How to make a million dollars a year as a Doctor...

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Oh, and just to compare. I don't know the real stats, but lets just say a doc got payed $200,000 in 1990. They SHOULD get payed $313628.54 now. That would be the proper equivalent, when inflation is factored in.

Originally Posted by PreMedDocMD

Ok, one more thing...everyone has SAID that the trend is going down, but is there some sort of internet source, graph, etc. that also shows actually stats? Real numbers and fats would be good...oh, and for all specialties.

Here you go, PreMedDocMD:

http://forums.studentdoctor.net/show...6&postcount=74

You can see that compensation is stagnant with some decreases at the end of the curves and the TMA reports that for 2006 55% of physicians reported a decrease in reimbursements (you can find that on their web site or I can get the link / source for you if you would like).

Thanks, that was good. It appears that surgery, and DR seems to be SLIGHTLY increasing, after inflation. IM (excpet gastroenterology which skyrocketed) seems to be the same or going down slightely.

OncoCaP, do you think it is safe to assume surgery specialties will continue to keep up with inflation, and, dear I say it? Increase slightely in pay?

Originally Posted by PreMedDocMD

do you think it is safe to assume surgery specialties will continue to keep up with inflation, and, dear I say it? Increase slightely in pay?

No, that's not the expectation of most in the industry. Medical salaries as a whole are declining, and those that are doing best are currently only staying stagnant. It's predicted to get worse, not better, as insurance companies increase their stranglehold. Physicians are facing decreasing reimbursements, increasing insurance costs, and are bearing more than their fair share of the blame for rising healthcare costs. Expect compensation to continue its slow decline over the short term.

Making a million dollars a year would be difficult, but being a multi-millionaire at retirement would be quite easy with sound investing and financial management.

As to the richest doctors being the ones that went to the highest ranked medical schools, that is ridiculous. The states with the highest physician salaries are Arkansas, Texas, Oklahoma, and Louisiana. Being from Arkansas I know a few Harvard graduates here, but most (and I'm thinking of some very wealthy ones) did their undergrad, med school, and residency here.

I'm also hesitant to let out the secret, but here in "fly over" country doctors are still respected and still make a lot of money.

Originally Posted by PreMedDocMD

Ok, one more thing...everyone has SAID that the trend is going down, but is there some sort of internet source, graph, etc. that also shows actually stats? Real numbers and fats would be good...oh, and for all specialties.

just go to google, type in "medicare decreased reimburesment" for starters and you'll find some

Boutique medicine. I know a doc in NYC who pulls in between 3-5 million / year.

Originally Posted by MoneyDoc

Seriously, everyone is thinking this exact thought if you are in medical school. I don't want to hear those liberal whinings about the poor and all that crap. Everyone is concerned about their future bank account! So, we've worked hard for 4 years of school, and then (for surgery) like 6 to 7 years of residency and we want to make some money. If the system is socialized, the government will be in control of our wages as a whole. We cannot let that happen. What are some ideas to prevent that from happening as well as maximize our bank rolls?

Figure out a niche specialty or field where you can charge lots of patients cash, an amount thats not too much to bankrupt them right away but enough to make you very rich, and have them come back repeatedly for follow-ups b/c lets be honest, if numero uno is $$$ then who gives a **** if they're getting better or not.

I guess Botox sort of fits your interests. Honestly, based on your post you seem more suited for work in capital investment/finance than medicine.

I've decided that making a million dollars a year is not the most important thing. Instead I'm going to have my wages garnered so that Zach Braff can make $50,000 more per episode of Scrubs, taking his episode wage to $400,000. I'm really feeling bad that he isn't making enough money playing a doctor on TV. That is a really hard job with a lot of stress and it took a lot of work and sacrifice to get there. He needs to be paid well! I mean, as a culture, we really put our money where our priorities lie, right? And I'm telling you, in my economy, entertainment is more important than health. So, I'd rather be poorer so that a 'pretend' doctor can be rich. End of story.

