Pembirdie

Author: saragerman89

  • What price, a life?

    There’s the story about a guy who sees all these dying starfish washed up on a beach (why starfish? Probably because the name is cool) and sees a kid pick up a starfish and throw it in the water. “There’s no way you are making a difference,” the guy tells the kid, because he’s apparently a jerk. And the kid says that may be true but he made a difference for that one starfish. Inspirational lesson learned.

    Honestly, if you are in healthcare you kind of have to agree with the kid, because if you take a more utilitarian view you’d start advocating for all the dollars spent in the hospital to instead be allocated for buying mosquito nets and antiretrovirals and then you wouldn’t have a job. But the more I think about the story I do kind of feel what the kid was doing was pointless. I am that jerk sometimes.

    However, despite the temptation and my cynical tendencies, I am not a utilitarian. So I do have to say that throwing a single starfish back into the ocean makes a difference. (Maybe. Maybe the starfish was already dead. How can you tell? Obviously no experience with starfish here.) Using thousands of dollars of medical care to save the life of someone I’m caring for in the hospital is worthwhile, even when those thousands of dollars could theoretically save many more people in some underprivileged place. But… at some point, does it become too much?

    I struggle the most with this not when a saving treatment is really expensive, but when the “saving treatment” seems unlikely to be helpful or that it will have limited benefit. Active ninety-plus year olds choosing they want to be Full Code, when surviving a code situation would likely mean increased debility, dependence, hospitalization and an end to the healthy lifespan: that is hard for me. People with uncontrolled diabetes, end stage renal disease, and terrible blood vessels who cannot care for themselves who choose to go on dialysis for hours three days a week: that is hard for me. Cancer patients who have growing metastatic disease with chemo treatments that are sending them into the hospital every month with essentially zero chance of cure: that is hard for me.

    It is a good thing I am not in charge of medical gatekeeping, because I am not God. I do not know what the outcomes of our medical interventions will be, and when I guess I am more than often wrong. I do not know the value of a ninety-two year old living six more months, or a dialysis patient living three more years in a nursing home, or a cancer patient living an extra few weeks in the hospital. Where there’s life, there’s hope, at least from a spiritual perspective.

    What I worry about, however, is that we do not have endless resources. Sometimes I joke that it feels like practicing in the hospital is playing with fun money, because I can pretty much order any test I want and have it done, unlike in the outpatient setting. But the truth is, someone is paying for it. I worry that the people paying for it are maybe three years old right now. Will people in the future have more limited access to healthcare because we’ve already spent the money that was supposed to be for them? Will their insurance costs soar because the insurance companies are passing on their costs to the patients? It’s already happening.

    Thinking about these things leaves me frustrated, because I don’t have a solution. Maybe my personal solution is I need to be less judgmental about other people’s value judgments regarding their healthcare.

    SDG

  • Book review: The Children Money Can Buy

    The Children Money Can Buy: Stories from the frontlines of foster care and adoption by Anne Moody.

    Ms. Moody is a social worker who got her first job working as a case worker for foster children in Michigan. The job eventually become to mentally and emotionally taxing and when her family moved to Seattle, she began working for an adoption agency. She writes about her experiences with foster care and adoption, mostly focusing on adoption. Ms. Moody writes with a clearly positive slant toward adoption while at the same acknowledging its problems and advocating for best practices with realism that comes from experience.

    Her view on foster care is bleak. She acknowledges her experience dates from decades ago, but I suspect things haven’t gotten much better. Ms. Moody believes there is too much emphasis on reuniting the family, particularly when it seems clear that the parents are not making good faith efforts to correct their deficiencies and their children bear the burdens of the dysfunctional foster care system.

    On the other hand, she has a very positive view of adoption, and certainly comes at it more from the perspective of the parents. It was interesting to read this book in conjunction with “You Should Be Grateful” by Angela Tucker. They both discuss the fact that a percentage of adoptions “fail.” Ms. Moody emphasizes this is a small number, while Ms. Tucker feels the number is too large to be acceptable.

    Both are advocates for open adoptions. Ms. Moody believes this benefits everyone, birth parents, adoptive parents, and adoptees. She also feels very strongly that birth mothers must receive counseling on all the available options for them, including parenting. She acknowledges and strongly condemns coercive tactics by adoption agencies and consultants that pressure and guilt people into relinquishing their babies, and also discusses the ethical dilemma of couples essentially paying a woman for her baby. (Apparently in some states, like Washington, laws make the blatant exchange of money for baby less likely.)

