Did the expected salary for psychiatry make you hesitate about choosing psychiatry? If yes, how did you get over your hesitation?

[LimpSpatula]

That's not that hard to do in any setting. Inpatient or outpatient.

I worry about saying this aloud in our current climate. “And the doctor just sits there with their nice office, barking orders at the hard working nurses....woeisme.exe”

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[calvnandhobbs68]

I worry about saying this aloud in our current climate. “And the doctor just sits there with their nice office, barking orders at the hard working nurses....woeisme.exe”

lol you could say the same thing about derm or radiology...and they both make more money on average than psych

"and the doctor sits in his nice office sipping his latte looking at a computer screen all day"
"the doctor sits in her nice beverly hills office doing botox all day"

 

[LimpSpatula]

lol you could say the same thing about derm or radiology...and they both make more money on average than psych

"and the doctor sits in his nice office sipping his latte looking at a computer screen all day"
"the doctor sits in her nice beverly hills office doing botox all day"

Except a layman, MA, or Nurse looking at an image or any surgical procedure will think they could never do that job. We’re “just talking to people about their feelings and prescribing the same 8 medications. “

 

[Copper_Tracker]

Lets split the difference and say you personally wanted to make 750k. What would you do to make that happen?

Open a practice. You have to be a business owner, otherwise your labor is making somebody else rich

 

[Monocles]

What kind of jobs should one be looking at if they want a cush 200-300k job that allows for <40 hours a week. Would this be primarily inpatient?

Inpatient. Academia is doable, but you would have the best luck w/ locums. One of the job offers that I had last year was rounding on 10-12 pts for 384k a year. (just for ****s and giggles I negotiated up to 430k to have some negotiating practice) The MD who did it before me consistently got out before lunch each day. However the facility had chronic legal liability concerns so I ended up taking a community/academic job at a more reputable place.

I was so incredibly burned out at the end of fellowship that I made "lifestyle" my #1 goal in terms of job searches. The salary is only low 200s but the caseload is FAR lighter. (I haven't been above 6 at ANY given time) I'm a super saver anyway so even on a 200k salary I am still projected to retire and never work again by age 37, so it made sense for me the find the most humanly cush possible gig and just coast on that.

 

[Monocles]

Lets split the difference and say you personally wanted to make 750k. What would you do to make that happen?

Easiest way is probably cash only private practice. At $1000 a new eval/ $500 for 30 min follow up/ $750 for 45 min therapy you can see 20 patient hours a week, have 4 weeks off, and still swing that.

If you hate outpatient or don't like the responsibility of owning your patient panel, you can always cobble together a mix of an easy inpt gig, some consulting for schools (if kids) or nursing homes (if geri), and work some weekend/night ED shifts. But honestly that feels like way too much work.

 

[Mass Effect]

Easiest way is probably cash only private practice. At $1000 a new eval/ $500 for 30 min follow up/ $750 for 45 min therapy you can see 20 patient hours a week, have 4 weeks off, and still swing that.

If you hate outpatient or don't like the responsibility of owning your patient panel, you can always cobble together a mix of an easy inpt gig, some consulting for schools (if kids) or nursing homes (if geri), and work some weekend/night ED shifts. But honestly that feels like way too much work.

How does someone get a school consulting gig?

 

[Monocles]

How does someone get a school consulting gig?

In the Boston area the child training programs would have connections. From friends and attendings who have done it, they just simply expressed interest and would get put into contact w/ school admin. It might be a cultural thing here but every fancy school that can afford one has their own in-house psychiatrist, or a contracted consultant.

I imagine in most other areas, check w/ your academic psychiatry centres, outside of that if you are private practice, perhaps cold calling the school?

 

[calvnandhobbs68]

In the Boston area the child training programs would have connections. From friends and attendings who have done it, they just simply expressed interest and would get put into contact w/ school admin. It might be a cultural thing here but every fancy school that can afford one has their own in-house psychiatrist, or a contracted consultant.

I imagine in most other areas, check w/ your academic psychiatry centres, outside of that if you are private practice, perhaps cold calling the school?

