Tom Osinski • MD (@OsinskiReflex) header
Tom Osinski • MD (@OsinskiReflex) profile picture

Husband and father. Fellow and clinical instructor @URMC. #RaiderNation. Wellness and Urology research. Politics. Typo aficionado.

Penfield, NY
Joined January 2016
Photo by Tom Osinski • MD (@OsinskiReflex)Photo by Tom Osinski • MD (@OsinskiReflex)Photo by Tom Osinski • MD (@OsinskiReflex)Photo by Tom Osinski • MD (@OsinskiReflex)Photo by Tom Osinski • MD (@OsinskiReflex)Photo by Tom Osinski • MD (@OsinskiReflex)Photo by Tom Osinski • MD (@OsinskiReflex)Photo by Tom Osinski • MD (@OsinskiReflex)Photo by Tom Osinski • MD (@OsinskiReflex)Photo by Tom Osinski • MD (@OsinskiReflex)
Sending a frozen section at 6pm on a Friday
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Tom Osinski • MD retweeted
I realize I’m in a tiny minority here, but I consider Nvidia selling sensitive AI tech to a Chinese front org after Trump approved the sale despite warnings from US intelligence and Congress about security concerns to be a much bigger story than the Dana White foolish distraction.
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Tom Osinski • MD retweeted
So important to remember that mental health challenges are not a moral failure. As clinicians know, shame and stigma can delay treatment for years. And it’s especially true in certain professions like healthcare, military, aviation, etc. Seeking help is a sign of strength. If you are struggling, call or text 988 🌱
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Tom Osinski • MD retweeted
When CMS released its proposed 2027 Medicare Physician Fee Schedule, I posted several times about the proposed Modifier 25 cuts. I was surprised by how few urologists understood the implications for our practices, livelihoods, and patients. Most seemed to grumble and move on. Afterward, I emailed the AUA directly to express my concerns. To their credit, several weeks later, they responded with a comprehensive explanation of their advocacy efforts and communications with CMS. They made compelling arguments: Modifier 25 represents significant, separately identifiable physician work; CMS had not adequately demonstrated duplicative services; and these cuts would discourage efficient same-day care while threatening independent practices and patient access. But when I asked why AUA members weren't actively encouraged to submit comments during the public comment period, I never received a satisfactory answer. Now the final rule is out. CMS reduced its proposed 50% cut to 20% and narrowed its scope. Are we supposed to celebrate? I can't help wondering whether 50% was always an opening position, making 20% seem like a victory. But a 20% cut is still a cut. I worked in Congress before becoming a physician, first as an intern and later as a legislative aide. I can tell you firsthand that constituent calls and emails matter. As an intern, I tabulated contacts about specific issues. When enough constituents contacted our office, the issue was elevated to the responsible legislative staffer. Later, I became that staffer. Physicians have far more political power than we realize. We simply don't use it. Why isn't the AUA telling every member to contact their congressional representatives? Why isn't the AMA coordinating a national effort across every specialty society? I sometimes wonder whether organized medicine is so concerned about maintaining a good relationship with CMS that it's reluctant to mobilize its own members aggressively. But CMS certainly isn't doing physicians any favors. The reality is that physicians are terrible at advocating for ourselves. We don't want to lobby Congress or fight insurance companies. We want to take care of patients, go home to our families, and earn a reasonable living. And that reluctance to fight is precisely what makes us vulnerable. Look at the economics of modern medicine. A device manufacturer can receive several times what the surgeon earns for using its technology. A hospital can collect facility payments many times larger than the physician's professional fee. We've reached a point where we value the airplane more than the pilot, and then wonder why nobody wants to fly. This isn't simply about physician income. It's about preserving independent practice, physician autonomy, and access to care. Every incremental cut makes it harder for physicians to practice medicine without becoming increasingly dependent on large hospital systems. The AUA, AMA, and every specialty society should be mobilizing their members NOW. Give us talking points, congressional contacts, and a coordinated strategy. Make it easy for physicians to advocate. We have more power than we think. But only if we're willing to use it. We cannot keep expecting someone else to fight for us while we quietly accept another cut. @AmerUrological @DrOzCMS
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Unless RFK Jr. is interested in spending the next two years in front of Congressional committees, he should go ahead and resign now.
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And to think there was a time when saying “nucular” was a giant flub
Trump: We charted the human Ga-Nome to cure diseases.
