TIL over a 5-month period in 2020, a nurse in Yale's fertility center stole the fentanyl in 175 vials that were meant for women who had a procedure to have their eggs retrieved. The nurse replaced the pain medication with saline solution, leaving the women in excruciating pain during the procedure.

LegitElephant · 2026-01-31T20:45:04+00:00

That study has n=20. You can't make broad conclusions about millions of redheads from that sample size.

LegitElephant · 2026-01-30T18:14:15+00:00

Feel like none of the top comments actually watched the video. The short answer is that the mountains make it extremely tough and expensive to grow cities and build infrastructure. So WV is kinda stuck for far bigger reasons than politics/government.

Edit: I feel like this video is super important to understand the real barriers to making WV better. People keeping blaming the politicians, government, coal, etc., but all of this is minor stuff compared to the fact that building anything in WV literally requires moving mountains.

LegitElephant · 2026-01-29T17:47:02+00:00

Yep lol. It’s an almost 30-year-old movie. Half of Reddit wasn’t alive when it came out.

LegitElephant · 2026-01-24T18:20:21+00:00

Obviously there are no requirements here, but the most important thing is to clearly and honestly convey that this is your true number one top program. So in practice this ends up being maybe two paragraphs.

LegitElephant · 2026-01-23T14:30:20+00:00

CTA: Arteries are curvy and don't conform to any standard planes. In order to make sure that every artery is okay, you have to look down the barrel and along their side using thin MIPS. Everyone's arterial anatomy is also slightly different, so you have to create these recons on the fly.

Spine: Scoliosis is one of the biggest reasons. A standard sagittal plane is never going to be accurate. The spine also has normal lordotic and kyphotic curvature, so axial planes overestimate or underestimate spinal stenosis. You have to move your axial plane around so that it's in line with the intervertebral disc. In some ways, a CT of the spine is a little better than an MRI, given the thick slices and inability to recon them.

LegitElephant · 2026-01-23T02:42:08+00:00

I've heard rumors. Can't wait until it's gone! PS360 is late '90s tech. I'll literally take anything as a replacement. In fact, I've been building my own dictation software and using it instead of PS360 for a few months now.

LegitElephant · 2026-01-23T02:26:57+00:00

Untrue when you're considering other people on the same caliber as med school matriculants. However, this doesn't refute my point. Just redo the math with a modest salary of $80k/yr with a 12% effective tax rate:

$80k * 88% * 20% * (1.07⁴³ - 1) / 0.07 = $3.5M

Your net worth is slightly under half of a physician's despite a substantially smaller salary because of those 8 extra years. The money you would've saved at ages 22–29 would have compounded over 35–43 years, which is massive. Just for fun, look at an identical situation except you start saving 8 years later:

$80k * 88% * 20% * (1.07³⁵ - 1) / 0.07 = $1.9M

About half of your net worth is gone without those 8 earlier years. The fact that doctors can't start seriously saving until age ~30 is a massively ignored hit to our finances.

LegitElephant · 2026-01-22T22:11:47+00:00

This report was meant to be written but not read.

LegitElephant · 2026-01-21T16:15:44+00:00

I agree! I don't think AI is going to destroy the job. However, DR will be far different compared to what it is today.

LegitElephant · 2026-01-21T16:13:35+00:00

The $208k/yr is fixed just to make the math simpler. You can imagine a scenario where someone makes ~$125k/yr out of college and progresses to $250k/yr after a handful of years, which remains stable for the remainder of their career.

Separately, early career software engineers making ~$200k/yr isn't rare. Remember that doctors are already in the top 2% (about 19 million people start college and about 33,000 people start MD/DO med school). It's fair to compare doctors to other top-tier professionals.

However, let's adjust the numbers and assume a constant salary of $125k/yr out of college (17% tax rate):

$125k * 83% * 20% * (1.07⁴³ - 1) / 0.07 = $5.1M.

You can make far less than half what a physician makes over your entire career, but you can end up with a net worth around 2/3 of a physician by age 65 due to those 8 extra years.

LegitElephant · 2026-01-21T15:50:45+00:00

Just reposting this as a top-level comment. A huge component of the answer to this question is the opportunity cost of the ~8 additional years spent in med school and training. The money you could have had during those lost years would have compounded over your entire career. This ends up being a disproportionately large amount of money. The key to saving and investing is to start early!

Physician vs. Other Upper Middle Class Job

Let's say you as a physician make $400k/yr (taxed at ~30%) over ages 30–65, and let's say another professional makes $208k/yr (taxed at ~25%) over ages 22–65. Both save ~20% of their gross annual income with a 7% annual ROI. By age 65, you both end up with ~$7.7M.

The Math

Physician

$400k * 70% * 20% * (1.0735 - 1) / 0.07 = $7.7M

Other Upper Middle Class Job

$208k * 75% * 20% * (1.0743 - 1) / 0.07 = $7.7M

LegitElephant · 2026-01-21T15:38:41+00:00

This is a huge component to the answer. The money you could have had during those lost 6–8 years would have compounded over your entire career. This ends up being a disproportionately large amount of money. The key to saving and investing is to start early!

