Amazon is running a promotion on my book Medical Student Loans: A Comprehensive Guide so that it’s free on Kindle through the end of Friday. If you haven’t already, now would be a great time to check it out and get your finances in order.
Background:
I generally try to spend money deliberately, particularly when it comes to what might be considered “nonessential” purposes. This year that included the iPhone X.
Our son is two and a half, so the main reason I’ve been upgrading my phone annually the past few years is to have the very best smartphone camera possible. My wife has the iPhone 7 and (until last week) I had the 7 Plus. The increased quality of the plus (particularly portrait mode, but also low-light performance and even macro) was so substantial that when we’re out and about we would almost exclusively use my phone for photos. The best camera—the saying goes—is the one you have with you, so the premium to capture my son’s moments has been the primary motivator.
(It’s snowing!)
Also, I like shiny things. And it was also my birthday.
I also do what I imagine is a surprising amount of my writing on my iPhone. I dictated the majority of my second book as well as large portions of my blog posts (including parts of this one) using Siri. I even do a fair amount my typing on the phone directly with my handy Bluetooth keyboard and Ulysses. All in all, I consider having a great phone to be a worthy business expense (obviously, I’m still trying to justify myself).
Design & Screen:
I’m ambivalent about the notch. The speaker, selfie camera, and sensors have to go somewhere. Perhaps one day they can be embedded in the screen, but overall I don’t find it as galling as some reviewers have. My main pet peeve is that so far a lot of apps haven’t been updated to make use of the unusual “ears” or rounded corners on the display. Updated apps will often show the clock on the left and wifi/cell signal/battery indicators on the top. Older apps just pretend all that space isn’t really there leaving a black bar at the top and bottom as if it were the size of a regular iPhone 7/8. Over time this will improve, but I’m not sure how well cross-platform apps or the many apps that are essentially webpage viewers will be able to accommodate the new design.
The new OLED screen is really nice. It’s beautiful, bright, and for some reason, almost a little more paper-like and less fatiguing when reading text on a white background.
Face ID:
Touch ID is better, but Face ID works as advertised (mostly). It works in light and dark, with or with my glasses or even sunglasses. It’s marginally slower than Touch ID but not enough to make a difference in most situations, and the change in notifications mostly makes up for it. Now notifications are private on the unlock screen, only showing the app but not the content/message itself until unlocked by Face ID. Then you can tap the notification to go straight into the app, which is a clever little improvement. Elegant.
My main fail point is when lying down or holding the phone at an exaggerated angle it often won’t engage. I haven’t figured exactly how much face the phone needs to see but my experience has been variable (generally poor) in these situations. Bedtime is not a great time for Face ID. I also had a cold recently and if I coughed or made an odd face while trying to unlock it would also fail (it was a bad cold; this was happening more than you’d expect). Chewing also causes it to fail.
My other irritating corner case pet peeve is that Face ID is terrible for using your phone on a table or desk. With Touch ID, you could keep your phone on the table and unlock it with your index finger, never having to pick it up to look at alerts etc. With the X, you either have to hit the side button and loom over the phone to unlocked it or pick it up.
Camera:
In my limited usage thus far, the main difference for me between the 7 Plus and X has the speed of portrait mode (in addition to the new portrait lighting effects). The problem with fast moving toddlers is that sometimes the lag of portrait mode means losing the best moment by the time the photo is actually taken. It’s almost as fast as a regular photo now, though I have noticed some serious auto-focus glitches with close up portrait mode, which I hope will be resolved soon.
I rarely use the front-facing camera, so I haven’t taken any decent front-facing portrait mode photos yet, though it does work as advertised.
Overall:
I like it. Like every new iPhone I’ve purchased over the past six or so years, the iPhone X is the “best” phone I’ve ever had. But it’s still (just) a magical glass brick. Face ID is still mildly irritating and forces a number of unwelcome behavioral changes, and the bugs are annoying. The X’s design is nice but I think most Apple customers would be better off just sticking with the iPhone 8 Plus for this iteration.
A lot of people place their hopes on tech companies to save the planet and make literally everything better. At least the tech companies like to pretend they will.
