EM & Medicine - Plans to take today

[cyanide12345678]

It might be a case that the grass is greener...

100k would afford me a couple live-in maids and a driver in Malaysia or Thailand. Lol

$1500/month 15-20 years ago afforded our family in pakistan a cook, a driver, a maid for cleaning and a gardener.

Had never held a job or done household chores before moving to America for college. Actually didn’t even have to get up to get a glass of water, just would ask the household help for one and it would be there.

I don’t think Americans know the luxurious life money can buy in these cheaper countries.

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[JacobMcCandles]

$1500/month 15-20 years ago afforded our family in pakistan a cook, a driver, a maid for cleaning and a gardener.

Had never held a job or done household chores before moving to America for college. Actually didn’t even have to get up to get a glass of water, just would ask the household help for one and it would be there.

I don’t think Americans know the luxurious life money can buy in these cheaper countries.

People just hanging around my house waiting on me to ask them to do things? Strong pass. Having non-family/friends around the house all the time is not luxurious to me.

 

[HemorrhagicShock]

People just hanging around my house waiting on me to ask them to do things? Strong pass. Having non-family/friends around the house all the time is not luxurious to me.

He's using it as an example of the luxury and lifestyle that one can experience outside the US. Fine, don't have live-in maids and help, that's not the point. It's simply illustrative of how far your money can go to create a rich and full life, one that is fairly inaccessible to those in the US unless you make "f*ck you" levels of money.

 

[Splenda88]

He's using it as an example of the luxury and lifestyle that one can experience outside the US. Fine, don't have live-in maids and help, that's not the point. It's simply illustrative of how far your money can go to create a rich and full life, one that is fairly inaccessible to those in the US unless you make "f*ck you" levels of money.

Even in Portugal which is part of the European Union, 400k will go very far. Minimum wage there is 741 euros per month (~$810).

You also don't have to worry about someone gun you down in a mall or a grocery store while you are carrying out your usual daily activities.

 

[JacobMcCandles]

He's using it as an example of the luxury and lifestyle that one can experience outside the US. Fine, don't have live-in maids and help, that's not the point. It's simply illustrative of how far your money can go to create a rich and full life, one that is fairly inaccessible to those in the US unless you make "f*ck you" levels of money.

I understand the example he was using. If I don't want drivers and live-in maids, I don't see much use to live so far away from friends, family, things I enjoy, etc. I suspect many more people are similar which is why it's not incredibly common for people to retire and then move to those kinds of places. Sure, people do it but not near the number of people who talk about it.

 

[HemorrhagicShock]

I understand the example he was using. If I don't want drivers and live-in maids, I don't see much use to live so far away from friends, family, things I enjoy, etc. I suspect many more people are similar which is why it's not incredibly common for people to retire and then move to those kinds of places. Sure, people do it but not near the number of people who talk about it.

Yep! This is why my wife and I haven't considered escaping to another country either. Too many friends and family around, and I don't know if I would want to raise our kid outside of the US either. We lucked out - the neighborhood we live in has amazing schools and it would be hard to give that up.

Maybe once we're 60+, who knows?

 

[HemeOncHopeful19]

Even in Portugal which is part of the European Union, 400k will go very far. Minimum wage there is 741 euros per month (~$810).

You also don't have to worry about someone gun you down in a mall or a grocery store while you are carrying out your usual daily activities.

You could always just have your groceries deliveries I guess but I feel the danger of grocery or mall shopping is not that high.

Life expectancy in Portugal is basically the same as in the US.

 

[cyanide12345678]

People just hanging around my house waiting on me to ask them to do things? Strong pass. Having non-family/friends around the house all the time is not luxurious to me.

It’s hard for you to imagine it because you haven’t lived that life.

There isn’t really as much of a privacy issue, plus you chose how you want things. For example, a lot of upper middle class homes have ‘servant quarters’. So yeah…. Just like how homes here have mother in law suites, homes there have ‘servant quarters’.

The cleaning lady would come in do her cleaning and leave, she would work on multiple households. The driver would literally just be sitting in the front yard, not inside your home, he would essentially act as the equivalent of a New York apartment door man, until you stepped out and needed to go somewhere. Then we had a person who lived in the servant quarters, would show up to cook breakfast, would do dishes and then go back to his place, he would then show up for lunch and so on. You actually don’t have people hovering over you. You live your life, but if you need something, you have assistance available. For example, we literally had a button in our home that would ring a bell in the quarters.