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Tom Osinski • MD retweeted
The story keeps getting crazier. To recap everything that has been reported so far: - The US intelligence community discovered that Jensen Huang, the CEO of the largest company in the world, was sleeping with Alice Huang, a Chinese spy and an executive at Megaspeed. (FT) - Multiple independent investigations have concluded that Megaspeed is likely a Chinese cutout, which helps Chinese companies access AI chips or circumvent export controls. (NYT and Bloomberg) - The US intelligence community also concluded that Alice Huang’s goal was to convince Jensen to lobby the U.S. government to loosen export controls on advanced AI chips. (NYT) - The intelligence community relayed this information to “a small group of top US government officials” earlier this year. (FT) - Over the last year, Jensen Huang has repeatedly lobbied the U.S. government to loosen export controls on advanced chips. @BISgov has done so, not only by permitting the export of H200 chips to China, but also not enforcing export controls that would have required a license for exports of the most advanced Blackwell chips to Megaspeed and Southeast Asia. - Although @CommerceGov leadership was presumably briefed on this information by the U.S. intelligence community, @BISgov has taken no actions to tighten controls on Megaspeed or Southeast Asia. - Megaspeed remains a preferred cloud partner of Nvidia, and continues to receive Nvidia Blackwell chips despite employing a Chinese spy who reportedly is romantically engaged with the CEO of Nvidia. - Tens of billions of dollars worth of AI chips have been exported to Southeast Asia this year alone, and Malaysia and Singapore are now two of the four largest importers of AI chips in the world. What is going on here??? We need answers. The question of who gets the most advanced AI chips in the world is literally the defining strategic question of our time. And not only does it seem like the MSS may be directly influencing the debate on export controls in the United States, but also @CommerceGov is refusing to listen to the warnings of the IC on this issue. What is a POSSIBLE good explanation for why Megaspeed is still receiving chips? Why is there not a license requirement for AI chip shipments to all of Southeast Asia? This is beyond strange at this point. The fallout from this story will be massive. Obviously, the motivations underpinning Nvidia’s policy views opposing export controls must now all be questioned. But also, how did @BISgov sit on this information and has still taken no actions? We need answers.
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Tom Osinski • MD retweeted
Dear Physicians: Your Medicare cut must be devastating for the hospital CEO who hasn’t bought you yet. Thankfully, @CMSGov is working on making you more affordable. I, for one, applaud @DrOzCMS and @SecKennedy for their commitment to affordable, accessible healthcare. Every struggling independent practice brings a tax-exempt hospital empire one step closer to an affordable acquisition. Please consider the hospital’s position. Buying the competition takes money. Then there’s the expense of replacing your sign and explaining why your patients now need a facility fee to visit the physician they’ve seen for 20 years. You wouldn’t understand. You went to medical school. These people understand medicine at a much higher level. The holding-company level. And honestly, physicians, your timing is terrible. You’re complaining about reimbursement while a nonprofit executive has to walk into a board meeting and explain why you still own your practice. Have some compassion. Sell.
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Tom Osinski • MD retweeted
My position on “late term abortions for convenience” is similar to my position on brain transplants. I don’t have one because they don’t exist.
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Tom Osinski • MD retweeted
Jared Kushner has painted himself into a corner As part of an unprecedented effort to lead negotiations while being on the payroll of foreign gov'ts, Kushner has insisted that he is NOT a gov't official — just a volunteer This will make it very difficult for him to defeat a Congressional subpeona
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Tom Osinski • MD retweeted
It’s no longer doom scrolling, it’s hope scrolling. Now we must act.
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Tom Osinski • MD retweeted
Medicaid will pay me $350 to operate on your cervical spine to keep you from becoming a quadriplegic.
Just got 3 bids to clean the HVAC ducts at our house: Bid 1: $14,975 (HVAC company) Bid 2: $11,858 (HVAC company) Bid 3: $3,159 (Restoration company)
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Tom Osinski • MD retweeted
Susan Collins refused to give a concession speech to her voters, but she did have time to give a long interview to the New York Times to explain the ways in which they were ungrateful.
