u/photon11

Resident here, only done 3 epidurals with 2 of them being thoracic and 1 being lumbar. I know n=3 is a very poor sample but these are challenging procedures. At my institution, we often have BMI>35 and I struggle with palpation. My attendings are able to palpate but I struggle with even being able to feel for the spinous process.

I have not had my OB rotation, so I might just need more reps. With all 3 of my epidurals, i was off midline. Once I got back into midline, I was able to get it. Would love epidural advice to someone like me just learning from the start!

Types of programs for Cardiac

Finished cardiac and am def interested in applying! Curious to see peoples thoughts on the Midwest programs and specific recs? Just trying my best to avoid toxic OR’s and staff lol

Anyone know stuff about Cleveland clinic, vandy, Michigan, Indiana, Ky or cinci?

Pros and cons of those organs

CA2 here and wanted to ask the "adults" lol how do you keep up when you're done with training? Specifically, regardless of if you're PP or academics, are you reading journals (if so which ones) and if your're in a supervision model, do you sometimes take the intubations/IV's/A lines from the CRNA's just so you can get your reps in?

For context, 99% sure I want to move closer to home at least for a few years and have already talked to the major anesthesia groups here. There's one big academic hospital and a couple of PP groups but all are mostly supervision. The PP groups allow you to do your own cases if you truly want for the fun of it but mostly its CRNA supervision. The academic hospital is supervising residents and CRNA's as well as teaching responsibilities.

Just curious what resources and stuff everyone is using to stay uptodate and if there's recommended certifications to get?

for reference, CA2 and this is the year we apply for fellowships. Fellowships in anesthesia is not common because everyone is going general. I liked cardiac anesthesia and my rotation even though by the end of the rotation, I was almost dead from fatigue.

As residency goes on, I feel more and more succumbing to the idea that I just want to be done and travel and enjoy the hobbies I put on pause for residency. I don't have a SO but I like to spend time with family.

NGL, part of the allure of cardiac fellowship is the ego satisfaction of being able to do the sickest of the sick in the hospital and just getting to do heart procedures. But as an attending, I don't know how long that interest will continue.

It's almost this sense of guilt I feel as I wanted to do something complex and hard at first but now I kind of want "an easier life" and it seems like im choosing the easy path. Not sure if anyone else has felt this too

For someone interested in cardiac or ICU, what are your recommended programs? For me, culture and Amicable attendings are crucial lol. I feel like in interviews, everyone will say the cardiac surgeons are nice and attendings are great but hard to read through the BS

If cardiac, another minor consideration is room setups and anesthesia techs. I’m at a facility where the rooms aren’t stocked well and the techs aren’t the most helpful. It results in having to come 15-20 minutes earlier which can be tough when the mornings for hearts are 6:30 starts!

Finished hearts and thoracic , and while it was the busiest time of residency, it was very cool and fulfilling.

This is a weird post because I feel like I love the idea of a fellowship more than the reality. It would be awesome to have that echo skill set and have that understanding of physiology, but I absolutely hated the aortic dissections at nights but enjoyed the bread butter CABG’s

My dad who is a physician told me to think about 10-20 years from now if I’m gonna like being called in for heart emergencies which in my opinion are a lot more stressful than a stroke/ex lap or other emergencies…

For lack of a better word, the grueling schedule of waking up to be here by 4:45/4:30 to setup was hard on me too.

I have a lot of respect to cardiac trained people. It takes a special person to go through it. It’s weird of having this guilt in sometimes wanting easier cases and healthier people

I've rotated a few rotations now and cardiac was the most fun. Lines, and being involved in the case was great. However, I'm just 50/50 if I want to pull the trigger and commit.

pros: masters of physiology, lines, very involved in the case

cons: i hate the hour long setup, cardiac surgeons are difficult to deal with, i was told this straight is not a lifestyle specialty.

My personality is I love the train track days and healthy patients. If I were to do a fellowship, I would ideally want 1-2 heart days a week with the rest general for variety.

I got called in and the attending who i was working with said to not go into this for it being a lifestyle specialty.

I've gotten offers already from places near my home for 475/500k as a generalist and I just don't know how much cardiac is worth it in the end.