Originally Posted by MoneyDoc

I've decided that making a million dollars a year is not the most important thing. Instead I'm going to have my wages garnered so that Zach Braff can make $50,000 more per episode of Scrubs, taking his episode wage to $400,000. I'm really feeling bad that he isn't making enough money playing a doctor on TV. That is a really hard job with a lot of stress and it took a lot of work and sacrifice to get there. He needs to be paid well! I mean, as a culture, we really put our money where our priorities lie, right? And I'm telling you, in my economy, entertainment is more important than health. So, I'd rather be poorer so that a 'pretend' doctor can be rich. End of story.

what the hell?

For the most part, it's very difficult to get rich simply by being a doctor. Unless money is thrown at you (derm @ 500K/yr), it usually takes sound financial planning. For a long time, I've been extremely interested in business, and have read many books regarding the subject. I plan on combining the two (business and medicine) when I get out of residency. That being said, every authority on getting rich boils down to a few basic concepts:

1) Own your own business/work for yourself. People who earn paychecks don't get rich for 2 reasons. 1- the only financial reason to have you as an employee is if you bring in more money to the company than your salary. If you work for yourself, you reap the full benefits of your hard work. 2- Equity. Equity is the single most important source of wealth for anyone who's rich. The 10 mil + you're talking about ALL own their own business. Look at the Forbes 400: they're all CEO's/owners of corporations. They do it in different areas (law, oil, airlines, entertainment, the list goes on...) but they ALL own a business. Equity is simply the amount of the business you own. It's yours, just like your car, house, etc. It can be sold. The more profitable it is, the more it can be sold for.

2) Invest in tax-sheltered ways. Let's look at two examples. You and I both work, make $1000, and want to invest it all. I take the money out of my paycheck, and taxes take roughly 40% +/- out of it. I now have $600 to invest. I get 10% over 1 year and end up with $660.
Now you take the same $1000 and invest it in a tax-sheltered way. Your financial adviser will be better able to advise you, but this includes company retirement funds if you work for someone, investing directly in your business if you work for yourself, investing in IRA's (granted there are restrictions), real estate roll-overs, etc. The point is that if you do this, and you make the same 10%, you've got $1100. Now if I were to take this money out at 40% tax rate, I'd have the same $660 as you. However if we were to both leave our investments alone for 5 years, then take it out at the same 40% tax rate, I'd end up with $819.79, and you'd end up with $1244.20.
Taxes are, from what I've conferred from various sources, the single reason the average person doesn't become rich. The rich invest before taxes. Middle class invests after taxes.

3) Own a home. Real Estate investors, when they do well, do better than everyone else. Why? Well let's say you buy a home and I rent. My rent and your total costs (insurance, mortgage, upkeep), work out that I'm paying $100 less a month than you. Over 30 years, I've payed $36000 less than you. I'm $36,000 ahead, looks good for me, right? Well you've payed off a mortgage on a $150,000 house. You own it. If I move out, I've got nothing. If you move out, you sell a house that's probably appreciated to well over it's initial worth (over $600K if we're assuming an 5% appreciation, and you've paid $359,262 assuming a 7% mortgage and no down payment... granted you took it to term which rarely happens). So you pocket that money. It's the same principle as owning a business. Equity. (also there's the roll over. when you sell your house, you can take the profit that you made, and use it to buy a house tax free. So if you've make 100K on your house, instead of paying 40K in taxes and THEN buying a house, you just buy a house with all 100K. Talk to your accountant).
Now let's say you invest in real estate. Now you've got renters that pay your expenses for you. If you invest right, you'll make money every month. So you're making anywhere between 0 and a couple hundred a month. And after 30 years, your renters have paid your mortgage for you. Talk about a way to make money!

4) Have the goal of financial freedom. This idea means that you can choose to work or not work, and still pay the bills. Let's say you have monthly expenses of $1000. That means you're spending $12,000 a year. If you have $150,000 in investments earning 8% a year, you've just covered your monthly expenses. You can work or not, whatever you want.
There are two tricks to this: 1- making money and investing (playing offense). This is inherently easier for dermatologists. 2- keeping expenses low (playing defense). This means buying the smaller house, the used car, etc.

