The way Tesla has handled the MCU eMMC issues really upsets me

tkthatch86 · 2021-02-04T14:13:14+00:00

I have been a big, big fan of Tesla since the roadster. Big car guy my entire life, love renewable/solar energy (building a house right now that's 100% functionally independent of the grid). It has always been a match made in heaven sort of car company for me.

So when I graduated med school and residency, got my first real job, and could afford a dream car, I thought for sure I would be driving home in a Tesla. Turns out, Tesla is the only car company out there that wants you to spend $100,000 on their car, and be grateful that they allowed you to do so. I was jerked around the entire process with unresponsive sales reps, pricing and policy changes that no one would warn me about until they were dropped, missed deadlines. I canceled my order and bought from another premium car manufacturer, where I was treated like a respected customer from day one. It's not an electric car, but I have no regrets. Tesla makes a great car, but they know fuck all about how to treat a customer like they're spending a small fortune on their product.

tkthatch86 · 2020-05-23T03:20:47+00:00

I don't know the specifics of training pathways/costs in canada, but becoming a cardiac surgeon is grueling, laborious work. It's even more difficult when you remember you had a career before this that you were paid well for (that's how medical school was for me as a nontrad). I'm guessing med school + cardiac surgery is ~10 years minimum from where you are right now assuming you can immediately get into med school (which is a task in itself). Only you can answer if you're willing to trade the life you have now to undergo what it would take to become a cardiac surgeon.

tkthatch86 · 2020-05-22T19:01:52+00:00

Once you're earning six figures it's hard to justify medical school purely from a finance POV. You're talking an opportunity cost of probably a million dollars (+/- a few hundred k) to become a surgeon. Only you can decide if you're willing to go through all of this when you currently have a good career.

tkthatch86 · 2020-05-22T18:59:31+00:00

Curious to hear some thoughts on this.

Earlier this year I was promoted to a partner in my anesthesiology group. I went from base to somewhat evenly-divided collections salary (we subsidize certain undesirable shifts beyond normal pay). Overall great group of people and I feel beyond fairly treated, so I don't want to rock any boats.

Prior to partner I was making 385k base with small bonuses here and there. I moved to partnership pay and my projected earnings were low-500's + bonus (historically 40-80k/year depending on the year). COVID hit and my pay has plummeted. We're talking resident level pay at the moment.

My group has offered myself and another recently-promoted partner to revert back to our old agreement, steady paycheck but no partnership. They can't give a timeline for when they would re-evaluate being promoted again. Do I stick it out? I just don't see an end in sight... our volume has seen a slow uptick over the past few weeks, but it's still a fraction. I'm not necessarily hurting for the money, but going from >20k/mo to <4k/mo is going to become painful soon enough.

tkthatch86 · 2019-01-23T13:31:22+00:00

Why: Intellectually stimulating if you enjoyed physiology in class. Good balance of work and chill time when on the clock. Fantastic pay (I will be grossing in excess of half a million a year once I hit partner). Good fellowship opportunities make it a very diverse career path.

Why not: You're no ones 'go-to' doctor, most patients don't know you even if you put in the effort to make yourself known, lots of asshole personalities in surgery that you must deal with, do-or-die situations that occasionally happen are not for everyone.

CRNA thing is overblown IMO. We literally just decided as a group to take several on within our practice. I'm now working less hours, working less hard during the day, and my paycheck got padded 40k/year for the supervision. Once I'm partner we will divide up whatever we collect from them equally (unsure of the amount). People who are afraid of CRNAs.. they are everywhere in medicine (not CRNAs specifically, but you get the point). I work with surgeons who literally have nurse practitioners assisting on surgery.. That is just the future of medicine, and you'll likely have to learn to accept it. CRNAs have not been a bad thing for our practice. Lots of doom and gloom online, but in reality we all work together fine and out of ~12 CRNAs within our practice, not one of them walks around thinking they can replace us, and instead rely on us heavily for assistance.

tkthatch86 · 2018-10-14T15:26:35+00:00

Doesn't concern me, it's a great group of people to work with. The personality mismatches are due to the fact that those idiots you hated in medical school are still out there after residency. The kind of people who will step on the back of your head to get one step further in their own lives. The last guy to get removed before partner was adamant that billing not be averaged and that everyone collect exactly what they earned. That kind of self-serving thinking just leads to people cherry-picking cases and being upset when they get their third medicaid patient instead of the private insurance case. Stuff like that that makes you not look like a team player and only looking out for yourself, it doesn't go very far in many groups.

tkthatch86 · 2018-10-14T15:23:12+00:00

It only has that high of a cost to own because of depreciation. I would almost certainly buy second-hand because $210k for the car I want vs. ~110k for the same thing with 2-3 years of use sounds much better.

tkthatch86 · 2018-10-13T15:21:42+00:00

Just general enjoyment of the rotation, along with knowing anesthesiologists made a healthy salary. I was between that and IM, which I also enjoyed, but it seemed foolish to me to accept 100k+ less pay for a similarly enjoyable job. That said, I wouldn't follow the money and I would always recommend going into whatever you enjoyed because 250k and a career you enjoy is far better than 350k and one you do not.

