Engineering or medicine

[Kmdc]

Thanks so much to all those involved for the excellent discussion.

Could we please delve deeper into a discussion of optimizing overall compensation across professions, and which, as efle asked in one of his/her previous posts, might be the best for optimizing income?

As there seems to be a growing movement of effective altruism and "earning to give," for those of us hoping to similarly maximize our potential contributions to society through financial contributions to high-impact charities, I would be very interested in hearing your perspectives.

80000hours, an organization attempting to research how to maximize the potential for earning to give, seems to believe medicine is a relatively low-risk method of maximizing income, as the median incomes seem to be far higher than the median incomes of a career like finance:

"Earnings potential
Medicine is a high-earning career – potentially the top earning option for people who don’t want to enter finance or entrepreneurship (especially in the US). Although lower-earning than finance, the chances of dropping out are much lower once you’ve made it into medical school. This means you can contribute through earning to give. For more on the earnings within medicine, see our additional research." [https://80000hours.org/career-guide/top-careers/profiles/medicine/]

They caution that medicine comes with significant investments of time, however, and that the income is deferred. Law2Doc has mentioned in the past how medical students and physicians are likely a unique sample of professionals, however, as they went through a very competitive selection process to obtain entry into medical school and the career.

However, wouldn't the same issues that the typhoonegator and Law2Doc mentioned apply to most career options we have?

I would think those in the financial, legal, or entrepreneurial professions have to face similarly unpredictable reimbursement environments, so wouldn't we again return to the higher median compensation of those in medicine when evaluating the potential earnings of that field over the others?

In addition, wouldn't the larger spectrum of professionals in those other sectors, due to a less rigorous selection process, serve to reduce the incomes of those at the higher earning percentiles, as customers might decide to go with the less expensive attorneys, for example, because they are available?

Law2Doc has mentioned in the past how concierge medicine practices often fail when faced with competition, which causes competitive price cutting to a point where the business are no longer viable. Wouldn't this situation be even more common in the less selective professions, as there is a greater pool of potential competitors?

While ~80% of successful businesses, especially restaurants, fail, the low-price, high-service parlor that opened down the street would likely cause the income of the highly successful existing parlor to be depressed for at least period of time, right? Even if it were to ultimately fail? As the potential for these competing business to appear seems to be even greater than in medicine, due to a much larger potential pool of professional competitors, doesn't this serve to favor medicine, again, for those attempting to maintain a stably high median income across a career?

Thanks, again, for the wonderful discussion

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[Kmdc]

From the 2015 Medscape Compensation Survey:

"Physicians were asked to provide their compensation for patient care. For employed physicians, patient-care compensation includes salary, bonus, and profit-sharing contributions. For partners, this includes earnings after taxes and deductible business expenses but before income tax. According to this year's Medscape survey, the average compensation for specialists is $284,000 and for a primary care physician (PCP) is $195,000, which reflects a general modest trend upward, seen over the past few years. "
(http://www.medscape.com/features/slideshow/compensation/2015/public/overview#page=2)

"When asked about their compensation for patient care, the top three earners this year are orthopedists ($421,000), cardiologists ($376,000), and gastroenterologists ($370,000), and the lowest earners, starting from last place, are pediatricians ($189,000), family physicians ($195,000), and endocrinologists and internists (both at $196,000). The top earners have changed from the2011 Medscape Compensation Report. Although orthopedists led that year as well, the next top earners were radiologists and anesthesiologists. The bottom earners then were still pediatricians, PCPs, and endocrinologists." (http://www.medscape.com/features/slideshow/compensation/2015/public/overview#page=3)

 

[typhoonegator]

I think the Medscape survey is one of the better ones, particularly as it is large and really isolates income from being a physician. Not consultancies, not books, not medical-legal services. Those things can add a lot, and they aren't specified elsewhere. And remember, this is across each profession. Referral-based specialities rely on reputation and stature, so you tend to make more as you get older, and you also get more senior in the group.

