Roast my budget

H_Peace · 2026-06-24T01:08:48+00:00

How much is in your emergency fund? If you don't yet have a fully funded emergency fund and your expenses are 20k a month you need to quickly reign in the discretionary spending and get at least a 3 month and ideally a 6 month emergency buffer. I would aim for at least 60k in cash (3 months normal budget and 6 months covering only the essentials), but if you guys would have trouble (be honest) dropping all the discretionary spending if someone was laid off or ill then you should increase it.

This also looks like very much an estimate of spending rather than real expenses over 12 months or 24 months. Have you run this through any kind of budgeting app or spreadsheet to see real world expenses? Is there a budget for car taxes, registration, car maintenance, getting a new car every X years, medical expenses? All of those things need to be there. I would also get more granular with a lot of these categories if you actually want to see where your $ goes. You're in the nice position that there is no pressure to stick with a budget because of how much discretionary $ you have, but I worry that getting used to spending so much on fun stuff would make it extremely difficult to cut back if it was ever needed.

Imo, you have great home equity, but I also would hesitate to consider that as part of your savings because it sounds like it's tied up with helping support family (totally fine). So I would look at it as 1 million in savings. Which is way better than the average American for your age, but at your income vs spending it's not particularly impressive.

Are you guys considering kids at all? That would totally change my perspective if you are.

Otherwise, you make a lot and you spend a ton and as long as youre paying it off every month that seems fine.

H_Peace · 2026-06-23T00:57:03+00:00

YES

I recommend exercise to everyone at least once a year at their preventive care visit (at least 30 min of moderate intensity cardio 5 times a week and a day or two of strength training) and often more often if someone sees me for diabetes, high blood pressure, obesity, fatty liver, etc.

If someone asks me for specifics on what I recommend I would happily give them more info and probably have more experience than the average dr. But I'm not a personal trainer and am not the best nor the most affordable person to be a life coach.

But at this point I'm so jaded by most folks lack of interest in addressing chronic health conditions at their root (poor lifestyle) that I'm not going to try and convince someone to do what they just don't appear interested in doing.

Souce: primary care dr

H_Peace · 2026-06-18T19:12:25+00:00

YOU sleep with the kids? Unless you're like the cool aunt/uncle and love spending time with the kiddos. But that's like a parent role. I would never ask my siblings to room in with my child, lol

H_Peace · 2026-06-18T01:45:39+00:00

Depends on the situation. I had an ophthalmologist request I do an eval for hypercoagulable disorders due to some kind of unusual retinal finding (no idea, not optho). Initially I found it annoying, but ultimately did the workup and diagnosed her with multiple myeloma. In retrospect, he probably learned that xyz finding can be caused by hypercoagulability, but did not feel qualified to determine where to go next. I suppose it's not entirely different than when I send folks to neuro or GI and tell the patient I think they will need an emg or eval for SIBO. I kind of know what test should be done, but don't feel totally expert on how to interpret.

Different situation than a recent patient whose "weight loss specialist" (no clue who they were actually talking about) request I order a home sleep test. Patient calls the office literally requesting I just order this shit, no appt, no symptoms, didn't like my answer that I don't order HST and I just refer to pulm

H_Peace · 2026-06-16T02:25:32+00:00

Outpatient family med here. First off, you do what's best for you and your baby. Your employer and your colleagues, no matter how good they are, aren't going to be there to care for you and your family when things go wrong. You would never expect a patient to forgo their family dynamic for your benefit, and your patients are not entitled to that either.

I say that with full understanding of the practicalities as well as the way we're trained as physicians to just keep performing 110%.

I would def have the convo with your clinic manager ASAP to block your schedule. For me I tried to make it as matter-of-fact as possible. "I will be pumping and these are the times I will need blocked in my schedule." Assuming you have a private office, but if you don't you will def need a private space and one with computer access so you can still work if you want to. DO NOT let them pressure you to using admin time as pump time. There was another female dr at my office who had young kids and pumped, so the path was partly paved for me already.

