Daily reminder to do the bare minimum

Started by GonnaBeADoc2222
Panacea Financial Contract Review
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Arcan57 said:
Act 3 slowed down on my pretty recent desktop rig. The most intense parts of Act 3 are turn-based so none of the intermittent chugging messes with gameplay. Finished my obligatory bard run-through, trying to decide what to play as next since a killed a decent number of possible companions outright my first time and missed out on a decent amount of quest completions in Act 2 due to not realizing I'd be locked out of certain events during a specific moment the game warns you about. In general it seems like there's always a way to pick up your companions' quests but a quest that's act specific needs to be completed prior to when the game asks if you really want to continue.
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My current play through is a Dragonborn half elf Sorcerer which is reasonable solid as a charisma face and blaster. I’ve been playing it pretty white-hat and have collected too many companions for my own good, and of course they all want to visit me at camp…

My try paladin next, though bard also tempting… or a front line heavy armor cleric
 
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GonnaBeADoc2222 said:
This all day long. My shop was offering not even a 1.5x bonus. Get the F out. I won't get out of bed for less than 2x. The simps with the 7k sq ft houses scoopin them up tho.
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One of the guys I work with does 18-20 shifts a month, picks up patients until the last minute of his shift, and then sticks around 2-3 hours to get them dispo’d. He has been doing this for YEARS! 😬

Go get that cheese my man …
 
Mount Asclepius said:
Do the bare maximum and don't save the bare minimum. You'll end up with more choices.
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Good thread of responses regarding what happens to a small difference in income/savings over the course of 20+ years.

The closer you get towards concluding your career, the less the income differential matters – then the calculus between work-life balance, job misery, and, well, once you're old enough, your likelihood of just getting random death sentences increases dramatically. What good is busting your ass to retire at 55 if you get diagnosed with GBM at 52? Maybe I only got paid enough where my retirement age was 65, but I didn't miss as many of my kids' milestones ... makes the GBM at 52 a little more palatable ....

No one can tell someone else the precise value judgements they ought to make, as each of us have various unique pressures and neuroses.
 
xaelia said:
Good thread of responses regarding what happens to a small difference in income/savings over the course of 20+ years.

The closer you get towards concluding your career, the less the income differential matters – then the calculus between work-life balance, job misery, and, well, once you're old enough, your likelihood of just getting random death sentences increases dramatically. What good is busting your ass to retire at 55 if you get diagnosed with GBM at 52? Maybe I only got paid enough where my retirement age was 65, but I didn't miss as many of my kids' milestones ... makes the GBM at 52 a little more palatable ....

No one can tell someone else the precise value judgements they ought to make, as each of us have various unique pressures and neuroses.
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We all give up a chunk of our 20's and some parts of our 30's. I will speak for myself, but no way am I giving up my 30's to work anything close to being a resident.

My 30's was typically working 14 shifts, 8 hr shifts a month and avg about 28-30 hrs/wk in my late 20's to mid 40's. I essentially work less now in my late 40's.

Almost never miss kid events. Never pick up extra shifts for the $$$.

I can make more $$ when I am older/bored but can never create missed memories.

I know partners who worked 18+ shifts a month. Some who worked 24+ locums shifts a month and still do. Their income was prob 2x as mine but their spending prob 3x as much. You can't predict the future and no one can take away the bonds/memories I have with my kids.

My 15 YO daughter, typical PITA teenager, came out of the blue and gave me a hug which happens often. This bond wasn't created when she was 14. It happens from birth to 15 YO.
 
Mount Asclepius said:
I agree that the value add of work and income is dependent upon your age and stage of life. There are opportunity costs and money isn’t the only factor. For the average EP though that goes straight through graduating around 30, they should spend the first 5 if not 10 years of their career maximizing their earnings. This will give you financial freedom and more downstream options after falling behind in your 20s. Most being more highly educated and wealthier than the average person in society will have kids at a later age anyways. As you hit 10+ years of grinding you will reach a point where your kids are getting older and your net worth becomes more significant. The trade off of more money versus more free time changes. That’s perfectly expected and okay.

The main point though is not to give up work effort or settle for lower pay in the first 10 years of your career and especially not in the first 5. There is a very real time value of money. If you are in academics with a projected longer career or have a more clearly established out then perhaps it’s not as important. If you have the average EP career retiring around or before 50 then it’s really important to maximize your peak earning years.

