A physician’s love-hate relationship with dividends. And what he does about it.

Finance
January 9, 2018

When I described my drawdown strategy in early retirement, I stated we will “sell from the taxable account first.” I also plan to collect quarterly dividends from my index funds, but if Vanguard were Burger King and I could have it my way, I’d hold the dividends and take bites out of my account only as needed.

When I discuss the downsides of dividends, note that I …

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A physician’s love-hate relationship with dividends. And what he does about it.

Learn about Clostridium difficile infection with a Medcomic

Conditions
January 8, 2018

Clostridium difficile is a gram-positive anaerobic bacillus which secretes toxins (A and B) that cause diarrhea and pseudomembranous colitis. C. difficile is the most common infectious cause of nosocomial diarrhea. Transmission of C. difficile can occur from contact with contaminated humans and fomites. The organism contains endospores that can survive the acidity of the stomach and reach the large intestine.

C. difficile colonizes the intestinal tract after the normal …

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Learn about Clostridium difficile infection with a Medcomic

The non-difference between MDs and DOs

Education
January 8, 2018

“What’s a DO?” is something virtually every osteopathic medical student and physician have been asked at some point in their training. There is this public misconception that professionals who carry MD after their names are the only qualified people to medically treat their ailments. Any other degree is categorized as “alternative medicine” in their mental schema. Truth be told, DOs, or doctors of osteopathic medicine are just as qualified as …

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The non-difference between MDs and DOs

Please change the culture of surgery

Education
January 8, 2018

It is December 2017. I have been on the road for the last five months, completing my five months of elective rotations. I am a fourth-year medical student aspiring to specialize in family medicine. I also want to learn procedures, so I did two months of surgery, three months of family practice electives. At the beginning of this process, I had wanted to be a general surgeon, but I ended …

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Please change the culture of surgery

Why published trading strategies rarely work

Finance
January 8, 2018

When you browse finance-related websites, it doesn’t take long for you to see ads that claim that they can help you make money, fast.

“I’VE BEEN ABLE TO WIN ON 90% OF MY TRADES WITH THIS PROVEN STRATEGY.” – TYPICAL AD #1

“LET ME SHOW YOU HOW TO EARN 25% RETURNS, GUARANTEED.” – TYPICAL AD #2

“SIGN UP FOR MY NEWSLETTER AND I’LL SHARE WITH YOU THREE STOCKS THAT ARE READY TO EXPLODE.” …

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Why published trading strategies rarely work

Lessons from the psychiatric ward

Education
January 7, 2018

The specter of the psych ward looms large in popular culture: video games, horror movies, novels — the concept of a locked inpatient psychiatric ward is shorthand for a variety of terrors. This perception is driven by a complex cocktail of factors. Psych ward patients have struggled with historical and current abuses, which are compounded by misunderstanding and ignorance around mental illness.

During third year, I spent a six-week rotation in …

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Lessons from the psychiatric ward

Independent practice: Both nurse practitioners and physicians should be outraged

Policy
January 5, 2018

The United States is facing a looming physician shortage, and some groups see this as an opportunity to promote an agenda of replacing physicians with nurses.

The nurse-as-doctor concept appeared in the Institute of Medicine Future of Nursing 2011 report, which called for a radical change to the nursing structure in the United States, including a goal of …

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Independent practice: Both nurse practitioners and physicians should be outraged

Do physicians make the best politicians?

Physician
January 4, 2018

Even though we have probably 20 years of work remaining as physicians, like a lot of you, I like to think about how we will spend our retirement years. After all, in twenty years we will still only be in our early fifties, hopefully with no dependents and a lot of financial security. Of course, my wife and I are interested in traveling, spending time with grandchildren (hopefully), gardening and …

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Do physicians make the best politicians?

Plastic surgeon quits and couldn’t get a job at Chick-fil-A

Physician
January 4, 2018

I just got off the phone with Paul, a highly-sought-after plastic surgeon in New York.

“I don’t want to be a doctor anymore,” Paul says. “What else can I do? I have lots of restaurant experience. I’ve worked in 15 restaurants during my life. It’s not easy, but I could do it. I did research on chains and franchises, and I chose Chick-fil-A. …

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Plastic surgeon quits and couldn’t get a job at Chick-fil-A

Why the social history is important

Physician
January 3, 2018

From the notes I read, it seems that other medical specialties limit “social history” to whether or not someone uses tobacco, drinks alcohol, or uses drugs.

