Epic Physician Income Thread

[slatermd]

2011 Physician Compensation Report



The following links are consolidations of the discussion that took place in this thread:

How much money is $200,000 per year?

Pursuing a career in medicine "for the money."

The debt burden of medical school is increasing; physician pay is not.

What about differences in pay across specialties?

Cash-only practices

What options do physicians have to negotiate their pay?

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The Semi-Original Post


The issue of physician pay is a recurring theme on SDN, and it has come up a number of times in the past few days in several unrelated threads; I would like to consolidate the discussion here. I'll start by addressing two things that came up in the other threads, and we'll see where this goes.

The first issue is money as motivation for becoming a physician (bear with me, I'm not all up on a rant), and the second is the future of physician compensation and the implications of it changing. This is not an OMG O Noes! thread. Many of us are far enough along this path that we won't be avoiding the consequences of fluctuating income, so there might as well be some pragmatic discussion about it.

For housekeeping purposes, here are some things that go without saying, but I will laugh when someone says them anyway:

• I may not respond much during the next week (Finals).
• Don't bother bringing the Benjamin Brown article into this. If you want to reference it as the type of discussion we DON'T need to have, you can find it here (blah blah blah shenanigans) and if you enjoy the taste of fallacy enough for seconds: (you must be a glutton for punishment).
• If you take this discussion the way of tabulated net worth of X career vs. Medicine, I'm warning you now that you will get crapped on.
• The purpose of this thread is not to help people decide between medicine and another career. If it ends up helping with that, great but let's not tailor the discussion that way. It is meant to be a thread for people who have already wrestled with the decision and have chosen to go into medicine--in spite of the uncertainty of our futures, and recognizing that pessimistic forecasts, while not guaranteed to come true, may indeed and probably have legitimate foundations.
• Any reported physician income is likely to be contested by someone on the forum, regardless of whether the source is anecdotal or actually resembles data. However,
• Correcting a gross misconception about physician income is different than splitting hairs about the current figures. The former is constructive, the latter is not. For current figures, start with the 2011 Physician Compensation Report, or from a different source:

BLS salaries:

Anesthesiologists-------------------$211,750
Family and General Practitioners-----$168,550
Internists, General------------------$183,990
Obstetricians and Gynecologists-----$204,470
Pediatricians, General---------------$161,410
Psychiatrists-----------------------$163,660
Surgeons--------------------------$219,770
Physicians and Surgeons, All Other--$173,860
http://www.bls.gov/oes/current/oes_nat.htm#29-0000

Moving on from stats, but still housekeeping for the thread:

• Not all physicians are "salaried." Some are, others are reimbursed by insurance companies/Medicare/Medicaid based on treatments they administer and procedures they complete, and still others operate on a fee-for-service basis where patients pay cash for (or finance) procedures. While this is usually for elective procedures, there is at least one instance of a general surgeon doing this for cholecystectomies and such, discussed in one of Gawande's books (I believe it was Better, but could have been Complications, and I'm not going to dig it up for you). The prevalence and the administration of these payment modalities is quite likely to shift in the future. Let's not overcomplicate that portion of the discussion, but let's also avoid oversimplifying it by talking about all compensation as if it were a "salary" that materializes out of thin air every two weeks.
• This is not a hijack of the healthcare reform discussion, so let's get two pertinent points out of the way and then leave it alone. First, dipping into physician income is not going to pay for a solution to the healthcare crisis. Don't bother suggesting it, and don't assume that someone else did suggest it. It is still important to note that physician income is simply not speculated to increase (which is the second of the two points from the reform discussion):
• Reform is interested in increasing access to treatment and decreasing its cost. Of all the proposed methods to do this, the suggestions that have any chance of being implemented do not involve an increase in physician reimbursement. This thread is not about solving the healthcare reform Rubik's cube, nor is it about solving the "problem" of declining physician pay. It is about discussing the implications. Also,
• Don't molest me by bringing Ayn Rand or Ché Guevara into the discussion. And finally,
• You will make a terrible doctor. I will make a terrible doctor. Glad we got that out of the way.

A short time ago, in a thread far, far away, I was provoked by the following comments, which had the making of a good discussion but never took off (I have removed the quote tags but linked to the comments):

Wait, so some docs won't be making 400k anymore? How terrible, everyone needs a summer house and a maid!

I have a great idea. How about all the doctors who DON'T care about their salary going down take the hit, and subsidize those who DO care.

I sort of get the points being made by each side, but where do we go from here?

We can't just end the discussion by saying "don't do medicine for the money." And if you disagree, at least state why. I will elaborate on my opinion about this if the discussion heads that way, but I won't take it there from the outset. For now, suffice it to say there are people for whom compensation is a large factor, there are people who don't really care at all, and there are people who are legitimately concerned about being able to pay back their loans and live comfortably doing a job they enjoy.

