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

    There are many different ways to do single payer.   If it’s the Canadian system where ophthalmologists (and a number of other specialties) make over double what they do here (many ophthalmologists in Canada make over a million $ a year) and only have to deal with one insurance company (the gov’t),  sign me up!    (Unfortunately Canada won’t let outside ophthalmologists in very easily, and its so cold, or I would have moved already.)   The docs there are incentivized, just like we are with medicare, and they have some of the best ophthalmologists in the world.

    In Canada they pay the docs similar or more and pharmaceutical companies less – and how much they pay doctors there would likely surprised most of the US public and even US physicians.  Unfortunately, unless something changes with how wealthy special interest groups influence the government in the US, I doubt that doctors will come out the winners here.

    Avatar Dusn 
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    Joined: 01/02/2018

    It shifted my rent vs buy calculator strongly to the rent side. So I decided to continue to rent instead of buying a home this past year and likely will continue to do so.   I’m not sure what percent of the public actually pays attention to their finances/taxes like this though.

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

    Granted it’s been a long time since my intern year but that amount of responsibility doesn’t seem safe or humanely possible to me.  Is this a typical patient load for hospitalists/nocturnists?

    in reply to: Nocturnist Gig in a major city #184534 Reply
    Avatar Dusn 
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    Do politicians really care about the national debt or is it just something they pay lip service to when the other side is in power? Politicians will care about the debt of voters do but Does the public really care about the national debt when most don’t seem willing or able to fix their own personal debt?

    My prediction is increasing national debt until it reaches levels where it literally can’t get any higher… does anyone know what level that will be (I have no idea)? And taxes that may be higher than now but are still too low to decrease the debt.

    in reply to: Where are we going? Thoughts for 2019? Thanks for reading #184419 Reply
    Liked by Tangler, wonka31
    Avatar Dusn 
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    Status: Physician
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    Joined: 01/02/2018

    In my relationship my wife definitely spends less.

    (This thread has sort of derailed but on the other hand I don’t think there’s going to be much debate on the OPs scenario – they’re clearly not spending too much.)

    in reply to: CYAI: Earning 7 figures, but a MMM at heart #183358 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 199
    Joined: 01/02/2018

    If this is a problem with all private radiology practices then I would suggest looking at the VA. Salary will be much less but a much better work life balance. Academics might also be similar.

    in reply to: Off a cliff #182681 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 199
    Joined: 01/02/2018

    My Spouse is a Retina Specialist in a multi-specialty private Ophthalmology group made up of mostly comprehensive docs. We got the partnership contract and it looks like they are offering the same compensation structure as everyone else. Same base, same production. Based on my spouse’s full-time call and heavier patient care responsibility, is it wrong (or not wise) to ask for at least a bigger base salary? What do other partners do in the same situation (only Retina provider in multi-private practice)?

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    Retina specialists make substantially more than other ophthalmologists and generally use less overhead… so no.. I don’t think  that would be wrong.   They would also have to send all these patients out to a retina group of he/she did not work there… and she has to deal with all the disasters, emergency add ons, and post-op complications from the other ophthalmologists, which generally means staying later.  So no, I don’t think it would be wrong.   The production from a retina specialist would be way higher, however, so I would think the compensation based on production would lead to a higher income.  But full time call sucks and should be compensated.

    The only other thing I would keep in mind is that a lot of ophtho groups are being bought out by private equity (especially the retina groups), so if that’s a possibility that would add to my sense of urgency in  wanting to become a partner.

    in reply to: Practice Buy-In – Need some help #175579 Reply
    Liked by jfoxcpacfp, Tim
    Avatar Dusn 
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    Status: Physician
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    yeah I’m on to fourth-order TLH partners at this point, having to get creative

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    Me too. I was going to wait another week with international, but I might have to go to an ETF like iShares. It’s a pretty big loss not to harvest it right now.

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    I’m in a similar situation and my once simple stock portfolio is starting to look complicated and I have to keep a record to make sure I don’t accidentally rebuy a stock I just sold within 30 days.   If I’ve already realized >21K of losses, that’ll take 7 years to go through if we can only use 3K per year,  over which point there will probably be more chances to TLH.   Is this correct thinking?

    So am I correct in thinking that at this point it’s probably not worth selling a stock that I just bought while TLHing within the past 30 days.  If those stocks are still down >30 days since selling my original stocks of VTSAX and VTIAX,  I can sell them and return them to my original portfolio of all my stocks being in VTSAX and VTIAX.

    in reply to: PSA: It's another good day to TLH international #175571 Reply
    Avatar Dusn 
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    In 2008 the drop was due to the subprime mortgage crisis.   What would be the reason for the drop we are seeing and expecting now?   If it’s just because stocks were already overvalued and need to return to a more reasonable value then I would think it should not be that large of a drop.  If it’s because of this trade war… well.. then it’s entirely preventable and I would hope the people in charge will come to their senses soon enough.  Is there any evidence that the same or similar issues that came into play with the subprime mortgage crises are back again?

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    Look at the 5 year chart, this current drop is a mere blip.

