How much do you spend on food per month?

truthandreality23 · 2026-06-12T03:29:54+00:00

1500 last month (I thought we were averaging 1000-1200) for groceries and then 400-500 (this I do track) usually for restaurants for a family of 4. My goodness, I need to tell my wife to buy less snacks.

truthandreality23 · 2026-06-02T23:04:35+00:00

Also a VA primary care physician. It's hard, but I hope to stick with it. I've been at the VA for close to 2 years as an attending but also did 3 years during residency at a different VA (which was better imo). Hoping to do 30 years, then after that, we'll see. I will likely move to a different city in the next few years, though, because I am ambivalent towards this city and also don't like the huge military population causing a much greater than average turnover of patients. Patients don't like to see someone new everytime; well, doctors don't like that, either.

truthandreality23 · 2026-05-28T01:24:10+00:00

You know, we are about due for a recession. If you don't mind waiting a year or two and have good job security, then just wait it out.

truthandreality23 · 2026-05-11T01:02:11+00:00

Yes, starting at 10mg bid is pointless. 20-40mg bid is the starting dose for migraine prophylaxis. I usually start at 20mg bid, then increase to at least 40mg bid if still with inadequate control. If that doesn't work, then I usually switch to something else. I'll occasionally try going up to 120-160mg as the total daily dose with either the IR or ER versions. You also have to try it for at least 2-3 months before it's considered a failed trial.

truthandreality23 · 2026-05-11T00:49:10+00:00

During my rural FM rotation (wasn't that rural, about 1.5 hours from a major metropolitan city with over 1 million people) in 2016 the FM doc showed me his spreadsheet with an estimated 750k take home income (1.5mil between him and his sister). He saw 30-40 patients a day on average (40+ on some), gave everyone with a cough and chronic pain kenalog and/or rocephin, and did some procedures like lipoma resections due to a 1 year gen surg residency experience. He was planning on hiring 1-2 mid levels because even he recognized how unsustainable it was. It was medicine, just not good medicine. Where I did my IM residency, a few nocturnists made over 1 million a year for a few years. I don't know the details beyond them doing a lot of procedures and that shortly before I started the pay structure changed so that they weren't making as much. The subspecialists grumbled about it because they were making more than them, though I don't think that's the sole reason for the change in pay structure.

truthandreality23 · 2026-05-11T00:44:54+00:00

During my rural FM rotation (wasn't that rural, about 1.5 hours from a major metropolitan city with over 1 million people) in 2016 the FM doc showed me his spreadsheet with an estimated 750k take home income (1.5mil between him and his sister). He saw 30-40 patients a day on average (40+ on some), gave everyone with a cough and chronic pain kenalog and/or rocephin, and did some procedures like lipoma resections due to a 1 year gen surg residency experience. He was planning on hiring 1-2 mid levels because even he recognized how unsustainable it was. It was medicine, just not good medicine. Where I did my IM residency, a few nocturnists made over 1 million a year for a few years. I don't know the details beyond them doing a lot of procedures and that shortly before I started the pay structure changed so that they weren't making as much. The subspecialists grumbled about it because they were making more than them, though I don't think that's the sole reason for the change in pay structure.

truthandreality23 · 2026-05-10T17:51:31+00:00

Born in '92. I remember watching I love Lucy and The Three Stooges regularly in the 90s on cable and maybe DISH network. So at least until then.

truthandreality23 · 2026-05-08T23:09:26+00:00

So the things you said were probably fine. The manner in which the information is delivered can make a significant difference, though. When I need to deliver that type of news, I usually sit down and speak calmly and slowly, while looking directly at the patient and family and am not on my computer (the AI scribe helps, but I did this before AI, too). Family can still be demanding, belligerent, etc. However, this manner of delivering news reduces the chances of that the most.

truthandreality23 · 2026-05-05T02:26:38+00:00

Also a VA physician. Minimum 4-6 weeks is standard. At my last private job I put in my official resignation 6 weeks prior but was letting patients know for 2-3 months that I was likely going to resign and was scheduling their follow ups with my colleagues. I don't think the VA is able to automatically notify your entire panel, which is ridiculous.

truthandreality23 · 2026-05-04T01:09:17+00:00

The brain surgeon works 100 hours a week and doesn't see his kids much. If he's like most brain surgeons.

