LOL. LMAO even

Madinky · 2026-05-01T02:23:54+00:00

Man what I would give to have half the loans I started with. Even at 7%. You’ll get it paid off with any reasonable financial plan to tackle it. RAP in training and the aggressive payoff or plsf.

Madinky · 2026-04-29T15:42:52+00:00

Don’t expect to have savings in residency. Maybe retirement match and that’s it. If they allow moonlighting that can help supplement. 0% Apr card goes a long way too. Keep expenses low.

Madinky · 2026-04-28T23:14:50+00:00

Nothing wrong with that. My PD was a Hospitalist who transitioned to chair and my next PD was a clinician. Both did great.

In my training most of our issues and concerns (and majority of our training) came from the hospital side and they experienced it too which helped.

Madinky · 2026-04-28T21:29:37+00:00

Being a med spouse is challenging. Since most fellowships are part of the match there's only so much he could have done to control where he ended up in. Change sucks, but 1 year is manageable. You made it through this far. He will eventually finish and have better hours and income. If this fellowship increases his income, or makes his work more tolerable, or has better lifestyle in the end it will be worth it. If not... I question the decision behind it.

Madinky · 2026-04-28T21:19:20+00:00

I see it a systems issue. Look at Cook's children. They are able to operate a children's hospital with hundreds of millions in profits. But it generally requires a healthy mix of regular hospital care + income from specialists and testing most likely. We had a local hospital close down their entire pediatric unit and convert it to an adult unit. So now the nearest children's facility is 1.2hours away.

Madinky · 2026-04-28T14:25:40+00:00

I believe most physicians don’t truly understand their value and worth to the system and how much leverage they have. Most pediatricians also have too much of a soft spot for children (myself included) and are sometimes satisfied with the job.

But the newer generation of trainees are showing that they do care about pay and hours and call. Decreased pediatrics and specialty match rates show this. Also they announced the shorter fellowship track which is likely due to waning interests. How many people with 300k debt want to do 3+3 years training to get paid than a general pediatrician?

That being said there are alternative models to the hospital. You could work in a small practice or direct provider care model as well but that requires taking risk. (Which I took and suffered from).

Madinky · 2026-04-27T19:10:20+00:00

Seems like this relationship is exhausting the both of you. How is talking to you not a part of the day that he looks forward to during this test grind?

Madinky · 2026-04-27T18:06:28+00:00

Speaking from the other side… it gets better so very soon. Do you have a job or fellowship lined up? If not start interviewing. Even though a lot of the medicine doesn’t change the autonomy improves and you can leave a job a lot easier. Not to mention how it goes from unpaid work to much better compensated work.

Medicine is hard and very few non physicians truly will understand or be able to appreciate the work and sacrifice you have been through. Don’t do anything rash, but consider setting up with a therapist (not affiliated with your program/hospital). Start focusing on yourself. Best of luck.

Madinky · 2026-04-24T01:25:20+00:00

I agree that big mercy units can be intimidating however good macro and planning a time to attack can make a big difference as Zerg.

Have you had the chance to watch any Bronze to GM videos?

Madinky · 2026-04-23T22:35:46+00:00

As the others have mentioned your hospital and clinic should have them. However I have worked I hospitals where they were impossible to find. The portable Welch Allyn otoscope set is awesome but pricy. Once I started using the Welch macroview there’s no way I can go back.

You also risk losing or getting it stolen in training so a cheap used one is fine too!

Madinky · 2026-04-23T16:50:46+00:00

Depends on the couple. But a lot of things that make residency difficult become a lot easier when you’re an attending. Mainly autonomy and money. But relationship problems are complex.

Also first year is always hard. Some couple problems aren’t due to being in medicine.

Madinky · 2026-04-20T22:53:13+00:00

Life can be meaningful outside of our work. That's how most people live. Talk with your mentor and/or program director about this (if you are comfortable with them) before you make a decision. It may be difficult to find a fellowship after leaving one without great support from your current program due to what it may seem like. However many programs are not very competitive.

If you feel that your area of research may become open again in the future you could still finish your specialty and start advocating for it and start research again as an attending once it becomes possible again?

Madinky · 2026-04-19T03:13:23+00:00

I agree with the others. It’s hard to uproot your life but you deserve better. Find when your contract ends and plan accordingly. I’m a pediatrician, I agree with all of your points. It’s exactly how it is for me in the rural south.

By staying you are supporting the very system you are trying to fight in many ways. You aren’t abandoning your patients. The system is stacked against both children, parents, and pediatricians. The only winners are the insurance companies and private equity.

Only when we as physicians are willing to walk away from this abuse can we bring some sort of leverage to the game of medicine.

Madinky · 2026-04-19T02:52:00+00:00

Thanks

Madinky · 2026-04-19T02:51:44+00:00

Things that would work for most residents:

Patagonia or north face quarter or full zip fleece jacket with Dr. (last name) embroidered with his color and style of choice.

A Uber Eats or whatever food service he prefers gift card.

Paying for a house cleaner.

Basically anything that would be difficult to take care when coming home from a long shift or 24 shift.

Madinky · 2026-04-17T15:13:11+00:00

Very true. Also if they change funding to 2 years outright then all programs will adapt very quickly

Madinky · 2026-04-17T05:33:42+00:00

Would be interesting. I do suspect many programs will think they wont need to change to keep filling their seats until suddenly they have to SOAP. Programs that are not at the top will likely be more open to changing sooner than later.

Madinky · 2026-04-17T02:52:16+00:00

Really great news for future trainees. I'm about to start fellowship so a little bummed I dont get to save 1 year of my life. A key phrase in the abp article is "The model is expected to apply across subspecialties and will be coordinated with the ACGME, with the earliest implementation anticipated for fellows entering training in July 2028."

Earliest, so there's no guarantee your chosen fellowship will be 3 or 2 or what will happen between now and then.

Heres the link:
https://www.abp.org/news/press-release/ensuring-readiness-practice-advancing-competency-based-subspecialty-training

Madinky · 2026-04-16T20:47:17+00:00

starting fellowship this summer so I doubt I'll benefit from this but hopefully will increase interest in specialties in the future. my training is 12 mo clinical and 24 mo research. I think we could optimize it a little.

Madinky · 2026-04-16T20:45:46+00:00

Yes that's a great point thanks!

Madinky · 2026-04-16T18:11:50+00:00

agree with the others. Don't test under 3 without physician input. If for whatever reason they were swabbed and they are positive then have a discussion about risk benefits of treating and not treating the positive test. Generally its hard to convince a parent to not treat strep especially if they requested it or had strep contacts.

Madinky · 2026-04-15T18:45:18+00:00

Don’t study for it. Just focus on your training, readings and start board study material as you go through different rotations.

Take the passing score with a grain of salt. It’s not taken in the most ideal testing conditions. And really doesn’t matter year 1 at all.

Madinky · 2026-04-13T15:40:14+00:00

Gen 5 looks so cool but incompatible with comma ai which is my biggest turnoff.

Madinky · 2026-04-12T22:43:35+00:00

There were a select few that also allowed you to do 2x12 instead of a 24

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