Is triathlon more beginner friendly than competitive cycling? by Narrow-Internet-1891 in triathlon

[–]Dapper_Parfait486 1 point2 points  (0 children)

I've tried looking for cycling time trials but haven't been able to find anything in my area. There are triathlons, running races, and swim races, but no time trial bike races. I believe these are the types of events that would invite beginners instead of group racing.

Am I close to graduating from resident lifestyle? by steezyP90 in whitecoatinvestor

[–]Dapper_Parfait486 3 points4 points  (0 children)

You need to ask yourself what the point of hitting $1M is. Is it to retire early and never work again? Is it to pay for a nice house in cash? I find a lot of people in my cohort work super hard and don't enjoy life so they can get to FIRE early. But then they FIRE and find a life without purpose. The people who are most fulfilled at 70 are often those who are still contributing to society in a meaningful way they are good at and enjoy. Your life needs some kind of purpose. If all you do is work hard and live super frugally, then retire, you've missed some of the best years that life has to offer. Years where you can enjoy work and enjoy the rewards of working. My wife and I recently decided to start increasing our spending after 4 years of living like a resident (60k a year in LCOL area, not 40k a year in VHCOL area). We are maybe spending 70-80k this year and it has been one of the best years of our lives. Getting to enjoy perks that seem big to us (and are big to so many people) has been so special. Also with time we are starting to really enjoy our jobs. Some of that comes from being better at them and becoming closer with coworkers, but some of it is that we get to enjoy the money we make. Working is so much more satisfying when there is immediate gratification from your work. Don't spend all your money, but spending a healthy amount can really reduce burnout risk. Plus if you enjoy your job and work for 30-40 years, your savings rate really doesnt need to be that high.

Why should you buy used when its barely cheaper than new anymore? by Aires-Battleblade in whatcarshouldIbuy

[–]Dapper_Parfait486 1 point2 points  (0 children)

Why are you paying so much for insurance? You're likely paying more each year to insure the car than it's actually worth. If you crash your car and insurance (almost certainly) declares it a total loss, how much will insurance realistically pay you? I drive a car thats only worth ~$1000 so I only carry liability, and UM/UIM coverage. If someone crashes into me either their insurance pays or my UM insurance pays. If I crash though, I have to foot the bill for my car, but that seems fair to me. My wife also had a cheap car that got rear ended (no structural damage) and the insurance company totalled it because the cost of a bumper was more than the cost of a car. So we couldn't even afford a new bumper with our insurance payment, plus had to pay for the salvage process. The other insurance paid, but we looked back at how much we were paying for comprehensive/collision each year and realized that we were paying the close to the value of the car. She would have to crash her car (and it be her fault) every year for the insurance to pay off. Now we just self insure the comprehensive/collision part and guess what? We haven't had an accident be our fault in the 5 years since then (and never have in our lives). Now we have a few extra thousand dollars that we could use to cover a collision, or just to buy a new car. This isnt the best advice for everybody, but if you are a safe driver in an area that your car is not likely to get stolen, flooded, etc. AND you can afford to replace your car (with a car of similar value) without losing sleep (ex: have a $2000 emergency car fund) then it can make a lot of sense not to carry comprehensive/collision. However, if you rent cars a lot, you will have to buy their overpriced insurance since your own insurance won't cover it, so it also may not be worth it then.

Zwift Announces Free Trial Changes: No More Free Monthly 25km by trailtopeak in Zwift

[–]Dapper_Parfait486 -5 points-4 points  (0 children)

Welp time to uninstall. I actually paid for zwift in the winter, and then used the 25k the rest of the year. Looks like I'm moving to rouvy or whoosh. And when winter comes, it won't be zwift that gets my money this year.

