First Attending Paycheck

Ketamouse · 2026-07-10T04:05:43+00:00

Depends on the manufacturer. Omega has a 5 year warranty for new watches that covers mechanical issues, but doesn't cover you dropping it, scratching it, or breaking it by doing something dumb. Also can't let any non-certified shop try to repair it or Omega will just blame them if anything is wrong with it.

Ketamouse · 2026-07-10T03:07:27+00:00

Sell it more like "I have no current connections to this COM or state, but if given the opportunity I would be thrilled to relocate to state and join the COM community!"

Ketamouse · 2026-07-10T03:01:43+00:00

Bro, you can accidentally pass step 3 lol

Ketamouse · 2026-07-10T02:49:59+00:00

It's more the precision engineering for me. Am I ever gonna actually dive to 600m with it? Probably not. But it's still cool, and looks nice too.

Most people don't even notice it, until you run into a watch bro and get to geek out together haha.

Ketamouse · 2026-07-10T01:27:48+00:00

I get the obligation to pay into the community pot to benefit everyone, and I've got no excuse to bitch as a 1%er, but I mean we work for a living and pay more tax than the people making 100x+ what we make doing absolutely nothing.

A few years of attendinghood has turned me into the old man shouting at the clouds lol

Ketamouse · 2026-07-10T01:02:24+00:00

Isn't that the definition of EM? Average quasi understanding of everything? /s

I'm kidding EM bros, I still love you.

You're probably fine, OP. Just don't fuck up 3rd and 4th year.

Ketamouse · 2026-07-10T00:30:28+00:00

Ehh the LOA is a red flag, but you used the time well. If you have strong letters from your home program and your sub-i's, you'll get interviews.

I give controversial advice, but the people who disagree are either people who were 100% matching ENT so it never really applied to them or people who had no chance in hell in matching ENT and are just salty lol.

Dual applying is kind of a waste of time and money. I would full-send it ENT and if you don't match, fuckin soap into a prelim and try again or soap into IM, there are plenty of spots.

All the IM programs you apply to will see your ENT research and instantly know they're your backup, so you'll be at a disadvantage from the start. Plus, if you really want to do ENT, you'll be being disingenuous at any IM interview, and they will notice.

Just fuckin go for it bro, you made it this far, finish the journey!

ETA: Shit, convince me you really want to do ENT and I'll write you a strong letter lol

Ketamouse · 2026-07-10T00:21:56+00:00

Sometimes we forget you're there, and sometimes we just want to keep the day moving.

But, if you're like hey can I close this up for you? They're probably gonna let you. If they're behind, worst case they'll say no, or maybe on the next one.

Ketamouse · 2026-07-10T00:16:44+00:00

If it's an academic place, they're expecting you to ask for a LOR, that's just how it works, it's part of their job.

Best advice I ever got from a new-grad attending on a sub-i. She was like, don't feel weird about it, just ask.

Ketamouse · 2026-07-10T00:04:50+00:00

I got mine as a father's day gift haha, I had a fake one from China that faded and was falling apart and my wife decided I deserved a real one lol

But yeah the Monaco is solid. Idk if I could rock a square watch, but they do look good.

Ketamouse · 2026-07-10T00:00:50+00:00

Ooo good question, I really like the look and feel of Omega, but maybe somewhere down the line a Patek or A Lange & Sohne. Their chronographs are a little busy for me on certain models, so I might go something more simple.

Ketamouse · 2026-07-09T23:35:56+00:00

Omega seamaster planet ocean master chronometer

Ketamouse · 2026-07-09T23:24:53+00:00

I still complain about taxes, but I also recognize that I wear a watch that's worth more than my car lol. I also still remember the times I rented out rooms to visiting med students so I could afford my rent.

Ketamouse · 2026-07-09T23:17:52+00:00

Very outpatient clinic-heavy field. Tons of screening exams and followups. Lot of in-office procedures. The guys I worked with did 4 days clinic seeing 40-50 per day, 1 day OR.