If I developed a terminal diagnosis like GBM with clear knowledge of not much time left I would instantly quit my job. No way I want to spend the last bit of my life in the ED. However, my odds are probably better than average of living closer to the average life expectancy given wealth. If that’s the case, I’d prefer to set myself up well for the potential of those later years instead of still working those later years in the ED. Especially when I’m more likely to get that terminal diagnosis at that point. Plan for the worst, hope for the best. That’s really all we can do.
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So true. Oddly, and perhaps more specific to me, having a nice financial cushion and not needing to work makes work more enjoyable when it is optional and i dont feel like i need to grind because i need the money.

I worked like a dog the first 6 years out, I still work a fair bit but transitioned to more admin work. I find it rewarding and interesting.
 
xaelia said:
Good thread of responses regarding what happens to a small difference in income/savings over the course of 20+ years.

The closer you get towards concluding your career, the less the income differential matters – then the calculus between work-life balance, job misery, and, well, once you're old enough, your likelihood of just getting random death sentences increases dramatically. What good is busting your ass to retire at 55 if you get diagnosed with GBM at 52? Maybe I only got paid enough where my retirement age was 65, but I didn't miss as many of my kids' milestones ... makes the GBM at 52 a little more palatable ....

No one can tell someone else the precise value judgements they ought to make, as each of us have various unique pressures and neuroses.
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One of the pearls of EM is that I can take literally every day off when my kids have events, days off school, etc and when I can't (Because a school or whoever gave late notice), then someone will trade. I don't have a patient panel, scheduled cases, or anything else that gets in the way.
 
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TooMuchResearch said:
One of the pearls of EM is that I can take literally every day off when my kids have events, days off school, etc and when I can't (Because a school or whoever gave late notice), then someone will trade. I don't have a patient panel, scheduled cases, or anything else that gets in the way.
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I have 3 kids, they are very active. I cant be at all their events..
 
TooMuchResearch said:
One of the pearls of EM is that I can take literally every day off when my kids have events, days off school, etc and when I can't (Because a school or whoever gave late notice), then someone will trade. I don't have a patient panel, scheduled cases, or anything else that gets in the way.
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This is one reason that I would never trade EM for most other specialities. The flexibility/lower hours outweighs the erratic schedules.

We have 3 kids that are 11-15 (all 3 in club sports) and I can say I have never missed anything important and am present for all activities 90+% of the time even when I worked in the hospital. This to me is priceless.

People who have this will know. Once you have a trusting bond with your kids, you are allowed much more leeway with them.

The work you put in when they are young is paid back many fold with less work when they are older.

I know two surgeons parents with 1 kid that has a nanny pick him up from school. Know 2 cardiologist parents where they have other parents drive/pick their kid up from activities.
 
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Meh I had a nanny and had two MD parents. It’s not like we aren’t close or I felt “raised by strangers” but I guess they weren’t surgeons. You probably have less influence/control over how your kid turns out than you want to think.
 
HemeOncHopeful19 said:
Meh I had a nanny and had two MD parents. It’s not like we aren’t close or I felt “raised by strangers” but I guess they weren’t surgeons. You probably have less influence/control over how your kid turns out than you want to think.
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If that were the case, children growing up in single parent families should not have any negative impacts on their upbringing.
 
HemeOncHopeful19 said:
Meh I had a nanny and had two MD parents. It’s not like we aren’t close or I felt “raised by strangers” but I guess they weren’t surgeons. You probably have less influence/control over how your kid turns out than you want to think.
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My post may have been a bit hyperbole but I stand by the message. I have no idea what your relationship is with your parents, but I will say that I thought that I had a fairly normal and healthy relationship with my parents and would also say something like "it's not like we aren't close." I then got to know my wife's family and see how they interact. There is a world of difference between "it's not like we aren't close" and actually having a close-knit family with a lot of intrinsic trust.

TL;DR: I think that routinely spending significant time engaging with one's kids, particularly when they're young, has profound and lasting effects on any future family relationships and on general behavior.
 
I think the general advice to come out of the gate and make lots of cash for the first 5-10 years makes a lot of sense; eliminate debt, get that compounding interest nest-egg going, you likely have the physical energy/stamina to do it. Obviously I wouldn't recommend 24 shifts a month, but 16 with a couple per diem here or there... absolutely.