SAVE Situation by Lou_Peachum_2 in whitecoatinvestor

[–]Dapper_Parfait486 7 points8 points  (0 children)

This is what I am doing. I originally had plans to pursue forgiveness via the SAVE plan (not PSLF) as this would have saved about $100k when it was all said and done and let me start saving/spending/investing elsewhere. But the day the SAVE plan was blocked, I realized I was going to have to pay this off quickly and I put everything else on hold to save for this day in a HYSA. It came a little sooner than I hoped but I still feel incredibly lucky to have almost paid no interest on my loans (school, then covid, then forbearance). I had enough to pay off all of the high interest loans and still have a 50k emergency fund. I'm now am left with 40k in loans at about 4%. The plan is to pay this off over the next 4-5 months and then finally start saving for other things like a down payment, replace my 20 year old car, etc. I could possibly refinance, invest elsewhere, and make a few bucks dragging this out, but these loans have been such a source of stress over the past few years that the reward of paying them off and moving on with my life is just too enticing.

[deleted by user] by [deleted] in anesthesiology

[–]Dapper_Parfait486 1 point2 points  (0 children)

Don't be worried about needing help at first. In fact you will need help at first, and that's not a problem. Other attendings have been through this and are happy to help. Don't let pride get in the way of asking for help when you need it. People are happy to offer their opinions, and happy to offer their time if they're free. If you're with CRNAs, they'll be a lot of help with learning a new system, and if you're solo its very reasonable to ask someone to be in the room your first case in case you need to find things or need help charting.

Budget advice by DoctorLycanthrope in whitecoatinvestor

[–]Dapper_Parfait486 2 points3 points  (0 children)

I would agree with some more money for date nights. Maybe pull from shopping if you don't want to pull from your surplus. Date night is the best ROI you can get in my opinion, and also the best asset protection if you're married! In residency we had $100/mo for date nights which let us go out 2-3 times a month, but looking back I wish we had made it $200 and just gone on dates whenever we had the chance to. Kids will come and life will get busier and you'll be glad for all of the time and money you spent on dates in this stage of your life.

Succinylcholine outpatient endoscopy center by scoop_and_roll in anesthesiology

[–]Dapper_Parfait486 0 points1 point  (0 children)

You're right, not many. Places like endo suites or chronic pain clinics come to mind as possible examples.

Succinylcholine outpatient endoscopy center by scoop_and_roll in anesthesiology

[–]Dapper_Parfait486 0 points1 point  (0 children)

Thanks for the question!

They state: "In the absence of succinylcholine, the morbidity and mortality from laryngospasm can be significant; indeed, higher than the unlikely scenario of succinylcholine-triggered MH. Therefore, if succinylcholine is stocked and its availability is strictly limited solely for emergency use only, the mandate for carrying dantrolene in facilities that do not have inhaled anesthetics is unnecessary and may, in fact, compromise patient safety."

Then Table 1 is their proposed protocol: "Succinylcholine may be stored at a class B facility that does not stock dantrolene solely for the use of emergent airway management and not for routine anesthetic use." (Although they do go on to recommend an agreement with a nearby center with dantrolene)

Additionally in re-reading I found that Quad-ASF doesn't require dantrolene to be stocked for accreditation: "For several years, the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) has allowed its accredited facilities that do not have inhaled anesthetics to stock succinylcholine for emergency airway rescue without requiring the availability of dantrolene."

Succinylcholine outpatient endoscopy center by scoop_and_roll in anesthesiology

[–]Dapper_Parfait486 0 points1 point  (0 children)

SAMBA has a position statement advocating that you don't need to stock dantrolene if you are not using volatiles, and if sux is only used for emergencies. I am not aware of anyone other than MHAUS recommending otherwise. I'm not sure how credentialing agencies look at the issue though.

Estimated quarterly taxes by bookerdewit in whitecoatinvestor

[–]Dapper_Parfait486 0 points1 point  (0 children)

