Fidelity TLH Question

[PedsCCM]

Did y’all decide to skip the airstream dream?

[PedsCCM]

I would also say no. But I work in a healthcare system that explicitly forbids this...

[PedsCCM]

Wow. Y’all are going through a lot. It might help if you could give us an idea of what kind of savings rate you’ve had the last couple years and which...

[PedsCCM]

Hard case and impossible to judge without knowing the medical records. Opiate tolerance often leads to escalating doses while in the ICU and palliative...

[PedsCCM]

Surely this is most important in this discussion. You’re probably ok but things will be tighter than they would otherwise be if you don’t buy the...

[PedsCCM]

We have some of this in peds. PICU and NICU “hospitalists” who are gen peds trained and work under intensivists or neos are kinda common. I’ve seen...

[PedsCCM]

Did they agree in writing to your terms?

[PedsCCM]

Our calls are roughly proportional to our FTE

[PedsCCM]

OP I had to chuckle at some of the comments. I completely understand where the constructive criticism is coming from, but this feels a little like a casual...

[PedsCCM]

Our lender had a similar stipulation. We split my paycheck so that the mortgage amount is direct deposited to that account every month with the remainder...

[PedsCCM]

I think the precedent has already been set. See https://en.m.wikipedia.org/wiki/Christopher_Duntsch etc

[PedsCCM]

There have to be lines even in medicine that define adequate practice. It seems reasonable to me that far exceeding that line might lead to criminal liability....

[PedsCCM]

I have no idea if masks work or not to decrease COVID infections. I suspect there's benefit to decreasing viral load - even if it ends up being a small...

[PedsCCM]

Did he recently join twitter?...

[PedsCCM]

They're willing to unionize...

[PedsCCM]

The ombudsman group can be very helpful if you don’t get a more helpful answer soon. https://studentaid.gov/help-center/a.../how-to-contac...

[PedsCCM]

Do you need to buy ETFs? If this worries you, why not exchange for the appropriate mutual funds so both transactions happen at the closing prices and...

[PedsCCM]

I had to create a second EIN. I assume that's common

[PedsCCM]

I ran into a problem this week trying to TLH FSKAX Fidelity Total Market Index Fund. All my tax lots list the average cost basis and when I asked customer...

[PedsCCM]

Renally dose ivermectin?? That’s crazy. You dose it based on the patients shoulder height measured in hands. Here’s a conversion chart I found last...

[PedsCCM]

Well, we're getting killed. Midwest state with overlapping delta and now omicron over the last 4-8 weeks. Delta has crushed us with really sick patients...

[PedsCCM]

We don’t use “shaken baby syndrome” any more. We call the injuries what they are and will write that they’re consistent with abusive head trauma...

[PedsCCM]

Not 100% sure what you're saying, but here's the info on how the CDC counts data but I feel like we're moving the argument a bit. I admitted up front...

[PedsCCM]

Ah, I see how this myth persists. Firstly, only one person may sign to medically certify the death certificate. Who exactly may sign is outlined by state...

[PedsCCM]

Agree with billy. Please spend some time in those areas. Areas of similar size and distance form major cities can be wildly different. Huntsville, AL...

[PedsCCM]

I find “underconfidence” to often be the result once you actually understand something. I view this as more an appropriate level of uncertainty. Now...

[PedsCCM]

The intermediaries I’ve gone through (chosen by the charities) all cost more than a DAF and taxes are more of a pain. I’ve obv just gone to using...

[PedsCCM]

Ah. That’s an interesting way to present the data. I strongly suspect zero vaccines would withstand this type of analysis. The authors analyze the risk...

[PedsCCM]

About 1800 so a little north of 33k are vaccinated...

[PedsCCM]

https://www.indystar.com/story/news/...ed/5702753001/

Largest health system in Indiana had Sept 1 as the deadline for all employees to be...

[PedsCCM]

I'm not prescribing ivermectin outside of some super unusual actual indication but... Is this practice of negotiating with patients/families really that...

[PedsCCM]

This got semi-glossed over but I think it's important. Vaccine mandates are reasonable when 1) attempting to achieve herd immunity or 2) decrease overall...

[PedsCCM]

I don't think so. 67% of Dane county is vaccinated but vaccinated individuals made up only 38.5% of symptomatic cases. Prevention of symptomatic disease...

[PedsCCM]

https://www.dallasnews.com/news/watc...nation-status/...

[PedsCCM]

Immune dysregulation is REALLY complicated. Multiple pieces of this can lead to coagulopathy, endothelial damage, etc. I’m sure low insulin levels and...

