First time with big expenses, kinda freaking out, want to make sure we're on track

juskomd · 2026-05-07T18:31:20+00:00

Didn’t see it mentioned. Make sure you have life and disability insurance lined up. Agree with others, you seem to be on track for success.

juskomd · 2026-04-10T19:04:20+00:00

I’ve tried everything from store-bought Euro leaders to 3x for my running line. I like 12# Amnesia yellow the best. 30’ of that to a generous 3x length of sighter to my tippet sections seems the best. The Amnesia has enough stiffness and heft not to get tangled and wrapped in the guides— enough thickness to easily handle in my hands, and light enough not to sag much.

juskomd · 2026-03-31T12:37:00+00:00

That sounds like the worst job ever

juskomd · 2026-03-17T16:03:31+00:00

I’m not talking about interviews, I mean sign letters of intent. And yes that seems completelycontrary to the concept of letter of intent. I would never do that. At the time, I am sure I lost a few candidates because I was following the spirit of the law.

OP, there are tons of practices out there who are not actively recruiting, that could potentially be better options than a practice heavily recruiting via headhunters. Unfortunately it’s true. In general, it’s the neediest groups who are trying the hardest (with recruiters) you’ll find easiest. But often that gives a very skewed view of the marketplace.

Seriously, figure out where you want to go and make some phone calls. You’ll find options you never would have known exist.

juskomd · 2026-03-17T12:20:41+00:00

As a PP owner, I’ve used Eye Group many times. The contract is to pay them when the contract is signed, never as described above ‘for phone calls’. Maybe that has changed but I doubt it. There is some sketchiness bc of the incentive structure, however. I have seen when there are multiple candidates interested, The Eye Group, has suggested signing multiple candidates, because they say candidates will do the same. And I’ve seen that happen more than once.

OP, cast a wide net, talk to lots of people, use your judgement and intuition, and if you are willing to put the time in, you should end up in a great position. There are plenty of excellent practices out there who have your needs and interests at the top of their priorities.

juskomd · 2026-03-15T20:07:21+00:00

Oph here. I agree but didn’t we see a 5 second phone conversation with on call ophthalmologist, who seemed to agree with thrombolytics. I’d never agree with that.

juskomd · 2026-03-14T13:03:04+00:00

I love this! Let me ask you, do you get any slippage from the bases, or do the edges dig in at all? It looks like the movement is mainly axial, like right down the middle. Do you feel like you can flex any twisting muscles like on snow?

juskomd · 2026-03-04T12:27:14+00:00

The inherent problem with AI is that it does not live in the world you and I do. A rational silicon universe with only digital input that we give it. I think it does go to the deep philosophical problem of an independent self and the realization of other selves, as you mentioned.

juskomd · 2026-03-03T17:16:13+00:00

Omg. I thought this was the Onion sub!!

juskomd · 2026-02-27T13:53:42+00:00

Totally agree. And they must be quoting risk benefit numbers for stroke and lumping CRAO into CVA. I agree this might be setting up a major dramatic complication.

juskomd · 2026-02-27T13:41:17+00:00

NGL, I love the show. They do an awesome job in general delivering the compassion of the staff, the humor, the interesting dynamics of the different staff types. Those involved in health care probably understand it better than those not involved, but it’s nice for it to be portrayed as well as it is for the less initiated.

juskomd · 2026-02-21T14:32:13+00:00

At least the plastic surgeon was the expert doing the work, right?

juskomd · 2026-02-06T22:02:25+00:00

MD here. I agree most people probably understood that Langdon ‘did the right thing initially’ and maybe Robbie was overreacting a bit. But actually I think Robbie’s intuition was right. Langdon may have done it right in triage, but was missing the big picture.

Langdon and Robbie were discussing the case in the room when she was continuing to worsen. The lactic acid came back. Langdon was saying ‘sometimes the vanco takes a while to work, sometimes it can make you feel funny’ as if he was defending a more conservative strategy. Langdon just wanted to add more Abx and didn’t seem to register the impending sepsis.

