Switching From EM Into radiology?

[Birdstrike]

Do you think it's possible for our field to find some degree of balance, with caps on amount of midlevels one doc is expected to supervise and whatnot the way anesthesiology seemed to have?

That seems like a reasonable solution that's possible to implement. If I was 20 years younger, knowing what I know now, and was trying to decide whether or not to go into EM, I wouldn't worry about this mid-level, physician oversupply stuff. It'll work itself out, in my opinion. I wouldn't worry about it for one minute. What I would worry about is how to I was going to sustain working nights, weekends and holidays for the next 30 years, with maximal acuity and impossible expectations from an administration actively working against you.

I've since moved from general EM to Interventional Pain, and I've been the same sky-is-falling mumbo-jumbo from the Pain people ("CRNA's are going to go into Pain! omg...chiropractors steal business, we can't compete! omg....Medicare is gonna cut reimbursement, again! omg, omg, OMG!...)

Blah blah blah....blah blah blah...

Remember when CRNAs ended Anesthesiology 20 years ago? When the invention of angioplasty ended cardiothoracic surgery? When Pain injections ended Ortho-Spine surgery and weekend cosmetics courses ended Plastic Surgery? Yeah, me neither.

Just do something you'll like, that will be sustainable for your whole career. Ignore the other b******t. If that ends up being EM, make sure you do a fellowship, so you can reduce your shift work appreciably in the future, which will help with the sustainability.

That's my 2 cents.

---

Members don't see this ad.

 

[Birdstrike]

What were the previous doom-and-gloom scenarios of EM? I'm thinking there was a lot of worry that the ACA would decimate salaries (whereas it actually did the opposite), but anything else?

The ED overcrowding 'crisis' was going to destroy EM. But it didn't. It created the EM physician-shortage 'crisis' that was going to destroy EM, that raised your and my salaries, that you all are afraid will go away. Now that that crisis is being fixed by increasing physician supply, so you all can actually get some help in the ED so the volume and acuity aren't so high your blood pressure is 220/120 during shifts, it's an EM-physician oversupply 'crisis' that's going to destroy EM. Once that doesn't 'destroy EM' as predicted, and people successfully lobby to reduce supply again to bolster wages, you all will be short as Hell again in EDs across America, saying "We need more doctors! The shortage is going to destroy EM." It's all nonsense.

Let me give you a look into your future. This is what you're going to see:

Pendulum >>>>>>>>>>

<<<<<<<<Pendulum

Repeat x 30 years.


Disclaimer: Don't confuse anything I've written in the post or thread with me telling you "everything is okay in EM." It's not. The problems in EM are there, they're just not the shiny, bouncing ball everyone happens to be talking about this week or next week. The real problems are the ones they don't want you talking about.

 

[partypantss]

That seems like a reasonable solution that's possible to implement. If I was 20 years younger, knowing what I know now, and was trying to decide whether or not to go into EM, I wouldn't worry about this mid-level, physician oversupply stuff. It'll work itself out, in my opinion. I wouldn't worry about it for one minute. What I would worry about is how to I was going to sustain working nights, weekends and holidays for the next 30 years, with maximal acuity and impossible expectations from an administration actively working against you.

I've since moved from general EM to Interventional Pain, and I've been the same sky-is-falling mumbo-jumbo from the Pain people ("CRNA's are going to go into Pain! omg...chiropractors steal business, we can't compete! omg....Medicare is gonna cut reimbursement, again! omg, omg, OMG!...)

Blah blah blah....blah blah blah...

Remember when CRNAs ended Anesthesiology 20 years ago? When the invention of angioplasty ended cardiothoracic surgery? When Pain injections ended Ortho-Spine surgery and weekend cosmetics courses ended Plastic Surgery? Yeah, me neither.

Just do something you'll like, that will be sustainable for your whole career. Ignore the other b******t. If that ends up being EM, make sure you do a fellowship, so you can reduce your shift work appreciably in the future, which will help with the sustainability.

That's my 2 cents.

I think there is a lot of wisdom in this, and is convincingly beyond just optimism, it's realism. In the big picture I think it's true that we don't know how laws/ economics will continue to reshape and change, and the pendulum likely will keep on swinging back and forth. This'll help me sleep a bit better for the time being so thank you for the post.

 

[Vandalia]

I've seen the exact opposite where most people in radiology aren't worried about things like AI. It's mostly people outside of the field worrying.

I didn't mean AI. I am on record here as saying that will never happen; it is always something "a few years down the road."

The concerns they tell me are the fact that they can lose a contract at the drop of a hat; the nature of teleradiology means a company in California is a threat to a practice in Alabama (hire a few locums or locals at rock-bottom rates for the interventional stuff/babysitting), the fact that there is no longer any profit from a technical component, massive liability for a $5 payment on a plane film, requirement for fellowships (often multiple fellowships) to get hired, etc.