I no longer take it upon myself to judge motives, and I am not against making a lot of money. But I don't agree with the notion that completing medical school and residency entitles anyone to an awesome income. Education isn't the same valuable commodity that it once was. Having a bachelor's degree used to pretty much guarantee that you'd be paid well, but it doesn't anymore. It's not valued the same way in the job market, and now there's even a glut of people with Master's degrees moaning about their compensation. Can you read the writing on the wall?

The salaries in those charts above are what we used to be able to "expect," but in our lifetime this is going to change. Physician compensation will remain high enough to satisfy many, so this doesn't inspire panic.

If you *are* concerned about it, what do you plan on doing, besides "putting your foot down?" ... ... Making demands? Maybe throwing a temper tantrum? None of us will be able to waltz into the lifestyle of boats and hoez simply on the merit of having a medical degree.

[This is somewhat of an aside, but I wanted to work it in-- $200K/year is not really that much money, and this is coming from someone who lives well below the poverty line. It is about as much money per month as I live on in an entire year, but I don't get why so many of us consider "six figures," $200K, or even $400K to be the holy grail of incomes. Most of us are used to a lot less, but quite frankly I don't find $400K to be that impressive of a "goal" for anyone who acknowledges money as a motivator. This is just a curiosity of mine; ultimately whether or not the money-motivated have a chance at building real wealth through medicine is of little consequence to me.]


What's of plausibly more concern (but still not OMG ONOZ territory) is that the cost of medical education (as well as the undergraduate education you have to pay for first) will NOT decrease soon enough for the next generation of physicians to benefit. If the cost ever does go down, it will be well after most of us have paid somewhere in the neighborhood of $200K, plus the juice on our loans.

I don't lament this fact; I am confident in my own ability to generate a satisfactory income and pay back my loans, so in that respect I'm kind of sticking my head in the sand and waiting for the proverbial **** to hit the fan with physician compensation. When it does, I will act accordingly.

What about you? Especially those who continue deciding against the "opportunity" to GTFO and take your talent to another field? If your head isn't stuck in the sand, how are you thinking about handling this?

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[jdh71]

boooo

you structured the discussion in such a way that it will probably be no fun to watch

 

[Cleavername]

1: gather $$$
2: start a hedge fund
3: ???
4: profit.

 

[CaliGirl14]

 

[SoundofSilver]

Excellent post, thank you.

Personally, I'll be satisfied if I'm able to pay off my loans without much hardship within five years of finishing residency and am able to live relatively comfortably and save for retirement after my loans are paid off. This probably means a salary of around 200k. I believe most doctors will still be able to do this in the coming years. The field of medicine still remains brighter than almost any other field out there in terms of jobs and job security.

In my opinion, once you start crossing the 200k threshold for student loan debt, that's when things start getting a bit nauseating especially when you factor in all the uncertainty which you have mentioned. Unfortunately, more and more students every year are crossing this line. IBR and 25 year re-payment plans have made this do-able, but you are ultimately becoming a wage slave to the government at that point and you're paying an insane amount of interest.

 

[HumbleMD]

Don't go into medicine for money or an easy lifestyle. Seems simple, but I have classmates graduating now who are suddenly surprised.

What we lack in monetary compensation compared to our peers, we do have some of the best job security around (and tenure if you're going academic).

 

[FIREitUP]

this is news.

 

[Bravetown]

Don't go into medicine for money or an easy lifestyle. Seems simple, but I have classmates graduating now who are suddenly surprised.

What we lack in monetary compensation compared to our peers, we do have some of the best job security around (and tenure if you're going academic).

To say that you won't make money or have an easy lifestyle as a physician is also kind of a loaded statement. Honestly I don't know any practicing physician (who or whom ) has been unable to pay off their loans, buy a house, have a family/life, and do kind of whatever they want. Really no licensed physician works more than they have to (of course if you buy a $1.5 million house and lambo you may have to but you chose that). It really seems people are just pissed that medicine has really moved on from its glory days, back in the 70's and 80's when being a doctor was the greatest job ever and a doctor could go out and play golf 3 times a week or so I've been told. What really grinds my gears is when people go off on rants about physicians not making even 100K and its almost like really salaries are going to drop 40 - 50,000 over night, just like that ya. Of course I really don't understand compensation or billing so I'm really not qualified to comment, but if things get so bad we can always write scripts for weed on the side

 

[Propylene]

I honestly could see myself living very comfortably with 200k every year.

Are the average salaries really supposed to dip down so much?

 

[HumbleMD]

I honestly could see myself living very comfortably with 200k every year.