And then you realize how silly so much of it is and how poorly run many of these companies truly are, with so many of them desperately scrambling for their share of our attention paid via advertisements and tracking which we collectively despise.
Twitter is not as big as Facebook and will never make as much money. They don’t have as much data about you as an individual and thus cannot target you for ads with the same gusto. The growth solution, from Twitter’s thinking, is that the 140-character limitation is really holding the service back.
To the contrary, the 140-character limitation is probably Twitter’s only unique selling proposition. Twitter with longer tweets is just like a Facebook newsfeed with more strangers and fewer actual friends. The brevity and speed have been an integral part of the service since its inception. While the original limit was due to the technical limitations of text messages, it nonetheless became part of the character of the service (see what I did there?). It’s definitely a pro/con, but it is unequivocally a true differentiating factor. I’m sure this has been tested and debated for months if not years, but that doesn’t mean it’s the right long-term decision. Platform growth and health don’t always align. MySpace was doing “great” for a while too.
I wrote little stories crammed into tweets every day for over 7 years. 1 I started one of a handful of publications that feature and even pay authors for tiny stories that fit in a tweet.
For me, the constraint has always been the whole point.
Nanoism will always have a 140 character limit. Constraint is the USP of the platform. We’re not a Facebook publication for a reason.
— Nanoism (@nanoism) November 9, 2017
This isn’t to say someone couldn’t start a compelling 280-character limit fiction venue, but would it really be Twitter fiction? Twitter was inspiring as a creative venue for the same reason that people enjoy (if are also occasionally aggravated by) the linguistic acrobatics required to fit their thoughts into the short form. It’s challenging and often surprising.
Of course, I will fully admit that most of the 140-grumblings surely come from longtime users with emotional attachments, particularly writers. I don’t doubt that most people will be able to simply say what they want to say more easily with a longer limit, and that such engagement may—potentially—lead to more usage and advertising revenue.
But I’ll leave it to John Dingell (91-year-old former Congressman from Michigan):
99% of you people don’t even deserve 140 characters.
— John Dingell (@JohnDingell) November 7, 2017
See? No constraints and this post is way too long. Which is another way of saying that @nanoism will always have a 140-character limit.
Longtime readers know that I don’t do ads, guest posts, or push products. I do however share a coupon or referral code or two for something people might actually want if it results in someone saving money (and not just me making a few bucks).
Which brings us to SmashUSMLE. The bottom line is that if you’re interested, the coupon code BW10 saves you 10%.
I don’t think most people need to be interested at this point.
While SmashUSMLE has Step 1 and Step 2 CK qbanks, it’s essentially billed as a curriculum-replacement tool with hundreds of hours of video lectures. It’s got all the trappings: It has the FRED qbank software. It has accelerated video playback options. It has a phone app.
It’s competing with pricey options like DIT and Kaplan. And while it’s cheaper than both of those, it still costs a fortune ($395 for 1 month, $795 for 3 months). There is a 15-day free trial, however, so if you were planning on doing an expensive course, you wouldn’t lose anything by trying. 15 days is actually a really generous trial; you could get a lot of value for free if you remember to cancel it if you don’t think it’s worth the dough. The solo qbank product option is cheap ($59.99 for a month), but the competition on that front is really stiff.
From my brief review sampling, the qbank lacks polish. Questions use the clinical vignette format but do not ape the USMLE house-style particularly well. A UWorld replacement it’s not.
As for the videos, I would never ever personally be interested in buying a video course, so my intrinsic bias probably precludes a fair assessment. Like DIT, they follow First Aid. The style is pure casual whiteboard—like a friend trying to teach you in a room in the back of the library—which I imagine is nice and approachable for students feeling overwhelmed. But, again, these felt a bit on the unpolished side of the spectrum. I’m not sure I could imagine spending the 100+ hours it would take to watch them all even at 2x speed. The free sample online is representative, so you can make your own decisions.
Last month Betsy DeVos’ (Trump’s) Department of Education ended their cooperation with the Consumer Finance Protection Bureau, because, you know, the CFPB was “overreaching” in trying to actually protect student loan borrowers.
Shocking that the same DOE that wanted to consolidate the entire servicing industrial complex into one giant government contract with a shortlist that included a company currently being sued by the CFPB for defrauding students would now be cutting ties with the agency charged with dealing with exactly this kind of detritus.