Yeah the school consulting thing can be nice or be a pain depending on the setup. I think somewhere that can support super high end private schools with their own psych "consultant" is probably pretty lucrative (Boston, Chicago, NYC, SF, etc etc). but what I've seen is usually contracting out to public school districts or special ed schools. Which is nice if you want that kind of exposure (I might actually do something like that a day a week when the PP is more smooth sailing in the next year here), because then you can end up seeing the more medicaid/trauma/developmental disorder/autism population without having to worry about billing medicaid/insurance (they usually just pay you a set hourly rate to see the kids) and can see more what the school environment is like. But I could definitely make more per hour seeing followups in my private practice, it's more of wanting to see more of that population.

These can definitely be part time gigs though, as most school districts can't support someone coming in 5 days a week anyway, so they'll pay you a set hourly rate to come in 1-2 days a week.

 

[Monocles]

I think somewhere that can support super high end private schools with their own psych "consultant" is probably pretty lucrative (Boston, Chicago, NYC, SF, etc etc). but what I've seen is usually contracting out to public school districts or special ed schools.

That is a very good point! It very much depends on the market in your geographical location.

 

[tr]

Lets split the difference and say you personally wanted to make 750k. What would you do to make that happen?

Cash only ketamine clinic with upscale spa decor and wellness-type marketing perhaps?

 

[Sushirolls]

Cash only ketamine clinic with upscale spa decor and wellness-type marketing perhaps?

Let's sprinkle in some LSD therapy while we're at it.

 

[TexasPhysician]

Cash only ketamine clinic with upscale spa decor and wellness-type marketing perhaps?

Having looked into ketamine clinics, they generally aren’t that profitable. You’ve got the machines, increased staff, marketing, etc. It isn’t cheap. Each infusion is 1+ hour. How many can you do at once? It’s not many without hiring midlevels or doing them in a group room at a discount price with no privacy. Typical gross rate in my city is <$400/infusion. If I was willing to see high volume to maximize profit, I could make a lot more net by just seeing patients.

 

[Sushirolls]

Why would you need to have privacy in the room? Oncology does infusions in big rooms. If anything having more people would be nice. When I did them in residency every one was bored out of their mind wanting some sort of conversation to pass the time.

 

[hamstergang]

The salary is only low 200s ... I'm a super saver anyway so even on a 200k salary I am still projected to retire and never work again by age 37

If you graduated fellowship at 31 (as I did, people are generally not younger), that gives you 6 years of working. Even at a $250k salary and saving all of it paying no taxes, that's only $1.5 million. I feel I'm missing something.

 

[TexasPhysician]

Why would you need to have privacy in the room? Oncology does infusions in big rooms. If anything having more people would be nice. When I did them in residency every one was bored out of their mind wanting some sort of conversation to pass the time.

With ketamine, people are dissociating and some have bad trips. You’ll be more sensitive to sounds. One person starts getting frustrated and everyone will have a bad experience. Multiple bad experiences and negative reviews and there goes your business. The average ketamine center in my city has 4.9 stars on Google. Two 1 star reviews puts you dead last in the city for something that costs $2100 for a 6 part series.

 

[robellis]

If you graduated fellowship at 31 (as I did, people are generally not younger), that gives you 6 years of working. Even at a $250k salary and saving all of it paying no taxes, that's only $1.5 million. I feel I'm missing something.

They conveniently leave out their spouse is a doctor…

 

[Monocles]

If you graduated fellowship at 31 (as I did, people are generally not younger), that gives you 6 years of working. Even at a $250k salary and saving all of it paying no taxes, that's only $1.5 million. I feel I'm missing something.

Ah you are correct. The magic of compound interest my friend.

I've been saving like mad since residency and fellowship and averaged about 22k a year during training. All invested in sp500 each year. I finished fellowship with 110k in savings and 50k of stock market gains on top of that due to having good fortune of being in a bull market. The metaphorical snowball will be doing the bulk of the lifting to help me reach retirement goals. I actually don't have to save more than 100-120k a year to hit that 2M mark.

Doing some monte carlo simulations, my path to FIRE looks something like this, with the "zero" point set as Jan 1 2022, with a projected 240k in invested assets, near ~100% in VFIAX (vanguard sp500 admiral shares). Monthly contribution is 9k (saved from out of 11.5k post-tax salary)

And this is assuming more conservative market returns each year (50th percentile being 11% annual in next 10 years) and no bonuses, salary increases, inflation adjustments etc. So yeah 6-ish years is perfectly reasonable. I'm also thinking of picking up some sidegigs to accelerate my retirement too...

