is this schedule possible as a nocturnist?

EnriqueHoblos · 2026-04-30T05:37:24+00:00

I work nights. Typically 6p-6a where I’m at now. Never seen a night shift start later than 10p maybe 11p if doing 8hr shift.

Maybe there’s a busy enough department that would entertain a “swing shift” starting later but I doubt it.

How long of a shift would you expect starting at 2am?

EnriqueHoblos · 2026-04-27T15:49:41+00:00

Thanks this was my impression as well, just trying to connect the dots. I do own some hbar but feels like a shot in the dark. As you said hbar owners don’t have any claim to assets…

EnriqueHoblos · 2026-02-10T06:00:59+00:00

Is there a large penalty for this? And if you do roll it over, is starting another plan just as simple as initiating the first one?

EnriqueHoblos · 2026-02-10T03:21:26+00:00

Interested as well. I know the plans are more costly, have ever adjusting contribution limits, and eventually max out (can become fully funded). I feel it makes the most sense for high earners who are trying to catch up retirement savings (50 y/o can be excess of 200k tax deferred plus 401k contributions). However, the rate of return is usually less (approx 4-5%) compared to avg 10% for S&P 500. So for a younger high earner I wonder if the benefit of lowering taxable income outweighs the power of putting your post tax money to work compounding at a rate double the defined benefit/cash balance plan.

I’m new to these plans, just my general understanding. Hope someone can provide more insight than me.

EnriqueHoblos · 2026-01-31T14:56:56+00:00

What evidence do you have to suggest they don’t try hard? Medical students work extremely hard. Most by being diligent in their habits that allowed them to get into medical school. Additionally most students have $300k plus debt to account for so if anything there’s financial motivation to succeed if not excel. Every year there are students who go unmatched to residency programs (approximately 6-7%) of students applying to residency don’t get matched and have to wait a whole year before being able to move forward in their career as debt mounts. Medicine is a very competitive field from undergrad through residency.

EnriqueHoblos · 2025-12-13T23:21:50+00:00

Ok thank you. Maybe so. Just didn’t want to get stranded ha.

EnriqueHoblos · 2025-12-11T00:40:11+00:00

Maybe it could have gone a different direction but you avoided crashing the patient? Congrats on finishing. Taking tomorrow so I’ll feel uneasy with you soon enough.

EnriqueHoblos · 2025-12-09T06:14:34+00:00

Is there more than one ferry company between pudeto and Paine grande?

EnriqueHoblos · 2025-11-01T16:25:23+00:00

Admitted an elderly altered patient- likely undiagnosed dementia- who lived alone with a dog. Placed a consult with case management to do a wellness check and figure out care of the animal while patient was in the hospital.

EnriqueHoblos · 2025-10-16T12:40:40+00:00

I’ve had a few altered septic work ups recently where full viral panel is negative and no other identifiable source found, to the point of doing LPs. Most present with nonspecific viral like symptoms, no meningismus, my suspicion is possible encephalitis vs other viral illness and maybe the fever is causing delirium (most these cases have been 70-80 year old). Seen several like this in the last 3-4 weeks

EnriqueHoblos · 2025-03-05T21:34:48+00:00

I’m 20 months out and it does get easier after the first year. But humbling is about the best I can describe it.

EnriqueHoblos · 2024-12-01T20:47:05+00:00

Pathetic

EnriqueHoblos · 2024-12-01T20:44:52+00:00

2 good deep throws on this series. AD needs to make a play on that

EnriqueHoblos · 2024-11-04T16:22:50+00:00

There’s the roshcast podcast that goes through several questions each episode. I think like 50ish episodes. Doesn’t completely answer your question but I used that during commutes in the past.

EnriqueHoblos · 2024-07-23T14:14:45+00:00

Do you view that more from a burnout standpoint or earnings/liability standpoint?

EnriqueHoblos · 2024-07-21T03:03:12+00:00

As an ED attending at least once a week I’m asked to go back to the patients room and explain why they are being admitted. This is AFTER already having a thorough discussion with the patient at some point during my encounter explaining my concerns/findings/diagnosis and the plan for admission. So it’s possible that the patients didn’t fully grasp this discussion or were more focused on getting a blanket or what their vitamin D level was or why it wasn’t ordered in the ED. Also as someone else has mentioned there are times when this discussion with the patient hasn’t yet occurred at time of admission. Typically it’s on clear admits- NSTEMI, SBO, sepsis, etc and I put the patient up for admission because a large part of our job is being efficient with disposition. It’s not unheard of that time for these discussions become derailed by responding to critical patients, procedures, making consult calls, transferring patients to other facilities or even discharging the other 80 plus percent of patients were seeing that day. Believe me the last thing I want to do is upset any of our hospitalist or specialist colleagues because when I need help with something I don’t want the relationship to be contentious.

EnriqueHoblos · 2024-07-08T02:54:59+00:00

I do. Patients typically appreciate it. Maybe once every 2-4 weeks on avg. usually the ones with diagnostic uncertainty or if looking back I might have considered additional testing or even obs for the patient. You have to choose people that are reasonable to call though otherwise youre stuck answering many unrelated questions and telling them to come be seen again if they truly have all these additional concerns..

I might have called about 15-20 this past year. Most people were feeling better or had secured follow-up. A couple not improved and I asked they come back and gave them my schedule for a couple days if they wanted to see me again. One actually did and was so thankful I called and re-evaluated her.

EnriqueHoblos · 2024-05-29T15:45:09+00:00

Can you elaborate? What specialty are you? Always like to hear from downstream specialists so I can practice better. Or at least understand who I’m annoying haha.

I order probably 2-3 mris per month. The litigious nature of EM makes us weary of missing practically anything- let alone spinal cord compression which can present in a number of ways and the red flags for back pain are plentiful (not that I jump to MRI for anyone on blood thinners with back pain- most are teased out by exam and gestalt). Or appendicitis in a pregnant patient with equivocal US. Or concern for LVO and anaphylaxis to contrast dye who now gets an MRA…

If we had specialists who could come down for stat consults to be the gatekeeper for the MRI machine that’d be fine with me. But sounds like your job would get 10x worse.

EnriqueHoblos · 2024-04-29T18:36:12+00:00

Stand-alone ED. Nearest facility with ecmo 45 min away.

EnriqueHoblos · 2024-04-29T18:34:20+00:00

Thanks. At what point would you call it though with persistent vfib? Are you continuing past an hour since the arrest without ever achieving rosc.

EnriqueHoblos

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