of all medical trainees.

But I do think that a pediatrician and other lower-paid physicians should be paid more than this median $132,500. I also think a lot of medical students agree with that and that's why nobody wants to go into primary care these days.

Frankly, I don't blame them.

Higher education is expensive. Many Americans "invest" in higher education by taking out loans. However, student loans, billed to us as good loans, can be a burden. We are now beginning to realize that there is such a thing as too much student loan debt, here, here, and here. The Project on Student Debt, a non-profit advocacy group, says the average college graduate's debt has increased 50% in the past decade, adjusted for inflation. That is insane!

How much student debt is too much? It appears that if you have to pay more than 10 - 15% of your future earning back to the student loan companies that that is too much. Stated otherwise, one should not borrow more than their expected starting salary. The streets are filled with people who went to college believing that that alone would raise their future networth and now find themselves unemployed or underemployed and saddled with student loan debts that they cannot pay and are being forced to change lifestyle decisions eg. rent or buy a home, how much of a home to buy, where to live, when to get married, when to have children, and how many. That is sad! I feel worse for those who forgo cheaper state schools for expensive Ivy League, elite, or other name-brand schools and now find themselves in this predicament. All for what?

But back to the future doctor facing a future median salary of $132,500. A six figure salary. Compared to the median salary of all Americans pegged at $24,325 from the 2006 census (I doubt it's significantly higher now), that does sound like an awful lot.

But what did said doctor sacrifice to get to that magical six-figure salary? Well, let's see.

Average US college debt: $24, 000 for private college grad; 11,000 for public college grad

Average US medical school debt: $139,517

Average age of US medical school matriculant: 24 yrs

Therefore average age of US intern: 28

+ 3 - 4 years of pediatrics residency, during which loans have been deferred, our dear 31-32yr old rookie physician with an initial six-figure salary of $132,000 likely has ~ $160,000 PLUS worth of educational loans, who knows how much credit card debt, likely minimal savings, and probably wants to buy a decent car, get married, and have children....oh and yeah, start a retirement fund.

Again, is it any surprise that today's medical students don't want to do primary care? Would you want to take a job that is not going to pay you enough to meet your minimum payments? Those that have are the ones whining. They've been bamboozled.

In what other arena are people encouraged to over borrow money? Hmm, the housing bubble was one such, and now we are in a mortgate crisis. Is it time for student loans to be re-examined? I think so. And people need to realize that they need to figure out the cost-benefit analysis of a college education, or graduate school education for themselves. Too many kids out there get a liberal arts degree on credit with no plan at all. None what so ever! How do you graduate from college and not know what you want to do? And then tack on another 1-3 years for a masters degree also on credit hoping that will give you guidance? Or think you know what you want to do and find out that people without the degree from your fancy-named school could do the job you want? I want this "educational debt = good debt" bubble to burst and burst now. It's all too much!

WSJ: AMA Weighs Whether Docs Should Hang Up Their White Coats

Perusing the WSJ health blogs I came across this post: AMA Weighs Whether Docs Should Hang Up Their White Coats

Apparently, one of the policy questions addressed at the recent annual AMA conference was whether doctors should forgo their white coats mostly for infection control reasons. In Britain, ties, jewelry, and long sleeves have already been banned for these reasons.

I say it's time for doctors to forgo the white coat. Not for the potential infection control reasons but mostly because nowadays everybody wears a long white coat. Seriously everybody! From the unit secretary, to the case manager, to the food service delivery guy, to the physical therapist, to the janitor (in jest) etc. etc. So, really what is the point for a doctor to wear a white coat? Nobody can identify us anyhow by the coat!!!!

WSJ: How Much Do Rookie Doctors Make? The Latest Scorecard

This headline was very catching as I wanted to know myself. The truth is a lot of medical students, residents, and fellows don't actually know how much their first real salary will be. We hear low numbers from our academic supervisors and for those of us in primary care we begin to wonder if we will at least make the magic six-numbers that everybody else thinks we do.
On the other hand, we hear high numbers from somebody who knows somebody out there in the private world with business skills. Skills like those demonstrated in McAllen, Texas.