My attendings have even suggested that I don't even need to do cardiac when I am done. Some people just want that experience...

CA2 and I’m kinda liking cardiac even though I feel exhausted everyday lol

Are there specific programs you all recommend? Something that’s been important for me is having attendings who are patient and willing to teach. And positive OR staff! Not a big research person so would love a clinically oriented program

I feel like with anesthesia, part of your day is simply dictated by who you’re working with

Midwest to eastern area preferred . Once again not totally committed yet but liking this rotation

On my first month of cardiac and am just looking for tips on what to do to to at least look competent. Fortunately I had ICU already so I have an algorithm for A lines and central lines but moreso it’s information overload and the setup.

I’m in a different hospital for my cardiac stuff that’s gone through a lot of turnover and the rooms are horribly stocked. Half the battle is getting there at 4 AM and there being no hotline, no A lines, 5/10 cc syringes missing, some crucial meds not in the cart. I chase down pharmacy and anesthesia techs to help me stock while scrambling to set up all the drips.

I’m also trying to make sense of bypass and what’s happening in the surgery. Another issue is line organization, there are so many drips and I’m struggling to find a way to keep everything untangled…

Because I’m still slow, I’m getting there at 4 and we get relieved at 7 pm. Hopefully as I get faster, I will come in later but I would rather come in early and be prepared than rush. Does anyone have tips on how to succeed on this rotation?

I found my problem - Need help

So month 2 of learning the OTE entry model based on ICT concepts. My mistakes have been confusing internal and external structure. I get confused on what's my swing high and low and the noise in between.

2nd is contradicting timeframes. Lets say daily is bullish but 4 hour is bearish. I get confused on what direction to go.

3rd is how to use multi time frames. I use daily 4 hour and 1 hour or 30 mins. Im drawing supply/demand zones on each one of them and FVG's and am just making a mess.

Now that I know my confusion, I really am looking for help on making a set of rules. Please let me know if I am understanding this correctly. Lets say for example we are bullish on the daily:

Ruleset:

1. Go on daily and confirm higher highs and higher lows. Draw your daily demand zones and if theres any supply zones

2. The 4 hour is going to be our structure. Identify swing lows and swing highs. A low is valid only if it breaks structure! everything in between is internal. Identify demand and supply zones too

3. Draw fibonacci and identify golden area.

4. Go on 1 hour and see if there are any areas of interest - OB, FVG that line up with the golden zone of the fib.

5. Wait for price to come down to that area and confirm MSS to the upside and execute your buy position.

6. 2:1 ratio of reward to risk needed.

Does this make logical sense? Am I using the time zones correctly.

So month 2 of learning the OTE entry model based on ICT concepts. My mistakes have been confusing internal and external structure. I get confused on what's my swing high and low and the noise in between.

2nd is contradicting timeframes. Lets say daily is bullish but 4 hour is bearish. I get confused on what direction to go.

3rd is how to use multi time frames. I use daily 4 hour and 1 hour or 30 mins. Im drawing supply/demand zones on each one of them and FVG's and am just making a mess.

Now that I know my confusion, I really am looking for help on making a set of rules. Please let me know if I am understanding this correctly. Lets say for example we are bullish on the daily:

Ruleset:

1. Go on daily and confirm higher highs and higher lows. Draw your daily demand zones and if theres any supply zones

2. The 4 hour is going to be our structure. Identify swing lows and swing highs. A low is valid only if it breaks structure! everything in between is internal. Identify demand and supply zones too

3. Draw fibonacci and identify golden area.

4. Go on 1 hour and see if there are any areas of interest - OB, FVG that line up with the golden zone of the fib.

5. Wait for price to come down to that area and confirm MSS to the upside and execute your buy position.

6. 2:1 ratio of reward to risk needed.

Does this make logical sense? Am I using the time zones correctly.

So month 2 of learning the OTE entry model based on ICT concepts. My mistakes have been confusing internal and external structure. I get confused on what's my swing high and low and the noise in between.

2nd is contradicting timeframes. Lets say daily is bullish but 4 hour is bearish. I get confused on what direction to go.

