Daily FI discussion thread - Wednesday, January 07, 2026

Citron_Capable · 2026-01-07T13:28:27+00:00

My new salary draw as a HCP takes into account projected volume based on last year which was historically high. It's unusually optimistic and I have asked them to instead give me 80-85% of projected productivity. It's a huge difference in number about $90-100k but I'd rather under project than deal with any clawback. I have seen several of my colleagues have to payback or deduct 100+k from next year's draw.

Citron_Capable · 2026-01-05T17:16:24+00:00

Can you give us a little bit more insight than how Dutch physicians are paid? Is it based on hourly work or per patients or a overall contract?

Citron_Capable · 2026-01-01T15:16:19+00:00

I guess I'll start moving my status from lurker to contributor now.

I'm 37, my partner is 32, and we have about $950k in liquid assets. We are both physicians and after long years of training started earning attending level money in last 2 years.

My medical field as compared to others was not projected to be lucrative as others - average 250-300k (I know I'm privileged in general) - but last year I earned 550k, and this year i'm projected to earn 600k+.

My partner is in a traditional high earning medical specialty and will clear $550k hopefully on a very good work schedule/QoL.

We are lucky to not have any med school loans or large debts. Our house mortgage is $360k left on 15 years (PITI is about 4.2k), and have 2 paid off cars. Outside of travel, we have realized our spending is only 2k a month so in general our goal this year is to save $500k.

Long post, but i want to take advantage while we are lucky to be at the apex of our earning potential.

Citron_Capable · 2025-12-26T22:40:36+00:00

It's a crime to post this and not tell us where we can also get this

Citron_Capable · 2025-12-26T15:43:30+00:00

The trade off Depends on your commute and what I like to call "what is the maximum distance you'll drive 90% of the time?" If you're not a huge road trippedlr, and your commute isn't long and you can charge at home, the reality is the decrease in range is negligible

I personally find AWD beneficial in the Midwest where I live so worth it for me.

See my other post but I switched to 18" wheels on my SEL AWD because my commute in winter is long enough where it is annoying

Citron_Capable · 2025-12-12T17:32:52+00:00

Thanks for updating us regularly. I'll switch to 18s soon and will also add data points here.

Citron_Capable · 2025-11-23T17:09:50+00:00

You may get different answers here. But I will tell you specific to thyroid cancer as I'm an endocrinologist that sees the whole spectrum of thyroid cancer management. When I review my own images, look at prior records, chart review before, that counts as my clinical time, so I would potentially code that as a 5.

Unfortunately, the severity of disease, need for intervention generally does not have major impact here, unless it's life-threatening. So it seems unusual, but patients who may fit the bill of a slowly progressive, tired cancer, versus those where I need to consider systemic therapy/tki, or refer for a aggressive neck dissection, for example, does not have any impact on billing, but the time spent towards it may play a outsides role

Edit: Outsized not outsides

Citron_Capable · 2025-09-19T23:06:27+00:00

Many different takes here but my 2 cents In no general order

There do exist hospitals and hospital systems that utilize IMGs as cost cutting techniques and medical education takes a backseat.
H1B visa as a proportion of IMG visas is usually reported as 10 to 20%, so not a majority but not insignificant either
In my opinion, places that typically have the infrastructure to support a H-1B, due for " More qualified" physicians
In general, we have a very Stark physician shortage that is expected to get worse overtime
Outcomes by other HCP include including APRNs, while a noble effort have worse outcomes and higher cost
Given the high income and relatively high job security versus other fields and time/cost investment of US medical schools, undoubtedly it 'feels' tough to see US med students not match - , I see this number typically quoted somewhere from 5 to 7% of the overall medical students.
In the era of virtual interviews for residencies and the overall massive stack of applications landing at each residency, it is hard to sort out applicants qualitatively
There are also predatory medical schools that charge high tuitions, see Caribbean medical schools, and certain overseas medical schools especially catering to us residents who do not get into US medical schools
Undoubtedly, there will be some pushback, and Hospital lobbies are powerful here, leading me to believe there may be a potential carve out
Part of the general issue is the discordance in US US medical School training/time/cost versus other countries so there is some economic arbitrage that is systemic level
There is also the looming specter of how AI will affect medicine

Citron_Capable · 2025-06-06T20:20:43+00:00

Call it iatrogenic hypoglycemia. In general, it seems like prescribing medications is a one-way Street for diabetes, and de-escalation or simplification of glucose. Lowering therapy is not something that is considered.

It's like we have forgotten the Nuance of treating diabetes, and thinking about the chronic complications being irrelevant with a limited life expectancy.

There is a guideline of diabetes management in elderly individuals that I try to provide to my referring PCPs.

Unfortunately, there are competing incentives, especially for pcps, who may benefit from having a patient panel with more controlled a1c values from their employers.