 

[Monocles]

They conveniently leave out their spouse is a doctor…

Nope! Wife is a grad student and makes <40k a year. Projections currently account for zero spousal contributions. I will likely be retired by the time wife finishes her advanced degrees.

 

[robellis]

Ah you are correct. The magic of compound interest my friend.

I've been saving like mad since residency and fellowship and averaged about 22k a year during training. All invested in sp500 each year. I finished fellowship with 110k in savings and 50k of stock market gains on top of that due to having good fortune of being in a bull market. The metaphorical snowball will be doing the bulk of the lifting to help me reach retirement goals. I actually don't have to save more than 100-120k a year to hit that 2M mark.

Doing some monte carlo simulations, my path to FIRE looks something like this, with the "zero" point set as Jan 1 2022, with a projected 240k in invested assets, near ~100% in VFIAX (vanguard sp500 admiral shares). Monthly contribution is 9k (saved from out of 11.5k post-tax salary)

And this is assuming more conservative market returns each year (50th percentile being 11% annual in next 10 years) and no bonuses, salary increases, inflation adjustments etc. So yeah 6-ish years is perfectly reasonable. I'm also thinking of picking up some sidegigs to accelerate my retirement too...

You’re assuming 11 percent returns every year and calling that conservative? Also what about student loans?

 

[Monocles]

You’re assuming 11 percent returns every year and calling that conservative? Lol

I know past performance =/= future returns, but my rate of return on investments is 23.7% annually. We're already 20% YTD... so...

Best case scenario the market shaves another year or two off my career. Worst case scenario there's a 30% correction, in which I'll go harder and pick up a second job and throw every penny I got into that 30% discount and ride it out.

 

[tr]

Ah you are correct. The magic of compound interest my friend.

I've been saving like mad since residency and fellowship and averaged about 22k a year during training. All invested in sp500 each year. I finished fellowship with 110k in savings and 50k of stock market gains on top of that due to having good fortune of being in a bull market. The metaphorical snowball will be doing the bulk of the lifting to help me reach retirement goals. I actually don't have to save more than 100-120k a year to hit that 2M mark.

Doing some monte carlo simulations, my path to FIRE looks something like this, with the "zero" point set as Jan 1 2022, with a projected 240k in invested assets, near ~100% in VFIAX (vanguard sp500 admiral shares). Monthly contribution is 9k (saved from out of 11.5k post-tax salary)

And this is assuming more conservative market returns each year (50th percentile being 11% annual in next 10 years) and no bonuses, salary increases, inflation adjustments etc. So yeah 6-ish years is perfectly reasonable. I'm also thinking of picking up some sidegigs to accelerate my retirement too...

But what is the logic behind training for 12 years for a profession you only plan to practice for 6? Why wouldn't you just go to a trade school out of HS, start working as a plumber or electrician at 20, do your frugality/investment thing, and retire at 35? We just had a plumber come through who charged us $600 for something that took him an hour. That's more than my hourly and he did (I assume) 2 years of training post high school while I did 18.

 

[Monocles]

But what is the logic behind training for 12 years for a profession you only plan to practice for 6?

I had actually wanted to be a painter (applied to be an art major to college) but long-story short, parental pressure led me to medicine and I didn't know any better back then. Within the first few weeks of med school, I realised it was not a very good fit but was led to believe that other careers just weren't financially viable. I did not find medicine interesting throughout the past decade, but liked working with kids and teens enough to get me through now.

At this point it becomes a sunken cost fallacy. I could leave medicine in my mid-30s and go pursue my dreams of being an artist (without ever having to worry about money again), or I could keep practicing medicine into my 60s or whatever and regret never having had the opportunity to do what I loved on my deathbed. So it's a pretty clear cut personal decision for me.

Why wouldn't you just go to a trade school out of HS, start working as a plumber or electrician at 20, do your frugality/investment thing, and retire at 35? We just had a plumber come through who charged us $600 for something that took him an hour. That's more than my hourly and he did (I assume) 2 years of training post high school while I did 18.

This is a bit of a catch 22. I think that if I had not experienced the misery of residency, I would not have been desperate enough to find ANY means out of medicine possible and stumbled onto the FIRE movement. There's probably a very happy me who works as a plumber in an alternative universe that lives paycheck to paycheck, and would have never dreamed about retirement lol.

