Updates and changes

Hello wonderful readers.

I wanted to let you know that I will be revamping this blog a bit in the coming week. My blog has what some would call schizophrenia when they mean to say “multiple personalities” or dissociative identity disorder. To be fair, schizophrenia is a break from reality that makes it difficult to think logically or behave “normally” in social situations, and my blog also has that.

My blog also likes to use “unnecessary” quotation marks. My blog is so clever.

Anyway, there will be some reorganization (or merely a start to any kind of organization at all), perhaps some design changes (that is to say, some initial thought toward using any design at all, rather than haphazard use of whatever available theme), and I will be rolling out one or two new sites in the coming months to parse content into more meaningful/useful/relevant categories. Right now it’s all over the place, which is an accurate reflection of the author, but I think it would be best for everyone if it were more focused and readers could easily find the content that interests them without fishing through the content that interests someone else.

What will be the fate of medzealot? Feel free to comment or email me with your suggestions. So far, the best-liked content on this site has been humor, creative writing, personal details, and my ideas on how to not suck as a person. Aside from the funny med school interview stories, the med/premed content hasn’t garnered a lot of views, and I don’t plan on writing much more of that so it will be sanctioned out of the blog and into a static page where it can build its own readership without getting in the way. I think this blog will chronicle the rest of my education with intermittent reflection on my upbringing, providing a space for me to share stories, brain dump, comment on various phenomenon I encounter along the way, and hopefully host a discussion or two among readers. This may involve a name change or it may not; I will keep you all posted, especially if the URL changes. In fact, I may poll you or email some of you individually for your opinions if you don’t just offer them up freely 😉

I am creating a 2nd blog to focus on education in general: how to teach and learn, how the human mind works and how to leverage it, and updates on relevant research regarding education, learning, improving memory, teaching methodologies, and other more objective topics, sans personal overtone.

Thank you all for reading, and thank you for bearing with me through the changes.


Mostly written by my brother

Everybody’s got their excuses
for why and when.
“Learn to fly and then we can talk, boy.”
Before flight comes advice,
“Move slow, take time.”
All your hang-ups, not mine

are holding me back.

If I were a smart man
I might move slow.
First you see, then you know where to be.
I’m supposed to know,

but not really to live.
Not to play, just to give
to the world.

The world hasn’t shown me shit
but my eyes were covered.
I accepted it all and never wondered
why you’d hide my eyes,
like it’s all so bad.
I was too young to see, too young to even be
alarmed by it all.

Maybe you should’ve let me look,
so I could stand tall now
and realize how I’m to make my mark.

“Advice, like youth,
probably wasted on the young…”
You forget what you’ve done
and demand me a man.
Without warning I’ll come to it
in bloodshot highway fashion
I digress in my passion. I feign maturity.

How am I to be of use
when I don’t know my heart,
can’t see the part I’m supposed to play?
This screw-all game of luck and trust,
to live you must be free of it all.
To be free you must say “no”
to what you know, else you’ll crack.
I’ll leave you and then come back
to you, a man.

How am I to be of use
to your ideals that are dying,
when my heart is screaming, crying
for the trails I have not run?
I’m as deaf to your ideals
as I am to your advice.
I’m uncertain as dice
rolls, my life.

My life to date is blank.
A space to write and fill.
A place for heart and will
to be a man?

I could just move on and pretend
and be as useless now as then,
asking “Just when will I be a man?”
A matter of hours has broken
years of thought and practice,
of life and trying to act as if
I cared about any of it.

I need to run into the night,
to practice love and sin,
fuck it up and try again
to be a man.

I can’t take your path.
When I try, you stop me.
I’m just supposed to find the spirit of a man.

The man I haven’t learned to be
mocks me, laughs and gestures,
a smile but no answer to my questions
and points at my trail.

Step aside and I’ll walk.
I’ll come back and we’ll talk
together as men.

To be a man takes practice.
You can’t smile and teach.

Your goal I can’t reach

without time and pain.

The man I haven’t learned to be
is patient, and waits for me
to do whatever it takes to come back
to you, a man.

Tentatively titled “To you, a man”

Awesome writing I found today. Check out the author’s blog to see this in its original format; reblogging it removed the paragraph breaks.

Medicine for Money Part 2: How much is $200K/year?

In Part 1 of this series, How much do doctors make?, we saw a wide variety of figures. A career in medicine neither guarantees nor limits you to an income of $200,000 per year, so we’re going to work with that figure as it’s neither excessive nor out of reach.

How much is $200K/year? The short answer is $8000 a month, for a doctor with sizable student loans.

The average debt for graduates of medical school is reported to be between $150,000 and $200,000, depending on the source. Many recent graduates cite much higher numbers, so again, this is a somewhat worthless approximation.

