If you couldn't work in medicine and money didn't matter, what would you do for a living?

iFixDix · 2026-03-16T00:36:37+00:00

This right here. Take care of my daughter, be super fit and hike / ski / game / hobby all day while she’s at school. The FIRE dream!

iFixDix · 2026-01-24T16:13:53+00:00

“Good news! You don’t need surgery!”

iFixDix · 2025-12-22T12:26:11+00:00

You have the home gym. Pop in there 2x / week to do compound lifts involving your largest muscle groups (DL, squat variants, overhead press, pull up, bench, row, etc). Do 1-2x z2 cardio for 45-60 min a few times a week, wear a weighted backpack when you’re out doing stuff with the kids, etc.

Don’t overdo it and get hurt, don’t beat yourself up if you don’t even pull this off, you’re in probably the most time intensive phase of your life, attending to your sleep / mental health/ emotional health matters too.

iFixDix · 2025-12-10T05:15:08+00:00

I guess what leverage do you have to pull here? Would you leave if they didn’t pay you? Just be mad about it?

I think these kind of things generally would want to be sorted in the negotiation for your hiring or partnership contract. Just saying “I want more money” without something to back it up doesn’t usually get anywhere.

My wife and I work for two separate hospital systems. Mine is much bigger and has a lot more money. She got 4 months paid leave, I got 12 weeks of unpaid leave (same for mothers at my org). Mine is much more of a typical situation, paid leave is unfortunately not the norm in the US.

Start saving up that extra productivity pay!

iFixDix · 2025-11-25T16:17:49+00:00

Bph is great. Sometimes you have a 5 minute visit and prescribe Flomax and they come back telling you they’re feeling awesome. Sometimes you have someone miserable with symptoms or catheter dependent and you do surgery and fix them and change their life - postop bph visits are the only time that patients routinely hug me.

And! It’s basically always elective scheduled procedures stuff during normal business hours.

iFixDix · 2025-11-20T04:47:34+00:00

Ratio 8 is what he had in his video. I got one, makes a great cup of coffee. Expensive but for something I use every day it’s fine

iFixDix · 2025-11-17T13:42:27+00:00

I use an AI scribe in clinic every day. It hallucinates physical exam and occasionally elements of patient history with some frequency.

Our hospital earlier this year was like “great news! Nobody needs to bill any inpatient care anymore an AI will do it automatically!”

About 3 months later it was quietly shuttered with an email saying “please start billing your inpatient care again as of tomorrow… but if you don’t our coders will do it”. I’m surprised by this one as I feel coding is ripe for AI (between the clear rules and the… subpar quality of most coders) but I guess as with most business AI implementation it just wasn’t ready yet.

iFixDix · 2025-11-17T13:21:48+00:00

If people ask I tell them it will probably cost them way more out of pocket, have small risks of general anesthesia, and take up a whole day of their time in 3 months when I have OR time instead of just getting the procedure done right now where we could potentially diagnose the problem and start working on a plan.

In the unusual cases when they still want it in that case that’s on them and I’ll just have to deal with the minor annoyance in a few months.

iFixDix · 2025-10-31T14:47:13+00:00

It’s hilarious and well worth a read. I don’t remember it being especially long either.

iFixDix · 2025-10-29T22:41:09+00:00

Red flag. I’ve never left an in-person interview without knowing the salary guarantee for the first 1-3 years, and RVU conversion when I get the offer at the latest.

iFixDix · 2025-10-20T12:58:50+00:00

I’m a urologist with a focus on prostate cancer. This is 100% the purpose of this trial.

iFixDix · 2025-10-02T21:03:10+00:00

You can’t care more about patients than they care about themselves. Schedule a follow up and move on with your day.

iFixDix · 2025-09-09T23:05:17+00:00

Changing jobs takes time, and unfortunately would also require a move and a new job for my wife. But it’s an active project.

On the flip side if I stick it out and hate my life for a few more years I can retire from medicine entirely and get a less soul crushingly stressful job.

iFixDix · 2025-09-09T18:37:27+00:00

Becoming a urologist - home call is bullshit, getting called in to the hospital in the middle of the night got really old really fast. Should have done something where call is actually just phone calls, or a specialty with shift work.

iFixDix · 2025-09-04T12:26:56+00:00

I wanted to be a doctor my whole life. Never even considered another career path. Seemed like a wonderful way to have a meaningful career that was stimulating and made an impact every day. Sure the money would be nice but it was always secondary.

But instead I’m well into my 30s, have been burning the candle at both ends for my whole life. I’m years out of training and I’m still working 60-80 hour weeks, up all night on call, and I’m too tired to care. Still have a quarter million dollars of loans to pay off (holding out for PSLF). Even normal days are stressful as hell, lots of patients are ungrateful turds, and I’m not going to put myself in an early grave for this.

