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  • Avatar Roentgen 
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    Status: Physician
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    Joined: 03/02/2018

    To address the main point of the thread:

    CT scans as currently performed will shock future doctors.  High radiation exam (although getting less high as the years go by and we are attuned to it more as a profession) that seems to be used by many clinical physicians with little discretion.

    in reply to: Evolution of Medicine #253121 Reply
    Avatar Roentgen 
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    That’s part of the sociological needs, but humans need motivation to do what?  In a modern context, that would probably be to go to work, to make money, to buy stuff, to pay other people to go to work, etc.  But what if human labor is largely unnecessary?  You need some people to advance our knowledge base, but plenty (albeit likely a minority) of people would work on those things without external motivation.  What are we motivating everyone else to do?  I don’t know, but it’s fascinating to think about.
    I can’t speak for other humans but I can speak for myself. I need motivation to better myself whether that be financially, physically, mentally, etc. Human labor will always be necessary. The actual labor may change but not the need for it. The future you describe sounds like some dystopian movie and I don’t see humans going along with it. Are you saying everyone is provided basic necessities for life? Ok. What if I want something that is considered a luxury? Different people will want different things. I foresee lots of crime and war in a scenario like that.
    Click to expand…

    This is the future Earth as depicted in “The Expanse” series of sci-fi novels. Most people don’t work, government provides Universal Basic Income (simply called “Basic” in the novels), and to get into college you have to work first to prove you are able to be motivated etc or society doesn’t waste the resources educating you. It provides an interesting thought experiment.  Also in that series Mars terraforming has attracted the best scientists and most motivated people, who are attracted to the multigenerational project of changing a whole planet for human needs. This is all a small part of the high-quality world-building the authors are doing in those works.

    Of course The Matrix I think provides the best exposition of the need for motivation in human existence.

    in reply to: Evolution of Medicine #253104 Reply
    Liked by ScubaV
    Avatar Roentgen 
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    We just need a recession or bear market and people will have more interesting things to say!

    in reply to: Dead forum? #251042 Reply
    Avatar Roentgen 
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    I could go on and on, but for the sake of time I’ll thumbs up the Heinlein recommendation as well as The Expanse.

    Best thing I’ve read this week though is postings on the Wait But Why website.  His Elon Musk series is really great, but once you start rummaging around his web site there are just a ton of great postings.

     

    in reply to: What book(s) are you reading right now? #249640 Reply
    Liked by Lordosis
    Avatar Roentgen 
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    My sister has lived in Norway for over 20 years, she moved there in her early 20s and she has had health care both in USA and in Norway. This is an N of 1 but she really prefers care here. Care in Norway: long waits, no treatment for many problems, essentially seems like rationing. Interesting because i think we frankly might need some rationing here (end of life costs are not sustainable) but that is a difficult and complicated discussion. I think our system here has many problems but most people get great care. I think where we need to change is in end of life “futile” care for the elderly. Touchy difficult subject and i don’t claim to have a magic answer but people seem to want unlimited free healthcare AND no limits on cost/options. I don’t think you can have “free” anything for everyone and have unlimited options + great quality. Something has to give. How you decide who gets what, and who makes that decision etc. is beyond difficult. I feel sorry for the ICU folks as they get emotionally burned on this stuff all the time. Oh as for the original Q: candidates? Who knows. I wish we had a middle of the road candidate who was intelligent, fiscally responsible and was going to decrease spending and decrease the federal deficit. I would honestly be less worried / annoyed about tax increases if spending was also decreased. Wish the WCI would run as an independent. i would vote for him easy!

    Click to expand…

    Tangler you are describing a fundamental  dynamic to any sort of government provided health care, “The Iron Triangle of Health Care.”  You can create a system where you can get two of these three things – access, low cost, or high quality – but really only two of the three, because something has to give.  So which two of the three will the American public widely accept?  I think when we look at other publicly provided health care programs, the Iron Triangle is at play in identifiable processes.

    in reply to: Which democratic candidate has best policy for doctors #246903 Reply
    Avatar Roentgen 
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    if medicare for the elderly can work, I do not see why medicare for all won’t work.

    Instead of thinking about what benefits physician, the right question to ask is..what will improve the patient care?

    the data is straightforward….it works in most of the developed countries. And doctors are living comfortably there.

     

    I believe that we are in a bubble and most of the money is getting sucked into the healthcare industry. Growth of healthcare cost, premiums etc is highly disproportionate to average salaries. Although policies like Obamacare or medical for all won’t solve all the problems but are the steps in the right direction.