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    I agree.  Which is why I’m of the opinion that there will not be much of a drop unless there are factors at play besides “stocks being overvalued.”  I would not think the trade war should cause too prolonged of a drop either unless politicians really take it to the extremes and refuse to back off.  So I was just asking if there were any other reasons for a drop or recession people were worried about… (such as banks returning to the old days of giving out crappy loans again, etc..)

    in reply to: Predict how low the DJIA will fall #175555 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 199
    Joined: 01/02/2018

    In 2008 the drop was due to the subprime mortgage crisis.   What would be the reason for the drop we are seeing and expecting now?   If it’s just because stocks were already overvalued and need to return to a more reasonable value then I would think it should not be that large of a drop.  If it’s because of this trade war… well.. then it’s entirely preventable and I would hope the people in charge will come to their senses soon enough.  Is there any evidence that the same or similar issues that came into play with the subprime mortgage crises are back again?

    in reply to: Predict how low the DJIA will fall #175542 Reply
    Liked by FIREshrink
    Avatar Dusn 
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    Status: Physician
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    Joined: 01/02/2018

    “ I don’t get much respect in my average day, just a bunch of entitled folks who think they know better and are annoyed by a ten minute wait.”

    Things to do, places to go, people to see. The customer is always first. Impatience is built into our social fabric. Does anyone get irritated at POOR service? Even checkout lines at a grocery store take forever. Especially when you need one thing and the express lane (15 items) is clogged by some entitled person with a full cart that needs a price check and of course no one answers the page. Dang, that’s why they have signs.

    Or appointments, or complications or missed deadlines.
    I really appreciate the checkout person smiling and asking if I found everything OK. It’s not like she can’t hear the muttering and dirty looks AT the offender.
    Next, the best service she can give as efficiently as possible. Amazing how she takes the next customer complaining and smiles and agrees all the while trying to get them checked out.

    Patients and customers have a lot in common with physicians and checkouts, they get frustrated and always have. Equating frustration with disrespect is not the same as poor service. Dang that high school girl is so good.

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    We actually have great customer service where I work. Ten minute wait, very efficient, good docs, personal care, ability to get an MRI at any time of day or night When out-of-towners come, they always compare us favorably to their local ERs. None of this, however, is good enough for a subset of the local Medicaid population, who complain about our service constantly and don’t understand why we haven’t fixed their non-existent problems. Yet they still get customer service surveys. I still hear about them from risk. They get to judge me and control my employment. I don’t get to judge them.

     

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    Odd.  I’ve personally found the most frustrating, entitled and unrealistic population to deal with have been the very wealthy (and typically of baby-boomer age).  As I’m going over the informed consent with members of that group, they often leave me with the impression that they believe bad outcomes are things that happen to other people but should never happen to them unless you’ve committed malpractice. Every illness needs someone to blame, as if the inevitable outcomes of life — sickness and death — should not apply to them.

    in reply to: Anyone else feel Unaccomplished? #173060 Reply
    Avatar Dusn 
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    Status: Physician
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    Joined: 01/02/2018

    Costa Rica is nice – beautiful mountains, coast and great people.  The sloths were pretty cool too.  My sister has been to Nicaragua and said the surfing was good there.    Is Zika still an issue in those countries?

    in reply to: You Have One Week In March To Vacation #173008 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 199
    Joined: 01/02/2018

    The idea that a drop in the market somehow creates a good time to invest seems to validate a theory of market timing.

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    Except that market timing requires you to successfully predict not only that a drop will eventually occur, but exactly when the market drop will occur, and also exactly when the market recovery will begin.  Good luck with that!

    Bear markets generally occur once a decade, and last from 1-3 years.  But that is an extremely rough average!

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    I don’t believe in trying to time the market.  I’m trying to dispute this idea that a bear market is somehow a good thing because then you can “buy stocks at a discount.”

    in reply to: Is a market drop a good thing? #172730 Reply
    Avatar Dusn 
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    Status: Physician
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    Joined: 01/02/2018

    Yeah, I listened to them because I was curious.  It was a waste of time.  Basically they try to sell you on the idea that you need to be diversified equally amongst the different sectors of the economy and that a total stock market index fund is too heavily weighted towards the large tech and financial companies.   I don’t know how to judge their concept.  But I’m sure it’s not worth the 0.89% fee.

    in reply to: personal capital #172583 Reply
    Liked by snowcanyon
    Avatar Dusn 
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    Status: Physician
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    The way everyone talks about these tax losses makes them seem kind of desirable  ?

     

    It really goes to show that you you understand and use the system correctly a brokerage account can be quite tax efficient.

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    Seriously.  The way people seem to get excited about TLH and “buying at a discount” when the stock market crashes sounds like an illogical, psychological defense mechanism.   It is at best a small silver lining to a negative situation.  TLH will not be fully replacing the money you lost.  And when you buy when the market is down, you have no idea if you’re buying the market at a “discount” or buying it exactly where it should be priced at that time or buying a market that’s still overpriced and will drop further.   You don’t know that the market will go up to a greater extent in the future because it dropped now.  And most of us with a decent amout of savings in the stock market would probably be better off in the market doesn’t crash at all.  A market drop is not a good thing.

    in reply to: What happens when TLH losses >$3000? #172051 Reply
    Liked by Zaphod
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