Depressed and wanting to change careers

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How is that every single thread somehow routes back to some form of nail and callous care talk. Vision 2030 my ***. Everything circles back to nails and callous care no matter what. @ABFAS @ACFAS @AACPM where you at?

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How is that every single thread somehow routes back to some form of nail and callous care talk. Vision 2030 my ***. Everything circles back to nails and callous care no matter what. @ABFAS @ACFAS @AACPM where you at?
Fixed an achilles tendon today.

Preop right before I was ready to take patient back I asked the patient "are there were any final questions before we go back?"

"Yeah, when were done here remind me to make an appointment so you can clip my toenails every 2 months"

I just sighed and did the case with an empty feeling in my heart.

Luckily prone so I didnt have to stare at those crumblies the whole case as a brutal reminder.
 
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How is that every single thread somehow routes back to some form of nail and callous care talk. Vision 2030 my ***. Everything circles back to nails and callous care no matter what. @ABFAS @ACFAS @AACPM where you at?

It’s literally the most common service (“procedure”) podiatry as a whole provides. Of course any talk about our profession will eventually touch on nails and calluses
 
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At the end of the day calluses and nails are basically the backbone of podiatry. Chaos would ensue if routine care all of a sudden never became covered.

As the mustaches say - it keeps the lights on.

I like routine care. I get to hang with the boys every couple months and chat about what’s going on, how’s the golfing, cool vacations, etc and get paid to do it basically. Much less stressful than sweating in an OR room and worrying about complications
 
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I don’t really hate routine nails and such if they’re non-qualified and I can charge $70 cash for it. Don’t love it, but can’t complain too hard about $70 for 5 minutes of work. It’s when Medicare and insurance pays $20-30 for it that’s a kick in the nuts.
 
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I don’t really hate routine nails and such if they’re non-qualified and I can charge $70 cash for it. Don’t love it, but can’t complain too hard about $70 for 5 minutes of work. It’s when Medicare and insurance pays $20-30 for it that’s a kick in the nuts.
Is that just nails or nails and calluses? ie. the $70.
 
Is that just nails or nails and calluses? ie. the $70.
Either/or, both. Usually just nails. The lesser the better. If it’s a total knuckle busting hack job, I’ll usually dissuade them from coming back.
 
I had a nondiabetic pt show up for nail care recently. Late 50-something female. Not a ton of psych meds, someone told her she simply must see a podiatrist for her nail care.

I was deciding in my head if I was going to try to reach for a Q9 mod or just quote her a cash fee, when I heard myself say, "you don't need a doctor to trim your nails. Go to a nail salon." She was unhappy but it felt right. I'm using that again.
 
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I had a nondiabetic pt show up for nail care recently. Late 50-something female. Not a ton of psych meds, someone told her she simply must see a podiatrist for her nail care.

I was deciding in my head if I was going to try to reach for a Q9 mod or just quote her a cash fee, when I heard myself say, "you don't need a doctor to trim your nails. Go to a nail salon." She was unhappy but it felt right. I'm using that again.
1 star review for you

Bonus comment:
"My previous Dr X always took good care clipping my toenails - and my insurance paid! Now it doesnt? Never returning to this Dr. What a fraud!"
 
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Just a thought , and this isn’t my goal. Why don’t more people pursue a career in nursing homes ? Seems low stress, only have to work a couple days a week and possibly feasible to do other things during the extra time to make money unrelated to podiatry. I figure it’s partly an ego thing but I wanna hear from actual podiatrists
You shall find the answers you seek here.

It is absolutely terrible, depressing, physically exhausting work that uses maybe 2% of the skill and thinking you trained for.
 
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You shall find the answers you seek here.

It is absolutely terrible, depressing, physically exhausting work that uses maybe 2% of the skill and thinking you trained for.
I had a coresident who took a 175-200k mobile podiatry job out of residency supposedly. I wonder how that is working out realistically.
 
How much would you need to get paid to not feel bad about pay out of pocket nail trimming? Charge that amount.

For me it would be $200.
 
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Was with an attending today who made me do a KeryFlex. Couldn't help but laugh, died, threw up and cried inside and thought about @Pronation and the total toe nail replacement.
 
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I had a nondiabetic pt show up for nail care recently. Late 50-something female. Not a ton of psych meds, someone told her she simply must see a podiatrist for her nail care.

I was deciding in my head if I was going to try to reach for a Q9 mod or just quote her a cash fee, when I heard myself say, "you don't need a doctor to trim your nails. Go to a nail salon." She was unhappy but it felt right. I'm using that again.

