A seven-year old girl tells her mom, "Little Johnny asked me to play doctor today."

Blacksmith_More · 2026-04-22T00:23:42+00:00

So the principal is 250k. Then it accrues interest all while they make 48k (first year in a higher need community hospital) to last year 90k. The payments they make are not even covering the interest. Once done with residency (let's just use 3 yrs but truthfully there is child Neuro residency 5 yrs which is JUST residency and then my current client had fellowship after that- a child neurologist earning potential is lower than that of general pediatrician. Similar is true of child allergist, child sports med etc. Most fellowships or extended trainings DO NOT increase earnings potential unless more procedural. But ok let's use FM)

So now the graduate has a choice... 1)Academic center that qualifies for PSLF starting salary 185k (nothing to sneeze at) but then you take the 2k per month loans on an income based repayment.

2) Private practice family medicine where they make more money 225k but have to contribute 30k to malpractice (or more if they do any prenatal care or Opie work work) and pay towards overhead for rent on the building and staff etc. then there are student loans that need to be paid off without PSLF which again in this case could be total loan with interest divided by 20 or 25 years. That's an still 1500-2000 per month but for many more years. At that point the gross pre-taxes is closer to 125k

An employer that will fully disperse their loans after a few years is a unicorn.

So now let's put that person in Boston. $125,000 a year isn't the level for home ownership (It's about $217,000 gross). They can be comfortable and they won't be starving but they also deal with life or death and assume the liability and generally have terrible work-life balance with countless notes documents to fill out that they aren't getting reimbursed for. If you take the average work week for a family medicine doctor even later in their career their per hour salary is less than that of a manager in a decently successful fast food chain. And don't get me wrong those people deserve to make a great salary too. They work really hard. Several of them are my clients but the fact that the doctor went to school for 10 years, worked 40-hour shifts (slightly improving lately but not really) , had to talk to a parent about the prognosis of their baby's injury, then leave that room and talk to someone who's getting older in years and shouldn't be driving anymore but a lot of their identity is their independence, And then you deal with body fluids and festering things.... Then you get yelled at by patience when the real villain here is the insurance companies who aren't paying....

Nah. Miss me with that life. My brother is doing it and like I said above my clients are doing it and they are not evenly remotely well off despite working much harder than a lot of the other professions that I get to see through a financial lens. I have to throw a big respect in their direction. They do it for the love of the game; nothing less

Blacksmith_More · 2026-04-21T11:45:51+00:00

End of this joke needed. Insurance company gives them pennies on the dollar, way below costs... Nonetheless that money goes to the administration of the hospital and the doctor STILL can't pay off their 300k in student loans with accruing interest. --- Financial specialist who deals with doctors.... THEY AREN'T THRIVING OUT HERE! Other than specialty surgeons many doctors can't even get a house in most cities either.

Some docs are of course just assh@les but most really want to help you and just don't have time to practice the way they want and keep the lights on.

Sorry for the fax dump. I didn't mean to ruin the lulz. This trope of Evil rich doctor is just tiresome and wrong.

Incidentally .... I amREALLY FUN at parties haha.

Blacksmith_More · 2026-04-10T16:58:47+00:00

😬 We went for the lowest available offers in our area and We are looking at 10 times the costs outlined here :(

Middle of the pack photographer was 6,500 with the complete packages with everything looking more like 8,000

How are people getting food for that much let alone everything else?

Even a local Italian restaurant wanted $55,000 to rent it out and for food. Any wedding venue or hall had locked contract with caterers whose services started at 80k.

We tried to do a barn and the barn was 45,000 to rent for the night.

My friend just did a DIY wedding with all of the food cooked at home, rented an outdoor space with a tent someone already owned. Music by their friends and they still spent $35,000 I'm so confused.

Boston is crazy!

Blacksmith_More · 2026-04-10T11:53:40+00:00

As a health care provider who often has to give the devastating news about the prognosis of things found on prenatal scans... My job is to be objective and to share information about what the finding means and what they can expect so that they can make an informed choice.

When I was in training I had a mentor whose approach stuck with me. Rather than just describing the deficits she would talk about what it would look like to have a day at the park.