These are the ways that everyone who is rich got there. You talk about $10 million plus? Look at Bill Gates. Look at Warren Buffett, Steve Jobs, Mark Cuban. They all owned a company that did very well, went public, and had a huge payoff. Now there's a lot of risk, but they handled the risk and made it work for them. Is it easy? Hell no. A lot harder than being a Dr. and a hell of a lot more risky. But that's how rich people got rich. Even Tiger Woods makes more money from marketing his business (himself) than he makes from actually swinging a club.

I'm convinced that business should either be a pre-med requirement or a course in the med school curriculum.

hmm, thats quite interesting. makes sense.

Originally Posted by sirus_virus

When they came out with the study that showed that our tort system accounts for 150 billion dollars extra in healthcare spending, everyone said it was not significant enough to warrant change, but 50 billion dollars extra to physicians laden with debt means the sky is falling? Give me a break.

The ambulence-chaser lobby makes it VERY unlikely that we will see significant tort reform anytime soon. "But docs have a lobby in the AMA," you say? Wrong! The AMA is now actively increasing the supply of docs (by lobbying for student increases and new med schools) and seems more concerned keeping primary care docs in business than increasing pay for all specialties. So don't expect docs' legal environment to get better. Unfortunately, the $50bn that's been references is low-hanging fruit for politicians, so that is where they are and will continue to be focused for the foreseable future. John Edwards had at one point suggested a cap of $95k on doctors salaries. Hell, that guy must spend at least that much anually on hair products.

Biscuit and OncoCaP have hit the nail on the head. Good advice. In the coming decades, the government (which already pays for >50% of healthcare) will continue to slash reimbursement, particularly for procedures but everywhere else as well. I'm not talking just because of inflation, I'm talking actual cuts. The oligopoly of the large insurance companies will follow suit. And costs won't fall since docs will still have to order lots of tests due to constantly looking over their backs for lawsuits, extra patient visits to combat reimbursement cuts, and an aging population. Some docs will stop practicing, and the government may need to allow even more foreigners in to practice medicine, as well as allow NPs and PAs a broader scope of practice.

OncoCaP suggested that some forces will increase demand. This is true, but remember, we do not operate in a market economy for medical care. There are thousands (if not millions) of highly competent foreigners who the government can very easily let in. And this is probably a good thing for the American people (I, for one, had an excellent Indian-trained pediatrician in the small town that I grew up in), but bad for US-trained docs. We also are not able to set rates in a competetive environment. In what other industry do buyers (the afformentioned govt and insurance companies) say to the seller (the docs) "Here is what I will pay you... in six months... if you're lucky" and the seller is virtually powerless to say no.

IMO (worth exactly what you pay for it), physician salaries will fall across the board in the coming decades, and not just in real terms. Plan accordingly. Bottom line is, don't go into medicine for the $$$. Love what you do, and the money will be a bonus. Go into medicine for the money, and you will be angry and bitter.

Remember guys, it is not what you make but what you do with what you make that sets you apart from others. I know many engineers who are very rich and never earned big money but invested wisely and retired early. On the other hand my doc friends who earned big money in the hay days of doctors are still working their butt off at 68 years!

Originally Posted by Jeffsmith

Remember guys, it is not what you make but what you do with what you make that sets you apart from others. I know many engineers who are very rich and never earned big money but invested wisely and retired early. On the other hand my doc friends who earned big money in the hay days of doctors are still working their butt off at 68 years!

True, but remember that physicians invest a lot, and should be rewarded for that investment. There's nothing wrong with someone making 200K/yr after going through 8 years of school and 5 years of 80hr weeks for 20K/yr. It's very easy to say "oh doctors should just be more conscious about what they do with their money." Lord knows I agree with that, but at some point it's just not worth it to practice medicine. And due to the time/effort requirements to become a doctor, that premium is pretty high.

Originally Posted by Biscuit799

There's nothing wrong with someone making 200K/yr after going through 8 years of school and 5 years of 80hr weeks for 20K/yr.

