Brandon Petree, D.O. @_halfnormal

The biggest value add for most physicians is tax planning, cash flow strategy, and building a plan that actually works together Then, as wealth grows, the focus can shift toward diversification beyond just public markets The goal isn’t always higher returns Sometimes the goal is more stability, more optionality, and less dependence on what the market does tomorrow

Salty About Medical Education: Bryan Carmody on What the System Gets Wrong Pediatric nephrologist, medical educator, and "Sheriff of Sodium" Dr. Bryan Carmody joins Drs. Koka and DiGiorgio to challenge some of the most persistent narratives in American medicine. From the AAMC's physician shortage projections — which Carmody argues serve the interests of medical schools more than patients — to the mechanics of the residency match, application fever, ERAS pricing, and the largely unrealized promise of pass/fail Step 1, Carmody brings his characteristic data-driven skepticism to each topic. The conversation closes on what's arguably the most consequential question: what should residency selection actually be optimizing for, and why are program directors squandering the leverage they have to drive real change in undergraduate medical education? Chapter Markers 00:00 Introduction 02:02 How Carmody became the Sheriff of Sodium 05:03 Why people keep getting medical education wrong 07:46 The physician shortage: skepticism and incentives 09:03 Rebutting the AAMC's 86,000-doctor shortfall projection 11:17 Supply-induced demand and the limits of training more physicians 17:06 Third-party payment, discretionary care, and the real drivers of access problems 20:27 Who benefits from the physician shortage narrative 26:36 GME funding: $45 billion, hospital incentives, and the case for or against it 30:01 The Match explained: history, origins, and why it exists 35:22 ERAS, NRMP, and the financial architecture of residency applications 40:21 Preference signaling: what it is and why it's quietly capping application volume 44:12 Is the Match a monopoly? The congressional report and the anti-competitive argument 51:18 Step 1 pass/fail: the promise, the timing, and why it stalled 55:43 What actually changed — and what didn't — after 2022 58:00 What program directors should be demanding — and aren't 01:08:12 What we're not doing well in resident selection 01:11:59 Using selection systems to elevate the quality of every applicant, win or lose 01:18:45 The neurosurgery combine Co-Host Handles @anish_koka and @DrDiGiorgio Show Handle @drsloungepod Subscribe Links Spotify: open.spotify.com/show/44vw8eirs… Apple Podcasts: podcasts.apple.com/us/podcast/the… YouTube: youtube.com/@TheDoctorsLou…

Your financial success hinges on your A-team. This includes a planner, CPA, estate attorney, and even a money psychiatrist. Don't shy away from discussing finances—build your support system for short-term or long-term goals. #FinancialPlanning #WealthBuilding

If mean systemic pressure (Pms) is a zero-flow construct – and therefore does not literally exist during flow – then it cannot be the “driving pressure” for venous return. Does that mean Guyton was wrong? Not exactly. But he has been badly misunderstood. ⬇️

Ashley Miller @icmteaching

3 weeks ago

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The point of tax planning is to lower your lifetime tax liability, action taken based upon the following paramenters: 1) legal and ethical 2) relatively low hassle, low stress 3) supportive of your preferred mode of life