3rd is how to use multi time frames. I use daily 4 hour and 1 hour or 30 mins. Im drawing supply/demand zones on each one of them and FVG's and am just making a mess.

Now that I know my confusion, I really am looking for help on making a set of rules. Please let me know if I am understanding this correctly. Lets say for example we are bullish on the daily:

Ruleset:

1. Go on daily and confirm higher highs and higher lows. Draw your daily demand zones and if theres any supply zones

2. The 4 hour is going to be our structure. Identify swing lows and swing highs. A low is valid only if it breaks structure! everything in between is internal. Identify demand and supply zones too

3. Draw fibonacci and identify golden area.

4. Go on 1 hour and see if there are any areas of interest - OB, FVG that line up with the golden zone of the fib.

5. Wait for price to come down to that area and confirm MSS to the upside and execute your buy position.

6. 2:1 ratio of reward to risk needed.

Does this make logical sense? Am I using the time zones correctly.

Made a post yesterday but need to add clarification. I'm in medicine (anesthesia) with 2 years left in training. and then will be a full physician. Since college, I have been investing in VOO only. My plan will be to pay off loans ASAP dedicate 4-5k a month to VOO until retirement.

The reason for this post is i've always loved the idea of stocks and looking at fundamentals to try to find upcoming companies. I did an MBA and loved this portion of my finance/accounting class. My portfolio only has VOO but I would love to add growth/value stocks in the future.

What deters me are the classic stats of no one beats the index funds and the monkey experiment where they went head to head with wall street investors. My initial plan was to invest mostly in VOO 90% with 10% in stocks with the understanding that I could not make anything in that 10%.

Is fundamental analysis and learning more about valuation even a worthwhile skill or am I no better than a monkey lol? I love the idea and want to actually read books and learn more about it; but at the same time if its no better than gambling at the casino, it might not be worth it. I just do not want to spend hours on a skill that has little to no actual return.

Made a post yesterday but need to add clarification. I'm in medicine (anesthesia) with 2 years left in training. and then will be a full physician. Since college, I have been investing in VOO only. My plan will be to pay off loans ASAP dedicate 4-5k a month to VOO until retirement.

The reason for this post is i've always loved the idea of stocks and looking at fundamentals to try to find upcoming companies. I did an MBA and loved this portion of my finance/accounting class. My portfolio only has VOO but I would love to add growth/value stocks in the future.

What deters me are the classic stats of no one beats the index funds and the monkey experiment where they went head to head with wall street investors. My initial plan was to invest mostly in VOO 90% with 10% in stocks with the understanding that I could not make anything in that 10%.

Is fundamental analysis and learning more about valuation even a worthwhile skill or am I no better than a monkey lol? I love the idea and want to actually read books and learn more about it; but at the same time if its no better than gambling at the casino, it might not be worth it. I just do not want to spend hours on a skill that has little to no actual return.

Realistically, why would you want to invest in stocks vs just holding an ETF when the data says stocks underperform in the long run?

So im a medical resident with 2 years left and been investing in VOO since college. I have about 15k in it and plan to invest 3-4k a month of my monthly income once I finish residency until retirement. My main priorrity after finishing residency will be to aggresively pay off student loans.

I know this may be frowned upon here but I also set aside some money as "fun money." Stuff to invest in like up and coming stocks, swing trading forex. Money I am 100% comfortable losing.

At the same time, I don't want to just gamble. For the "fun money," what's the smartest way to go about it? I did an MBA and my favorite part was economics and accounting! I loved going through cash flows/balance statements and analyzing stocks. We did a stock simulator class and it was amazing.

My main question is that with my "fun money," is it a good idea to go invest in healthcare stocks/AI stocks that potentially are growth or value stocks? I won't have the actual capital for a few years but if it is something worth my time, I want to spend my spare time learning fundamental analysis since it's enjoyable to me anyway.

I went down the Forex day trading rabbit hole but It seems more like gambling to me than proven methods

So im a medical resident with 2 years left and been investing in VOO since college. I have about 15k in it and plan to invest 3-4k a month of my monthly income once I finish residency until retirement. My main priorrity after finishing residency will be to aggresively pay off student loans.