You know…. I’ve lived a life where i do all the chores and a life where i do none of them - the life where i didn’t have to do any cooking, cleaning, laundry, clothes folding, vacuuming, or mowing is the better life.

You don’t have to have that life - but you can afford it with probably 2500 dollars a month in pakistan now that things have gotten a little expensive. Unfortunately pakistan is very politically unstable and unsafe, but the quality of life is incredible if you have money. Just too unsafe right now to actually be there.

 

[emergentmd]

It’s always hilarious when people pretend the quality of life in America isn’t great, especially for someone making a physician income.

Some people just live in a dark place where nothing makes them happy. They think going to another country would be so much better but they never leave. They are full of rainbows and devoid of reality. It is great to focus on the bad and complain, its the American way.

I don't think anyone is saying America is perfect.

I have been to Asia, Europe. I could easily live in a SE Asia country on my current retirement with a maid/cook/driver until I die. Cheaper, yes. Better lifestyle, IMO, no way. Nothing beats the diversity and ease of living than America.

 

[cyanide12345678]

Some people just live in a dark place where nothing makes them happy. They think going to another country would be so much better but they never leave. They are full of rainbows and devoid of reality. It is great to focus on the bad and complain, its the American way.

I don't think anyone is saying America is perfect.

I have been to Asia, Europe. I could easily live in a SE Asia country on my current retirement with a maid/cook/driver until I die. Cheaper, yes. Better lifestyle, IMO, no way. Nothing beats the diversity and ease of living than America.

America is great, it has just taken a turn for the worst in the last 7-8 years and the trajectory isn’t that great.

I would pick America probably over 90 percent of the world countries.

But it’s become a very divided country. There’s more hate now and the country isn’t doing enough about gun violence. It’s not a good path this country is on right now.

I think in the next 2-3 decades, we will all witness the decline of this empire.

 

[JacobMcCandles]

It’s hard for you to imagine it because you haven’t lived that life.

There isn’t really as much of a privacy issue, plus you chose how you want things. For example, a lot of upper middle class homes have ‘servant quarters’. So yeah…. Just like how homes here have mother in law suites, homes there have ‘servant quarters’.

The cleaning lady would come in do her cleaning and leave, she would work on multiple households. The driver would literally just be sitting in the front yard, not inside your home, he would essentially act as the equivalent of a New York apartment door man, until you stepped out and needed to go somewhere. Then we had a person who lived in the servant quarters, would show up to cook breakfast, would do dishes and then go back to his place, he would then show up for lunch and so on. You actually don’t have people hovering over you. You live your life, but if you need something, you have assistance available. For example, we literally had a button in our home that would ring a bell in the quarters.

You know…. I’ve lived a life where i do all the chores and a life where i do none of them - the life where i didn’t have to do any cooking, cleaning, laundry, clothes folding, vacuuming, or mowing is the better life.

You don’t have to have that life - but you can afford it with probably 2500 dollars a month in pakistan now that things have gotten a little expensive. Unfortunately pakistan is very politically unstable and unsafe, but the quality of life is incredible if you have money. Just too unsafe right now to actually be there.

Just not the life for my family. I enjoy cleaning. My wife loves to cook. I like to think I’m super important but I don’t need a driver to maximize my efficiency and I have not had awesome passenger experiences in foreign countries. Even if I did want those things there’s just way too many things/people I’d miss that I could only get in America.

 

[Yale Medicine]

America is great, it has just taken a turn for the worst in the last 7-8 years and the trajectory isn’t that great.

I would pick America probably over 90 percent of the world countries.

But it’s become a very divided country. There’s more hate now and the country isn’t doing enough about gun violence. It’s not a good path this country is on right now.

I think in the next 2-3 decades, we will all witness the decline of this empire.

If the USA falls in 20 years, move to El Salvador where Bitcoin is the standard.

 

[emergentmd]

America is great, it has just taken a turn for the worst in the last 7-8 years and the trajectory isn’t that great.

I would pick America probably over 90 percent of the world countries.

