Notices by TayFoNay🍿🇺🇦 (tayfonay@beige.party)

46 of my scientific publications have been indexed by Meta’s stupid AI.

Most of them are just conference abstracts. But apparently I’ve died and my obituary was published in The Lancet.

https://www.theatlantic.com/technology/archive/2025/03/search-libgen-data-set/682094/

Drove past a Tesla dealership and there were a bunch of cybertrucks sitting in the lot, lined up along a curb because there wasn't any space to put them. This may mean nothing or I will run with my interpretation that Tesla is struggling to sell all models of their swasticars.

[drags chair across the floor]

Hi, US friends. Have you heard of the “RVU system” in medicine? If not, stay a minute for story time. It’s a major reason US healthcare sucks so badly.

Once upon a time there were some “researchers” at Vanderbilt University who wanted to test a new model of paying physicians using performance metrics based on the RVU system in Medicare, which had been around for a while but never used in this way. The new scheme assigned units to the duties a physician does as part of their job, and gave more weight to a duty that collected more money for the hospital or clinic.

So, for example, a return visit for an established patient doesn’t generate much money so they gave it a lower number like 0.2. But a procedure, like a colonoscopy, is billed much higher so that might get a 2.0.

Each physician is assigned a quota of RVUs. If they don’t meet their quota, they get a warning first and then their pay will be docked. Yes, this is true. So low RVU tasks become psychologically negative. They get labeled as “low performers” even if they’re excellent doctors.

The researchers found using an RVU system motivated physicians to work harder. They published their study and then a few of them went out into the country and got jobs that allowed them to implement this system. One of them came to the academic hospital where I worked in the mid 00s. Over a decade or so, I watched the entire system transform into a corporate grind focused on metrics and electronic medical record documentation. Also with shorter visit times, long waits for follow up appointments, and increasing physician burnout. Then COVID hit.

Not all clinics use the RVU system but if you’re at a place affiliated with a university I can almost guarantee they do. I always ask when I see a new doctor and their reaction is usually telling.

RVUs + private equity led us here.

[drags chair back across the floor]

Study on RVUs: https://journals.lww.com/academicmedicine/abstract/2003/07000/effects_of_performance_based_compensation_and.8.aspx

So I have to buy something on Amazon, which I've boycotted and canceled PRime since the WaPo refusal to endorse Harris.

Make it make sense:

My kids had a Constitution test in school yesterday. For non-US folks, believe it or not, students here are required to pass at least 1 test on the constitution.

My daughter made a joke that she should write somewhere on the test “this is how it used to be” and I said I’d give her $50 if she did. My son heard this offer and well now I’m out $100.

Spent some time at the airport watching the ground crews getting a plane unloaded and loaded for its next flight. It’s really a masterpiece in human cooperation and engineering to operate an airport. This may be controversial, but hear me out: I’d like these folks to be happy and well paid with reasonable work hours and OSHA protections and not have to email 5 things they did today.

It’d be super unprecedented if we could stop calling what’s going on “unprecedented” all the time

We were out at a thing yesterday and ESPN 8 was on one of the TVs. Events included:

Corgi racing
Competitive rock skipping
Some sort of 4 player chess

More “the Ocho” in 2025

I'm seeing articles calling the CEOs of various tech companies "cowards." And I agree wholeheartedly. However, this isn't limited to these broligarchs. I learned the hard way most people with any semblance of power or influence are cowards if speaking out or going against the grain threaten their status. This happened when Chris McNaughton sued UHC - maybe you've seen his @ProPublica story passed around recently with the Luigi incident. If not, linked below.

The reality is several "big name" physicians were approached to join the fight, whether it was on social media or as expert witnesses and very very few stepped up. The ones who did were like oh fuck yeah, let me at 'em. But the ones Chris thought would be there, who even talked a big game about the insurance industry being corrupt at the time, were silent. Because speaking out was risky. The universities who employ them have policies about such things, and the policies are basically shut the fuck up. It was incredibly disheartening.

So I guess I learned then, don't look toward those in power to be the ones with courage in this country.

https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis

@aral @archaeohistories Thanks, I missed that the little box was missing

Spent more time learning about cesspools yesterday than I care to admit. I did discover the Gates’ Foundation has a “toilet challenge” funding toilet innovation projects.

Make 2025 the year you start replying to emails with "Am I supposed to give a shit about this?"

I’ve never been to Delaware.

Hypothetically speaking, if you’re thinking of putting anything on a Tesla, like a sticker or perhaps a note of some kind, please remember there’s something called “Sentry mode” that turns on the cameras and records if the car senses certain movements nearby while parked. So keep yourself unrecognizable. Hypothetically, of course.

Today’s “punch a Nazi” hat outing is the morning rush hour commuter train into Chicago Union Station.

Can we just stop calling these fucking things Executive Orders and call them what they are, Project 2025 decrees, already?

Anyone else feel like they're just walking through soup? Watching people going about their business, pretending that this shit isn't happening or it's "not that bad"? I'm a trained psychologist with 16 years of experience to help me "cope" and "reframe" and all that shit, and I don't even know what to do with myself half the time.

Got a hug and a “bless you” from the car rental shuttle driver, I presume for my punch a Nazi hat since nobody else got one 😂

Violence against nazi’s unites us.

Got a compliment on my “Punch a Nazi” hat at O’Hare. I also think I genuinely made an old white businessman type uncomfortable in the United Club lounge by how he stared at me 😂 I take both of those as wins

This seems like a solid idea 🙄