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i ain’t reading all that i’m happy for you though or sorry that happened
History was made last night. For months, we were saying that 2026 was the most consequential midterm election of our lifetimes. Unfortunately, we were right. Sometimes history is to be celebrated; other times, it is to be mourned. Always, it must be reckoned with. 2026 was not simply a blue wave; it was a blue tsunami. It was an ass kicking. It was not simply a bad 2006 midterm election. It was a Watergate-level repudiation. What happened, and why? What are the consequences, and where on earth do we go from here? When all the votes were counted, the problem wasn’t turnout. Instead, our voters, Republicans, Libertarians, Independents, showed up and voted, and rejected our candidates, voting Democrat instead. We’ve lost the House. We’ve lost the Senate. When all is said and done, we will have lost eight to 10 Senate seats. We lost in historically red states, like South Carolina and North Carolina, Kansas and Iowa. We lost in purple states, like Michigan, and New Hampshire, and Georgia. And we just barely won by just a single point in bright red states like Florida and Louisiana, and then there’s Texas. Nowhere are the consequences of this election greater than Texas. In the Lone Star State, we lost every single statewide election. For weeks, I had been publicly warning on this podcast that we were in very real danger of losing everything in Texas. Far too few believed that was possible. I am very, very sorry that it came to pass. Texas has not had a Democrat governor since 1994. We haven’t had a Democrat senator since 1993. Now we’ll have both. Why were the results so overwhelming? Pundits and analysts will break down the results for weeks or months or even years to come, but several things are already evident today. Years ago, the very best political advice I ever got was from Heidi. She said, “It’s not about you. It’s about them. It’s about their kids, their families, their hopes, their dreams, their futures.” Too many politicians forget that. Take the state of Kansas, for example, a state that has not elected a Democrat senator since 1932. It just did. Here’s what exit polling showed were the top issues in Kansas. Number one, cost of living, energy, and groceries. That was listed as number one by 30.6 percent of voters. Corruption. Number two, 18.5%. The cost of the Iran war, 10.1%. The candidates are terrible, 7.9%. The Canada trade war, 7.6%. The GOP didn’t do enough to support Trump, 6.6%. Republicans didn’t pass the Save America Act, 5.6%. Trump’s focus on monuments, 5.5%, and data centers and AI, 3.8%. The top issue, cost of living, is very real. Too many in politics dismissed it. They didn’t understand. They pointed to the macro numbers showing the stock markets soaring, median income at record highs, and poverty at record lows. Those data are true, but they don’t tell all of the story. Here are some stats that are a lot more real and personal. Spam, Hormel’s processed meat substitute, broke record sales, selling 113 million cans last year. That is nearly as much spam as was sold during the entirety of World War II. 29 percent of Americans have used buy now, pay later for groceries this year. That’s double the share just two years ago. In August, banks repossessed 42% more homes than they did last year. In 2024, car repossessions topped 2.3 million, above the 2009 peak in the middle of the Great Financial Crisis. In 2025, 6% of 401k holders took hardship withdrawals, paying penalties. That is a record, and triple the norm. And here’s one that’s really stunning. Americans made more than 75 million paid plasma donations in 2026. That’s another record. That means 200,000 Americans every single day, with a needle in their arm, just to pay for groceries. That is very real pain from real Americans, and too many Republican politicians seem like they didn’t understand or they didn’t care. Food is too high, gas is too high, diesel is too high, insurance is too high, life is too high. Tariffs have made everything too expensive, and the Iran war has dragged on too long. It should have been brief, decisive, and over. It needs to end, and we should never, under any circumstances, give the Ayatollah billions of dollars. There’s a very real economic disconnect. Our K-shaped economy is a yawning divide. Last year, we saw the world’s very first trillionaire, a modern-day Thomas Edison, at the very same time that millions were struggling to feed their families. Data centers being constructed were turning billionaires into centibillionaires, while simultaneously the average American’s electricity bill went up 30% in the last five years. Understandably, people were pissed off, and elected Republicans didn’t do enough to address their very real pain. So, what do we do now? We need to listen and respond. We need to champion economic policies that make a real difference in working people’s lives, and we need to deal with the consequences. Texas is blue. That is a hard sentence to utter. But Texas, today at least, is blue. As we sit here today, I am the only statewide elected Republican who remains in Texas. That’s not something I ever thought I would say. We can be certain that the Democrats in Austin and in Washington will overshoot. In Texas, they will try to raise taxes dramatically. They may even try to adopt a state income tax, or even a California wealth tax. They will try to shut down the energy industry, destroying jobs across our state. They will embrace the radical transgender agenda. They will persecute those they perceive to be enemies, especially Elon Musk. And in Washington, they will attack Trump every single day, constantly. Impeachment hearings, subpoenas, his family, cabinet members, business leaders, open