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Dusn

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  • Avatar Dusn 
    Participant
    Status: Physician
    Posts: 198
    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: 198
    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: 198
    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: 198
    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
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 198
    Joined: 01/02/2018

    I remember just a few years ago all my radiology friends could not find jobs and now there’s a shortage of radiologists? So weird.

    in reply to: Implosion of small radiology private practice #205900 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 198
    Joined: 01/02/2018

    “The other physicians said the administrative day is basically a day off because there is no requirement to go in to the office and it should be easy to finish paperwork during the other work days.”

    I’d be surprised if this is entirely true.  Most primary care docs I know are swamped with paperwork, charting, patient phone calls, and lab/result follow ups.  They spend as much time doing that uncompensated stuff as actually seeing patients.   But it is a very good thing that they give her a day to catch up on this stuff!.. most of the primary care docs I know have to complete most of that at home after putting their kids to bed or on the weekends.

    in reply to: Administrative day #200427 Reply
    Avatar Dusn 
    Participant
    Status: Physician
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    Joined: 01/02/2018

    Last I checked the NYTimes calculator was a bit outdated with the new tax law.  You can still make the calculator work but may have to negate some of the tax benefits associated with deducting mortgage interest and property tax.

    in reply to: Just matched! Going to buy a condo/townhouse #199084 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 198
    Joined: 01/02/2018

    You should not need to max out the 19k in the tsp to get your full 5% match at the VA. Can’t you get the full match at both institutions? Why do you have to figure out which match is better?

    in reply to: VA and non-VA retirements #198852 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 198
    Joined: 01/02/2018

    No. Good grief. If this is the way medical care is going maybe we’ll hold off on having that second kid. Are respiratory therapists competent to handle this? b/c that’s all that was present during our daughter’s birth with meconium.

    in reply to: ER covering deliveries/neonatal resuscitations #198597 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 198
    Joined: 01/02/2018

    The nation’s debt went up dramatically as a result of this tax law.

    And red states by in large receive far more federal assistance:

    https://wallethub.com/edu/states-most-least-dependent-on-the-federal-government/2700/

    in reply to: How much income tax did you pay in 2018? #198566 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 198
    Joined: 01/02/2018

    Real estate depreciation. And then outright tax fraud – it isn’t a loophole but seems to get discovered frequently when extremely wealthy individuals get investigated for something else (ie manafort). Making me suspect that it’s fairly common and not frequently caught.

    in reply to: How much income tax did you pay in 2018? #198431 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 198
    Joined: 01/02/2018

    Or I guess they could try to close the loopholes that seem to allow many far wealthy than we are to pay nothing in taxes. Something strange is going on when my physician colleagues in Canada make more than I do but do not pay higher taxes.

    in reply to: How much income tax did you pay in 2018? #198342 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 198
    Joined: 01/02/2018

    Paid over 6 figures.

    It fine b/c The only way to cut taxes is by cutting the biggest costs: Medicare, medicaid spending, which will undoubtedly first mean cuts to our reimbursement. (They never seem to want to negotiate down the crazy high costs of the meds). Either way we lose.

    Or they could just keep borrowing debt to pay for
    It and we can have our cake and eat it too.. until we can’t.

    in reply to: How much income tax did you pay in 2018? #198341 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 198
    Joined: 01/02/2018

    Business.

    The way more and more physicians are becoming employed and increasing healthcare costs do not bode well for the future of our profession.

    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 198
    Joined: 01/02/2018

    Botox doesn’t worry me. We had first year Ophtho residents who knew nothing injecting themselves in the face with leftover Botox at the end of clinic. If you mess up the ptosis will go away after a few months…

    Filler is a different story. If you mess up, the blind eye from that retinal artery occlusion isn’t going away.

    in reply to: Aesthetic Procedures/Botox Course #195544 Reply
    Liked by Zaphod, childay
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