Yeah, there is a ton of liability in EM, but we generally don't leave all the evidence behind. If you say the abdomen was non-tender, the jury doesn't have access to the patient at that moment in time to judge for themselves.


The real threat in medicine is not mid-levels, it is "tele-medicine". As of this moment, at least tele-EM is not much of a threat. Someone may lose a contract, but whoever gets that contract is still going to have to put EM in the building.

 

[kumatie]

The ED overcrowding 'crisis' was going to destroy EM. But it didn't. It created the EM physician-shortage 'crisis' that was going to destroy EM, that raised your and my salaries, that you all are afraid will go away. Now that that crisis is being fixed by increasing physician supply, so you all can actually get some help in the ED so the volume and acuity aren't so high your blood pressure is 220/120 during shifts, it's an EM-physician oversupply 'crisis' that's going to destroy EM. Once that doesn't 'destroy EM' as predicted, and people successfully lobby to reduce supply again to bolster wages, you all will be short as Hell again in EDs across America, saying "We need more doctors! The shortage is going to destroy EM." It's all nonsense.

Let me give you a look into your future. This is what you're going to see:

Pendulum >>>>>>>>>>

<<<<<<<<Pendulum

Repeat x 30 years.


Disclaimer: Don't confuse anything I've written in the post or thread with me telling you "everything is okay in EM." It's not. The problems in EM are there, they're just not the shiny, bouncing ball everyone happens to be talking about this week or next week. The real problems are the ones they don't want you talking about.

You sit in your ivory tower of pain management telling the grunt docs down below not to worry, all while being out of clinical EM for....how long?
If you were working now you would realize there’s no pendulum anymore
The pendulum crashed and burned and now there just a pile of burning dog **** that is EM.

please tell me how the pendulum is going to swing back after CMG own the majority of the contracts , took away all cme funds, cut hrly pay, drop benefits (all before covid). This specialty is not controlled by docs anymore, but by private equity.

 

[Birdstrike]

...now there just a pile of burning dog **** that is EM.

I didn't tell them not to worry. You must have missed this...

Don't confuse anything I've written in the post or thread with me telling you "everything is okay in EM." It's not. The problems in EM are there...

That being said, if you say "EM is just a pile of burning dog ****," I'll take your word for it. That's why I made the move to expand and diversify my skill-stack 10 years ago and I'm in a much stronger position now, with two specialties and the ability to move from one to the other, depending on where the conditions are better. Not only did I do a fellowship, I helped get that subspecialty brought into ABEM as an official subspecialty under EM.

You, on the other hand, seem deeply unhappy. When are you going to do something about it?

 

[namethatsmell]

You sit in your ivory tower of pain management telling the grunt docs down below not to worry, all while being out of clinical EM for....how long?
If you were working now you would realize there’s no pendulum anymore
The pendulum crashed and burned and now there just a pile of burning dog **** that is EM.

please tell me how the pendulum is going to swing back after CMG own the majority of the contracts , took away all cme funds, cut hrly pay, drop benefits (all before covid). This specialty is not controlled by docs anymore, but by private equity.

Things are crappy right now, but let's not go after each other. Not gonna solve anything.

I can see how you'd interpret Bird's post in a way where it'd seem like he's minimizing our current reality, but I don't think that was his intent. I'd suspect his point is that EM as a field has legit issues underlying it that pre-date the confluence of the rivers of **** that are currently raining down upon us. If you go back and read his posts you'll see he's been talking about the downsides of EM forever. He also doesn't have a track record of taking dumps on EM from high towers. If he's been consistent with anything, it's been telling EM docs that we can do more than just work in an ED.

As for pendulums...yeah I agree EM's is pretty lifeless right now. I'd guess our field is gonna be cruising on a dumpster fire trajectory for at least the next several years in many parts of the country. There will still be some good jobs out there for people already working, people in the right place/right time, and those with geographic flexibility. But the thing is, we don't know what the future holds. I mean, would any of us have ever guessed that there'd be a big demand for anesthesiologists these days despite the existence of CRNAs? Or that there's still a decent market for CT surgeons despite the rise of interventional cards? Or that FP docs, pooped on by the house of medicine for the last 30 years, can get a 9-5 M-F no call/nights/weekends/holidays job in literally any zip code they desire (some of which pay 300k or more)?

As for the need for certain publicly-traded/PE companies to GTFO...so true. So needed.

 

[Birdstrike]

Things are crappy right now, but let's not go after each other. Not gonna solve anything.

I can see how you'd interpret Bird's post in a way where it'd seem like he's minimizing our current reality, but I don't think that was his intent. I'd suspect his point is that EM as a field has legit issues underlying it that pre-date the confluence of the rivers of **** that are currently raining down upon us. If you go back and read his posts you'll see he's been talking about the downsides of EM forever. He also doesn't have a track record of taking dumps on EM from high towers. If he's been consistent with anything, it's been telling EM docs that we can do more than just work in an ED.