But, if you had education loans of $200,000 paid on a 20-year repayment plan, your monthly payment would be in the neighborhood of $1520 (http://www.finaid.org/calculators/sc…anpayments.cgi). Assuming a debt of $250K, your monthly payment would be around $1900 (http://www.finaid.org/calculators/sc…anpayments.cgi). Hilariously enough, that calculator says:

It is estimated that you will need an annual salary of at least $229,002.00 to be able to afford to repay this loan. This estimate assumes that 10% of your gross monthly income will be devoted to repaying your student loans. This corresponds to a debt-to-income ratio of 1.1. If you use 15% of your gross monthly income to repay the loan, you will need an annual salary of only $152,668.00, but you may experience some financial difficulty.

If your debt is $300K, it suggests you need a salary of $275K to comfortably make payments over 20 years. Let’s just call the monthly payment amount $1600 for a debt amount close to $200K. If you wanted to pay it off in 10 years, you would have to pay $2300 per month.

Assuming you want to save the most you can for retirement, you’ll max out your 401K by putting in $16,500 of your pretax income each year. This will lower your taxable income in this hypothetical from $200K down to $183,500. If you maxed out an IRA each year it would be another $5,000 per year. If you owned your own practice (or another business) there could be different contribution limits and tax implications; we won’t go there in this hypothetical.

Your new pre-tax income is $183,500. The marginal tax bracket for federal income tax on that amount ranges from 18% – 25% depending on whether you file independently or with a spouse (http://www.dinkytown.net/java/TaxMargin.html). Well call it 21% for the sake of easy calculations. Tax burden varies by state, but the average is just under 9% (http://cfo.dc.gov/cfo/frames.asp?doc…fo/09STUDY.pdf), so we’re at a total tax rate of 30%.

0.3 * 183,500 = $55,050 paid in taxes. You’d be left with $128,450, but keep in mind you’ve already put $16K away for retirement.

This comes out to $10,704 per month. If you decided to max out a Roth IRA (instead of the traditional IRA that I mentioned above, but did not include in any calculations) that would require another $417 per month, leaving you with $10,287 per month.

Take out the loan payment of $1600 discussed above, and you have $8687 per month. For the 10-year repayment plan, taking out $2300 drops you down to $7987 per month. Your mileage may vary tremendously here, depending on your regional cost of living and the lifestyle choices you make.

Just for example, if you tried to buy a million-dollar home, with a 30-year mortgage at 5.5%, your monthly payment would be around $5978, leaving you with $2009 per month to pay for cars, gas, groceries, utilities, “saving for your kids’ education,” and whatever other expenses you have. Take the same mortgage terms on a $500,000 house and your payment is about $3000 per month depending on property taxes and home insurance (http://www.bankrate.com/calculators/…alculator.aspx). That could afford you a very comfortable house in many parts of the country, but I wouldn’t expect it to go far in NYC. Either way, you are left with about $5000 per month.

Assuming you’re willing to put $1000 per month toward a car or cars for you and your family (leaving you with $4000/month), you could afford $56,000 worth of vehicle (http://autos.msn.com/loancalc/newloa…nt=120&pmt=290). This could be one fairly nice car, 2 x $23,000 cars, or any other combination. If you’re willing to put $2000/month toward cars (leaving you with $3000/month for everything else), you could afford $108K worth of car. You could also put that extra money into a larger mortgage, so this is well past the point where the breakdown becomes highly individualized.

Basically, making $200K per year with a debt burden of about $200K, after maxing your retirement contributions and making the minimum monthly payment on your loans, you would be left with around $8,000 per month for mortgage/rent and living expenses, investment, or to otherwise allocate as you please. As has already been mentioned, you can live comfortably but this won’t afford you a lavish lifestyle of vacation homes and Lamborghinis.

My dad could most assuredly beat up your dad

When I say he was tall I mean that he was 5’10 and I was 6’1 and nobody knew I was taller. He was barrel-chested—not fat but not in good shape but confusingly strong. In a moment of frustration he could slam his fist down on the table so hard you wondered why it didn’t go crashing through the floor into the basement.

He was not handsome. He had a thick auburn beard which he sometimes trimmed to just a moustache—one that would have looked ridiculous on somebody else, but somehow made him more of an icon and less of a mortal. When he lost his moustache to chemo was when I knew he was going to die. The gravity of the situation before that point was lost on me. The missing moustache got me to pull my head out of the sand.

Medicine for Money Part 1: how much do doctors make?

