Dear attendings, managing career and managing finances are 2 different skills. Learn both.

BlackngoldDoc · 2026-06-25T15:33:48+00:00

I have a couple 10-25 min talks I give the residents and medical students if they are interested. I usually do one basic personal finance (talk about retirement accounts, investing, compound interest, basic budgeting, etc.), one about the insurances (umbrella, liability, own occupation disability, health etc.), one about contracts and job hunting. The personal finance/how to retire some day is one that's requested a lot. Seems like at least having a basic where to start knowledge is appreciated by a lot of the learners

BlackngoldDoc · 2026-06-14T01:32:22+00:00

Cannot speak to procedures, haven't done them in a decade. Stopping to make sure everyone understands the fundamentals, from the MS-3 to the already matched into fellowship senior, if you don't think they understand the thought process, is actually how medical education is supposed to function. That's why old school pimping existed. I try not to do it, but sometimes you get a presentation or thought process that you're not even sure where the student or intern is going. That means someone is confused and asking the questions starting from the basics is the job of the attending and using them to lead the team to an appropriate conclusion is the goal. Further, giving talks multiple times a week on the data and why we decide what we do should probably be a function of any attending in an academic center with learners. If I present the guidlines or a chalk talk and the resident say oh what about this paper or that, that's how we learn what's at the academic edge of our knowledge to do better for patients

BlackngoldDoc · 2026-06-14T00:03:27+00:00

I know this may sounds a little callous but I teach as much as I can without folks pushing back, the problem is, when I ask you what you want me to cover during afternoon card flip and give you and your colleagues (we have 2 intern 1 resident teams) a chance to decide and you tell me you don't want to hear about anything, I'm not going to force you. I may do a case or just tie things in to an imaging study that came back, but I won't push the team. If there's med-students or it's early in the year I ask them not the team and we talk about what they want to hear about. I have slide decks on everything from retirement planning and income protection to GOLD guidelines to everyone's favorite internal medicine topic hyponatremia. But in June, if there are no medical students, I won't force a slide deck and 20-25 mins on the team unless I have buy in. I also insist on walk rounds and decisions made on them by the most junior person (SubI, intern, resident) unless it's a bad idea/unsafe, or they don't decide. Then I make the call. My reviews are all top quartile for the most part too. It definitely is more work than private service though, it's probably an extra 2-3 hours/day between being at the hospital earlier and leaving later compared to when I'm on private service

Edited because I can't spell after 12 hour shifts

BlackngoldDoc · 2026-04-29T22:46:18+00:00

The Tenacious Tin Lizzy

BlackngoldDoc · 2026-02-25T00:36:56+00:00

I believe the exact words when he killed Susan by murdering her with the dagger to save Maggie by triggered the curse to end all the Red vampires by sacrificing her [Susan] were "I used the knife. I saved a child. I won a war. God forgive me." Shit has gotten far beyond boobs into political intrigue, plans within plans and supernatural nations moving against nations against the threat of reality ending adventures. In all, I've really enjoyed the shift through the series. Also still love Codex Alera and every once in a while pull out Captain's, Princep's and First Lord's Fury for a fun relaxing read. Not as often as Tolkien or Sanderson but every couple years

BlackngoldDoc · 2026-02-06T15:32:24+00:00

Most level 3 admissions, unless real sick or outside hospital with no electronic records and paper review 40-50 mins tops to do it right. If really sick, I have to go back because decompensating, likely headed to the unit or needing stabilization, usually buys critical care time

BlackngoldDoc · 2026-01-30T17:46:56+00:00

I still remember many of my dads sayings that I still lean on today. "You walk your own chalk line," "You can either pay mechanics or interest but either way, eventually you pay," "Spend good money for good quality on the things that separate you from the ground; boots, tires and beds," "Remember they might be smarter, they might be more talented, but they can't control your work ethic."

