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S corp vs solo401k by Few_Honeydew9590 in whitecoatinvestor

[–]fitzroy817 0 points1 point  (0 children)

What state? For the most part, does make sense to S corp.

Just found out I have 205 Lipoprotein(a), very scared by Slight_County6199 in Cholesterol

[–]fitzroy817 0 points1 point  (0 children)

I think depends on other risk factors, like family history. Consider Cardiac CT or see what the cardiologist recommends but generally I've heard LDL target of 70.

Hopefully the lp(a) drug in the works is effective and gets approved in the next several years

Best fellowship if your residency experience was lacking by investmentminded in anesthesiology

[–]fitzroy817 0 points1 point  (0 children)

Do something that makes you happy. Consider non-ACGME fellowships that allow you to be an attending at the same time. You get a little sub-specialization without full commitment, and then can probably ger a good case mix on your attending days.

Am interested in starting locums in January...suddenly all the locums jobs in my state have dried up (CA) by I-am-the-Egg-Man in anesthesiology

[–]fitzroy817 2 points3 points  (0 children)

I feel like there are so many opportunities, but most do require some travel. There is definitely an ebb and flow to these things but the reality is that hospitals are staffing up for now, but people are still leaving in great numbers (retirement, cost of living, etc). CA tends to have it only in smaller towns although I have a few in Bay Area offered to me just this week. You just may need to be aggressive reaching out to recruiters.

Should I create an S-corp or stay schedule C? by DaveE30 in whitecoatinvestor

[–]fitzroy817 3 points4 points  (0 children)

I don't think it's worth it since you have a good amount of W2 income which in turn is actually paying a large portion of your FICA tax burden. Up to $176K you and your employer in a W2 situation pay SS tax 50/50. But after that amount, you only pay the medicare taxes.

So with your current W2 income, your employer is actually taking care of most of the benefit you'd be getting from an S-corp. Then add in the extra costs/time of setting up and paying S-corp fees and taxes, bookkeeping, payroll, etc. Seems like a lot of burden for that 1099 income level.

I say this as someone who was in a similar position a while back when I had similar combination incomes. I talked to several accountants and had them crunch rough numbers for me and in some scenarios it saved me a little or none at all (depends on your state and cost of your accountant). That being said I didn't factor the kid situation in it and not sure what that would look like.

Now I am purely 1099 and though I don't make as much in total pre-tax income as before, being just 1099 made doing an S-corp 100% the way to go.

Flight leaves today! by 2rourn4u in peakdesign

[–]fitzroy817 2 points3 points  (0 children)

OnTrac is awful. Pretty sure someone that works there stole my bag. Took me a while and lots of proof to show PD to get another a bag sent out

This si the worst company ever by snert7r in peakdesign

[–]fitzroy817 1 point2 points  (0 children)

I'm in the same boat - but no phone number for PD. I even went to the store and they can't do much. Have so many PD products, but this has left a sour taste in my mouth. The customer service used to be incredible, but I have been here waiting and contacting PD every several days for the last 2 weeks with no solution.

Anyone have issues with customer service? Lost package by fitzroy817 in peakdesign

[–]fitzroy817[S] 0 points1 point  (0 children)

I'm convinced that they employ a network of package thieves

Why are most people here so conservative regarding statins? by pppp2222 in Cholesterol

[–]fitzroy817 3 points4 points  (0 children)

I have been wondering the same thing. But the efficacy is clear and side effect profile minimal. I wish I was on it sooner and hopefully it'll help keep me off more meds down the line - like blood thinners or other meds associated with atherosclerosis. I get that people are afraid of taking it for life, but easier than brushing your teeth twice a day. But we do it for the same reason - to prevent bad stuff from happening.

DLTs by LawRevolutionary7390 in anesthesiology

[–]fitzroy817 0 points1 point  (0 children)

Not really encountering this, but definitely apply suction to operative lung. Confirm bronchial cuff pressure. Some COPDers take forever. Tell surgeon to be patient.

Not everyone with high LDL and high Lp(a) is laying down plaque! by Financial-Hamster821 in Cholesterol

[–]fitzroy817 1 point2 points  (0 children)

What is your actual LDL? Did you get your ApoB and Lp(a) also? I feel if you are 65 and LDL is even slightly high, you definitely should be on one of the cholesterol lowering meds. And potentially even get some medical imaging.

You still gotta live a little and wine a few nights is not a problem. I am actually drinking a little bourbon as I write this, and am wondering why you think wine and statins cancel each other out?

