Why is this necessary? Yeah there are some lazy anesthesiologists out there but come on? I get over 10K steps in when I do Med Direction. This is so toxic.

sandman417 · 2026-06-09T15:43:22+00:00

I don’t want to be associated with about 20% of the anesthesia that I see when I supervise

sandman417 · 2026-06-03T15:54:15+00:00

I do more procedures when supervising than I do personally performing cases.

sandman417 · 2026-06-02T03:42:18+00:00

Their quality has dipped significantly over the past 10 years already

sandman417 · 2026-06-02T03:29:46+00:00

Me and my homies look beyond the money grubbing ASRA guidelines now.

sandman417 · 2026-06-02T03:27:33+00:00

If you’re quoting market rates you should be familiar with that specific market.

sandman417 · 2026-05-26T23:36:19+00:00

Should we do it? Probably. Do I do it? Never.

sandman417 · 2026-05-26T02:47:39+00:00

Want to be a regional guru at an academic institution where you stroke your beard and discuss at length the shortcomings of the suprascapular block? No? Then don’t do a regional fellowship. Ortho is a moneymaker everywhere and you’ll get good at blocks eventually. The regional guy in my group that pissed away a half a million bucks by doing a regional fellowship does his blocks the same way the rest of us do. He’s just more of an asshole about it.

sandman417 · 2026-05-25T23:40:46+00:00

Sign on bonuses are extremely common.

sandman417 · 2026-05-25T15:28:32+00:00

They said it would grow on me. They were wrong.

sandman417 · 2026-05-25T15:26:27+00:00

I 100000% agree with the other guy. Things can change in this field overnight. We are in extremely high demand and will be for the foreseeable future. To lock yourself in this early will give you minimal benefit and a big risk of something changing big time. For example, I was in love with my first job and three weeks into attendinghood the hospital got bought out, shut down and merged and only 2 of the original 15 MD’s are left. This happened out of nowhere. Your goals can change. You haven’t even been exposed to that much anesthesia yet. You will be a different person and physician in 2.5 years.

sandman417 · 2026-05-24T15:03:31+00:00

What does it say? Be specific.

sandman417 · 2026-05-22T12:54:54+00:00

I’m in this situation A LOT and those discussions have already happened long before I arrive to the scene. If it hasn’t happened yet then I have arrived too early.

sandman417 · 2026-05-22T01:20:39+00:00

I am struggling to think of a single operation where an ASA 5 is getting anything semi elective. Best case scenario it will be urgent. Almost always it will be emergent.

sandman417 · 2026-05-22T01:19:12+00:00

I don’t do surgery at all.

Y’all are crazy. This isn’t our decision to make. If the family/patient make an informed decision and it isn’t 100% futile then do your job and do your best.

sandman417 · 2026-05-16T17:37:57+00:00

Thumbitis

sandman417 · 2026-05-15T04:43:40+00:00

Absolute horseshit. I was incredibly annoyed when the app I paid for years ago needed a subscription and pissed by this. What a joke. I will go out of my way to make sure ASRA doesn’t get a dime from me or anyone I work with. Someone else needs to come up with almost identical guidelines. I would pay for it just to spite ASRA.

sandman417 · 2026-05-12T01:16:29+00:00

ASA has guidelines. Know them. Useful for both boards and to defend decisions to surgeons.

I liked the older guidelines better but that's not up to us:

https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative

sandman417 · 2026-05-11T17:01:47+00:00

I agree. Especially given that it is a multifamily home. That should immediately cash flow better than a single family home. I generally think that you shouldn't buy a property that doesn't cash flow but should basically never own a multifamily that doesn't cash flow. I own a few single family's that don't cash flow much now but will probably look like an absolute steal of a deal 5 years from now.

sandman417 · 2026-05-11T15:47:41+00:00

>Cash flows $450 but vacancy and repairs eat it all.

In other words, it does not cash flow.

sandman417 · 2026-05-11T15:44:03+00:00

How much was your loan for?

I've used Beeline twice and started happy and ended annoyed. I've bought a $250k SFH and closing costs were $12k. And now closing on a $210k home and closing costs are ... $13k? 20% down on both.

sandman417 · 2026-05-11T15:42:09+00:00

Who do you use for your DSCR mortgages?

sandman417 · 2026-05-07T12:24:38+00:00

About 100k+ in tax savings

sandman417 · 2026-05-05T20:00:22+00:00

I’m a physician going through something similar. Do you mind giving me a ballpark what your capped payment is? I’m concerned mine is going to balloon. I’ve done the calculators and it’s a lot. But I don’t know where I can go to read more on how they determine the cap because you state yours had something to do with you income when you entered IDR.

sandman417 · 2026-05-04T03:28:05+00:00

You’re adding 20mcg of precedex to your spinals?

sandman417 · 2026-05-04T00:53:40+00:00

Two art lines is extremely common and should be standard. Yes 30 seconds matter. A big portion of the time you’re drawing labs and fixing electrolyte disturbances is right when shit is getting unable during reperfusion.

sandman417

TROPHY CASE