Menu

Dusn

Home Dusn Replies Created

Forum Replies Created

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

    Surprised very few votes for ophtho. Total banking hours, sit down for surgeries, fast cases, cool tech, light call, happy patients for the most part. Tougher to make bank as compared to hospital based specialities, but with the right mindset and surgery center, sky is the limit. Demand should also sky rocket as baby boomer ophthalmologists retire.

    Click to expand…

    I don’t know if ophtho spends as much time in the OR as the OP wants.  I think 1 day a week in the OR is pretty typical for most ophthalmologists.   The incentive to go to the OR is even lower because with cataract surgery reimbursement cuts they can often make more in the clinic than the OR;  I think medical retina is one of the highest earning subspecialties, with in office injections and laser procedures.

    Mohs Surgery is the clear winner, IMO, if you can get into it.  IR might be something to look into as well — it’s tough in private practice but not as bad in academics where you have fellows taking call for you.

    in reply to: Best surgical lifestyle? #215678 Reply
    Liked by Zaphod
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    Tomw, federal gov’t workers pay into the pension.   It’s 4.4% of your salary that gets taken out of your paycheck  (for the people who started years ago it’s 0.8% but they raised it for new hires several years ago) and most people can’t get the pension until you reach retirement age (I think that’s 65?).   For someone who’s 60 it makes a lot of sense because that money has no time to grow anyhow.  But if you’re 30 years old I’m not sure it’s really such a good deal because if you invested that 4.4% it would be worth a lot more in 35 years.

    There is also no absolute guarantee, even with the federal gov’t.  This past year the white house was pushing to seriously decrease the pension benefits.

    Everyone thinks the federal gov’t pension is such a great deal but for younger workers I’m not sure if it is.  I can’t find anyone else making that argument online to back me up though so I’m not sure if I’m missing anything here.

    The gov’t does offer 5% matching, however, and the TSP is really good.   And I think you can choose to get that 4.4% back and forgo the pension when you leave the fed gov’t.

    in reply to: VA Hospital or Independent Contractor? #215664 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    What happens if she delivers early, does the program have backup to cover for that?

    To the OP– it sounds like your wife and/or you may have initially not realized the difficulty of the last few weeks of pregnancy. Which is understandable, this is your first baby.   But post-pregnancy is generally way harder, especially if your wife has any goals of breastfeeding.  I would try to get as much time off (for both of you) as possible and as much help as possible.

    As a philosophical aside, doesn’t the gov’t/medicare provide the salaries for residents and fellows and then pay the hospitals extra on top of that?   I think the goal from the government’s prospective is to educate future doctors, not provide academic hospitals with free labor so that they can cut back on hiring fully trained physicians.  If a hospital doesn’t hire enough attending physicians to take care of its patients, whose fault is that?

     

    in reply to: Reasonable Work Accommodations During Pregnancy #214321 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    The best food in NYC is the pizza. Followed by the bagels. $1-3 dollars for a meal. So delicious.

    Chicago deep dish on the other hand… definitely not worth paying those taxes for.

    in reply to: Today Illinois, Tomorrow Everywhere #211876 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    It’s a mystery to me why anyone would live in IL, or NJ, or CT, or NY state. I could somehow comprehend CA or maybe NYC. But those places are just not that special…I know….family. Then I’d relocate to a neighboring state. IN, IA, WI, NH, PA, are all better choices. Just my humble opinion.

    Click to expand…

    I presume you are talking about physicians.  There are plenty of people making enormous amounts of money in NYC, SF, DC, etc that they could not make anywhere else.  If you work in a hedge fund, a FANG tech company, as a top executive in almost any major company, or a big law firm, where else are you going to live? This is where the vast majority of major companies are headquartered.  My friends who went into finance in NYC and SF make way more than almost any physician, had well into the 8 figures in wealth and income by age 30, and don’t find living in NYC or SF to be a hardship — in fact they wouldn’t dream of living anywhere else.

