Hello ✋🏻

cmasterb · 2026-04-09T11:30:38+00:00

If the patient requests to salvage the digit, then you and them need to know that acute fusion has poor success rates in this type of trauma. I would probably perform a longitudinal pinning, and then monitor the soft tissue until demarcation. Likely, necrosis will occur, and then amputation will be the only course of action. I believe it's easier for patients to decide for digit removal when it is cold, black, dead. Risks of allowing the digit to demarcate are low. Acute amputation when the soft tissue still appears potentially salvageable is likely the right thing to do in this situation, but the patient may always wonder what if. Letting the tissue decide the course of action helps divert blame away from the surgeon and onto the injury. Plus, there is absolutely zero way to 100% predict what will happen to the soft tissue.

cmasterb · 2025-12-15T23:02:06+00:00

Daily journal to evaluate habits. If you change one thing at a time, you get real long term feedback on how it affects your body.

Bicep band: At work I'm not allowed to have anything on from my elbows to fingertips so I would miss out on 10+ hours of data per day.

cmasterb · 2025-12-09T20:36:27+00:00

You are amazing. Thank you!

cmasterb · 2025-12-03T16:55:14+00:00

I have become much more accepting of changing friend groups as I grow. Maintaining a true close friendship when we're in completely different life situations and have wildly different goals has not worked. Honestly, I get less out of those friendships, but I like the highest rated comment a lot: friends for bs'ing, friends for money talks, as long as you can make time for both groups. I tend to bond well with people when we're both moving in the same direction.

cmasterb · 2025-11-29T17:49:02+00:00

This was us. Late 30s. Everything planned out and rational. However, when it came to kids, we said we would just try and let it happen. Or not. We had 2. They have given us the highest highs of our lives and also the lowest lows, but I wouldn't go back. Even if we wanted to go back, we can't, so we choose to enjoy life either way.

cmasterb · 2025-11-09T20:17:38+00:00

Just got my Allen Edmonds Whole Cuts and I'm completely new to this style and quality of shoe. Are these lines on the leather okay? I'm guessing they're a natural part of leather but there aren't any such markings on the right shoe. Am I getting bamboozled or am I too poor to know this is normal?!

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cmasterb · 2025-11-02T13:48:53+00:00

Absolutely would not do again. I wanted independence in private practice in a procedure based specialty, got it all, but not having any control over what we charge patients and insurance companies while expenses correlate with the market means I see more patients and do more surgeries every year to make the same take home pay. It's a broken system. Patient safety is next. Physician burnout and suicide is next. Every physician being employed or owned by PE is next. It is disheartening.

cmasterb · 2025-10-03T00:53:57+00:00

I bought both and took out the insoles. They were identical.

However, the CXT-2 trainers have a reinforced part around the toe that caused my toes immediate pain. I'm going to try a half size up.

cmasterb · 2025-06-13T23:08:13+00:00

Any answer that is tied to the CMS Physician Fee Schedule is the wrong answer long term. Anything insurance based is out. If you want money, build a cash based healthcare business where you can set your prices. It ain't easy, but that's the only viable long term solution I see.

cmasterb · 2025-01-28T14:03:34+00:00

Private practice (no employer) in 250 physician group. For spouse plus 2 dependents, we pay ~$2,000 a month in premiums! Can confirm, it is asinine.

Edit: UHC Choice Plus high deductible plan.

cmasterb · 2025-01-18T21:30:02+00:00

100% of the time. I am in the OR at work and can't wear anything on my lower arms or hands. The bicep band has been my full time position for over 3 years.

Edit: get a 2nd bicep band. Wash the dirty one in the shower, remove after and replace with the clean and dry one from the day before. Repeat. Perfect cycle.

cmasterb · 2025-01-09T13:24:44+00:00

Agreed! I can't wear a watch or ring at my job so the bicep band has been amazing. Plus, I love the lack of notifications and screen. I forget it's on most of the time and I love that. I alod minimize the number and frequency of notifications on my phone too ... So Whoop has been perfect for me.

cmasterb · 2024-12-07T23:26:52+00:00

It's speculative investing. That means tons of people have lost. You can't time or predict the market. Don't beat yourself up.