I know this may be frowned upon here but I also set aside some money as "fun money." Stuff to invest in like up and coming stocks, swing trading forex. Money I am 100% comfortable losing.

At the same time, I don't want to just gamble. For the "fun money," what's the smartest way to go about it? I did an MBA and my favorite part was economics and accounting! I loved going through cash flows/balance statements and analyzing stocks. We did a stock simulator class and it was amazing.

My main question is that with my "fun money," is it a good idea to go invest in healthcare stocks/AI stocks that potentially are growth or value stocks? I won't have the actual capital for a few years but if it is something worth my time, I want to spend my spare time learning fundamental analysis since it's enjoyable to me anyway.

I went down the Forex day trading rabbit hole but It seems more like gambling to me than proven methods

So im a medical resident with 2 years left and been investing in VOO since college. I have about 15k in it and plan to invest 3-4k a month of my monthly income once I finish residency until retirement. My main priorrity after finishing residency will be to aggresively pay off student loans.

I know this may be frowned upon here but I also set aside some money as "fun money." Stuff to invest in like up and coming stocks, swing trading forex. Money I am 100% comfortable losing.

At the same time, I don't want to just gamble. For the "fun money," what's the smartest way to go about it? I did an MBA and my favorite part was economics and accounting! I loved going through cash flows/balance statements and analyzing stocks. We did a stock simulator class and it was amazing.

My main question is that with my "fun money," is it a good idea to go invest in healthcare stocks/AI stocks that potentially are growth or value stocks? I won't have the actual capital for a few years but if it is something worth my time, I want to spend my spare time learning fundamental analysis since it's enjoyable to me anyway.

I went down the Forex day trading rabbit hole but It seems more like gambling to me than proven methods

Medical resident in anesthesia here. Been investing in VOO since college and have about 15k there! Plan is to just aggressively invest in VOO every month 4-5k until retirement. Running the numbers, that can equate to 5-8mill by 65!

Now my main question is what avenues are there for supplemental income as a physician. I want to support my parents and pay off their mortgage but obviously the game with ETF's is you have to wait.

I feel like the answer is simple which is to work more lol. I'm just in residency halfway done and just don't know the finances of extra call shifts and what they will look like when I am done.

It would be great to be able to have something which doesn't involve exchanging more time for money. I have a "fun money" fund which is a small account for things like crypto or forex but I haven't deeply gotten involved in technical or fundamental analysis. Maybe this is an avenue?

Would just love other people's advice on skills or potential avenues I can be doing to supplement my income when I am done with residency!

So im a medical resident with 2 years left and been investing in VOO since college. I have about 15k in it and plan to invest 3-4k a month of my monthly income once I finish residency until retirement.

I know this may be frowned upon here but I also set aside some money as "fun money." Stuff to invest in like up and coming stocks, swing trading forex. Money I am 100% comfortable losing.

At the same time, I don't want to just gamble. For the "fun money," what's the smartest way to go about it? Would technical analysis be best or trying to flip stocks using methods that Warren Buffet talked about to find undervalued stocks. I think it would be great to find a way to have some supplemental income and at the worst case scenario, I learn fundamental analysis/technical analysis/

I just don't know how to approach the fun money investing and what skillset I should be learning!

For context, I've been backtesting ICT concepts on forex and it still just seems low probability and luck. I just don't know what would be the best market and best method "technical or fundamental" to go about

So im a medical resident with 2 years left and been investing in VOO since college. I have about 15k in it and plan to invest 3-4k a month of my monthly income once I finish residency until retirement.

I know this may be frowned upon here but I also set aside some money as "fun money." Stuff to invest in like up and coming stocks, swing trading forex. Money I am 100% comfortable losing.

At the same time, I don't want to just gamble. For the "fun money," what's the smartest way to go about it? Would technical analysis be best or trying to flip stocks using methods that Warren Buffet talked about to find undervalued stocks. I think it would be great to find a way to have some supplemental income and at the worst case scenario, I learn fundamental analysis.

I just don't know how to approach the fun money investing and what skillset I should be learning! I think I am interested in learning about growth stocks!