Got my contributing editor’s copy of The Best Small Fictions 2017 in the mail the other day.
Nanoism had another finalist this year, to accompany our finalists and winners from 2015 and 2016. Great little collection of very short stories.
As many as four to five times a day, Leskosky said, he found serious errors in prior readings, despite just four other radiologists being on staff. In one particularly egregious case, a radiologist missed a 17-centimeter tumor in a patient’s pelvis.
…
In private practice, radiologists may miss key findings once or twice in a lifetime, Leskosky said.
…
A large part of the problem, Leskosky said, is some of the other radiologists on staff were flipping through 50 to 60 patient scans a day, instead of the industry recommended 25 to 30 and, as a result, missing critical findings.
Losing a 17-cm tumor is a pretty aggressive miss, but 1) people in private practice absolutely miss a key finding more than once or twice per lifetime and 2) there is no “industry” to recommend a work-level (let alone one that’s used in practice).
Firing the whistleblower, however, is a pretty egregious no-no, and I’m pretty sure I’ve done some online modules at the VA about that being against the rules.
All said, the “industry” does need better PR though, because there are a lot of radiologists in practice who would love to read just 25 cases a day.
DeVos has taken heat since May from members of Congress and representatives from the loan-servicing sector over the plan to pick a single servicer that would hire subcontractors to collect loan payments. Department officials at the time argued that the plan would make oversight of servicers by the government more efficient.
But the proposal found critics among both Republicans like Senator Roy Blunt of Missouri, who argued that the system would remove choice and competition, and Democrats like Massachusetts Senator Elizabeth Warren, who warned against creating a federal contractor “too big to fail.”
Blunt and Warren were part of a bipartisan group of senators who introduced legislation ahead of the department’s announcement Tuesday to block the single-servicer plan. Their bill would instead require the participation of multiple loan servicers.
Instead, 2019 will still see the consolidation of the different servicer websites to a single portal that interacts with the borrowers (which was the original Obama-era plan already in motion). Everything else will remain separate. How that will happen basically remains a mystery, but the site itself will be developed and managed by the Office of Federal Student Aid.
Hopefully, they don’t take any tips from Navient, because their website is singularly terrible.
Medscape’s newest resident compensations survey is out and discussed in “Most Residents Say They Deserve Big Raise, Survey Shows.”
The main thrust is fine, discussing that today’s residents feel more underpaid than generations past, which is no surprise given the proliferation of mid-levels who work alongside them making considerably more (and likely combined with the envy caused by their better-off friends parading happily on social media [when #YOLO, #FOMO can be devastating]).
But then this:
Resident salaries in 2017 vary considerably by specialty. Trainees in hematology lead the pack, at $69,000, while family medicine residents bring up the rear, at $54,000.
The gender gap in resident pay is negligible. Men averaged $57,400 or 1.2% more than women, who received $56,700.
Ugh. Who writes up these Medscape survey articles? I even wrote about the same misleading fake resident gender pay gap back in 2014.
To summarize:
All trainee salaries are based on PGY year and location. There are absolutely no differences between specialties or genders of trainees of the same seniority. Any differences are related to the differing duration of training between specialties as well as the geographic spread of the relatively small sample.
Ultimately, any attempt to differentiate annual salaries by specialty is intrinsically misleading. Any differences that can be created between genders or specialties are simply reflective of different numbers of respondents at different levels of seniority within the PGY scale. The difference between a family practice resident and a “hematology resident” is that almost every family medicine resident finishes in three years while any hematology fellow will be at least a PGY4 or higher. The fact that hematology “led the pack” and not—let’s say—cardiology or gastroenterology just means of the respondents of the survey, slightly more senior hematology fellows answered compared to their other IM-fellowship peers.
There is a real gender wage gap in medicine, but it does not apply to residency. As I discussed almost exactly three years ago, any differences in gender pay during training are related to the known disparities in gender representation among certain fields, particularly surgical specialties (which have longer training lengths and thus get “paid more”). Now, if we want to talk about the “gender surgeon gap,” that would be a different and worthy story. Because there are fields in which women are underrepresented—that’s the story when it comes to residency. Not a misinterpretation of the statistics.