No shame in saying that. I’ve given up explaining the rules, I offer them anti fungal cream and that’s it. They usually stare at me , obviously expecting the next step but I get up and leave.
 
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I had a coresident who took a 175-200k mobile podiatry job out of residency supposedly. I wonder how that is working out realistically.
Usually with bases that high they are having fun with billing your Medicare number and billing for all sorts of things. Now if it is a percentage only then that is up to the individual provider what to bill for.

There are some who see a high enough volume and who have good enough notes and avoid who also avoid the usual traps of billing for patients not seen or calling everything a nail avulsion that seem to make an entire career this way with a reasonable income....usually near a large city or lots of travel.
 
I would suggest if you guys ever come across patients admitted into hospitals for osteomyelitis due to long nails puncturing into the adjacent skin with infection, then use this opportunity to request a peer to peer talk with the regional medical director of the patient's insurances. For me most of them are on some kinda managed care Medicaid plan with neglected care and probably poor self care as well. And I always request these meetings. I am now authorized 6 visits a year reimbursed at $150 for nails/calluses combined (either or both, doesn't matter if it's 11721 or 11056) for these patients on a particular HMO insurance. Not always successful with all insurances, but definitely worth a try.
 
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I would suggest if you guys ever come across patients admitted into hospitals for osteomyelitis due to long nails puncturing into the adjacent skin with infection, then use this opportunity to request a peer to peer talk with the regional medical director of the patient's insurances. For me most of them are on some kinda managed care Medicaid plan with neglected care and probably poor self care as well. And I always request these meetings. I am now authorized 6 visits a year reimbursed at $150 for nails/calluses combined (either or both, doesn't matter if it's 11721 or 11056) for these patients on a particular HMO insurance. Not always successful with all insurances, but definitely worth a try.
How many days are you placed on hold for a call like that?
 
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How many days are you placed on hold for a call like that?
Actually not bad, someone over there will take down your info and returns the call to set up a meeting. This is all handled by the front desk. I just initiated the request. And then during the actual meeting I just gave them the info of the patient that was seen in the hospital, propose my plan and see what they say. Works great for smaller local IPAs or regional HMOs. I
The exception is Molina. I gave up on them at this point.
 
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I would suggest if you guys ever come across patients admitted into hospitals for osteomyelitis due to long nails puncturing into the adjacent skin with infection, then use this opportunity to request a peer to peer talk with the regional medical director of the patient's insurances. For me most of them are on some kinda managed care Medicaid plan with neglected care and probably poor self care as well. And I always request these meetings. I am now authorized 6 visits a year reimbursed at $150 for nails/calluses combined (either or both, doesn't matter if it's 11721 or 11056) for these patients on a particular HMO insurance. Not always successful with all insurances, but definitely worth a try.

Oh man, just wait until APMA hears about this!
 
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As I enter my PGY3 year I must say that podiatry was the worst choice I've ever made in my life. I am completing a grueling residency. The work is nonstop. I feel surgically competent in some areas and deficient in others. I have looked at jobs and have been in talks with some people and the offers are all below $150k. I have nearly $300,000 of student loans. I completed 4 years of undergrad, 4 years of podiatry school, and now I am finishing a 3 year residency. In total I have went 11 years beyond a standard high school education. All of the time and effort I have put into this career is not worth it. There are others who did not waste all of their "prime" years of their life and their 20's to a profession with no reward. I am called a doctor, but I cut toenails.

This post is not a troll. This post is a cry for help. At what point is this just the sunk cost fallacy? What can I actually do with my life now that I have a degree that will never payback my loans? Cost of living is outrageous right now even in rural areas.
Just an FYI. I started out in 2013 and was barely making 60K/yr....It took me to my 3rd year of practice to reach over 300K/yr. I originally started as an employed doc, was a horrible experience and long-term plan for me. Starting in private practice took work and focus but things worked out and the practice is growing. Our new associate was making over 100K in his first year on a contract that just paid a % of collections. There is plenty of money to be made in our profession. However, the cost of schooling is ridiculous and needs to be addressed.
 
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Just an FYI. I started out in 2013 and was barely making 60K/yr....It took me to my 3rd year of practice to reach over 300K/yr. I originally started as an employed doc, was a horrible experience and long-term plan for me. Starting in private practice took work and focus but things worked out and the practice is growing. Our new associate was making over 100K in his first year on a contract that just paid a % of collections. There is plenty of money to be made in our profession. However, the cost of schooling is ridiculous and needs to be addressed.