What hospital pays residents 20k/yr? Change that to 40k you're more in the ballpark.

for those who are interested in money, it is not made in medicine. the large amount of money that some physicians take home is not from the clinical side. it is from the buisness side. physicians increase their income by owning things, MRI scanners, physical therapy, pharmacy, and surgery centers.

so, i would advise getting you MBA and practicing in a low malpractice state in an area with a good payer mix.

pedi out

Originally Posted by PediBoneDoc

for those who are interested in money, it is not made in medicine.

pedi out

People make money in medicine all the time. However there is a disturbing mindset in the medical profession that putting effort into making money is inherently evil and goes against the ideals of patient service. This is a ridiculous notion that needs to stop propagating. Physicians, in a way no other profession ever has, completely ignore the financial aspects of their job, business, and life. I have an uncle that used to work at a law firm. They had a phrase. It was "DDD" which stands for "Dumb Doctor Deals" because Dr's were notorious for getting themselves into foolish monetary situations. It is extremely important that a physician understand the basic concepts that make her/his business work. Think of it like auto repair. If you know nothing about cars at all, you take your car to a mechanic, he tells you your flux capacitor is broken, and you pony up the $1000 to fix it. But if you know about cars, then you can tell him that he's full of s#it. Physicians need to know how to handle financial matters, both personally and professionally. They are going to be dealing in large sums of money personally, and a wide variety and volume of transactions professionally. And to have no idea where your money is going in either case? Well we've all heard horror stories of the office manager who steals all a practice's money...

Originally Posted by Dakota

What hospital pays residents 20k/yr? Change that to 40k you're more in the ballpark.

fair enough... but the point remains.

People make money in medicine all the time.

yes they do. i am actually one of the money making areas of medicine. i do spine surgery. the money to be made is not in the practice of medicine so much as it is in the incidentals. you can make money if you own other things as i had stated. if you have developed a cash business, then of course you will make money. if you rely on insurance companies who base their payments on a percentage of medicare (medicare is actually a pretty good payer now), then you end up having to see a lot of patients.

if you want to make money, you can do it. be smart and invest well. own your own surgery center, physical therapy, and MRI, and you will do well.

this has to be the most hilarious thread. OP: thank you for the laugh. seriously.

Okay I realize this guy was a troll but it certainly was a funny read. I don't think ANYONE would go into medicine today to make money! Also, docs in other countries don't make 'nothing', look at GP salaries in UK (median, not mean) and you'll see a different story! Doctors, actually, a probably the least money lusting people...if they were they would just a finance degree or an MBA, much more earning potential!

Originally Posted by SupergreenMnM

Okay I realize this guy was a troll but it certainly was a funny read. I don't think ANYONE would go into medicine today to make money! Also, docs in other countries don't make 'nothing', look at GP salaries in UK (median, not mean) and you'll see a different story! Doctors, actually, a probably the least money lusting people...if they were they would just a finance degree or an MBA, much more earning potential!

Really, I think people are exaggerating a lot now. Of course doctors make a lot, they still make more than almost any other job out there (in US). "You shouldn't become a doctor for the money" means there is money to be had by becoming a doctor. Period.

Invent a medical device

prostitute yourself to 1000 fat chicks for 50 bucks.

...or 50 REALLY fat chicks for 1000 bucks.

Originally Posted by PreMedDocMD

Really, I think people are exaggerating a lot now. Of course doctors make a lot, they still make more than almost any other job out there (in US). "You shouldn't become a doctor for the money" means there is money to be had by becoming a doctor. Period.

Actually not exaggerating at ALL. Look at the education vs earning income (which includes starting earlier and time to work up to a better position) for MDs vs people with finance and MBA degrees; they will be making your MD salary while you are starting residency...and with 1/10th the hassle.

Hello!
My country is socialized and here the max a very good doctor can make at the end of his career would be about 100k $. Of that he must pay 50-60% income tax because he is so "well-payed". So the net is 50 000 $ in your pocket a year.

So I guess if you want to make a million dollars a year as a doctor- socialized health care is not the way.

Originally Posted by SupergreenMnM

Actually not exaggerating at ALL. Look at the education vs earning income (which includes starting earlier and time to work up to a better position) for MDs vs people with finance and MBA degrees; they will be making your MD salary while you are starting residency...and with 1/10th the hassle.

I saw a figure where they figured out the rate of return on each our of graduate school. MBA's and JD's (lawyers) had the comparable (and very high) rates of return, while MD's were shamefully low.