    While Ms. Moody has worked with birth mothers (and fathers) at her adoption agency, her insight into their perspectives is limited. Her book also lacks the adoptee perspective. She and her husband adopted a daughter named Jocelyn from Korea, and while she talks about her and even includes one of her other daughter’s perspectives, we don’t hear directly from Jocelyn, or other adoptees. While acknowledging unique challenges that adoptees may face, Ms. Moody feels that overall problems are exaggerated, and it’s hard for me to know what to think about that.

    Overall, I felt this was a helpful book to read. I read it after “You Should Be Grateful“ and initially it came off as perhaps a bit too optimistic about adoption, but as I continued through it it felt more balanced.

    Of note, Ms. Moody has a positive view toward adoptions by gay couples, although I can’t say much about it as I skipped that chapter.

    SGD

  • Book review: “You Should Be Grateful”

    “You Should Be Grateful”: Stories of race, identify, and transracial adoption, by Angela Tucker.

    I came across Angela Tucker while googling adoption. I listened to one of her podcasts. She comes across as a gracious, well-spoken, intelligent and empathetic woman.

    You Should Be Grateful tells part of her adoptee story and her perspective from working at an adoption agency and mentoring adoptees, as well as incorporating research and philosophies related to adoption and transracial adoption in particular. (Transracial adoption referring to people adopting a child of a different race/ethnicity/skin color.) Ms. Tucker is a Black woman who was adopted as a young child by parents who also adopted multiple other children of various ethnicities and raised her in a loving, supportive environment. Despite having a closed adoption, Ms. Tucker was eventually able to track down and reconnect with her birth parents, relatives and half-siblings.

    Although I think it’s becoming more common now, historically there are more narratives from adoptive parents than adopted children, and while no doubt every adopted child’s story is different, reading about an adoptee’s experience is valuable. Ms. Tucker writes generously and honestly, both about the excellent upbringing her adopted parents provided her and her irrepressible longing to know her birth mother, as well as the complicated emotions that were part and parcel of finding and connecting with her birth family.

    In the book, Ms. Tucker introduces three words/concepts that were new to me:

    1. Hiraeth (here-eyeth): A deep yearning for a home that never was. Angela makes the case that all adoptees have some degree of hiraeth.
    2. Exulansis: The tendency to give up trying to talk about an experience because people are unable to relate to it. (A neologism coined by John Koenig in The Dictionary of Obscure Sorrows.)
    3. Sondersphere: A realm where every person in an adoptee’s life has a place–where birth parents and adoptive parents and biological aunties and foster parents and adoptive cousins all exist together. (Coined by Ms. Tucker, based on a word coined by John Koenig.)

    Another concept she discussed was that of a “ghost kingdom,” essentially what someone imagines their life would have been like if an event (such as adoption) had not happened.

    Ms. Tucker is not anti-adoption, and she is not anti-transracial adoption although she raises a lot of concerns. However, as the word “sondersphere” suggests, she is strongly in favor of adoptions being widely open. While she understands that adoptive parents have a responsibility to care for their child’s wellbeing and that birth parents may very well not have the capacity to be a healthy presence at times, she argues that honest information sharing is the best policy. In her own experience, she found that connecting with her birth family actually strengthened the (already strong) bonds she had with her adopted family. I could see adoptive families having concerns that if their bond with their adopted child is not very strong, bringing in the birth family could weaken them further. At the same time, those concerns are centered on the adoptive parents, rather than on the child.

    Ms. Tucker also touches on the microaggressions that transracial adoptees may face, and helpful or unhelpful ways their adoptive parents interact with their race. She believes it is imperative for transracial adoptees to interact with children and adults who share their birth culture so adoptees can connect with that aspect of themselves, rather than ignoring it’s existence. Interestingly, she includes a discussion of how assigning food-labels to a racial characteristic (“chocolate” skin, “almond-shaped” eyes, “oreo”) carries the connotation of being able to eat, and therefore dominate, the person with this trait. I’m still on the fence on what I think about this one. This afternoon I called my cat, “honey.” My dad and mom called each other this all the time. Were they subconsciously trying to dominate each other? I think not.