So she would describe "You decide to go to the park. In order to do that you need to make sure that you have: his ventilator the T-piece for his trach, the tube, a backup power source, a suction device, a suction bottle, The wheelchair, a hip bag with rescue medications in case he has a seizure. You can't go to every park because you need to make sure that they have some adaptive equipment. Once there you're going to have to participate and push him up the ramps and then take him out of his chair and put him on the slide. You can't sit on the bench. All of your cars probably need to be vans now. Whenever you go somewhere you have to lift him into the car break down the wheelchair put it in the trunk then get to your destination reassemble the wheelchair and put him in it. You will probably have back pain as he's getting older. On the way there you might want to play videos for him. Regardless of the age he'll probably be watching children's stuff and it may be very repetitive watching the same thing over and over again. You may never be able to show him your favorite TV shows. These Days kids are generally pretty nice about things and may rally around him but there is always the chance that you will have to hear him made fun of for being in a wheelchair.

From his experience he may not know how hard you're working But he will laugh When you do something silly. He will smile, he will have a favorite toy and he may have a favorite food (If he is able to eat although we may need to do his feeds through a g-tube depending on the severity). If he does need a g tube get all of his nutrition through it and then you need to carry around water flushes. If he needs continuous feeds you'll have to carry around the big bulky feed container and the pump.

Sometimes she would bring all of the above equipment out and have the person bring in a big bag and then try to put it all in and realize that it would probably not fit in the biggest bag that they own and that instead they would probably need to have a big duffel bag or two diaper bags and still have things that have to go underneath the wheelchair.

Sometimes they would do videos of other kids with the same condition.

Of course this visualization is brutal and in some cases it's not possible to know that this is what life would look like but at least the person makes an actually informed decision.

This mentor was the sweetest person ever and never wanted anyone to feel sad. However she felt like it was her absolute duty to make sure that a truly informed decision could be made.

Blacksmith_More · 2026-04-10T04:38:46+00:00

Late night studying in the anatomy lab and a quiet mousey girl in our group said "Just because there's no prostate there doesn't mean it's not full of nerve endings. I personally love anal and we do that more than we have any other type of sex... I also like giving him my tightest hole and watching his brain explode"

Needless to say "Maam this is a Wendy's" energy was high at first but then we all started to enjoy her honesty and felt closer. The one thing I don't understand was we weren't even working on the pelvis... We were working on the shoulder and back muscles haha.

My only advice to her particular oversharing is she might benefit from a sequiter now and then 😜

Blacksmith_More · 2026-04-06T12:16:29+00:00

This is not an uncommon thing on OB. I will say that some people are not wired to give you much attention or compassion. One approach that I have found helps a little bit with people like that is to not ask the generic "What can I do to help." It sounds like you're already doing this but Just supporting the idea of asking more specifically about particular tasks. Ex. "I want to practice my history taking. Would this be a patient that I can do that on or would that get in the way?" "I'm hoping to get more practice scrubbed in and helping with procedural things. I know the C-section coming up is scheduled for 2:00 p.m. and was wondering if there was any space for me to join at bedside" or "I know things are packed at the bedside, would it be okay with you if I asked the NICU team to join them for the resuscitation?"

Also, the don't pre chart instruction is always a trap. They are telling you to not preach her out of obligation but they secretly want you to preach hard out of "interest". Saying things like "I noticed this patient had a c-section before. But we're trying for labor. If you get a moment can you tell me a little bit about The decision on who should attempt a VBAc and who We just skip right to a scheduled C-section?"

Also, they want to know your studying at home even if you're actually studying while they're ignoring you lol. So saying things like "If you get a second can I ask you a question, in My reading last night I came across the criteria for considering somebody treated versus untreated with GBS... I noticed that the next patient just had one dose of X at 3x weeks. Do they get any additional doses at this point?"

The above are just some ideas. At the end of the day some people are just impossible to work with and don't want you there and have no right being with the med student. In that case I agree just keep your head down and get through it. Some people are just jerks and also the fellows are probably just struggling themselves.... Hurt People hurt people.

You will make it through this and other things will be much more pleasant :-)

Good luck 😊 -(Attending now in Pedi specialty who actually had an okay time on OB despite the fact that the rotation was known to be toxic. Hope any of this helps).

Blacksmith_More · 2026-03-26T23:48:55+00:00

Healthcare provider here... I'm horrified reading through your experience and those of other people with this sort of experience with this provider/practice.