As for pendulums...yeah I agree EM's is pretty lifeless right now. I'd guess our field is gonna be cruising on a dumpster fire trajectory for at least the next several years in many parts of the country. There will still be some good jobs out there for people already working, people in the right place/right time, and those with geographic flexibility. But the thing is, we don't know what the future holds. I mean, would any of us have ever guessed that there'd be a big demand for anesthesiologists these days despite the existence of CRNAs? Or that there's still a decent market for CT surgeons despite the rise of interventional cards? Or that FP docs, pooped on by the house of medicine for the last 30 years, can get a 9-5 M-F no call/nights/weekends/holidays job in literally any zip code they desire (some of which pay 300k or more)?

As for the need for certain publicly-traded/PE companies to GTFO...so true. So needed.

Well said

 

[Birdstrike]

...and you're right, @namethatsmell, in that no one has sounded more alarms on SDN regarding the state of EM than myself, over the past 10 years. If fact, I was often slammed for being "too negative." Now, I'm slammed for being "too positive." Lol. Where's @kumatie been these past 10 years that it says he/she's been on this forum, when I was sounding the alarm?

He was probably one of those saying, “Shut up you’re too negative on EM.”

 

[Backpack234]

@namethatsmell and @Birdstrike make pretty good points here. I don't know the full history of CT surgery or Anesthesia, but were their graduating residents ever in a situation where some of them can't find a job? It's still not certain how this will turn out by July when these residents graduate, but as of now my residency program has 2 PGY-3's with job offers/contracts and the rest without. Maybe the rest will find jobs somewhere, but even the docs I work with are now discussing the lack of jobs in case any of us were to be let go, so I doubt it.

While I agree that the pendulum will swing back and forth, I'm not sure that comparing us directly to other specialties is really apples to apples. Is this current lack of jobs that we're facing right now (and that will likely continue into the next few years) unique?

 

[Birdstrike]

Is this current lack of jobs that we're facing right now (and that will likely continue into the next few years) unique?

I don't know if it's unique or not. However, many subspecialties can be incredibly saturated and incredibly competitive in desirable areas. I happen to be in one, and in such a location. Either way, if things are as bad as @kumatie says they are, I hope they get better, for his sake and everyone else's.

 

[cyanide12345678]

I don't see the pendulum swinging the other way any time soon. It's really just supply and demand economics.

Our market will struggle to accommodate all 2500 2021 grads this year. A lot of the really hard to staff places will suddenly start to get full staffing this year. My really really really hard to staff hospital had 4 applicants for my position when i informed them I'm leaving. Class of 2022 is probably completely screwed as even hard to staff places may already be full. So good luck.

There are not going to be significantly more ERs built. Even urgent cares are mostly going to be run by nurse practitioners. We really don't have many places to work other than hospital ERs....

Either way, I'm going part time in 2-3 years. So F this. I'm out.

 

[Backpack234]

@cyanide12345678 weren't you posting a while back about grinding really hard and starting a few website businesses? I thought you were still early in your FI path. 2-3 Years seems pretty early, but if you can do it more power to ya!

 

[cyanide12345678]

@cyanide12345678 weren't you posting a while back about grinding really hard and starting a few website businesses? I thought you were still early in your FI path. 2-3 Years seems pretty early, but if you can do it more power to ya!

You're right. I'm fairly early in my path towards financial independence, but I'm fairly certain i can go part time in a few years if i want to.

Here is some math and some facts. I'll just answer your question with graphs and numbers.

I graduated residency June 2019. I've been an attending 1.5 years exactly and have received 17 attending paychecks.

My net worth at graduation was around negative 80-100k with 145k of debt left. I paid off debt with 6 attending paychecks and was debt free feb 2020. I have a separate post how i paid off total 195k debt within months of graduating. I started investing very aggressively starting March 2020.

See attached image for my net worth since that time (First picture). This is a screen shot of e money that is linked to all my accounts and tracks my overall finances. This account never had student loan accounts added, so the jan and feb numbers aren't accurate as the liabilities aren't accurate, but everything after that is accurate. In short, in 1.5 years of being attending, I've gone from -100k to 450k in net worth.

4-6 months ago, i started learning options. 1-2 months ago i also completely sold every index fund i owned and went into all cash to only sell naked puts as an investment strategy on RUT or SPX. This is my only investing strategy now, other than retirement accounts which have Target funds.

See attached images for my return in my etrade account in last 6 months vs sp500 (image 2). This account is basically all options now. And look at the asset growth in this account (image 3), this includes money I'm personally putting in as well. The divergence between my account and sp500 in the last 3 months is my slowly tilting towards all options. I've tried educating others about this, for free. Spent hours responding to DMs, and have listened to a lot of crap from people on here about it, people who aren't willing to open their minds to possibilities. Some people did, and are also now doing better. But it works, math doesn't lie, the risk I'm taking is similar to investing in Spy or iwm directly.