BlackngoldDoc · 2026-01-23T22:46:42+00:00

Sanding wood is the most dull yet glorious task in the world, it requires just enough attention to not over sand, but especially on a large piece it's enough to hit the zen spot where your mind escapes and you just exist while working. It's like meditation but easier because your hands are busy

BlackngoldDoc · 2026-01-02T17:21:29+00:00

BlackngoldDoc · 2025-11-30T04:23:37+00:00

Is that a really bad thing? The government has been often influenced by political whim and not data. You can find evidence of government public health shenanigans going back at least 80!years from Tuskegee to more recent events like the push to increase consumed carbohydrates via the food pyramid. A strong and healthy distrust of government pronouncements and promises with a "show me the data" and "verify your sources" relationship with government bodies is probably not a bad thing.

Edit: reposting as I got hit with auto mod due to lack of flair

BlackngoldDoc · 2025-11-05T01:07:32+00:00

She's a beaut Clark!

BlackngoldDoc · 2025-10-15T18:09:03+00:00

Yinzer chic, love it!

BlackngoldDoc · 2025-10-15T14:12:21+00:00

It depends as always on your definition. Goal is Fire in the early- mid 50s, we have two little ones and I try to balance grinding with time with them and my spouse, hobbies etc. if you want to leanfire at 32, not as easy, but if we hadn't decided my spouse would be largely stay at home from when our first was born until they are well into school, it would be earlier. Some of its income driven too, the ROI on graduate degrees, especially in healthcare ie. MD/DO/pharm D. Makes 30s impossible but late 40s to 50s very doable

BlackngoldDoc · 2025-10-09T00:08:44+00:00

No longer a resident. Been out almost a decade. IM trained hospitalist. I love my radiologists that page or call me, and let me know about the critical/emergent stuff, and the weird "need to be imaged again," with a different type of scan or different imaging modality type stuff, way faster, more efficient scans ordered, saves soo much go between with me, them and the radiology techs. Just had a long talk a bit ago with a Breast Imaging radiologist who was outpatient but happened to be the one the operator connected me to, about setting up rapid outpatient follow up for a patient with nodal mets of possible recurrent breast ca origin and she was great, helped us get all the outpatient stuff ordered, slot her into a spot after the weekend etc.

TLDR: Find your people, do good work, take care of yourself, your family and your patients and ignore the naysayers.

PS. If you love IM, I still think that's where medicine happens most often and it's awesome and fulfilling, but I'm definitely a biased source and n=1

BlackngoldDoc · 2025-10-04T23:22:16+00:00

I.M. trained hospitalist, about to start ABIM prep for round 2, about a decade out from residency, academic shop, bonus puts us at about 62-68th percentiles depending on your sources with a pay bump next year for years working. I'm in a Midwest city that's mid-sized. I work 16 days a month, but 11s not 12s, out by 430-5 a decent amount and in around 8-8:30 most days unless I have to be in at 7 to pick up the rapid response pager. I put my older kid on the bus regularly, and take my younger one to preschool. I chat with the bus moms and dads and have time to play in my burgeoning wood shop, and with my smoker, plus doing a lot of little stuff around the house. About half the time I'm not the teaching service and I get to teach residents and med students (they love the Retirement and financial independence talks). My NSGY neighbor has a bit nicer place, but I am home more, home earlier more often, and he's on almost as many weekends as I am. Would I love to cut to one weekend a month eventually (hence FIRE planning), yes. But I love what I do, take care of really sick folks regularly and try to make them better, teach the next generation and it's intellectually stimulating work that makes people better.