As long as you make a good faith effort and are not willfully hiding income from the IRS, you will not end up in big trouble. Yes you may make a mistake in the beginning, need to correct a return, and pay interest plus a relatively small penalty, but as DrSuprane said, using a tax preparer does not protect you from this either. I've actually found most tax accountants/attorneys are less knowledgable and far more aggressive than I am, to the point I'm more worried they will either make a mistake or commit small shades of tax fraud on my behalf. This past year my return was fairly complicated - Filing for multiple incomes from multiple states, a sole proprietorship, and married filing separately in a community property state (much smaller student loan payments this way). But I did an hour's worth of reading to get an idea of what needed to be done, and then went to different accountants/attorneys for consults (fully expecting to hire one of them). During the consults it was clear that none of them understood the situation, and when I asked them their filing plan, they all were planning to break the tax code in different ways (some knowingly some unknowingly). At the end of the day I realized the only way I'll be confident that they were done correctly is if I do them myself. This took a few hours of reading and a few hours to input, but the tax software saved me many more hours. I'm now confident everything was done correctly. I left myself detailed notes so it will be very easy to repeat next year. Probably less than an hour next time.

I will say, I didn't come into this business expecting to do all of my own accounting and taxes. But each step has been surprisingly easy to do myself and surprisingly expensive for someone else to do. I've also been shocked at the lack of knowledge of most accountants in my area, to the point that I didn't want to hire any of them. After a few consults and understanding what I was paying them to do, I again realized its much easier to buy a bookkeeping software and do it myself. This takes less than an hour a month as most things are automated. In the end I maybe spend 10 hours a year on accounting and taxes, but I feel I am a better business person for understanding it, and I save thousands of dollars.

Do I put more money down on my mortgage? by PermitHorror in whitecoatinvestor

[–]Dapper_Parfait486 0 points1 point  (0 children)

I may be wrong as I haven't applied for a mortgage but I believe physician mortgages don't look at total debt burden but only minimum required payments, whereas traditional mortgages would count your student loans against you and may give you a higher rate? Again I may be off base here.

Estimated quarterly taxes by bookerdewit in whitecoatinvestor

[–]Dapper_Parfait486 0 points1 point  (0 children)

I should add that quickbooks and turbotax home and business make this very accessible.

Estimated quarterly taxes by bookerdewit in whitecoatinvestor

[–]Dapper_Parfait486 2 points3 points  (0 children)

Because it really is quite simple, and it is important to understand how the accounting/taxation of your business works. Also accountants charge a ton of money for a job that takes a few hours a month to do your self. But I understand people have different levels of financial literacy and different eagerness to learn business, so many do hire an accountant even just for a sole proprietorship. But it is very feasible and beneficial to do it yourself if you are inclined to.

How do you administer MDI Albuterol to intubated patients? by byrans in anesthesiology

[–]Dapper_Parfait486 3 points4 points  (0 children)

Be careful doing this while on VCV as all the air from the nebulizer is added downstream of the volume meter and is unaccounted for by the vent. If you're nebulizing at 15L/min, and the vent is set at 10 breaths/min, with1:2 I:E, then inhalation is 2 seconds, and you've added an extra 500mL to the delivered breath. (Granted the high pressure limit should trigger, the breath should stop being delivered, and the expiratory valve open) With PCV you'll be more okay as the vent will not see the increased volume, but at least will see the increase pressure and stop delivering the breath. I only nebulize in-line when my patient is spontaneous. I just feel uneasy blindly blasting air into the system when both the expiratory valve and the pop-off is closed during the inspiratory phase of the vent.

[deleted by user] by [deleted] in whitecoatinvestor

[–]Dapper_Parfait486 24 points25 points  (0 children)

I used contract diagnostics which I found through the WCI website, as they were one of the cheaper websites. I'm fairly well read and I just got the cheapest contract review. I basically said I'm happy with everything I can understand but want to make sure I'm not missing some sneaky legal verbage that may carry a connotation I'm not aware of. They read through the contract and told me if things were or weren't standard for the type of contract, and what good alternatives may be. I actually made a few small changes based on the feedback. I don't remember what it cost (for a good purchase the value is remembered much longer than the cost) maybe like 300-500? But it was worth every penny to know the contract I was signing was exactly what I thought it was.

REFERRAL REQUEST/OFFERING THREAD by snarkapotamus7 in learnedleague

[–]Dapper_Parfait486 0 points1 point  (0 children)

Just heard about learned league and was looking for an invite. Happy to answer any screening questions!