    Of course, reading a book like this, I can’t help but relate it to my own experience, not as an adoptee but as a member of a household that included two transracial adoptees, my African American youngest brother and Chinese youngest sister. Their adoptions were closed. We grew up in a small town in southwest Nebraska, where there were two other (also adopted) Black kids, one other (also adopted) Asian kid, and one (also adopted) Indian kid. There were a decent amount of Hispanics who mostly stayed together and everyone else was White. We had an (also adopted) Korean aunt, a Black uncle, and an (also adopted)Korean cousin, but they lived far away. I’m not aware that my siblings had meaningful, sustained relationships with any Black or Asian adults during their childhoods. We did not participate in an adoption-related activities or camps, that I am aware of. As a kid, I truly did not believe racism was still a problem.

    I know now that I was wrong.

    My brother experienced things growing up that I didn’t know about until much later in life. I don’t know about my sister, but she’s shared events from the past few years that demonstrate she deals with microaggressions on a regular basis. (Recent example: her boss said she was a standout member of the ESL program at work.)

    My siblings have never seemed interested in talking with me about being adopted, or about the emotional struggles they may or may not be going through. I wonder if they have experienced “exulansis.” I’m sure I haven’t presented as a great listener. While I don’t think I’ve ever felt that they “should be grateful,” growing up I never considered they would feel different at all. I wish I’d known better.

    Cautions regarding this book: it is certainly not from a Christian perspective. It trends toward “wokeness” but I don’t believe to the point of being unhelpful. When describing group discussions with adoptees, Ms. Tucker is always careful to describe that she introduces her pronouns when starting the discussion, which is something that goes along with LGBTQ+ affirming practices.

    SDG

  • Gaps in my financial experience

    Because of my parents’ generosity, I don’t have experience with two major expenses that it seems a majority of people have to deal with: student loans and a mortgage.

    My parents funded 529 college savings plans for all of us. Thanks to my highly specific skill at excelling at standardized multiple choice exams, scholarships covered my college tuition and half of my medical school tuition, but the 529 plan paid for college room and board and the other half of med school. (I think I paid for the four pre-med classes I took at USD, but they weren’t very expensive.) (I also know my 529 plan didn’t pay for it all, Mom moved some around from my brother’s plan, as he had an all-expenses paid education at the Air Force Academy.) Making it through college and medical school without student loans is a major boost and has no doubt saved me countless worries.

    When my husband and I decided to move back to Omaha, Mom told us we didn’t have to worry about applying for a loan: she’d give us the money for the house, and we’d pay her back. In retrospect, I don’t think we set the arrangement up correctly – turns out you can’t just give someone a large sum of money and have them pay you back without some contractual and estate planning considerations – but this arrangement has worked out great for us. Turns out there are a lot of extra expenses you don’t have to worry about when you pay for a house with cash. We have a very reasonable “mortgage” payment that I transfer to Mom’s bank account every month, and with the inheritance we received from various estate sell-offs (again, a major boost!), we’re going to have her paid back in the next seven years, God willing.

    As a result of my family’s wealth and generosity, I won’t be able to offer advice based on personal experience for several areas that typically have a large impact on a person’s financial life. This is a good problem to have, but something I will need to keep in mind when I’m tempted to compare my financial situation to someone else’s.

    SDG

  • How much is walking worth?

    On Monday, someone came from the wheelchair company to measure me for a wheelchair. He explained that the standard-issue wheelchairs are made in Mexico, but the fancy ones are made in Wisconsin. I’m not sure if he was implying that Wisconsinites make nicer wheelchairs than Mexicans or if that was his explanation for why the nicer wheelchairs are so much more expensive.

    While the insurance gods will ultimately determine what kind of wheelchair I get, we’ve decided to “try” for the fancy kind that has removable wheels and an extra light frame and comes in whatever color you want. (I’m going with candy red. It might be a mistake.) The man estimated that if we meet our deductible the wheelchair will cost around five hundred dollars. If that will allow me to consistently get to work by myself and diminish my fears of the wheelchair making me fall over as I try to get it in/out of the trunk — worth it.

    Even better, if, as per Murphy’s law, paying a lot of money for a fancy custom wheelchair would increase the chance of my hip problems spontaneously going away, that would be five hundred dollars extremely well spent.

    As I was thinking this thought to myself whilst driving home after almost falling over getting my wheelchair into the trunk at 11 PM at night, I kept on the same track and wondered, if I could pay money to make my hip problems go away, what’s the most I would pay?