Are the average salaries really supposed to dip down so much?

Peds, family practice, and many OBGYNs (my future field) don't necessarily make that much.

Bravetown, agreed. Do remember that the majority of MD students have an albatross of loans hanging around their neck until they're 40-45. Also recall the opportunity costs of NOT earning an income during the 4 years of med school.

 

[Bravetown]

Peds, family practice, and many OBGYNs (my future field) don't necessarily make that much.

Bravetown, agreed. Do remember that the majority of MD students have an albatross of loans hanging around their neck until they're 40-45. Also recall the opportunity costs of NOT earning an income during the 4 years of med school.

I thought an albatross was a good thing , but there are also huge perks that come with being a doctor: stability and security, after residency maybe a sense of normalcy, maybe some power sprinkled on there. It honestly is hell not knowing if your father is going to be out of work and your house is going to be repossessed year after year and maybe its just me but I haven't heard of layoffs for doctors. If anything its usually the nurses (not trying to start something, just saying) that get axed first. And I get the whole, I'm stressed the f out cause I've got loans for school, for my house, and for my kids school, but at least there is money coming in even if it slows down a little it doesn't stop and I think that's something we should all be thankful for that people keep getting sick or we would all be out of a job.

 

[HumbleMD]

I thought an albatross was a good thing , but there are also huge perks that come with being a doctor: stability and security, after residency maybe a sense of normalcy, maybe some power sprinkled on there. It honestly is hell not knowing if your father is going to be out of work and your house is going to be repossessed year after year and maybe its just me but I haven't heard of layoffs for doctors. If anything its usually the nurses (not trying to start something, just saying) that get axed first. And I get the whole, I'm stressed the f out cause I've got loans for school, for my house, and for my kids school, but at least there is money coming in even if it slows down a little it doesn't stop and I think that's something we should all be thankful for that people keep getting sick or we would all be out of a job.

Haha, we need to stop. Look at my earlier post - I said this is the big plus of medicine (just in fewer words).

PS, congrats on OSU, but as a Wolverine I have my doubts...

 

[thuc]

im graduating from a family medicine residency in two months [ extremely excited ]. i knew that entering into this field would put physician compensation at lower numbers than the specialists.

even though the salary is lower, i am pretty satisfied. i think 200k is a lot of money! i'll be making a little less than that after graduation. as a resident, i make roughly 50k per year and am able to put money away for retirement and still have fun. putting that into perspective, when i start my "real" job, i will feel very well off. have you read the book, The Millionnaire Next Door? i highly recommend it.

over the three years of residency, i've looked into alternative practice models for primary care that would either increase the quality of life as a physician or increase the compensation or both. ie: ideal medical practice model, direct-pay practice, concierge care, becoming a principal investigator for clinical trials, cosmetic medicine, doing procedures, taking on administrative roles, etc. what i found is that it is possible to increase your income.

with that said, it takes a certain risk (financial, time commitment, success vs fail) to delve into those kinds of potential income streams. are you willing to take that risk? i was. until i remembered my loans.

so how do i plan to handle this whole physician income thing? my first goal is to eliminate my loans. i'm accomplishing this by working at an NHSC approved site and have the NHSC pay my loans for me in return for 2 years of my life. for those with more debt than myself, you can receive 25-30k per year free for working at a rural site.

in the meantime, i'm getting an MBA to enhance my administrative worth in medicine which will yield a higher income in the future.

im looking forward to hearing everyone else's plans for the future. and good luck!

 

[Bravetown]

Haha, we need to stop. Look at my earlier post - I said this is the big plus of medicine (just in fewer words).

PS, congrats on OSU, but as a Wolverine I have my doubts...

My bad totally didn't see it

 

[Morzh]

While money is not my primary motivation for going into medicine, it will go a long way in making me more content to work 60+ hours/week (even post-residency) for my entire career, including nights, weekends, and on-call.

I wouldn't mind 200K/year or even a bit less to do what I love, given the 12+ years of post-secondary training/education, if I only had to work 8-4, M-F.

But I, like OP, cannot predict the future. I know this is what I want to do regardless of the uncertainties that lie ahead. When the "proverbial **** hits the fan", I too will also act accordingly. Until then my biggest concern is having my chosen career and the dignity with which I view it be demonized by media-hysterics and exploitative politicians.

 

[Narmerguy]

While money is not my primary motivation for going into medicine, it will go a long way in making me more content to work 60+ hours/week (even post-residency) for my entire career, including nights, weekends, and on-call.

I wouldn't mind 200K/year or even a bit less to do what I love, given the 12+ years of post-secondary training/education, if I only had to work 8-4, M-F.