It depends whom you ask. It also depends on choice of specialty, practice modality (private practice vs. academic vs. other options and combinations), and whether you practice in a rural or an urban area. We’ll start with some data from an MGMA survey…I would link it but the link I had a year ago is now expired. The sample size was over 60,000 but I don’t remember anything else about the survey. This bit just compares median incomes for each specialty in “academic” practices vs. “other” practices.

All Primary Care:————$158,218———$191,401
Family Practice—————$164,469———$183,999
Internal Medicine————$161,916———$197,080
All Specialists——————$235,587———$325,916
Cardiology: Invasive———-$295,050———$481,878
Cardiology: Noninvasive——$240,781———$421,377
Emergency Medicine———-$223,385———$262,475
Endocrinology—————–$157,000———not reported
Infectious Disease———–$159,502——-not reported
Maternal/Fetal Medicine—–$296,933——-not reported
Neonatal Medicine————-$208,762——-not reported
Nephrology———————-$183,093——-not reported
Orthopedic Surgery————$400,335———$496,264
Pathology: Anatomic———–$214,557——-not reported
Pulmonary Medicine———–$183,475———$288,279
Radiology: Diagnostic———$350,000———$478,824
Rheumatology—————–$166,767——-not reported
Surgery: General—————–$280,121———$336,084
Urology—————————-not reported———$390,678

All Nonphysician Providers————————-$94,441
Nurse Practitioner————————————$85,706
Physician’s Assistant (Surgical)—————–$101,000
Physician’s Assistant (Primary Care)————$89,021

All of the pretty graphs below are from a physician income survey done by Medscape. You can still go directly to their site to check out the methodology, etc. All of this should serve to get the point across that physicians have a tremendous range of incomes, and that there is still overlap between physician income brackets and other health professions.

Pretty Graphs From Medscape

I had heard that physicians in smaller towns earn more. The explanation I got from a family medicine resident was that, at least for salaried physicians, the pay had to be better in more rural areas as an incentive to go somewhere you wouldn’t want to live elsewhere. Regardless of the reason:

Regrading hours worked per week, and breakdown between patient care and other activities:

There’s a lot more info in the study about other compensation factors. You’ll need a Medscape account to view it, and if you don’t already have one I highly suggest you check it out ASAP. It is a great resource.

My narcissism is bipolar

What the hell is blogging, anyway? I mean aside from the obvious cases where people are either talented writers, have something useful to say, are hilarious, or some combination of all three.

What about the other 99.9% of us who brazenly post the written equivalent of our verbal diarrhea on the interweb? What are we doing? What are we thinking?

Jeffrey Parks wrote an excellent post about this, especially relevant to medical, or medicalish, blogs that talk about patient encounters. For a minute he looked like he was going to throw in the towel on his blog. When it was Jeff (who didn’t, and still doesn’t, know me), I was sitting there thinking, “damnit man! You can’t stop writing!” I sent him an email saying “I understand how you’re feeling (and basically, you’d be a major turd if you didn’t feel this way), but you probably shouldn’t stop writing. Your blog is great, people love it, and you’re getting new readers every day. Unless you’re at a point where you’re going to start producing lousy, uninspired content, you should keep writing.”

They guy even wrote me back, thanking me for my “well-honed thoughts.” A truly awesome blogger. But what about the rest of us? What about the people who write about every boring thing they do on a given day as if the whole world were starving for their opinions and melodrama? Should we keep writing? God, why would we?

I started this blog thinking I had something to say that people might enjoy reading. That was arrogant.

I stayed away from this blog for months, thinking I should give up writing because how could I ever have anything to say that would be worth reading? That was insecure.

Insecurity and arrogance are both forms of narcissism. Blog for your ego, avoid blogging for your ego…you’d think you end up at the same place at the end of the day. But you don’t.

For one thing, people read this stuff. Whoever you are reading this, thanks for stopping by! I don’t know who you are, but you show up in my stats panel. And I genuinely appreciate your taking the time to read this drivel, whether you think it’s good or you think it’s crap. If you ever feel inclined to say something, please comment. It makes the blogging experience better for me, you, and other readers.

Secondly, inaction, or some emotional/paralytic avoidance of action, has completely different results than action, even if the motives for both behaviors are essentially the same. I could avoid blogging to preserve my ego, or blog in an attempt to feed my ego. Action takes courage, and cultivating courage is a good thing.

If you’ve thought about blogging, just do it. It doesn’t matter what you write (your best posts according to readers won’t be what you expected anyway). It doesn’t have to be perfect (and it won’t be). All it takes is a little chutzpah. Write for yourself. Develop a healthy indifference to what your potential critics might say. Come to terms with the inevitable: some of your writing will be crap.

Some of it could be good, but you’ll never know if you don’t write anything. The only thing you learn by not writing is that you didn’t have the balls. At least, that’s what I learned. And then I hit blog puberty.