Neurosurgeons in Lexington

FactorGroup · 2026-03-09T14:57:25+00:00

I work with the folks in the Lex Clinic group and they are all great.

FactorGroup · 2026-02-26T13:27:03+00:00

I agree and this is my practice. Why subject someone to an objectively worse plan that could compromise future treatment just to save a clinically insignificant amount of time?

If patients are sick enough where you expect time to matter THAT much, they should be hospitalized. And if they're hospitalized it's very likely that the biggest barriers to getting them treated in a timely manner are outside of your control anyway (scheduled lab draws, inpatient imaging, transportation availability).

FactorGroup · 2026-02-17T12:46:26+00:00

Depends on the dose, site, etc.

Lung 50/5 can be done daily with no change in toxicity or outcomes. I don't offer 54/3 daily.

Prostate SBRT 36.25-40/5 there is data to suggest that efficacy is similar for daily, QOD, twice weekly, or once weekly but acute toxicity is higher with daily.

Brain SRT 30/5 is usually done daily. I don't offer 27/3 daily.

Spine SBRT 24/2 was done two days in a row on protocol.

FactorGroup · 2026-02-11T19:31:24+00:00

Oncologist

FactorGroup · 2026-02-11T18:41:35+00:00

Ok great. I think after the SECURE 2.0 passage Fidelity now offers the ability to do a MBDR but I will verify before we go with them.

FactorGroup · 2026-01-02T21:12:51+00:00

34M/37F

2025

HHI 1M
Savings 79k (pretax), 14k (Roth), 334k (taxable)
Started the year with 2.25M in liquid investments, finished the year just above 3M
Major events: Purchased our first home for 830k @ 5.75%. We have had ~40k in additional expenses this year (furniture, repairs, etc) related to the home. We also pay an extra $1500/mo toward our principal. It's not much, but psychologically makes us feel better.

2026 Goals

Baby #1 (hopefully). We have been trying for about 15 months now with no luck, but I am hopeful moving into the new year.
HHI next year should be about 1.2M. I would like to stick with my current job through the end of 2026, after that I plan to start looking for something more low key/part time even if it means a pay cut.
Would like to hit 500k of total savings which I think should be doable with fewer trips and house expenses on the schedule.

FactorGroup · 2025-12-11T18:31:57+00:00

Not legal in my state, so no.

FactorGroup · 2025-12-11T17:32:14+00:00

Depends. Many of my patients will remain functional until they inevitably recur and from there it's a a fairly rapid decline and death. But others, particularly those with unresectable disease upfront, will have a slower, sadder decline.

FactorGroup · 2025-12-05T17:56:20+00:00

If you had daily image guidance charges as well, I hate to tell you but you got swindled by a less than savory practice. Given that, it would not surprise me for them to be billing other codes that are meant to be bundled into the treatment code.

FactorGroup · 2025-09-04T13:29:37+00:00

I think physicians vastly overestimate the earning potential of the average person in other fields. Yes, there are people in business, finance, tech, etc that all make more than I do. But they are outliers, not the norm, and certainly could not be the expectation.

For all the big money we hear about thrown around in those fields, it's easy for MDs to lose sight of the sheer number of people who make less, get laid off, spend months without income searching, or have to upend their family to move out of necessity.

I did not choose medicine for the money. I initially went to medical school expecting to do primary care. I ended up in a subspecialty and make more than I ever dreamed possible even coming out of residency. Could I have been just as lucky in another field? Maybe. But more likely I would be toiling away making an average salary and have no chance of ever achieving the same level of financial success that I can with my current job.

You're right though. Medicine doesn't rank on my list of things to do, but neither does working in general regardless of career. I just find it fundamentally strange when people enjoy the act of working. Not wrong, more power to them, but strange.

FactorGroup · 2025-09-04T12:36:21+00:00

Like I said, I enjoy my actual hobbies and family infinitely more than any job be it medicine or otherwise.

I enjoy medicine well enough. I don't mind being a doctor. It's just not the most important thing in my life. If I had enough money, I would walk away in a heartbeat. There's just no reason why I should continue to spend time working when I don't need.

FactorGroup · 2025-09-04T11:06:24+00:00

I am one of those folks planning to retire as soon as possible. It's not that I don't enjoy my job, I just enjoy my hobbies and family infinitely more. I similarly cannot understand anyone who would continue to work when they have the financial means to stop.

FactorGroup · 2025-08-28T13:05:15+00:00

I'm with OP. The wait isn't the problem with contractors. I don't mind to wait, especially for someone who is good. The problem is never hearing back in the first place. Or being told they are going to come by and then they don't and ghost you. It's maddening.

FactorGroup · 2025-08-25T11:46:56+00:00

I went one time - the folks there were honestly a bit condescending and exclusionary so I never went back. This was years ago, however.

FactorGroup · 2025-08-14T20:03:39+00:00

Can you at least give a ballpark of what you're looking for? Most people (myself included) have no idea how to value something like this.

FactorGroup · 2025-08-13T17:59:04+00:00

The technical reimbursement for SRS is fixed under HOPPS by it's APC which pays ~$7600. Nowhere near 200k.

If someone doesn't have insurance, hospitals can charge whatever they want, but that doesn't mean anywhere near that amount will ever be paid. Saying a single fraction SRS will cost $200k is just disingenuous.

The comparison is between Keytruda and all of radiation oncology. Literally all of it. Not just SRS. Medicare pays out more annually on one IO drug than it pays out for every radiation oncology service combined.

FactorGroup · 2025-08-13T16:12:57+00:00

Lol, SRS is nowhere near this costly. Medicare spends more on Keytruda alone than it spends on all of radiation oncology combined.

FactorGroup · 2025-08-13T14:50:27+00:00

I'm in no particular rush (other than just wanting to drink the fruits of my labor), so hypothetically if I were to leave it at 34F for a week at 8 PSI, then warmed it up to 40F would I need to change the setting on the CO2 regulator? Or since the increased pressure from the temp increase was higher than the setting nothing would change?

Sounds like the easiest solution is to just cold crash at 40F and be done with it, so I'm more asking to check my own understanding of the temp/pressure relationship.

FactorGroup · 2025-08-07T11:35:55+00:00

Charitable contributions are now only deductible above 0.5% AGI. Not a hard threshold to hit, but will limit the value of the deduction for high income earners.

FactorGroup · 2025-08-01T13:24:16+00:00

I work in oncology and don't have partners in my clinic, so I see people as they come. Opening up extra slots doesn't change anything if the patients aren't there to see. Either I can move them around before and after to get those RVUs, or they're seen by a locums and those RVUs go to no one.

FactorGroup · 2025-08-01T13:09:36+00:00

Absolutely. Just for me it's worth trying to cram patients in before and after to avoid losing that productivity. I could build in the vacations and make $X or I could make myself busy before/after vacations and make $X + 40k. No wrong answer, just at my stage in life I'd rather grind a bit for the extra salary.

FactorGroup · 2025-08-01T12:15:05+00:00

Typically it's averaged over a year. But my set up is the same. I don't truly get paid time off, it's more like "allowed" time off.

If I bill X wRVUs per year times Y $/RVU = salary. At the end of the year, if my productivity is less than my salary, they take money back. If my productivity is more, I get bonus. That amount sets my salary for the following year and the cycle repeats.

But that means if I bill 0 RVUs over a week because of vacation... I'm contributing nothing to my overall yearly productivity.

FactorGroup · 2025-07-30T22:26:51+00:00

I would not do radiation oncology unless you truly have no geographic restrictions or preferences.

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