But it’s become a very divided country. There’s more hate now and the country isn’t doing enough about gun violence. It’s not a good path this country is on right now.

I think in the next 2-3 decades, we will all witness the decline of this empire.

I agree with the slow downfall. I will save money, so when crap does hit the fan, I can move to somewhere better. Its just not right now and when the US does hit the fan, I am sure most will too...

 

[MechEDoc]

Any docs who wants a low risk avenue to retirement should just throw 10K in the S&P each month and in 5 years have over 1M. Sit back, never check it, and at age 50, you should be over 4M. Nothing wrong with this but you also missed a big benefit of being a high income worker which is leverage.

RE/Syndications are all about leverage. If you put 50K into a syndication and it goes up 20-30%, in 3 yrs then you have doubled your money. If you put it in a Stock market REIT then your 50K has gone up 20-30%. When the syndication closes, you can 1031 into another tax free. If you want to sell a REIT and put it into another, then you have to pay 20%+ taxes.

Both you can lose all of your money and no more.

Its a no brainer to me. If you have access to good operators, Apt/storage syndication all the way.

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Camden and Mid America are some of the larger REITS operates in the Class A/B sector. Both over 5 yrs has gone up 20-40% with about 5% yield.

The syndication I have been in over 2-3 yrs have doubled with 8% yield. This makes sense as the syndication are leveraged 3-4x

Do these syndications provide deductions that can be used to offset passive income? I will likely a one off of ~160k of passive income and I would love to reduce my tax burden.

 

[cyanide12345678]

Do these syndications provide deductions that can be used to offset passive income? I will likely a one off of ~160k of passive income and I would love to reduce my tax burden.

Yes. Make sure to pick syndications that will do a cost segregation analysis for the 80 percent bonus depreciation to maximize depreciation losses.

Passive losses can ONLY be used to offset passive income.

 

[emergentmd]

As Cyn said, yes they do.

I have rental properties with property managers = passive income
My medical business has some classified passive ownership = passive


The syndications I have been in essentially goes like this and I bet most good operators do it this way for tax benefits.

Put 100K into syndication. Next yr K1 comes showing close to 100K loss and I believe these loses goes against my active income (1099). So eventhough the syndications are passive, I get a large active income offset.

I started syndications prob 4 yrs ago and doubled my money in avg of 2 yrs but it was a hot RE market so I doubt this will happen again with high interest rates/less VC money around. But syndications have been my 2nd best return on money even better than my personal RE holdings which takes some work.

If you have no interest in RE, have 50K to throw around, I recommend putting it in to a syndication and would be a good learning process. As with any business, the operators matters the most. When syndications became really popular 5-10 yrs ago, you started to see operators pop up like weeds.

 

[GassYous]

America is great, it has just taken a turn for the worst in the last 7-8 years and the trajectory isn’t that great.

I would pick America probably over 90 percent of the world countries.

But it’s become a very divided country. There’s more hate now and the country isn’t doing enough about gun violence. It’s not a good path this country is on right now.

I think in the next 2-3 decades, we will all witness the decline of this empire.

Doubt it. There are no viable alternatives for a hegemon at this time. No one can project power like America can. There are two large oceans and two friendly neighbors here. You can't even get close without being shot out of the water. Meanwhile the two major rivals can't control territory right next door. No one has the knowledge, resources, logistics and wherewithal that America commands.

 

[cyanide12345678]

Put 100K into syndication. Next yr K1 comes showing close to 100K loss and I believe these loses goes against my active income (1099). So eventhough the syndications are passive, I get a large active income offset.

I don't think you can do that. But if the IRS is letting it fly, I guess you could keep doing it. But you cannot use your passive depreciation losses against your active 1099 income. Had a long talk with my accountant about this last year and they confirmed that I couldn't do it - Had 90k of passive losses last year and plenty of 1099 income to count it against, but instead I had to roll my losses forward to this year's taxes. Will keep rolling losses to offset rental income and gains from sales.

 

[emergentmd]

I don't think you can do that. But if the IRS is letting it fly, I guess you could keep doing it. But you cannot use your passive depreciation losses against your active 1099 income. Had a long talk with my accountant about this last year and they confirmed that I couldn't do it - Had 90k of passive losses last year and plenty of 1099 income to count it against, but instead I had to roll my losses forward to this year's taxes. Will keep rolling losses to offset rental income and gains from sales.

