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Dusn

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  • Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    We hire people to become our partners, not to screw them over.

    Click to expand…

    I think, in many medical fields, that sentiment has changed….  But a contract negotiator still won’t help.

    in reply to: Physician Contract Negotation #243055 Reply
    Liked by billy
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    I found it sort of ridiculous because it ignores the length of residency/fellowship training.  I know many female physicians who’ve had to undergo IVF or could not have children, likely at least partly due to waiting until training was over.   I think our residents get two weeks off after delivery.

    Better alternatives: CRNA, probably dental, many fields of business, law, engineering…

    Alternatives in terms of making the system more family friendly?  Shorten undergrad-medschool so that training is typically completed several years earlier like it is in other countries.

    in reply to: Times article about female docs and work/life balance #240803 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    What area of the country are you?  What’s the noncompete?  What leverage does she have?  I agree, your wife is getting severely underpaid.   Ophtho is a predatory field with large noncompetes, where younger ophthalmologists are, IMO frequently getting screwed, and somehow both Lizzie and mjohnson are correct in the range of salaries they’ve quoted – despite there being such a large disparity in their numbers.   I think the higher end of salary range really has to do with having ownership, ASC etc.

    I would apply to other jobs so that she can go to the negotiating table with higher offers or leave if they don’t give her what she wants.   Is there a VA nearby?  Because the VA will probably pay her about 100K higher than her current salary with likely better benefits (and will not be restricted by her noncompete).  If they know she can’t leave, unfortunately her negotiating power will be limited.

    Unfortunately it sounds like they’re using her to build up their satellite clinics without adequate compensation.

    I’d read the book “Never Split the Difference” and watch some videos on negotiating on youtube (Deepak Malhotra is good: https://www.youtube.com/watch?v=km2Hd_xgo9Q ).  But I think she also needs some leverage from competing job offers.

    And if she ever decides to go out into solo practice, this blog might be a good resource:

     https://solobuildingblogs.com/2017/07/30/my-story-why-i-opened-my-solo-practice/

     

    in reply to: Advice on academic ophthalmology contract/salary??? #240725 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    I think they’re ultra paranoid about any file sharing — sending files out or putting any files on their computers.   You can’t even stick a USB drive into a VA computer.  To be fair, I’m sure the VA is a huge target for ransomware and they’d make national news if there’s a large data breach.   So as long as the forum can’t do that I doubt they’d care.

    in reply to: I can access the forum from my VA computer??? #240521 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

     

    WashingtonPost, “Democrats back off once-fervent embrace of Medicare-for-all:”

    https://www.washingtonpost.com/politics/democrats-back-off-once-fervent-embrace-of-medicare-for-all/2019/08/19/13c76ffe-c28b-11e9-b5e4-54aa56d5b7ce_story.html

    And we haven’t even gotten to the general election season yet… let alone getting the bill through congress, and then the political pressure from lobbying groups, and then the general public freak out about losing their insurance plan…

    Honestly, if I were a politician I wouldn’t want to have any responsibility for the healthcare system.

    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    Well, it turned into a political thread (guess I shouldn’t have been surprised!). I understand this is an important sociopolitical issue, but I don’t want to jump into a flamewar as a new poster, so…

    Guess the advice is: keep costs low, save money, and treat it like a possible illness, job loss, or divorce? I’m wondering about stuff like: I’m probably going to have more money coming in now than I will in the future, does that mean I should be more conservative than I otherwise would (more bonds relative to stocks)? Or should I put more in stocks to build capital while I’m able? Does the fact that I’d be paying lower tax rates later make tax-loss harvesting less useful? Stuff like that.

    Click to expand…

    I think the advice is not to worry about it.  “Socialized medicine” is irrelevant. Don’t change your financial plan.

    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    1) Many specialists in Canada make far more than specialists in the US.   Ophthalmologists in Canada frequently make >1mil, so do interventional radiologists.  They also have far less malpractice and insurance headaches.  So socialized medicine, by itself, does not necessarily mean physicians are going to be paid less.