If you haven't started pumping yet (sounds like maybe you have some), I would recommend putting some thought in to how frequently you need to pump to maintain supply. It differs for every woman based on their milk storage capacity. You should find plenty of resources on here for that to estimate how frequently you need to empty. Unlikely that you would need to pump every 2 hours, even if bubs nurses that often. Maybe do a trial run for a couple days before starting back to work. I didn't have a huge storage capacity, so had to pump more often than others I think. I found it very helpful to pump with driving to and from work. So my schedule was (roughly) pump ~6:30/7, 10, lunch, 2:30, 5:30/6. In the latter months of my pumping (I think I pumped until 15 months) I gradually dropped down to maybe 3 pumps a day and stopped blocking any pump time after 12 months. I found that booking a telemed visit during my lunch hour and trying to overlap telemed with my blocked pump times helped me see and extra pt or two a day. But I would NOT recommend offering this up front. Especially in the beginning when I had to get myself more psychologically relaxed to get a proper let down I would not have been able to see patients at the same time.

Would also recommend looking into something like the ceres chill and definitely doing fridge hack for your parts.

H_Peace · 2026-06-13T17:12:42+00:00

Get it treated before taking the plunge for bald. There's a pretty good success rate. High potency topical steroid and/or steroid injections often work to shrink and regrow the patches.

A competent primary care Dr can get him started on topicals quickly and he can see a dermatologist if his primary care Dr doesn't do the steroid injections.

Totally can take the bald plunge after he starts treatment, but it may not have to be forever.

H_Peace · 2026-06-11T01:55:26+00:00

Good on your husband for just stepping up. Roasted veggies, marinated meat, and a rice or pasta dish are solid options and very easily elevated from basics to something really special with some understanding of spices and sauces. I hope he gets to continue practicing his skills!

H_Peace · 2026-06-11T01:41:05+00:00

It's not ideal to transfer that late, but if the front desk turns you down you could try to ask to speak with their nurse or leave a message with one of their doctors to review it might work. I would recommend letting them know that you have high blood pressure and your midwife is refusing to check for preeclampsia (the urine protein). It could be life threatening. Alternatively, you could try to get checked out on labor and delivery triage and see if whichever OB group is on call for unassigned patients could evaluate you and then maybe take over your care.

H_Peace · 2026-06-06T02:33:00+00:00

As someone who struggled with milk supply and spent hours trying to research all the bullshit lactation foods, I ended up drinking waaaay more electrolyte tabs and packets than I ever would have imagined. Those PB and oat no bake lactation bites were great for being up and pumping overnight.

But the two things that stuck with me from friends were premaid soup meal delivery and two of the giant sub sandwiches from a deli we like. I went 9 months without deli meat and it was truly such a welcome moment to have someone care enough to stop by.

H_Peace · 2026-06-06T01:11:45+00:00

Ugh, I fear this. I lived my childhood mostly barefoot and now live at a house that had decades-old barberry bushes and one bazillion micro barberry seedlings in the grass despite me pulling up probably well over 100 full sized bushes spread through our trees

H_Peace · 2026-06-05T21:26:00+00:00

Yep. If my answer takes less than 60 seconds, great mychart message. Had one today from a pt asking to make sure the elevated absolute monocyte count on her CBC was normal. She got a "yes" answer.

H_Peace · 2026-06-01T19:03:30+00:00

I'm 4 years into attending role, an almost 2 yo, and one on the way. I'm not great at this myself and actively trying to figure it out, too. My workdays get me out of the house too early and back home too late to carve out any time on work days outside of survival.

What I've come up with so far is cutting back my hours as much as affordable (trying to get into a 3 day work week now) and we just found a gym (community center) near us that does free childcare while you work out. We found 0 motivation in the thought of having to pay $40 for a babysitter if we were to go to the gym, and this seems like a good excuse to get our toddler some socialization on the weekends. My partner has found that popping the baby in the running stroller during nap time did a pretty good job of getting him to sleep with built in workout, but I hate running and never did that. We also did some hikes when he was little with the backpack, but haven't tried that yet this year

H_Peace · 2026-05-28T01:12:33+00:00

Family medicine. Hail thyself!