This sort of willfully misleading interpretation has no place on a website that caters to physicians. Medscape should know better. And, reading some of the comments suggests that some readers (primarily the nonphysicians) do latch on to these “differences” despite simply being a distraction from the real issues at play.
From the ABR’s July 19 email:
Some of you are wondering why it has taken so long for the ABR to provide a solution. We apologize for the delay as we know this has been stressful for you. More than 450 candidates were affected by this situation. The cause of the problem was not initially apparent, and it was important for us to have time to investigate, review preliminary scores of all candidates, obtain direction from our board members and some program directors, and devise a solution that was most appropriate for all stakeholders, including you, your program, and your patients.
The ABR board also received input from the breast imaging community, which feels it is imperative for residents to be tested on breast content at some point in the certification process. The board members considered requiring a breast module on the Certifying Exam for those who did not receive the module on the Core Exam. However, all were concerned that more than two years of delay would require you to study again for the breast module.
The board feels strongly that we must administer the content as soon as possible, and that we should not require travel, other expenses, or additional resources, which is aligned with what we have heard from the breast imaging community. Therefore, we decided that we should trust you to take the online module in a setting of your choice. In addition, the breast module has been carefully edited to ensure that all findings are visible without the need for a high resolution monitor.
[…] We will schedule residents who need to take the breast imaging module at specific times on two dates: September 7 and September 18, 2017. You will select your desired start time when you register.
Still missing: what actually happened in Chicago, what the technical glitch was, how they’ve taken steps to prevent this from happening again, how this module is graded, how “hard” it will be to pass, if it’s actually possible to fail, and a finally—what happens if someone actually manages to fail.
It is interesting that you can take it anywhere you want but that you still must take it at specific times—presumably a compromise to prevent cheating/sharing of the exam content without resorting to using an official testing center. The real exam is proctored with a bathroom monitor, but the fabled mammo content is on the honor code. To me, this is highly suggestive of lip service to an apparently deeply hurt mammography community.
And, speaking of testing centers, the ABR recently released the following narrative about why they haven’t been able to disseminate the exam:
These delivery requirements have proven to be insurmountable obstacles for the numerous commercial testing vendors that we’ve engaged over the years. It’s important to remember that the vast majority of these vendors’ clients deliver text-based question exams with little or no multimedia content.
[…]
Just last year, we engaged two prominent commercial testing vendors to explore our goal of delivering the diagnostic radiology initial certification exams at local testing centers. Both vendors were given in-depth details of our exam delivery needs and asked to provide a proposal for our consideration […]
…but neither was interested.
I like that they’ve finally publically responded to these perennial requests.
I imagine these two were Prometric and Pearson VUE, because (despite the claim of “numerous” vendors) there are only a handful of large commercial testing centers around that could possibly furnish the exam. I suppose it’s possible the big two passed in years past. I have no doubt that the ABR’s demands for administration are not worth the time and expense for most vendors to meet given the low exam volume. The follow-up question, however, is whether or not it’s possible to write a Core exam that can be disseminated.
For example, the video portions of the exam are small in number and generally useless outside of cardiac MR (which, if we’re being honest, plays a comically outsized role on the test). The multi-slice scrolling capacity is rarely used and usually only a handful of images anyway. Mammo and radiographs could be selected that do not require high-resolution high-filesize images. The ACR in-service exam, of note, was able to snag a contract and is also image-based.
We are committed to making the initial certification process as facile as possible. While our past efforts have not been successful, we will continue to pursue our goal (and your wish) of delivering diagnostic radiology exams in local commercial testing centers. As we all know, technology is constantly evolving, and perhaps local exam delivery will become more feasible in the future.
I don’t doubt that the exam the ABR created couldn’t be ported to Prometric as is. Shucks, it didn’t even work in Chicago. But couldn’t we have a Core Exam that was functionally equivalent but wasn’t so off-putting? Exams need to be written with the administration in mind from the onset, not just as an afterthought.
Perhaps putting our hopes in the possibility that bandwidth and memory will be so cheap one day that testing companies won’t find our poorly written and conceived exam so unpalatable isn’t the best plan.