Knock Knock, Hi! with the Glaucomfleckens

I'm on call July 4th for the first time in what feels like forever, and I have fully lost perspective on what call should feel like. 2018 me, fresh out of an Iowa trauma center, would be horrified at how nervous private practice me has gotten about it. I'll report back after the holiday. Today's main event is World Cup eye injuries. Every professional sport needs an ophthalmologist on the sideline, soccer included, and I walk through three I'd be ready for. First, a 50 MPH ball off Erling Haaland the Viking's foot straight to the face, hyphema, open globe risk at the equator and limbus, retinal dialysis in young patients. Second, a player smashing their face on a goalpost, orbital floor fractures, the workup for extra-ocular muscle entrapment, and a full breakdown of eyelid laceration repair: above brow, below brow, eyelid margin, and canalicular. Third, the soccer flop, where grass exposure can deliver a corneal abrasion or an allergic reaction, and the drops I reach for. I've got more on deck if the tournament keeps giving me material. Takeaways: A high-velocity soccer ball to the face can cause hyphema (sheared vessels in the anterior chamber), an open globe at one of the eye's two weak points (the equator behind the extra-ocular muscles and the limbus at the edge of the cornea), or a retinal dialysis, especially in younger patients Hyphema management is driven by eye pressure: normal pressure means strict couch-potato rest until the blood clears, because a second bleed is always worse than the first; very high pressure may require surgical evacuation A face-into-goalpost impact most commonly causes an orbital floor fracture; suspected extraocular muscle entrapment is a PANTS patient, the ophthalmologist comes in, the orbit gets scanned, and forced duction testing rules entrapment in or out Eyelid laceration repair depends on location: above the brow is straightforward, below the brow uses skin-only sutures because there's an eyeball underneath, eyelid margin lacerations require specialized technique, and canalicular lacerations need temporary tube placement Even a soccer flop can cause real eye injury, grass exposure can lead to corneal abrasion or an allergic reaction in the fornix, treated first-line with antihistamine drops like Patanol, Pataday, or Zaditor, with short-course topical steroids for severe cases To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://glaucomflecken.com/glauc-to-me/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ If you are interested in buying a book from one of our guests, check them all out here: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amazon.com/shop/dr.glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://anatomywarehouse.com/?aff=14⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Plus for 15% off use code: Glaucomflecken15 -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.  Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

I've been watching the Sheriff of Sodium break down medical education data on social media for years, so I'm thrilled to finally have Dr. Bryan Carmody on the show to help me understand what's actually happening to the system that turns medical students into doctors. We start with the basics What the Match is, why it was created in the 1950s to solve a headhunting problem that was stressing everyone out, and how the algorithm actually works. We quickly get into what's gone sideways since then: the residency selection arms race, where every year applicants have more publications, higher board scores, and more research experiences than the year before, and yet the match rate hasn't moved, meaning they've all just collectively agreed to suffer more for the same outcome. Bryan also breaks down what happened when Step 1 went pass/fail and the uncomfortable fact that about 25% of medical student publications have never been cited by anyone, ever. We also go through the 2026 Match data, who's thriving, who's struggling, and what it actually means when programs can't fill their spots. Bryan puts the "physician shortage" debate in real context: it's not that we don't have enough doctors, it's that we've created terrible incentives for where doctors practice and what they do. We get into international medical graduates, the growth of new medical schools, and the signaling system, a newer mechanism that tries to fix the problem of people applying to 200 programs just to hedge their bets. I also reveal that stand-up comedy is what got me my residency interviews, which honestly tracks. Takeaways: The residency selection arms race is real but largely self-defeating, match rates for US medical students haven't meaningfully changed, meaning all the extra publications, research experiences, and board prep have just raised the floor without helping anyone actually get ahead. The "physician shortage" is mostly a distribution and incentives problem, not a numbers problem, there are about 1.3 residency positions for every graduating US MD/DO, and the real issue is that doctors rationally choose to practice in places with better pay, better amenities, and better working conditions. We probably don't need more medical schools, the constraint isn't classrooms, it's clinical training sites, and adding more schools without more high-quality hospital rotations just dilutes an already strained system. Family medicine, pediatrics, and emergency medicine are the specialties with the most unfilled residency spots and it's a combination of too many new programs being created and not enough applicants choosing those fields, driven by the same incentive mismatches that cause geographic maldistribution. Signaling is a genuine improvement to a broken application process, it gives programs a way to identify applicants who actually want to be there, rather than sifting through hundreds of applications from people who clicked every available program just to maximize their odds. — Want more Dr. Bryan Carmody: @jbcarmody on X/Instagram/Threads/Bluesky and Sheriff of Sodium on YouTube. To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

