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Are you sure you want to be a doctor?

Discussion in 'Pre-Medical Allopathic [ MD ]' started by sirus_virus, 05.16.07.

  1. sirus_virus

    sirus_virus nonsense poster

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    "I have increased stress, high blood pressure," he says. He's so wound up by the time he gets home from the office that his wife won't talk to him for an hour afterward. He's watched a couple of physician friends undergo open-heart surgery. Still, he's reluctant. His income dropped 25 percent in one recent year."

    "Doctors have lost ground. Insurance companies have ganged up on them. "I have anxiety about staying in business," says an internist who's put his own money toward payroll. The trouble isn't just financial. Perks, privileges, esteem (self-esteem too) have all been hit. Many physicians work longer hours. And now, it seems, all kinds of people -- including clerks! -- are telling them what to do."

    "many American doctors are unhappy with the quality of their professional lives." The literature on this reads like the intake form at a depression clinic: "increasing marginalization," "discontent," "confused," "angry," "insulted."

    "Lately, lots of doctors have to pick up work on the side. Horowitz works as a medical consultant at Juilliard. One doctor got involved with a dot-com for a few years -- which was the last time he flew business-class. Some physicians augment their incomes by selling herbs, food supplements, cosmetics, even household cleaners in their offices. Schayes sells vitamins. "I buy wholesale and sell retail," he says. "It was kind of embarrassing at first. But at the end of the year it makes a big difference." Last year, Schayes, an M.D. approaching the height of his earning power, earned about $120,000 -- which doesn't come close to buying what people once thought of as the M.D. lifestyle. Soon, Schayes figures, his wife will have to go back to work. She hasn't worked in five years while the kids grow up. "She doesn't want to, but I'm making her," says Schayes. "Besides, she's a lawyer. Her earning potential is greater than mine."

    "As Fox explains, "I don't have any clout." Insurance companies have clout, institutions have clout, even patients have some. And so, just like any disgruntled worker, doctors -- doctors! -- are turning to unions."

    "The insurance industry has created a slave workforce out of the doctor," says Moshe Rubin, a gastroenterologist at Columbia."

    http://nymag.com/nymetro/health/features/5044/

    This is today, just imagine what it will look like ten years from now:scared: .
  2. emaj1n

    emaj1n M1

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    Only 120k a year? How do they survive?!
  3. mongrel

    mongrel Assoc. Prof. Dogsuit

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    Doctor unions? Wow- is that horrifying to anyone else?
  4. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    Once you get to that level, you will realize it doesn't go all that far, especially if, like the dude in the article, you are supporting a wife and two kids and living in a NY suburb. In such cases you will be living a quite modest lifestyle, and not saving or investing anything. It only sounds like a lot until you get there, and after taxes and expenses, you have nothing in the bank. Sure, it's more than most people in the US, but it's hardly living rich.
  5. mongrel

    mongrel Assoc. Prof. Dogsuit

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    I guess we'll find out when we get there... but it certainly seems like a lot. 120k is well over twice what my parents' combined income is from both of them working day jobs and a running a farm business on the side. And I don't think we live too modest. I suppose I've never lived in an area with a high cost-of-living though.
  6. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    If their mortgage was tripled and they were paying significantly more taxes you'd see my point. Trust me, you won't be living like a rockstar on $120k if you have dependants and work in Manhattan. In NYC that's a very good salary for a young single professional whose just starting out, but kind of rough for someone married with kids and 15 years into a career such as the guy in the article.
  7. Kikaku21

    Kikaku21 Senior Member

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    Its a lot of money. Especially if there are 2 incomes. Yeah, when you get used to any amount of money it seems like less. But please, please please, when you are a doctor making over 100K, remember what the average employee in America makes. Remember that doctors in America make MORE money than doctors in any other country.

    There is also evidence that they do worse than some other countries as well: http://news.yahoo.com/s/nm/20070515_nm/healthcare_usa_dc;_ylt=AkpaSDv9tMZxNHPVQKAgYxkDW7oF

    And as for being "marginalized," go work in business for awhile, or engineering. Unless you are an executive, you will have a boss. You will, in short be a member of a team. Doctors now have to work like the rest of America. And, on average they still make more.