persecution, and nonstop retaliation. Make no mistake. Nationally, the radicals are in charge. The communists and the Islamists who have taken over the Democrat Party have now taken over the United States Congress. They will be unleashed. Sadly, that means many Americans will be hurt. Texans will be hurt. Their assault on business will make Texas a much less attractive place to start or grow a small business. Texas will become more like California if they succeed in halting all new investment into AI. The economic results will be dramatic. Over $700 billion in new projects are scheduled to start in the next year. If the Democrats shut them all down, our country will very likely go into a recession. That will suit the Democrats just fine. They’ll just blame it all on Donald Trump. In the next two years, we need to do two things. One, fight the madness. I will work with Democrats when they’re willing to be reasonable. Last night, I called James Talarico. I congratulated him on his very impressive victory. It was a pleasant conversation, and I told him that I looked forward to working with him to try to benefit Texas. So, if there are things like flood relief for the Hill Country, or trying to get the space academy to Texas, he and I will work together. But if the newly elected radicals push policies that hurt Texas, raising taxes, destroying jobs, opening the border, releasing violent criminals, threatening our children, undermining our constitutional rights, I will fight with all of my strength to defend Texas and to defend the Constitution. And number two, we need to rebuild, getting behind policies that directly benefit the constituents we lost. There’s a complicated story, no doubt, of what happened on Election Day, but as I see it, the key constituencies we lost were blue-collar voters, what had rightly become the core base of our party, Evangelical Christians, who didn’t show up with the same numbers and fervor as prior elections, farmers and ranchers. Tragically, we alienated rural America. Young people, who excitedly had voted Republican in 2024, and who shifted hard blue this cycle. And of course, Hispanics. For Hispanics, there’s a strong overlap with young people and blue-collar workers. In 2024, just two years ago, I was proud to carry Hispanics statewide in Texas by six points, and we swung the Rio Grande Valley red for the first time in a century. It can be done, but in this election, those Hispanic voters overwhelmingly went back Democrat. We have got to turn that around. And for young people, we need to be the party of the future. We need to champion policies that expand their future. Our two single biggest legislative accomplishments of the past two years, Trump Accounts and the school choice tax credit, which will unleash tens of billions of dollars in new scholarships for kids, are generationally powerful. I was proud to author both of those transformational policies, and yet too few candidates all across the country ran on that record. Too few voters were even aware of what we’d accomplished for their kids and their future. But we need to build. We need to expand to continue creating a new investor class for hundreds of millions of Americans, help everyone, every American, become an owner, to have real skin in the game, to create new generations of capitalists ready to reject socialism. People voted as they did because they were angry. Ironically, the Democrats that they elected are going to advance policies that will make affordability worse. The Democrats want gas prices higher. They want to ban gasoline engines altogether. Their extreme environmental mandates will drive up food prices and the prices of everything else. But hear me now: we will bring Texas back. I am filled with hope and optimism. Texas will be red again. We have not suddenly become a bunch of tofu-eating, gun-banning, tutu-wearing pinko commie liberals. That ain’t us. Texas is still Texas. We will rebuild as a true blue-collar party, not by embracing socialism, but by being real free-market conservatives. The way we built the Texas economic miracle in the first place, and we will build and rebuild America as well. When the zealots overreach, and they will, we will stand ready to lead in the direction of freedom, of prosperity, of safety, and security, and common sense. We will return to a new dawn of freedom in America. It is dark right now, but it is always darkest before the dawn, and morning is coming. That is my fervent prayer, and that is my commitment to you.
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Tom Osinski • MD retweeted
“I'm just I'm disappointed because I was looking forward to that $5,000 check that we were all going to get.” Warriors coach Steve Kerr has jokes after last nights Blue Wave midterm elections.
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Tom Osinski • MD retweeted
The vote was rigged. Just really clear examples of fraud, especially coming from the South. I mean Texas? Mississippi? Are you serious? That's the only explanation I can come up with for why a one loss Notre Dame team is #11.
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Tom Osinski • MD retweeted
JUST IN: Elon musk is suddenly deleting tweets where he aggressively push people to vote for republicans. @grok start with true false
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Tom Osinski • MD retweeted
Netanyahu says Texas is two weeks away from developing a nuclear weapon
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#MedTwitter 2 physicians were elected to the US Senate last night. Part of this is America still trusting the profession, part of this is Americans looking to us to help solve the healthcare crisis Congrats @AnnieAndrewsMD and @AbdulElSayed
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