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 …
Do physicians make the best politicians?
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. …
Plastic surgeon quits and couldn’t get a job at Chick-fil-A
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 …
Why the social history is important
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 …
Why are so many doctors doing multi-level marketing?
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 …
Surgeon suicide-homicide: What happened to Dr. Chris Dawson?
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. …
Relative risk reduction is a troublesome way to convey the benefits of treatments
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 …
What would you do if you won the lottery? Here’s one physician’s plan.
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, …
How to choose between a traditional and Roth 401(k)
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 …
Learn pulmonary hypertension with a Medcomic
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 …
MKSAP: 64-year-old man with diabetes
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 …
Safe pediatric dental anesthesia is the right of every child
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. …
The physician’s relationship with the beeper
A common question from readers is what to do about an account that contains a bunch of high expense ratio mutual funds or individual stocks.
The reason for having such an account varies from person to person. Maybe it was the only funds available to them in their 401(k) portfolios. Perhaps they collected a bunch of individual stocks and actively-managed mutual funds over the years based on tips from magazines or …
What to do if you have high expense ratio mutual funds
Learning to budget is scary. After all, it means you have to say NO to unnecessary purchases and keep your eye on long-term goals at the expense of short-term pleasure. There are a variety of ways to budget, ranging from the restrictive and somewhat impractical “envelope system” to the more vague and potentially ineffective “wing it” system. I’d like to present a balanced approach to budgeting that …
How to create a household budget: a physician’s simple approach
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 63-year-old man is evaluated for severe mid-upper back pain following a minor fall 1 day ago. He also notes progressive fatigue of 6 months’ duration and a 6.8-kg (15-lb) weight loss. Medical history is notable for an 80-pack-year smoking history, although he is currently a nonsmoker.
On physical examination, temperature is 37.3 …
MKSAP: 63-year-old man with mid-upper back pain
More than 15 percent of last year’s new crop of first-year medical students completed a post-baccalaureate program. These programs exist in two flavors: one type helps students who want to improve their undergraduate academic record, and the other helps those who want to redirect their careers toward medicine, like me. Both are growing rapidly in number.
With so many future doctors launching …
What it’s really like in a post-baccalaureate program
Let’s talk about the cycle of abuse. No, I am not referring to the very serious issue of domestic violence. Instead, I am talking about the graduate medical education system. No one is a resident forever: the duration of each residency is predetermined with a wide range of three to nine years. The self-limited nature of this experience decreases the incentive for participants to advocate for changes. And the attitude …
End the resident physician abuse now
What would medical education that is relevant for the here and now — for America in the early 21st century — address? It is impossible to teach the content relevant for an entire career. It is important to educate practitioners able to adapt to the changing landscape of medicine. We must consider what the future might hold.
Watching science fiction may serve to prompt future physicians to practice preventive medicine for …
Are post-apocalyptic disaster films inspiration for doctors?
“Nurse practitioner (NP) education is seriously underfunded. The profession is attempting to saddle private physicians with this cost.”
That is how “Dr. X” replied to my email asking whether he would be willing to precept a nurse practitioner student for her clinical rotation. I read through his clearly disgruntled letter and wanted to explain to him why NPs have to train “on the backs” of physicians and why funding for nursing …
Why nurse practitioners train on the backs of physicians
I have good days and bad. Some days I am content, connected, focused, and motivated. On those days I enjoy my job, I enjoy the people I’m with, I am willing to be inconvenienced by interruptions.
On other days, not so much. I wake up as grumpy Rob and (despite multiple cups of coffee) the old codger doesn’t leave me alone. I keep score of all the ways in which life …
A doctor saved a patient’s life. Twice.
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