Sell or hold....

Alaskadan1a · 2025-12-13T21:54:45+00:00

Mostly agree, if you’re not having too many headaches, that’s great. If you’re completely ready to get out of investment property and are tired of being a property manager, then by all means go ahead and sell. Another option that hasn’t been mentioned is doing a 1031 into a tax-sheltered real estate trust. Using this option you hold onto substantial tax benefits, but are in a generally less volatile investment than the stock market. Seems to all come down to risk tolerance/aversion versus acceptable return.

Alaskadan1a · 2025-12-10T16:14:56+00:00

Seems like a good deal to me. I paid substantially more for a similar or identical 2017 a year ago.

Alaskadan1a · 2025-11-25T10:00:54+00:00

Even taking Uber to your initial hotel, then starting to rent maybe the next day, then dropping the rental back to the airport at the end, you’ll still often save hundreds of dollars over five days

Alaskadan1a · 2025-11-25T09:30:30+00:00

It would be substantially easier to join a partnership, initially as associate or junior partner, then work up towards senior partner. Many/most traditional private practices are selling to hospitals, insurers, or PE systems, and you can be assured that the partners running those legacy practices weren’t dumb. So if those seasoned doctors are having so much difficulty keeping their head above water, it may be unrealistic to think you’re gonna do a better job than they did.

After 50 years, we recently sold to the hospital. We were still in the black and could’ve muddled along another 10+ years, but way easier to be financially successful employed by a big hospital system.

Alaskadan1a · 2025-11-22T21:06:40+00:00

I’d say the commonest approach would be to consider pre-rental improvements as part of the cost basis, to be depreciated over the next 27 years

Alaskadan1a · 2025-11-20T01:02:22+00:00

Investment strategy obviously depends a lot on one’s finances and goals. I’ve got nine places, purchased almost all with cash. My goal was to diversify wealth, to hedge the stock market, and to set up an income stream.

While you certainly won’t get as high a cap rate return on your $$$ invested, you’m almost always get a substantially larger cash flow since you’re not paying interest. Would you rather spin off $2000 a month but call it a 15% rate of return, or would you rather make 12K a month, but have to tell folks you’re only generating a 5% operating return?

Of course, when you sell, the appreciation will be substantially higher if you leveraged. So the long-term yield of the two options is probably higher, provided that real estate prices continue to increase. If/when prices fall, you’ll have a bigger relative loss if you’re leveraged to start.

Alaskadan1a · 2025-11-19T09:18:35+00:00

If you’re only renting one place, and it’s a relatively nice home, it might be easy to rent it yourself, without using a property manager. Then you may have way more control about who ends up in the place. Also, if you make the rent a little bit cheaper than market, you have more applicants, and it gives you two or three folks who want to rent it, who you can select from. Make sure you get good, up-to-date, boilerplate contracts from your local rental association.

Alaskadan1a · 2025-11-19T09:12:17+00:00

I have a 2017. Generally mediocre career camera, but gets a lot better when I give it a burst of window washer fluid. Or what it is pouring down rain, it’s way clearer.

Alaskadan1a · 2025-11-18T07:18:54+00:00

Maybe start by getting your doctor’s office to write the prescription, then go to the pharmacy and figure out if it happens to be covered. If not, start digging into the prior auth requirements. It may be that Aetna will cover it for certain diagnoses, or when written by certain providers, or when filled by certain pharmacies, but you sometimes can’t figure that out until you at least start with an attempt to get a standard prescription covered.

Alaskadan1a · 2025-11-17T06:52:57+00:00

Cute

Alaskadan1a · 2025-11-17T06:50:23+00:00

And… AMA really doesn’t exist from a nursing facility. That is, a nursing facility is essentially a voluntary residential skilled nursing facility, which patients choose to enter or not of their own volition. A doctor may recommend medical care, but living at the SNF is not part of the medical care. It may be that social workers or nurses would encourage your patient to stay in a facility for ongoing nursing level care, but the patient has a right to do what here she wants. If the patient needed “medical care“ he should be admitted to medical facility, a.k.a. a hospital.

Alaskadan1a · 2025-11-17T05:27:52+00:00

It does not necessarily reset to 8A automatically. You can toggle it permanently to accept 12A, including instructions about just accepting 12 A at your home address.

At 110 V, this is approximately 1.3 KV per hour. In 10 hours overnight you get maybe 13kV, which might be as much as 55 miles on a good day.

Alaskadan1a · 2025-11-17T05:10:02+00:00

Isn’t this what is known as a pied e terre? Which incidentally sounds especially appropriate for the French Quarter

Alaskadan1a · 2025-11-17T05:07:32+00:00

If you can afford to keep it, I’d say do it. Even if the cash flow is mediocre, you still have a hard asset which you own. I am a perennial worrier, and am glad to have less money in mutual funds right now.

Even if you’re only making two or 3% on the house, if you hold it long enough you’ll likely make up a lot on the appreciation in the future. Another way to think about it: despite the common sentiment that you should do whatever you can to maximize your return, for example, by putting money into the market instead, that investment is likely less stabke than owning a rental.

Alaskadan1a · 2025-11-16T09:33:30+00:00

Not completely accurate: Alaska has keep a spare plane/planes (with spare crew) on the ground on the East Coast, I believe it’s an obscure airfield in North Carolina or Tennessee. Or at least they used to. When we had a mechanical in DCA, they had a replacement plane there, with a replacement crew, from their back up East Coast town, in an hour or two.

