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  • Avatar Perry Ict 
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    Status: Physician
    Posts: 61
    Joined: 01/20/2019

    Twitter is a dumpster fire.  It’s just more messy than the neatly packaged dumpster fire of most news organizations.  The amount of astroturfing and ignorance on display never fails to depress me.

    On topic – I tend to look for places that tell both sides of the story. Some of my usual go-to’s are WSJ, Business Insider, and Reddit (also a dumpster fire, but I find pearls among the garbage).  The Intercept tends to be hit or miss.

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    I do like the Intercept.  It’s one of the few outlets around that acts as a watchdog and actually holds the government and other powerful actors accountable, as journalists are supposed to do.

    in reply to: Where do you get your news? #245904 Reply
    Avatar Perry Ict 
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    Status: Physician
    Posts: 61
    Joined: 01/20/2019

    .

    in reply to: Resignation advice #243198 Reply
    Avatar Perry Ict 
    Participant
    Status: Physician
    Posts: 61
    Joined: 01/20/2019

    Zaphod, re: the percentages, I agree with you, I was more saying that it could drop up to 50% and that is the potential downside, but I certainly wouldn’t stay on the sidelines waiting until it’s down by that much.

    in reply to: HUGE sell off today! #241289 Reply
    Liked by Zaphod
    Avatar Perry Ict 
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    Status: Physician
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    Joined: 01/20/2019

    Just want to clarify that I am not calling for a recession, but there are some notable headwinds that should be taken seriously. Those can be politicked or growthed away of course, info and data changes and so should your assumptions. Just about risk tolerance and reasonableness of discussion. You dont have to and shouldnt change your AA even, unless you’re in a mighty risky position you might not feel comfy with of course.

    Its all about how much more upside vs. how much downside there is. If data and rhetoric keep up, we have loads of downside ahead. Even if rhetoric cools on one side, we have temporary reprieve and await data (it happens slower). Im not interested in being a hero, just happier with a lot more bonds in my portfolio lately.

    I have been focusing on debt lately, but less to do with market and more with goals. If the market indeed starts to turn sour, I will reverse course and pump it into the market instead.

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    I agree with your general line of thinking (re: perceived upside vs downside). I don’t think it has a lot to do with rhetoric though, much less tweets as a lot of the headlines love to imply, but rather the data that suggests that we are at the end of an economic cycle.  With that, I think it is reasonable to make a projection as to what the stock market might do over the course of the next few years and invest accordingly.  On the other hand, I’m very skeptical of anybody who claims they can predict what the stock market will do on any given day or week based on events or headlines.

    Right now, my view is that there is more downside than upside in the stock market, so I’m being extra careful (I’m going to forgo the attempt to squeeze out an extra 10-20 percent because I suspect downside could be upwards of 50%).

    in reply to: HUGE sell off today! #241282 Reply
    Avatar Perry Ict 
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    Joined: 01/20/2019

    Literally when has there ever not been good long term value in the US stock market?

    You can debate what it’s going to do in next yr but pending a total collapse, in 10-20 years it will be up, likely substantially higher than it is now

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    This is an erroneous belief, maybe you have been drinking too much indexing cool-aide.

    You only need to look at 10 or 15 year rolling returns since 1970 for recent episodes.

    There have been multiple periods where the actual return has been less than the risk free (30 year government bond) rate.

    There is no guarantee the SP500 will be higher in 10 or 20 years.

    Indexing may still be a good investing strategy.

    Returns in an index fund or any risky asset are not guaranteed.

    Obviously there is some risk of permanent loss of capital over the time period.

    What do you suppose that probability is: 0.1%, 1%, 10%, 50% ?

    Maybe you think it is 0.1%, then realize in a crisis, it is 10% and it may feel like 50%. Who knows what the actual risk of negative return 15 years out in 2009 was ? Maybe it was 10%, maybe it was actually 50%, or maybe it was 0.1%.

    I tend to think the risk of negative 10 year return here is 10%, but that’s just my guess, which could be completely wrong.