 

[Psychresy]

But what is the logic behind training for 12 years for a profession you only plan to practice for 6? Why wouldn't you just go to a trade school out of HS, start working as a plumber or electrician at 20, do your frugality/investment thing, and retire at 35? We just had a plumber come through who charged us $600 for something that took him an hour. That's more than my hourly and he did (I assume) 2 years of training post high school while I did 18.

Because then you'll have to be a plumber.

 

[LimpSpatula]

Because then you'll have to be a plumber.

Who’s interventions have effect size >1. We’re lucky to be paid this well and have this level of respect, although the latter is dwindling. Not to pick on you but not so long ago a plumber had much more respect than a psychiatrist.

 

[Mad Jack]

Ah you are correct. The magic of compound interest my friend.

I've been saving like mad since residency and fellowship and averaged about 22k a year during training. All invested in sp500 each year. I finished fellowship with 110k in savings and 50k of stock market gains on top of that due to having good fortune of being in a bull market. The metaphorical snowball will be doing the bulk of the lifting to help me reach retirement goals. I actually don't have to save more than 100-120k a year to hit that 2M mark.

Doing some monte carlo simulations, my path to FIRE looks something like this, with the "zero" point set as Jan 1 2022, with a projected 240k in invested assets, near ~100% in VFIAX (vanguard sp500 admiral shares). Monthly contribution is 9k (saved from out of 11.5k post-tax salary)

And this is assuming more conservative market returns each year (50th percentile being 11% annual in next 10 years) and no bonuses, salary increases, inflation adjustments etc. So yeah 6-ish years is perfectly reasonable. I'm also thinking of picking up some sidegigs to accelerate my retirement too...

This guy has my strategy.

I'm probably going to keep working forever, but I'll have enough in the bank to be able to walk away around 9 years in (I've got a lot of student loans)

 

[TexasPhysician]

Because then you'll have to be a plumber.

I’d be pleased if one of my children becomes a plumber or electrician. How many people price shop when they need a plumber? Met a plumber who only takes jobs >$200/hr. I’m trying to have a small lighted/mounted sign moved from one building to another less than 1 mile away. Finding an electrician to do it for <$1000 has been impossible and still none within 1 week.

If you can instill good financial education including starting your own business, the potential is high.

 

[Monocles]

This guy has my strategy.

I'm probably going to keep working forever, but I'll have enough in the bank to be able to walk away around 9 years in (I've got a lot of student loans)

You got this friend!!! 💪

I know the market is multifactorial and my enthusiasm for finance is sadly NOT matched by knowledge... but in speaking with experts who know far more than I do, the sentiment is that Jerome Powell has been an extremely popular fed reserve chair who is well liked on a bipartisan basis. Under his policy we've essentially weathered through the covid crisis (in market terms) and his actions send a very secure and powerful message to investors in building faith in our financial institutions.

Long story short, I'm optimistic that the 20s will be an AMAZING decade for physicians to build wealth and really knock out debt. The wind is in our sails!!

 

[Bartelby]

I'm aiming for financial independence too, which I should reach within 5 years (with a high earning spouse but a bit less discipline than others here I think!). I think knowing I'm choosing to work every day (which I intend to keep doing) will make this career path even better. And I also earn a pretty standard salary working pretty normal hours. Early FI is still very achievable in psychiatry unless you start out with absolutely crushing debt levels.

 

[Psychresy]

Who’s interventions have effect size >1. We’re lucky to be paid this well and have this level of respect, although the latter is dwindling. Not to pick on you but not so long ago a plumber had much more respect than a psychiatrist.

Yeah I guess I just don't see the satisfaction in helping unclog ****ty pipes at all comparable to the work we do in psych. so yah you can bill 200 bucks an hour, but the meaningfulness in that sort of routine manual labor is kind of miniscule.

 

[Stagg737]

Ah you are correct. The magic of compound interest my friend.

I've been saving like mad since residency and fellowship and averaged about 22k a year during training. All invested in sp500 each year. I finished fellowship with 110k in savings and 50k of stock market gains on top of that due to having good fortune of being in a bull market. The metaphorical snowball will be doing the bulk of the lifting to help me reach retirement goals. I actually don't have to save more than 100-120k a year to hit that 2M mark.

