u/WallabySea9477

I work as a Nocturnist at a severely understaffed facility. My colleagues and I are often having to handle cross coverage of 150-200+ people with effectively no assistance with many nights of 30-40 admission/transfer requests shared between just 2 MDs. (APP cross covers floors without helping with admits for a few hours early in evening as part of a "swing shift". Many times that shift is empty because they cannot find APPs willing to work here.)

This has been ongoing this entire year, and despite having a promise to "get us help", it has not happened. (I know they have a locums pool, but they are not seemingly willing to pay to bring them in)

So my question for all of my lovely, intelligent colleagues who come across this post, is how can I word an email to the directors and admins that paints a clear picture about how ridiculous this is? Something that highlights that they seem to be knowingly allowing "disaster response scenario" volumes of admissions and transfers to overwhelm an understaffed hospitalist program on a near nightly basis without providing adequate assistance to safely handle it for a prolonged period.

Part of this post is to vent, but part of it is to maybe see if there is language that can be universally adopted to start moving the needle in discussions.

...and you already know which national companies are the culprits behind this "workforce optimization" without having to ask. It's common knowledge for those who have been around. I won't name and shame for my own identity protection... but you know who they are. Folks in comments feel free to say the obvious if it is needed.

They explicitly stated in the earnings call that they plan on returning 100% of "excess cash" to shareholders. As long as the margins stay relatively high and demand stays strong - they will have the "excess cash". A lower share price going into the next quarter can setup for an even more significant buyback from management.

They only real concern that any serious investor should have about MU isn't its day to day price, but what fundamentally drives the record setting revenue: AI datacenter capex spending. If that holds strong, we get rewarded every time they have "excess cash" (which is likely to continue each quarter through 2030, at the least).

Not trying to sound like your grandpa, but just have patience. Do the math yourself: ballpark just $10 billion in buybacks/quarter for 12 quarters on 1.13 billion outstanding shares. Could shrink outstanding shares by close to 10% assuming all thing conservatively equal. And if they instead use the money for R&D on developing HBM 2 electric-boogaloo for more specialized AI "non-cyclical" demand, all the better to shore up the long term price stability.

TLDR - management gonna reward investors for holding as long as AI datacenter capex spending stays strong.

From slide 29, "Outlook", from the Q3 earnings report.

https://investors.micron.com/static-files/2354ecda-77a0-4ddd-8462-a631eb491356

This single sentence has made me double down hard on MU as a long term holding. Regardless of hitting or missing targets, they are going to return significant value to shareholders starting later this year.

"With free cash flow margins expected to approach 50-60%, both firms flagged a significant inflection in shareholder returns. Micron announced plans to return 100% of excess free cash flow to shareholders beginning in December, once CHIPS Act restrictions on certain uses of cash expire."

https://finance.yahoo.com/markets/stocks/articles/micron-shares-surge-time-high-162700030.html

I know folks like to inverse Cramer as a meme, but MU is one of the best things money can buy right now. I encourage any doubters of the value of MU as a long term holding to actually read what is in the Q3 report and presentation. Buy it while you can and pray for even more price drops - just more buying opportunity at lows it will likely never reach again.

A respectful request to all nurses, ahem *cough*:

STOP SENDING THIS AT THE END OF EVERY TEXT!

It is aggravating to read when most messages are about petty nonsense. If I need to advise, I will. Otherwise wait for an order.

"Patient requesting melatonin, please advise."

*Advise* what? I *advise* that you give the PRN ordered. What exactly in that situation is there a need to *advise* about? Are you incompetent? I *advise* you to look into a different career path if you need the MD to tell you how to look at your computer for orders.

Sorry, not sorry. Stop sending aggravating texts to the overworked Nocturnist. Use some sense.

...and to you ER doctors, stop sending admit requests with "I got one for you..." that phrasing is even more aggravating than "please advise". Another rant for another day... but just stop it.

So... when did solo Nocturnist APPs become a thing exactly? As a locums nocturnist, I'm seeing jobs that are traditionally staffed with experienced MDs in smaller facilities with small open ICUs being handed over to FNP/PA new grads with zero acute care training or experience. They are so inexperienced that they do not even know how dangerous the job can be... Multiple times this year I have encountered this and it genuinely blows my mind. I could understand someone with 2 or 3 years of experience - but fresh out of school... as an outpatient trained FNP?

American Medical Association - are you there??? Uh, what are you doing about this crazy nonsense? I mean, why don't we just let day 1 interns be attendings and let fresh LPNs perform intubations? Let ChatGPT decide who gets what meds and set it on autopilot, who cares right? Hell, let's just open up the front door and let anyone off the street pick up a census and start rounding and putting in orders. Pay them a half eaten sandwich and three-fifty for their trouble.

I'm floored that I do not see more discontent over this. If it was your loved one in the hospital, would that be acceptable to you? Not trying to be antagonistic but, actually, yeah kinda, because this feels insane. As an experienced nocturnist who has seen just how dangerous night coverage can be, I find this genuinely upsetting and an extremely unsafe way to handle patient care. This is not acceptable in Hospitalist medicine and no one should stand for it. If you disagree with that sentiment - well, I just hope you experience this care model when you are hospitalized, and I pray for your soul that nothing happens to you at night...

...and before you scream Noctor, this is a genuine safety issue that needs to be addressed by the profession as a whole. APPs have a role in Hospitalist medicine, but solo night time cross coverage of an ICU with ZERO experience is not that role...