 

[efle]

From the 2015 Medscape Compensation Survey:

"Physicians were asked to provide their compensation for patient care. For employed physicians, patient-care compensation includes salary, bonus, and profit-sharing contributions. For partners, this includes earnings after taxes and deductible business expenses but before income tax. According to this year's Medscape survey, the average compensation for specialists is $284,000 and for a primary care physician (PCP) is $195,000, which reflects a general modest trend upward, seen over the past few years. "
(http://www.medscape.com/features/slideshow/compensation/2015/public/overview#page=2)

"When asked about their compensation for patient care, the top three earners this year are orthopedists ($421,000), cardiologists ($376,000), and gastroenterologists ($370,000), and the lowest earners, starting from last place, are pediatricians ($189,000), family physicians ($195,000), and endocrinologists and internists (both at $196,000). The top earners have changed from the2011 Medscape Compensation Report. Although orthopedists led that year as well, the next top earners were radiologists and anesthesiologists. The bottom earners then were still pediatricians, PCPs, and endocrinologists." (http://www.medscape.com/features/slideshow/compensation/2015/public/overview#page=3)

I'd guess BLS > medscape and I'd also point out there is no way in hell by either source that people like anesthesiologists or radiologists are making 150-200k.

 

[Kmdc]

While we might think there could be part-timers in those fields who are making well below the average compensations, I believe Law2Doc has emphasized that these part-time positions are extremely difficult to find, especially when not owner of the practice, as our employer or client is likely not going to want to pay a part-timer when there are plenty of full-time workers available, and the full-timers typically come with lower total costs when compared to having to staff a practice with multiple part-time workers.

However, it may also important to point out, as I believe was done earlier in the thread, that these values are averages, so it is likely that incomes are skewed much further to the right, with average income being higher than median income due to a smaller number of highly paid professionals. This seems likely to be the case in most fields, however, not just in medicine.

 

[efle]

While we might think there could be part-timers in those fields who are making well below the average compensations, I believe Law2Doc has emphasized that these part-time positions are extremely difficult to find, especially when not owner of the practice, as our employer or client is likely not going to want to pay a part-timer when there are plenty of full-time workers available, and the full-timers typically come with lower total costs when compared to having to staff a practice with multiple part-time workers.

However, it may also important to point out, as I believe was done earlier in the thread, that these values are averages, so it is likely that incomes are skewed much further to the right, with average income being higher than median income due to a smaller number of highly paid professionals. This seems likely to be the case in most fields, however, not just in medicine.

BLS values are medians, and if their data is checked against or built with tax info its going to be better than any medscape style survey

 

[Kmdc]

Thanks, efle. I noticed that, and I would tend to agree on the BLS superiority, as it appears that data based on tax information is far more likely to be accurate than data from a survey.

If we look at BLS data for Family and General Practitioners:
http://www.bls.gov/oes/current/oes291062.htm

Median annual: $180,180
Mean annual: $186,320

 

[efle]

Thanks, efle. I noticed that, and I would tend to agree on the BLS superiority, as it appears that tax information is likely far more likely to be accurate than a survey.

If we look at BLS data for Family and General Practitioners:
http://www.bls.gov/oes/current/oes291062.htm

Median annual: $180,180
Mean annual: $186,320

Not a huge skew after all. And the idea of specialists mostly falling in 150-200k remains wildly inaccurate...

 

[typhoonegator]

Not a huge skew after all. And the idea of specialists mostly falling in 150-200k remains wildly inaccurate...

Well, the IQR for PCPs is going to be different from orthopods.

And what do you mean by specialists? A level 4 visit bills the same regardless of what fancy fellowship you did. Do you mean procedural specialists? A preventative cardiologist will never bill as well as an interventional cardiologist. Solid tumor guys complain about all the critical care time the liquid tumor guys get on the BMT service. Once again, I'm not saying people aren't out there making money, but you're painting with a very broad brush.

At major academic institutions, I can assure you that there are armies of subspecialists making around $200K or a little less.

 

[efle]

nephrologists hematologists, radiologists, anesthesiologists, trauma surgeons, oncologists, neurologists, gerontologists, psychiatrists who make 150-200K.