Doing some monte carlo simulations, my path to FIRE looks something like this, with the "zero" point set as Jan 1 2022, with a projected 240k in invested assets, near ~100% in VFIAX (vanguard sp500 admiral shares). Monthly contribution is 9k (saved from out of 11.5k post-tax salary)

And this is assuming more conservative market returns each year (50th percentile being 11% annual in next 10 years) and no bonuses, salary increases, inflation adjustments etc. So yeah 6-ish years is perfectly reasonable. I'm also thinking of picking up some sidegigs to accelerate my retirement too...

If you don't mind me asking, what simulator are you using above? Or is that a personal spreadsheet you or an advisor made?

 

[Monocles]

If you don't mind me asking, what simulator are you using above? Or is that a personal spreadsheet you or an advisor made?

Portfolio visualiser!

Monte Carlo Simulation

Online Monte Carlo simulation tool to test long term expected portfolio growth and portfolio survival during retirement

www.portfoliovisualizer.com

It's really fun and I'm kind of obsessed with it. Let me know if you have any questions about the parameters and stuff!

 

[Ludwig2000]

Who’s interventions have effect size >1. We’re lucky to be paid this well and have this level of respect, although the latter is dwindling. Not to pick on you but not so long ago a plumber had much more respect than a psychiatrist.

I don’t doubt what you’re saying here, but am curious which era you’re referring to?
I had thought there was a time during the psychoanalysis heyday when psychiatrists were quite respected (maybe depending on who you asked). Others might say that the biological revolution + “effective medications” of one form or another is when they started gained/regaining respect. Wonder if you would expound, thanks

 

[LimpSpatula]

I don’t doubt what you’re saying here, but am curious which era you’re referring to?
I had thought there was a time during the psychoanalysis heyday when psychiatrists were quite respected (maybe depending on who you asked). Others might say that the biological revolution + “effective medications” of one form or another is when they started gained/regaining respect. Wonder if you would expound, thanks

The 60s and 70s and what I predict will be the late 2020s and 30s, following the continuing failure of novel treatments. Eventually someone will say “Where is all this money going?”

 

[whopper]

I went to medical school only to be a psychiatrist because I loved psychology as a major. I entered with an open-mind considering something might lure me in but stuck with psychiatry after I did my clinical rotations. Ob-Gyn and surgery were the next-best things I enjoyed.

Psychiatrists make less in several yearly reviews vs other fields of medicine, but they don't take into consideration that psychiatrists don't work as many hours as many of the other professions. E.g. if the average psychiatrist worked, (and this is only an example to clarify a point) say, 40 hours a week and was making $200K, and surgeon worked $400K a year while working 80 hours a week then there really is no hour-hour difference. A psychiatrist could choose to work those types of hours if they wanted. In this situation money-wise alone I'd prefer psychiatry cause then you make the same hour-hour and and you have the choice to work less hours while most surgery departments have more stringent requirements on work hours.

While the above is only an example, each time I see those average annual salary thingees I never see an hour-hour breakdown other than it only says "working full-time."

Also in terms of making money, really becoming wealthy is really about force-multiplying your income in various ventures such as investment. If you work less hours as a doctor you have more mental room to invest as a hobby and actually know what you're doing. Almost all surgeons I know are bone-tired from working excessively and make bad investments. You have very little room to do anything else than be a surgeon.

Further I make way more now in psychiatry than the median income for a surgeon, and I work about 50 hours a week. So what do I care? There's a lot of opportunity in this field and salaries aren't static. It's not like you graduate and bam-same salary as everyone else. You do good work, go to the right place, etc. there's high room for improving your income.

 

[PikminOC]

Because then you'll have to be a plumber.

Better than being a doctor.

 

[Psychresy]

Better than being a doctor.

I dunno. I've been working with a woman get over the trauma of being raped by her step father. After six months she's finally starting to turn a corner. She's got a 3 year old with whom she is much better able to engage with now too; maybe this kid will end up with a better life as a result of the work we're doing and the cycle will diminish. Stuff like that seems so much better than unclogging pipes, but maybe I'm missing something about the virtues of plumbing?

 

[PikminOC]

I dunno. I've been working with a woman get over the trauma of being raped by her step father. After six months she's finally starting to turn a corner. She's got a 3 year old with whom she is much better able to engage with now too; maybe this kid will end up with a better life as a result of the work we're doing and the cycle will diminish. Stuff like that seems so much better than unclogging pipes, but maybe I'm missing something about the virtues of plumbing?