But I, like OP, cannot predict the future. I know this is what I want to do regardless of the uncertainties that lie ahead. When the "proverbial **** hits the fan", I too will also act accordingly. Until then my biggest concern is having my chosen career and the dignity with which I view it be demonized by media-hysterics and exploitative politicians.

I think it's important to point out that most non-surgical (who are compensated quite well) do not work over 60 hours a week. Also, 8-4 just isn't realistic in today's society if you're in the top working class group. Sure if you are super super rich you can pull that stuff, but even ibankers, consultants, top executives are putting in much more than the 8-hour a day, 5 day a week work. If they weren't, the market would very quickly find someone that would.

Great job OP but I think that most people won't read the entire first post. Also, too many stupid people on this forum that enjoy arguing/complaining for this to really be too productive.

Any way, as someone that aspires for academia, it's very likely my salary will be even lower than that of my private practice peers. What I would love to see is a real, no BS workup of what a physician salary would give. Perhaps, since everyone loves criticizing every little tax level or food payment, we could make it a group effort so everyone is mostly satisfied. Hell we could even produce 5 different workups. Either way, there's a lot that's said both way about what a primary care income will get you or what $400,000 will get you and sometimes I wonder if my future colleagues simply have extremely expectations or contrastingly intend to eat bread and water for life.

When someone tells me $200,000 is not a lot of money...what does that mean? When someone says $400,000 is not a lot of money--what? It's more money than most of us can really imagine dealing with unless one of our parents/close friends was pulling in that kind of bank and even then, we don't know what they were spending it on.

 

[bucks2010]

This definitely isn't the 'glory days', but keep in mind that many of us will have options (i.e. working less if we want) that the previous generation may not have had. A lot of the previous generation sold their souls to the profession and did receive some generous monetary compensation for it. While our generation will not be so handsomely rewarded, it seems like overall most of us will work fewer hours than the previous generation (take, for example, the shift to physician employment vs. running your own practice).

The debt is very concerning to me personally. None of us know anyone unable to pay off their loans because tuition probably wasn't nearly as high when the attendings we know were going through the process. But if the trend keeps up and tuition rises while wages fall ... we may have a situation on our hands.

 

[LuciusVorenus]

I'd be totally fine with earning about 200K in a relatively stable job (no matter the hours or specialty) if I wasn't buried in debt.

How much would it cost to completely subsidize all medical education in this country? It couldn't be more than 5-6 billion a year could it? That's just a drop in the bucket in our budget. At the very least it'll draw more people to primary care. What if we just completely subsidized medical education for those going into primary care?

Also, as Namerguy pointed out above, the 40 hour work week is a joke these days. I don't think there's anything special about the hours physicians work (at least in most specialties - i.e. not Neuro or Spine). What sucks about all those other jobs is you're often paid for ONLY 40 hours, but you have to meet the timeline regardless of how much you're being paid, so prepare to work at home for free or lose your job.

 

[RelicLTD]

This is somewhat of an aside, but I wanted to work it in-- $200K/year is not really that much money, and this is coming from someone who lives well below the poverty line. It is about as much money per month as I live on in an entire year, but I don't get why so many of us consider "six figures," $200K, or even $400K to be the holy grail of incomes. Most of us are used to a lot less, but quite frankly I don't find $400K to be that impressive of a "goal" for anyone who acknowledges money as a motivator. This is just a curiosity of mine, because whether or not the money-motivated will end up building wealth through medicine is of little consequence to me.

Hardly any other profession "guarantees" a good wage so long as you get there are keep your nose clean. I'm of the mind that almost anyone can become a doctor if they work hard. The same cannot be said for becoming ultra rich. The billion dollar ideas, the athletic skill, and the sheer luck that goes into making the super successful cannot be achieved by everyone. While hard work and intelligence are CERTAINLY in there, they are not the only factors.

If medicine guaranteed you'd become a multi-millionaire by taking on 8 years of postgraduate training, we would have MANY more applicants than we do now.

Medicine promises employability and a good wage in virtually any situation. It might not be the "fast-track" to money, and I'll leave your interpretation of "a lot of money" up to you, but the path is pretty well scoped out. You know exactly what you need to do, and when your reach the other side, you won't have trouble finding and keeping a job. And in the past, you may have expected a good income, and not nearly as much debt as today.


I didn't get into medicine for money, per se, but if I wasn't confident in my ability to pull ~$200k/year, I would've gone elsewhere.

 

[Law2Doc]

...
[*]Correcting a gross misconception about physician income is different than splitting hairs about the current figures. The former is constructive, the latter is not. For current figures, start here:
[*]http://www.cejkasearch.com/view-compensation-data/physician-compensation-data/#
[*]http://www.merritthawkins.com/uploadedfiles/merritthawkings/surveys/mha2010incentivesurvpdf.pdf...