Lastly, my travel website became a dud, minimal traffic and eventually i shifted focus. But my fully automated dropshipping sextoy store website called lovermart is gaining popularity. This is completely passive. I pay $340/mo for SEO, and pretty much do nothing else. I pretend to read the weekly reports that the SEO person sends and respond to their message saying everything looked great. Orders automatically transmit to dropship whole sale retailer, as long as i have a balance in the account with them, order automatically fulfills and is shipped.

See attached image for increasing Google traffic - 1000 organic visitors last 3 months with 30k+ impressions on the website on Google. SEO work really starts to pick up over time. I'm being patient on this.

So that's the long answer to your question. But I've come from negative 100k to 450k net worth in 1.5 years. My wife becomes an attending in 7 months. At this trajectory i fully expect to hit 1.5M in net worth in 3 years and with my option trading usually returning 20-40 percent cash on cash annualized return, i expect to start replacing my future income with my portfolio as it grows.

 

[Backpack234]

@cyanide12345678 pretty great story you've got! Last I remember I saw a post from you where you weren't taking such high risks anymore and planned to stick with index funds. Not sure how long ago that was. But hey, it looks like you're doing great! More power to you.

Let's say for a second I'm interested in learning options trading, where should I start?

 

[cyanide12345678]

@cyanide12345678 pretty great story you've got! Last I remember I saw a post from you where you weren't taking such high risks anymore and planned to stick with index funds. Not sure how long ago that was. But hey, it looks like you're doing great! More power to you.

Let's say for a second I'm interested in learning options trading, where should I start?

PM me and we can talk

 

[kumatie]

Just Curious, you seem like a relatively young attending, when did you know you’re getting burned out. Was it in residency, early attendinghood, and what was the deciding factor to make you change?

 

[Franzd'Epinay]

4-6 months ago, i started learning options. 1-2 months ago i also completely sold every index fund i owned and went into all cash to only sell naked puts as an investment strategy on RUT or SPX. This is my only investing strategy now, other than retirement accounts which have Target funds.

Can you explain this for the idiots among us?

 

[RustedFox]

Can you explain this for the idiots among us?

He sold everything that he wrote down on an index card and sits naked in front of a "put" for cash. He's on OnlyFans at RUT-SPX, and likes to spend money wisely at Target.

(Seriously, I have zero idea what he said, too - but it sounded very cool.)

 

[Rekt]

Can you explain this for the idiots among us?

He stopped playing Texas Hold'em and started playing slots.

 

[cyanide12345678]

Can you explain this for the idiots among us?

*Sigh* Lets see...

SPX = SPY 500 Index
RUT = Russell 2000 Index

They are literally the indexes themselves, not ETFs. Trading options on the index itself, rather than ETFs that follow the index (SPY or IWM) have distinct advantages - 60/40 long term/short term capital gains tax treatment, no early execution (european style execution), cash settlement, lower transaction costs since SPX = 10 x Spy.

Selling Put = Selling a promise/contract that you will buy something at a certain price "strike price" and on a certain date and time. For selling this promise/contract, you get paid a premium. This premium is your profit.

Cash secured put = You need 100% of the cash in your account when you say you will buy this something that you promised that you will buy

Naked put = you only need 10%-30% of the money to do a trade depending on what you're trading - you're leveraged essentially. SPX and RUT only require 10% of the money. So you're leveraged 10X in a naked put on Spx and IWM. But you can use this leverage to actually make very safe trades and still maintain excellent return.

Real numbers follow from current market prices, see attached screen shot from option chain from my etrade account (See Screenshot_57):

If you sold a $1790 (strike price) Put for RUT for expiration date Feb 26th, 2021 (1 month from today). You will receive a premium of $800 for a market order (current bid price).

This $1790 strike price is 17.5% below todays price of $2163. For a Naked put I require $17900 cash in the account (10%) and I will receive $800 of profit on this money.

So, if in the next 1 month, RUT (russell 2000 small cap index) does not drop 17.5%, then I have made $800 profit on cash deposits of $17900. This is a 4.4% return in 1 month. Rinse and repeat every month to get a similar 3-4% monthly return. Enjoy 40%+ annual return when the going is good and market doesn't crash.