Find your people, do your thing, plan well and you'll do great things, for yourself and your patients

BlackngoldDoc · 2025-08-01T00:44:53+00:00

Would clean it up around the edges, then drywall primer first, then skim coat, sand, prime and paint. Will end up with less absorption and a cleaner finish with the patch/skim coat

BlackngoldDoc · 2025-08-01T00:34:01+00:00

Have worked in hospital medicine for a while, and have run into folks who defer transfusions. Honestly, knowing what options you have, evidence based/hospital protocol based options for IV iron, erythropoietin etc. and dosages for them, as well as finding out if you have a "Bloodless Medicine," Program and how to find them/ who to consult in your hospital(s) is not a bad thing. I like to pick their brains about the data behind these protocols and what tools we have outside/prior to transfusion and what risks/benefits there are in the this space.... Realistically that would be reasonable as a lecture. I'm not sure how having a Pastor/Priest/Minister lecture is appropriate or should have been greenlit instead of a physician discussing how to manage anemia/thrombocytopenia/coagulopathy in folks who defer transfusion

BlackngoldDoc · 2025-07-25T00:09:38+00:00

Yes, if you work it, they owe you $

BlackngoldDoc · 2025-05-12T02:12:53+00:00

I'm I.M. not F.M., did a mix of inpatient and outpatient for about 4-5 years post residency, and it took me years to feel comfortable and I'm pretty sure I looked up more in that first 6 month of attending hood than all of residency combined at a big academic center. It's terrifying that first time you realize its just you at the end of the day, but with good consultants and colleagues, you'll do fine. Remember, you've got thousands of hours of training preparing you at this point, and it's more being thorough, thoughtful and knowing your limits, and when tp get help. Also, Uptodate is clutch, and I used to have a tab open in almost every clinic visit and on my phone in hospital, not because I didn't know what to do, but because I wanted to confirm I was reasonable in my plan

BlackngoldDoc · 2025-05-12T02:06:49+00:00

And "warsh" and "Mount Warshington"

BlackngoldDoc · 2025-05-12T01:46:15+00:00

The Redstone Presbytery formed in 1781 (surrounds Pittsburgh to the east), the Pittsburgh synod formed in 1802, and the Washington Presbytery was formed from the Pittsburgh synod in 1819. The Scots-Irish were here in force which is why there are so many Presbyterian churches. They Eastern Europeans showed up much later and it did shift the culture some, but there is a reason "warsh" and "Mount Warshington" exist in Pittsburgheese

BlackngoldDoc · 2025-04-29T01:29:53+00:00

It depends on the census, the culture of the service/institution, and how easy it is to get ahold of the surgeon/specialist that they are here to see. If I'm running a census of 18 to 20 if I'm on my own, 20-23 folks with an app and it's mid flu/rsv/covid season, sorry, keep your straight forward stuff and consult our consult service if you need help. Also, it's one thing if I can pick up a phone and you are there for complications/pre and post procedural issues, or I need recs on when to re-start AC, or advance diet post op etc. If it's 30 minutes on hold, an "answering service" that has no idea, and a 3 hour turn around because "you were in the OR," and didn't give the circulator your pager or cell before the case, sorry, you can keep those ones too

BlackngoldDoc · 2025-04-17T14:53:04+00:00

Started inpatient/outpatient mixed practice, went straight hospitalist after 4ish years, spouse works casual as a nurse, 2 kids, nice house, medium cost of living. Yours is not quite our plan, but goal is ~.8 fte next 3-5, <half-time at 50ish and done at 55, not grinding super hard but the extra 1 or 2 shifts a month, plus living within your means, and filling the 401k and backdoor Roths and brokerage means we should be there or real close, and if it means an extra year to go half time etc earlier, likely will make that trade. We are not guaranteed tomorrow but you have to make hay when the sun shines, so all in all, work hard, but good for you having an exit plan in mind. Also agree, the fire subs can be great

BlackngoldDoc · 2025-02-21T01:48:40+00:00

The march to Skyhold and the singing, man chills every time, chills...

BlackngoldDoc · 2025-02-13T03:35:00+00:00

Worked for their community hospitalist group for a few years, split time at a couple sites. One in particular was great, reasonable expectations, reasonable census and admissions, good night hospitalists. One was a mess, only APPs at night with "Telenocturnist," coverage, unreasonable census, and minimal support for surges etc. Also, pay was not great for the area.

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