[PedsCCM]

Probably yes. Worse obesity is definitely worse but even a BMI 25-29.9 seems to put you at greater risk for hospitalization, mechanical ventilation and...

[PedsCCM]

Critical care is all about distilling hundreds or thousands of patient data points, many will be contradictory, into a coherent plan. I cannot wildly...

[PedsCCM]

I don’t think a recommendation for universal masking is the inevitable conclusion given the data we have. Maybe it’s the correct choice. Maybe not....

[PedsCCM]

Call the police

[PedsCCM]

Are folks seeing hospitals fill up again? We’ve been fortunate so far and our cases in the Midwest haven’t really accelerated...

[PedsCCM]

On Clouds are ridiculously comfortable but only really look ok with scrubs. I have some sort of Allen Edmonds sneakers that are light brown leather and...

[PedsCCM]

Spiritrider

Dogma Band V

[PedsCCM]

Pediatric critical care is a fantastic field. Very little scope creep, kids are fun to work with and largely get better. Maybe more importantly, they...

[PedsCCM]

Super reasonable. I’ve been really surprised at how quick some of the policies have been implemented. I honestly expected them to wait for full approval...

[PedsCCM]

As contentious as this is, I'm sure there will be a lot of lawsuits in general. But why is this different than flu or MMR? Aside from specific, protected...

[PedsCCM]

I don't think we can really confidently say one way or the other just yet but the current data and my observations have been that COVID's overall pediatric...

[PedsCCM]

1. 2018 - about a year out of fellowship
2. Googled something financial - probably what amount of mortgage was reasonable
3. Working through...

[PedsCCM]

May sound that way but it's true. First and last paragraphs normally have code phrases. "I have been asked to write a letter for ____" is totally...

[PedsCCM]

How long has it been since you lived in this area? Things change and even with family still there, you may be surprised at the suburb/township/neighborhood...

[PedsCCM]

Yep totally understand and a really important point. I wish I would have converted this back in March 2020 when the value was around $12k...

[PedsCCM]

Yep and I do like a cigar every now and then ...

[PedsCCM]

You're right. We are debating where the line is. My argument over the last several pages is that vaccines under EUA should not be required but I expect...

[PedsCCM]

ENT Doc Thanks for that explanation! Really helpful and I appreciate your patience. I'm still not certain I agree with your conclusions but it absolutely...

[PedsCCM]

Ok now I'm really confused. In my thinking this fit squarely into the money is fungible category. When I withdraw, my marginal rate won't differ regardless...

[PedsCCM]

I very much appreciate the libertarian basis for this but I think you might be missing some important employer (and patient) interests. Let's take a simple...

[PedsCCM]

I think your calculation assumes no additional savings over the next 25 years and I hope that does not come close to true. Still, this pushes me much...

[PedsCCM]

Great question. I suppose that's what it comes down to. I feel like tax brackets are pretty low right now from an historical perspective and my goal is...

[PedsCCM]

This may end up being an equivocal situation but wanted to double check with the wisdom of the forum. I have an old 401k at a previous employer that is...

[PedsCCM]

I'm a little surprised that employers would make it mandatory before a full FDA approval. After that it seems inevitable. If flu shots are mandatory at...

[PedsCCM]

Couple points that I haven't seen mentioned yet:

• Training during your clinical year(s) is heavily influenced by the residents you work with. Great residents

...

[PedsCCM]

Another vote for rent and get a newer car. I just finished a couple 75+ hour weeks and found myself way behind on yard work with rain in the forecast....

[PedsCCM]

Yes the IRS forms ask for the basis even though capital gains aren’t applied - unless you donate shares that you’ve owned for less than 1 year

[PedsCCM]

I find it super unlikely that you could force this on a conscious kid's face and actually pull anything out. I'd much rather do the heimlich.

[PedsCCM]

What is your fed loan interest rate once the pause ends? What's your plan for dealing with that debt? PSLF or pay off? My vote is to work to eliminate...

[PedsCCM]

BB13 have you looked at the real difference between the two long-term? I used the FV function in Excel.

$58,000 in year 0 compounded at 8%...

[PedsCCM]

With respect, you're conflating medical decisions, even for populations, with political messaging. Phase IV evaluations have utilized similar outcomes...

[PedsCCM]

Tim, phase IV studies have always fallen under the oversight of expert scientists and physicians. If they’re concerned enough to pause the distribution,...

[PedsCCM]

Some states (seems like more in the Midwest) have state-run programs that function as supplemental malpractice insurance. See Indiana’s here https://...