Specialty as in not GP/family Med. Specialty as in things like anesthesia radiology nephrology neurology. Christ, you may be grossly underpaid along with everyone you know, but can you seriously not admit that my original statements were correct? According to the gold standard for wage data the median specialist physician income is near 400k. You absolutely can earn 300+ by going to well paid specialties. Sure there are poorly paid people in any specialty. But no there are not a thousandfold more anesthesiologists in the 150-200 range compared to 300+.

now can we stop this ridiculous argument? I don't know how to support what I said earlier any more clearly than with the BLS data

 

[typhoonegator]

I said at the outset that some people in some specialties can make $350K plus. I also said that average incomes from any of those sources don't tell you much of anything, because you're simply lumping together numbers without any conditional filtering. You seem to like the numbers that are coming out, but this is by no means the golden age of medicine (for physicians at least) and you've got a long way to go before you're even in the job market. Things are likely to be different still by the time you arrive, and if the past is any indication, it won't be changing for the better. I'm not arguing with some kid on the internet to try to "win", I'm trying to urge caution that deriving some sense of satisfaction because if you can just become a "specialist" you'll make $300K is a reduction to the absurd.

Nowhere in here has anyone mentioned what they actually WANT to do with their lives. You're young, don't you care about something other than making money? If you could make $5M per year until you're 65 sitting in an empty room and staring at a clock for 8 hours 5 days a week, would you do it? How long do you think you'd last? Believe me, regardless of how well you are reimbursed, you can still hate every minute of your job. You couldn't pay me enough to sit in a clinic every day looking at people's rashes and lasering dark spots. You couldn't pay me enough to not have dinner with my family almost every night. You couldn't pay me enough to stand in the OR and place facet screws all day long, or stand on the other side of the curtain charting BPs and HRs and occasionally being terrified when someone arrests. These sorts of preferences throw all that median income crap right out the window. What if you meet the love of your life and want to live in Manhattan? What if halfway through your residency Congress decides that Medicare is reimbursing too much for spine procedures? Does any of this median income data help you?

We say it time and time again, but go into a profession because you want to do it. If you really like engineering, why are you worried about whether doctors will eclipse your earning potential once they hit middle age? Who knows! That's 30 years from now! Doctors have to mortgage their 20's to live well in their 50's, and unless Daddy's rich, you'll be paying the equivalent of a second mortgage in loans on top of your squandered youth. Don't do it because the Bureau of Labor Statistics analysis from 2012 says you're going to be in the 1% (as long as you avoid primary care -- that would be the worst).

 

[efle]

I said at the outset that some people in some specialties can make $350K plus. I also said that average incomes from any of those sources don't tell you much of anything, because you're simply lumping together numbers without any conditional filtering. You seem to like the numbers that are coming out, but this is by no means the golden age of medicine (for physicians at least) and you've got a long way to go before you're even in the job market. Things are likely to be different still by the time you arrive, and if the past is any indication, it won't be changing for the better. I'm not arguing with some kid on the internet to try to "win", I'm trying to urge caution that deriving some sense of satisfaction because if you can just become a "specialist" you'll make $300K is a reduction to the absurd.

Nowhere in here has anyone mentioned what they actually WANT to do with their lives. You're young, don't you care about something other than making money? If you could make $5M per year until you're 65 sitting in an empty room and staring at a clock for 8 hours 5 days a week, would you do it? How long do you think you'd last? Believe me, regardless of how well you are reimbursed, you can still hate every minute of your job. You couldn't pay me enough to sit in a clinic every day looking at people's rashes and lasering dark spots. You couldn't pay me enough to not have dinner with my family almost every night. You couldn't pay me enough to stand in the OR and place facet screws all day long, or stand on the other side of the curtain charting BPs and HRs and occasionally being terrified when someone arrests. These sorts of preferences throw all that median income crap right out the window. What if you meet the love of your life and want to live in Manhattan? What if halfway through your residency Congress decides that Medicare is reimbursing too much for spine procedures? Does any of this median income data help you?

We say it time and time again, but go into a profession because you want to do it. If you really like engineering, why are you worried about whether doctors will eclipse your earning potential once they hit middle age? Who knows! That's 30 years from now! Doctors have to mortgage their 20's to live well in their 50's, and unless Daddy's rich, you'll be paying the equivalent of a second mortgage in loans on top of your squandered youth. Don't do it because the Bureau of Labor Statistics analysis from 2012 says you're going to be in the 1% (as long as you avoid primary care -- that would be the worst).