So let me get this straight, you’re clearing 300k+ and you’re bragging that you paid your associate less than half of what you make and less than a PA makes?

How podiatric.

Gotta love how saturated podiatry is.
 
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So let me get this straight, you’re clearing 300k+ and you’re bragging that you paid your associate less than half of what you make and less than a PA makes?

How podiatric.

Gotta love how saturated podiatry is.
Where’s the burn center meme/hotline
 
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So let me get this straight, you’re clearing 300k+ and you’re bragging that you paid your associate less than half of what you make and less than a PA makes?

How podiatric.

Gotta love how saturated podiatry is.
Yah saturation is so bad young owners are growing mustaches and not even realizing it and repeating the cycle.
 
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As I enter my PGY3 year I must say that podiatry was the worst choice I've ever made in my life. I am completing a grueling residency. The work is nonstop. I feel surgically competent in some areas and deficient in others. I have looked at jobs and have been in talks with some people and the offers are all below $150k. I have nearly $300,000 of student loans. I completed 4 years of undergrad, 4 years of podiatry school, and now I am finishing a 3 year residency. In total I have went 11 years beyond a standard high school education. All of the time and effort I have put into this career is not worth it. There are others who did not waste all of their "prime" years of their life and their 20's to a profession with no reward. I am called a doctor, but I cut toenails.

This post is not a troll. This post is a cry for help. At what point is this just the sunk cost fallacy? What can I actually do with my life now that I have a degree that will never payback my loans? Cost of living is outrageous right now even in rural areas.

What on earth are you even talking about? Does someone here need to do the math for you on how long it will take to payoff 300k loans on a garbage 100-120k salary, aka “six figures”? Enjoy living a lower middle class lifestyle while making “six figures” after pissing away your youth in podiometric medakul skool and then an unnecessarily long 3 year pod residency. I understand you’re trying to give this person some encouraging words, but don’t blow smoke up their arse. It is what it is.
Why the need to immediately pay off loans? What about the income driven repayment plan? Also every physician is "pissing away" their youth, they know that when they decide to go into medicine. If people want to fully enjoy their 20's then they should have gone into tech. And with all these negative comments, I mean, op is clearly already stressed out. Why not have a more positive attitude and offer actual advice that can actually be utilized by op?
 
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So let me get this straight, you’re clearing 300k+ and you’re bragging that you paid your associate less than half of what you make and less than a PA makes?

How podiatric.

Gotta love how saturated podiatry is.
You just gotta put in your time. It's a rite of passage.
 
Why the need to immediately pay off loans? What about the income driven repayment plan? Also every physician is "pissing away" their youth, they know that when they decide to go into medicine. If people want to fully enjoy their 20's then they should have gone into tech. And with all these negative comments, I mean, op is clearly already stressed out. Why not have a more positive attitude and offer actual advice that can actually be utilized by op?
Welcome to SDN
 
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Why not have a more positive attitude and offer actual advice that can actually be utilized by op?

Many of us here are experienced and talented surgeons, certification debates notwithstanding. An important part of surgery is being a hard nosed realist about your work. Non unions, malunions, infections, hematomas are all what they are, and it is a matter of personal integrity to acknowledge that they really are happening.

That kind of unvarnished honesty translates into other aspects of our professional life. If we can recognize bad things happening to our patients, we have a duty to acknowledge bad things happening in our profession
 
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Non unions, malunions, infections, hematomas are all what they are, and it is a matter of personal integrity to acknowledge that they really are happening.

I will only acknowledge that these are happening because it's the patient's fault and never my own. Even when I'm looking at X-rays and the screw is halfway into the joint I'll be like "Oh no, how did you do this yourself?!" before booking them for a hardware removal.
 
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Why the need to immediately pay off loans? What about the income driven repayment plan? Also every physician is "pissing away" their youth, they know that when they decide to go into medicine. If people want to fully enjoy their 20's then they should have gone into tech. And with all these negative comments, I mean, op is clearly already stressed out. Why not have a more positive attitude and offer actual advice that can actually be utilized by op?

True. I personally don’t get the rush to pay it off ASAP and spend some of the more prime years of our life living on rice and beans for 5-10 years just to do so.