If market does crash that month, no biggie, now you do a "rollover", which is when you "buy back" and close this 1 month Put that you sold (you might be paying $1600 or whatever for this put that you had originally been paid $800 for). But you sell another option that is further out (1 year for example) with a much lower strike, and essentially use the new premium to pay for the cost of "buying back" the losing option trade, and put the surplus in your pocket. Screenshot_58 shows what a rollover trade would look like. With todays number such a trade gives another $3000 in profit, and drops the cash requirements (the 10% required) to $13500 because the strike was effectively dropped to $1350 from $1790 and the time was extended to January 2022. Thus, making it unlikely to reach this new lower strike price. Rinse and repeat if needed if markets keep declining, can push time up to 3 years out, and with each time push can drop strike price by a decent amount. Essentially you're the insurance company that keeps collecting a premium against disasters - but when the disaster happens, you change the terms of the contract The big assumption here is that Russell 2000 will not go to 0 - its an index of 2000 companies, it shouldnt. If it does, we're all screwed anyway.

Now lets say 1 year from now, January 26th 2022, price of RUT is 35% below todays - $1405. If you were an index fund investor with a heavy small cap tilt your account is down 35% roughly. The $1405 price is ABOVE my $1350 strike. My option is out of the money and expires worthless. Your account is down 35%, my account is up by $3800 on the original $17300 cash - 22% up.

 

[cyanide12345678]

He stopped playing Texas Hold'em and started playing slots.

More like I stopped playing slots and started playing high stakes poker.

 

[BoardingDoc]

*Sigh* Lets see...

SPX = SPY 500 Index
RUT = Russell 2000 Index

They are literally the indexes themselves, not ETFs. Trading options on the index itself, rather than ETFs that follow the index (SPY or IWM) have distinct advantages - 60/40 long term/short term capital gains tax treatment, no early execution (european style execution), cash settlement, lower transaction costs since SPX = 10 x Spy.

Selling Put = Selling a promise/contract that you will buy something at a certain price "strike price" and on a certain date and time. For selling this promise/contract, you get paid a premium. This premium is your profit.

Cash secured put = You need 100% of the cash in your account when you say you will buy this something that you promised that you will buy

Naked put = you only need 10%-30% of the money to do a trade depending on what you're trading - you're leveraged essentially. SPX and RUT only require 10% of the money. So you're leveraged 10X in a naked put on Spx and IWM. But you can use this leverage to actually make very safe trades and still maintain excellent return.

Real numbers follow from current market prices, see attached screen shot from option chain from my etrade account (See Screenshot_57):

If you sold a $1790 (strike price) Put for RUT for expiration date Feb 26th, 2021 (1 month from today). You will receive a premium of $800 for a market order (current bid price).

This $1790 strike price is 17.5% below todays price of $2163. For a Naked put I require $17900 cash in the account (10%) and I will receive $800 of profit on this money.

So, if in the next 1 month, RUT (russell 2000 small cap index) does not drop 17.5%, then I have made $800 profit on cash deposits of $17900. This is a 4.4% return in 1 month. Rinse and repeat every month to get a similar 3-4% monthly return. Enjoy 40%+ annual return when the going is good and market doesn't crash.

If market does crash that month, no biggie, now you do a "rollover", which is when you "buy back" and close this 1 month Put that you sold (you might be paying $1600 or whatever for this put that you had originally been paid $800 for). But you sell another option that is further out (1 year for example) with a much lower strike, and essentially use the new premium to pay for the cost of "buying back" the losing option trade, and put the surplus in your pocket. Screenshot_58 shows what a rollover trade would look like. With todays number such a trade gives another $3000 in profit, and drops the cash requirements (the 10% required) to $13500 because the strike was effectively dropped to $1350 from $1790 and the time was extended to January 2022. Thus, making it unlikely to reach this new lower strike price. Rinse and repeat if needed if markets keep declining, can push time up to 3 years out, and with each time push can drop strike price by a decent amount. Essentially you're the insurance company that keeps collecting a premium against disasters - but when the disaster happens, you change the terms of the contract The big assumption here is that Russell 2000 will not go to 0 - its an index of 2000 companies, it shouldnt. If it does, we're all screwed anyway.

Now lets say 1 year from now, January 26th 2022, price of RUT is 35% below todays - $1405. If you were an index fund investor with a heavy small cap tilt your account is down 35% roughly. The $1405 price is ABOVE my $1350 strike. My option is out of the money and expires worthless. Your account is down 35%, my account is up by $3800 on the original $17300 cash - 22% up.

Unless I'm completely missing the plot, you seem to have some math errors.

Your account is not up 3800 in this hyopthetical scenario. It's up $2200. You said you sold a put and made 800 bucks. You then bought it back for 1600. Now you're down 800. You then sold another put for 3k. You're now up 2200. Assuming your new put expires worthless, you're up 12% on 17.3k.

Is this still better than where you would be in the hypothetical scenario where the other person bought $17900 worth of RUT in a single bulk transaction today? Obviously yes. Even if that person is cost averaging and buying steadily over the course of the entire year, you're still up on them (using these hypothetical numbers).

That said, if the market crashes precipitously, there is no guarantee that you're going to be buying that original losing put back at 1600. It could be substantially, substantially higher. If you had simply bought RUT, and it bounces back (AKA what we all saw earlier last year with COVID), you'd be golden with your long term RUT buy, and absolutely knackered if you had a poorly timed option.