Unfortunately like many 21 year olds my really passionate interests in girls and video games aren't employable! But there are plenty of people that enjoy sciencey, brainy stuff in general and would be happy in niches in the worlds of engineers or doctors. The fact that one has more security and pays a lot more in the end is worth considering among many other things. If you're the type of applicant with a shot at competative specialies and/or scholarships for Med school the finances for MD are pretty unbeatable for being such a sure bet. I'd still be going medical if the pay was 150k for everybody but the fact that its 300-400 in some areas will certainly make me pay some extra attention to those specialties.

 

[deleted393595]

I have a just below a 90% average and have taken all science classes except for biology. I figured a few years ago that I would settle with mechanical engineering since I like working on cars and enjoy math and science. I want a career in sciences 100%. However, deep down I would love to be a doctor. I've spoken to two doctors who said I should choose engineering. I don't want people saying follow your heart and stuff like that. Money isn't an issue since both professions pay way above average. I'm scared that if I choose medicine, I'll take the 4 years of sciences than wont be accepted to med school. I only say that because in my school alone there is about 1000 people with a 95% average all wanting to go to medicine. So realistically, I don't think I'll make it compared to those smarter. I know someone who went into sciences and did not get accepted to dental school so now they're taking another major. Any thoughts?

There are plenty of opportunities for engineering in medicine. So I say...

 

[Kmdc]

Thanks so much for the discussion.

There's actually a growing body of evidence in positive psychology to suggest that our life circumstances contribute only a very small portion to our overall happiness, approaching 10-15%, with ~40% based on our perspectives, and ~50% based on our genes.

In addition, due to hedonic adaptation, there is likely no such thing as a perfect, or imperfect, job, or a perfect/imperfect anything else: http://greatergood.berkeley.edu/article/item/sonja_lyubomirsky_on_the_myths_of_happiness

Thus, evaluating career choice by something more stable and potentially meaningful, such as compensation per hour, may be a more prudent choice. Especially when we consider that humans seem to gain far more pleasure from giving resources away than from obtaining those resources:

"While other studies have suggested adults are happier giving to others than to themselves and that kids are motivated to help others spontaneously, this is the first study to suggest that altruism is intrinsically rewarding even to very young kids, and that it makes them happier to give than to receive." (http://greatergood.berkeley.edu/article/item/being_kind_makes_kids_happy)

 

[efle]

Thanks so much for the discussion.

There's actually a growing body of evidence in positive psychology to suggest that our life circumstances contribute only a very small portion to our overall happiness, approaching 10-15%, with ~40% based on our perspectives, and ~50% based on our genes.

In addition, due to hedonic adaptation, there is likely no such thing as a perfect, or imperfect, job, or a perfect/imperfect anything else: http://greatergood.berkeley.edu/article/item/sonja_lyubomirsky_on_the_myths_of_happiness

Thus, evaluating career choice by something more stable and potentially meaningful, such as compensation per hour, may be a more prudent choice. Especially when we consider that humans seem to gain far more pleasure from giving resources away than from obtaining those resources:

"While other studies have suggested adults are happier giving to others than to themselves and that kids are motivated to help others spontaneously, this is the first study to suggest that altruism is intrinsically rewarding even to very young kids, and that it makes them happier to give than to receive." (http://greatergood.berkeley.edu/article/item/being_kind_makes_kids_happy)

You must not have worked many jobs. Hell I've only had 3 and i can tell you some are much more stressful, boring, etc than others.

 

[Kmdc]

Thanks for the feedback.

I'm just sharing the evidence Weren't we just discussing how the plural of anecdote is not data?

Edit: (After Efle's post below, sorry )
Based on the evidence, it really does appear that attitude may be almost everything, especially in terms of happiness.

 

[efle]

Thanks for the feedback.

I'm just sharing the evidence Weren't we just discussing how the plural of anecdote is not data?

That some jobs are ****ty is more conventional wisdom than anecdote. Pay may not correlate with overall life happiness but I bet if you surveyed people in the middle of a workday some would rate their jobs higher.

 

[Kmdc]

If you look at the link I provided, I believe they examined jobs from far more dimensions than simply pay.

I believe one of the studies contributing to the finding was among janitors. The janitors who viewed their professions as contributing to their personal growth and to their larger community, and that allowed them to meaningfully connect with others, were persistently happier in their perspectives and their lives than those janitors who did not view their jobs as similarly meaningful.

We see the same from most other aspects of our lives, including disability, marriage, winning the lottery, promotions, the birth of a child, divorce, etc.