    In terms of physician who are being paid by insurance or medicare, yeah I agree.   Although many of the ones I know who live in these cities are married to someone with a high salary who needs to live there.

    in reply to: Today Illinois, Tomorrow Everywhere #211827 Reply
    Liked by Zaphod, Dreamgiver
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    “Our daughter can not sleep lying flat.  We have no idea why.”

    Reflux?   My medical textbooks have found a new use as we put them under the front legs of the bassinet to elevate the head of the bassinet slightly (don’t elevate too much or the infant can slowly slide down the bassinet overnight).  A good swaddle helps a lot too and putting them to sleep just before they’re showing obvious signs of getting overtired.   Simethicone drops and probiotic drops seemed to help too, or maybe was just a good parent placebo.  Congrats! Good luck! and try to rest when the baby’s sleeping!

     

    To the OP – I forgot to add that Amazon is a great place to do a baby registry.  If you create a baby registry with them they give you 15% off on up to two orders of $2000.00 US Dollars combined value ($300.00 discount with Prime Membership) for up to 60 days after your expected arrival date.

    And luckily our baby could care less if the milk is warm (thank goodness!) so some things, like the bottle warmer mentioned above, I’d wait to see if you really need it.

    in reply to: Preparing for first baby financial tips #211128 Reply
    Liked by Doc Spouse
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    Take a vacation during the second trimester.

    Get your FMLA paperwork in hand.  For both of you.  A lot of people seem to forget how hard those first few months were.  Or they had stay at home spouses, lots of family help, no medical issues, or had kids in their early 20’s when biologically it’ll probably be a lot easier physically.   Take as much time off during the first year, and especially during the first few months as you can get.  And be prepared with a strategy to have to take more time off as a backup, just in case…  or have a parent available to come.   You need surprisingly little stuff during the first few months; what you need is time and sleep.   It gets much easier each month but it’s still very difficult to hand over the baby to a stranger to take care of early on.  They’re tiny and very cute.

    I would go to some lactation classes pre-baby and schedule some appointments with a lactation consultant for after the baby comes out.   Breastfeeding is hopefully easy but can be surprisingly very difficult and sometimes not work out exactly as planned.

    Just figure out what state you’re doing the 529 with and look at their website.  NY was pretty easy.

    If you don’t have life insurance – get it.  For your wife, hopefully she got it before getting pregnant, but she could still try.

    Third trimester – get a car seat and install the base in your cars.

    Store pre-prepared food in your freezer.

    Read about the 5 S’s for helping the baby sleep.  For some babys the Snoo (an expensive automated bassinet) can help wonders.

    The baby will grow out of all clothes very quickly, and people will buy you so many baby clothes.  For clothing we just used hand-me-downs and gifts. You don’t need much space for a newborn (unless you have family staying in your home to help) and you don’t need a lot off the stuff they try to sell you.  Basically we needed a car seat, stroller, diapers, wipes, bassinet, changing pad, and rented a hospital-grade breast pump from the hospital.

     

     

    in reply to: Preparing for first baby financial tips #211102 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    People live in Manhattan, Tokyo, SF, Paris, London and other urban centers. These are some of the most expensive RE in the solar system and everyone lives on a busy street. Granted, I like telling my kids to get out of the house to go bike around.

    Click to expand…

    I’ve lived in Manhattan and other cities and the buildings seemed far quieter than the places I’ve lived in in more rural areas.  It may be due to materials they’re using to soundproof the buildings.  So I think the only way to really judge noise level is by actually sitting inside the home for awhile.     But you’re right that plenty of kids seem to be fine without a backyard.

    in reply to: New home on busy street? #210846 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    I have about $500,000 available that I took out of a commercial investment that I had with some partners.

     

    I am trying to figure out the best way to invest this money right now. Here are the options I can think of. Please provide your suggestions.