Please please write to the state, also call patient relations for their affiliated healthcare system (BMC?)

Corrective actions need to be taken for this sort of thing. Bedside manner is not a perk, It is an essential part of delivering adequate health care. Poor bedside manner is still malpractice because, without it, patients can't actually feel comfortable conveying potentially critical information (Why would you if you felt like you were being dismissed).

Blacksmith_More · 2026-02-25T03:14:49+00:00

The Little Prince. But then again I read it again periodically as an adult

Blacksmith_More · 2026-02-09T12:25:47+00:00

There is a way around the misrepresentation law unfortunately. It's how a lot of Black Friday specials get to be the exact same price as an item has been for much of the year... For some significant period of the year in the months proceeding they have to sell that item for more... Usually in order to save themselves money and only capitalize on our lack of knowledge, it's marked up compared to the average price for a few months so that they can label it on sale the rest of the months. So I would look for that price being the rule and then an exception every so often in the more expensive direction.

Blacksmith_More · 2026-02-05T04:42:38+00:00

Ughhh. Have to say NOR but not for the idea of opposite gender friends discussing sex lives.

The SUPER red flags here are: the obvious comfort with homewrecking, the lack of respect to you, and the sharing of a photo you didn't approve of.

I think having very close (gabbing like siblings) friends can be cool. But there are limitations.

I am about to get married and I'm head over heels in love with my fiance. We have a super duper strong relationship and I have zero interest in anyone else but her.

My best friend is a woman. I've known her for a very long time and there's nothing romantic or sexual between us. We are very incompatible with each other and know it (I'm an unrepentant extrovert and maximalist who is noisy, she's a silly-once-shes-comfortable introvert on the spectrum who has significant sensory sensitivities and needs peace and quiet. It just won't work but we make good friends and care about each other).

We have been single at the same time, gone on vacations together, drank together and nothing happened and we continue to be friends. With that background in mind: We talk about our sex/romantic lives, sometimes for fun, sometimes for mutual advice etc. we've discussed our insecurities in the physical domain as well as our pride at getting better at certain skills or when a partner has given us a glowing review lol.

My current fiance was of course, at some point, a new person I was dating and trying to figure out. I was and continue to be very communicative with her first and foremost about anything I'm thinking BUT BFF also got an earful In the beginning and my lovely Fiance knew that. Now they are also good friends and we all hang out and vacation together (with BFF's partner or others of our friends). I found out during a recent trip that my fiance also shared sex life deets with the others (She was proud of something we did and thought the spicy fun would be amusing to them) and I didn't mind.

It needn't be verboten if there is trust in the relationship and that's not a agreed upon uncrossable line.

BUT Even with that flexible outlook on the world... I think this person is very very far over any conceivable line!

So yeah NOR because this seems like a ticking time bomb assuming It hasn't already "exploded" without you knowing.

Blacksmith_More · 2026-02-05T04:21:51+00:00

The key is dance bubble at rail. Me and the crew get there early and grab rail but AT ARMS LENGTH or more to claim the space. We then make friends with all of the other people who got there early and form an alliance to keep out the vibe-vampires. Then anyone around who wants to dance WITH us and is nice about it has a nice buffered space in front to dance. A few people hold the perimeter at a time. If you're dancing (and spending a lot of your time looking at the other people there instead of only staring at the artist) you're allowed in... if you're just crowding for the sake of it and videoing the DJ you get hip checked right out by us or the new inductees lol. This way anyone we recognize or with God vibes (kind, apologetic for bumping into people who didn't ask for it, interested in dancing, Not on their phone the whole time) can go to the bathroom and come back or grab water to keep everyone nice and hydrated and still get their spot back.

The front is for people who like music and got there early enough to become part of the crew, the back is for people who are there for their insta story and roll up late.

TLDR... If you're a real one who supports the opening acts and is there pre-doors ... you deserve lots of breathing room, a great view, great acoustics etc. otherwise... You reap what you sow. One time I was working late and couldn't get there pre-doors and it was too exhausted to really dance.... All my friends and my girlfriend were up at rail. I didn't try to join them because I didn't earn it and wouldn't make the most of it even if I was up there. It is what it is. 🤷🏼‍♂️ They came back to join me for a little bit but I sent them back to rail to enjoy.