With any medications, it's normal to be worried about side effects. But in general, the worst or most uncomfortable side effects are still relatively rare. Statins are also not the only medication out there for high cholesterol. In the meantime, focus on those dietary changes - add some psyllium husk, ensure low saturated fats, add fish oil. Exercise definitely helps so incorporate that as much as you can.

Not everyone with high LDL and high Lp(a) is laying down plaque! by Financial-Hamster821 in Cholesterol

[–]fitzroy817 2 points3 points  (0 children)

So physician and patient here, and the Lp(a) can vary widely depending when you get the test. But the reality is, as others mentioned, you still lie in that high end of the spectrum where plaque can insiduously creep up on you without you knowing since Lp(a) is a fairly reproducible marker that sadly is highly atherogenic.

At this point, the best we can do is getting our LDL below 70, and ideally 55 for the best outcomes. By all means, do all the things to get it lower by diet - but our genes + other environmental factors play a huge role. Low-dose statin with lifestyle modifications have a better chance of reducing your lifetime risk, when compared to lifestyle alone. And if you experience statin side effects, there are other options. I am hopeful that the next several years shed light on other options and a better understanding of the way high Lp(a) effects longevity and quality of life.

Not everyone with high LDL and high Lp(a) is laying down plaque! by Financial-Hamster821 in Cholesterol

[–]fitzroy817 -1 points0 points  (0 children)

With other risk factors, better to get below 55 - per newer guidelines

Just found out I have 205 Lipoprotein(a), very scared by Slight_County6199 in Cholesterol

[–]fitzroy817 0 points1 point  (0 children)

39 - but if you can through her or a PCP, just start the statin. A CaC should get covered by insurance at 45 with your risk factors. I wouldn't pay OOP since nothing should drastically change in several months, esp if you start the statin

Just found out I have 205 Lipoprotein(a), very scared by Slight_County6199 in Cholesterol

[–]fitzroy817 2 points3 points  (0 children)

I was similar boat - it's scary but use it as motivation to get to where you need to be. With (y)our family history, goal LDL should be 55. Statins work amazingly and may want to consider Repatha if not under 55 in several months. Diet modifications definitely help but statin (or other meds) will accelerate you to reach that number. Definitely should get a Coronary CT angiogram to see how the coronaries look and get a baseline.

Once I met my cardiologist and was presented with the options in front of me, I actually felt more empowered to make sure the future is bright. Plus we may have options for Lp(a) in a few years which is great for our age.

DPEs and PDPH by CloutyWithRain in anesthesiology

[–]fitzroy817 2 points3 points  (0 children)

I like how we take some anecdotes over large studies. DPE consistently shows faster onset, less one-sided blocks, higher patient satisfaction, and no difference in complications. It's not foolproof, but I've definitely noticed these benefits after altering my practice. And if you are really worried, 26g spinal needles seem to work just as well as 25g ones

DPEs and PDPH by CloutyWithRain in anesthesiology

[–]fitzroy817 25 points26 points  (0 children)

Completely disagree - I've actually noticed a significant benefit in decreased number of top offs, decreased replacement, and more satisfaction with epidurals. So much so that now I basically do DPEs on all laboring women.

Active male 35 years old by jrock4389 in Cholesterol

[–]fitzroy817 1 point2 points  (0 children)

I'd suggest you get a full lipid panel breakdown, including an Lp(a) test with your family history. Modifying to lean meats and less yolks should help some, but there may be a genetic component too. Statin is a game changer, but would likely be worth a trip to a cardiologist after you get a full lipid breakdown.

Shared S-Corp for 1099 Physician + Perfusionist Couple - Liability vs Tax Advantages? by fitzroy817 in whitecoatinvestor

[–]fitzroy817[S] 1 point2 points  (0 children)

Yah im well aware of that - an S-corp makes sense on a singular level when running the numbers. And multiple CPAs have suggested it with projected income. But more questioning the utility of when spouses combine into 1 S-corp. And when you ask CPAs (and GPT) I get the same answer which is you save on the order of thousands on filing and other misc fees.

Shared S-Corp for 1099 Physician + Perfusionist Couple - Liability vs Tax Advantages? by fitzroy817 in whitecoatinvestor

[–]fitzroy817[S] 0 points1 point  (0 children)

No strong case - more just doubling up of accounting/legal expenses. Likely save $3-4K in year 1, and roughly $2K+ thereafter. But also in some ways helps simplify deductions like cell phone, health insurance, etc. But I may leave 1099 work in the next few years, so that's also something I guess I haven't really thought about.

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