George Tolis: TAVR, Broken Training, and What's Really Wrong With Cardiac Surgery. Dr. George Tolis, section chief of coronary and general cardiac surgery at Brigham and Women's Hospital, joins Drs. Koka and DiGiorgio for a wide-ranging conversation on the state of cardiac surgery. He makes the case that TAVR — while genuinely transformative for the right patient — is being systematically applied too broadly, driven by industry incentive and the erosion of meaningful surgical consent. He discusses his collaboration with John Ioannidis that found no statistically significant mortality benefit for any new cardiac surgery technique introduced over the past 35 years, the paper's rejection by every major surgical journal, and what he paid out of pocket to make it open access. The conversation moves to the collapse of surgical training — fragmented pathways, work hour restrictions that leave residents unprepared for attending life, an academic promotion system that ignores teaching, and a culture that routes incompetent trainees around rather than out — and closes with a brief on Vasily Kolesov, the Soviet surgeon from Leningrad who performed the world's first documented coronary bypass years before Favaloro, and whose work was buried by the Cold War. Chapter Markers 00:00 Introduction 01:02 Air-cooled VWs, concert piano, and how Dr. Tolis got here 02:40 TAVR: genuine breakthrough or being abused? 08:02 Finding the TAVR threshold — and why informed consent is the real problem 11:46 Collaborating with John Ioannidis: no mortality benefit for 35 years of new techniques 20:02 Why the major surgical journals wouldn't touch the paper 21:52 Minimally invasive surgery: minimal access vs. minimally invasive 26:24 When do CABG survival curves diverge — and what does it mean? 30:05 Surgeons signing off on TAVRs in young patients 33:51 Health system economics and the heart team dynamic 37:50 How to actually pick a good surgeon (ask the scrub nurses) 40:36 Cardiac surgery training: the three pathways problem 44:04 Work hour restrictions and the residency simulation gap 51:16 General surgery is like MTV — they don't operate anymore 53:21 A resident who finished training without ever applying a cross-clamp 56:34 How to evaluate if a program actually trains 59:27 Academic promotion has nothing to do with teaching 01:01:33 Dr. Tolis's resident outcomes database and three papers nobody cared about 01:05:32 The training timeline: finishing at 49, no runway left 01:07:08 One-size-fits-all RRC rules for cardiac surgery and psychiatry 01:09:16 Cardiac surgery as a disposition, not a therapy 01:12:24 When ECMO becomes the final common path 01:13:38 How you become nationally recognized without being a good surgeon 01:17:16 Vasily Kolesov: the Soviet surgeon who did the first bypass Co-Host Handles @anish_koka and @drdigiorgio Show Handle @drsloungepod Subscribe Links Spotify: open.spotify.com/show/44vw8eirs… Apple Podcasts: podcasts.apple.com/us/podcast/the… YouTube: youtube.com/@TheDoctorsLou…

Most trainees think they’re “behind” because they haven’t started investing yet But when your future paycheck is $20k+ per month, your biggest asset right now isn’t your Roth IRA It’s your future income Learn the basics, avoid bad debt, and build good habits From today's new episode:

Medical students think being a cardiac surgeon means waking up, going to the OR, doing something incredible, and going home. That couldn't be further from the truth. And we're not correcting them. Three different pathways to become a cardiac surgeon. 5-2. 4-3. I-6. Programs change their pathway depending on the year. Depending on who came back from the lab. "There's no other field like this. If you want to become a pilot, there is a path. With cardiac surgery, there are three different paths — and programs change them depending on the year." And the work hour restrictions meant to protect residents? "I'm convinced they hurt the residents." Residency is supposed to be a simulation of the rest of your life. We're not giving them that simulation. We're giving them a highlight reel. And then sending them out to practice.

As of today, what happened to me now should never happen to another physician in training. Everything has changed. Here’s the story… I got denied disability insurance when I was a 4th year med student. Tremor and ADHD on my chart. I am now permanently uninsurable, and if I lost my income it would be a massive problem for my family. This happened because an insurance agent talked me into a fully underwritten disability policy as a 4th year med student. He didn’t have access to a GSI — a guaranteed standard issue policy that doesn’t dig into your medical history — so he never brought it up. He couldn’t make money on it. The underwriter saw an essential tremor and a history of ADHD. I got denied. I’m permanently uninsurable to this day. A catastrophic financial mistake before I’d earned a single attending paycheck. Turns out I’m one of the ~50% of doctors who need a GSI. And that group is bigger than you’d think — treatment for anxiety or depression, a BMI over 30, hypertension, sleep apnea, an old ACL repair from college. Any of these (and many others) can get you denied. My mistake is the entire reason Money Meets Medicine Disability has always existed. To make sure what happened to me doesn’t happen to any residents who come across my work. And now we can essentially guarantee it doesn’t happen to anyone else. Here’s the news: MMM Disability is one over very few agencies in the country that now has access to a brand-new national GSI offer available to every resident and fellow in the country. It’s an individually owned, own-occupation policy that’s yours to keep after training. Until today, getting a GSI meant hoping you trained somewhere a carrier had made one available — and these aren’t offered by or associated with your program, which is why most programs don’t even know they exist. If your hospital didn’t have one, you were stuck. Not anymore. As long as you haven’t had an adverse decision — a denial, rating, or exclusion — in the last 2 years, we can essentially guarantee you coverage, no matter where you train. So residents 🚨 don’t let an agent without GSI access run your paperwork. That’s the exact mistake that cost me my insurability. If you want to see your options (including the GSI all residents now have available), we would be honored to help you at MMM DI.