For me being about 12yr out, the question of when to take the foot off the accelerator, and how much is reasonable to cut back... its a big question in my head. I like my kids, and my oldest has <7yr left in my house (assuming she moves out for college). That's not very long! I've cut out the moonlighting I was doing during the peak pandemic times (say 10-12% cut in income?), and dropped one shift from my core site in the past 6mo (say another 8% drop)... but I've picked some side gig stuff that basically adds back 8%.

at what point do i pull the ripcord and drop to say 9-10 shifts a month? My initial plan was to go hard to age 50 then cut hard to 6-7 shifts / month until I was ready to walk into the sunset, but now I think a more prolonged / gradual glideslope may make more sense, vis-a-vis having more family time now, not when my oldest is in college...
 
BoardingDoc said:
TL;DR: I think that routinely spending significant time engaging with one's kids, particularly when they're young, has profound and lasting effects on any future family relationships and on general behavior.
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This is certainly true, but those profound and lasting effects can be positive OR negative depending on how that time is spent.
 
I’ll say this.. get your $$ right.. once thats done choices are easy.. dont work for thr trsiler trash rate… get paid properly. For those working under 300//hr im sad for u.. i havent worked for that that rate in a while. Find something better, if you can.
 
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Janders said:
I think the general advice to come out of the gate and make lots of cash for the first 5-10 years makes a lot of sense; eliminate debt, get that compounding interest nest-egg going, you likely have the physical energy/stamina to do it. Obviously I wouldn't recommend 24 shifts a month, but 16 with a couple per diem here or there... absolutely.

For me being about 12yr out, the question of when to take the foot off the accelerator, and how much is reasonable to cut back... its a big question in my head. I like my kids, and my oldest has <7yr left in my house (assuming she moves out for college). That's not very long! I've cut out the moonlighting I was doing during the peak pandemic times (say 10-12% cut in income?), and dropped one shift from my core site in the past 6mo (say another 8% drop)... but I've picked some side gig stuff that basically adds back 8%.

at what point do i pull the ripcord and drop to say 9-10 shifts a month? My initial plan was to go hard to age 50 then cut hard to 6-7 shifts / month until I was ready to walk into the sunset, but now I think a more prolonged / gradual glideslope may make more sense, vis-a-vis having more family time now, not when my oldest is in college...
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How much is in your retirement accounts and emergency fund?
 
bravotwozero said:
If that were the case, children growing up in single parent families should not have any negative impacts on their upbringing.
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My understanding is that its boys that have difficulties growing up in single mom households. The girls seem to do OK when controlled for education and income level.
 
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EctopicFetus said:
I’ll say this.. get your $$ right.. once thats done choices are easy.. dont work for thr trsiler trash rate… get paid properly. For those working under 300//hr im sad for u.. i havent worked for that that rate in a whi8le. Find something better,
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"Anyone who's not working for >90th percentile EM compensation is a SUCKER."

A take so hot i need sunglasses to look at it.
 
GonnaBeADoc2222 said:
"Anyone who's not working for >90th percentile EM compensation is a SUCKER."

A take so hot i need sunglasses to look at it.
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Smarter interpretation is dont forgo current income for hopes of better future income. yes I realize that 300/hr isnt easy to find nor is it an option in many parts of the country and im not a big locums guy. Thats what i meant. Even an SDG should be paying really close to market rate for their pre-partners. I would highly discourage a new grad from earning 50-100/hr less than market just to work at an SDG. of course those market based pay cuts are coming for everyone and some SDGs are ill equipped to handle it.
 
EctopicFetus said:
Smarter interpretation is dont forgo current income for hopes of better future income. yes I realize that 300/hr isnt easy to find nor is it an option in many parts of the country and im not a big locums guy. Thats what i meant. Even an SDG should be paying really close to market rate for their pre-partners. I would highly discourage a new grad from earning 50-100/hr less than market just to work at an SDG. of course those market based pay cuts are coming for everyone and some SDGs are ill equipped to handle it.
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Our price of admission is lower pay increasing until partnership, and we have no shortage of applicants. You're right though, there is some risk. When I calculated it out before making a job choice, the break even on the SDG versus an employed position I considered was about 4.5 years for equal hours, but now I should be pulling ahead by something like $70-100k annually until the music stops.
 
Janders said:
How much until you would feel comfortable dialing back?

My initial feeling was retirement + investment accounts + pessimistic valuation of home - mortgage > 3million would feel reasonable to take the foot of the gas, though I’ve had others say their number would be higher.
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Find your coastFI number. A single number rarely works cause much depends on your age. If I had $2m at age 35 I would feel pretty good about cutting back as compared to being 60 and having $2m.

Also this number depends on what your life looks like. Are you traveling and staying at 4 seasons or camping and paying $10/night for a campsite.

Kids in private school? Medical issues in your family etc.
 
