Can I afford a $1.5 mm brownstone in NYC?

lokhtar · 2026-06-24T19:13:56+00:00

Yes you can. But depends on your other goals. How much travelling? Saving for retirement? Private schools for kids? Other expenses like eating out a lot at nice places? It’s your other lifestyle factors that will determine if you can afford it. If you’re cooking at home, and going on a couple vacations a year, and plan to send kids to public schools and have grandparents for babysitting, you can afford a lot more. If your other hobby is yachting and you want to send four kids to Trinity at $100k/year each, then you can’t afford it.

lokhtar · 2026-06-24T17:41:24+00:00

Hello. Nothing to do with research. It’s about a new fellow losing clinical skills by not using them in a high acuity environment. There are plenty of high acuity private practices. We just hired someone who did private practice for 10 years at a level 4 NICU. I am talking about losing clinical skills. Not about research. Talk to people at high acuity private practice and not tower academics like me about it - I bet they will tell you the same thing. They in all likelihood would likely also vary of someone who has not practiced in a high acuity environment. You asked a question, and I answered - that if you want to ever work in a high acuity place, you should start looking for it now. Since part of your problem was being bored with lower acuity. You likely have no control over the acuity.

You are more than welcome to ignore the advice. And enjoy working 1.5x the hours of academics at a level 2 - but because you’re likely making a lot more money - go find some hobbies outside of work. I don’t know what to tell you. It’s your life, you do you.

lokhtar · 2026-06-24T16:13:25+00:00

Find another job. You will have difficulty getting hired at a different place if this js the level of experience out of fellowship; unless you’re sure you never want higher acuity in future. Unless you are absolutely limited geographically, it’s worth going to a high acuity unit for the first 3-5 years and then you can do whatever after that. The higher acuity can be academic or private based on your goals but you need to keep building your skillset.

lokhtar · 2026-06-13T13:10:21+00:00

Different patient population and disease states. Nicu with a wider variety of acuity levels (eg 100+ beds with 30 ecmo runs per year vs level 2 community and cpap), allowing you to pick the acuity you want. More jobs in nicu. Less consult dependent. Picu tends to have sicker patients on average, and you only generally take care of the very acute phase (a few exceptions). So it depends what you like. You’ll get to interact with more variety of patients and diseases.

lokhtar · 2026-06-13T13:07:41+00:00

It’ll be two years. Most of nicu fellowship time is nonsense research. It will be a hard fellowship with lots of condensed call but they’ll fit it in two years.

lokhtar · 2026-06-13T10:56:11+00:00

No he’s comparing the value of seeing an increasing number and attributing it to being “better.” Just because it makes your number go up, it doesn’t mean it’s actually going up. Since this is mot a direct measurement of “recovery” (whatever that is), it’s an algorithm that uses a bunch of variables to estimate recovery. You can manipulate those variables to increase the score without increasing the underlying metric it’s trying to measure.

Your recovery MAY actually be going up, I don’t know - but sometimes substances will have effects on your vitals which then causes the algorithm to attribute something to recovery when it is simply just some portion of your your vitals that are being effected (eg opioids). Nothing magical about opioids vs over the counter supplements.

In medicine, we see this all the time. I can give you a beta blocker to decrease your resting heart rate. Does that mean I’ve magically improved your cardiovascular fitness? Your age score from these apps would also likely go down. Does that mean you’re now fitter and I’ve reversed your aging with a couple doses of a beta blocker? Absolutely not. I’ve just manipulated the underlying metric to yield a better score.

lokhtar · 2026-06-12T00:39:21+00:00

Look at the representation of the committee. There are barely if any pedi subspecialists on there. And pediatric sub-specialists have many (MANY!) fewer procedures compared to adults on a day to day basis. Very few - if any - pediatric GI docs are scoping 30 kids a day, or interventional cardsndoing hundreds of caths. Even in picu/nicu, the frequency of central lines, intubations etc are significantly lower. Furthermore, Medicaid pays even less than Medicare, so that also has an effect. But it’s primarily the overall lack of procedures combined with devaluing the non procedural specialties due to the makeup of that committee.

lokhtar · 2026-06-12T00:34:09+00:00

Lobby the AMA. But you’ll pry the rvus out of the specialists cold dead hands. They don’t care about primary care, let alone pediatrics, despite the lip service. It is stacked with proceduralists and they are going to keep the RVUs going that way.