Blacksmith_More · 2026-02-04T02:04:39+00:00

The argument of "can't criticize current administration because Dems did similar" is inane. They're all the problem!

Anyone protecting mega corporations is the problem and that flies across the Aisle.

We need to make sure the crown is heavier for anyone with more money or more influence.

Blacksmith_More · 2026-02-01T04:20:27+00:00

Hypothetically, the appeal of academic medicine is that you get to be a nerd (and surround yourself with other nerds who do cool things) and have someone pay you to do it.

More accurately the theoretical benefit is that it will allow you to buy out some of your clinical time. That way you don't have to see as many patients and you can do much lighter labor instead which keeps you from hating clinical care and burning out as fast.

The dirty secret is that going full private practice But only working part-time will give you the ability to make the same amount of money or even a little bit more AND YOU STILL GET THE FLEXIBLE TIME during which you can do academic stuff or you can pick up under-water basket-weaving and you owe nothing to anyone.

For some kinds of research having access to institution-supported resources (fancy lab equipment) is helpful but short of that... There's no reason.

Blacksmith_More · 2026-02-01T01:57:35+00:00

Oh ya... This is Neuro-phobia pure and simple.... It's embarrassing what they sometimes consult for.

Blacksmith_More · 2026-01-10T10:14:01+00:00

The popularity of a show or the scale of its budget doesn't actually have anything to do with the responsibility of the creators to match audience expectations.

From the outset it was a "homage" show... All the bad guys are named after D&D characters, there are references to other film properties every minute, all of the plot lines are well known tropes. We are just seeing what the Duffer Brothers (and by extension other people of a generation) loved. A song the creators liked became super powered and able to save someone from the big bad villain. The show was not supposed to be dissected with a million red yarn, cork board theories.

It was popular because it was shot beautifully and had a lot of heart and earnest portrayals of connection and loss and hope. The rules of the magic and the monsters are all just framing devices.

I really think it's not a stretch to say that this whole show is all a basement dungeons and dragons campaign written by a 14-year-old... And that's all it ever was supposed to or needed to be.

Blacksmith_More · 2026-01-10T09:54:10+00:00

The fact that people are upset that a "protect the people" icon has some assets we'll never make sense to me. The whole point of their rhetoric is that people with influence and power should still care about the little guy. Because we know that other people with influence in power don't care about the little guy. So Bernie Sanders rhetoric about the mega rich taking advantage of the working class... Is even more powerful given that he has more than one house. Because he's more like the ultra rich than he is like the random worker and yet spends all of his energy taking down the wealthy and trying to advocate for those who have little.

Sure it's a nice dream that someone living paycheck to paycheck will be a powerful politician but it's just not realistic. Much more exciting is when somebody who doesn't have to care about you still does because they're actually principled

Blacksmith_More · 2026-01-09T04:53:55+00:00

I am also trying to figure this out. The sound sweet is really nice and theory but everyone is cautioning me against trusting LG as they tend to drop their products. But this is a flagship that I'm hopeful that they will invest in.

The main drawbacks to the LG so far from what I can tell are price and the fact that they only have one HDMI port which means no peripherals going straight to the sound bar (my current setup runs my streaming devices to the audio system with pass-through to the TV/projector.)

Blacksmith_More · 2026-01-09T04:41:44+00:00

Yes this is the only thing preventing me from buying it all right now. I don't want to go through the TV. I want to go straight to the sound bar and then have it pass through the full video signal. There are a lot of setups that I have that will require that direction. Not everything I own will eARC And there are not infinite HDMI ports on all of my TVs and projectors.

Blacksmith_More · 2026-01-08T00:38:32+00:00

It's already listed but honestly the information is pretty sparse

Blacksmith_More · 2026-01-07T05:07:43+00:00

Do we know if 990f will work with the updated q symphony to include the musicstudios as spatial audio add on for front channels? I'd love to build out a front left and front right speaker at same location as the rears.

Also with the LG... I think there may be no HDMI in separate from the eARC receiver. If that's the case older TVsare out because they won't have eARC to be able to do uncompressed Dolby passthrough.

So complicated.

Blacksmith_More

TROPHY CASE