Yes, there are ways of mitigating this risk as well, provided that you're paying close attention to the markets and are knowledgeable enough to execute an appropriate balancing trade as needed.

The point I'm trying to make is not to correct you or dissuade you from doing this (as you seem to generally know what you're doing). I am trying to ensure that people who see what you wrote as a path to easy money realize that there are massive monetary risks involved if you don't know what you're doing (and still can be, even if you do).

 

[cyanide12345678]

Unless I'm completely missing the plot, you seem to have some math errors.

Your account is not up 3800 in this hyopthetical scenario. It's up $2200. You said you sold a put and made 800 bucks. You then bought it back for 1600. Now you're down 800. You then sold another put for 3k. You're now up 2200. Assuming your new put expires worthless, you're up 12% on 17.3k.

Is this still better than where you would be in the hypothetical scenario where the other person bought $17900 worth of RUT in a single bulk transaction today? Obviously yes. Even if that person is cost averaging and buying steadily over the course of the entire year, you're still up on them (using these hypothetical numbers).

That said, if the market crashes precipitously, there is no guarantee that you're going to be buying that original losing put back at 1600. It could be substantially, substantially higher. If you had simply bought RUT, and it bounces back (AKA what we all saw earlier last year with COVID), you'd be golden with your long term RUT buy, and absolutely knackered if you had a poorly timed option.

Yes, there are ways of mitigating this risk as well, provided that you're paying close attention to the markets and are knowledgeable enough to execute an appropriate balancing trade as needed.

The point I'm trying to make is not to correct you or dissuade you from doing this (as you seem to generally know what you're doing). I am trying to ensure that people who see what you wrote as a path to easy money realize that there are massive monetary risks involved if you don't know what you're doing (and still can be, even if you do).

It's not easy money, it takes knowledge and a deep understanding of options to fix a trade. I wouldn't recommend it unless you understood everything that you were doing.

I used today's numbers to just demonstrate concept. The account will actually be up more. Also, there's no math error based on today's, those are the exact numbers for a rollover based on today's prices. The error is in your understanding. Let me explain.

If you look at the second screenshot, the Ask price was roughly $9 for the 1790 strike and the bid price is $40. So, the rollover trade pays you $4000 to sell the 1 year put with strike $1350, and then out of that you pay $900 to buy back the previous contract. These are today's prices. The net gain was $3k, so the cost of buying back was already accounted based on today's price. This is just the concept.

Now, that's based on today's price. But in a crash, if I'm paying $2000 or whatever for something that can be bought back for $900 today, then the premium i receive for selling the extended trade will be a lot more than the $4000 right now (8000 for example if premiums have doubled). Premium pricing depends on the greeks - the most important of which are current price, and volatility. If the cost of premium of my put has doubled due to dropping prices and increasing volatility, then the premiums for the longer puts that i sell will be more or less doubling too compared to today's prices. So in reality id make more than 3800.

So the math isn't wrong. You just don't know the game yet.

Edit: alright, no more option related arguments. Do radiology. That's the point of this post. Have a good life, do radiology. Never see patients again.

 

[turkeyjerky]

So how high does GME have to get b4 you FI? 🚀🚀🚀🚀😎😎😎

Gamma Squeeze baby!!!

 

[RustedFox]

So how high does GME have to get b4 you FI? 🚀🚀🚀🚀😎😎😎

Gamma Squeeze baby!!!

Grandmas squeeze babies.

 

[JacobMcCandles]

In short, he’s doing something that works well until it doesn’t. When it doesn’t it completely financially devastates people.

 

[bravotwozero]

Can you explain this for the idiots among us?

Just take your lifesavings and put it into Gamestop for teh lulz....

 

[Birdstrike]

*Sigh* Lets see...

SPX = SPY 500 Index
RUT = Russell 2000 Index

They are literally the indexes themselves, not ETFs. Trading options on the index itself, rather than ETFs that follow the index (SPY or IWM) have distinct advantages - 60/40 long term/short term capital gains tax treatment, no early execution (european style execution), cash settlement, lower transaction costs since SPX = 10 x Spy.

Selling Put = Selling a promise/contract that you will buy something at a certain price "strike price" and on a certain date and time. For selling this promise/contract, you get paid a premium. This premium is your profit.

Cash secured put = You need 100% of the cash in your account when you say you will buy this something that you promised that you will buy

Naked put = you only need 10%-30% of the money to do a trade depending on what you're trading - you're leveraged essentially. SPX and RUT only require 10% of the money. So you're leveraged 10X in a naked put on Spx and IWM. But you can use this leverage to actually make very safe trades and still maintain excellent return.