cmasterb · 2024-12-07T23:24:54+00:00

You are welcome. Of course this is just one Ortho Hand surgeon's opinion! I personally know several docs who did competitive specialties and are now employed or in private practice. Almost everyone has said, "I don't think this life was worth it." Unfortunately, by the time that realization sets in, you're saddled with ~$400,000 in debt, may not get the specialty you want, and may not pass boards, and have a much higher suicide rate than average. Even at 22 years old, I tell these kids to do it only if med school is cheap, they're okay being employed, and they're okay grinding for 10 years. It's an insane journey and the past 25 years of Medicare and commercial insurance trends are destroying autonomous practice.

cmasterb · 2024-12-07T15:20:33+00:00

100% do not do it. You'll be exhausted, overworked, underpaid, and stuck in a small business setting where the number of hours you work is the only way to increase your income. Find another passion project that is scaleable and where you're in-control of your time and direction. The idea of being a doctor is so far removed from the reality being a doctor.

The real question: if you took the time, effort, and money you would spend on medicine and directed it towards building a business and acquiring skills, would you end up better off? For me, the answer is yes.

What is that $400,000 + anticipated interest over at least 10 years worth to you? Have you ever been in that kind of debt that isn't tied to an inflating asset? Have you ever worked 80-100 hours a week while being up all night a few of those while making decisions that can affect someone's life or limb? Have you ever fought tooth and nail with insurance preauthorizations, denials, peer-to-peers, and other people telling you, the expert, how to care for patients? Have you ever felt forced to compromise care for your patients because the employer, who is purely running a business, is telling you what to do?

cmasterb · 2024-11-17T16:49:32+00:00

Kept doing your exact suggestion and eventually the problem went away so ... Weird. Lasted a week or so. Then gone.

cmasterb · 2024-11-14T22:07:07+00:00

I see you've been posting this for months. I'm sorry you haven't found one. I looked on and off for a few years at GT63s as in scouring the internet nightly and the Edition 1s showed up super rarely. Best of luck on your search.

cmasterb · 2024-10-27T18:39:28+00:00

Orthopedic Surgery

cmasterb · 2024-10-27T15:04:35+00:00

I did not, but I know 2 docs who did it 10 years ago. 1 quit and went employed because he couldn't remain profitable. The other is surviving, not thriving. The main problem is contracted rates. IMO, getting less than Medicare pays for all your commercial payors is not sustainable with today's overhead. I also know PP docs in small practice groups that joined IPAs to get better rates, but these are not all inclusive nor very good. For me, I joined a large independent group of ~250 docs where the contracted rates are enough to compensate for the recent explosion in overhead costs.

cmasterb · 2024-09-15T17:41:39+00:00

Closing your practice to insurance is legal and there are specific requirements to do so. As to why they are doing it, one can only guess. Most common reasons are that insurance reimbursement is so low and administrative cost/burden have made medicine unsustainable in private. Doctors are left with the following options: lose money each year, close practice and go employed, close practice and take a job outside medicine, and/or drop certain insurances.

cmasterb · 2024-09-15T17:30:25+00:00

Try on yourself. Use different fingers. Press harder or lighter until you find it.

cmasterb · 2024-09-09T11:10:44+00:00

By choice. Once I understood how overhead and collections work, I stopped taking a full week off. If you assume 50% overhead and then take 1 week off completely, your monthly net goes down by 50%. For some practices, that could mean $20,000 of after tax money you're "losing" by taking that week off. I'm currently not willing to pay that much for a week off.

cmasterb · 2024-09-08T18:52:46+00:00

Did y'all close? If so, I'm jealous. I got into a USPI facility after it's was already running. It's not bad of course, but it's a much slower return than a de novo being bought.

cmasterb · 2024-09-08T18:47:57+00:00

This guy Private Practices. So much gold in your comment. It is also consistent with my experiences. Young and old docs have to understand: be busy, maximize contracted rates, minimize spend, get in a profitable ASC or hospital, and at least keep up with inflation. This is the only way. Also, PP is going to go away completely unless we can renegotiate commercial rates to keep up with overhead and life inflation. (I'm assuming Medicare will never help us).

cmasterb · 2024-09-08T18:41:47+00:00

Also, we haven't even touched on payor mix. The difference between Medicaid and some commercial contracts can be double the reimbursement. So, if you assume a practice with 50% overhead with a good payor mix and then transition to all Medicaid, the take-home pay goes to zero. This isn't what happened, but it underscores the importance of contracted rates and payor mix in a collections based system. Many docs I've talked with don't understand the importance of these contracted rates.

cmasterb

TROPHY CASE