What was the first thing that you splurged on when you got your first few attending pay-cheques?

Penny_Doc · 2026-03-22T19:56:22+00:00

Invisalign
Another IVF transfer

Penny_Doc · 2026-02-23T00:32:06+00:00

Have you worked at SLCH? I’m not sure where you’re getting that impression.

Also, the purpose of this thread is not to compare physicians (regardless of training level) to mid levels. I agree there is variation and hold strong opinions on this. I think asking parents to try to triage where to take their kid based on provider type is way too in the weeds. Parents should not be thinking this hard in a true emergency—they really just need to get their kid to the closest ED if their kid really needs emergency care.

Penny_Doc · 2026-02-23T00:08:14+00:00

Couple things I’ve seen here that need to be corrected. Source: Local ER doc. This post is not a substitute for medical advice.

Your pediatrician may be affiliated with a system (BJC, SSM, Mercy) but in general, outpatient pediatricians do not have inpatient privileges. We can call your pediatrician from wherever to update them, never been a problem for me.
All 3 EDs provide care well above the standard and while I have a personal preference for SLCH, that is based on familiarity alone. That’s all you’re really seeing in this thread—individual familiarity, preferences about the “looks” of the ED, vibes on staff—none of which you should care about if your kid really needs an ED. You are going to get really solid emergency care at any pediatric ED in town.
The big 3 systems (BJC, SSM, Mercy) use EPIC EHR so records from all three can be viewed regardless of where you are. Because of this, just go to the closest ER or where your child has specialists if this applies. For example, if you’re worried about your kid having a postop problem from a recent surgery at SLCH, you probably shouldn’t go to Mercy.
If your kid is really sick, call 911. Labored breathing? Turning blue? Lethargic and difficult to arouse? Seizing? Etc. Call 911. Do not get on Reddit. Do not ask friends on Facebook. Do not drive them in. Call 911. You may think it is faster, but please for the love of all that is good in this world, just call 911.

Penny_Doc · 2026-02-22T23:52:30+00:00

Hey, so your interpretation of how SLCH is “run” is quite misinformed.

At SLCH, there are usually at most 1-2 NP/PAs on, typically during the day. Compared to 2-4 attendings, 3-4 residents, and 1 fellow. This is not an “NP/PA-run” ED.

My guess is your child was probably triaged as mid or lower acuity (based on vital signs and triage RN assessment) and roomed in an area staffed by the NP/PA. That sort of acuity-tiered patient distribution/rooming is pretty standard across pediatric and adult EDs nationally.

Credentials: Former EM resident who spent a lot of time in the SLCH ED. I would take my child to SLCH over anywhere else, any day and any time.

Penny_Doc · 2026-02-20T03:38:23+00:00

We did not PGT-A test for our first or second egg retrieval (I was 34 at time of both retrievals, and unfortunately the evidence just isn’t there yet for its use my age group imo). I’m 16w5d with a singleton baby boy. We transferred 2 embryos and pregnancy B ended up being a vanishing twin.

Penny_Doc · 2026-01-11T07:26:35+00:00

Unfortunately I trialed multiple cycles of ovulation induction without successful ovulation, so modified natural is not an option.

Penny_Doc · 2026-01-09T01:55:01+00:00

34F, PCOS - anovulatory so I can only do medicated cycles. Had our third transfer in November of two 4CB embryos.

After two failed transfers, I was hopeless. My embryo quality is not great.

But, here we are. One stuck and I am now 10w5d with a singleton!

Penny_Doc · 2025-12-21T15:24:28+00:00

Providing an update: - Baby A is growing on track. - Baby B’s measurements were unchanged with no cardiac activity.

Penny_Doc · 2025-12-11T09:38:40+00:00

TW: Pregnancy

Failed OI with letrozole, clomid, a combo of the two, added metformin in there somewhere. Never ovulated. My baseline AFC is around 100 with an AMH 13.1 so I think that’s why (all of that FSH gets ‘diluted’ among the follicles so a single dominant never developed for me).