    It is hard to feel sorry for people complaining about being in the upper middle class, in one of the richest countries on earth.
  8. sirus_virus

    sirus_virus nonsense poster

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    nope.
  9. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    There weren't dual incomes in the article.
    And, having come from an industry where some folks start at this salary when they are still young and single, I would suggest that after 15 years of practice such as the guy in the article no, $120k would not be looked at as "a lot of money". Again, sure, it's more than the national average. That's not really the point -- every person who goes down this road had the opportunity to be average; the hope was to invest in yourself and do hopefully significantly better than that. But when you also spent $200k in debt and 10 years more of your life than the average person to get there, probably working longer hours than the average person too, I can see how it might be frustrating to have to downgrade cars, send your wife back to work, and have to pick up a side business to make ends meet. Once you earn $100k you will see that it doesn't go as far as you thought when you were in undergrad. As I've said in other threads, in medicine, you tend to be comfortable but not rich. This article supports that, showing folks who are even having to make lifestyle changes just to maintain comfortable.

    (Other countries are somewhat irrelevant to this discussion and you can always find someone on the planet who is doing worse -- doesn't mean you aren't getting hosed -- But in most foreign countries, you start down this road earlier, don't pick up the tab, the hours tend to be more reasonable, and the cost of living is often very different.)
  10. dewdrinker23

    dewdrinker23 Removed

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    120k in New York, Boston, San Francisco, San Diego, Chicago, Washington D.C., and some other places will not take you far. However, 120k in some Midwest City like Madison, Iowa City, St. Louis, and others can take you further. With having said that, the life style you live determines how far a 120k salary can take you. What is wrong with just having one car (a used car that cost less then 15k), having a 3 bedroom and 2 bathroom house (if you have 3 children or less), having a town house, and not buy new things every week.

    Look at this way:

    (Per month)

    House payment: $1,500
    Health Insurance: for a family of 5 - it all depends on your policy
    Car insurance: 500 dollars/3 months (for a small used car)
    Groceries: 400/month
    Utilities: 100/month
    Bills: 150/month (cable, internet, etc)
    School debt: 800/month

    You could theoretically have monthly expenses in the range of $3,000 – 5,000. This is based on a family of 5.

    On a 120k salary AFTER taxes are taken out will give you roughly a 10k monthly income.

    That is about all you need for monthly basics. Everything else is just extra (unless I missed some essential basics in my list).
  11. Phoenix.

    Phoenix. In memory of Riley Jane. Moderator Emeritus Lifetime Donor

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    Kikaku: I'm not going to make any statement on the adequacy or inadequacy of doctor's incomes under discussion here, but your plea, "please, please please, when you are a doctor making over 100K, remember what the average employee in America makes," is faintly ridiculous. You are comparing apples to oranges. Does the average U.S. employee invest a huge chunk of change in a medical school education and spend 8+ years in training?
  12. Kikaku21

    Kikaku21 Senior Member

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    Doctors, on average, make more than any other professional. On average, lawyers make less, MBAs make less, and any graduate school program pretty much makes less.

    For example:
    These starting at $120,000 lawyers you hear about graduate from the best law schools-- they are the best in the pack. Most lawyers make less-- and you have to subset to large, private firms to be at that level at all.

    So, to answer you question. Doctors make more, and they train more. Seems to make sense, huh?
  13. sirus_virus

    sirus_virus nonsense poster

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    BTW, it is not the present income that is the problem. The biggest problem is the decline of income. So that 120K that you are satisfied with might not be there 10 years from now.
  14. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    Your bills and utilities are extremely low for manhattan suburbs, and if one spouse is working in the ciy you either need a second car or a monthly commuter pass on the LIRR, so that's another decent expense. And gasoline. And you are assuming nothing every breaks, the kids are never growing out of clothes, no orthodontia, no private schools, no vacations, no eating out, no lawncare/home maintenance, etc.
    So as I suggested, comfortable (bordering on modest) but not rich. Which is fine, but don't plan on having money to burn.
  15. dewdrinker23

    dewdrinker23 Removed

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    Just how does the average American make it. It's actually not hard to figure it out. Guess why there are so many uninsured people in this country (for both health and car insurance)? It is because they can't afford it!!!!!!