     

    1. Stock market (4 fund portfolio) – but stock market has gone up 16% this year already!

    Sure, this year’s been good but you could also just look at it as making up for the drops in 2018.

    in reply to: Need recommendations on investing 500K #210549 Reply
    Liked by hatton1
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    I’ve heard the I Fund in the TSP is only developed markets and does not include emerging markets.   Personally I’d prefer vanguard total international or something else for my international allocation because of this.  And I’d utilize the TSP account more for my bond allocation in the G fund.

    in reply to: help with simplifying my international portfolio #210415 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    Hold onto it. I can’t imagine that Buffett, at his age, hasn’t already offloaded the majority of the responsibilities of Berkshire to his managers. If the stock drops after Buffett passes away, I think that’ll be a good time to buy more.

    in reply to: what to do with BRK-B – 5% of portfolio? #210259 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    When you’re trading time for money, I think the answer about which mentality is “right” depends on how long you and your loved ones end up living and being healthy.  Hard to predict.

    in reply to: Fatlittlepig vs. Lazy Millennials ? #208084 Reply
    Liked by pulmdoc, q-school
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    Why don’t you think you’d like IR? There’s such a large range of pathology that they treat and there’s so much you can do with it if you go to a good program. As you know, it’s nothing like diagnostic radiology.

    You said you think you think you’d enjoy just about any surgical field including vascular surgery and ophthalmology. But IR is way more similar to vascular surgery in my mind than Ophtho is.

    in reply to: Career Advise-Feasibility of a Second Residency #207876 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    Thank you all for the very well thought out advice!   To be honest, when we wrote the question and before we received all your responses, we weren’t even sure where we stood financially and so we haven’t figured out the follow up questions that you all have  brought up, which is HOW we will find jobs that allow us to cut back.   As Anne alluded to, we’re unfortunately not in shift work fields and it’s not going to be easy to make part-time work out.  I think if we start trying to figure that out now, it’ll take 1-2 years before it actually fully happens, at which point I’d project us to be closer to 1.7 – 2mil in savings.

    We have no interest in ever having a million dollar home and we’re hoping we don’t have to send our kids to private school.  Renting does have some benefits in that it makes us more flexible in terms of changing jobs if we need to.  We also don’t have a ton of stuff and so I’m hoping renting would allow us to just move to better school districts in the area when we need to.

    For me, if I cut back to fewer days, they’ll simply compress the same number of patients into fewer days, as no one else does what I do in our clinic and the patients need to be seen.  It’s been a losing struggle to prevent myself from rapidly becoming way busier than I want to be.   Eventually I think I’d have to do something non-clinical like the FDA and/or figure out something creative where I can work a day or two a week to see subspecialty patients in someone else’s comprehensive clinic, the VA, etc.

    For my wife in primary care it’s been a similar struggle.  If we even take a few days off for vacation, she comes back to work to find an overbooked schedule, with a huge stack of lab/imaging/consult notes that need to be reviewed, patient phone calls to be returned, etc.  There do seem to be other primary care docs who would be interested in sharing a patient panel and she’s been trying to figure out how to make that work.   Their styles of practicing medicine would have to mesh well and they’d have to work well as a team.  Alternatively, she’s still fresh enough from her training that she could switch to being a hospitalist.  And since hospitalist is a shift work job maybe there are positions, (maybe locums?)  that would let her work fewer shifts a month.   But we weren’t sure if the hospitalist schedule works better with young children than primary care.    Could any internists could share their thoughts on making part-time work out, as either a hospitalist or primary care?

    Thank you also for your thoughts about how parenting may change over time.  It’s something we’ve thought about but find it hard to fully appreciate at this early period as parents. All your thoughts have been greatly appreciated!

     

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

    You mean- how do you calculate the income that you write on the life insurance form?

    in reply to: Term Life Insurance Estimation #206664 Reply
Notifications Mark all as read  |  Clear