A few things on the agenda today. First, RFK Jr. and the MAHA crew want medical schools to dedicate around 40 hours, roughly 20% of preclinical training, to nutrition education. I have some thoughts. We already have dietitians, med school is already a fire hydrant, and the Krebs cycle had it coming, but this isn't the way. Then a Mark Cuban appreciation segment, because he's out there on X dragging the entire healthcare system toward transparency. His latest pitch: someone buy a hospital, charge Medicare rates for every single thing, expose every dollar in and out, and prove whether Medicare for All can actually work. In theory, I'm in. In practice, you can't slash physician pay without first addressing the $500,000 in debt that gets people into the door. The Australian model, a real public safety net coexisting with a private system, makes more sense to me, but only if we fix the training pipeline first. After the break, ophthalmology. A young man got a bamboo shoot to the eye six months ago. Healed up fine. Now he's waking up at 2 AM in excruciating pain, no trauma involved. That's a recurrent corneal erosion. I walk through why it happens, why CPAP can make it worse, and the whole treatment ladder, ointment, bandage contact lenses, superficial keratectomy, corneal micropuncture. Also: don't let your cornea melt. That's the headline. Takeaways: RFK Jr. and MAHA are pushing medical schools to dedicate around 40 hours, or 20%, of preclinical training to nutrition, a shift that ignores the existence of dietitians and would crowd out essential physiology and disease education Mark Cuban has floated a real-world test case for Medicare for All: buy a hospital, charge only Medicare rates, and operate with complete financial transparency to show whether the model is sustainable Any serious move toward Medicare for All or an Australian-style public-private hybrid will require addressing the roughly $500K in training debt physicians carry; otherwise the math doesn't work and recruitment collapses Recurrent corneal erosion happens when an old abrasion never fully reattaches to the underlying stroma, patients typically wake up in severe pain because the eyelid scrapes loose epithelium across a dry cornea overnight, and CPAP without a good seal makes it worse Treatment escalates from aggressive nighttime lubrication (erythromycin ointment, Genteal gel) to a bandage contact lens, and in stubborn cases to a superficial keratectomy or corneal micropuncture to create a smoother, more firmly attached corneal surface To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://glaucomflecken.com/glauc-to-me/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ If you are interested in buying a book from one of our guests, check them all out here: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amazon.com/shop/dr.glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://anatomywarehouse.com/?aff=14⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Plus for 15% off use code: Glaucomflecken15 -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.  Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

