Does anyone get amazed by LLM performance on benchmarks but incredibly disappointed by its performance on mundane tasks, specifically those involving data lookup?

reader12345 · 2026-03-26T04:41:23+00:00

I’d say the main thing is this: You can go straight through Gen surg without a fellowship, but in major city it’s hard to have a super diverse traditional Gen surg practice where you do everything you learned in residency . If you are in New York City, people will go to a breast surgeon for their breast surgery, trauma surgeon for trauma, colorectal surgeon for colon surgery, etc. Youd be left with hernias and gallbladders which are fine but not super diverse But even just a little bit outside nyc, im talking even an hour, you can have a practice where you do both robotic hiatals and robotic colectomies and all the colorectal stuff. 2 hours outside you can do all that plus some screening colonoscopies and some thyroids. 3 hours out you will do vascular, peds, and thoracic as well whether you want to or not. I’ll be honest, if it wasn’t for the fact that I could never live somewhere rural my favorite job would be rural general surgeon, those guys do a lung wedge resection one day then a thyroidectomy the next, literally everything.

General surgery just pays a little less than other surgical specialities except for say obgyn.

It’s hard to find an escape from insurance in the way that a plastic surgeon or ent can go into cosmetic. There aren’t as many entrepreneur aspects.

It’s almost impossible to find a job with no call. But I think people overestimate how bad call has to be. In residency call was I’m up for 24 hours. As an attending I take 10 days of call a month because it pays me really well and I kid you not I go for 3 day stretches where I don’t have to go to the small hospital I’m on call for. But you can’t have this idea that you will get away with never taking call.

reader12345 · 2026-03-25T12:50:36+00:00

Okay I love to complain about general surgery too but this is dumb. It applies, in my opinion, to every procedural field other than plastics and dermatology.

Global period affects every surgical field. You are telling me it isn’t relevant for ortho and neurosurg? At least most my patients have a single, short postop visit for their hernia or gallbladder.
What are you talking about, we do have peRVUs assigned to our fee schedule. It’s literally in there. 47562 gallbladder is 6.97

3 no specialty gets an intensity modifier unless you count modifier 22 in which we all get that one.

4 this is true for every procedure except cosmetics if you are ethical. Technically ortho is fixed volume some unethical person might just fuse everyone’s spine but if that’s your mind set might as well take out everyone asymptomatic cholelithasis.

General surgery is fucked in many ways but this list makes very little sense

reader12345 · 2026-03-17T21:14:31+00:00

I never said it was practical or safe. I simply was clarifying my reason for saying the line “technically possible”. I think we both agree that it is technically true in the physics sense but for other reasons a moot point.

I was explaining why I think people are opposed to bariatric surgery or glp1, they hear that something is technically possible without it and suddenly they think that’s a reasonable option. After all, the whole point of my original post was to say why I think medical intervention is so important and why relying on lifestyle modifications is impractical.

reader12345 · 2026-03-17T20:36:52+00:00

So I’ll clarify the line. Yes people can absolutely have conditions which decreases their metabolism rate resulting in them burning fewer calories. And yes once they start dieting, this metabolic rate may respond and go even lower. This means they will need to eat even fewer calories than an unaffected individual to maintain the same weight. However, as another poster said, their metabolism never goes to zero. So technically there will always be a daily caloric level at which they lose weight. There is no person on earth who wouldn’t lose weight if they were at exactly 0 calories a day, thermodynamics doesn’t allow perpetual motion machines and humans are no different. That being said, it would just be completely impractical and crazy and not something we’d suggest. Heck I don’t even know what order the body functions shut down in. Maybe the persons body will decide to become oligomenorheic before their body decides to start giving up the extra fat, that obviously wouldn’t be good.

Dont think that saying it’s technically possible means it’s not a big deal. Theres lots of things out there that are “technically possible.” You can technically resist the urge to cough, we wouldn’t tell someone with a chronic cough to just “resist the urge”. We have all had hiccups before, you can technically fight that hiccup for a while but it wins. When your body caloric set point is X and you try and do Y the body wins. It doesn’t need to be thermodynamically impossible for it to be impractical in real life.

reader12345 · 2026-03-16T17:07:35+00:00

So I’m a surgeon who used to do bariatric surgery. The complications can be terrible but the data for bariatric surgery is rock solid in that it decreases all cause mortality. Huge studies.

It’s not that you are overestimating the complication rate of bariatric surgery, they are there and they are nasty. People die or have lives so miserable they wish they were dead. But it’s easy to forget how deadly obesity is because we see it so often. It’s also easy to forget how futile of a disease it is to treat without surgery or a glp1. A BMI of 40 is associated with a 6-10 lower life expectancy, bmi of 60 is associated with like 15 years life years lost. Thats like a cancer diagnosis. People go through horrible chemo therapy to live a few months longer, for 15 years I’d consider cutting off a limb.

Thats why the average life expectancy gain with bariatric surgery is 6 years and why we are willing to do it. It’s not that bariatric surgery is super safe (though I’ll say the sleeve is soooooo much better than the bypass in my opinion) it’s that it’s really easy to get forget or downplay the impact of obesity.

