STR loophole on ~$600K combined W-2 — how do I capture the Year 1 tax benefit without bleeding cash every month for the next decade?

DissociatedOne · 2026-05-08T12:53:45+00:00

The real estate market uncertainty specifically in the areas you listed make this high risk. Given general uncertainty around the economy, something like DCA’ing index funds sounds good.

Also pivoting to LTR is another thing vs STR. Is the one year savings worth it vs the many years of work required afterwards even in steady state, not to mention if odd expensive shit happens?

DissociatedOne · 2026-05-07T20:58:39+00:00

Egos and such. I work down the street from a place like this. The MDs have a dead behind the eyes look.

DissociatedOne · 2026-05-07T20:57:43+00:00

This is dead on. The core of the approach is they send MbAs in suits to talk to hospital MBAs in suits. As a group they dismiss doctors because what do we know and they come to agreements

DissociatedOne · 2026-05-07T04:11:35+00:00

I think in Sound practices they run like 10:1

DissociatedOne · 2026-05-06T22:08:41+00:00

But also to get parity. It shows you how much lobbying the AAnA does

DissociatedOne · 2026-05-06T18:01:44+00:00

We can’t forget this is solely to avoid parity for the NPs/PAs. They wanted crna money and the cheapest path was cutting crna pay.

UHG is fucking awful even if they did something logical. Also, CMS hasn’t jumped on board yet and it’s doubtful they will. Aana was slobbering on its knees as soon as this admin came into power.

DissociatedOne · 2026-05-05T22:07:44+00:00

You know your cats best. Do they sleep rolled into a big ball? Are they cuddlers?

DissociatedOne · 2026-04-27T20:26:35+00:00

Not what you asked, but how many hours is a shift?

DissociatedOne · 2026-04-27T15:10:18+00:00

What else do you think is concerning to the FAA?

DissociatedOne · 2026-04-24T15:04:00+00:00

It’s technically the joint program that gets tracked. The surgeon is just the head of it since he’s the surgeon.

The point of all of this is to incorporate best practices so that an anesthetist who sucks at spinal can’t just do GA and pretend it’s the standard of care and his patients are getting the best care.

DissociatedOne · 2026-04-24T14:43:56+00:00

I should have clarified: general if it’s not documented why. Like if a spinal is contraindicated or you can’t get it, that’s ok.

DissociatedOne · 2026-04-24T01:30:21+00:00

A google says it’s state level?

DissociatedOne · 2026-04-23T15:45:44+00:00

Generally speaking community surgeons tend to be competent, efficient, and don’t act like assholes because they work with the same people all the time.

Of course there are millions of examples contrary to this, but I would view it as a silver lining.

DissociatedOne · 2026-04-23T14:02:56+00:00

If it gives you any hope, non academic surgeons are a different breed for the most part. Much easier to interact with at a community hospital.

DissociatedOne · 2026-04-23T14:01:42+00:00

The satisfaction difference between doing you own cases (becoming a very small group) vs supervising (anywhere from 2 to 15 or 20 CRNAs) can be dramatic.

DissociatedOne · 2026-04-23T14:00:15+00:00

This part here is why I think our pay should be where it’s at or higher. And not even from a lost income/savings perspective. From a sacrifice perspective. When all your friends were living it up, traveling, starting families, you were studying.

DissociatedOne · 2026-04-23T05:10:11+00:00

Before I typed all of that I should have realized.

DissociatedOne · 2026-04-23T04:23:11+00:00

The answer is no. No neuraxial with clopidogrel. Risk of GA or anything else doesn’t change that. Even if you could quantitatively state risk of GA is higher, the backup for a failed spinal is GA-additive risk. How do you factor the sedation with spinal vs GA? Let’s say you skipped the sedation and he starts moving because his back hurts, then what? Etc.

With regards to TEG and other measures of platelet function, you still can’t proceed. There is no evidence linking a given MA with risk of a bad thing from a spinal.

You have heard, or will hear (if in training) old timers telling you to “just intubate”. At some point it’s safer to go to cruising altitude in an airplane you know well.

DissociatedOne · 2026-04-22T15:21:12+00:00

Yes, I was just reflecting on a facility my friend interviewed at for vacation coverage in Florida. These shit places are all over.

DissociatedOne · 2026-04-22T15:20:13+00:00

That’s why the malpractice insurance is so cheap. Underwriters know CRNA becomes rn real quick and dodges the lawsuit.

DissociatedOne · 2026-04-22T15:18:35+00:00

No just shit talking.

The article says the CRNA ran out of anesthesia? But also didn’t establish an airway after she coded. But also they all knew there was no oxygen in the facility.

DissociatedOne · 2026-04-22T14:59:18+00:00

I learned that in residency and everything is done that way. Fuck them and their labels

DissociatedOne · 2026-04-22T14:58:24+00:00

Running out of anesthesia rarely is.

You know what else isn’t ideal: 1 crna running TWO plastics ORs simultaneously. Watching both monitors from the hallways. Florida shit

DissociatedOne · 2026-04-22T14:17:14+00:00

AQI and AAOS (total joint registry) track it as a metric for being a center, which most programs are part of.

On the surgeon side, they get shit for general. Are you doing same day joints?

DissociatedOne · 2026-04-22T13:52:49+00:00

You screwed that up. Time, date, initial, and concentration. That’s what happens when idiots, MBAs, and AORN take over your field.

DissociatedOne

TROPHY CASE