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NW up 1195% due to hitting back to broke around the new year last year and massive savings and loan pay off this year. We saved about 75% of take home. Though taxable account that we started this year is down 8% from basis.
This is not the situation for risk taking, just do what is medically recommended.
Seriously, call the hospital billing and ask for the cash rate and do the math. We have a HDHP and saved 5 figures by paying cash rate for surgery this past year, and it was SO MUCH EASIER than dealing with insurance over this particular issue. No paperwork other than the a receipt for a 5 figure payment. The latter is identical to those that come out of the printers in gas station self pay stations, and we got a lot of laughs out of it.January 1, 2019 at 9:45 pm MST in reply to: Considering signing out AMA after wife delivers – am I crazy?? #177765
Contributed 6K + 7K today and will convert this week. Vanguard tells you what your maximum contribution is for 2019. Love Roth dollars.
I graduated in my 40s, and I can say that money is not everything but should be factored into the equation if you are starting out anywhere near 40. I am very, very happy to be in a high paying surgical speciality, it buys us a lot of freedom. You won’t have the extra decade to save and compound, and there is a huge difference over time between 250K$ and 500K$ a year. You might be surprised that you may not want to work for 20+ years. I really like my specialty, but my priorities changed the past 10 years in ways that I could not predict or imagine, and I would now rather spend time on things other than building a career with case after case.
Also figure out clearly how you feel about both call and about longitudinal attachments to patients. If you do IR (or surgery), there will be some degree of short to long term relationships with follow up and patient calls, and these can be a time sink. And complications. The latter are inevitable in a procedural specialty and can be heavy on the soul. The cool, complex cases in a procedural field are wonderful challenges but can come with a lot of stress and responsibility. You might tire of the adrenaline drive and look forward to the bread and butter days!
The flexibility of the EMDs is hard to beat, but I agree with others that you have to at least like your specialty to make it sustainable. Your specialty does not have to be a life calling, I know many docs who see their specialty as a job and enjoy it without feeling it was the only way to be happy as a doctor. I did not think this way when I trained and probably would have made different decisions.
I am a pediatric surgeon. If I had to do over, I would consider neonatology since I love newborns and would do well with shift work and still see the coolest pathology of my current specialty, and the training would have been 6 versus 10 years. Or derm, for the variety of pathology and the option to do procedures and a very low rate of emergency acne cases!
It sounds as if you can afford the tickets and that having first class tickets determines whether or not you will take this trip. Acknowledging that, yes ,this is a lot of dough, I would just buy them and go and plan the best trip possible. This is not a big rock item that will determine your financial future. If you regret it, then take economy class from then onward. If you decide that the extra expense improves your life and expands horizons, then new doors have opened for you.
I spent most of my life sitting upright in front of the rear lavatory, knees under chin, waiting 2 hours after take off for the beverage cart to arrive. I saw a lot of the world this way. But I have to say that comfort and first class have been a revelation: we arrive rested and refreshed, there is room to move around and stretch, the plane operates at 25 decibels less in the front of the plane versus the rear, and we can converse and sleep with less noise. For long flights in particular, the extra expense translates into far better travel experiences with less fatigue and stress. And I am not really old yet!
We are also pretty cheap people, we drive old cars and have no debt, but comfortable travel really ranks for us and gets us to new places several times a year. We spent about 30% of our take home on travel last year.
Nothing ventured, nothing gained.
I am a general surgeon and used to live about 25 minutes away and ended up taking in house call to avoid the drive or uncertainty in trying to sort things out by phone. Slept on my office floor many times. Now we live 2 blocks away, this was a game changer and a huge improver of QOL. It is so easy to come and go home for meals, breaks, to say hello to spouse between things, make early morning and rush hour meetings. I also never hesitate to walk to the ED to see a patient in order to make a decision, and I sleep better for it between pages. My partners who live farther away often exchange several phone calls with the ED between labs and CT scans rather than come in, and by that time I am in and out and have the plan already made and am back in bed. Agree with Anne to rent as close as you can then decide what living situation would be optimal.
I appreciate the security comments here, very illuminating. I use PC and love it, I log in every day. I caught a fraudulent charge not too long ago, easy to spot with all the transactions listed, in real time, it seems. I am fairly new to investing and really enjoy learning from the daily market ups and downs, especially recent volatility, which are so easy to track in PC. Over the past 2 years, it was highly motivating to see our NW change daily as we moved from 6 figure negative to 6 figure positive. The clear graphics for spending categories have changed where and how much we spend. Tracking investment returns and losses in bulk and individually is plain educational. I do think that tracking NW has been the most life changing, as I used to confuse income and buying power with wealth. For someone more settled and mature in their financial life, these features may not be as compelling.