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    Excellent points.  There are a range of scenarios for indexing, and not all of them will necessarily be good ones over 10 to 20 year time frames.

    in reply to: Time the Market with me! #237780 Reply
    Avatar Perry Ict 
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    Joined: 01/20/2019

    It depends.
    Price:income ratios for cities are like PE ratios for stocks.
    Maybe average house price to household income is : 5:1

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    This is a good point.

    Though I don’t know exactly what that price:income ratio is, right now it is fairly high, so there will probably be a reversion to the mean (and will probably overshoot the mean to some degree, since that’s the way sentiment works).  Actually, glancing at some news items, it seems that housing prices in many of the hottest cities (NYC, for example) have already started dropping.

    in reply to: Housing prices #237778 Reply
    Liked by AZPT
    Avatar Perry Ict 
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    Joined: 01/20/2019
    Earnest refinancing bonus

    Entrepreneur, MD,
    Yep index funds suck. Please borrow as much as possible and pick some stocks. Buy some crypto while you are at it.

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    I agree, diversifying into commercial real estate at this point is better than just continuing to put all your eggs into an old bull. I have more than I want there already. It’s been sideways for 18 months. A wasted 18 months versus the growth in my business, income, real estate, etc.

    I am not smart enough to pick stocks and don’t know enough about cryptocurrency. I’ll stick with 30 fold specialty fund returns, versus 3-4 fold index fund 10-year bull market return.

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    I don’t disagree that this stock market is “an old bull”, but you could say the same thing about real estate.

    in reply to: Time the Market with me! #237714 Reply
    Liked by Tangler
    Avatar Perry Ict 
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    My big worry is that the US will eventually have a decade or two or three like Japan.   I know its never happened before here 

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    The Nikkei is currently about 1/2 its 1989 value (and hasn’t paid a big dividend along the way), so I don’t think the US has experienced that, but LT real returns have been awful several times in the past — always following high valuation levels.

    From Shiller’s (first edition) Irrational Exuberance: The 5-, 10-, 15-, and 20-year total real returns following 1901, 1929, and 1966 were (percentages):

    1901: 3.4, 4.4, 3.1, and -0.2

    1929: -13.1, -1.4, -0.5, and 0.4

    1966: -2.6, -1.8, -0.5, and 1.9

    From dqydj.com:

    2000 (starting April after the March peak): -4.90, -2.95, 2.11, pending

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    Very informative, thank you.  From my conversations, it seems like a lot of investors right now aren’t willing to look at those examples and take them into account as possible scenarios for the future.

    in reply to: Time the Market with me! #236921 Reply
    Liked by Tangler, CM
    Avatar Perry Ict 
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    With all due respect, you missed the point (or maybe helped make the point), which is that people tend to ignore how cyclical these things are. Going back to 1999 up to the present time, that’s an entire 20+ year stretch that gold miners outperformed the stock market, and that’s even after the miners are way down from their peak in 2011 while the S&P 500 is at its all time high. I am not at all a gold bug (like I said, gold miners are only a small portion of my portfolio), but I find that fascinating when you consider how hated these stocks are by many mainstream investors. Anyway, Ray Dalio is one of the most successful investors in the world, so I would not be too dismissive of his ideas.

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    Okay. You found a 20 year period. But it started at a massive peak in stocks and the lowest nadir for gold in the last 30+ years.  Why aren’t you talking about a 15 year period or a 25 year period? Oh wait…I know the answer to that one.

    Same nonsense people did with the “lost decade” stuff for years.

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    I “found” a 20 year period? That 20 year period isn’t some random period picked out from the past when the s&p produced no returns. This is a 20 year period going back from TODAY. Today, as in, the S&P 500 is at RECORD HIGHS, and precious metals miners are at roughly a third their 2011 highs. So if you are accusing me “cherry picking” some random period to make it look like the S&P has done lousy and the miners have done as great as ever, then I’ve done an awful job “cherry picking”.