I stand corrected. Syndication is passive going against my passive business income.

 

[HemorrhagicShock]

I stand corrected. Syndication is passive going against my passive business income.

If you don't mind educating a small-time pit doc on this one: what are some examples of things that count as passive business income? What counts as active?

 

[JacobMcCandles]

If you don't mind educating a small-time pit doc on this one: what are some examples of things that count as passive business income? What counts as active?

Consider active income something you materially participate in and passive income something where you aren’t really participating or making the decisions.

Active Income: Overview, Examples vs Passive Income

Active income refers to income received for performing a service. Wages, tips, salaries, and commissions are all examples of active income.

www.investopedia.com

Passive Income: What It Is and Ideas for 2024

Passive income is earnings from a rental property, limited partnership, or other enterprise in which a person is not actively involved.

www.investopedia.com

 

[JacobMcCandles]

I don't think you can do that. But if the IRS is letting it fly, I guess you could keep doing it. But you cannot use your passive depreciation losses against your active 1099 income. Had a long talk with my accountant about this last year and they confirmed that I couldn't do it - Had 90k of passive losses last year and plenty of 1099 income to count it against, but instead I had to roll my losses forward to this year's taxes. Will keep rolling losses to offset rental income and gains from sales.

The IRS isn’t letting it fly. I suspect if the IRS ever gets fully staffed then we’ll see some people in a world of hurt.

 

[DoctorMD1]

It’s hard for you to imagine it because you haven’t lived that life.

There isn’t really as much of a privacy issue, plus you chose how you want things. For example, a lot of upper middle class homes have ‘servant quarters’. So yeah…. Just like how homes here have mother in law suites, homes there have ‘servant quarters’.

The cleaning lady would come in do her cleaning and leave, she would work on multiple households. The driver would literally just be sitting in the front yard, not inside your home, he would essentially act as the equivalent of a New York apartment door man, until you stepped out and needed to go somewhere. Then we had a person who lived in the servant quarters, would show up to cook breakfast, would do dishes and then go back to his place, he would then show up for lunch and so on. You actually don’t have people hovering over you. You live your life, but if you need something, you have assistance available. For example, we literally had a button in our home that would ring a bell in the quarters.

You know…. I’ve lived a life where i do all the chores and a life where i do none of them - the life where i didn’t have to do any cooking, cleaning, laundry, clothes folding, vacuuming, or mowing is the better life.

You don’t have to have that life - but you can afford it with probably 2500 dollars a month in pakistan now that things have gotten a little expensive. Unfortunately pakistan is very politically unstable and unsafe, but the quality of life is incredible if you have money. Just too unsafe right now to actually be there.

Would you consider to retire at a place where those things standard? if yes, which countries would you consider? thanks

 

[cyanide12345678]

Would you consider to retire at a place where those things standard? if yes, which countries would you consider? thanks

Absolutely would consider moving. It would be so damn nice never to do laundry again. I feel like a lot of my days off go towards adulting - i hate adulting . The only two things keeping me here right now are my current paycheck and the opportunities my child will have. Because the US does have more opportunities than other parts of the world. I’m just starting to get in a phase of life where I’m reaping the benefit of the opportunities and will no longer need further opportunities.

Im anticipating to be in a place where i don’t ‘need’ a paycheck in 4-5 years, so age 38-39.

Places that we are giving some real consideration.

Kuala lumpur Malaysia. Low cost of living, seems very reasonably safe. Cheap labor, easy to afford household help. English widely spoken, beautiful tropical beaches nearby. Cons - weather is a little too hot for my personal taste. While 70 percent of the population speaks English, it is not the first language there. Higher Education system is meh…but 100 miles away is singapore where the educational system is one of the best of the world - for example the national university of Singapore is truly a world class institute.

Dubai/abu dhabi/kuwait/qatar - haven’t really looked into these countries but if money was no object since dubai is kind of expensive, then i think it’s a solid choice - safe, American curriculum schools, can even practice in these places and make 200-300k with minimal local taxes. Can definitely find household help if you have money. The language barrier however will exist since i don’t speak Arabic. And man….i hate 120 degree weather. Some of these Arab countries make it very difficult for foreigners to own property though.

