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Dusn

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  • Avatar Dusn 
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    Status: Physician
    Posts: 199
    Joined: 01/02/2018

    Is NY no longer in the running for “Best 529”?

    in reply to: Best 529 investment plan #152679 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 199
    Joined: 01/02/2018

    When you go to private practice the worries you have right now will become legitimate concerns.  At the VA they are not.

    1) They can’t just fire you at the VA without a reason.

    2) It’s going to take them way more than 4 months to find someone and get them credentialed, especially a surgeon.

    3) If they’re anything like our VA where they’ve been on a “hiring freeze” for the past year… it’s going to take them WAY longer than 4 months to replace your position.  At least the announcement that you’re leaving might give them some sort of argument to whoever it is that controls the purse strings to allow them to hire someone else.

    4) This isn’t like private practice where the patients don’t want to see a doctor who’s about to leave and where the partners don’t want to lose money on you if you’re leaving so they’ll fire you.   They can still fill your schedule at the VA until the end and probably have more than enough patients to fill your schedule even if they hire another doc.  The other doctors at least would love to have the extra help.

    Sean – every VA and even every dept with the VA can be very different from one another so the best information is if you can somehow get an inside scoop about the specific VA and particular dept that you’re thinking of working for… maybe even from one of the residents who has rotated there?    But the benefits StonesBonesIceCreamCones mentioned are all ones I’d agree with also.

    in reply to: Question about leaving the VA #152242 Reply
    Liked by Seabass
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 199
    Joined: 01/02/2018

    Japans stock market index looks like it’s been pretty stagnant for the past 30 years, after a long, consistent history of very strong growth prior to 1990.   In fact it looks lower now than in 1990.  I wonder if the die-hard buy-and-hold “Bogleheads” over there are still wondering when their strategy is going to finally pay off… luckily most Japanese people live for a long time.

    I guess the hypothetical reasons given for this are: an aging population, a freeze on immigration, and poor population growth.  I don’t see why the same thing can’t happen here, especially with the aging baby boomers and anti-immigrant sentiment… like all of you I’m hoping it doesn’t and plan to continue the course if the market crashes or stagnates but I’m fully aware that’s a hope and there is real risk in in the stock market even for longterm holders.  Japan’s 100% stock holders are doing way worse than the bond holders.

     

    in reply to: 100% stocks #152128 Reply
    Liked by llessac15
    Avatar Dusn 
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    Status: Physician
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    Joined: 01/02/2018

    Engineers are so full of themselves. I have no doubt that AI will be a big deal in some fields inside and outside of medicine and may help doctors but there’s no way it’ll be able to replace us.

    I remember when google was hyping their Google Glasses a few years back and the ophthalmologist in me was thinking, “how in the world did they make it comfortable for users to constantly look back and forth between an image 1 inch from their face and images far off in the real world.”  I was starting to doubt my own common sense.  Common sense prevailed.

    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 199
    Joined: 01/02/2018

    A little off topic from AOA but here’s my experience with medschool “discrimination:”  Everyone on my 3rd year rotations mixed me up with a classmate of my same ethnicity.  They would call us by the other person’s name and it was clear they had mixed us up on at least a few evaluations.  The icing on the cake was when they sent his deans letter to the residency programs I was applying to instead of mine… and he wasn’t even applying to ophtho!   My school then had to resend my actual deans letter with an explanatory letter delaying my application past the SFmatch deadline.

    Luckily I still somehow matched…. I probably would have matched better if only he were a better student.

    To be fair, despite that experience, I’ve also mixed up the names of my residents of the same race.  It’s the way our brains work but it’s something we should actively work against.

    in reply to: AoA Discrimination- Doximity article #150021 Reply
    Avatar Dusn 
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    Status: Physician
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    Joined: 01/02/2018

    I tried the “doesn’t hurt me at all” bit before an eye injection once…  yeah… they don’t seem to find it as funny when they’re about to get a needle in the eye.

    in reply to: Best jokes/shtick with patients? #149978 Reply
    Avatar Dusn 
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    Status: Physician
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    Joined: 01/02/2018
    Splash Refinancing Bonus

    Think of it from the bank’s perspective.   They seem to think that loaning that money to you at 4.25% is a better investment for them than putting it in the stock market (despite the typically higher returns of the stock market) because you’re a lower risk.  So then taking that money and investing it into stocks in a taxable account doesn’t make sense to me unless you think you’re a better investor than the bank.   My rule of thumb is that the only reasons for me to not pay off loans first is if I can get a better return in a no-risk investment (which never happens) or there’s some tax advantage or I badly feel the need to diversify part of the money because if I just pay off the loan all off my money is essentially in a single real estate property (and I’m not sure if that last reason is logical or just emotional thinking).

