here's the latest garbage i'm dealing with

[MirrorTodd]

Question: Is the new Supra German or Japanese?

It's biracial.

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Members don't see this ad.

 

[GassYous]

This person either lives somewhere with good public transportation, is bike friendly, or I’m skeptical

Every car I look at has some sort of 5k market adjustment price addon

 

[BobBarker]

I ordered a Hyundai Elantra Blue. 52mpg. $25000

 

[finalpsychyear]

You guys are following the EM Track. You/EM do not own pts or bring any extra business in.

CMGs/Hospitals will take over with small pockets of SDG regardless of how well you are liked by specialist/give good care.
They will come in, screw everything up, cost hospital more money but its a small amount and they don' t care. They want control and will never admit it was a mistake.
Once they figure out the shortage of Anesthesiologist, CMG/HCA will open a buttload of residencies, flood the market, and drive down prices.

This is the time to make your money, pay off debt, invest in passive income streams so you can leave the Pits on your own terms.

EM still make 250/hr but it is a much harder job and not in the best places. This is what you guys will be left with in 5-10 yrs.

Spot on. People don't know how quickly this is coming. Make your money now folks and invest like mad. I have 0 hope for medicine in the next 5-10 years. Everyone is going to be largely replaced with mid levels who will have full autonomy. Hospitals will only have employees outside of locums and truly be able to cut salaries. Happening faster than i imagined. I'm working more now than ever till 2030. Hope I am wrong.

 

[finalpsychyear]

Nope, I just don’t value cars or most other shiny toys. I’ll drop that on a single vacation but have no interest in cars.

Harder to get section 179 for PP with that 25k cap.

 

[kidthor]

Spot on. People don't know how quickly this is coming. Make your money now folks and invest like mad. I have 0 hope for medicine in the next 5-10 years. Everyone is going to be largely replaced with mid levels who will have full autonomy. Hospitals will only have employees outside of locums and truly be able to cut salaries. Happening faster than i imagined. I'm working more now than ever till 2030. Hope I am wrong.

Yup...

Here's a study from Health Affairs I saw this month: https://www.healthaffairs.org/doi/10.1377/hlthaff.2022.00308

Sorry it's partially paywalled - but they showed that PE acquired practices in derm, optho, and GI all started flooding their sites with midlevels post-acquisition. At the same time I just listened to a podcast outlining all the legal supervision requirements for midlevels, and how they're all quickly being pared down to nothing.

 

[finalpsychyear]

Yup...

Here's a study from Health Affairs I saw this month: https://www.healthaffairs.org/doi/10.1377/hlthaff.2022.00308

Sorry it's partially paywalled - but they showed that PE acquired practices in derm, optho, and GI all started flooding their sites with midlevels post-acquisition. At the same time I just listened to a podcast outlining all the legal supervision requirements for midlevels, and how they're all quickly being pared down to nothing.

Thanks for the link. I don't like the idea that this is happening but it is. I just fear for my colleagues who largely think this is not an issue. Maybe I'm wrong and working 2 FTE while spending 10k/mo and investing everything else is paranoia. Bump in 2030 and again I hope I am wrong. My EM friends were so happy a few years ago and they have told me they wished they had done more to maximize their situation when it was a better pay scale for them and now its not going great and they likely overspent and under earned assuming it was going to stay the same for the next 5-10 years.

 

[GassYous]

Thanks for the link. I don't like the idea that this is happening but it is. I just fear for my colleagues who largely think this is not an issue. Maybe I'm wrong and working 2 FTE while spending 10k/mo and investing everything else is paranoia. Bump in 2030 and again I hope I am wrong. My EM friends were so happy a few years ago and they have told me they wished they had done more to maximize their situation when it was a better pay scale for them and now its not going great and they likely overspent and under earned assuming it was going to stay the same for the next 5-10 years.

That's why I'm worried about buying a house. Yeah I can afford a nice one now but what happens if I'm making half of what I do?

 

[dabears505]

That's why I'm worried about buying a house. Yeah I can afford a nice one now but what happens if I'm making half of what I do?

Bro then just sell it.

 

[finalpsychyear]

Buy less house. Not sure if your in a hcol that does make it a bigger deal. I get 4000 sq foot less than 10 years for 700-800k in my area and i still dont like it.