Valencia/algarve or some other place in spain or portugal. But language issues still exist. I’ve never been to these places but seems like they are highly preferred by expats. All the websites seem to put these places at the top of all lists.

Other places to consider: bahamas, singapore, belize, canada. Singapore is wayyyyyy more expensive so I’ll probably never go there lol.

 

[emergentmd]

Canada would be one of the last places I would think. Its just as if not more expensive, cold, wet to the west.

I have 3 Americanized kids who will hopefully have grandkids so doubt we will leave America which is great with me. I am also Americanized and have grown accustomed to the ease of living due to access. I mean, I can get anything anytime here which doesn't happen in almost any other country.

So Probably when kids are in College, we will do month long trips abroad.

If I really considered living in another country, the middle east is way toooooo hot and socially restrictive. I don't see South America being much better.

I would look to SE asia. Vietnam is super cheap, food is good, lots of Expat areas. Its communist by government but functions as a capitalistic society. .

I would start by doing a 3-6 month world cruise, experience the different places and then decide where you would want to be.

 

[DoctorMD1]

Absolutely would consider moving. It would be so damn nice never to do laundry again. I feel like a lot of my days off go towards adulting - i hate adulting . The only two things keeping me here right now are my current paycheck and the opportunities my child will have. Because the US does have more opportunities than other parts of the world. I’m just starting to get in a phase of life where I’m reaping the benefit of the opportunities and will no longer need further opportunities.

Im anticipating to be in a place where i don’t ‘need’ a paycheck in 4-5 years, so age 38-39.

Places that we are giving some real consideration.

Kuala lumpur Malaysia. Low cost of living, seems very reasonably safe. Cheap labor, easy to afford household help. English widely spoken, beautiful tropical beaches nearby. Cons - weather is a little too hot for my personal taste. While 70 percent of the population speaks English, it is not the first language there. Higher Education system is meh…but 100 miles away is singapore where the educational system is one of the best of the world - for example the national university of Singapore is truly a world class institute.

Dubai/abu dhabi/kuwait/qatar - haven’t really looked into these countries but if money was no object since dubai is kind of expensive, then i think it’s a solid choice - safe, American curriculum schools, can even practice in these places and make 200-300k with minimal local taxes. Can definitely find household help if you have money. The language barrier however will exist since i don’t speak Arabic. And man….i hate 120 degree weather. Some of these Arab countries make it very difficult for foreigners to own property though.

Valencia/algarve or some other place in spain or portugal. But language issues still exist. I’ve never been to these places but seems like they are highly preferred by expats. All the websites seem to put these places at the top of all lists.

Other places to consider: bahamas, singapore, belize, canada. Singapore is wayyyyyy more expensive so I’ll probably never go there lol.

Thanks for sharing your perspective. Malaysia does sound great. I am thinking about working remotely from Malaysia and see how it goes.

 

[DoctorMD1]

Canada would be one of the last places I would think. Its just as if not more expensive, cold, wet to the west.

I have 3 Americanized kids who will hopefully have grandkids so doubt we will leave America which is great with me. I am also Americanized and have grown accustomed to the ease of living due to access. I mean, I can get anything anytime here which doesn't happen in almost any other country.

So Probably when kids are in College, we will do month long trips abroad.

If I really considered living in another country, the middle east is way toooooo hot and socially restrictive. I don't see South America being much better.

I would look to SE asia. Vietnam is super cheap, food is good, lots of Expat areas. Its communist by government but functions as a capitalistic society. .

I would start by doing a 3-6 month world cruise, experience the different places and then decide where you would want to be.

"I can get anything anytime here which doesn't happen in almost any other country." - Can you give an example of things not available in europe, but available in US? Thanks.

 

[RustedFox]

"I can get anything anytime here which doesn't happen in almost any other country." - Can you give an example of things not available in europe, but available in US? Thanks.

3 AM DoorDash

 

[HemeOncHopeful19]

"I can get anything anytime here which doesn't happen in almost any other country." - Can you give an example of things not available in europe, but available in US? Thanks.

Good salary

 

[cyanide12345678]

Thanks for sharing your perspective. Malaysia does sound great. I am thinking about working remotely from Malaysia and see how it goes.