TooMuchResearch said:
Our price of admission is lower pay increasing until partnership, and we have no shortage of applicants. You're right though, there is some risk. When I calculated it out before making a job choice, the break even on the SDG versus an employed position I considered was about 4.5 years for equal hours, but now I should be pulling ahead by something like $70-100k annually until the music stops.
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Every partnership has some version of this. No one is fully equal on day 1 save for some employed jobs. The question is if market rate is 200 are you paying 180 that’s one thing. Paying 110 is another.

Most places are gonna be pretty close nowadays. I’m as big an sdg fan as there is but there are some crooked ones. Down the line wages will drop drastically in my opinion and I would rather be locked into an sdg than a cmg.
 
Janders said:
How much until you would feel comfortable dialing back?

My initial feeling was retirement + investment accounts + pessimistic valuation of home - mortgage > 3million would feel reasonable to take the foot of the gas, though I’ve had others say their number would be higher.
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For me, im going to stop picking up extra shifts at 1 million, cut back to 0.8 FTE at 2 million, 0.6 FTE at 2.5 million, retire at 3 million. I could bust my ass and retire earlier but I want to do things with the kids while they are young.
 
GonnaBeADoc2222 said:
-admin doesn't care about your well being

-nursing wants path of least resistance , regardless of how it harms you or patients

Therefore:

1) take good care of your patients

2) do the right thing

3) don't do any extra work

4) all charts done at work

5) go home on time
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Working to rule? Is there some sort of industrial action happening in US hospitals that we're not aware of? If so you have my full support. 🙂
 
DocEspana said:
I heard some of you aren't doing the bare minimum.... CUT IT OUT.
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To those going above and beyond, I understand and sympathize. For your own well being, realize that the game is rigged. It always has been. But now it's been weaponized against us. People that never experience the consequences of their actions deliberately withhold resources so that every day is designed to be a just barely avoided disaster.

And not because that's the way it has to be, but because these people dream that turning our EDs into burnout factories will get them wealth and a promotion that will give them the chance to do the same thing to even more people. Don't invest your self-worth in playing a game you're designed to lose.
 
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Arcan57 said:
To those going above and beyond, I understand and sympathize. For your own well being, realize that the game is rigged. It always has been. But now it's been weaponized against us. People that never experience the consequences of their actions deliberately withhold resources so that every day is designed to be a just barely avoided disaster.

And not because that's the way it has to be, but because these people dream that turning our EDs into burnout factories will get them money wealth and a promotion that will give them the chance to do the same thing to even more people. Don't invest your self-worth in playing a game you're designed to lose.
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Focus on what you enjoy. I do more than the bare minimum but I very much minimize anything I don’t enjoy or think is stupid. Hospital emails deleted. Requests to change my charting. Deleted.
 
Arcan57 said:
To those going above and beyond, I understand and sympathize. For your own well being, realize that the game is rigged. It always has been. But now it's been weaponized against us. People that never experience the consequences of their actions deliberately withhold resources so that every day is designed to be a just barely avoided disaster.

And not because that's the way it has to be, but because these people dream that turning our EDs into burnout factories will get them money wealth and a promotion that will give them the chance to do the same thing to even more people. Don't invest your self-worth in playing a game you're designed to lose.
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Wow.
How very powerfully stated.
 
Arcan57 said:
To those going above and beyond, I understand and sympathize. For your own well being, realize that the game is rigged. It always has been. But now it's been weaponized against us. People that never experience the consequences of their actions deliberately withhold resources so that every day is designed to be a just barely avoided disaster.

And not because that's the way it has to be, but because these people dream that turning our EDs into burnout factories will get them money wealth and a promotion that will give them the chance to do the same thing to even more people. Don't invest your self-worth in playing a game you're designed to lose.
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Love the term "Burnout Factories". It perfectly describes how admin organizes most EDs.
 
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RustedFox said:
Daily reminder to do the bare minimum.
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I got chewed out last night by a surgeon for "not writing holding orders" on a patient. This was at 7PM and surgeon was physically in the hospital. Why are we expected to do the work of other physicians during reasonable hours when they should be awake? Also EMR makes it easy to put in orders from anywhere.
 
ScepticSkeksis said:
I got chewed out last night by a surgeon for "not writing holding orders" on a patient. This was at 7PM and surgeon was physically in the hospital. Why are we expected to do the work of other physicians during reasonable hours when they should be awake? Also EMR makes it easy to put in orders from anywhere.
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Lol. What year is this? 2008?
 
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