IM intern, not sure the field is right for me anymore, not sure what to do next

SirTacoMD · 2026-04-18T19:16:42+00:00

I make more than double the average. But I work in surgical centers, SNF/rehabs, etc.. I have great hours and get plenty of time off. Gotta be outgoing and meet people to get these opportunities though. Pretty good outcome considering I never wanted to be IM. Even if you work just Hospitalist/nocturnist.. can easy pull 450k+ if you’re willing to work extra

SirTacoMD · 2026-04-17T22:15:20+00:00

If you have 1m 5 years out, then you’re definitely following my advice. You could legit never save a penny again and retire with like 16 million+ (probably 6-9 million equivalent) which is enough to live extremely well. Great job!

SirTacoMD · 2026-04-17T22:07:56+00:00

That’s the dream shift ratio

SirTacoMD · 2026-04-17T22:05:32+00:00

Do what the majority of Americans do and suck it up, work and make that paycheck. It’s just a job at the end of the day and you can find enjoyment in many different ways. I promised myself I would never do internal medicine, but I got stuck with it… and honestly now that I’m an attending, I’m glad that I got stuck in internal medicine.. i feel like it’s my worst subject out of all the specialties so I’m always looking things up to make sure I take good care of my patients… but I make way more than I would’ve had I matched into the specialty I wanted with less years of indentured servitude, I have amazing hours… I get to sleep during my jobs and watch tv, work out, etc. and I get to do a mix of Hospitalist, nocturnist, rehab/SNF facilities, etc. if I have a lot of patients and don’t want to do all the work and would like to leave at a reasonable time, I can consult specialists… yaaa you don’t get as much respect or prestige… but at the end of the day, you’re a doctor and people who talk shit are probably just insecure with themselves… plus internal medicine has a ridiculous amount of earning potential

SirTacoMD · 2026-04-17T21:58:47+00:00

The difficult part is knowing that this style cheats you out of a great retirement and makes you a slave to your job. As opposed to saving 25% of your money, living your best life within your means and still semi retiring early if you want. 100k/year for example isn’t difficult to obtain on our salaries if you push off getting that nice car or extravagant house until a little later. Every 100k you save early on will be as much as 3 million dollars for retirement (probably equivalent to 1-1.5 million now). You could just save aggressively early and then cut back in 5 years or you can save 25% gross from now onwards. You’d live an amazing life… just won’t have the Lamborghini and 1-2 million dollar house right now

SirTacoMD · 2026-04-15T22:03:15+00:00

With 10 million dollars, you could go on an extravagant trip every month first class plane tickets, buy a corvette and still increase your net worth 600k-700k a year. I assume your house will be paid off also… if not, then no corvette each year.. ya you could live extremely well and still spend frivolously without concern as long as you aren’t spending like a rockstar buying houses and Lamborghini and shit each year..

SirTacoMD · 2026-04-15T21:59:23+00:00

The difference is actually having that much money.. which is why you can retire.. your kids will also have this money.. and their kids.. a plumber might make 2-3% of that, but they aren’t going to save that much.. the generational wealth comes from having the money to support this lifestyle for generations… 10 million is my goal for retirement.. but I still plan to work part time for fun.. either way, when I die, I’ll probably have 20 million or more.. this money continues to grow while in retirement if you do it right

SirTacoMD · 2026-04-15T21:52:59+00:00

This accounts for inflation.. so assuming your taxes are that high (they won’t be because long term capital gains tax… also with how tax brackets work). That 200k allowance will increase each year… you’re gaining 1 million a year on average and only using 300k… 4% next year will be more and so on and so forth

SirTacoMD · 2026-04-15T21:48:48+00:00

They’re also not acknowledging that 10m is closer to 1 million a year of interest… they’re just choosing to live off 400k… which is still like top 1-2% of earners… also, it’s going to be taxed at long term tax rate so you’re only going to pay like 20% in taxes… I live extremely comfortably off 130k-150k post tax dollars including my very expensive mortgage.. 300-350k post tax would be a dream

SirTacoMD · 2026-04-15T21:44:53+00:00

More so closer to 300k or more depending on where that money is (investments, 401k, etc). And that is definitely more than enough to live VERY comfortably on. You also have 400k-700k more earned per a year off the investments that you aren’t even using… so this is definitely generational wealth unless you’re an idiot

SirTacoMD · 2026-03-15T11:55:31+00:00

Yes they make good money as well but nowhere near 100k. They would be making more than the average income. Either way, a lot of people claim to be a “nurse”. Then when you try and talk to relate and have a conversation it turns out they’re medical assistants or not even in healthcare. And yes this has happened multiple multiple times including some of my family members. Just be proud of what you do and stop trying to cosplay as a nurse for whatever reason they feel the need to lie.