Plumbing is better. Problem solved fast

 

[PikminOC]

Ah you are correct. The magic of compound interest my friend.

I've been saving like mad since residency and fellowship and averaged about 22k a year during training. All invested in sp500 each year. I finished fellowship with 110k in savings and 50k of stock market gains on top of that due to having good fortune of being in a bull market. The metaphorical snowball will be doing the bulk of the lifting to help me reach retirement goals. I actually don't have to save more than 100-120k a year to hit that 2M mark.

Doing some monte carlo simulations, my path to FIRE looks something like this, with the "zero" point set as Jan 1 2022, with a projected 240k in invested assets, near ~100% in VFIAX (vanguard sp500 admiral shares). Monthly contribution is 9k (saved from out of 11.5k post-tax salary)

And this is assuming more conservative market returns each year (50th percentile being 11% annual in next 10 years) and no bonuses, salary increases, inflation adjustments etc. So yeah 6-ish years is perfectly reasonable. I'm also thinking of picking up some sidegigs to accelerate my retirement too...

2 Mill is enough to live 40 more years on?

 

[frosted2]

Inpatient. Academia is doable, but you would have the best luck w/ locums. One of the job offers that I had last year was rounding on 10-12 pts for 384k a year. (just for ****s and giggles I negotiated up to 430k to have some negotiating practice) The MD who did it before me consistently got out before lunch each day. However the facility had chronic legal liability concerns so I ended up taking a community/academic job at a more reputable place.

I was so incredibly burned out at the end of fellowship that I made "lifestyle" my #1 goal in terms of job searches. The salary is only low 200s but the caseload is FAR lighter. (I haven't been above 6 at ANY given time) I'm a super saver anyway so even on a 200k salary I am still projected to retire and never work again by age 37, so it made sense for me the find the most humanly cush possible gig and just coast on that.

Damn. Good for you!!!!! Thats awesome!!

 

[hallowmann]

2 Mill is enough to live 40 more years on?

4% rule means $80k a year withdrawal indefinitely. If you want to be more conservative, using FireCalc suggests that $2 mil with $80k withdrawal annually will last 40 yrs in 85.6% of projections. They'll be collecting social security before the end of that though. Cutting withdrawal annually to $75k increases it to 93.7%.

 

[PikminOC]

4% rule means $80k a year withdrawal indefinitely. If you want to be more conservative, using FireCalc suggests that $2 mil with $80k withdrawal annually will last 40 yrs in 85.6% of projections. They'll be collecting social security before the end of that though. Cutting withdrawal annually to $75k increases it to 93.7%.

Will that money always be worth the same?

 

[Bartelby]

Here is one article on the "4% safe withdrawal rate:" What Is The 4% Rule For Retirement Withdrawals?

Basically in early retirement communities the thinking is that if you withdraw only 4% of your total investment portfolio each year you can keep that going indefinitely even accounting for inflation. So basically once you can live on 4% of your total wealth you have hit a level where you can make it indefinitely without working for additional income and are thus truly financially independent. This calculation is based on past market performance, which does not guarantee the future but gives you a good gauge. In reality, you can also either do some work or reduce spending in bad times to further ensure your savings will last if you need an extra cushion.

 

[hallowmann]

Will that money always be worth the same?

No, but there are ways you can calculate how inflation will affect things. As you can also see in those calculators, there is quite a range for what the outcome might look like (your net worth might go up by a factor of 10 or you might completely run out). You can adjust how much you take out each year depending on what the year looks like, move some money around to target better investments, choose where you take it from, etc. Take out less early on and you'll have much more later when the dollar isn't worth as much.

 

[Monocles]

2 Mill is enough to live 40 more years on?

Will that money always be worth the same?

Great questions.

No, but there are ways you can calculate how inflation will affect things. As you can also see in those calculators, there is quite a range for what the outcome might look like (your net worth might go up by a factor of 10 or you might completely run out). You can adjust how much you take out each year depending on what the year looks like, move some money around to target better investments, choose where you take it from, etc. Take out less early on and you'll have much more later when the dollar isn't worth as much.

Hallowmann is exactly right.