Um no. Never start at recruiters for accurate salary figures. Recruiters want you to call them. You won't call them if they post accurate figures, you call them because they post pie in the sky figures. Also bear in mind that the "average" salary posted on the cejka firm site isn't an average at all, because their average employer "has 272 physicians and 13 satellite locations.". That isn't exactly your typical employer. So you can't really extrapolate that out to be an average physician's salary. Sorry. The Modern Healthcare publication you cited compiled a number of recruiter's figures, so I'm no sure that is any better; they basically compounded the problem.

JAMA periodically lists salary figures that are reasonably accurate. The Bureau of Labor and Statistics periodically publishes average physician salaries. These are impartial sources with no incentive to inflate, and thus a better resource for salary figures.

Not really sure what your agenda is here, but all I'm saying is that you are going to come across a lot of puffery from search firms during the course of your career, but in truth if you see some salary figure that is too good to be true, you are going to call and they will inform you that they no longer have that position available, but have one almost as good at some fraction of the salary. That's just the way the headhunting world works.

 

[Law2Doc]

...
Medicine promises employability and a good wage in virtually any situation. ...

Nothing is guaranteed. Right now quite a few specialties are seeing folks do second fellowships to bide their time because there aren't jobs out there in all fields.

 

[RelicLTD]

Nothing is guaranteed. Right now quite a few specialties are seeing folks do second fellowships to bide their time because there aren't jobs out there in all fields.

Relatively.

 

[LuciusVorenus]

Um no. Never start at recruiters for accurate salary figures. Recruiters want you to call them. You won't call them if they post accurate figures, you call them because they post pie in the sky figures. Also bear in mind that the "average" salary posted on the cejka firm site isn't an average at all, because their average employer "has 272 physicians and 13 satellite locations.". That isn't exactly your typical employer. So you can't really extrapolate that out to be an average physician's salary. Sorry. The Modern Healthcare publication you cited compiled a number of recruiter's figures, so I'm no sure that is any better; they basically compounded the problem.

JAMA periodically lists salary figures that are reasonably accurate. The Bureau of Labor and Statistics periodically publishes average physician salaries. These are impartial sources with no incentive to inflate, and thus a better resource for salary figures.

Not really sure what your agenda is here, but all I'm saying is that you are going to come across a lot of puffery from search firms during the course of your career, but in truth if you see some salary figure that is too good to be true, you are going to call and they will inform you that they no longer have that position available, but have one almost as good at some fraction of the salary. That's just the way the headhunting world works.

For those interested in the BLS salaries, here they are:

Anesthesiologists-------------------$211,750
Family and General Practitioners-----$168,550
Internists, General------------------$183,990
Obstetricians and Gynecologists-----$204,470
Pediatricians, General---------------$161,410
Psychiatrists-----------------------$163,660
Surgeons--------------------------$219,770
Physicians and Surgeons, All Other--$173,860

http://www.bls.gov/oes/current/oes_nat.htm#29-0000

 

[45408]

I just wish there was more parity among specialties. At my specific institution, I know for a fact that the gastroenterologists are making WAY more money than almost every other specialty, and that their reimbursement per RVU is through the roof.

They are definitely making more than my surgery attendings (all of whom are fellowship trained), with better hours and less risk.

I'm not out to take away someone else's income, but it honestly feels rather demeaning to be told that your specialty isn't "worth" as much as another, just because their set of procedures pays better than yours.

 

[jdh71]

I like my job. I think it's really cool. Yeah, I complain about hours, dumps from other services, and non-compliant patients, or whatever, but there isn't much else I'd rather be doing. Maybe if I could fly a fighter jet or be a navy seal that would be cooler. Of course residency is not the same as being out on your own, especially if you're the one in charge of your own private practice. I've never felt or thought that I was entitled to a certain pay scale or range. What I feel I am entited to is to be able to make as much money as I possibly can based on whatever the market will bear. If that means $400,000 . . . yay.

Get money, get swoll, get bishes.

 

[Scotty knows]

Get money, get swoll, get bishes.

Aww the key to life. A truly inspirational quotation. You kind sir are a sage.

[YOUTUBE]http://www.youtube.com/watch?v=HPzDLGfyjw0&feature=related[/YOUTUBE]

 

[slatermd]

boooo

you structured the discussion in such a way that it will probably be no fun to watch

I agree jdh. I didn't realize that by requesting intelligent responses I was so drastically limiting participation. Hopefully the new format will produce something more lol-worthy, while leaving room for srs business.