     

    Click to expand…

    It’s interesting that here in America we have an example of a nationalized system in the Vet Administration hospitals, and a different example of a “Medicare for all” option insurance company in Medicare, and yet another “public option” in Medicaid.  So that variety can tell us what the future would look like under different possibilities.  It’s not like we are considering these in a vacuum.

    in reply to: Which democratic candidate has best policy for doctors #246882 Reply
    Liked by Tangler
    Avatar Roentgen 
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    “I have read of the very wealthy superfunding 529 plans (even in multiple states) as a way to transfer wealth and also achieve tax protected growth.  I have also heard of 529 plans being used as a tax deferred wealth accumulation vehicle, if the 529 owner will be in a much lower tax bracket in retirement (to overcome the 10% penalty).  Does Mr. Kitces see any changes coming to 529 plans, perhaps due to unintended planning practices around their use, or because they will come to be seen as a benefit only for ‘the wealthy?’ “

    in reply to: Bringing Michael Kitces on the Podcast #239955 Reply
    Avatar Roentgen 
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    Another vote for diagnostic radiology (not interventional radiology.)  Also, Nuclear Medicine which is a residency that can be entered into from Internal Medicine OR Radiology, and is 18% diagnostic, and totally 9-5 job.  Rad Onc is a great suggestion too.

    Avatar Roentgen 
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    There was a recent thread over on the bogleheads forum about what real rates people use for their planning that got me thinking about whether my assumption for my planning is reasonable. What real rate do you use (or would you suggest) with the following assumptions: an 80/20 or 75/25 portfolio and investing for 25-30 years (i.e. for someone now in their early 30s).

    I was surprised to see that most folks over on the other thread were saying they would use a 1% to 2.5% real rate, with a few outliers saying they use 3% to 4.5% (and maybe one person saying they’d use 5%+). There were lots of cautions to not use anything too optimistic, which seems to them to be anything more than 1.5% or 2.0%.

    Does that seem right to you? What do you use? If a real rate of 2.0% to 2.5% or so really is realistic, it seems pretty challenging for most people (including a lot of medium- and high-income earners) to comfortably get to a point where they can retire with $100k or $120k per year coming from their investments (using a 4% or 3% rule for the required size of a portfolio at retirement), particularly if they want to do it before age 60 or so.

    Thoughts?

    Click to expand…

    For US stocks: The dividend yield plus the LT real growth rate of earnings (1.25% according to Siegel, and about 1.5% according to Arnott, and about 1.55% from Shiller’s spreadsheet IIRC) minus a haircut for a fall in valuation. That is, I apply a PE10 of 15 to 20 at my horizon of interest. That change (i.e., decline) in valuation is very important over short horizons, but less so over long horizons.

    For bonds: The real yield on TIPS.

    Click to expand…

    Sounds like you are an acolyte of William Bernstein’s work.  My assumptions are basically the same.

    in reply to: What is a reasonable real rate of return? #235833 Reply
    Liked by Tangler
    Avatar Roentgen 
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    I say “I’m Firstname Lastname, one of the radiology doctors who work here.”  Both personal and also links the fact that radiologists are doctors.

    in reply to: How to address NPs and PAs in letters #234900 Reply
    Liked by ENT Doc
    Avatar Roentgen 
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    Not sure what Portlandia is referring to, but the Pension Benefit Guarantee Corporation is specifically meant to address the risk of individual pensions failing.

    in reply to: The Retirement “Reform” Continues #234655 Reply
    Avatar Roentgen 
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    We had a primary care clinician in our system with a DNP (Doctor of Nurse Practitioner) degree.  He requests to be addressed as “Dr.” Smith. That’s a mind bender for me.

    in reply to: How to address NPs and PAs in letters #233733 Reply
    Avatar Roentgen 
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    My sister asked me to review the investments her WF “advisor” put her retirement money in.  I ran into the same issue – I couldn’t do it – there is no available data on the funds they were using for her.  I gave it back to her and said that WF as a company has a track record of institutionalized abuse of their clients and that this whole things makes me deeply suspicious.  Would love to hear if anyone else found a solution to this problem?

    in reply to: How to evaluate funds without a ticker symbol? #232806 Reply
    Avatar Roentgen 
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    If anyone wants a fun read or TV viewing experience that is set in human civilization after the colonization of the moon, Mars, asteroid belt, and much of the Solar system, consider reading “The Expanse” series of sci-fi books or watch the 3 (soon to be 4) seasons of The Expanse on TV (was on Sci-Fi network, switching to Amazon network this fall.) I prefer the books, they get into the science and practical realities of such a world in a much more scientifically accurate way.

    in reply to: Tonight is Apollo 11 night #232223 Reply
    Avatar Roentgen 
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    Congratulations to you and your wife!  If you have read the books you describe, found this website (and this forum in particular), and really paid attention to what they contain then you are in a fabulous position, already wiser than 95% of your fellow medical professionals. Now you need to act on those principles and use your resources to meet the goals you and your spouse decide are important!

    However, its impossible for any of us to comment intelligently on your post unless you list out your debts, as well as the expected amount and nature of the “lucrative buy-in opportunity.”  The specific amounts matter greatly, as well as the form; student loans, car loans, home mortgage(s) with terms (15 vs 30 year, rate of interest, amount of equity so far in home). But if you list that you will likely get a really good analysis of your situation from forum members, who like to help folks just like you.  You already listed the income as $1 million, so that helps us understand the inflow part of the equation, but now we need to know the balance sheet.

    These forums are anonymous, so you shouldn’t have to worry about privacy/being identified.

    in reply to: High income early in career #229310 Reply
    Liked by SLC OB, Infinity
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