Real numbers follow from current market prices, see attached screen shot from option chain from my etrade account (See Screenshot_57):

If you sold a $1790 (strike price) Put for RUT for expiration date Feb 26th, 2021 (1 month from today). You will receive a premium of $800 for a market order (current bid price).

This $1790 strike price is 17.5% below todays price of $2163. For a Naked put I require $17900 cash in the account (10%) and I will receive $800 of profit on this money.

So, if in the next 1 month, RUT (russell 2000 small cap index) does not drop 17.5%, then I have made $800 profit on cash deposits of $17900. This is a 4.4% return in 1 month. Rinse and repeat every month to get a similar 3-4% monthly return. Enjoy 40%+ annual return when the going is good and market doesn't crash.

If market does crash that month, no biggie, now you do a "rollover", which is when you "buy back" and close this 1 month Put that you sold (you might be paying $1600 or whatever for this put that you had originally been paid $800 for). But you sell another option that is further out (1 year for example) with a much lower strike, and essentially use the new premium to pay for the cost of "buying back" the losing option trade, and put the surplus in your pocket. Screenshot_58 shows what a rollover trade would look like. With todays number such a trade gives another $3000 in profit, and drops the cash requirements (the 10% required) to $13500 because the strike was effectively dropped to $1350 from $1790 and the time was extended to January 2022. Thus, making it unlikely to reach this new lower strike price. Rinse and repeat if needed if markets keep declining, can push time up to 3 years out, and with each time push can drop strike price by a decent amount. Essentially you're the insurance company that keeps collecting a premium against disasters - but when the disaster happens, you change the terms of the contract The big assumption here is that Russell 2000 will not go to 0 - its an index of 2000 companies, it shouldnt. If it does, we're all screwed anyway.

Now lets say 1 year from now, January 26th 2022, price of RUT is 35% below todays - $1405. If you were an index fund investor with a heavy small cap tilt your account is down 35% roughly. The $1405 price is ABOVE my $1350 strike. My option is out of the money and expires worthless. Your account is down 35%, my account is up by $3800 on the original $17300 cash - 22% up.

Where did you learn all this?

 

[partypantss]

It's not easy money, it takes knowledge and a deep understanding of options to fix a trade. I wouldn't recommend it unless you understood everything that you were doing.

I used today's numbers to just demonstrate concept. The account will actually be up more. Also, there's no math error based on today's, those are the exact numbers for a rollover based on today's prices. The error is in your understanding. Let me explain.

If you look at the second screenshot, the Ask price was roughly $9 for the 1790 strike and the bid price is $40. So, the rollover trade pays you $4000 to sell the 1 year put with strike $1350, and then out of that you pay $900 to buy back the previous contract. These are today's prices. The net gain was $3k, so the cost of buying back was already accounted based on today's price. This is just the concept.

Now, that's based on today's price. But in a crash, if I'm paying $2000 or whatever for something that can be bought back for $900 today, then the premium i receive for selling the extended trade will be a lot more than the $4000 right now (8000 for example if premiums have doubled). Premium pricing depends on the greeks - the most important of which are current price, and volatility. If the cost of premium of my put has doubled due to dropping prices and increasing volatility, then the premiums for the longer puts that i sell will be more or less doubling too compared to today's prices. So in reality id make more than 3800.

So the math isn't wrong. You just don't know the game yet.

Edit: alright, no more option related arguments. Do radiology. That's the point of this post. Have a good life, do radiology. Never see patients again.

Or just buy bitcoin

 

[cyanide12345678]

Where did you learn all this?

YouTube 😂😂 and lots of websites. And then just critical thinking about all outcomes and what i would do. Now i have a very defined algorithm essentially.

 

[cyanide12345678]

In short, he’s doing something that works well until it doesn’t. When it doesn’t it completely financially devastates people.

Incorrect but sure. I don't feel like explaining.

 

[JacobMcCandles]

Incorrect but sure. I don't feel like explaining.

"Can't lose"?

 

[cyanide12345678]

"Can't lose"?

"Absolute financial devastation" is hard. Time will tell, I'll post something in a few years, don't worry

 

[Birdstrike]

"Absolute financial devastation" is hard.

Unless you shorted GameStop a few days ago

 

[bravotwozero]

Unless you shorted GameStop a few days ago

They're so butthurt now the hedgefunders are preventing people from buying AMC and GameStop.

So what does the reddit crew do now? Pump up silver!

6% jump out of nowhere, lol

 

[Splenda88]

Radiology job market is leaps and bounds better than EM. A radiologist at worst is still making better money than your best EM job in big cities. Mid level.encroachment in radiology is in its infancy and isn't gaining ground anytime soon.

Though fellowship IS required. So you must be ready for the 6 years.