    You are better of not having car insurance then you are not having health insurance.

    The average American makes about 25k I think. So the average married couple has about a 50k combined income (this is the national average). A 50k yearly income puts you at about a 4,166k montly income. So a 125k salary after taxes are taken out is a huge difference for the monthly income IF YOU LIVE SMART.
  16. Kikaku21

    Kikaku21 Senior Member

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    US physicians make MORE than ANY other physicians in the world. Come on. Yes, we will pick up the tab. But we make more--- by far. Yes, it takes longer. But again, we make more. Its a trade off. And I bet if you found the total earnings... the area under the curve, we'd come out ahead.

    Largely, I agree with you. Comfort, not wealth, is what we will have.

    But when I see an article like this, it just makes my skin crawl. People complaining about not being rich. People complaining about being comfortable in the upper middle class.

    We have the opportunity to work hard and get to somewhere because of it. We invest our time and take on debt, and really go somewhere. So many people NEVER have such an opportunity.

    Yet here we are, complaining. I think its crazy.
  17. MChitty

    MChitty

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    I personally think the debt argument is a little weak. I understand investing 8 years and coming out 200K or more in the hole afterwards sucks. But using that as reasoning that doctors should make more money is weird. People take on that kind of debt for undergrad and while I understand that it's only 4 years, there's no guarantee at all that you're going to make anywhere near 120K.

    I feel like it's a little hard to sympathize with a doc that has luxury cars etc. and has to 'downgrade.' I mean, it's unfortunate that physicians are feeling the crunch and that it's not as lucrative at is used to be, but at the same time, you can either work all the time or cut out some expenses and enjoy your life.
  18. mongrel

    mongrel Assoc. Prof. Dogsuit

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    Ok, so the main tool of a union, the WALK-OUT, is something that you'd be willing to do to your patients?
  19. dewdrinker23

    dewdrinker23 Removed

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    A yes, gas!!! Dah me. I don't know the expenses of sending a kid to school and such. The eating out is a choice, not something you need to do. Gas can be cheap or it could cost you a lot. That is why the majority of Americans that buy cars now are purchasing cars that get good MPG. But yet you still see people purchasing those Hummers :scared: .

    Living in the Manhattan suburbs is a choice, not something you need to do. I will refuse to live in a big city like New York, San Fran, Boston, etc because of the outragous cost of living.
  20. Kikaku21

    Kikaku21 Senior Member

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    Good. Move out of Manhattan.

    This will help solve the misdistribution of healthcare in America.

    Get rich in Iowa, and do something for the system.
  21. Koch

    Koch

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    You mean I won't get to live in a solid gold house with a rocket car. But that's the only reason I want to be a doctor. I have to seriously rethink my life.
  22. sirus_virus

    sirus_virus nonsense poster

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    Why not. Especially since my patiennts don't mind sueing the crap out of me for even stuff beyond my control. Dude, doctors are no longer special. Wake up.
  23. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    Not accurate. Yes, those lawyers coming out of the top schools or going into the big firms starting at $140k-150k are in the minority. But after 15 years of practice the number of lawyers making that amount is not insignificant. Many solo practitioners and partners at smaller or midsized firms are pulling in that kind of money, not just the big firm places. (Some of the big firm partners are pulling in 10 times that kind of money by 15 years out.)

    Also bear in mind that you get in trouble comparing averages, because it's somewhat of an apples and oranges comparison -- one group dwarfs the other significantly and encompases a much larger range of individuals. There are MORE lawyers earning six digits than doctors because there are many many times more lawyers. But the average is much much much lower because of the size of the group and the range. I've met lawyers who earn millions and lawyers who earn $20k. You don't see that kind of range in medicine. And I (and others) would argue that the typical person who has the stats that would enable him to decide between law or medicine would not be average in law, making the average a useless reference point.