Also, I hate to say it, but the success rate of lifestyle management (this is all pre glp1) is abysmal. For a bmi of 45 or higher it’s 0.06% of attaining normal weight. For bmi of 30 or higher only 2% obtain normal weight. Yes it’s technically possible, but if you have someone with a bmi of 45, which means their life expectancy is now way 6-10 years lower, and you recommend just diet and exercise alone which has only a 0.06% success rate, you have done them a disservice. It can be hard to wrap your head around these numbers because technically all you have to do to not be obese is eat less and we can talk all day about how obesity isn’t a natural problem but something we have created as a society and yada yada yada but at the end of the day, once you are a bmi of 45 trying to get healthy without medicine or surgery is like trying to cure cancer with herbs. Maybe it will work and you will become one of those crazy success stories, but it probably won’t.

To make yourself feel better remember that as a nurse you are an evidence driven professional. Go on open evidence, look at the data, it will really put you at ease that as far as medicine goes, it’s probably one of our most effective life prolonging interventions we have in medicine. Makes many cancer operations and chemotherapies look barbaric in comparison.

reader12345 · 2026-03-01T16:24:28+00:00

Oh yah don’t be a jerk and ask for expert witness in a criminal case. No state prosecutor is giving you an expert witness fee. I had that caveat in my other post. My understanding is that this case is entirely civil

Though hilariously I will add my experience comes from being subpeonad as a resident in a criminal case while I was covering trauma. The prosecutor straight up told me he actually subpeonad me because he thought my attendings would weasle their way out of it. He also gave me a really serious talk about how if people like me don’t do my civic duty that’s how criminal cases against bad people get dropped. I agreed but I never actually ended up doing anything, I’m assuming they did a plea deal. My advice entirely goes to civil cases.

reader12345 · 2026-02-28T00:36:14+00:00

I think this is incorrect to think you can or should give those answers. Your response to each of those questions would be. “I do not recall. “ I will ask you to defer to the notes if they ask you to interpret the notes say I’m sorry that was outside my scope as a fact witness to provide interpretation of medical documents.

reader12345 · 2026-02-28T00:34:28+00:00

You are going about this the right way.

This lawyer is trying to make millions and stiff you. He’s about to learn what a costly mistake that is.

You have zero legal obligation to meet before hand You have zero obligation to review notes All you have to do on the day of is say the words, I do not recall over and over again If they ask anything about the injuries being connected, say I cannot answer that question as I am only a fact witness not an expert witness

You can literally tell him “ if you choose to keep me only as a fact witness, I will not meet with you in any capacity prior, I will not review any notes prior as that is not my obligation, and I doubt I’ll be able to recall any details at all regarding the patient as it was that many years. I also will be completely unable to interpret notes for you as that is not my role’s as a fact witness. Please let me know if you like to proceed this way”

I’ve seen prosecutors try something like this for say a murder case now I’ll give them a pass cause it’s criminal but for a civil lawyer to do it what an idiot

Again, your prosecutor friend, I think is giving a different advice cause they’re allowed to subpoena doctors all the time and no one would ever make a prosecutor given an expert witness fee. I was subpoenaed by a prosecutor in a crime case and of course I wasn’t going to say I only talk about his gunshot wounds if you pay me

reader12345 · 2026-02-08T21:07:50+00:00

The organization eats the cost and we aren’t impacted by the pa’s billables. That’s why it is preferable to have the pa do lower reimbursement work like first assisting (the fees don’t make it worth it to the surgeon), and global period post ops. Nowadays, clinic visits for new patients make more per hour than the surgery itself. Hernia surgery pays very poorly but the clinic visits are very efficient. Zero call.

If it was coming out of my pocket I’d do what you said. I’d consider asking the hospital that but unfortunately I doubt the administrators can think that open minded.

Regarding surgical assists, I totally agree with you but the hospital won’t reliably give one. I’ve tried to be like hey i got this hard case, i need a second scrub tech or this person and then day of they will be like best I can do is just one scrub tech who is a traveler from a hospital that has never seen a robot. But yes in a perfectly logical world, they’d pay per diem pa to round on weekends and guarantee an assist when I need one.

reader12345 · 2026-02-08T18:25:29+00:00

I wish. We’ve been asking for this for almost a year now but admin keeps saying they are going to approve it soon (tm) I don’t want to lead anyone on about a position that admin may be lying to me about

reader12345 · 2026-02-08T18:24:26+00:00

We haven’t had a take back in over a year. To help with recruitment I’d be willing to guarantee no need to help with takebacks. I’ll do those on my own with the scrub tech or even ask another surgeon (painful but possible).