Originally Posted by ladynice

Hello!
My country is socialized and here the max a very good doctor can make at the end of his career would be about 100k $. Of that he must pay 50-60% income tax because he is so "well-payed". So the net is 50 000 $ in your pocket a year.

So I guess if you want to make a million dollars a year as a doctor- socialized health care is not the way.

Well at least you get to feel all warm and fuzzy inside because everyone gets the same access to care

Originally Posted by ladynice

Hello!
My country is socialized and here the max a very good doctor can make at the end of his career would be about 100k $. Of that he must pay 50-60% income tax because he is so "well-payed". So the net is 50 000 $ in your pocket a year.

So I guess if you want to make a million dollars a year as a doctor- socialized health care is not the way.

Hello!

My original country (Japan) has socialized health insurance and doctors still make bank.

So I guess if you want to make a convincing argument against socialized health care- referring to the poor situation in a single nation is not the way.

Originally Posted by lord_jeebus

Hello!

My original country (Japan) has socialized health insurance and doctors still make bank.

So I guess if you want to make a convincing argument against socialized health care- referring to the poor situation in a single nation is not the way.

Hmmm..maybe I'll practice in Japan Socialized medicine, fair pay rates, and the BEST seafood in the world!

Originally Posted by SupergreenMnM

Hmmm..maybe I'll practice in Japan Socialized medicine, fair pay rates, and the BEST seafood in the world!

Unfortunately you have to pass a rather difficult Japanese language exam to accept national health insurance.

You can operate a cash-only practice, however, and make insane money catering to the expat population, or really rich Japanese people who think foreign-trained doctors are better. I know a British GP who likely makes more than "a million dollars a year" as the in-house doctor of a huge complex full of rich people.

Wow, cool...
just curious, how does Japan get their system to work while UK and Canada are having problems? Is there something unique about the way it is done there?

Originally Posted by SupergreenMnM

Wow, cool...
just curious, how does Japan get their system to work while UK and Canada are having problems? Is there something unique about the way it is done there?

The doctors have a national organization with quite a bit of political influence. Unlike this country, where neither political party really cares about us, they have a strong symbiotic relationship with the conservative "Liberal Democratic Party", which has pretty much run the country since 1955.

Other advantages include a less litiginous society (and the few malpractice awards are in the tens of thousands instead of tens of millions). Because everyone has health coverage, a doctor who commits malpractice doesn't have to pay the high costs of future health care for those that are harmed.

There are questionable things too -- for instance doctors are allowed to make money selling the meds they prescribe (and they all do), and hospital stays are absurdly long.

Originally Posted by old_boy

John Edwards had at one point suggested a cap of $95k on doctors salaries. Hell, that guy must spend at least that much anually on hair products.

what?? when did he say that?

Originally Posted by TheProwler

what?? when did he say that?

I can find no evidence of such a statement on Google. I tend to doubt it - it makes no sense. (I mean, as a trial lawyer, tt would severely hinder his ability to get rich suing them, wouldn't it?) So I call shennanigans.

Originally Posted by Law2Doc

I can find no evidence of such a statement on Google. I tend to doubt it - it makes no sense. (I mean, as a trial lawyer, tt would severely hinder his ability to get rich suing them, wouldn't it?) So I call shennanigans.

I read it on SDN. Must be true : http://forums.studentdoctor.net/show...9&postcount=20

Although I, too, just tried to find a *real* source for it, and failed, so it's probably made up. I apologize.

But he still spends a lot on hair products.

i was thinking about it, and hidden fees are the way to make a million dollars. i mean we have to make up for the medicare and medicaid so we charge for "oral rehydration therapy"=drinking out of the water fountain=$87.50 charged to all patients with private insurance. Another would be "sanitary nasal discharge instrument fee"=$54.75 with a biological fluid disposal fee=$300. That's the way to make a mil.

Originally Posted by peanutbutterman

i was thinking about it, and hidden fees are the way to make a million dollars. i mean we have to make up for the medicare and medicaid so we charge for "oral rehydration therapy"=drinking out of the water fountain=$87.50 charged to all patients with private insurance. Another would be "sanitary nasal discharge instrument fee"=$54.75 with a biological fluid disposal fee=$300. That's the way to make a mil.