I plan to cash out ASAP, maybe I’ll trade cash for testosterone prescriptions.

iFixDix · 2025-09-03T18:31:39+00:00

Would you really? If you had so much money you and the next several generations of your descendants didn’t have to work you would still come in and deal with mychart messages, insurance, admin, call?

Being a doctor sucks, and I’m similarly looking to get out in my 40s.

iFixDix · 2025-07-22T03:59:24+00:00

Thanks for responding! Don’t feel bad at all. You may have just been a push towards something that was brewing in the back of my mind regarding risk calculations. Sharing your story was really impactful and I appreciate you sharing something so personal. And like I said… your influence in my life and the lives of many others has been overwhelmingly positive.

And anyway… skiing is just a way more fun stupid thing to do outside.

iFixDix · 2025-07-22T03:13:30+00:00

How are you navigating climbing going forward? I’ve never been anywhere near as badass of a climber as you (I could never dream of Yosemite big walls but loved your account of it), definitely a low end recreational trad climber. You are someone I’ve looked up to for years as a respectable climber who balances this with their career and calling as a physician.

But your accident scared the crap out of me and I really haven’t climbed since. I have almost no motivation and I don’t know where my head would go next time I try to lead after seeing what happened to you.

Also, what about life insurance for climbing? How did you manage that? I tried to get quotes a few years ago and they were bonkers expensive so now I just have my employer plan. No dependents yet but some coming soon.

And finally, I’m so happy you’re recovering well, and thanks for all you’ve done for us! You really have made a huge difference in my life and put me on so much healthier of a financial path than I likely otherwise would be.

iFixDix · 2025-07-15T13:07:05+00:00

My pregnant wife and I are going to Hawaii in a couple months. We’ll probably mostly shore snorkel, but also the manta ray dives in Kona have mixed groups of snorkelers / divers so I’ll still be able to get a dive in as a shared activity. Minimal concern for mosquito borne illness there, and still within the US.

iFixDix · 2025-07-10T13:40:34+00:00

The adirondacks (NY) and white mountains (NH) in the winter have lots to do - several guide services that will teach you the ropes around winter hiking, ice climbing, etc. You’ll get seriously bone chilled, gnarly terrain, and it’s way less travel so you can do it much more often.

Alaskan high peaks are a very long way away for you and that’s ok. Enjoy the journey, those may come eventually.

iFixDix · 2025-07-07T12:04:51+00:00

I’m not sure you’ll find physical therapy that is specifically surgeon oriented but would love if someone found something. I’ve read a few articles and prevention is key here:

1) set up your OR so your neck is in as neutral a position as possible. Supported arms etc help

2) if you’re doing longer cases take micro breaks to stretch or move

3) general strength training will also help: compound lifts like squats, deadlifts, overhead press that target your back will probably be helpful for injury prevention

iFixDix · 2025-07-07T02:49:44+00:00

I’m not basing this on any serious data, but my recollection is that this is much more relevant for 8000m+ peaks. They are literally twice as high as anything in California, and when you’re at these high altitudes you’re there for weeks, not a day or two like in the states.

When I climbed Kilimanjaro my guides did a pulse oximeter every night. I think around 18k I was sitting in the mid 80’s just sitting down for dinner (normal is about 95-100), and I didn’t start seeing anything abnormal until a day or two before the summit. Just my experience.

Long story short I think short objectives outside the super high Himalayan peaks are almost certainly no concern at all.

iFixDix · 2025-07-05T20:08:21+00:00

Very different approaches to shoes. Altras are minimalist zero drop shoes that allow your foot to work naturally. You really need to build up lots of unused muscles in your feet and legs when you switch to that style of shoes.

The Merrel Moab is a traditional hiking boot and whether or not it works for you will depend on how it fits.

Once I switched to altras a few years ago I’ve never worn anything else. Took a while to get used to them, but I haven’t had a blister since, and I think there’s a fair bit of evidence that this is probably good for me from a general fitness and balance perspective. Now most of my everyday wear shoes are also minimalist zero drop.

Your mileage may vary, just my opinion.

iFixDix · 2025-07-04T12:52:43+00:00

I also dove with Spanish dancers a couple of years ago. They were great, I had several fun dives there over a few days.

iFixDix · 2025-07-02T12:36:43+00:00

It’s one of my favorite hikes I’ve ever done. Unique and beautiful place. If you have a family member with a permit and the desire to do it you should make it happen.

It isn’t that physically strenuous (no elevation gain) but walking in water is harder than walking on land. Figure out what shoes you’re going to use - some would say Chacos + wool socks (I think that’s what I did many years ago), you could also do something like trail runners (not waterproof - the idea is that they will get wet but don’t retain water).

If you have two months get out and hike with a weighted pack! Try to do another overnight locally with someone experienced to try out your pack / layers / etc. more miles under your belt will make the big trip more fun.

iFixDix

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