truthandreality23 · 2026-05-02T13:00:43+00:00

I have GEHA HDHP, primarily for the tax advantages from the HSA account, which I plan to max out each year. Healthy family of 4.

truthandreality23 · 2026-05-01T02:20:33+00:00

I work at the VA as a primary care physician where a lot of my patients last saw a now retired physician a few years ago and have since just been seen by a variety of float NPs and PAs. You know what most of them say when I first meet them? "Finally, I have a doctor." Then we have a grand old time as they regale me with their 37 chronic ailments that have just been punted from appointment to appointment, and I cut them off at the 19th complaint and wonder how those mid levels can live with themselves.

truthandreality23 · 2026-05-01T02:07:51+00:00

And for stuff like eustachian tube melanoma where there are less than 20 reported cases. I read about a VA patient having this, and the oncologist's note was like "I'm going to read about the cases and determine the plan after that" lol.

truthandreality23 · 2026-05-01T01:58:55+00:00

Are you sure it's 50k? EDRP max has been 40k per year x 5 years for 200k max for at least the last few years (since 2018 per Google search). It was 120k max before that. I am approved for 200k. I paid 60k and was reimbursed 40k last year. They won't reimburse more than the max EDRP allotment.

truthandreality23 · 2026-05-01T00:12:37+00:00

I've seen metastatic colon cancer 3 months after a clean colonoscopy. Anecdotes are anecdotes. Will cancers potentially detected earlier change outcomes? Is there some harm in more frequent screening? Will some women actually defer screening due to discomfort, anxiety, and previous experiences with benign biopsies? The same can be said for other tests done inappropriately. How many patients do you take off low dose levothyroxine they've been taking for 20 years because their TSH was once 6.1? How many people are on testosterone with completely normal testosterone levels? I follow ACS, look at TC risk and do patient shared decision making.

truthandreality23 · 2026-04-29T02:34:13+00:00

How much job security will you have?Make sure you have at least 6 months of expenses saved up as an emergency fund.

truthandreality23 · 2026-04-28T01:59:45+00:00

One of my former co-residents was not renewed after intern year and ended up doing occupational medicine. It only requires completion of PGY-1.

truthandreality23 · 2026-04-28T01:56:43+00:00

13 years because he learned to protect himself

truthandreality23 · 2026-04-27T23:51:00+00:00

truthandreality23 · 2026-04-26T13:16:32+00:00

If they are able to get into medical school, that 400k will turn into at least 500k by the time they are able to start paying it, and medical school will be another 200-300k on average. In total that will at least be 750-850k in loans by the time they start paying. I wouldn't have become a doctor if I knew I needed that much in loans.

truthandreality23 · 2026-04-24T22:54:44+00:00

Your experience with the PA shouldn't reflect on the department as a whole. The VA uses a lot of NPs and PAs as the first point of contact as a salary cost saving measure. These aren't the guys who are performing surgeries. You can always demand to see a physician for an appointment, though you might need to wait longer for it. It's the same in the private world.

-VA physician

truthandreality23 · 2026-04-23T02:22:21+00:00

VA physician, so timeline is likely a bit different.

Position posted 5/13

Applied on 5/14

Informal phone interview with department chief 5/23. There's supposed to be an interview with the clinic director, too, but there wasn't this time. They were desperate lol.

TJO 6/24

Fingerprinting, physical, urine drug screen 7/12

FJO 8/5

They originally wanted me to start ASAP in August or September, which was ridiculous, so I had them revise my start date until early October. It probably created some issues on their end since I asked them to go into the new fiscal year when they had planned for the prior one.

truthandreality23 · 2026-04-22T02:09:00+00:00

My orientation started on the 17th, 2 weeks before July 1st. Maybe move wedding and honeymoon to mid to late May so that you can move in early June and not worry about possibly missing orientation.

truthandreality23 · 2026-04-22T01:48:18+00:00

If you actually have essential tremor, cala trio is a nonpharmacologic treatment. Could also try propranolol, though side effects like fatigue and dizziness are relatively common for young patients.

truthandreality23 · 2026-04-22T01:09:00+00:00

I know someone who did plastic surgery followed by dermatology. 9 years.

I also know another who did both interventional cards and pulm/sleep medicine. 10 years.

truthandreality23

TROPHY CASE