“Social history” is meant to get a sense of the context in which people live. Where do they live? Who do they live with? How did they come to live there? Where did they grow up? What sort of work do they do? How much …

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Why the social history is important

Why are so many doctors doing multi-level marketing?

Finance
January 3, 2018

My goal with this post is to try to answer some of the more popular questions that we get asked about multi-level marketing (MLM). Why write about it? Besides the fact that my wife and I are involved in one, and it’s made a significant impact on our income, the number of physicians getting involved these days is huge.

My goal is not for everyone to go out and …

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Why are so many doctors doing multi-level marketing?

Surgeon suicide-homicide: What happened to Dr. Chris Dawson?

Physician
January 1, 2018

Sometimes there are no words. Not even a eulogy.

Then one courageous family writes this obituary. (This obituary was written by Rachel Dawson, his wife, with the blessing of his parents.) In it, they share how their son lost his battle with severe depression. How he adored his children. How he sacrificed fun, free time, and relaxation to receive his medical …

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Surgeon suicide-homicide: What happened to Dr. Chris Dawson?

Relative risk reduction is a troublesome way to convey the benefits of treatments

Meds
January 1, 2018

How excited would you be about a medication that lowered your risk of cardiovascular death, heart attack or stroke by 1.5%? Excited enough to spend a few thousand dollars a year on the drug? I expect not.

What if, instead, the drug reduced those same terrible outcomes by 20%? That’s probably enough benefit to interest some in the drug.

Well, those statistics come from the same clinical trial, evaluating the same drug. …

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Relative risk reduction is a troublesome way to convey the benefits of treatments

What would you do if you won the lottery? Here’s one physician’s plan.

Finance
January 1, 2018

Yup, I won the lottery! $785 million dollars. Pinch me because I must be dreaming. I am a physician finance blogger; I would not recommend buying a lottery ticket. But I did. So screw all the people who said it was a waste of $2.

So here I am, the big time winner: What to do now? Well, that is what this post is about.

(In reality, I did not win the …

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What would you do if you won the lottery? Here’s one physician’s plan.

How to choose between a traditional and Roth 401(k)

Finance
December 31, 2017

In my post, “Use it Or Lose It,” I talked about the awesome benefits of the Roth IRA.  You do have to pay taxes on the money now, but it grows tax-free, and you can withdraw the money after age 59.5 without owing any taxes.  It’s the only way to win the tax game.  It is 100% your money, forever!

In comparison, money in a traditional IRA, traditional 401k, …

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How to choose between a traditional and Roth 401(k)

Learn pulmonary hypertension with a Medcomic

Conditions
December 30, 2017

Pulmonary hypertension (PH) refers to increased pressure in the pulmonary circulation. It develops when pulmonary vessels become constricted and/or obstructed, which can occur in a wide variety of conditions. The increase in pressure is measured by right catheterization, and is defined as a mean pulmonary arterial pressure ≥ 25 mm Hg at rest.

PH leads to right ventricular hypertrophy and enlargement as the …

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Learn pulmonary hypertension with a Medcomic

MKSAP: 64-year-old man with diabetes

Conditions
December 30, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 64-year-old man is evaluated for his quarterly diabetes care follow-up visit. Point-of-care HbA1c level is not at goal for this patient, who has high function, long life expectancy, few comorbidities, good support, health literacy, and access to care. Medical history is significant for hypertension, hyperlipidemia, and obesity. His family history is notable for type …

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MKSAP: 64-year-old man with diabetes

Safe pediatric dental anesthesia is the right of every child

Physician
December 29, 2017

When you tell anyone in health care that “sedation” to the point of coma is given in dentists’ and oral surgeons’ offices every day, without a separate anesthesia professional present to give the medications and monitor the patient, the response often is disbelief.

“But they can’t do that,” I’ve been told more than once.

Yes, they can. Physicians are not allowed to do a procedure and provide sedation or general anesthesia at the …

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Safe pediatric dental anesthesia is the right of every child

The physician’s relationship with the beeper

Physician
December 29, 2017

If you’re thinking about a career in medicine, there’s a piece of technology you’ll come to know intimately. It’s small and sleek, with excellent battery life and remarkable durability. It’s not an iPhone; it’s not a Pixel. It’s a beeper. You will come to know, and to respect, this tiny black rectangular prism. It will govern your life. You will be at its mercy, yes, but it also offers you a chance at salvation. …

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The physician’s relationship with the beeper

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