I just accepted that I’m going to do the income based repayment and have the remainder forgiven 25 years from now, if I’m even still alive by then. Also, I anticipate over the next decade or so there’s going to likely be some radical changes in student debt, I’d hate to pay it all off early unnecessarily if 5 years down the road they end up implementing more forgiveness, or change it so interest doesn’t accrue as long as you’re making payments.
 
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Im in the pay it off ASAP camp. Compunding interest doubles the overall cost.
No thanks.
 
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25 years from now, if I’m even still alive by then

Are you also worried about dying from severe lung tissue damage? Have you considered a water spray suppression system?

Here is a link to a highly regarded journal: Fungal Lung
 
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So were back to talking about nails again.
Never use a dremel. Ever. Its so nasty.
 
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Im in the pay it off ASAP camp. Compunding interest doubles the overall cost.
No thanks.
I understand. If I was making 300k I’d probably be singing a different tune, but for anyone making sub 200 while not the wisest financial move, it’s definitely more comfortable to go IDR especially if you have family or other things to spend your money on (or god forbid already tithing a part of your income to a church)
 
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So were back to talking about nails again.
Never use a dremel. Ever. Its so nasty.

I'm sorry that you don't take having a patient's life in your hands seriously but there is no way I would risk having a potential sharp corner result in the death of my patient. Saving lives is an oath I took as a total toenail replacement surgeon, with multiple certifications.
 
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True. I personally don’t get the rush to pay it off ASAP and spend some of the more prime years of our life living on rice and beans for 5-10 years just to do so.

I just accepted that I’m going to do the income based repayment and have the remainder forgiven 25 years from now, if I’m even still alive by then. Also, I anticipate over the next decade or so there’s going to likely be some radical changes in student debt, I’d hate to pay it all off early unnecessarily if 5 years down the road they end up implementing more forgiveness, or change it so interest doesn’t accrue as long as you’re making payments.
Some people just doesn't like to hang onto debt (living with debt) and pay the interests to the banks while the banks build fancier, more expensive buildings. Sallie Mae (insert student loan provider) is an ugly nasty woman. Nobody wants her in the spare bedroom of the house for 25 years. We need her to move the hell out and be financially at peace, debt free. Your way of thinking about debt is "normal". Normal sucks and it's a great way to stay in debt forever, and that's how most Americans live (in some form of consumer debt). And don't depend on the stupid government to take care of your loans. They never will forgive the student loans. It's all political and it will be taxpayers forking it. You took the loans. Pay it off.
 
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Some people just doesn't like to hang onto debt (living with debt) and pay the interests to the banks while the banks build fancier, more expensive buildings. Sallie Mae (insert student loan provider) is an ugly nasty woman. Nobody wants her in the spare bedroom of the house for 25 years. We need her to move the hell out and be financially at peace, debt free. Your way of thinking about debt is "normal". Normal sucks and it's a great way to stay in debt forever, and that's how most Americans live (in some form of consumer debt). And don't depend on the stupid government to take care of your loans. They never will forgive the student loans. It's all political and it will be taxpayers forking it. You took the loans. Pay it off.
I dont know PSLF works. My podiatry loans are gone because I went from my residency straight into non profit rural hospitals for 9 years and I still work for a nonprofit hospital today. I still have a small amount of private loans that I plan to have paid off. Thanks George W. Bush for signing PSLF and Thanks Biden for tweaking it.
 
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I think we can say the following about podiatry:
It’s a procedure driven specialty and every CPT is worth something. There is definitely money to be made.

Even with our saturation you can still do well and be happy if you accept the fact that most of DPMs are just outpatient based. You should be able to earn a good living just doing DMEs, injections and some routine care all day.

Don’t be a hero. Do not touch that trimal malunion with syndesmotic instability and valgus deformity. Don’t try to reconstruct a Charcot just using internal fixation. Never get too excited when Ortho gives you a diabetic Pilon. You remove all these stressors then podiatry is a 9-5 outpatient lifestyle specialty.

The problem is the money is not evenly distributed. The pp owners maybe millionaires while the associates are just making entry level six figures.
For every practice owner driving a Maserati, there are 10 associates holding on to their 15 yo Honda Civics that just got the catalytic converters stolen in this crazy society.

The solution? None. We have not reached a tipping point yet. The plot is building up though. And when it collapses it will be awesome.
 
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True. I personally don’t get the rush to pay it off ASAP and spend some of the more prime years of our life living on rice and beans for 5-10 years just to do so.