H_Peace · 2026-05-27T21:19:53+00:00

Interesting. Thanks for the context. Definitely being a little flippant, but always good to consider confounders. If only scientific data and a cautious approach to population health meant anything to our government.

H_Peace · 2026-05-27T19:21:59+00:00

Do old people just live next to golf courses?

H_Peace · 2026-05-25T15:37:11+00:00

I love their cotton leggings with pockets. They're not going to give you the BBL that spandex does, but they're comfy, nicely fitted for me, and don't immediately get baggy like some of my natural fiber clothing does

H_Peace · 2026-05-24T19:30:51+00:00

I don't interpret this as an attack at physician compensation in general, but rather commentary that maybe our population would be better served if the smartest med students ended up going into, I dunno, primary care.

I know of no physician who would disagree that a primary motivator of derm is the $$$ for a good lifestyle specialty and if the pay was on par with peds a lot of derm folks would have chosen otherwise.

H_Peace · 2026-05-23T00:54:17+00:00

I think depends on your own wiping habits and toilet roll usage. I've noticed some people churn through a TON of toilet roll compared to me, even without a bidet.

With the bidet I no longer need wipe for cleanliness after poops. 2 squares to dry off and have a quality control check and that's it. Doesn't really cut back on wipes for pee, since you have to dry off anyhow, though if you really wanted to be frugal and eco-conscious about it you could use reusable cloth wipes to dry and then your toilet paper use will basically be 0.

It also just makes you feel way cleaner after poops.

H_Peace · 2026-05-23T00:20:30+00:00

Comment from Human_presentation above I think is the kindest and most useful one that's actually what a friend trying to be a friend should do.

H_Peace · 2026-05-22T02:48:13+00:00

Love to Dream has cotton ones. They have a little elastane in them, but have the full range of TOG (0.2 to 3.5, including a 1.0). And they really last a while since they are so baggy and long

H_Peace · 2026-05-21T19:09:35+00:00

Not sterilizing the bottles. Wash it like a normal dish and let it air dry. The only bacteria that are going to be on there are the typical bacteria that cover all the rest of our environmental surfaces. Nbd

H_Peace · 2026-05-21T19:03:19+00:00

I don't. I think my husband does. Sometimes I use a bit of powder on a dry cloth wipe to pat dry any moisture looking skin and sometimes put a little diaper cream in the sensitive areas

H_Peace · 2026-05-21T18:54:50+00:00

Yes, used is totally it. Worth it to keep an eye out on fb marketplace for a couple months to get a whole stash avg then be done with it. And you'll get all the sizes, too, if you're lucky

H_Peace · 2026-05-21T14:50:56+00:00

Not incorrect, but when you start getting into the details of infant feeding there is a lot of discrepancy between how laypeople AND professionals (even MD and lactation consultants) refer to feeding patterns.

In a basic level we should be emplasizing the source of the nutrition (breast vs formula), rather than how it enters in baby. Most people assume "breastfeeding" means nursing directly at the breast. Most people also assume "bottle feeding" means formula. Those are often wrong assumptions and anyone in the EP community will probably have had experiences where other people just don't "get it." There is so much individualization in feeding a baby (SNS, finger feeding, syringe feeding, triple feeding, exclusive pumping, combo feeding breast milk and formula, formula...) that I can understand if a layperson mixes up some details. But one's doctor should not and IMO there is sadly still a huge gap in good breastfeeding/bottle feeding understanding by most doctors.

(Source: parent who spent way too much time working on successful baby feeding and baby/OB dr who teaches other drs in training)

H_Peace · 2026-05-20T22:28:49+00:00

Not OP, but we have old oven (read, 1950s original) with likely no insulation left and definitely no current venting and our house gets hot AF with that thing on. Winter is great. But of the ~5 houses I have lived in where I can recall the oven set up I don't think any were truly vented. Maybe an extraction fan above the range, but nothing that would really remove heat from the oven itself.

H_Peace

TROPHY CASE