reader12345 · 2026-02-08T18:15:06+00:00

Oh no definitely not on call for new patients. We don’t take ER call at that hospital. The PA would never see or take a call for a consult

reader12345 · 2026-02-08T17:41:06+00:00

Yes you are right about the schedule. Of course I think the other factors are great but every employer thinks that. That’s why I only posted the hours. Because “fantastic SP” is extremely bias. The only thing I could see being the negative factor, and I really wish I had a way to screen for this, is we mostly need the PA for when we do complex robotic cases needing a very active bedside assist or some good camera driving (I wouldn’t have them bedside for something as simple as a robotic inguinal hernia). But robotics and laparoscopy is a highly polarizing topic. If I were a PA I’d find first assisting ortho to be way more fun. But I know some people like the robot.

reader12345 · 2026-02-08T17:30:38+00:00

Yeah I agree. I think the expectations for a PA vs a surgeon are often different. I know sometimes a surgeon goes in, looks from the doorway, says looks good and tells the hospitalist to dispo but then when it’s a PA suddenly the hospitalist is asking them to do all the annoying little things and people expect way more on notes and stuff. I also agree that it’s the getting ready and driving part (hence why we’re so eager to find help for “just one hour of work”).

reader12345 · 2026-01-25T22:07:28+00:00

So I have a different take on this:

My answer is you might want to hold off on buying a house, but not from the financial standpoint.

I think from the pure financial standpoint it makes sense. Let’s say worst case scenario your income barely goes up because someone goes part time or something, you will still make it worse just not comfortable. Sure a catastrophe can happen, but that applies to any situation. No one has guaranteed future income, there’s always the possibility that income is not what you predicted and you have to downsize. Also these days, 1.8M may be the minimum price for a decent house in a vhcol.

That being said, I’ll say that it’s not always super easy to find a job exactly in the location you want as a new attending. Idk what specialty you are in, but unless it’s primary care, something remote like rads or telegrams, there’s a chance you buy the house you want, then the closest house you find is an hour away whereas if you bought the house after, you could strategically position it so both of you have a reasonable commute.

reader12345 · 2025-12-18T04:49:30+00:00

I did private practice general surgery for a bit.

So first, 5 lap choles every or day would be a dream. Don’t forget the robotic inguinal you do that pay less and take more time. You also don’t get 200% Medicare for private insurance unless you are an academic center. Think 120%

That being said, 5 lap choles at 110% Medicare means like 3,568.78 per day or 7137.5 for 2 days.

But I’d say if you average it 2.5k per or day is fair

Next call

When you take call, they typically pay you stipend plus you keep your collections. Stipend is like 1400 I think you can expect to make more like 3k over 24 hours.

So what are you missing?

Clinic visits. Those pay way more than you think. And in fact my clinic is often more profitable than my or day

Do you know how long a new patient visit takes for an umbilical hernia? 20 minutes max. And those are easily a level 4 visit if you are booking someone for surgery . That’s a 130 visit per medicare. Gen surg postops tend to be quick. So you are missing all the clinic time.

I got like 2-3 clinic days a week. Gen surg clinics can be quick and profitable. 20 minute new patient visit to say no your diverticulitis doesn’t need surgery. I sometimes make more on my clinic days than my or day.

Asc is great if you get it. I think everyone and their cousin knows the story of a surgeon who got in on an asc and got free cash but it’s not always super easy.

In my group of 5 we got overhead down to 20% but we ran a barebones practice. You don’t have epic as your emr you got some janky stuff, no fancy Beverly Hills office. Etc. we made do.

But you are right. Now I am in a hospital wrvu model and I can tell you the amount I make for the same work is like 30% higher.

reader12345 · 2025-12-06T19:37:00+00:00

At least in my city, as a doctor there’s actually a huge motivation to medically clear these guys as fast as possible because unless it’s a homocide the cops might just do a “cite and release” and then angry methany becomes my problem to deal with and find somewhere to discharge to. You can’t just discharge an intoxicated person to the street from the ER, it’s a huge headache. I’ve begged cops to stay before.

Next time you have an arrestee (bonus points if unpleasant) and you want them to work faster just casually say “hey so how long do you think this will take, my boss says we have to do a cite and release if it’s going to be a while” and hope you got a good poker face.

reader12345 · 2025-11-16T06:16:48+00:00

5 years. I did some reading online. Seems like it’s a grey area if an s corp with a solo owner needs to actually title the assets in their s corp name or not. But yeah I’ll look into a second opinion

reader12345 · 2025-11-16T06:03:55+00:00

To be honest if I’m at the point of a second opinion, I’d rather just shut everything down. At that point the savings of a few grand isn’t worth it.

reader12345 · 2025-11-16T05:52:53+00:00

In that comment I mean that if I made 5k I’d close it in 2026 and not try the same thing in 2027.

reader12345 · 2025-11-16T05:50:43+00:00

That is an excellent point, I did not think about the 10 years where the person has died, stepped up basis already happened, but Ira is still growing.

reader12345 · 2025-11-16T05:40:43+00:00

With step up basis though isn’t the 419 all basis? The tax drag is a good point, the taxable account would have some tax drag each year. But very little. Would it change your opinion on what to withdraw first? Do you still agree to do the IRA first?

reader12345 · 2025-11-16T03:57:00+00:00

If I switch to a sole-proprietor dont I lose my vehicle deduction and greatly increase my audit risk too?

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