It appears, that humans tend to become more or less happy for a relatively brief period of time, then, due to hedonic adaptation, return to baseline.

The only way to delay the hedonic adaptation seems to be if we are constantly ruminating on either the positive or negative event, and refreshing some aspect we find positive or negative. This appears to be is how "happy marriages" manage to stay happy longer, or how disabled or depressed individuals can see their quality of life lowered for far longer than is typically observed.

 

[efle]

If you look at the link I provided, I believe they examined jobs from far more dimensions than simply pay.

I believe one of the studies contributing to the finding was among janitors. The janitors who viewed their professions as contributing to their personal growth and to their larger community, and that allowed them to meaningfully connect with others, were persistently happier in their perspectives and their lives than those janitors who did not view their jobs as similarly meaningful.

We see the same from most other aspects of our lives, including disability, marriage, winning the lottery, promotions, the birth of a child, divorce, etc.

It appears, that humans tend to become more or less happy for a relatively brief period of time, then, due to hedonic adaptation, return to baseline.

The only way to delay the hedonic adaptation seems to be if we are constantly ruminating on either the positive or negative event, and refreshing some aspect we find positive or negative. This appears to be is how "happy marriages" manage to stay happy longer, or how disabled or depressed individuals can see their quality of life lowered for far longer than is typically observed.

If you google job satisfaction ratings youll see some are pretty universally terrible. Plus not many people have actually experienced a huge range - how many janitors can rate their job stress or feelings of fulfillment compared to to attorney or physician positions? Perhaps they're happy but could've been even happier. There's no shortage of evidence that people tend towards happy and unhappy, but there's also no data from a bunch of pediatricians made to work ten years as a dead end burger flipper to see how much that would impact them, etc. Essentially everything from the field of positive psych should be accompanied by a giant grain of salt to begin with...

 

[typhoonegator]

Thanks so much for the discussion.

There's actually a growing body of evidence in positive psychology to suggest that our life circumstances contribute only a very small portion to our overall happiness, approaching 10-15%, with ~40% based on our perspectives, and ~50% based on our genes.

In addition, due to hedonic adaptation, there is likely no such thing as a perfect, or imperfect, job, or a perfect/imperfect anything else: http://greatergood.berkeley.edu/article/item/sonja_lyubomirsky_on_the_myths_of_happiness

Thus, evaluating career choice by something more stable and potentially meaningful, such as compensation per hour, may be a more prudent choice. Especially when we consider that humans seem to gain far more pleasure from giving resources away than from obtaining those resources:

"While other studies have suggested adults are happier giving to others than to themselves and that kids are motivated to help others spontaneously, this is the first study to suggest that altruism is intrinsically rewarding even to very young kids, and that it makes them happier to give than to receive." (http://greatergood.berkeley.edu/article/item/being_kind_makes_kids_happy)

This may all be true within a certain range, but when you're driving in to work at 5pm on the 4th of July to work a 12 hour ED shift, that steady source of income is cold comfort if you don't derive pleasure from what you do. Medicine is so disruptive as a career choice -- it eats into every corner of your life. How many other people do you see wandering around Target on a Saturday morning with their family, wearing a pager dangling from their cargo shorts?

 

[Kmdc]

Thanks for the feedback.

If you google job satisfaction ratings youll see some are pretty universally terrible. ... Essentially everything from the field of positive psych should be accompanied by a giant grain of salt to begin with...

I would rank the quality of evidence of the peer-reviewed, published evidence from positive psychology a bit higher than a google search.

I certainly agree that we should always remain skeptical, however, regardless of where the evidence appears to be coming from.

This may all be true within a certain range, but when you're driving in to work at 5pm on the 4th of July to work a 12 hour ED shift, that steady source of income is cold comfort if you don't derive pleasure from what you do. Medicine is so disruptive as a career choice -- it eats into every corner of your life. How many other people do you see wandering around Target on a Saturday morning with their family, wearing a pager dangling from their cargo shorts?

I would also agree that medicine provides a very unique level of stress and disruption.

While I don't have any peer-reviewed, published data on hand, I thought this PayScale survey on job satisfaction, stress, meaning, and pay was interesting:
http://www.payscale.com/data-packages/most-and-least-meaningful-jobs/full-list

Medical professionals seem to derive some of the highest meaning out of their jobs, especially among the highest paid professions, but, as you mentioned, they also report some of the highest levels of stress.