    I’ve also seen the family savings of physicians destroyed by loans when something happens to the income of the breadwinner.

    in reply to: Investing vs paying off debt #148991 Reply
    Avatar Dusn 
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    I’d also like to see the details.  We have a similar dual physician income, paid off our loans in a year, spend 60K per year (although over double that amount goes to our taxes), all savings goes to standard index fund investing, and I don’t expect to have anywhere near 6M by age 41.

    in reply to: Where are the Fatlittlepigs? Are Fatlittlepigs rare? #147707 Reply
    Avatar Dusn 
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    Nice. What worked for me was a diet of vegetables, nuts, beans, lentils, Greek yogurt, fruit, and olive oil. Lost weight, lowered my cholesterol and feel great. Sometimes my bowels can get unhappy if I overdo the beans and lentils but I tell them that I’m saving them from colon cancer.

    in reply to: The Obesity Code posting by Miss Bonnie changed my life #147671 Reply
    Liked by Firefly
    Avatar Dusn 
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    Status: Physician
    Posts: 199
    Joined: 01/02/2018

    Why wouldn’t the umbrella insurance cover it?  Isn’t it supposed to cover things such as if someone falls and breaks a hip in your home?    If not then what does it do?

    in reply to: Nanny Worker’s Comp Insurance #146571 Reply
    Avatar Dusn 
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    Status: Physician
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    Joined: 01/02/2018

    How did they calculate a nationwide average household wealth in the first place?   These are not straightforward numbers….  I was amazed when I learned how complex and somewhat arbitrary a process it is to even calculate the GDP.

    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 199
    Joined: 01/02/2018

    I don’t think the vast majority of people are forced into primary care.  When I checked last year, the average USMLE score for Internal Medicine was 1 point higher than for Anesthesia or for Emergency Medicine; by all other criteria IM looked equally competitive as well.  I imagine many of those internal medicine residents don’t further specialize and end up doing primary care.   Take any of the top IM or peds programs (CHOP for example) and I’m sure all of those residents could have gone into much higher paying specialties.

    I went into ophtho but I almost chose peds…. to be frank, I think some of us were too idealistic for our own good back in medschool.

    Avatar Dusn 
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    We need better advocates. As someone who did a brief stint in journalism before medschool the algorithm is simple and unfortunately the rules for what people will read in journalism are the same as in all writing and storytelling. There needs to be: 1) conflict 2) interesting and unique characters, possibly a sympathetic victim 3) an emotional hook to grab the reader. 4) why is this important now? (Probably the only part unique to journalism) . There are other factors that can help sell a story too but you get the drift.

    One way science journalists find stories is by skimming the “for the public” sections of major journals like Nature or NEJM. But I’m sure they also get fed stories by parties that have ulterior motives. Most journalists get paid very little and will snatch up and report anything that will sell.

    in reply to: Doctors vs Media #145336 Reply
    Avatar Dusn 
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    Status: Physician
    Posts: 199
    Joined: 01/02/2018

    Wow.  Can you tell us what made you think in 2007 that this property would be such a good investment?

    If I could sell part of it that’s probably what I’d do.  Then again I don’t have nearly the experience you do.

    in reply to: Cash in on a property or hold #145271 Reply
    Avatar Dusn 
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    Status: Physician
    Posts: 199
    Joined: 01/02/2018

    I hate how doctors have become the government’s gatekeepers of prescriptions drugs rather than the patient’s advisors of their health.  My wife (primary care) has been physically and verbally threatened by patients for not prescribing opiates.   My parents (also primary care) have been robbed in their office at gunpoint and during the robbery were asked where they kept narcotics (they have never kept narcotics in their office or prescribed them).

    A small, very libertarian part of me wishes that all prescription drugs were available over the counter (except antibiotics which would rapidly become ineffective if overused) and patients can come to doctors if they choose to for advise on how and when to use those drugs.

    in reply to: How bad is the Opioid Crisis…Really? #144965 Reply
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