Time is on your side as a physician You don’t need to stress about having everything perfect the second you finish training - Build some cash reserves - Get breathing room - Then crank up retirement savings From tomorrow's new episode of Physician Cents

One of the most underrated financial goals during training: Protecting your mental health Not every dollar has to go toward investing Sometimes the best financial move is creating breathing room, reducing stress, and giving yourself confidence

A starting Apple Genius Bar tech in San Francisco clears ~$30/hr. A second-year general surgery resident down the street clears ~$17/hr. The surgeon has $300K in debt and 80-hour weeks. The Genius Bar tech doesn't. Tell me again which job is picked for prestige.

🚨 16 years after TEVAR's approval in Japan (2009), the bill is coming due. Our center's data (2003–2025, n=8,690): Stent-graft explantations are surging. → 32–35 cases/year since 2022. Post-approval trend: +2.3/year (p<0.001) 🔴 Paraplegia: 4.1% vs 1.0% — 4× higher (p=0.003) 🔴 In-hospital mortality: 6.4% vs 3.6% — 1.8× 🔴 OR time: 386 vs 307 min (p<0.001) Late TEVAR complications start emerging at ~5 years. A wave of salvage surgery hits at ~15 years. TEVAR is not a panacea. Patient selection is everything. #AorticSurgery #TEVAR #EVAR #Aorta

Calling all surgeons working in heart and lung transplant: Submit your research for the chance to present to your peers at #MechSummit2026 in October. Don't pass up this opportunity to share your work: events.aats.org/mechanical-26/… Deadline: June 29

When physicians compare W-2 and 1099 income, the biggest mistake is focusing only on the headline pay. A better framework is to ask: - Who is paying the payroll taxes? - Who is covering health insurance and malpractice? - What retirement plan opportunities exist in each setup? - What deductions are actually available? - How much extra complexity are you taking on? Higher gross pay and *possible* increased benefits of the 1099 realm does not automatically mean a better financial outcome, let alone a better life outcome. I’ll be unpacking this in next Wednesday’s episode of A Good Problem to Have.

How best to treat a critically ill pt w/ agitated delirium who's not mech ventilated. We are seeing more of these pts in our practice. They can be difficult to treat. In this episode, we discuss the 4D trial & some evidence on Rx strategies for these pts. icuedandtoddcast.buzzsprout.com/2116359/episod…

Why Smart Docs Still Stress About Money (Even When They're Set), Ep #28 😵 Physicians assume that once their income stabilizes and their savings plans are in place, they will have peace of mind. But what if that peace never shows up? Now live ➡ physiciancents.com/links

New Attendings: Let’s Tackle Debt, Emergencies, and Taking Vacations, Ep #6 🩺 Why you need to take a vacation [4:33] 🩺 Pay off high-interest debt quickly [10:47] 🩺 Build an emergency fund [18:51] 🩺 What we’re covering in Part 2 [23:05] Now Live ➡ physiciancents.com/links

🏡 Is a Physician Mortgage Worth It? Ep #12 𝐖𝐞 𝐜𝐨𝐯𝐞𝐫 (𝐚𝐧𝐝 𝐦𝐨𝐫𝐞!): 💎 Is a physician mortgage a trap? 💎 Conventional vs. physician mortgage 💎 The origination of physician mortgages Now live 🎉 𝐖𝐚𝐭𝐜𝐡/𝐋𝐢𝐬𝐭𝐞𝐧 𝐇𝐞𝐫𝐞 ⬇ = physiciancents.com/links

#SaturdayMorning☕: The WealthKeel Weekly 4/30 go.wealthkeel.com/WKW43026 🚩2026 Changes to Student Loans @Kiplinger ⚖️Wealth, Millionaire Tax Push Spreads to More States @CNBC ⏸️1 in 2 AI Medical Responses Flagged As Problematic In New Study @mindbodygreen