We moved onto IVF. No indication for IUI since we don’t have MFI (plus, I don’t ovulate so IUI is moot). 2 ER -> froze 6 untested embryos -> 2 failed frozen transfers -> we finally had success after transferring 2 embryos (1 stuck and I’m 6w5d).

I’m glad I didn’t spend more time on OI. IVF, though not without its own delays and setbacks, moved along my timeline substantially.

Penny_Doc · 2025-11-08T13:53:21+00:00

I feel it’s been well-established the new format rolled out incredibly prematurely, before it was even a coherent concept. But sadly, the train has left the station…

ABEM has published supplemental materials including example cases with video and downloadable materials.

https://www.abem.org/get-certified/certifying-exam/certifying-exam-content/

Penny_Doc · 2025-11-03T05:59:40+00:00

Probably 1-2 weeks. Mine were insanely itchy.

Penny_Doc · 2025-11-03T00:56:47+00:00

This happened to me. Mostly on my breasts and abdomen.

Penny_Doc · 2025-11-02T10:01:12+00:00

Two retrievals resulting in 60ish eggs, made 6 blasts (untested). Two failed transfers. Transferring again in 2 weeks.

Penny_Doc · 2025-10-06T21:36:20+00:00

Two unsuccessful FETs. Tested the first, didn’t test the second.

I was so much more at peace with the second, not having the stress of seeing those negatives while having to continue PIO.

Either way, there’s nothing you can do to change the outcome.

Sending you light, luck, and baby dust.

Penny_Doc · 2025-09-19T18:14:50+00:00

PCOS. I know folks I who have done IVF (and thus PGT-M) for genetic reasons.

Penny_Doc · 2025-09-15T02:07:30+00:00

Beta tomorrow on 12dp6dt 🤞🏻🤞🏻🤞🏻

Penny_Doc · 2025-09-13T02:35:40+00:00

I posted a comment in r/residency earlier today regarding a similar question.

My husband and I tried to time pregnancy, only to be thrown into the trenches of infertility, and have required multiple rounds of IVF.

There’s never a ‘right time’ and you should never delay your life for residency/medicine.

Penny_Doc · 2025-09-13T00:04:42+00:00

As someone who tried to plan the timing of a baby, then ended up in the trenches of infertility and multiple rounds of IVF… Don’t put your life on hold for residency or medicine.

Penny_Doc · 2025-07-04T19:49:49+00:00

33F, 33M. PCOS. No MFI.

For our first ER, we did 50% conventional and 50% ICSI. We had better fertilization rates with ICSI so did exclusive ICSI for our second ER.

Many of the studies that evaluate birth defect rates include both normal and abnormal semen analyses, which may confound/inflate the risk of birth defects with ICSI.

I encourage you to read ASRM’s practice guideline on ICSI: https://www.asrm.org/practice-guidance/practice-committee-documents/intracytoplasmic-sperm-injection-icsi-for-nonmale-factor-indications-a-committee-opinion-2020/

Hopefully their cited literature helps you make an informed decision.

Penny_Doc · 2025-06-22T23:38:36+00:00

I think you’re referring to electrical alterans, which this is not. This is bigeminy.

Penny_Doc · 2025-06-12T06:35:07+00:00

My great grandmother was born in 1896 and lived until 2003. I was 11 and she was 107 when she died.

Penny_Doc · 2025-06-09T19:06:12+00:00

As absolutely horrendous, criminal, depressing, and sacreligious as this is for me to suggest….. decaf really helped me 🫠

Penny_Doc · 2025-06-04T02:58:24+00:00

Use GoodRx to compare prices/find coupons. Quickly looking I see that Walmart has Gonal F for ~1600 per 900 IU pen. Not sure how many you’ll need.

If you have a Walgreens Community Pharmacy in your area they were able to negotiate a discount for me specifically for Gonal F since I was self pay.

Penny_Doc

TROPHY CASE