It's definitely a lot to consider, especially for a high school student. I hope our discussion so far and any further insights that may result serve to help all those who encounter them make more informed decisions about their futures.

Thanks, again, for your contributions

 

[efle]

Thanks for the feedback.



I would rank the quality of evidence of the peer-reviewed, published evidence from positive psychology a bit higher than a google search.

I certainly agree that we should always remain skeptical, however, regardless of where the evidence appears to be coming from.

There are peer-reviewed studies on job satisfactions. Try google scholar

 

[TUVIX]

I have a just below a 90% average and have taken all science classes except for biology. I figured a few years ago that I would settle with mechanical engineering since I like working on cars and enjoy math and science. I want a career in sciences 100%. However, deep down I would love to be a doctor. I've spoken to two doctors who said I should choose engineering. I don't want people saying follow your heart and stuff like that. Money isn't an issue since both professions pay way above average. I'm scared that if I choose medicine, I'll take the 4 years of sciences than wont be accepted to med school. I only say that because in my school alone there is about 1000 people with a 95% average all wanting to go to medicine. So realistically, I don't think I'll make it compared to those smarter. I know someone who went into sciences and did not get accepted to dental school so now they're taking another major. Any thoughts?

Major in engineering and take the med school prerequisite courses as electives. Don't get into med school? Be an engineer. Done.

 

[efle]

Major in engineering and take the med school prerequisite courses as electives. Don't get into med school? Be an engineer. Done.

Its a shame that the heavy grade deflation of engineering schools makes this so much harder of a premed path.

 

[TUVIX]

Its a shame that the heavy grade deflation of engineering schools makes this so much harder of a premed path.

True but it's the only way to cover both options.

 

[efle]

True but it's the only way to cover both options.

Also a great way to doubly sink yourself as both premed and engi have high weed out/attrition!

 

[invisibleman023]

As Engineering major (at a top 10 school) who got into medical school, I'll tell you that grade deflation can really sink your application. Medical schools just don't care about your major and care a lot more about the average statistics of admitted applicants. So you're right about that.

As far as the broader question of "engineering vs. medicine" it just seems like such an odd comparison. Its like comparing the entire GM lineup of cars to a Honda Accord. My point is that "engineering" means so many things and can be achieved only after 4 years of undergraduate training from which you have many options to choose what career you want. Most engineers do NOT work in the field they exactly majored in. And if you add in those people who receive MBAs or go directly into finance/consulting from undergrad, you realize that majoring in "engineering" doesn't really offer you a specific path. It makes a lot more sense to make comparisons amongst professional degrees like medicine vs. law, medicine vs. dentistry, medicine vs. PhD.

Once you've decided to go for a STEM career, you should NOT think about what you like or enjoy in the classroom. I enjoyed mathematics and biology just like every other smart nerd in America. That basic lecture material has little to do with the day to day activities of that profession.

• If you are considering engineering, ask yourself these questions: Do I like working on a design team? Am I okay with having longitudinal projects with deadlines? Catering to corporate clients? Would I enjoy and be good at programming/AutoCAD (obviously not every engineer needs this but its a BIG plus for companies hiring)? Am I okay with climbing the corporate ladder? Do I need to have nearly every weeknight and weekend off?
• If you are considering medicine, ask yourself these questions: Do I want to SERVE sick people? Even when they have many co-morbidities and poor lifestyle choices and combative families? Am I okay with having clients/patients who use a middleman (extremely powerful and profitable ones) to reimburse me at a fraction of what I charge them? Do I want a career that may often tip the work-life balance scale towards the work side by requiring paper work and doing charts for patients? Is prestige/respect something I really want in my career (yes, it has gone down but it still exists)? Do I need more autonomy (once again, this has significantly decreased in medicine but still exists in comparison to many corporate engineering jobs)? Am I okay with someone dying under my care?

These are the questions you should ask yourself because engineering and medicine in practice ARE NOTHING alike. And once you find an answer, THEN you can think about salary and money. Once you're in engineering, does money really matter to you? Okay then go into petroleum engineering or get an MBA and climb management. If you're in medicine, then avoid primary care and try to enter a field with ancillary cash/cosmetic services. This is the way you should decide your career.