    MBA is not actually a profession, so it often confusedly gets lumped into these discussions, but again the range is huge because folks with MBAs encompass a variety of jobs. I assume you meant I-banking, in which case there are analysts and brokers who earn lower salaries and bankers who can earn a ton. The key difference is that there is no ceiling, so the upside is much higher than any other field. If you are a risk taker and focused on money, it is perhaps a smarter choice than law or medicine.

    But none of this has much to do with the point of this thread, which was talking about how doctors aren't making bling anymore. So comparing other fields doesn't make them any richer. In fact, based on a study this past year, reported in the NYTimes, the average medical salary over the past decade receded by about 7% while law and other professions saw a 7% increase. Based on such data it's hard to argue that things haven't gotten worse for doctors even if you like to focus on other fields as a benchmark.
  24. mongrel

    mongrel Assoc. Prof. Dogsuit

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    Oh I am awake. Outside of actual *crack the whip* slavery, I couldn't justify hanging patients out to dry because I don't make enough money to pay on the third mortgage on my house. Maybe I'm being an idealist here, but I say that's the what we agree to and must deal with as physicians.
  25. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    If, 15 years out of med school and having a family to support you still think you are rich on $120k I will give you more credence. Until you get to that income level it sounds bigger than it is.
  26. Phoenix.

    Phoenix. In memory of Riley Jane. Moderator Emeritus Lifetime Donor

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    Kikaku: This statement is a little off: "These starting at $120,000 lawyers you hear about graduate from the best law schools-- they are the best in the pack. Most lawyers make less-- and you have to subset to large, private firms to be at that level at all."

    True, most lawyers make less. But otherwise, your statement is misleading. I was a lawyer. Starting salary for first years at top firms is more like $140,000. And you don't have to go to a big or even a top firm to get that kind of salary. Or have graduated from one of the top 10 law schools. I know lots of mid-sized law firms that pay that, and lots of attorneys who didn't go to a TOP school who can match that. Granted, they went to a good law school and graduated near the top of their class, but you're suggesting that only the top of the top at the largest top tier firms make that salary. Not so.

    But this is really neither here nor there. Law school is only 3 years. Tops. And nowhere near as expensive. In my opinion, lawyers shouldn't be making more than doctors. I think lawyers are over-paid as it is.
  27. BallerinaDoc

    BallerinaDoc Junior Member

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    Just wanted to point out that this article is from August 2001. I would be interested to see updated stats.
  28. mongrel

    mongrel Assoc. Prof. Dogsuit

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    I suppose so. But I think what most are doing is comparing to our parents or friends who still fall below this after having spent 15, 20, 25+ years in a career and still find themselves living comfortably. I think there is a large stigma for people going into medicine to believe they then become "finacially invincible" and subsequently find themselves under heavy debt after adding a large house, expensive car, and misc before they've actually established themselves financially. Those are the people who find themselves complaining about not making enough. What's wrong with living modest anyway?
  29. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    The average wage earner in the US has borrowed nothing -- no student loans at all. Someone who goes to an expensive college is not going to be the average. And the typical med school grad has borrowed for BOTH college and med school -- putting him way above the average, who again is debt-free. Which is why comparing to the average is not so useful. And the decade of time difference is the big ticket item.

    I don't necessarilly think their ought to be a quid pro quo for the time and expense you incur getting to be a physician. It just is frustrating when people point to some national average, of people they probably have never met, and say I'm rich compared to him/her. It's silly. Rich is based on an individual's buying power. If you have to take on a second job, send your spouse out to work, and downgrade things, in order to pay your mortgage etc, you aren't living the high life. That's all. It's comfortable, not rich. Which is fine. But people need to adjust their senses of reality. And some need to adjust their notions of how much money is a lot because once you get to $120k you will see that you can live a certain lifestyle but it's nothing close to what you would have imagined when you were in undergrad, particularly if you have decent expenses.
  30. jochi1543

    jochi1543 President, Gunner Central

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    I don't think the drop in income is necessarily terrifying. It's only terrifying for people whose only goal in the profession is to make money. Yes, it offers a good lifestyle, but it's not the kind of field where you're gonna get super-rich. Some specialties will let you earn tons of money, but they will also require many more years of poorly paid training (various surgery subspecialties) and often involve a poor lifestyle. It's a trade-off.

