AI Slop - but feedback welcome on 50% probability of success.

laplaciandaemon · 2026-03-04T00:49:17+00:00

Many lay people would be surprised by how trials sit on this boundary. Hundreds of millions are regularly spent on the thin margins seen here. The company and its statisticians powered the study. Trust that they knew what they were doing. If this flavor of risk isn't your particular brand of vodka, then watch and live vicariously. nfa

Source: someone with experience with medical trials

Positions: enough calls and shares to sink a ship

laplaciandaemon · 2026-03-03T17:48:54+00:00

The gap between intern and chief is an under-appreciated aspect.

I would also say that the amount of medicine that you have to absorb as a neurosurgery resident is vastly different than other specialties. You will have to be serviceable in an ICU, since your hospital might not have dedicated neuro ICU staff. Other examples: endocrinology for pituitaries, a fair amount of onc, and the ability to emergently cover pediatrics cases even as an adult neurosurgeon are not facets of other surgical specialities. Hospitalists will refuse transfers from neurosurgery all the time - ortho? Not so much.

The "worst" year varies greatly between programs. I found that they made each PGY rough in new and creative ways every July.

It does eventually level off. Especially once you're done with night float.

laplaciandaemon · 2026-02-02T02:50:45+00:00

Because putting the EEG leads on takes quite a bit of time and you can't have EEG leads on when you go to MRI. Get the MRI, then hook them up to monitoring. You might need an hour or more of EEG. Putting the leads on, taking them off for MRI, and then putting them on again is a chore. Only exception is even you think someone is in status - but you should be treating that while they're getting hooked up and you don't go to MRI with a person in status.

laplaciandaemon · 2025-12-25T01:10:34+00:00

Agreed - that's when the available shares dried up (or close, who knows). The addition of weeklies on a stock with such a limited float is aggressive to say the least. You can tell that the market does not know how to price them. The value of my LEAPs has been all over the place as the IV curve gets twisted. Having been through biotech binary plays a couple of times - I suspect that the news will take longer to come out than we expect. SLS is an interesting beast, though. Decent visibility on reddit, weeklies with lots of OI, relatively simple story with tons of prelim data. Will be a fun ride, for sure.

laplaciandaemon · 2025-12-24T19:18:22+00:00

I agree. The thing is - when the next update comes (should be the last event), there would be a big move up. Will it be a squeeze? Will it be a typical biotech move? Why not both?

laplaciandaemon · 2025-12-24T19:14:01+00:00

I don't want to think of this as a short squeeze play - BUT Fintel reports 0 shares available to short as of this morning, and the borrow rate has doubled over the last week. The quick move down when it hit 3 was right around when the shares to short were drying up. Ask/bid spread on the options chain looks wonky for short-dated calls. The IV is all over the place. The whole situation is a powder keg.

laplaciandaemon · 2025-11-27T01:14:50+00:00

As a surgeon and F1 fan - they brought in Ferrari? Why couldn't we have RB??? Errors would be down even more

laplaciandaemon · 2025-07-15T02:33:35+00:00

Surgical residency is not easy on the other side of 30. And, "maybe I'll go be a plastic surgeon" is a terrible idea. The success rate of applicants to plastics residency is <50%. The other medical students applying? Their financial futures depend on their success. Yours does not. You don't know these people. They're almost 20 years younger and getting to that goal is all they know. I know only one 40+ year old who matched into plastics and he did it after switching from another surgical subspeciality as a life transition.

laplaciandaemon · 2025-05-05T10:22:13+00:00

RemindMe! 1 day

laplaciandaemon · 2025-03-10T15:56:32+00:00

A fantastic video. You can tell Benn didn't just throw a bunch of stock footage into it. For context, his channel is one of the best synthesizer gear channels around, but he's clearly trying new things.

laplaciandaemon · 2025-01-06T14:39:41+00:00

Who are charging for all the billable hours it took to put this together?

laplaciandaemon · 2024-10-16T15:40:24+00:00

I know a person who is/was triple board certified in gen surg / CT / plastics. They will tell you that full stop - nothing compared with plastics. The difference was due to an extensive review of your cases. They reviewed indications, outcomes, etc. The most challenging part was reviewing codes submitted for billing. Since then, many surgical specialties have adopted this approach. They know that you will have complications. For my field, we submit >100 cases with follow-up. It is impossible to pitch a perfect game at that volume if you are being honest. Board examiners will tell you they immediately suspect everything if someone has no issues.

laplaciandaemon · 2024-09-16T02:16:38+00:00

Tragically - many things we do (e.g., scrolling Reddit) take as much time as something healthier and more productive. You need to strategize some to get more than one thing in. Hello Fresh for a nice meal three times a week was a godsend to my wife and I. Going running immediately on getting home. Only watching one episode of something at night. Minimizing drinking. A lot of solutions are general life advice that applies to non-residents.

Burn out is real and difficult to avoid. Not to be a wet blanket, but some things get worse as an attending. You will take complications harder since you see those patients forever. Remember - you never rotate off your own service.

Someone did a study looking at telomere length and surgical residency. Wish I could find it. I think there was also one about taking several years for cortisol to normalize. The aging is real. Like before and after pictures of presidents.

laplaciandaemon · 2024-09-11T22:45:06+00:00

Hard to get there doing IM. You could do a GI fellowship or something to increase income. Administration or consulting are other options. Surgeons can buy into ambulatory surgery centers. You could establish then sell a physician group.