The security concerns raised here do give me pause. I know I would never keep up with an excel worksheet, it would be the last thing I ever got to in a day.
Unless you are in a VHCOLA where 3M$ houses are the median and move quickly through the market, I would use the next two years of cash accumulation to think this through carefully. Aside from the initial and ongoing outlay, a 3.5M$ house is a set up for a high maintenance lifestyle that will chain you to a high paying position in perpetuity. And without easy extrication given the slow market you describe. I can’t imagine even the cost of furnishing a 3.5M house much less the electric bill and cost of keeping it clean. Landscaping costs and lawn maintenance? Do some math with worst case scenarios. MDs do become disenchanted with their jobs, lose them altogether, take pay cuts, and you would be chained to a led zeppelin. Even with your net worth, a house purchase of this magnitude will significantly affect your long term finances. Sorry to rain on the parade.
If you have the requisite board scores and like derm, I agree with others that it ticks all the boxes that matter most as an attending, and I would seriously consider it. Derm is a very interesting speciality, very few night/weekend/holiday derm emergencies, good compensation and versatile in terms of possible practice models. There are residency programs that are more surgical than others, if that’s your interest. Your priorities will change after medical school, and finding a speciality that feels like a life calling is really not essential to a happy, long lived medical career. QOL, compensation, work like balance very much matter, and if these are in check, then you are likely to enjoy a career in many specialities. Don’t choose surgery unless you feel this is your life calling. I am a surgical specialist, well compensated, but the call, nights/weekends/ holiday/burnout wear on everyone in my practice. I wish I had considered derm and cannot imagine even 15 years in my specialty. Good luck!
Happy thanksgiving everyone. I’ll add to the chorus sincere thanks to WCI, PoF and to everyone who posts here. Especially the crew of regulars. I would be in a far different situation now 2 years out from fellowship had I not found this site. Rather than driving a V12 G wagen and paying 6 figures of debt over 30 years, we are debt free with 6 figure net worth and driving a 2003 Toyota !
Kudos. Enjoy the peace of mind.
In all seriousness in the 5 years I’ve been involved with recruitment I don’t think a 45 year old has ever come up.
As a medical student and resident, I was lucky to be at institutions with a fair number of 35-40+ year old trainees. Always there was an interesting background: a former professional soccer player, a published poet, immigrants who were repeating medical school so they could practice in the US. We had a gold medalist para Olympian who had taken several years to train and compete. These were innately driven people who deliberately chose to become physicians and who were creating their futures. For the OP, it seems the situation is different and more a matter of a good career choice.
When you are looking at applicants on the PD side of ERAS you see their picture and their b-day is on what amounts to the home screen.
MPMD thanks for posting that information, glad I did not know it at the time ! Yeah I was busy doing a lot of interesting things and agree OP seems to be in a different situation.
With regard to the issue of ageism: Probably there is a component of this, I don’t think I experienced it. My CV reflected the additional years well with a lot of accomplishments that a younger person could not have had without serious ambitions in preschool : D. I don’t think the applications for residency and fellowship have your age on it, and interviewers cannot ask, and I don’t think age held me back at all. I also did not experience the fatigue and slowing down in my 40s mentioned by others, but I can see this as a concern. You do need a lot of energy to get through it, much less make the most of it.
dont mean to come off even harsher than the direction the thread is taking, but you are indeed making excuses. Let them go and focus on whats ahead and how you can tackle that, no benefit to discounting things based on the past.
Also, I second Anne’s post in its entirety.
Your excuses and negativity are holding you back, no matter what path you take. The more important question here is Who do you want to be right now? Put your past behind you, why are you choosing to cloud every perspective you have with your past? Many successful and happy people here come from poor backgrounds with hardships of all kinds. Hell, I should exchange stories over a few beers with Zaphod.
I am a successful non traditional student who worked through undergrad, medical school, etc… graduated residency at 48…, I could write a country song about the hard knocks and lonely, dark road… but my mindset was totally different, and lo, so were my opportunities. I went to top programs, had a hand in many interesting projects as a trainee, and now am paid well for my specialty. Not because a parent went to Harvard or I inherited a trust fund or had a privileged or pleasant childhood. You are not too old, but your attitude is going to keep you from realizing who you really are no matter what you do.
On a practical note, since this is a financial blog at it’s heart, the challenge with starting out at 48 has been that we don’t have 30 years of saving and compounding ahead, so we compensate with brute force savings. I borrowed for everything, we had a ton of debt. Lived in a camper for 1.5 years as an attending. Made major sacrifices as a resident and fellow. Everyone does, especially parents. My female colleagues really took a hit with very tough decisions. One had three nannies, all wearing pagers. Routinely they worked until going into labor. Finally, you need to put the hours into residency so you can be at least good if not excel at your specialty. Ask if you can really do this.
I wish you the best.