 

[slatermd]

Um no. Never start at recruiters for accurate salary figures...*snip* because they post pie in the sky figures. Also bear in mind that the "average" salary posted on the cejka firm site isn't an average at all, because their average employer "has 272 physicians and 13 satellite locations.". That isn't exactly your typical employer. So you can't really extrapolate that out to be an average physician's salary.

Duly noted. For what it's worth, if you average the national figures on payscale, across all specialties it comes out to something like $161,000. But someone always comes in and cries about payscale under-reporting and that being too low. These are the reasons I made no approximation of "average physician income" in my original post. I didn't even list a number.

Not really sure what your agenda is here, but all I'm saying is that you are going to come across a lot of puffery from search firms during the course of your career, but in truth if you see some salary figure that is too good to be true, you are going to call and they will inform you that they no longer have that position available, but have one almost as good at some fraction of the salary. That's just the way the headhunting world works.

This is very interesting to know about the recruiters. Regarding my agenda, my assertion is that we should probably expect to make less in the future than what we read about on the internet today. So if these numbers are inflated, that makes a stronger case for what I'm implying here. Now I just want to know, of the people in my cohort who are thinking about this, what do they think?

Of course the real gems in these threads always come when the residents and attendings drop by. I was definitely hoping that you would be one of the people to make a contribution, so thank you.

 

[slatermd]

I just wish there was more parity among specialties. At my specific institution, I know for a fact that the gastroenterologists are making WAY more money than almost every other specialty, and that their reimbursement per RVU is through the roof.

They are definitely making more than my surgery attendings (all of whom are fellowship trained), with better hours and less risk.

I'm not out to take away someone else's income, but it honestly feels rather demeaning to be told that your specialty isn't "worth" as much as another, just because their set of procedures pays better than yours.

Yeah, I don't want to bash either, but I have never understood why GI compensation is SO high. I mean I guess you'd have to pay me quite a lot if a major chunk of my career were colonoscopies and having patients show me Polaroids of their most recent bowel movements.

Thanks for contributing, Prowler.

 

[Thirteeen]

That was epic!

 

[orthomyxo]

 

[IcemanMD]

Well I guess I'll be pre-dental then.

 

[slatermd]

That was epic!

You could spend hours trying, but you'll never see what I did there.

 

[aSagacious]

You could spend hours trying, but you'll never see what I did there.

In the few months that Thirteen has been on SDN, I think I can count the number of valuable contributions by her on one hand.

 

[TheTruckGuy]

1. What are your thoughts about increased debt and decreased wages? What, if anything, are you going to do about this?
2. How much is $200K, really? What kind of lifestyle does it afford? Oversimplifying the calculation, it's about $13,000 a month after taxes (calculation is below). What can we really do with that?

1. Military medicine FTW! - They pay for my school, and pay me to go to school.
2. Military medicine FTW! - Lower cost of living while on active duty, tax free income while deployed to certain regions, go career and earn half my base pay after retirement, allowing me to not only work and get that check on top of everything, but if I want to I have income security giving me the ability to spend less time working and more time volunteering. And 200k is a crap ton of money, I could live very comfortably off 50k. I'm a very frugal person and manage/invest my money very well.

And the best part of military medicine - I get to serve!

 

[Thirteeen]

In the few months that Thirteen has been on SDN, I think I can count the number of valuable contributions by her on one hand.

And I am assuming that you consider all of the garbage that you post as valuable? LOL

I think fecal matter has more substance than your postings. Pretending to know everything and anything about how to get into medical school or who should get into med school does not make you an expert my friend. You are not on any admissions committee and neither are you a medical student. You are probably living in your mom's basement, bored and lonely. Thank you for reading.

 

[Bravetown]

1. Military medicine FTW! - They pay for my school, and pay me to go to school.
2. Military medicine FTW! - Lower cost of living while on active duty, tax free income while deployed to certain regions, go career and earn half my base pay after retirement, allowing me to not only work and get that check on top of everything, but if I want to I have income security giving me the ability to spend less time working and more time volunteering. And 200k is a crap ton of money, I could live very comfortably off 50k. I'm a very frugal person and manage/invest my money very well.

And the best part of military medicine - I get to serve!

There's a great spreadsheet (made by someone taking the military scholarship) comparing the military doc and the non-military doc salaries and debt. I think its around 10 years into practice that the non-military doc catches up and then takes off. Of course the military doc is debt free right after so there's that, but to each his own. And dude totally agree with you 200k is a definitely a crap ton of money could definitely live well off that.

found a link this dude's numbers could be off, but they look relatively ok: http://halfmd.wordpress.com/2007/03/23/financial-analysis-of-the-health-professions-scholarship-program/

 

[aSagacious]

And I am assuming that you consider all of the garbage that you post as valuable? LOL

I think fecal matter has more substance than your postings. Pretending to know everything and anything about how to get into medical school or who should get into med school does not make you an expert my friend. You are not on any admissions committee and neither are you a medical student. You are probably living in your mom's basement, bored and lonely. Thank you for reading.