    2)  Unfortunately in the US the physician lobby is very weak compared to pharma, insurance, etc.  So in the US, physicians will probably be paid less.   But we’re going to get paid less with or without socialized medicine; physicians get cuts to reimbursement every year regardless but I have yet to see pharma get cuts.  The problem is our weak lobbying groups and the fact that political lobbies have such a huge influence on how our tax money is spent.  I don’t see private insurance acting much better than the gov’t in this regard.

    3)  At least in my speciality, the biggest issue for new grads is Private Equity buying out all the practices before they make partner.  Now PE is learning how to buy out all the smaller referral practices to force large groups to sell out at a lower price.  That’s a threat that is here and now and shows no signs of stopping.  Socialized medicine won’t matter much once physicians have become like the pharmacists working for Walmart.

    4) Socialized medicine might solve the biggest issue with FIRE (how to pay for healthcare).  If socialized medicine succeeds (doubtful), there will likely be mass retirements.  Save up and at least you can enjoy early retirement with the rest of us.

    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    Also I think COBRA coverage (which I’m glad for) was supposed to be the main purpose of HIPAA originally.   That P stands for “portability” not privacy.   I’m not sure how all the excessive privacy regulations got wrapped into it or if they are really even part of it or are made up by “inspectors” who don’t actually know the law.

    in reply to: HIPAA Nonsense #239605 Reply
    Liked by Zaphod, billy
    Avatar Dusn 
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    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    Agreed.   Meanwhile the only people that I really don’t want to have my health information (insurance companies) already have it and apparently can easily share that health information amongst themselves and with future insurance companies that I may want to buy a policy from.

    in reply to: HIPAA Nonsense #239599 Reply
    Avatar Dusn 
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    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    Heading towards a recession with astronomical levels of national debt is not my idea of fun.

    in reply to: HUGE sell off today! #239003 Reply
    Avatar Dusn 
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    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    I’m sure anything that could help her (or both of you) get more rest and sleep in those first few months would be greatly appreciated.

    Congrats!

    in reply to: Ladies – Help! #236813 Reply
    Liked by AZPT
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    Timing the market gets a bad rap.  If you’re friends with some key politicians, in either China or the US, you could make a fair bit of money timing the market with this fabricated volatility if you get a little bit of forewarning.

    in reply to: Time the Market with me! #236614 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018
    Splash Refinancing Bonus

    $6M isn’t FatFI?  I’m now more worried about what you mean when you say that you’re “quite a bit heavier.”

    in reply to: When to let Term Insurance Lapse #236564 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    I’ll just state the obvious issue here:   most doctors don’t think an online course and 6 weeks of shadowing is adequate to practice medicine.

    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    I consider NY to be an unfriendly state for physicians and high earners in general.  I was at a conference and a representative from one of the state medical societies and a couple of state representatives was explaining their plan to make the state a single payer system and they would afford this by doubling the state tax.  I questioned the effect that doubling an already higher then average state tax would have on recruiting new physicians to the state and they assured me that was not going to be a problem because people do not look at those things or care much about local taxes.  I gave up and walked away.

    First off I know this is likely not going to happen and the people I was talking with were small potatoes so I do not expect much.

    Am I crazy to think that If my state tax went from 7 to 14% that might deter people from working in the state?  I live here because of family and would hate to move but PA is not that far away and I would consider it if it would greatly impact my financial life.

    Do you think this scenario would effect the average doctor from coming to NY or just the financially literate ones?  (who will probably retire early anyways) As dumb as our profession can be with finances we seem to be a pretty tax adverse group.

    I would love other opinions.

    Thanks!

     

    Click to expand…

    Well the biggest question I have regarding FIRE is how I would pay for good health insurance if I’m no longer employed, especially as I get older and get more health issues, preventing me for getting a good health insurance plan.    So I’d move there if they became single payer.   Of course I’d be retired so my taxes would be lower and I wouldn’t be a practicing physician except part-time or volunteer.

    But that proves your point… state single payer is a horrible idea for the state.  Everybody <65 y.o. who’s not working, like the future me, will move there.

    in reply to: State taxes #231625 Reply
    Liked by Lordosis
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