    That is a tough question. Of course there are variables. Could the problem spontaneously remit on its own, or are we assuming there is otherwise no cure? Would this payment essentially keep me healthy for all time, or could I get another debilitating ailment the next year, or could the condition come back? Could other people contribute to the monetary amount?

    Ten thousand dollars, I would pay without thinking about it. Twenty thousand dollars (essentially our three-month emergency fund)? Mmmph… probably. Ninety thousand dollars (essentially what we have in our taxable account)? Yikes, that seems like too much. But we could probably afford it. Is ninety thousand dollars too much to pay for the ability to be able to roll around in bed without waking up to think about it, painless sex, being able to walk to Lindy’s grave, hiking?

    If there weren’t other options, I think I’d do it. If I wasn’t in a position of being blessed with monetary resources, then I guess it would be tough luck. Despite this being a hypothetical scenario, it seems problematic that I would be able to pay my way out of not being able to walk when someone without my resources would not be able to. On the other hand, my parents have paid me out of having to wear glasses or contacts (thank you, Lasik!) and smiling with crooked teeth, and that doesn’t seem so problematic. Maybe it’s because those “upgrades” seem more superficial, but I guess everything is on a sliding scale.

    SDG

  • Book review: Wicked Marigold

    (Spoilers to follow.)

    I am just outside the demographic for Wicked Marigold, by Caroline Carlson. This is an elementary or middle school-aged novel, and sometimes that is just fine but for this book I felt my age.

    It tells the story of Princess Marigold. Before she was born, her older sister was kidnapped by an evil wizard, but she unexpectedly returns one day and immediately sucks up her parents’ and the kingdom’s attention. Marigold finds it all very annoying, throws a tantrum that creates a giant mess and inadvertently gives her the idea she is wicked, and runs away to stay with the evil wizard to prove it. Hijinks ensure.

    One of the book blurbs said it was reminiscent of Howl’s Moving Castle, which is a book I adore. In retrospect, this comparison my have set my standards too high and let me to draw unflattering comparisons. There are definitely similarities, but Wicked Marigold loses every time. The evil Wizard Torville? He likes to sulk and makes messes and is very particular about certain things, but he’s no match for Howl, who steals every scene he’s in. The demon Pettifog, who has a magical contract to help the wizard with his magic? I prefer Calcifer. Marigold has nothing on Sophie Hatter (not to mention she is at least seventy years younger).

    Other parts of the book seem a bit precious or twee, in ways that Howl’s Moving Castle and The Ordinary Princess do not. Maybe it is trying too hard. Six guards resign on the spot when three year old Princess Marigold throws a gigantic tantrum. The kingdom has a famously irritable dragon. Marigold learns how to greet a stranger seventeen polite ways. Why do these things bother me? I don’t know, they just do. I felt a similar dislike for stylistic choices in The Girl Who Circumnavigated Fairyland in a Ship of Her Own Making, but eventually got past it and cried when September had to kill the fish. Nothing in Wicked Marigold tempted my tear ducts to flow.

    All the negative comments aside, I enjoyed the book. It didn’t go along with my expectations, but that isn’t always a bad thing. I kept waiting for Marigold’s angelic sister to reveal that she had a bad side… but she didn’t. She’s a completely good, beautiful, nice person and that’s it. Kind of refreshing. The evil “bad” guy is not as evil as he first appeared… but on the spectrum of “good” vs “bad,” he still chooses to identify with the “bad” side and I’m not convinced he doesn’t belong there. It was rather a relief that the book wasn’t populated with any “diverse” LGBTQ+ characters who use they/them pronouns. The book was stuffed with worldbuilding, and if it had more time to explore things (like Gentleman Northwinds and his relationship with Torville, for instance) I think I would have enjoyed it more. That’s the tradeoff with junior fiction, I guess.

    SDG

  • On death and dying

    I haven’t had as much experience with death as some.

    On one hand, my childhood contained plenty of animal death. Cows died sometimes. My dad shot three of our dogs when they got too old to move, and we tearfully brought another dog to be euthanized at the vet when it was diagnosed with diabetes. Countless cats disappeared, and more than a few kittens kicked the bucket, some in gruesome ways. One night when I was ten or eleven, I wanted to feel sad (kids are weird) and tried to tally up all the animals I knew that had died. I can’t recall the total but it seemed like it was over fifty.

    On the other hand, I was spared the death of someone I loved until after college.

    My dad died in a plane crash the summer I turned twenty-three – that was my first real experience.

