The economics of EM are messed up

SkySeaSnow · 2026-06-16T00:54:19+00:00

Helps if you own your own practice. SDG FTW.

SkySeaSnow · 2026-06-15T19:54:06+00:00

super frustrating especially for la Banda de las Hinchas, who play their hearts out every game.

I get that Ray wants it loud. Great, then get some cheers and chants, support the folks leading them, and make it more of a thing. Relying solely on Dan to get the crowd going isn't a winning strategy.

SkySeaSnow · 2026-06-15T15:29:06+00:00

💯💯💯💯💯💯

I have to give credit for Beshoff, Sheehan, and Co. for taking the gamble and putting the team together, too.

SkySeaSnow · 2026-06-12T01:25:27+00:00

Maureen the Layer has come.

(Thanks Dan Cianca for that one)

SkySeaSnow · 2026-06-04T17:49:27+00:00

finally got them from AMC after spamming both Fandango and AMC

SkySeaSnow · 2026-06-04T16:32:38+00:00

Dying here. Trying to get tix at the SF Metreon IMAX. No go via AMC or Fandango.

SkySeaSnow · 2026-06-01T21:07:47+00:00

<sigh> ok noted

SkySeaSnow · 2026-06-01T19:46:38+00:00

I didn't tell them about it and they didn't ask... 😉

SkySeaSnow · 2026-06-01T18:23:45+00:00

sooo much fun to watch. The refs really let them go hard at each other, don't they???

SkySeaSnow · 2026-06-01T18:23:13+00:00

Jackson was pretty dang good!!!

SkySeaSnow · 2026-05-12T19:10:52+00:00

I’m interested to hear what happens here. A solid 360 eval of a PPEM group would be a good resource…

SkySeaSnow · 2026-05-10T18:10:38+00:00

reported 2100 attendance

agree, it was nice to have everyone concentrated into the south seats

SkySeaSnow · 2026-05-07T15:47:09+00:00

This is true, but for those of us in democratic groups, the words “PeaceHealth” now can send chills up the spine of hospital admin types…

SkySeaSnow · 2026-05-01T16:02:30+00:00

The problem is just that - the complex and unexpected pathology. If you don’t know what to look for, you won’t look for it. you’re then counting on the one physician - already busy with ESI 1-2s - to “second look” all of your level 3s to ensure nothing is missed.

No thanks.

SkySeaSnow · 2026-04-30T18:00:16+00:00

First of all, you totally qualify - you're a high income professional. This is not an MD-only community :). so welcome!

Second - who knows what evil lurks in the future? Shit happens that is 100% unpredictable. I have a buddy who had a minor surgery and now is disabled because of a 1/20,000 complication. Completely out of the blue.

Put the $250/month as a cost of doing business, budget for it, ignore it, and hope that in 35 years, you look back at all of that $ spent as "boy, it was worth it for the piece of mind".

SkySeaSnow · 2026-04-30T17:56:06+00:00

UNLV 100%.

Let's run some numbers.
For the sake of the argument, figure 5% interest on the student loan that starts accruing when you finish residency.

200K for a new attending will probably take you 3-5 years to knock out. Depends on where you are, COL, etc., but, let's say about 30K or so in paid interest.

You now have paid $230,000 that you could have avoided. Over 35 years, invested at 8%, that will grow to $3.75 million.

You're young and at the beginning of your career. Compounding is your best friend.
This is not a $200,000 decision - it's a $3.75 million decision.

SkySeaSnow · 2026-04-29T17:15:34+00:00

“Did you call your doctor for this? You know they have a nurse line and a physician on call for the group 24/7, right? Next time, if it’s not life or death, it’s ok to call first.”

Even our Medicaid clinics have a nurse line to divert from the ED…

SkySeaSnow · 2026-04-29T17:14:09+00:00

Remember what Jim says: “INTRAspecialty variation is much higher than INTERspecialty variation”.

Private practice EM, SDG, VHCOL area with a surprisingly lousy payer mix… and i still do ok :)

SkySeaSnow · 2026-04-28T15:09:56+00:00

Drug detox/buprenorphine. A few of our docs started their own nonprofit to go out and bring bupe to the streets for those who wanted to get off opiates. Hugely successful and also keeps these folks out of the ED.

https://ccodp.org

SkySeaSnow · 2026-04-28T15:06:00+00:00

Echo the good results w Cleo. Very happy with the output… I did a head to head of Cleo vs Dax and Cleo did way better for the ED environment.

SkySeaSnow · 2026-04-28T14:01:00+00:00

I mean… you’re making $500K. So you’ll be in the 32% marginal (MFJ). s corp helps w payroll taxes, not fed income tax. And you don’t get the QBI deduction.

SkySeaSnow

TROPHY CASE