The day that physicians will act on a 'radiology read' by a midlevel instead of a radiologist is the day that we all can say 'it's over'

 

[Splenda88]

Your PD will likely understand. Even my faculty sees the writing on the wall wondering what they'll be doing with grads for the foreseeable future since ACEP thinks it's a non issue

I am a PGY3 IM and I have not been able to find semi desirable hospitalist job yet (250k+/yr not in the South/North Dakota or rural Arkansas). So it's not only EM.

 

[Dr Mantis Toboggan]

The day that physicians will act on a 'radiology read' by a midlevel instead of a radiologist is the that we all can say 'it's over'

Yes plus the current demographics suggest a ton of radiologists are going to retire in the next 10 years. They will be fine.

 

[Backpack234]

I am a PGY3 IM and I have not been able to find semi desirable hospitalist job yet (250k+/yr not in the South/North Dakota or rural Arkansas). So it's not only EM.

250k+ seems pretty high for hospitalists. My SO works at a pretty good gig with base closer to 225. But I have heard or 300k+ for hospitalists in the dakotas.

 

[Splenda88]

250k+ seems pretty high for hospitalists. My SO works at a pretty good gig with base closer to 225. But I have heard or 300k+ for hospitalists in the dakotas.

It's not too high... Many of my co-residents are getting 300-350k with 50k sign on bonus in places that I don't want to live. Therefore, I feel like 250k/yr in a nice suburb in the southeast should be reasonable.

 

[dadaddadaBATMAN]

It's not too high... Many of my co-residents are getting 300-350k with 50k sign on bonus in places that I don't want to live. Therefore, I feel like 250k/yr in a nice suburb in the southeast should be reasonable.

It’s not my field and it’s not my life, but my unsolicited advice is to pay close attention to things that are not $. I think new grads tend to get a little myopic (understandably so considering debt) on pay.

Hospitalist feels like em in some ways: getting paid 400k to move 3/hr + mid level patients in an inefficient malpractice dumpster fire is a very different job than 2/hr for 325k with physician hours >mid level hours at the site with great transfer agreements.

The money is absolutely important, but I’ll take decent pay and reasonable expectations over high pay and insane expectations every day of the week.

 

[cyanide12345678]

It’s not my field and it’s not my life, but my unsolicited advice is to pay close attention to things that are not $. I think new grads tend to get a little myopic (understandably so considering debt) on pay.

Hospitalist feels like em in some ways: getting paid 400k to move 3/hr + mid level patients in an inefficient malpractice dumpster fire is a very different job than 2/hr for 325k with physician hours >mid level hours at the site with great transfer agreements.

The money is absolutely important, but I’ll take decent pay and reasonable expectations over high pay and insane expectations every day of the week.

I'll second that, but i also did make my money in a not so desirable place too so I'm guilty of doing the same. But those are wise words.

 

[Natremia]

250k+ seems pretty high for hospitalists. My SO works at a pretty good gig with base closer to 225. But I have heard or 300k+ for hospitalists in the dakotas.

I’m in a major city and hospitalists here, on average, crush 225.

you’re SO is getting hosed, ie 10% tile mgma

 

[wamcp]

It's not too high... Many of my co-residents are getting 300-350k with 50k sign on bonus in places that I don't want to live. Therefore, I feel like 250k/yr in a nice suburb in the southeast should be reasonable.

There is 300k base pay (340k with bonus) hospitalist job open that is 40 min out from greenville SC. I don’t know SC well, is that a rural place?

 

[wamcp]

I’m in a major city and hospitalists here, on average, crush 225.

you’re SO is getting hosed, ie 10% tile mgma

300k for day hospitalist in major city suburb here.

 

[Splenda88]

There is 300k base pay (340k with bonus) hospitalist job open that is 40 min out from greenville SC. I don’t know SC well, is that a rural place?

I don't know... @VA Hopeful Dr is from there, maybe he can tell us.

 

[VA Hopeful Dr]

There is 300k base pay (340k with bonus) hospitalist job open that is 40 min out from greenville SC. I don’t know SC well, is that a rural place?

Depends where exactly. I grew up in Spartanburg which is smaller than Greenville but isn't a bad place to live. Much cheaper but still has the basics, plus a fair amount of non-chain restaurants that are surprisingly good.

I did residency in Anderson. Smaller still but in a good way (very Mayberry-ish) plus there's a big lake running right outside town to live on if that's your thing.

Anywhere else is going to be much less ideal for living there but might not be a bad commute.

Mind sharing the exact location so I can give more specific information?

 

[YCAGA]

300k for day hospitalist in major city suburb here.

Any idea what suburban/rural (IM) nocturnist pay is like? Would $400k be out of the question for 7 on 7 off?

 

[wamcp]

Any idea what suburban/rural (IM) nocturnist pay is like? Would $400k be out of the question for 7 on 7 off?

370k for 15 night shifts a month, closed icu, at my city suburb hospital.

I opted for 10 a month which is still considered full time, so i get 250k.

400k should be very well within reason if open icu (even with no procedures) or in a more rural place