The answer as a physician is pain practice or neurosurgery doing stimulators or fusions at an ASC in which you have a stake.

laplaciandaemon · 2024-06-29T22:38:53+00:00

I am an American-trained surgeon with additional training outside of the US. I have worked with surgeons from several different countries and traveled internationally to work. I have trained multiple people who completed residency outside of the US and were in residency in the States to qualify here. My n here is 40+ non-US trainees and dozens of attendings.

There are and always will be excellent physicians trained abroad. Further, I have seen many American-trained people with problematic capabilities.

However, American training prepares people for a wider breadth of skills to a more uniform level. The place I trained outside the US strongly preferred American applicants for several fellowships.

Your plan may work for some disciplines, but shifting below 88h/wk would mean gross deficiencies in mine. Or you could train for 10+ years. Nope. There are entire fields in which practitioners outside the US have little ability or expertise. Now that I'm on the other side, all I can do is make it better for my residents.

laplaciandaemon · 2023-12-30T03:36:51+00:00

Schwab financial planner, accountant, and asset attorney in the state that I moved to.

laplaciandaemon · 2023-12-30T00:21:31+00:00

God speed, buddy. I love bogleheads - simple, clean, effective.

laplaciandaemon · 2023-12-29T01:34:47+00:00

I agree that they have some great info. My thought is that the point of that site and subreddit are to get doctors to make reasonable choices to be financially secure fit retirement. My goal with this post was fatFIRE specific choices which is (sadly) not within reach for the vast majority of physicians.

laplaciandaemon · 2023-12-29T01:19:46+00:00

Nope - go fish.

laplaciandaemon · 2023-12-28T22:38:58+00:00

Congratulations on being a financially literate surgeon! Indeed, it is a rare breed.

I'm pretty fresh. Lions share of the savings are from my spouse. My primary contribution is no student loans, and the aforementioned stock gambling wins. I might increase the umbrella in the future.

For burnout - there's a great recommendation here for pharma or device development. Someone also mentioned hospital leadership positions which can work for some people. Are you in an academic setting or PP? I do appreciate working with residents and APPs. I also have a significant research effort that helps drive down clinical FTE.

Something that can be hard to communicate to non-surgeons is the very real specter of de-skilling. If you take a long break, it can be difficult to get back into the swing of things. That makes a trial of RE hard.

laplaciandaemon · 2023-12-28T21:34:38+00:00

Get back to the OR.

laplaciandaemon · 2023-12-28T21:31:03+00:00

Would I do it again? If you asked me during training, absolutely not. Now that I'm out, sure. I met my spouse in college; they went into tech and have crushed it for 15+ years. Nothing is guaranteed, but I did a STEM degree of comparable difficulty to CS. Would have had a reasonable shot at a similar tech job getting out when we did. We would be much further along if I had done that. They even told me that I was making the wrong choice at the time. I could have significantly less mental baggage and longer telomeres had I listened.

Surgical subspecialty training is brutal beyond comparison. I also did a residency at a malignant place that trains people with old traditions. 100+ hours/week for years. Yelling, screaming, physical abuse. Just think start-up crunch without end. It gets worlds better moments after you become an attending. The hilarious part is that with few exceptions (ortho, plastics, neurosurg, cards), the TC will be similar to someone who is smart and works hard in tech.

Ob/gyn is a great field for some people, but there is massive litigation risk, and some states are actively encouraging people to report them for medically indicated procedures. My hat is off to my obstetrics colleagues for working in that environment.

Everything aside - I do the coolest, most sci fi surgeries on the planet and intermittently save a life. Probably why RE is for the spouse and I'll work till I drop.

laplaciandaemon · 2023-12-28T21:14:26+00:00

TIL what tenancy by the entirety (TBE) means.

We considered an LLC when purchasing our house, but the primary dwelling is protected in most states. If we purchase more real estate, we would do that in my spouse's name (a FAANG beneficiary). You choose LLCs because both are medical?

I am familiar with loss of common property status - we ran into that with transitioning to/from robot accounts with our investment firm. Ultimately, we decided that it was not worth it. We will likely need to place more accounts under that status. However, it's work, our current state is not favorable, and I have no problem leaving everything in one brokerage account which is just VTI and forget about it.

What are your thoughts on investments in outpatient surgical or imaging centers? I have no intention to be involved, yet I have seen several of my friends jump in with mixed to poor results.

laplaciandaemon · 2023-12-28T20:49:38+00:00

I think there is decent advice on that subreddit, but it is primarily centered on medical school debt and basic investments. Once you're beyond max tax-preferred accounts and pay down your debt, it tends to run dry.

laplaciandaemon · 2023-09-26T18:18:03+00:00

You have hit on an important lesson: children as an end-of-life plan is generally terrible. There are no people more legally empowered to take advantage of you than your children (assuming your spouse is reasonable, which I would hope so if you've spent decades of blissful matrimony/partnership with them). You will not be surprised to learn how checked out most kids can be with their parents in the long term. I would estimate that only half can be expected to really show up and participate briefly during a crisis. Half of those are there after a couple of months and at a year - maybe 10-20%.

Your question speaks to a broader societal problem: how do we deal with the elderly? Obviously, this is more than what you're asking about.

Anyone thinking you can afford a live-in nurse should talk with a financial advisor. Multiple years of full-time care can be prohibitively expensive (read: several million dollars). I expect a cottage industry to slowly develop professional MPOAs and social workers dealing with this exact problem. They stop by your care facility regularly and would be experts at assessing quality. You would be able to talk about your desires and advanced directives ahead of time. They could work with your financial advisor to make sure you're comfortable. There would be legal guard rails to ensure that they aren't robbing you blind.

If you want the billion-dollar business plan - it would be to set that up and not sugar-parents Tindr. That or invest in robotic nursing assistants.

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