    Besides, the individual in the article has a stay-at-home wife. Get real, how many Americans can afford to have one parent not work.

    And honestly, here in Canada, we have a good # of doctors who choose to work part-time. Yes, malpractice insurance here is lower (the highest, for an ob-gyn, was about $25,000 a year when I last looked at it 2-3 years ago), but so are the salaries, so the net income is in the same range (I've seen the breakdowns, so I'm not just saying - US net salaries are only about 10-20% higher). These doctors simply trade off luxury lifestyles for something more reasonable in order to have less stress and more freedom. It all depends on your priorities. I think we all know that if money is your # priority, medicine is not for you.
  31. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    Actually, when you have two small children the cost of daycare can often use up much of the second spouses salary. Some people in such situations don't come out very far ahead sending the second spouse to work.
  32. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    If you are not able to put any money into savings or retirement funds during your most productive years you should be terrified, regardless of your goals. Bad things happen all the time and if you have no parachute, you are SOL.
  33. Koch

    Koch

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    And how do you know what I imagined when I was in undergrad. Not everyone sees being a doctor as a ticket to unimaginable wealth. Maybe 120k won't make me the richest man alive, but I would sure as hell be satisfied.
  34. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    That's fine -- I think doing what you want to do is more important than being rich. (Which is why I'm making the career change I'm making). But there are folks on here talking about how they have no sympathy for someone whining about only earning six digits, and I'm just pointing out that we are not really talking about someone absurdly wealthy. I don't know what you imagined in undergrad, but certainly know what I thought was a lot in undergrad and it really wasn't when I got there.
  35. jochi1543

    jochi1543 President, Gunner Central

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    Yup. Reminds me of that Chief Medical Examiner I visited/spoke with. He mentioned that his wife, a primary care physician, makes double what he does, however... You concluded from his conversation that he makes just about 120K (don't know if it's pre- or post-tax though). But he works 5 days a week 7 to 3, is on call 1 week a month (at once, not 7 days spread out over the entire month), and he doesn't have malpractice because he works with deceased patients. The state covers any legal issues that can arise in his field. Hardly a poor arrangement. To rub it in, he had the military pay for his schooling and graduated with zero debt. And he doesn't live in Manhattan or any other ridiculously expensive area (his title combined with his location would identify him, so I'm not gonna say where he lives).
  36. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    I'm not sure how someone with a dual household income of $360k and no debt has any relevance to an article about someone with higher expenses earning a third of that.:confused:
  37. Kikaku21

    Kikaku21 Senior Member

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    A few things here....

    On comparing averages with lawyers: What else would you have me compare? I always hear the comparison between lawyers making $150,000 starting, which is better than the doctor who peaks at $120,000. (Or some similar comparison.) This is comparison of the starting salary of a lawyer, usually from a good school, to the lowest salaried doctors in medicine. (The average is around $160K) I could compare orthopods to human rights lawyers and balk at that comparison as well. This is apples to oranges. In looking at lawyers vs. doctors, I see doctors have a higher average, and as you said, lawyers have a larger range. The best predictor of a distributions outcome is the average, so if you want to make more, be a doctor. Perhaps it is closer to even when you subtract the 3 - 5 years of residency at low pay. Both require an investment of between 100 and 200K for school, so we can ignore that.

    On MBAs: Yeah, its not a great comparison. But it is a path you can choose, and on average, it pays more like a profession and less like academia. So I include it. Coming from the business world myself, I can tell you that there are an awful lot of us in the $50 - 80 K range, with 10 years of experience. Looking at I-banking is taking the right hand side of distribution. Guys who come from the best schools usually, and work the hardest. They work harder than doctors, with 90+ hour weeks on average. This is also apples to oranges. So, compare the averages.