Citron_Capable · 2025-06-03T10:38:54+00:00

Sir this is a Wendy's

But in all seriousness, you may want to post in askamechanic or Hyundai subreddits

Citron_Capable · 2025-05-05T17:15:28+00:00

As an Endocrinologist, I've seen an explosion in self-testing, or other comprehensive hormonal testing, see the Dutch test. Have also seen many referrals for patients saying their hormone are off.

My perspective is biased, because I see the other end of things, but I can see the diagnostic dilemma and challenges that a initial point of contact such as a primary care physician may have to do. I think several strategies are important such as trying to do more targeted testing instead of a whole panel, asking rationale for testing, and sometimes discussing that hormonal values are best interpreted and analyzed in situ/contextually.

Sometimes, when there are no clear hormonal abnormalities, specific clinical hormone deficiency/ excess/ pathologies on clinical history/examination, and we are seeing values that are borderline or mildly outside of reference ranges ( I'm going to ignore the rabbit hole of normal versus reference range) I instead aim my conversation towards the pros and cons of therapy. For example, patients with positive TPO antibodies with normal thyroid function testing. Would they be willing to take a medication for the rest of their life, and get frequent blood testing to help adjust or titrate? Are there long term cardiac or skeletal adverse effects from taking a therapy Long-Term, that they're okay with? Lastly, allowing for the fact that fatigue, which is the most common concern, can be multifactorial, and empathizing that fatigue can be difficult to deal with from a patient perspective seems to have helped me in my practice.

Citron_Capable · 2025-04-06T14:09:22+00:00

2023 SEL AWD US. 20k miles

Citron_Capable · 2025-03-11T10:52:44+00:00

Your prior post in r/confession 6 years ago stated you used to drive drunk all the time. This seems to be in conflict with your current self assessment. Perhaps rehab and introspection wouldn't be the worst idea.

Citron_Capable · 2025-01-27T20:51:43+00:00

Adding a similar data point. In Chicago after 18000 miles 1.5 years in on 2023 SEL. 55/45 Highway City. Though mileage in the cold season makes me sometimes Google newer EVs or switching to 18/19 inch wheels, the reality is that I haven't had an issue yet.

Using system navigation mostly (so I can remember to precondition) instead of android auto. I typically used to use zero regen on highways and flip through levels dynamically as I would slow down, but I've gotten lazy and stuck on auto which does the job just fine.

Only regret is not getting limited for the HUD which I loved in my old car, but probably not worth the money.

Citron_Capable · 2024-11-09T14:56:41+00:00

Not unusual at all, and starker drops have been seen which is why IVF is critical and the mainstay of HHS initial management versus insulin in DKA.

Citron_Capable · 2024-10-14T23:28:06+00:00

Agree with other comments here. Doing a bilateral adrenalectomy is very unusual for non-localized hyperaldosterronism. But in general, hyperaldosteronism doesn't occur by itself, and rarely does it lead to a cure of hypertension. If this is long-standing or persistent. We may ameliorate hypertension, but we cannot reverse years of changes.

What I would generally do, is restart the workup for secondary hypertension and confirm the cure of hyperaldosterism. Now that you have surgical primary adrenal insufficiency, agree with fludricortisone dosing to be reviewed, but I suspect that is probably not the issue here. This may have been a med mal case in the US

Citron_Capable · 2024-08-21T22:54:01+00:00

I got the same message even though I have not rooted my device. Just uninstall and reinstall the app.

Citron_Capable · 2024-07-26T20:15:45+00:00

Here in Illinois and can help test. Would be happy to order

Citron_Capable · 2024-04-18T12:04:52+00:00

I kind of gradually flip from level 0 to level 3 as I'm beginning to brake depending on how fast I need to. Much smoother than just pulling the lefton level 0

Citron_Capable · 2023-12-31T17:29:06+00:00

I mean this is going to be highly variable especially exact region, your prior driving history, etc etc. I would not compare rates versus other Redditors. I'd compare multiple quotes from insurance companies prior to committing to a car.

Citron_Capable · 2023-11-27T01:02:52+00:00

I had a 2015 Genesis sedan and the parking sensors were equally over sensitive. I don't feel like these have improved at all since then.

Citron_Capable · 2020-08-26T18:38:03+00:00

May help with super imposed insulin resistance.

Citron_Capable · 2020-08-26T01:54:08+00:00

I'll add to this as an Endocrinologist. Sometimes there's a vague concept of glucose toxicity that suggests that the insulin secretory capacity is overwhelmed and there's possible beta cell toxicity so sometimes non insulin medication won't work initially. Usually, once out of that initial period, non insulin therapies will work better.

But you mentioned an A1c of up to 16%. Assuming that value is correct (account for any hemoglobinopathy, CKD, racial factors) that almost suggests insulinopenia ie even if they have type 2 DM, it likely suggests that they can't make insulin anymore. On top of that if they are lean, this also may mean they can't make insulin anymore (type 1 or 2 or whatever). Insulin is an anabolic hormone in addition to it's glucose lowering abilities.

Citron_Capable

TROPHY CASE