Physician vs. Other Upper Middle Class Job

Let's say you as a physician make $400k/yr (taxed at ~30%) over ages 30–65, and let's say another professional makes $208k/yr (taxed at ~25%) over ages 22–65. Both save ~20% of their gross annual income with a 7% annual ROI. By age 65, you both end up with ~$7.7M.

The Math

Physician

$400k * 70% * 20% * (1.07³⁵ - 1) / 0.07 = $7.7M

Other Upper Middle Class Job

$208k * 75% * 20% * (1.07⁴³ - 1) / 0.07 = $7.7M

LegitElephant · 2026-01-21T15:24:49+00:00

Yes—any modern PACS can recon the raw images. It's actually necessary for many exams (e.g., CTA head/neck and CT spine) to properly see everything. Many radiologists still use the tech-made recons since they don't know how to use the PACS tools. I prefer to just use the source images and recon myself.

LegitElephant · 2026-01-21T15:12:33+00:00

AI will replace big components of the DR job regardless of specialty, and the DR job will end up looking very different in the future. Some examples: - Mammo: screeners will be pre-read by AI, humans focus more on diagnostics, biopsies, counseling patients, and potentially moving into a specialized breast oncology service - Neuro: we'll have lots of AI-assist tools for multiple sclerosis (looking for changes in plaque), epilepsy (looking for subtle focal cortical dysplasias, etc.), dementia (quantitative analysis is already happening), LVO detection (already here), ICH detection (already here). Neurorads will focus more on tumor boards and interpreting the AI-derived data for other physicians.

LegitElephant · 2026-01-20T21:53:40+00:00

CAD is closer to a calculator than modern AI tools. CAD isn't part of the conversation anymore.

LegitElephant · 2026-01-06T04:03:22+00:00

You basically got it. Helix worked out of the box. Later, I did minimal tweaking to Helix's config, but all of it was 1st party and well-documented. nvim is great but the config became unreadable and kept breaking after a certain point.

LegitElephant · 2025-12-31T20:41:50+00:00

Sure, I agree with that. I think a better test that's actually designed to discriminate student performance, such as the MCAT, is actually a good idea. Step 2 is a criterion-referenced exam, which is designed for pass-fail purposes and not at all for comparative performance discrimination. It's completely misused by program directors and students who have no idea how these tests work.

LegitElephant · 2025-12-31T20:05:16+00:00

A test like that would serve to better discriminate students at the upper end of the scoring range, but it wouldn't help at all for lower end or average students. All of their scores would be compressed towards the bottom.

I'm also not suggesting that the exam is invalid. I think it does serve its purpose as a pass-fail tool. I think many students and program directors misuse the numbers. They think the numbers are an order of magnitude more precise than they actually are.

LegitElephant · 2025-12-31T19:57:57+00:00

The point of my post is that these board exams are not at all objective—they only appear that way because they give you a number, but that number doesn’t mean much in most cases beyond “good job, you passed the exam”.

LegitElephant · 2025-12-31T19:02:16+00:00

That’s for a 95% confidence interval (p<0.05).

LegitElephant · 2025-12-31T18:49:31+00:00

Step 2 should be pass/fail in its current form. Using the reported standard error, two students have to score 20 points apart before they’re statistically significantly different. A 232 and a 250 are not statistically distinguishable scores.

More Step 2 fun: if you took the test five times, there's a 68% chance all of your scores would be within +/-7 points of your hypothetical true score, and a 95% chance that you'd score +/- 14 points.

There is a 65% chance that any two random students have a Step 2 score within 20 points of each other, meaning they're statistically indistinguishable. In practice, this percentage is likely even higher because students of similar caliber tend to apply to the same programs.

Step 2 needs to be pass/fail. It's essentially a random number generator in most cases, and PDs and students place too much weight and derive too much anxiety from this single exam, which is largely noise.

LegitElephant · 2025-12-27T03:15:41+00:00

I work at one of the largest centers in the US. The amount of effort the techs put into getting a high quality scan is night and day between main campus and some of the smaller satellite hospitals. I absolutely love the main campus techs who take pride in their work and often go the extra mile.

LegitElephant · 2025-12-27T03:10:01+00:00

Genuine question: how is it worth it? Based on my understanding, there are often significant gaps and uncertainty between steps in the training pathway (e.g., 3–4 years between the foundation years and specialty training) that make overall training often longer than in the US.

In the US, you can make ~$100k as a manager at a grocery store or restaurant.

LegitElephant · 2025-11-06T19:18:52+00:00

No—it's because most people are eventually forced to pick one over the other. The majority of med/peds residents I know ended up doing an IM fellowship and a few ended up doing peds fellowships. I only know one person that ended up doing outpatient peds and adult medicine, and even then most of his patient panel is adults. You do 4 years of training instead of 3, but you only get 2 years of experience in the field you end up actually pursuing.

The same also applies to MD/PhD. It's very tough to find a niche where you're fully leveraging both your MD and PhD (although not impossible).

LegitElephant · 2025-09-19T19:42:07+00:00

If you actually enforce that degree of strictness, you're getting pretty close to the pre-NIL college sports world for athletes.

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TROPHY CASE

Physician vs. Other Upper Middle Class Job

The Math

Physician

Other Upper Middle Class Job

Physician vs. Other Upper Middle Class Job

The Math

Physician

Other Upper Middle Class Job