I just accepted that I’m going to do the income based repayment and have the remainder forgiven 25 years from now, if I’m even still alive by then. Also, I anticipate over the next decade or so there’s going to likely be some radical changes in student debt, I’d hate to pay it all off early unnecessarily if 5 years down the road they end up implementing more forgiveness, or change it so interest doesn’t accrue as long as you’re making payments.
This is the way. Compounding interest doesn't matter when it's forgiven after 20-25 years. Sure there may be a tax bomb at the end, but even with the tax bomb repayment is probably less than total loan repayment.
You took the loans. Pay it off.
OK boomer. Tell that to everyone who took PPP loans and never paid back a dime.
 
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This is the way. Compounding interest doesn't matter when it's forgiven after 20-25 years. Sure there may be a tax bomb at the end, but even with the tax bomb repayment is probably less than total loan repayment.

OK boomer. Tell that to everyone who took PPP loans and never paid back a dime.
Yep. It can be the difference between paying $700 a month or $3,000 a month which is massive in terms of quality of living.

I would rather instead of forgiveness for x amount they honestly just make it so interest doesn’t accrue as long as you keep up monthly payments on an IDR plan. Everybody wins. You still pay off your debt, and can do it in a manageable and realistic way without having to live like a fast food worker as a doctor. Though I guess that’s a bad example as Panda Express pays 6 figs now
 
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Yep. It can be the difference between paying $700 a month or $3,000 a month which is massive in terms of quality of living.
Precisely. I don't understand the "eat rice and beans for 5-10 years as an attending" mindset. Who becomes a doctor to struggle through school & residency for 10 years only to be rewarded by 5-10 years of eating rice and beans? Not I. And as you alluded, delayed gratification only works if you know you're going to be alive, happy, and healthy long after you've delayed that gratification.
I would rather instead of forgiveness for x amount they honestly just make it so interest doesn’t accrue as long as you keep up monthly payments on an IDR plan. Everybody wins.
The banks do not win on this one. And as we all know banks >> people in this wonderful captialistic society. Policymakers would rather banks get full payout through decades of compounding interest at the eventual expense of taxpayers than to just set a reasonable stable interest to begin with.
 
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Precisely. I don't understand the "eat rice and beans for 5-10 years as an attending" mindset. Who becomes a doctor to struggle through school & residency for 10 years only to be rewarded by 5-10 years of eating rice and beans? Not I. And as you alluded, delayed gratification only works if you know you're going to be alive, happy, and healthy long after you've delayed that gratification.

The banks do not win on this one. And as we all know banks >> people in this wonderful captialistic society. Policymakers would rather banks get full payout through decades of compounding interest at the eventual expense of taxpayers than to just set a reasonable stable interest to begin with.

Yeah exactly. I’d rather have a fun life in my 30s than a fun life when I’m 45. I think more new grads need to know that you can actually live like an attending as long as you go the IDR route. The only pods I’ve seen pay off their loans within 5-10 years of residency have married spouses with good jobs who contribute to the net household income to offset those massive loan payments.

Assuming you don’t work a 300k job, it’s either bottom feeder bean life, IDR pimpin, or marry rich.
 
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Precisely. I don't understand the "eat rice and beans for 5-10 years as an attending" mindset. Who becomes a doctor to struggle through school & residency for 10 years only to be rewarded by 5-10 years of eating rice and beans? Not I. And as you alluded, delayed gratification only works if you know you're going to be alive, happy, and healthy long after you've delayed that gratification.

The banks do not win on this one. And as we all know banks >> people in this wonderful captialistic society. Policymakers would rather banks get full payout through decades of compounding interest at the eventual expense of taxpayers than to just set a reasonable stable interest to begin with.
Well if podiatry wasn't podiatry you would only have to live like a resident for 1 to 2 years like WCI talks about. That isn't that hard. 5 to 10 would suck. Another reason why podiatry is a terrible return on your investment.
 
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Not for a majority of DPMs. You don’t qualify as an associate in a podiatry group, despite the fact that you are compensated like an employee of a non profit organization…
Yes it’s a benefit of going rural… 🤔. Good pay and eligibility for PSLF. Your marriage might not survive but you could be debt free
 
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Yes it’s a benefit of going rural… 🤔. Good pay and eligibility for PSLF. Your marriage might not survive but you could be debt free
Good point. Thought about working for Indian Health Services before. Then watched Yellowstone. Nah.
 
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Good point. Thought about working for Indian Health Services before. Then watched Yellowstone. Nah.
I did a lot of work on IHS patients, they are good people...its the bureaocracy that should worry you. Think the VA but worse and underfunded.
 
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