I ran these calculations at the beginning of the 2021 calendar year for funsies and nearly shat bricks when I saw the numbers on the upper projections. I thought to myself "there's no way this is right" and had a couple of financial advisors verify it and they did. Essentially with a 2M portfolio, if you go with a 3% SWR (safe withdrawal rate) instead of a 4%, all projections survive into perpetuity. The truly crazy part is how much the portfolio can balloon over the course of decades. I remember asking my financial advisor "wait so if I retire by 40 on 2M, never work a single day again in my life and withdraw 3%, there's a 50-50 chance that I'll end up with 16M by age 70???" and his answer was "yup that's how compound interest works".

Of course we have to take into consideration inflation as well. At the rate things are going (5% inflation will likely stretch into the end of 2022 at least, I'm calling it now!), in the more pessimistic projections, 100k in 2060 will only have a fraction of the purchasing power compared to 60k in 2030. Hopefully even in retirement I'll be actively learning more and adjusting my portfolio in the decades to come to mitigate that.

This graph is nearly 10 months out of date. Looking at it now it's stupid how much the market has grown this year and has essentially shaved off another 3 years in my retirement projection. (down from age 40 to 37 FIRE)

 

[PikminOC]

In 2008 with the crash lots of physicians who thought they could retire had to keep working.

 

[Monocles]

In 2008 with the crash lots of physicians who thought they could retire had to keep working.

Well, yes. If you have the unfortunate timing of a recession or a -56% drawdown occurring at the beginning or your retirement, there's no option but to go back. The question is for how long though? Assuming a physician put off retirement from 2008 until the market recovering to the original position in 2011, that's only three extra years of working. During that time if they had been contributing per usual, they would have enjoyed that MASSIVE 56% discount on stocks and I would argue be way ahead in numbers than if the recession had never happened at all.

Interestingly we have not talked about the 2020 covid crash with a notable -34% drawdown... which ONLY lasted 6 months. If you had 2M the day before the market dropped in Feb 2020 and held the entire way through, not only would you be back to your original numbers by Aug 2020, but at 2.6M easy by today. Do I know docs who went back to work last summer? Sure. But they've all gone back to retirement now as soon as the market perked up again w/ news of vaccines. (n of 3 personally)

 

[PikminOC]

I went to medical school only to be a psychiatrist because I loved psychology as a major. I entered with an open-mind considering something might lure me in but stuck with psychiatry after I did my clinical rotations. Ob-Gyn and surgery were the next-best things I enjoyed.

Psychiatrists make less in several yearly reviews vs other fields of medicine, but they don't take into consideration that psychiatrists don't work as many hours as many of the other professions. E.g. if the average psychiatrist worked, (and this is only an example to clarify a point) say, 40 hours a week and was making $200K, and surgeon worked $400K a year while working 80 hours a week then there really is no hour-hour difference. A psychiatrist could choose to work those types of hours if they wanted. In this situation money-wise alone I'd prefer psychiatry cause then you make the same hour-hour and and you have the choice to work less hours while most surgery departments have more stringent requirements on work hours.

While the above is only an example, each time I see those average annual salary thingees I never see an hour-hour breakdown other than it only says "working full-time."

Also in terms of making money, really becoming wealthy is really about force-multiplying your income in various ventures such as investment. If you work less hours as a doctor you have more mental room to invest as a hobby and actually know what you're doing. Almost all surgeons I know are bone-tired from working excessively and make bad investments. You have very little room to do anything else than be a surgeon.

Further I make way more now in psychiatry than the median income for a surgeon, and I work about 50 hours a week. So what do I care? There's a lot of opportunity in this field and salaries aren't static. It's not like you graduate and bam-same salary as everyone else. You do good work, go to the right place, etc. there's high room for improving your income.

Where are you working now?

 

[whopper]

Something I've heard from several private practice owners say is the key thing about it is adaptability. You have to be on top of a lot of stuff you wouldn't have to worry about as a hospital doctor. You are in charge of salaries, you need to hire the right team, you could hire someone who is terrible, employees get sick, quit, get fired, changes happen in the field that change your practice, etc.

Where are you working now?

I do private practice and I'm the medical director of an addiction clinic. I do some forensic work on the side.

The private practice is 5 days a week but one is a half day. The addiction clinic stuff is the other half day. The addiction clinic is largely self-running. I got an awesome team and they only have to call me on the tough stuff. The clinic also has room for rapid expansion and the owner told me he's got plans to make this a multicenter thing (it's already 3 sites) with dozens of sites in several states so the addiction clinic may in the future supercede my private practice.