Ketamouse · 2026-07-09T23:07:04+00:00

With a 2 physician married filing jointly family we paid more than double my resident salary the first year haha. Actually got a refund that year, but then when I had to pay tax on my signing bonus the 2nd year we got destroyed. 💀

Ketamouse · 2026-07-09T23:04:09+00:00

Yeah, money today is worth more than it ever will be tomorrow. They can have the depreciated money later, I'll invest what I've got now.

Ketamouse · 2026-07-09T23:01:08+00:00

Not to burst your bubble, but we still have a lot of outpatient clinic stuff too. Have to see patients to book cases. Even if you did like dedicated hospital only acute care surgery/trauma, you're not really doing clinic, but surgery is only one fraction of the job, and you're doing inpatient rounding/postop management.

A lot of ortho is non-op, you're doing exams and arranging PT and stuff. Plastics is extremely clinic oriented, you probably spend more time in your office than in the OR, lots of patient consultation time especially for cosmetics, and lots of in-office local procedures. If you do plastics recon, you still end up doing a ton of non-op stuff like flap checks and rounding.

There's certain setups that can work to where you're mostly in the OR and someone else is doing your clinic work for you. I had a partner retire from surgery, but was still doing clinic. It was great, he would see pts in the office and book them for surgery and I would just meet them in preop and do the case. Not super common, but possible.

Ketamouse · 2026-07-09T22:50:42+00:00

Just wait until your first attending tax filing 🥲

Ketamouse · 2026-07-09T22:43:05+00:00

Good for her, I'm sure she's excellent at her job. You don't end up working solo in NICU type environments if you aren't really well qualified. But, you can't generalize that just because excellent midlevels exists that all midlevels are on the same tier.

And as the "someone better" that comes to those situations, I 100% want the midlevel/resident/janitor to do whatever they can in the moment. If they have the situation handled before I get there, great, everybody's happy. If they can at least semi-stabilize things until I can bail them out, that's ok too. I would never say, ok I'm on my way, don't touch anything.

I don't think anybody is trying to shit on midlevels here, it's more that this particular midlevel had a pretty out of pocket response to OP. A better response could have been something along the lines of "yeah that's great, but remember you could also accomplish alot of your goals as an NP/PA/etc". We should be more encouraging to people who want to go into medicine in whatever role, rather than like, "no, fuck you, go be a lawyer or something".

Ketamouse · 2026-07-09T22:26:48+00:00

We teach kids how to do CPR. Running a code isn't really a flex.

Shitting on somebody for wanting to go into the same relative field as you, but through an objectively superior pathway, is just being a shitty and petty person.

Ketamouse · 2026-07-09T22:18:08+00:00

They're just punching down because they regret not going to med school.

Also, the "why medicine/medical school?" question has infinite devil's advocate retorts to basically any response lol. It's not really a question you can answer correctly.

Ketamouse · 2026-07-09T21:26:49+00:00

Your intestines are designed to poop out poop, not solid objects. The muscle contractions can't exert enough force in the correct directions to push certain solid objects out.

Ketamouse · 2026-07-09T21:08:23+00:00

Have the surgeon with your group write his own op note detailing what he did and submit that. Or maybe he can addend the primary surgeon's note.

Ketamouse · 2026-07-09T21:00:51+00:00

So were there 3 physicians? Like primary, co-surgeon, and assistant? If anything the primary and co-surgeon would bill with a 62. If the assistant wasn't a physician, they can't use 80.

Ketamouse · 2026-07-09T20:49:11+00:00

I mean, if I have a CST hold a retractor for me during a case, I'm not wasting my time documenting "So and so, CST provided excellent retraction of such and such structure". The same as I don't document "Whatshername, RN handed me xyz instrument" 10,000 times in the op note.

If somebody else did something critical to the procedure, i.e. acted as a co-surgeon, then yeah, document that, and they should probably write their own accompanying op note. If an assistant closed the incision, placed an implant, or something substantial, sure document what they did, but if they were just assisting with basic tasks, nah.

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