    A fact about me I’m ashamed to share: I’ve never performed CPR in a read code event. The opportunity never came up in med school, and when someone coded in the ICU during residency and I saw everyone lining up for their turn at chest compressions in what seemed quite obviously to be a futile attempt at resuscitation, it didn’t seem like giving a few of my own chest compressions was going to help me or the patient.

    I’ve observed several codes, none of which ultimately was successful. (This demonstrates how few I’ve seen, because statistically in the hospital about 1/3 to 1/4 are at least successful at restarting the heart.)

    I didn’t pronounce someone dead until my fellowship year. An older woman in my care had been placed on comfort care with the goal of leaving the hospital on hospice. She wasn’t doing well, but had been stable for several days. Right before the end of my shift, her nurse paged and asked me to come up, because my patient had died. In a moment of gallows humor, I had a shock when I was listening for a heart beat and watching the patient’s chest – it was rising and falling. Then I realized her air bed was still on. The nurse turned it off, and she was still.

    Our daughter, Lindy, died in our arms. She just gradually stopped breathing. The nurse listened to her heart and said she had died, but when the nurse practitioner came to confirm, her heart was still beating, slowly. It kept beating for a few more hours as we held her close in the hospital bed.

    Yesterday I spent the afternoon sitting next to a great aunt who is dying. Part of the time she moaned and moved her head back and forth, most of the time she slept. I don’t think she knew I was there. Her pulse was high, probably 120 beats per minute. Still breathing steady but sometimes with a rattle. I sat with her in the hospital in July and thought she was dying then, although she’s further down that path now. I don’t know how long her earthly journey will continue. Sometimes it happens so quickly, like with my dad. Other times over a few hours, with Lindy. My great aunt is taking a harder, longer road, God only knows why.

    I hate death. People say death is just a part of life, but they’re wrong. It wasn’t supposed to be like this.

    What I do know is that the God of the universe experienced death as Jesus Christ, and he conquered it.

    Resurgam.

    SDG

  • Lumpy bumpy expenses and peace of mind

    When I was using a Google Sheets spreadsheet to track our purchases, I found that “one time” expenses were always popping up. There would be the airline tickets to visit my mom for Thanksgiving. Then our semiannual insurance premium. Then Christmas presents. Then an unexpectedly expensive car repair. It seemed like every month had one or two of these “unpredictable” expenses. It made planning hard.

    After struggling with this for some time, I finally realized: you can plan for these expenses. You just need to look a little farther into the future.

    You see, most unexpected expenses really aren’t that unexpected, they’re just easy to forget. A semiannual insurance premium, for instance, predictably occurs twice a year. Christmas happens every December 25th. Mom wants a visit at least once a year (okay, twice a year).

    Here’s a list of some of our expenses that may or may not come at predictable times, but they definitely come some time:

    • Property taxes (so expensive! Like $8,000 per year expensive!)
    • Insurance with semiannual premiums (we do all our insurance this way, it saves a little money) (also expensive!)
    • Automobile registration (gets less expensive each year your vehicle gets older!)
    • Phone plan (we use Mint Mobile, you can buy a year at a time for a discount)
    • YNAB
    • Home maintenance (various sources say to estimate spending 1-4% of your home’s value per year – you may not spend it every year but will have larger expenses every so often like paying for a new roof or HVAC system)
    • Auto maintenance (I have no idea how to estimate this one… we randomly chose $500/month. If we have extra it will just help pay for our next car)
    • Medical expenses (I aimed to save enough to meet our yearly deductible)
    • Home projects (subjective, but necessary when your husband loves interior design and building furniture)
    • Travel (again, subjective, we need to pay for a least two flights a year)
    • Presents (depends how generous you are, I guess)

    After compiling all these lumpy expenses, I came up with a dollar amount that we’d need for each expense for the year. Our house cost $370,000, for instance, so 3% of that for home maintenance is $11,100. Divide that by twelve, et voilà! Each month we need to set aside $925 for home maintenance. Essentially, you create sink funds for all these categories to draw upon when the lumpy expense finally appears.

    I love this, because now instead of feeling slightly panicked when an “unpredictable” expense comes up, I know the money is there in the sink fund, just waiting to be used. So far I’ve done a good job predicting these “unpredictable” expenses, but if a truly new, unsaved-for expense came up we’d move things around and then I’d add a new category for the future.