Can’t see patients who use Medicare or Medicaid while being settled internationally

 

[TooMuchResearch]

Can’t see patients who use Medicare or Medicaid while being settled internationally

Do you have a reference on this?
We have a night telehospitalist at a rural site that reportedly lives in Europe (can confirm I hear children in the background during what would be AM hours there). Would the hospital just eat admission H&P costs? Maybe they can still bill for hospital services and physician billing would just be the day shift rounder?

 

[HemeOncHopeful19]

Do you have a reference on this?
We have a night telehospitalist at a rural site that reportedly lives in Europe (can confirm I hear children in the background during what would be AM hours there). Would the hospital just eat admission H&P costs? Maybe they can still bill for hospital services and physician billing would just be the day shift rounder?

I came across this article which seems to touch on the exact situation you are describing but with ICU coverage

Doctors Outside US Cannot Bill Medicare for Telehealth, Court Confirms

RemoteICU, a telehealth company that has been fighting a legal battle to enable its physicians outside the U.S. to receive Medicare payments during the pandemic, has lost its appeal.

mhealthintelligence.com

 

[CoolDoc1729]

I came across this article which seems to touch on the exact situation you are describing but with ICU coverage

Doctors Outside US Cannot Bill Medicare for Telehealth, Court Confirms

RemoteICU, a telehealth company that has been fighting a legal battle to enable its physicians outside the U.S. to receive Medicare payments during the pandemic, has lost its appeal.

mhealthintelligence.com

I mean. I feel like EM and CC are not that suitable to be done remotely anyway, but what difference does it make to the government where the provider is located for a remote-appropriate service ? Kind of odd. I could see there being issues with fraud but I’m sure there already are lol

 

[TooMuchResearch]

I mean. I feel like EM and CC are not that suitable to be done remotely anyway, but what difference does it make to the government where the provider is located for a remote-appropriate service ? Kind of odd. I could see there being issues with fraud but I’m sure there already are lol

A couple of small places I work have inpatient tele ICU coverage. They can assist hospitalist with recommendations, BIPAP, advise earlier transfer, etc and ideally avoid the floor rapid response or code at which point I get involved.

 

[MechEDoc]

"I can get anything anytime here which doesn't happen in almost any other country." - Can you give an example of things not available in europe, but available in US? Thanks.

Lots of consumer items are available much more cheaply in America.

Also, guns.

 

[TooMuchResearch]

Lots of consumer items are available much more cheaply in America.

Also, guns.

And guns can be used to obtain consumer items at a significant discount. Not financial advice.

 

[cyanide12345678]

Do you have a reference on this?
We have a night telehospitalist at a rural site that reportedly lives in Europe (can confirm I hear children in the background during what would be AM hours there). Would the hospital just eat admission H&P costs? Maybe they can still bill for hospital services and physician billing would just be the day shift rounder?

Doctors Outside US Cannot Bill Medicare for Telehealth, Court Confirms

RemoteICU, a telehealth company that has been fighting a legal battle to enable its physicians outside the U.S. to receive Medicare payments during the pandemic, has lost its appeal.

mhealthintelligence.com

Can I Do Telemedicine From Abroad?

Can you do telemedicine while abroad? Can you travel and still see US patients and bill for it? Yes. But you can't if they are CMS patients.

www.digitalnomadphysician.com

 

[GassYous]

Can’t see patients who use Medicare or Medicaid while being settled internationally

That is too sad

 

[DoctorMD1]

Can’t see patients who use Medicare or Medicaid while being settled internationally

I am a rad. No, I can not give final read on medicare/medicaid patient, but can give prelim on emergency cases and there are plenty of those

 

[cyanide12345678]

I am a rad. No, I can not give final read on medicare/medicaid patient, but can give prelim on emergency cases and there are plenty of those

Right, the night hawk rad essentially does not do billing and the morning group that over reads the images does the billing.

Yes that is completely possible to do as a radiologist. But as an EM doc, that is harder to accomplish if i was doing telemedicine. Im sure if i looked i could find opportunities where billing is cash only. But if you are billing Medicare while living outside of the US you could be potentially committing Medicare fraud.

 

[RustedFox]

And guns can be used to obtain consumer items at a significant discount. Not financial advice.