 

[dannyboy1]

That's why I'm worried about buying a house. Yeah I can afford a nice one now but what happens if I'm making half of what I do?

Only on SDN do we have people making 500k/year wondering if they can afford a house…

 

[GassYous]

Only on SDN do we have people making 500k/year wondering if they can afford a house…

Obviously it's not wondering if I can afford a house but if I can continue to afford the same house.

 

[nimbus]

Obviously it's not wondering if I can afford a house but if I can continue to afford the same house.

Just buy a house you can afford on 300k.

 

[2Fast2Des]

Just buy a house you can afford on 300k.

Exactly, just because you're a doctor doesn't mean you need a house to prove it. I will live in my starter townhouse until I run out of space and it's time to upgrade. Saving a ton of money on mortgage, maintenance, etc. And plus I don't care what people think, so I'm not keeping up with the neighbors.

 

[doctalaughs]

Harder to get section 179 for PP with that 25k cap.

Yeah, plenty of my partners have bought 110k hummers and justified it with the section 179 deduction.

Lol- it’s a loophole/deduction, not free! And I’m pretty sure the gas they spend on those monsters is not a financial win either.

Whatever- it’s their money and if they enjoy it as much as I enjoy 4-5 long family international vacations then all the power to them!

 

[Dr. Rude]

Exactly, just because you're a doctor doesn't mean you need a house to prove it. I will live in my starter townhouse until I run out of space and it's time to upgrade. Saving a ton of money on mortgage, maintenance, etc. And plus I don't care what people think, so I'm not keeping up with the neighbors.

Not a fan of her, but I do like this quote:

“Stop buying things you don’t need, to impress people you don’t even like.”​

— Suze Orman

 

[ambiturner]

Exactly, just because you're a doctor doesn't mean you need a house to prove it. I will live in my starter townhouse until I run out of space and it's time to upgrade. Saving a ton of money on mortgage, maintenance, etc. And plus I don't care what people think, so I'm not keeping up with the neighbors.

To play devil’s advocate - I subscribe to this strategy as well, and it has kept my monthly costs down so far, but it also in all likelihood resulted in me ending up in a much more modest house than I could have had for the same payment had I stretched earlier on.

The main factors in this were condo appreciation not keeping up with single family prices, salary inflation in other fields besides medicine, and a once in a generation upending of the housing market. These factors are unique and the strategy would have been a smart one from 2010-2020, but the facts are that I and most of the people in my group are now unable to afford homes in many of the nicer neighborhoods in my city that were easily attainable in 2015-2020.

 

[Beeftenderloin]

Obviously it's not wondering if I can afford a house but if I can continue to afford the same house.

We bought something we could afford while I was still on a training salary and wife making about the same. Lots of partners with much bigger setups now, but it was a massive step up for us at the time and we’re paying our mortgage every month in stead of someone else’s (ie renting). Definitely pay cut proof down to CRNA rates.

 

[Gasworks]

My formula, not judging others just sharing:
Home < 1yr gross income
Car < 1 month gross income
Retirement / savings = 10% gross income

Good stuff:
Boat = 1/2 cost of home, paid cash
Toys = anything that I can afford to pay in cash
Family vacations = blank check

I have been house poor before, won’t make that mistake again. Even worse was watching that house sit on the market for almost a year which tied up a huge chunk of my net worth while I was trying to coordinate a cross country move.

 

[GassYous]

My formula, not judging others just sharing:
Home < 1yr gross income
Car < 1 month gross income
Retirement / savings = 10% gross income

Good stuff:
Boat = 1/2 cost of home, paid cash
Toys = anything that I can afford to pay in cash
Family vacations = blank check

I have been house poor before, won’t make that mistake again. Even worse was watching that house sit on the market for almost a year which tied up a huge chunk of my net worth while I was trying to coordinate a cross country move.

"Only on sdn do people worry about buying a house blah blah blah"

This is exactly the kind of situation I am thinking about and I know it happened to one of the old posters here.