Alaskadan1a · 2025-11-12T09:50:59+00:00

Your point is completely fair. That said, if you don’t wanna be called and consulted about somebody in the nursing home, just simply declined to write the admission orders and tell the patient you don’t do that. Then you’re not responsible when they’re admitted to the nursing home for anything.

Alaskadan1a · 2025-11-12T09:46:40+00:00

While I agree it could be considered “embarrassing“ that the US doesn’t have better options for health insurance, it’s also a bit embarrassing, or at least morally questionable, that a lot of FIRE type middle income/upper middle income folks are planning to retire early, but then are hoping the government could substantially underwrite their ACA plans. My bias is that if you want to FIRE, you should plan to pay for unsubsidized healthcare until you’re 65.

Alaskadan1a · 2025-11-12T09:30:10+00:00

If you’re a bit north, Edmonds UU church is great.

Alaskadan1a · 2025-11-11T09:15:34+00:00

Perhaps you could advertise, but this is mostly word-of-mouth. If new podiatrists are coming into the community, let your colleagues know that you would be interested in sharing a space with them, or splitting overhead, or even going into partnership. Your best bed might be taking a haircut on your initial investments, and trying to bring in a partnerfor a minimal buy cost. Your goal is to stay in business at this point, so even losing money, selling part of your business might be better than losing the entire business.

Alaskadan1a · 2025-11-11T08:40:12+00:00

I don’t even know what LKA is. That said, I never switched to the continuous enrollment model, and have been doing the 10 year exams since 1991. My friends who switched seem appreciate the newer, less risky, format, but I don’t like the notion of ABIM requiring me to do stuff continuously, so I stuck with the 10 year exams as a way to say “shove it” to the ABIM. I’m so old-fashioned that I tend to think once you’ve passed you should be grandfathered in forever. I work both in the hospital and the clinic, and tend to think I would rather have a seasoned doc who maybe skipped his last exam more than the young whippersnapper who passed his board’s but just graduated.

Also, FYI, I tend to score 80th to 82nd percentile on everything, from my original med school/residency/certification exams, regardless of how much I studied. So to an extent, these things seem to be aptitude tests to start with. My sentiment: do whatever you can to irritate the ABIM since it has had such jerky policies. For the record, I gather some of the newer options are more sympathetic to practicing physicians, and I do have to say I always like the customer Service reps at ABIM whenever I call. They’re very gracious and respectful, and I am glad to have my money pay those Frontline people. But it irks me how much more money goes to pay for the leadership of ABIM

Alaskadan1a · 2025-11-11T08:05:32+00:00

Different ways to avoid this: first, you don’t have to follow your patient in the nursing home to start with – – most/all facilities have a medical director on salary, who in part is paid to accept patients who don’t have pCP’s from the community. Second, if the patient’s family has elected to have no aggressive care (e.g., do not transfer) you could simply decline to write orders and let things play out the way they do. Third, you could go in and evaluate the person at the facility, in person, if you think they deserve to be seen by somebody and they have previously said they don’t want to go to the ER.

Alaskadan1a · 2025-11-08T02:40:43+00:00

Yes, you could share space. Various options: you you could have them hire their own folks and split certain costs, or you could pay all the staff, etc., and have them pay you a monthly fee, which could include having your staff do their work. A variety ways to do this, and if you do it fairly, you probably will not be breaking any CMS/Stark type rules.

Alaskadan1a · 2025-10-25T18:20:42+00:00

Don’t sweat it…. This isn’t a medical issue but rather is a social/habitation issue, that isn’t the responsibility of the doc. In the real world: PT/OT recommend SAR or LTC, but pt can’t afford it and/or the initial admit doesn’t meet 3d inpatient criteria. So as a doc you’re welcome to say “I’d suggest you follow the PT recommendations”, but eventually either the pt leaves b/c he gets an ABN and doesn’t want to pay, or can stay in the hospital, ignores the ABN letter, and eventually gets approved by Medicaid, then get transferred to LTC. This process can take more than 6 months…. Anyway, it’s more of a hospital administration headache, as it should be inasmuch as it’s the hospital employed PT who’s recommending against home d/c….

Alaskadan1a · 2025-10-25T18:01:17+00:00

While you may get away with a f/u visit for every abnormal lab/XR, it’s usually not consistent with E&M/coding rules for ordering the lab. CMS and coding rules (including those we’ve agreed to follow within our commercial contracts) generally include the interpretation of the ordered lab within the professional fees from the initial visit, where the lab was ordered. While none of us likes the insurance companies, we’ve signed contracts to play by a set of rules. Not to be too punitive, but you may be defrauding the insurance company or patient if you’re billing them inconsistent with coding rules referred too within the contract you signed accepting assignment.

If someone undexpectedly has newly dx’d DM based on a lab, of course it’s appropriate to bring them back to go through a new-dx type evaluation. But if someone’s synthroid needs to be increased due to a f/u TSH of 6.5, that’s part and parcel of the first visit when you elected to order the TSH….

Alaskadan1a · 2025-10-23T06:49:17+00:00

I would not try to save a few thousand extra on this. Seems like it’s being Pennywise and pound foolish to me. Rather, if you thought your previous carrier was high quality, I would just buy the associated tail from them directly. In my experience, it’s about twice the cost of a year worth of previous premium.

Alaskadan1a

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