    This is definitely possible to do with a spreadsheet, but YNAB makes it easier to see what we’re doing (especially helpful for my husband!), and other budgeting apps have similar capabilities.

    SDG

  • Maybe we’re not going to see the world?

    I am on the Internet a lot (sigh) and spend a lot of time reading personal finance blogs. It seems that people blogging about personal finance, financial independence, and FIRE have something in common besides wanting to be good with money and to retire early and do whatever they want (like blogging): they all love to travel.

    Now, a lot of these blogs also happen to be geared toward physicians or high earners, so I guess that should adjust my mindset somewhat, but it’s common to read about people spending 20-50 grand a year on travel. Which makes my eyes widen a bit.

    It’s not just on the blogs. At my job, every new hire gets introduced by a faculty member at one of our monthly meetings. Invariably, at least one slide on their introduction PowerPoint will show them hiking, posing in front of a big building, etc., and we will be informed that this person “loves to travel.” Colleagues discuss their European vacation plans.

    Admittedly, this is selection bias. People don’t talk about how they aren’t going on a European vacation, and bloggers tend not to post about how they spend $2,000 on travel this year, not because they were awesome at credit card hacking but because they just didn’t travel anywhere other to visit their parents a few states away.

    Of my immediate family, baring the one who is incarcerated, I am probably least traveled. I was born in Europe but we moved to Nebraska before I could remember anything different. Since then, I’ve been to Mexico and Canada a few times, Peru, some of the Caribbean (on a cruise), England, and Uganda. The sister after me has spent the last two years of her life in Uganda, went to Egypt on a work trip there, visited Israel in seminary, toured through Italy and Ireland during Bible college, went on a river cruise from Austria to the Netherlands a few summers ago, and is currently visiting a friend in Finland and a cousin in Switzerland. My brother went on a world tour after graduating from the Air Force academy including more places than I’m aware of, and spend three years with his wife in England where they went on frequent trips to France, Poland, Greece, Germany and more. My youngest sister studied abroad in Spain. My mom and dad met in Japan and spend the first few years of their married life in Europe. Enough said.

    Actually, typing out all the places I’ve been is making me realize I’ve actually been to quite a few places. Ok, so this is my privilege speaking. Nevertheless…

    When I read and hear about other people’s adventures, part of me feels jealous, like I’m missing out on awesome experiences. Another part of me acknowledges the reality: I’ve been pretty busy for the last 9 years (medical school + residency + fellowship + moving, having a baby and starting my first attending job), I’m a homebody, and my husband accepts traveling as a necessary evil of being married to me.

    While I do hope to visit (some more) cool places some day, I think don’t travel will ever be a major category in our budget, unless we start paying to bring people with us. (That is a distant dream of mine!) That’s ok. My homebody heart and my husband are happy.

    SDG

  • Mistakes I’ve made: IRA edition

    Toward the end of residency, I realized I didn’t know a lot about how to manage money. I started looking for information. Like a lot of physicians, I found The White Coat Investor and read through the archives when I had spare time. I quickly learned that I had a lot to learn.

    One of the first things I learned was a forehead slapping moment, although it arrived too late to be of much use.

    What I learned was a 401(k) or 403(b) has no relation at all to an IRA. Funding the former does not prevent you from funding the latter. They have separate contribution limits. You can max out both. In my ignorance, I thought you could only contribute to the 403(b) and Roth IRA up to the 403(b) contribution limit – whatever you contributed to one account would limit what you could contribute to the other. (For example: if 403(b) contribution limit was $20,000 and I contributed $15,000, I thought I could only contribute $5,000 in my Roth IRA, even if the IRA max was $6,000.) Once, when filling out my taxes, I thought I overcontributed since I had maxed out my Roth IRA and came close to filling up my 403(b) at the same time. Basically, I thought I owed a tax penalty. I don’t know if I actually ended up paying a penalty or not (and I’m not motivated enough to go back through my old tax returns to check) but I did my best to do so!

    I was in the dark about the difference between 401(k)s and IRAs while I was a dietitian and as a PGY-1/PGY-2 resident. During those years, I preferentially funded my Roth IRA and didn’t max out my 403(b), even when I could have. Extra dollars went into my taxable account, instead of a tax-advantaged account.

    Since I now have a 403(b) and a 457(b), for ease I’m focusing on maxing them out and not worrying about funding a backdoor Roth IRA, at least for now.

    SDG