 

[deleted875186]

My formula, not judging others just sharing:
Home < 1yr gross income
Car < 1 month gross income
Retirement / savings = 10% gross income

Good stuff:
Boat = 1/2 cost of home, paid cash
Toys = anything that I can afford to pay in cash
Family vacations = blank check

I have been house poor before, won’t make that mistake again. Even worse was watching that house sit on the market for almost a year which tied up a huge chunk of my net worth while I was trying to coordinate a cross country move.

Unfortunately this isn’t remotely possible with home prices on the east or west coast.

 

[Gasworks]

Unfortunately this isn’t remotely possible with home prices on the east or west coast.

Somewhat agree.. you have to pick where you live carefully. We moved from astronomically high COL in the northeast to below average COL southeast at just the right time. I feel for anyone buying a home these days.. inflated prices AND high interest.

 

[nimbus]

Unfortunately this isn’t remotely possible with home prices on the east or west coast.

But it is possible to get a nice house for 2x gross.

 

[anes121508]

oh, this guy was good.

so he first tells us that it's just a "meet and greet" to start to understand our practice. then he shares his vision of what he's trying to accomplish across all sites. as advertised, it's just a bunch of new agey feel-good mumbo jumbo. he follows that up by saying that he hopes to meet with us several times over the next few months to assess our needs.

here's the kicker...

he tells us that he wants us more involved in the coordination of the day-to-day operations. i respond telling him that i'm already in enough meetings and that as a full-time clinician it is hard to find time in the day away from patient care. then he says, basically, that our ongoing subsidy is dependent on us "stepping up" (his words) into being more involved in the operations and ostensibly reporting to him what's going on.

i will tell you this. by industry standards our stipend is a joke. our OB census is spotty and yet we are expected cover 24/7/365 for OR emergencies, c-sections, pain consults, etc. this is all in the face of a growing overall surgical census as they continue to hire surgeons and increase block time. they also asked us to hire another person in anticipation of more ORs opening in the next two years. we're not bringing in another person until we're sure all of that is going to happen.

bottom line is this guy is just another academic dip**** who should have stayed at his previous job at university hospital medical center as a low-level director. because that's all he is. i'm satisified that he's already pissed enough people off that he won't be here in 2 years time. seems to be his pattern. but our group just has to survive until then. and right now unfortunately he's holding the reins on our contract. he's been on a firing spree lately and replacing people from his prior job who are loyal to him and happy to drink his koolaid.

this is the **** they don't teach you in residency, residents. everyone who matters locally is happy with the service we provide. but that doesn't matter to some ***hole sitting in a office somewhere that doesn't understand the relationships you have with the surgeons, the CRNAs, and ultimately the patients in the local community.

more to come i'm sure. i will never direcly work for this idiot. that much i will certify to you now.

wouldn't a reasonable and smart person be able to make the argument that your smaller place is highly effective and efficient and surgeons and patients are happy, so why change it?

honestly makes zero sense if all is as you say

unless all they want is whatever potential profit is tied to billing for anesthesia services at your location

seriously what's the point of what they are trying to do?

 

[2Fast2Des]

wouldn't a reasonable and smart person be able to make the argument that your smaller place is highly effective and efficient and surgeons and patients are happy, so why change it?

honestly makes zero sense if all is as you say

unless all they want is whatever potential profit is tied to billing for anesthesia services at your location

seriously what's the point of what they are trying to do?

Because doing nothing makes them seem useless, so by changing things around allows them to justify their existence. I see it too often, and it only pisses people off and turns a well oiled machine into a miserable place

 

[ZzzPlz]

Because doing nothing makes them seem useless, so by changing things around allows them to justify their existence. I see it too often, and it only pisses people off and turns a well oiled machine into a miserable place

Yep just like the AORN

 

[Iso4ane]

People say you can usually comfortable afford a house 2.5-3x your income. Even assuming a salary of 300K and spending only 2x on your house, 600K will buy decent house in many many locales.

 

[Fpg1245]

People say you can usually comfortable afford a house 2.5-3x your income. Even assuming a salary of 300K and spending only 2x on your house, 600K will buy decent house in many many locales.

Gotta bump that multiple up. 3-4x is really for most major metros.

 

[abolt18]

i have 3 job offers elsewhere already. we are having a come-to-jesus meeting with administration next week. they play ball with us, or they are ****ed.

Any updates?