[PedsCCM]

I don't have form 8606 in front of me to double check, but I believe you'll owe taxes at your marginal rate on the $1,000.

[PedsCCM]

That sounds like a great QI/QA process for practice that has clear evidence and isn’t particularly pressured by time....

[PedsCCM]

FSKAX - US Total Stock Market
FTIHX - Total International
FTBFX - Total Bond
FXNAX - Total US Bond...

[PedsCCM]

Yes I'm a little confused about your current roles as well. Are you 50% clinical, 50% admin and looking to drop 10% of clinical? If so would that make...

[PedsCCM]

Thank you for all the incredible work you have done over the last year and for being so willing to share your experience with us. I can still distinctly...

[PedsCCM]

Oh very interesting. I had just assumed it was mostly microthromboembolic hits to lungs, heart, brain and other organs from the awful coagulopathy we...

[PedsCCM]

Same here. I track a lot of stuff just to see where waste (too much money spent on things we don’t truly value) might occur but the actual budget is...

[PedsCCM]

Aw dang I must have gotten lucky bc I did mine the same way and it was accepted...

[PedsCCM]

I'm not sure how rare this is, but I took a loan from my 401k during residency for an unexpected car purchase need. Yes, I know... I was not very knowledgeable...

[PedsCCM]

Yeah since I’m working on PSLF, it’s pretty unreal good...

[PedsCCM]

It’s all on hold aka $0 payments every month for 18 months...

[PedsCCM]

OP, first of all congratulations! You've developed excellent habits and you're working hard toward increasing your net worth. Agree with everyone above...

[PedsCCM]

I love pediatric critical care and would do it for less pay. There are many days where I can't believe they pay me to do the job. I wouldn't ever trade...

[PedsCCM]

Very interesting. I added the old and refi loan insurance and taxes together and entered them as a single loan. No difference. Same deduction, same total...

[PedsCCM]

Hi MK$. Happy to help. I did mine a few weeks ago but hopefully the update will help you. Feel free to private message me if you’re still stuck. ...

[PedsCCM]

My TT return looks like it accounted for this correctly. I used both 1098 forms sent by my mortgage lender and entered them one at a time. I've attached...

[PedsCCM]

I agree with Lordosis. Local banks have a lot more flexibility and can often help in these less common scenarios....

[PedsCCM]

I’m curious. How would you grade the US’s WW2 response? Divided country. Close to half the population wanting to ignore or minimize the dangers. Big...

[PedsCCM]

Doesn't this depend on the confidence state officials have in the supply chain? We've only been at this for 5 weeks. If you have low confidence in the...

[PedsCCM]

Lol I should know better than to answer a specific question in a long post with a short answer. I completely agree that we're likely being overly cautious...

[PedsCCM]

Rotavirus can be transmitted by asymptomatic and previously vaccinated kids. Mumps probably can as well

[PedsCCM]

Same here. Mild arm soreness after first shot but had about 18 hours of shaking chills, myalgia, headache and fatigue after the second. Then back to feeling...

[PedsCCM]

Agree with Cord. Fidelity, Vanguard, Schwab are all basically equivalent. Having some funds in all 3 (across taxable and tax protected) gives me a tiny...

[PedsCCM]

Sarcasm. Get your money in and keep investing when you have more to invest.

[PedsCCM]

There are a lot of plausible if not necessarily likely problems. Which cells take up the mRNA and produce the proteins? They're going to express that...

[PedsCCM]

How do you get rid of individual stocks if you pick winners? I used a small bit of my portfolio to buy Delta, Southwest, Boeing and Airbus in April, May...

[PedsCCM]

I think this makes a lot of sense for many people. I'm just looking at getting vaccinated as volunteering for phase 4. I'm not sure I'd be as willing...

[PedsCCM]

You should listen to this:

https://podcasts.apple.com/us/podcas...=1000494207535

...

[PedsCCM]

Let me ask a dumb question. What's our goal as physicians? Do we primarily want to restrict ultimate ownership of patient care to physicians understanding...

[PedsCCM]

I've flown a couple times in the last 3-4 months and used a standard medical mask without a problem. None of my trips included really busy airports. The...

[PedsCCM]

This argument never made sense to me. You’re proposing that ICU/ER/pathologist physicians are committing insurance fraud so their hospital system can...

[PedsCCM]

The unusual pathophysiology of COVID makes standard ventilation strategies particularly fraught with risk. In classic ARDS, hypoxemia is highly linked...