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Dusn

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

    I hear people talk about the 1% rule all the time, however, just on the face of it it makes no sense. There are very very few places where you’re getting 1k per each 100k in price. It just doesnt happen that often, yet plenty of people do fine with real estate.

    Actually, since there is more of a hard floor on properties than any linear relationship to price:rent, cheaper places in low cost of living areas can be easier to cash flow even. You dont get to choose a rent based on what you paid, etc…you pay whatever the market offers in your area and it will be supply/demand, wages, growth, etc…but you’ll have no say and no one cares how much you paid for a place.

    How many people got 1% in each and every deal they have for rentals, every time? This would mean a standard little 200k house should fetch 2k a month, which is on its face ridiculous and wont happen most of the time. You can prove this to yourself by going on zillow or whatever and randomly select cities and look at zestimate/comps and what theyre asking to rent for similar homes.

    Click to expand…

    I agree completely.  Does anyone expect to get 1% of purchase price in rent?   Where I live I can find rentals for typically 0.5% of what the equivalent home is selling for.    Maybe I’ve seen some condominiums get close to 1%, or if someone used it as a vacation rental…  do condos count under the same rule?

    in reply to: Investing in real estate #193799 Reply
    Avatar Dusn
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    Status: Physician
    Posts: 199
    Joined: 01/02/2018

    What is the buy in cost for partnership?

    in reply to: What do we tackle first? #192760 Reply
    Avatar Dusn
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    Joined: 01/02/2018

    Turbo tax shows you your effective tax rate.  Mine went from just over 24% in 2017 to 22% in 2018. I’m in a moderate tax state.  And our charitable deductions were a little higher this year (we still are able to itemize).  I’m happy to keep an extra $2,000 of every $100,000 I earn.

    Click to expand…

    What Tim says still holds true… it is very difficult to truly compare the effect of the new tax law on you unless you’re entering 2017 numbers into this year’s tax software. There are always other variables.  For example, tax loss harvesting for the first time lowered my effective tax rate compared to prior years… but am I happy that I lost 60K in the market so that it could lower my effective tax rate?  No.

    Yes, I would guess that due to the new tax law my taxes would be a little bit lower even if I got rid of all the confounding variables.  But I really don’t care enough to take the time to do that and when you’re looking at just a 2% difference, there is a margin of error.  I do know that it definitely wasn’t enough money to impact my life or retirement plans.

    in reply to: anyone else compare their 2018 federal taxes to old system? #191867 Reply
    Liked by Tim
    Avatar Dusn
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    Joined: 01/02/2018

    Fiscal conservatism is dead when, in a rising economy, the so-called conservative party unnecessarily increases the national debt and distributes that debt in the form of temporary tax cuts and you’ve got educated people on a financial website going, “Woohoo! Look at the money I got back!”

    Avatar Dusn
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    Status: Physician
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    Joined: 01/02/2018

    I got a small decrease in taxes.  I consider it a temporary loan from the National Debt until someone in the gov’t realizes that they actually need to pay that debt off and raises taxes back up again high enough to compensate.

    Avatar Dusn
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    Status: Physician
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    Joined: 01/02/2018
    Splash Refinancing Bonus

    VC is buying out ophtho as well.  I can’t imaging they’re not also buying ortho practices.

    With re: to the future of healthcare as a whole:  It’s a zero sum game with a limited amount of money for healthcare. Physician groups have got to push to lower healthcare costs by convincing politicians and the public to cut the costs of pharmaceuticals, administrative costs etc. or the gov’t will just continue cutting reimbursements to physicians. Single payer does not have to be horrible for physicians — Canadian physicians get paid very well (Canadian ophtho makes way more than in the US). I’m assuming their healthcare costs less through savings from other sources, like lower drug costs.

    Pushing for laws eliminating physician non-competes (like the laws in Massachusetts and California) will also, at the very least, give employed physicians more negotiating power against VC groups and hospitals and increase physician autonomy and independence.