    And yes, to answer your question, some might dismiss my observation as ridiculous because, as you pointed out, there are other years we could look back to, like 2003 or 2010 where we get a result where the S&P outperforms, and thereby conform to the widely held belief of retail investors to just keep aggressively investing in the most popular US stocks/funds and ignore other asset classes, regardless of the market climate, because the mantra is that those US stocks/funds will always produce superior returns over 10-20 years. The point is, isn’t it helpful to also see the other possibilities (also ask yourself, is this market climate closer to 2000 or 2010?). As investors, regardless of what decisions we ultimately make (buy and hold S&P 500 and/or diversify, etc), do we really want to be blind to the less optimistic scenarios?

    in reply to: Ray Dalio and gold #234081 Reply
    Liked by PhotonsRGR8
    Avatar Perry Ict 
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    I’m curious how these replies would look if we weren’t in a bull market for the last 10 years.

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    Ditto. Most investors (in general, not necessarily people here) are most optimistic at the tops and most pessimistic at the bottoms.

    in reply to: 529 Allocation #233852 Reply
    Liked by TrumpMD, Lordosis
    Avatar Perry Ict 
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    Status: Physician
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    Joined: 01/20/2019

    With all due respect, you missed the point (or maybe helped make the point), which is that people tend to ignore how cyclical these things are. Going back to 1999 up to the present time, that’s an entire 20+ year stretch that gold miners outperformed the stock market, and that’s even after the miners are way down from their peak in 2011 while the S&P 500 is at its all time high. I am not at all a gold bug (like I said, gold miners are only a small portion of my portfolio), but I find that fascinating when you consider how hated these stocks are by many mainstream investors. Anyway, Ray Dalio is one of the most successful investors in the world, so I would not be too dismissive of his ideas.

    in reply to: Ray Dalio and gold #233623 Reply
    Liked by PhotonsRGR8
    Avatar Perry Ict 
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    Interesting article by Ray Dalio.  One takeaway for me on things like gold stocks is that most assets are cyclical even if they don’t seem like it, so it’s not a bad idea to diversify a little into less popular asset classes.  I’ve done so by putting a little bit of my portfolio in gold and silver miner etfs in the past couple months (So far so good on those).

    On that note, if you look back at the gold bugs index (“HUI”) since January 2000, and compare it with how the S&P 500 has done since January, 2000, HUI has actually outperformed the s&p 500, up about 300% compared to about 200% for the S&P. If I hadn’t looked, I would have guessed otherwise. Just one example of how the very recent past can distort our perception of reality.

    in reply to: Ray Dalio and gold #233568 Reply
    Liked by PhotonsRGR8
    Avatar Perry Ict 
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    Does anybody know what is typical for weeks of PTO (if any) for a 7 on 7 off neurohospitalist position?

    in reply to: Transitioning from outpatient to inpatient only #232087 Reply
    Avatar Perry Ict 
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    It’s funny that you should say that you should get paid 50-100K more.  I was listening to a podcast where someone was citing a study stating that everybody thinks that their lives would be so much better if they got paid 30% more then what they currently get paid.   It’s interesting, because it doesn’t matter how much you get paid, whether it’s 50K or 500K, everybody thinks that if they only got 30% more, their lives would be that much improved.

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    I think there’s a lot of good advice on this thread.  I quoted the above because, while some of your frustrations might be due to being relatively underpaid, you also have to ask yourself whether you would be totally happy with the situation if you were just paid more.  When it comes down to it, you are still working 60-80 hour weeks, basically working like a resident, and I wonder how sustainable that is even if your employer obliges with any salary increases.

    Avatar Perry Ict 
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    I’m sure you’ll be fine.  As Lordosis mentioned, a key to efficiency in the outpatient setting is knowing how to delegate your work.  That was one thing that I had to learn after training, since as a resident I was used to doing so much tedious work that didn’t necessarily require a medical degree. If you have a good proactive office staff, that can be very helpful and save you a lot of annoyances.  On the other hand, there are some nuisances that are hard to avoid – I find denials from insurance sometimes happen no matter how well I document (a simple phone conversation with insurance reiterating exactly what I documented usually gets the approval).

    Also, with regard to documentation, I’ve noticed a lot of physicians using medical scribes. I don’t use them, but if you find yourself struggling with tons of notes to write I’d imagine it could be helpful.

    in reply to: Transitioning from outpatient to inpatient only #229401 Reply
    Liked by Lordosis
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