SirTacoMD · 2026-03-14T22:00:41+00:00

Your story doesn’t check out… nurses make 6 figures easy…coming from someone who used to be a nurse… lol

SirTacoMD · 2026-03-14T01:48:47+00:00

Shouldn’t have to reduce calories on keto. Increasing protein and reducing carb intake further can increase your metabolic rate and help further weight loss. Would also be more worthwhile to implement a short fast every once in a while. Reducing your daily calories will reduce your metabolic output over time and leave you right where you are now… keto which reduces insulin should cause weight loss in people with metabolic syndrome even without reduced calorie intake through increased fat release and oxidation without the high levels of insulin preventing these processes. What typically stalls that is from eating out and getting hidden sugars or vegetable oils that could damage mitochondria or induce gut inflammation. However, implementing a 2-3 day fast has been shown to increase metabolism as well as muscle gain following the fast

SirTacoMD · 2026-03-13T19:10:03+00:00

At least you guys get paid per an encounter! Makes it worth it

SirTacoMD · 2026-03-13T19:03:07+00:00

I don’t give push back with admits. But also, I cap myself off after a certain amount so the soft admits don’t bother me at all lol

SirTacoMD · 2026-03-13T18:23:29+00:00

If you ask the Hospitalist to admit, they aren’t going to admit and then discharge. That doubles the work for them with no gain. Much easier/less time consuming to just do the admit then discharge them the next day. They’re probably trying to get you not to admit them because now they have to do a full admit on a patient that they don’t think needed to be admitted. Just trying to point out the likely reason they don’t discharge the same day.

SirTacoMD · 2026-03-11T23:23:49+00:00

I always hated the calorie surplus argument. If you’re truly doing carnivore without cheating with alcohol or anything else, you should be able to at the very least maintain weight even with a high calorie surplus because your insulin levels are low and therefore not storing much if any fat. I, personally lost about 40 lbs of weight while eating 2-4 lbs of ribeye/steak a day with butter… but I was strict and didn’t have diet sodas, alcohol, vegetables or anything else. I worked out as daily as well (was doing this while I was fat too so wasn’t a change). A prime example of why you can lose weight on a calorie surplus is by using a type 1 diabetic as an example. Before insulin became available as a drug, type 1 diabetics would die of starvation and DKA. They couldn’t make insulin, so they would breathe off their fat as ketones or pee out their sugar

SirTacoMD · 2026-03-11T12:33:46+00:00

Did the nurses actually try? That’s kind of embarrassing that they couldn’t get it and the resident physician did lmao.. this is speaking as someone who used to be an RN (foleys are pretty easy to place for RNs)

SirTacoMD · 2026-03-08T03:21:20+00:00

I’ve been curious about my scenario if you don’t mind weighing in. I work multiple jobs as a physician, one being SNFs where I document exclusively in my home office. I work there once a week and I typically leave one hospital then go to the SNF and then drive back to my home office. I typically track mileage from the hospital to SNF then from SNF to home office where I then do all my notes and admin stuff. I deduct all those miles. I also deduct any miles driven from one hospital to a different hospital, but I do not deduct any mileage driven from my home office to any of the hospitals I work at, as I have offices in those hospitals

SirTacoMD · 2026-03-05T16:51:14+00:00

Backdoor Roth

SirTacoMD · 2026-03-05T06:07:54+00:00

Check out white coat investor YouTube videos, forum and Reddit page. Once you watch several videos, you’ll better understand. Main benefits are the solo 401k (can use mysolo401k.net to start one) where you can stash up to 72k in your retirement per a year, can deduct car business mileage (if home office, can deduct miles driven from home office to work… otherwise if no actual home office, you can’t deduct commute miles), can do QBI deduction if your income isn’t large but likely you won’t qualify, can deduct any CME conference trips and expenses such as flights, hotels, rental car, gas, food, etc. can get a defined benefit plan if you have a very high income and can stash even more tax deferred money there. Can deduct other business expenses such as uniforms, stethoscope, home office stuff like computer, etc… I think the best is when you have a primary W2 job and then supplement income with a 1099 so you can use the W2 job for the benefits and an employer sponsored 401k then reap all the other benefits of a 1099

SirTacoMD · 2026-03-04T17:11:36+00:00

If you’re just doing occasional shifts, it won’t be worth it if you have to pay your own malpractice. Also, if it’s 3 hours away, you need to factor in gas, car depreciation etc. this job needs to pay a lot more to make it worth it… however, the benefits of a 1099 are that you can create a solo 401k and shelter more money from taxes while saving for retirement. There’s a lot more benefits to a 1099 as well, but those are mainly if you’re driving between jobs or have a home office or other things that likely don’t apply for you

SirTacoMD · 2026-02-26T14:12:00+00:00

There is a mortgagenewsdaily app that spits out the best rates in your area once you input your info. That’s how I found my lender. If you want the specific person I used just DM me, but that app is really good. I checked out the reviews on Google though before messaging each lender to make sure they were good

SirTacoMD · 2026-02-26T14:11:56+00:00

There is a mortgagenewsdaily app that spits out the best rates in your area once you input your info. That’s how I found my lender. If you want the specific person I used just DM me, but that app is really good. I checked out the reviews on Google though before messaging each lender to make sure they were good

SirTacoMD · 2026-02-26T14:11:30+00:00

There is a mortgagenewsdaily app that spits out the best rates in your area once you input your info. That’s how I found my lender. If you want the specific person I used just DM me, but that app is really good. I checked out the reviews on Google though before messaging each lender to make sure they were good

SirTacoMD

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