     

    in reply to: Future of Emergency Medicine #191481 Reply
    Avatar Dusn
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    Status: Physician
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    Normally I’d argue that the length of EM training should be longer.  It seems absurdly short to have only 3 years to learn how to diagnose and treat all emergencies in adults, children, babies, pregnant women, and do procedures, intubations, etc…  to make matters worse is that you’re in a field where you don’t always get feedback on whether a diagnosis was correct or not, which I think would make the process of learning through experience a bit slower.   A retina specialist spends 6 years of residency/fellowship learning how to diagnose and treat just a tiny tissue in the back of the eye and believe me, all six of those years are necessary.

    But since NPs and PAs are allowed to do EM with even far less training.. well… clearly competence is not our nation’s priority right now.  If they don’t fill the spot with a physician, they’ll just fill it with an NP or PA.

    in reply to: Future of Emergency Medicine #191312 Reply
    Liked by Tim, Seabass, RosieQ, Zaphod
    Avatar Dusn
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    Joined: 01/02/2018

    Sounds like you’ll end up paying for your kids to go to a private school with a long commute in the rural area. I’d pick the suburb.

    in reply to: geographic arbitrage #189190 Reply
    Avatar Dusn
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    And an FYI – As prior posters have said FMLA allows 3!months after childbirth. You’re wife is consider as being “sick” for 6 weeks after vaginal delivery and 8 weeks after c section. This is federal law and applies to everyone

    in reply to: Less than 1 day off for birth of child for resident #188486 Reply
    Liked by snowcanyon
    Avatar Dusn
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    That is illegal and frankly if they pushed this issue your residency should have its credentialling revoked and be reported to the medical board and to major news agencies. (I’m not saying this as actual advice as I don’t want you to get in trouble but more as an emotional outburst). The law is the law and sorry but doctors and residency programs do not have some special privilege to break it

    As someone who’s has recently had a child, I’ll tell you that it can be extremely difficult. You can’t assume the best case scenario. You’re wife may have a difficulty recovery herself and one day is not enough for anyone. She can’t be expected to care for a newborn on her own one day after delivery. If she had a c section, hemorrhage, sutures, mastitis, chorio, etc etc. breastfeeding can be extremely hard for many women, especially early on and have complications on its own. The baby can also have problems and frequently can have jaundice. Frankly it would not have been safe for my wife to drive to the first Peds appt due to severe sleep deprivation. Those first weeks are NOT easy! (I’m also guessing that many of your attendings probably contributed nothing other than money to helping their wives with childcare and are now divorced).

    Avatar Dusn
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    Status: Physician
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    The people who know best are the residents and fellows who operate with them.

    It’s not just surgery skill that matters. It’s taking the time to make sure the operation is necessary and is the correct operation. This sometimes means reviewing records and images and unfortunately many surgeons just act like technicians and mindlessly perform whatever operation the referring physician (or NP, PA or optometrist) sent the patient to them for.

    “World renowned” really is does not always mean anything. Most of my attendings in residency and fellowship were “world renowned.” Most were very good but some of them frankly sucked.

    in reply to: What makes a good surgeon? #187735 Reply
    Avatar Dusn
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    Status: Physician
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    Joined: 01/02/2018

    Term4sale just connects you with a broker, right? That’s how we got our first broker.

    in reply to: Re-applying for Life Insurance #187520 Reply
    Avatar Dusn
    Participant
    Status: Physician
    Posts: 199
    Joined: 01/02/2018

    I was under the impression that snow tires stop much faster on snow but take longer to stop if no snow or if there’s rain compared to all weather tires. Is that the case? That sounds like they could make things safer if you’re expecting snow on the majority of days but otherwise could be more dangerous?

    in reply to: Losing Resolve: a Polar Vortex Story #187183 Reply
    Avatar Dusn
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    Status: Physician
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    Joined: 01/02/2018

    I’m in a virtually identical situation except my child’s grandparents are in NY and I’m in a state that has no 529 tax benefit. I’m thinking of actually opening a NY 529 account with them as the owner and my child as the beneficiary so that at least someone can get the tax benefit.

    The only part I’m trying to figure out is how to make this work given that they have no understanding of what a 529 is and what happens with the account should they pass away.

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