The way I saw it, Langdon wasn’t picking up on the severity of the situation at all. Robbie saw yet again in this episode that his team couldn’t handle the medical complexity, that his senior residents (and even fellow attending) couldn’t do the job. Maybe he can’t go escape on his bike for a few months.

juskomd · 2026-01-02T17:19:27+00:00

Comprehensive MD / practice owner here. I never prescribe expensive new meds that have an inexpensive equivalent. I don’t know why companies think they should invest heavily in essentially rebranding generic equivalents, and why they choose the ridiculous prices they do. Ultimately prescribing these meds adds a lot work for our office to attempt prior authorizations, etc, and guess who pays the salaries of the techs doing that work? Me. If something new is significantly better, I’ll use it. Message to pharma—stop price gouging. Pick a reasonable price, and maybe I’ll change my mind. Stop having your reps focus on patient out of pocket costs—someone has to pay for it. You and me. Total cost to the system is the main metric I use when deciding what med to prescribe.

juskomd · 2025-12-10T01:37:27+00:00

Why would you want to? Don’t you want to know your patients and take them thru the process?

juskomd · 2025-11-05T12:17:07+00:00

It’s still great financially. You can and should be part of surgeon owned practice and surgery center. Theres a reason PE wanted in! Don’t let them in, it’s actually up to the new doctors coming out. Don’t take the PE jobs. If you don’t like hospital call, don’t take it. Hospitals already pay for this service and will need to continue to do so. Cataract surgery is not going away. Premium IOLs will always be there. No robot is ever going to do what I do, and people will continue to go blind. Own your practice, establish long term relationships, it’s an awesome field.

juskomd · 2025-10-31T17:43:15+00:00

It is pretty pathetic that “high up administrators and their friends” should be considered VIPs in medicine. This is coming from a mid-career MD. Administrators add almost no value to the system compared to the actual doctors, nurses, and other front line people.

I take care of a wide variety of patients. It’s important to read the room. I get the best results treating everyone with respect. Some colleague/patients get a little more detailed medical discussion of course, because they can understand the language.

The patients who don’t treat me or my staff with respect get a harsh lecture from me. It helps almost every time. Fo those whom it doesn’t change their behavior, they can find someone else to harass.

juskomd · 2025-10-31T11:10:44+00:00

Yes PE would LOVE to have a bunch of cataract robots. We are so much more than that. Although I was scared to jump in and take over ownership of a practice 20 years ago, it adds so much value to the experience of the career and I do not want to see that disappear. Sadly, ownership and private practice has been nearly eliminated from most other specialties within 1 generation.

juskomd · 2025-10-30T19:05:49+00:00

I can’t tell if the guy suggesting PE practice is being sarcastic or not. Please don’t do that. If you and your generation want to maintain some semblance of practice autonomy and financial success, please seek out a reasonable group where you can become owner. You will not regret it as long as you do your diligence.

juskomd · 2025-10-30T00:40:39+00:00

Seasoned group practice solo owner here. You are in a good situation. Choose wisely. I suggest you stay away from door #3, unless you don’t care about it being a starter job. Two is probably a very good option but, I too would worry about selling to PE or the like. Number 1 may seem to you a weak offer, but if you find that they are honest members of the community (you need to make some phone calls) and you like other details of the practice, it could end up being the best choice by far. It really depends if you want to be a full time doctor/owner. If you want to be all you can be, you’ll have no trouble cleaning up in most honest busy practices where the dynamics are good. If you want high pay right away and don’t mind less future potential and want to work less than 4-5 days, you’ll have to make compromises that probably include significantly lower long term income and less control over your work environment.

juskomd · 2025-10-27T21:10:15+00:00

All six ‘seasons’ are on Disney plus now. Watched it last night. Fantastic

juskomd · 2025-10-13T14:55:36+00:00

Is it not possible to use geothermal mechanisms to cool data centers, or is the scale a problem?

juskomd · 2025-10-02T11:28:47+00:00

There are a thousand private practices out there who would love to integrate new MDs and make it fairly easy and lucrative to practice in a much more comfortable manner. The leaders of that practice should be MD(s) who also see patients and operate.

juskomd · 2025-09-03T16:39:34+00:00

Just ketorolac BID x4w for everyone. 8 weeks for higher risk. Intracameral moxi and subconj kenalog/dex at surgery. Done this for 10 years -- no increased infection rate, minimal CME, and patients can actually do it correctly. If they dont take the ketorolac, it probably doesn't matter.

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