So, I copy verbatim from the WSJ article by Laura Yao:

Good news for med students worried about their debt loads: Physicians coming out of residencies last year reported increases in their starting salaries in many specialties, according to a survey by the Medical Group Management Association, a trade group for medical groups.

Here are the specialties with the biggest jumps in 2008 from a year earlier based on data from 3,520 physicians:

Neurology: $200,000 to $230,000 –- up 15%
Non-invasive cardiology: $350,000 to $400,000 – up 14.29%
Anesthesiology: $275,000 to $312,500 – up 13.64%
Emergency medicine: $192,000 to $215,040 – up 12%
Internal medicine: $150,000 to $165,000 – up 10%

And as if we needed any more reminders about why there’s a shortage of pediatricians and family practitioners, the report also contains data on the extremes: The lowest starting salary in 2008 was for pediatricians — $132,500. The other lowest-paid specialties, in ascending order: family practice, geriatrics, urgent care, internal medicine and infectious disease.

The highest specialty salary was for those starting out in neurological surgery — $605,000. Others at the top of the heap, in descending order: radiology (nuclear medicine), thoracic surgery, cardiology and orthopedic surgery.

The data points are medians, to avoid confounding effects of any outliers. The MGMA said the survey, which depends on voluntary participation by physicians, may not be representative of the entire industry. Collaborating on the survey was the National Association of Physician Recruiters.

I'm an American Top Physician!!!!

Congratulations on your prestigious recognition in the "Guide to America's Top Physicians". Being chosen for this listing is an honor, and your impressive achievements have you among the Nation's most excellent...

So began the mailing I received today. It looked like junkmail but it had "medical license" somewhere on the envelope and I didn't want to chuck it for fear of it being something really important.

How pleased I was to hear that without even finishing my fellowship I am already a top physician in the US. And for this accomplishment I am being provided "an aesthetic display" of my ranking.

It goes on to read:

Using only the finest material, your name can be inscribed with the use of imported marble, thick jade glass and Italian mahogany frames. From your office to your home, our museum grade table-tops and elegant plaques, sadistically display this proud moment.

And on the insert, yes there's a cheap looking blue flyer within this glossy card, I am told that Consumer's Research Council of America, presumably the company that has bestowed this honour on me, is a private company that evaluates and compiles lists of America's Top Professionals in various industries.

And yours truly has been chosen for inclusion in the new 2009 Consumer Guide. On what basis you might ask? Well, the selection process is based on a point value system that awards points for education, years in practice, and affiliations with professional associations. Furthermore, no fees, sponsorships, donations, or advertising are accepted from physicians, professional practices, medical treatment facilities or hospitals to insure an unbiased selection.

Guys, I am pretty special!!!

And to prove it to the rest of the world I can get the Proclamation plaque (the hand selected finest imported mahogany finished lacquered hardwood frame which comes with a distinguished foil stamped proclamation with the official seal of CRCA (don't ask)) for the great deal of $229 or I could get a sweet bargain for the Ambassador series ( a laminated hardwood plaque featuring the actual cover of the "Guide to America's Top Physicians) for a mere $169 (emphasis mine)!

One thing they got right - I am smart. It is so obvious that this is a scam. But I wonder how many doctors out there actually buy these plaques. I mean if I were out there in practice 10 -15 years and I got one of these things, I would be feeling rather special. The blue insert said "no purchase of any products is required" so I am to assume that even if I don't buy "an aesthetic display" of my achievement, I am still going to be listed. Is this book even real? If so, I also wonder how many consumers come across guides like this and actually take it at face value.

The whole thing reminds me of when I was selected for the Who's Who Among American High School Students. I was who was who in the 1996 edition, along with the rest of the top 5% of American high school students. I actually took that thing seriously because let's face it, I was hella smart in high school, it offered a boat-load of scholarship money, and college applications were all about listing all your many honours and achievements as if you were the greatest thing on earth since sliced bread.