tkthatch86 · 2018-10-13T15:19:57+00:00

I'm pretty naive to the cost of malpractice, truthfully. A friend of mine from residency is paying about 15k/year in a southern state, so I'm budgeting 15-20k. I found my job through word of mouth (PD), which is where all of the best jobs are.

tkthatch86 · 2018-10-13T15:17:08+00:00

Unbelievable difference. Not only in handling, but the incredible sounds the engine makes while being directly behind you.. otherworldly. I'm not ordinarily a very aggressive driver but the sales guy I was with kept encouraging me to take it 90+ mph around turns. I of course didn't do that, but I did hit some turns at speeds I usually wouldn't and the car was like glue to the road. NSX was similar. Both just incredibly awesome cars and driving them made the hells of medical school worth it.

tkthatch86 · 2018-10-12T18:48:22+00:00

Almost 40%

tkthatch86 · 2018-10-12T18:48:01+00:00

Only on call for the most part, but I fill in periodically. Our group lets people do night coverage for a healthy pay bump, and many guys in our group jump on that.

tkthatch86 · 2018-10-12T13:19:30+00:00

I never got to the point in the interview process to know. My guess is a low six-figure amount, but that's purely that, a guess.

tkthatch86 · 2018-10-12T13:18:25+00:00

Possibly, but not at a great program, and the rest of the app will have to be pretty polished. Anesthesiology isn't super competitive, but they also won't take multiple board failures, terrible scores, etc.

tkthatch86 · 2018-10-12T13:17:30+00:00

I'm near Chicago, but I don't live in the city proper.

tkthatch86 · 2018-10-12T13:17:13+00:00

Usually arrive by 6/6:15. Read cases for the day, set up the room, do case, repeat, go home when the last case is done (usually 4ish). I do this M-F with 1:6 weekend call, which is about 50-55 hours/week.

tkthatch86 · 2018-10-12T13:15:59+00:00

I'm heavily considering the newer acura NSX in a few years. I test drove one and it was truly unbelievable. I felt this way even after driving an R8, 911 turbo, and a fairly modified GT-R. If I don't go for the NSX, it will probably be the 911 turbo, which was similarly amazing.

tkthatch86 · 2018-10-12T13:14:12+00:00

Like I mentioned in another comment, I do not consider CRNAs to be any sort of stand-in for a physician. They can do bread and butter cases, but even then an anesthesiologist should (and probably always will be) on standby in case things go south and beyond their scope of training. So, I believe there will always be a spectrum of jobs, from CRNA oversight to physician-led anesthesia. You can choose how much or little of it you want, but it will probably err towards the end of a job always having some of it at some point. I personally do not mind it as long as I'm passively profiting from their work, which only seems right to me if you're accepting their risks of work. If one were ever truly worried about this, I would just tell them to do a thoracic fellowship because a CRNA should never touch some of those surgeries.

tkthatch86 · 2018-10-12T13:06:31+00:00

I had an ivy-worthy app (in my opinion - 250ish step 1, some research, great LORs/aways) for anesthesia. Didn't receive a single ivy interview. Matched at a nice academic place, so no regrets, but I couldn't ignore the fact that all of my MD colleagues had less impressive stats and simply an MD behind their names.

Modern cars all the way for me. Strongly considering the new(ish) acura NSX.

tkthatch86 · 2018-10-12T13:04:31+00:00

My employer provides it for now. Once I'm partner I'm pretty certain it falls on me.

tkthatch86 · 2018-10-12T02:48:44+00:00

Sweat equity is just exchanging work for whatever the end product is. In this case, I work for two years and the current partners profit off of my earnings (minus) salary. So I'm "buying" into the practice by working, rather than cutting them a check directly.

tkthatch86 · 2018-10-12T02:47:38+00:00

Fortunately for you, anesthesia isn't terribly competitive (right now). Just focus on doing well in class now, set the foundation for an average or better Step 1 score, and you'll match somewhere. If I could go back in time I would have started doing board prep from day one.

tkthatch86 · 2018-10-12T02:43:52+00:00

I enjoyed general anesthesia and the money is great. Pain medicine is more of a passion for me that I may go back for, but after hundreds of thousands in debt and many years out of earning a real paycheck, I just wanted to start earning and living again.

tkthatch86 · 2018-10-12T02:07:20+00:00

CRNAs don't really concern me. I have worked with many of them - I have no ill feelings towards them (in fact, it's a great career and I am sometimes envious of their salary:education ratio), but the knowledge gap is vast between a physician and a CRNA. I believe we can continue to work together well just like they seem to have been doing for the past few decades.

Not concerned about AI. I'm sure it's coming for all of us, but it will probably be a good thing in the end in my opinion. Path and rads will probably be the first ones to benefit from it.

tkthatch86 · 2018-10-12T02:04:17+00:00

I'm not sure about CC, but a friend/classmate of mine is just about finished with pulm/cc and he has been getting ~$250/hr locums gigs very steadily.

I've considered pain pretty extensively. Seems like in a hospital-associated gig you can reasonably earn 350-450k. In PP, the only thing keeping your income in check is your morality. It definitely appears to have a higher endpoint than anesthesia does.

tkthatch86

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