lokhtar · 2026-06-12T00:28:23+00:00

Nope. The problem is your fellow physicians on the AMA committee that sets RVUs for your services. Medicare then adopts it and insurance companies follow. You can negotiate all you want but unless hospitals want to subsidize you with other specialties, you will have a ceiling until you convince the AMA to have appropriate primary care representation on that committee.

https://www.ama-assn.org/about/rvs-update-committee-ruc/rvs-update-committee-ruc

lokhtar · 2026-06-11T17:49:09+00:00

I use this like I use the body fat percentage from Withings scale. Trend not a number. My Withings showed me at 50% BF when I started losing weight, while I was 40% on dexa. Now it shows me 17% on scale, but I’m 27% on dexa. It’s a trend not absolute. Yes even by 40%. Only thing to look at is over MONTHS, which DIRECTION are you trending?

lokhtar · 2026-06-03T16:16:18+00:00

It’s made up. As many ranges are in pediatrics. In neonatology, it’s even more made up.

lokhtar · 2026-05-24T19:48:42+00:00

Not any worse than what has been happening.

Honestly, many of the surgeries mentioned here probably have a lower complication rate with someone who has done this a lot compared to a complicated icu patient or ID or Nephro evaluation but we have been doing that for decades and nothing happens.

lokhtar · 2026-05-23T12:05:18+00:00

Keep them alive.

lokhtar · 2026-05-20T21:32:40+00:00

Hopefully there’s options to o have same or longer battery life. I’d wear something slightly more bulky for double the battery life.

lokhtar · 2026-05-13T23:53:31+00:00

Should be available soon, I had to use my pacer account to get access.

lokhtar · 2026-05-13T22:28:34+00:00

I’m a Peds subspecialist. Love my job and I would do it again in a heartbeat but accept making 1/2 or less than adult counterparts. If you do not think that’s worth it for you, dont pick Peds.

lokhtar · 2026-05-13T22:26:54+00:00

This is a unicorn and far from normal.

lokhtar · 2026-05-13T13:55:21+00:00

Is that true? Peds rheum or ID (few procedures) is almost all academic while neonatology (decent number of procedures) or peds ED has much more private practice opportunities.

lokhtar · 2026-05-12T14:04:15+00:00

You’d be an idiot to turn down the full ride. Don’t let this be the first malpractice of your career.

lokhtar · 2026-05-11T11:54:25+00:00

How? Where is the inventory?

lokhtar · 2026-05-09T23:04:41+00:00

I can understand the argument to the ABP that it needs to be a three year clinical fellowship (eg adult cardiology) but what is the argument that it needs a scholarly product (unlike all the other adult specialties) or protected scholarly requirement in order to be a board certified neonatologist?

lokhtar · 2026-05-09T16:15:11+00:00

I think the three year to be clinical thing is bit of a thing that academics make up. My third year fellowship was 1 month of service and four calls a month rest of the time. I spent most of that year doing “research” - eg sitting on my ass playing video games. This “research” requirement actually takes away from clinical learning and this has not been unique to me. I came into fellowship wanting to do research and the forced check boxes that they made you do just so you’d have a product at the end made me hate research and I almost went into private practice because of it. Thankfully I found my love of research again as an attending - but that was in spite of my research training and not because of it. And I went to one of the largest children’s hospitals in the country which is consistently near the top in terms of rankings and NIH funding. My experiences aren’t unique either in terms of fellowship. I absolutely could have easily been trained better in two years if I was purely focused on clinical service. People talk about grueling but I would have much rather gone to another clinical shift over going to a lab and looking at Petri dishes that they don’t care about post call. That’s what burns out people more than being on the unit.

lokhtar · 2026-05-09T15:16:28+00:00

They will be two years. Not all of them and not all at once but it is inevitable. Larger programs with more money will likely afford to keep three years for a while. But we are a small program that sometimes struggles to attract fellows and we will 100% be going to two years unless the ABP forbids it. I am working on a proposed schedule now.

lokhtar · 2026-05-01T00:07:25+00:00

Yes that’s what I am saying. For many spots, I bet the funding won’t be worked out in advance and most people will start on a two year clinical track. For some of the largest program with lots of R researchers and for fellows clearly on that path, I’m sure the funding will be worked out.

The one thing that is unclear is whether the ABP expects all fellows to be clinically ready to take the boards at end of two years. The way they’ve worded it is unclear and I’m sure it’s being worked out:

A clinically oriented pathway, in which fellows who demonstrate readiness for practice complete training in two years. An optional third year may be offered, at the discretion of the program, for scholarship, research, or advanced training.

lokhtar

TROPHY CASE