    On the point of the thread: Yes, its that doctors make less now than 20 years ago. I brought up the comparisons in order to point out that less is still more than most other professions/career pursuits. I find doctors complaining, while still being wealthy, to be a little silly. So I think making a comparison is plenty valid an argument to suggest toning down the complaints.
  38. jochi1543

    jochi1543 President, Gunner Central

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    I'm not talking about their household income, I'm talking about a doctor who makes the same amount and yet has a totally reasonable lifestyle - no complaints about open heart surgery. He is so stressed, his BP is sky-high? Anybody ever think of the kind of stress you have when you are a working-class single mom working MORE than that doctor does for $10 an hour? People like that can't "invest in their education" if they WANTED to - they just don't have the luxury of stopping to work or cutting down their work hours and studying at the same time.

    Anyway, I think these conversations serve well to show the underlying motivations behind people's ideas to go into medicine. If you are so appalled at the prospect of not driving a Ferrari and actually *gasp* being stressed out from working enough to make 120K, just go into another field.

    Think of all the doctors who go into rural medicine, missionary work, etc. You don't hear them b!tching about how poor they are - because they actually care about the work they do.
  39. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    I agree with your sentiment but think a whole lot of people on here have no understanding of the vast difference between being Ferrari rich and $120k comfortable.
  40. emaj1n

    emaj1n M1

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    Wow, this thread blew up. 120k is more than my parents make on a combined income. I'll take it. Oh, and I wouldn't live in a New York suburb (which is different than the "Manhattan suburb" discussed above).
  41. jochi1543

    jochi1543 President, Gunner Central

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    Yeah, I know what you are talking about. This is all about living beyond your means, whatever income you have. Choosing a ridiculously expensive neighborhood to live in, choosing a house bigger than you require, having more than 1 car (2 for a family), having a spouse stay at home are all just that, choices. Some of these, like the multiple cars and the stay-at-home wife or husband are not even available as choices for many people.

    BTW, in regards to childcare - I don't know what it costs in NY, but I just spoke to someone from around here last week who has 3 children and an au pair from the Philippines. She pays her $1200 a month and the lady gets free room and board. I know for a fact that in Vancouver (a much larger city - the woman I spoke to was from a rural area) the costs are the same. Of course, the free room in Vancouver would technically translate into more money, but then again, it's not like these families would normally rent those rooms out for cash to some stranger. Besides, her au pair also does housework, cooking, and what not, so it's really a great arrangement - (for the housekeeper as well, because she's there to get Canadian citizenship, which comes fast for them through the au pair program). So unless your spouse is only capable of earning $10 an hour and is not willing to work full-time, this is definitely a child care solution. I can't imagine there being some sort of DRASTIC cost difference in the States.
  42. jochi1543

    jochi1543 President, Gunner Central

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    BTW, I hate to ask having come back from New York just 3 weeks ago, but WTF is a "Manhattan suburb"? You mean, Queens or something?
  43. Dayfed

    Dayfed

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    Wow, I feel strange that I'm going to be the first to say that there's a lot more to being a doctor than just money.

    yes, it's stressful, yes it takes up a lot of your time and money in education, yes, you'll probably lose sleep over your job, yes, it's the most intense training of any job.

    But think about this, if you know that it is what you want to do, you'll find a way. I feel like there is no more rewarding job on earth. Anything that is rewarding takes a lot of stress and effort to achieve. But making people's lives better is a risk I'm willing to take, because I feel that it is my purpose, my calling.

    Is money important? Absolutely. Is it my priority? not my first.
  44. mongrel

    mongrel Assoc. Prof. Dogsuit

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    Ha... you weren't the first.
  45. emaj1n

    emaj1n M1

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    My point exactly.
  46. Funky

    Funky This space is for sale

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    I believe they're talking about LI or Westchester. I guess some parts of queens could be considered a suburb.
  47. jochi1543

    jochi1543 President, Gunner Central

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    No, I was before you.:smuggrin: LOL.:laugh:
  48. jochi1543

    jochi1543 President, Gunner Central

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    I get it now, hehe.:laugh: I was like, "maybe I just don't know the area enough or something? Must not embarrass self on SDN!":scared:
  49. sirus_virus

    sirus_virus nonsense poster

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    Just in case you have not noticed, the problems doctors are facing are a whole lot more than just money.
  50. riceman04

    riceman04

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    agree for the most part :thumbup:

    The diff though is that you will most likely be drowning in debt if you go to medical school

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