She has claws

 

[Wolfman89]

Honestly even with my debt load I feel I can make quite a comfortable living for myself at ~$200000 per year.

Like a lot of people have said I am not going into medicine for the money,but it is a nice perk so to speak.



Also the real reason to go into medicine:

 

[DbDan]

There's a great spreadsheet (made by someone taking the military scholarship) comparing the military doc and the non-military doc salaries and debt. I think its around 10 years into practice that the non-military doc catches up and then takes off. Of course the military doc is debt free right after so there's that, but to each his own. And dude totally agree with you 200k is a definitely a crap ton of money could definitely live well off that.

found a link this dude's numbers could be off, but they look relatively ok: http://halfmd.wordpress.com/2007/03...f-the-health-professions-scholarship-program/

he commits 100% of residency salary to paying off loans and assumes no interest. Plus 30k tuition, which many schools are higher. The figures are pretty off to be honest.

 

[bucks2010]

200k is a pretty nice sum, but the question it raises is how hard would you be willing to work to earn it? I mean, is this an 8-5 FP or 3/12 EM doc we're talking about, or is this a >60h/wk + call general surgeon? At what point does doing a job you love not become worth the compensation you receive?

 

[5280]

I just wish there was more parity among specialties. At my specific institution, I know for a fact that the gastroenterologists are making WAY more money than almost every other specialty, and that their reimbursement per RVU is through the roof.

They are definitely making more than my surgery attendings (all of whom are fellowship trained), with better hours and less risk.

I'm not out to take away someone else's income, but it honestly feels rather demeaning to be told that your specialty isn't "worth" as much as another, just because their set of procedures pays better than yours.

I bet pediatricians and family medicine docs feel the same.

there isn't much else I'd rather be doing. Maybe if I could fly a fighter jet...

+100


I liked this - http://sls.downstate.edu/financial_aid/pdf/MedicalSchoolDebt.pdf

 

[TheTruckGuy]

There's a great spreadsheet (made by someone taking the military scholarship) comparing the military doc and the non-military doc salaries and debt. I think its around 10 years into practice that the non-military doc catches up and then takes off. Of course the military doc is debt free right after so there's that, but to each his own. And dude totally agree with you 200k is a definitely a crap ton of money could definitely live well off that.

found a link this dude's numbers could be off, but they look relatively ok: http://halfmd.wordpress.com/2007/03...f-the-health-professions-scholarship-program/

That's true. I think family medicine doctors in the military start earning more money than their civilian counter parts after year 11 or so. Other than that, the odds of making more money are slim. But the feeling of being debt free and being able to start investing/saving for retirement while still a med student has got to be worth some of the higher pay your civilian counterparts will be recieving. And if you live in a place like Texas, where cost of living and tuition is really low, you're going to be doing pretty dang good. I'm also going to be doing a different program than the guy in the link you posted (I'm doing HSCP through the Navy, he did HPSP), which works out better if you plan on staying in the military for longer and if you live in a state like Texas.

Also, it's something I want to do, not something I feel I have to do for the money.

 

[calvnandhobbs68]

In the few months that Thirteen has been on SDN, I think I can count the number of valuable contributions by her on one hand.

And the number of fingers up on that hand would be zero.

 

[WeAreNotRobots]

This is zealot's worst post evar! Where are the lolcats?

But seriously, way to lay out some sensibility for the sdn community. I hope to maybe post some figures on the trends of rising debt and lowering income, as well as typical monthly payments people can expect on $XXX,000 of loans. But it will have to wait a few days...

 

[painmd87]

over the three years of residency, i've looked into alternative practice models for primary care that would either increase the quality of life as a physician or increase the compensation or both. ie: ideal medical practice model, direct-pay practice, concierge care, becoming a principal investigator for clinical trials, cosmetic medicine, doing procedures, taking on administrative roles, etc. what i found is that it is possible to increase your income.

Note bolded.

The docs who bring in the most money are those that do clinical trials and boatloads of procedures.

In the practice where I work, we do about 5% clinical trials, 95% direct patient care. The clinical trials account for nearly a third of our income.

 

[RelicLTD]

I have been reading up on some cash-only practices, or those opting out of medicare, as possible ways to increase autonomy and reimbursement. I chose two to post that reflect the different ends of reimbursement and practice type (office visit vs procedural): Family medicine and Ortho.