Each of these things have brought me much more pay than usual work. My private practice generates much more money than the average or median income as a psychiatrist. The addiction clinic pays me 6 figures for a half-day of work but if a real bad and serious case comes in I have to be ready to work all day long on it. This almost never happens so part of that pay is the expectation of things could get serious. In the last year this only happened once and it was really the therapists making a mountain out of a molehill.

Personally both jobs are very fulfilling. I make good money and at the addiction clinic I'm mostly in administration offering leadership that they want from someone with experience although I do see patients because as I told them, I won't know how the institution's running unless I'm also on the field seeing what's happening. I liken my job to less of me being a clinician and more of me being like Gordan Ramsay coming to a train-wreck restaurant, fixing it, and then maintaining it. We're past the first 2 stages. Now that it's stage 3 it's easy and good money. The addiction clinic's leadership (minus myself and a few others) are also mostly ex-addicts that really give a damn and want to pay it forward. That was very refreshing to me to work with an administration that gives a damn.

The owner of the addiction clinic is a highly successful businessman who wanted to divert a large sum of money into a dream addiction clinic cause his own journey to going clean was something where he wanted others to get the same experience. I was hired because one of the top addiction therapists in the area specifically recommended me. Which is why I tell people always do a good job. Aside that in our field where we heal people this is ethically mandatory it can pay off bigtime. I got the problem now of being very comfortable or taking to the next (likely stressful) level of being a part of a rapid expansion into something that could become several states-wide and working with some very powerful people in this process. I'm being introduced to some powerful people with national business reputations. As cool as this sounds, I'm a bit wary about this cause I'm enjoying being a father and having time with my family. When I first joined this place the first few months were a lot of work because I had to whip a lot of people into shape and fire some idiot doctors and NPs. I know with each new place we open it'll be another venture into whipping a new team into shape and each existing place requires maintenance.

 

[robellis]

Something I've heard from several private practice owners say is the key thing about it is adaptability. You have to be on top of a lot of stuff you wouldn't have to worry about as a hospital doctor. You are in charge of salaries, you need to hire the right team, you could hire someone who is terrible, employees get sick, quit, get fired, changes happen in the field that change your practice, etc.

I do private practice and I'm the medical director of an addiction clinic. I do some forensic work on the side.

The private practice is 5 days a week but one is a half day. The addiction clinic stuff is the other half day. The addiction clinic is largely self-running. I got an awesome team and they only have to call me on the tough stuff. The clinic also has room for rapid expansion and the owner told me he's got plans to make this a multicenter thing (it's already 3 sites) with dozens of sites in several states so the addiction clinic may in the future supercede my private practice.

Each of these things have brought me much more pay than usual work. My private practice generates much more money than the average or median income as a psychiatrist. The addiction clinic pays me 6 figures for a half-day of work but if a real bad and serious case comes in I have to be ready to work all day long on it. This almost never happens so part of that pay is the expectation of things could get serious. In the last year this only happened once and it was really the therapists making a mountain out of a molehill.

Personally both jobs are very fulfilling. I make good money and at the addiction clinic I'm mostly in administration offering leadership that they want from someone with experience although I do see patients because as I told them, I won't know how the institution's running unless I'm also on the field seeing what's happening. I liken my job to less of me being a clinician and more of me being like Gordan Ramsay coming to a train-wreck restaurant, fixing it, and then maintaining it. We're past the first 2 stages. Now that it's stage 3 it's easy and good money. The addiction clinic's leadership (minus myself and a few others) are also mostly ex-addicts that really give a damn and want to pay it forward. That was very refreshing to me to work with an administration that gives a damn.

The owner of the addiction clinic is a highly successful businessman who wanted to divert a large sum of money into a dream addiction clinic cause his own journey to going clean was something where he wanted others to get the same experience. I was hired because one of the top addiction therapists in the area specifically recommended me. Which is why I tell people always do a good job. Aside that in our field where we heal people this is ethically mandatory it can pay off bigtime. I got the problem now of being very comfortable or taking to the next (likely stressful level) of being a part of a rapid expansion into something that could become several states-wide and working with some very powerful people in this process. I'm a bit wary about this cause I'm enjoying being a father and having time with my family.

How much do you make?