This made me laugh SO hard.

 

[emergentmd]

"I can get anything anytime here which doesn't happen in almost any other country." - Can you give an example of things not available in europe, but available in US? Thanks.

I am not sure if you are being factitious, but from my experience

1. I can get something at the 24 hr supermarket/CVS/Pharmacy/Walmart 24.
2. I got a cash paid MRI of my ankle in 3 dys for $375
3. I can get food 24 hrs a day including sit down diners
4. I can walk into 10 ERs within a 30 min drive from my house and some have zero waits.
5. I can get 10 different types of food throughout the day
6. I can go to my gym almost 24 hrs a day
7. There are 7 golf courses within a 20 min drive of my home

There really are not many places like a big city in America when it comes to variety and access if you have money.

 

[DoctorMD1]

Right, the night hawk rad essentially does not do billing and the morning group that over reads the images does the billing.

Yes that is completely possible to do as a radiologist. But as an EM doc, that is harder to accomplish if i was doing telemedicine. Im sure if i looked i could find opportunities where billing is cash only. But if you are billing Medicare while living outside of the US you could be potentially committing Medicare fraud.

Correct. You can only bill Medicare if you are on US soil.

 

[bravotwozero]

Lots of consumer items are available much more cheaply in America.

Also, guns.

Guns are definitely available in other countries, just not as easy to acquire. Not necessarily a bad thing.

On the flip side, lots of other countries have good, efficient high speed rail and transit, something not found here.

 

[JacobMcCandles]

On the flip side, lots of other countries have good, efficient high speed rail and transit, something not found here.

I think that is more of a demand issue. Enough Americans just aren't interested in high-speed rail for it to make sense from multiple angles.

 

[HemeOncHopeful19]

I think that is more of a demand issue. Enough Americans just aren't interested in high-speed rail for it to make sense from multiple angles.

I used to be interested in it but I now recognize that we don’t have the population density compared to Europe for it to make sense in a lot of areas, and for those areas where it would make sense they are (IMO) more than welcome to fund it locally but I don’t see why I should have to pay for it federally.

There are various “projects” underway in California, Florida and Texas IIRC that appear to be mired in various states of corruption with nothing to show for the billions spent on them.

Edit: keep in mind there is not a single country in Europe that is even the size of Texas for example

 

[Birdstrike]

Emergency Medicine is God's work. Chances are you're doing it.

 

[MechEDoc]

I think that is more of a demand issue. Enough Americans just aren't interested in high-speed rail for it to make sense from multiple angles.

Having lived in a European country for 3 years, I think railroads are typically a population density issue. Also, the places that could support them in the USA are too politically dysfunctional to pull it off (e.g. need eminent domain without extensive litigation, etc).

 

[MechEDoc]

Yes. Make sure to pick syndications that will do a cost segregation analysis for the 80 percent bonus depreciation to maximize depreciation losses.

Passive losses can ONLY be used to offset passive income.

Do you have recommendations for where to start with regards to syndications? I'm looking for something on the safer end of the spectrum. With stocks and bonds I'm a Vanguard person (either total stock and total bond market index funds). Any good primers for educating myself on syndications?

Thanks!

 

[cyanide12345678]

Do you have recommendations for where to start with regards to syndications? I'm looking for something on the safer end of the spectrum. With stocks and bonds I'm a Vanguard person (either total stock and total bond market index funds). Any good primers for educating myself on syndications?

Thanks!

Open door capital has an open deal that is currently 70 ish percent subscribed, so it’s probably going to close soon.

It’s 3 apartment buildings in Texas - 1 in katy, 1 in stafford, one in Austin. Katy is the best suburb of Houston, stafford is essentially sugar land, it’s right next to it, which is again a very desirable suburb. And Austin is Austin. 673 units total.

These apartments were on sale for 136 million last year, but they are now under contract for 111 million - $25 million discount to last listing price.

Plus it comes with fixed 3.8 percent debt for another 7 years which makes it a very safe deal especially given the 60 percent ltv. And i believe Sponsor is putting in 30 percent of the money - 17 million i think as far as i remember

I’m going in on the deal if they drop their minimum to 50k. Hopefully they do. If they stick with their 100k minimum then I’m probably not doing it.

Do your due diligence.