This is an Orthopedic Group Round Table discussion on opting out of medicare, going cash only, and becoming out-of-network providers. A variety of practices and doctors are consulted on the impacts and hurdles.
http://www.orthosupersite.com/view.aspx?rid=26705

Overview
There are three primary types represented:
-Practices opting out of medicare.
-Practices going cash-only.
-Practices acting as third-party or out-of-network providers.
General Trends
• Increased reimbursement in all cases, and reduced patient volume and paperwork.
• Highly reduced patient population over 65 (duh), even when willing to treat previous medicare patients for free.
• Most provide assistance to patients in billing their own insurance.
• Charity and discounts at your own discretion.
• A variety of pay schemes are feasible (Cash up front, payment plan).
• Ethical hurdles from access to care, and increasing disparity.
• Not viable in all locations and practices.
• Most examples are quite old, and may not be as applicable today and in the future.

The second article is a family practice physician who decided to decline a salaried position at an academic center in order to go cash-only.
http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=652945

Overview
• Established in 2002 (article written 2010).
• Accepts no insurance or Medicare.
• See's at most 16 patients per day, and goes home at 5pm every night.
• Pre tax net income between $275-495K per year (broad range, but directly from the article)
• Has 2,500 active patients.
• Keeps costs low by eliminating insurance administration duties, keeping a minimal staff, and negotiates low outsourced lab fees.
• Has a price board out in front of his office ($45 Office visit, $25 Sport physical, $25 Lipid panel, etc.).
• Gives patients print-outs of prepared CPT and ICD-9 codes for their visit if they wish to file their insurance.
• Very low wait times, and long patient interaction times (5min/50min)
• Keys to success include his quality time spent with patients. Low costs alone aren't enough. Patient satisfaction made his practice grow rapidly.
• (Side Note) Physicians not accepting insurance in North Carolina went from .1% to 5% over three to four years.

Obviously these are limited in scope, and I'm sure it isn't easy to set up a cash only practice (even more so for procedural ones). Also, with the healthcare system in serious flux at the moment, it is hard to say if the idea is still reasonable. At least it is proof of concept that it can be done, and generally raises reimbursement and lowers paperwork hassles and general workload.

 

[Cleavername]

For those interested in the BLS salaries, here they are:

Anesthesiologists-------------------$211,750
Family and General Practitioners-----$168,550
Internists, General------------------$183,990
Obstetricians and Gynecologists-----$204,470
Pediatricians, General---------------$161,410
Psychiatrists-----------------------$163,660
Surgeons--------------------------$219,770
Physicians and Surgeons, All Other--$173,860

http://www.bls.gov/oes/current/oes_nat.htm#29-0000

those do not include academia salaries, which tends to be lower, if only they did tell us what portion of them were private practice.

 

[Wolfman89]

The second article is a family practice physician who decided to decline a salaried position at an academic center in order to go cash-only.
http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=652945

Overview
• Established in 2002 (article written 2010).
• Accepts no insurance or Medicare.
• See's at most 16 patients per day, and goes home at 5pm every night.
• Pre tax net income between $275-495K per year (broad range, but directly from the article)
• Has 2,500 active patients.
• Keeps costs low by eliminating insurance administration duties, keeping a minimal staff, and negotiates low outsourced lab fees.
• Has a price board out in front of his office ($45 Office visit, $25 Sport physical, $25 Lipid panel, etc.).
• Gives patients print-outs of prepared CPT and ICD-9 codes for their visit if they wish to file their insurance.
• Very low wait times, and long patient interaction times (5min/50min)
• Keys to success include his quality time spent with patients. Low costs alone aren't enough. Patient satisfaction made his practice grow rapidly.
• (Side Note) Physicians not accepting insurance in North Carolina went from .1% to 5% over three to four years.

Obviously these are limited in scope, and I'm sure it isn't easy to set up a cash only practice (even more so for procedural ones). Also, with the healthcare system in serious flux at the moment, it is hard to say if the idea is still reasonable. At least it is proof of concept that it can be done, and generally raises reimbursement and lowers paperwork hassles and general workload.

At first I had issues with charging cash, but when you consider what most co-pays are.

A question, since I am not 100% sure how insurance works, why would the patients file with their insurance?

 

[TooMuchResearch]

Not really sure what your agenda is here, but all I'm saying is that you are going to come across a lot of puffery from search firms during the course of your career, but in truth if you see some salary figure that is too good to be true, you are going to call and they will inform you that they no longer have that position available, but have one almost as good at some fraction of the salary. That's just the way the headhunting world works.

That's pretty much the way car dealerships work, too.

he commits 100% of residency salary to paying off loans and assumes no interest. Plus 30k tuition, which many schools are higher. The figures are pretty off to be honest.

The figures are definitely way off (and the military pay used is outdated), and it's important to keep in mind that many that go the military route either separate or transition to a Reserve component after their initial commitment is up.