The burn of the beam/For thirty-three days/Day after day/Of high-energy rays

Writing and doctoring/nursing are twin professions in my mind. It makes perfect sense that the two things I love most in this world are literature and medicine.

What a Sisyphean effort–both pursuits–spending all hours of the day and night fighting against entropy, suffering, and for your efforts being sometimes baffled at moments of transcendence. Making sense of this big mess of human stuff.

Poets, doctors, nurses, practice in the space between what we know as fact and the mystery of pretty much everything else. It’s a magical space, and for many people I think it must be where god lives. It’s where I keep cellular respiration and Leaves of Grass.

Women in medicine

Consider this post one of innumerable on women in the medical field.


The MD-RN dynamic is old saw (sidebar–the no. 1 problem with RN retention at my health system is “I need to move to find a man.” Take heed undergrads, the be-a-nurse-marry-a-doctor plan is not working out). As health systems move toward the team model of care we nursing pups are told that the doc is not your boss. Administratively speaking this is true. In practice getting chewed out by a doc is one of a new grad’s greatest fears. The power differential is entrenched.

One of my classmates brought up a super prescient question this past semester while we had the ear of an old school doc who battled it out in the 1960s as the only female member of her med school class. What is going to happen to MD-RN relationships now that near 50% of med school grads are women? The doc sidestepped the question (which was, of course, a landmine), but did share a thought worth repeating: in the US, as the prestige of being a doctor declines the number of women entering the profession increases. This isn’t coincidence. Either as prestige drops more women are viewing medicine as something that they are capable of OR as more women become doctors the stock price on an MD drops (see teachers, secretaries). To both of those possibilities I give a big eye roll-y OH BROTHER.

Breaking ACA data!!

First let’s be clear: this data describes state-run health insurance marketplaces. It describes plans available through those marketplaces. It does not describe group or employer health insurance plans. But, we (or at least I) can assume that there might be a trend worth following. This is the first year where we get a preliminary look at whether the ACA might push premiums down (and I mean relatively–remember most if not all plans were going up by many percentage points year over year before the marketplace).

Modest Premium Changes Ahead in Health Insurance Marketplaces in Washington State and Maryland – The Commonwealth Fund.

Maryland and Washington (state) are two early reporters, and for the benchmark “middle of the road” silver plan premiums for singles, couples, or families are up by less than 1% in MD or 3% in WA. Singles silver plans are down by 1-2% in both states.

Now it is a little apples-to-oranges to make this comparison, and obvi I am using the same foundation to grab it, but I have to stress that pre-ACA premiums were rising at a crazy rate year over year. This report  (Interactive wow I’d insert it but I don’t want any confusion since it is pre-marketplace) maps hows the increase in employer-sponsored premiums related to percentage of household income 2003-2011. In my home state of VA premiums increased 62% (family) and 49% (individual). Ouchie. Overlay a chart of my increasing depression and you’ve got near identical data.

LAST POINT: for everyone who banking on capitalism to bring prices down (god forbid you bring this up on a long car trip with me), per this report here’s a tasty lick:

One factor behind these modest premium increases may be that new carriers entered the marketplaces in both states, fueling competition among plans. In Washington, one carrier, Moda Health, entered the market, and two, BridgeSpan and  Coordinated Care, increased their plan offerings more than threefold. On the whole, the number of silver and gold plans offered nearly doubled from 2014 to 2015. In Maryland, three carriers—Cigna, United Healthcare, and Carefirst (GMSHI)—entered the marketplace.