Well, if you accept insured patients you will have no ability to bill them independently without violating contractual agreements with the insurers. If you did a conceirge service practice (ie only accept patients paying cash) you could do this, but the number of patients you would have would drop significantly as they would be paying out of pocket. In most noncosmetic specialties practitioners have determined that volume is still more lucrative than a cash business.

The only way to make a mil purely through the practice is to do enough procedures to generate reimbursements in that amount. That may mean finding ways to double bill your time -- you have two hands, so move the tables close enough together that you can be doing two procedures at a time.

Get an idea, start a company. Get somebody (preferable a relative) to run it while you practice medicine and keep the practice 'of the people'.

One family doctor here offers cash-only free service for some $100-200 a month. He has a lot of patients who want to go to the doctor as many times as they like without copay. (These do not including me). Primarily rich neighborhood.

Originally Posted by MoneyDoc

Seriously, everyone is thinking this exact thought if you are in medical school. I don't want to hear those liberal whinings about the poor and all that crap. Everyone is concerned about their future bank account! So, we've worked hard for 4 years of school, and then (for surgery) like 6 to 7 years of residency and we want to make some money. If the system is socialized, the government will be in control of our wages as a whole. We cannot let that happen. What are some ideas to prevent that from happening as well as maximize our bank rolls?

Just think about that statement for a second..."the poor and all that crap"...how do you think that sounds to people...and you want to be a doctor?...I hope I dont ever come to you for medical services ...the one thing I know that does not fly in real world when trying to argue agaisnt socialized healthcare is the fact that physicians will not be able to make a lot of money...believe it or not, most people out there does give a "crap" about how much doctors make, try going to a healthcare forum arguing against socialized healthcare because you will not be able to make a million dollars a year, see how far that gets you...I also believe that it is a bit selfish as well...

make a mill in a year. Simple, find a boutique niche, work you butt off, problem solved. If you're in it for the money, you'll find a way. Try human growth hormone, big money in manipulating it as the fountain of youth. Bottom line, yeah, we would all like to make more money, but how much do you really need? That's a personal question, but I think we would all agree we're going to that number.

i still question all this talk about doctors and not making enough money. doctors still have the highest salary in the nation according to salary.com/usnews:

http://www.usnews.com/usnews/biztech...areertable.htm


making a million dollars is another ballgame but having a decent living is certainly attainable. perhaps is my naivety but i expect to make a good amount of money. all this talk of not making enough and decreasing compensation seems silly to me as according to the averages, doctors make the most still.

umm yeah

Originally Posted by nekrogg

making a million dollars is another ballgame but having a decent living is certainly attainable. perhaps is my naivety but i expect to make a good amount of money. all this talk of not making enough and decreasing compensation seems silly to me as according to the averages, doctors make the most still.

I don't think this thread ever had anything to do with making a decent living. Compensation in medicine has on average been decreasing (hard to deny when it has even made it to the popular media (NY Times, etc), and hours increasing, but people are certainly not in the poorhouse yet. The OP wants to do much better than decent, though. As such, he has perhaps picked a path that doesn't lead to his target in most cases.

Originally Posted by DoctaJay

Sorry, I couldn't resist, but this guy just freaks me out. I don't know why. Maybe it's that little curl he meticulously styles on the side of his hair, or his bizarre martial art sessions in between procedures.

Just a small FYI for new people reading this thread...

The OP was obviously a troll, likely an SDN regular who temporarily adopted a new identity for the purposes of this thread alone.

Definitely agree with SomeDoc regarding the above.

Originally Posted by old_boy

John Edwards had at one point suggested a cap of $95k on doctors salaries. Hell, that guy must spend at least that much anually on hair products.

Originally Posted by TheProwler

what?? when did he say that?

A few days ago ABCnews or NBC reported that he spent a total of $800 on two haircuts. What the??? !

Originally Posted by SomeDoc

A few days ago ABCnews or NBC reported that he spent a total of $800 on two haircuts. What the??? !

He got robbed.

Originally Posted by Dakota

He got robbed.

which brings me to my new career switch, 400 dollar a head barber, lol, i be making 3 times as much as ER docs for way less training, stress and effort, by the way thats not including tips!!! who tips u as a doc, lol except for the nurses, hehe...