This week we sit down with Dr. Chris Allen, board-certified sleep medicine physician, board-certified pediatric neurologist, and a man who has been on CPAP therapy for 22 years. We cover how a sleep study actually works, the real misconceptions around sleep apnea, why CPAP isn't the only treatment option, and what the difference is between a home sleep test and a full in-lab polysomnogram. Oh, and we get into parasomnias, which is the fancy medical word for "doing things in your sleep you shouldn't be doing", a category that, as Kristin helpfully reveals, includes me putting on dress pants in the middle of the night and getting back into bed. We also go deep on kids and sleep. Turns out a lot of children diagnosed with ADHD actually have undiagnosed sleep apnea, and treating it can change everything. Plus night terrors , revenge bedtime procrastination, neurodivergent sleep challenges, and why your brain isn't actually out to get you, it just really needs you to stop scrolling. Chris also has a children's book called Sweet Dreams, which is his personal story adapted for kids, and it's exactly the kind of advocacy that makes this stuff actually land. Takeaways: Snoring is never normal, it always means your airway is partially obstructed during sleep, and while it doesn't automatically mean sleep apnea, it's always worth asking the questions. Sleep apnea isn't just a "big guy" problem, anyone can have it regardless of body size, it affects women at the same rate as men after menopause, and in children it often shows up as inattention, hyperactivity, and moodiness that gets mistaken for ADHD. CPAP is great but it's not the only treatment, there are multiple ways to treat obstructive sleep apnea depending on your anatomy, age, and situation, so don't let the Darth Vader mask reputation scare you away from getting evaluated. Parasomnias like sleepwalking, night terrors, and confusional arousals are all under one umbrella, they're common, they're often made worse by other untreated sleep disorders, and there are actual medications that can help if they're disruptive enough. Revenge bedtime procrastination is real and your brain chemistry explains it, caffeine blocks adenosine (your sleep hunger signal), screens suppress melatonin, and cortisol from daily stress keeps your fight-or-flight response lit, which is why 11 PM you keeps doing laundry instead of going to bed. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

I just watched The Backrooms and now I can't stop thinking about hospital liminal spaces. The basement. The pathology lab. The OR at 2 AM when you're going in for an open globe. We start there. Then a great Spotify question pulls me into ophthalmology boards, what the written test is like, the oral exam I took inside an examiner's actual hotel room (with their luggage in the corner) during a hotel workers' strike in San Francisco, the $2,000 fee, and why the whole recertification industry feels like a money grab. Also a quick rant about why physicians start their careers $400K in the hole and a decade behind everyone else. The main event is a tale of two health systems. You already know PeaceHealth in Eugene, where the emergency physicians fought back, used Oregon's corporate practice of medicine law, and took it to court. Now meet Valley Health in Virginia's Shenandoah Valley, where CEO Mark Nance just cancelled the contract for EMBER (Emergency Medicine of Blue Ridge) and handed it to SCP Healthm a private equity outfit backed by Canada's Onex Corporation. Same Apollo MD playbook. Same damage. But Virginia has no corporate practice of medicine law, no physician union, and no nurses' union, and Valley Health is flush with cash while blaming Medicaid cuts. I'm fed up, and I'm going to keep making this content as long as people keep sending it to me. Takeaways: Valley Health in Virginia's Shenandoah Valley cancelled its 20-plus-year contract with EMBER (Emergency Medicine of Blue Ridge) and handed it to SCP Health, a private equity-backed corporation owned by Canada's Onex Corporation, mirroring the Apollo MD/PeaceHealth situation in Eugene Despite blaming Medicaid cuts from the "Big Beautiful Bill," Valley Health holds over $1 billion in assets, $700 million in cash reserves, and reported $100 million in net profit in 2024 and continues to build new facilities Valley Health has also forced out Front Royal Family Practice under CEO Mark Nance, revealing a broader pattern of consolidating independent groups and eliminating physician autonomy Virginia has no corporate practice of medicine law, no physician union, and no nurses' union, leaving healthcare workers without the legal and organizational protections that allowed the Eugene physicians to fight back successfully Ophthalmology board recertification, board exam fees, and roughly $400K in training debt mean most physicians don't start meaningful earnings until age 31 or later, a financial reality often missing from broader debates about physician pay To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://glaucomflecken.com/glauc-to-me/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ If you are interested in buying a book from one of our guests, check them all out here: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amazon.com/shop/dr.glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://anatomywarehouse.com/?aff=14⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Plus for 15% off use code: Glaucomflecken15 -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.  Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices