ER docs — How do you keep your wife happy?

[VA Hopeful Dr]

I don't think so? She works for the same hospital system so I'm essentially just trying to keep patients within the same system. Her name is up with all the rest of our "in hospital" referrals and she is in the outpatient referral list that pops up when I need to refer someone for f/u.

Could be an issue if its a overwhelming majority of your referrals and the patients don't realize y'all have a personal relationship.

Before we moved I sent most of my OB/GYN patients to my father-in-law but I told them who he was and documented that they were OK with it.

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[southerndoc]

You’re mostly saved by the fact that you aren’t married/legally related I think. Stark also covers Medicare and not private patients I believe.

But IF you were married AND involved Medicare patients AND she did get paid based on these visits then I do think it would run afoul of Stark law.

I doubt the feds would ever touch this.

 

[sloh]

So, technically....if you think about it. I'm the one who would stand to benefit from a marriage, especially if I retired early and she remained working, generating most of our income. I think that's why I've been warming up to the idea, the older I get... It doesn't sounds so bad like it once did.

This mindset wrt marriage seems like a siren song, especially for a male in a heterosexual relationship

 

[Mad Jack]

Unless I have interest in kids, I would Never get married. I see no reason to get married unless you have kids.

if something happened to my wife, No way in Hell would I ever get married even if this would be a deal breaker for her. Another marriage with kids just means someone telling my kids what to do which is a big no no. Another wife means having splitting my inheritance up. So many reasons to not remarry and almost no reason to remarry at least for me.

Eh, I got married because my wife doesn't work and there are a lot of things that are made much easier for us if we're married, from health insurance to death benefits and the like. There's a lot of scenarios in which a nonworking partner stands to lose a lot in the absence of marriage. If you want to make sure they are taken care of in your absence, marriage makes sense.

 

[Angry Birds]

OK, so I owe my wife an apology. I spent time with her and she happy now. I have to dedicate time to her in my day.
And she did not make me write this.

(I will respond to other posts soon... I am a big fan of marriage and kids, hehe, and think it's nuts to think otherwise.)

 

[GonnaBeADoc2222]

(I will respond to other posts soon... I am a big fan of marriage and kids, hehe, and think it's nuts to think otherwise.)

Eesh...that social conditioning really shining through.

 

[Groove]

When we were looking for NP/PA covid help, our pay offer was on the high end of market. Had a good PA wanting to pick up some shifts and when he heard the offer said it was too low b/c he could pick up extra shifts working in the hospital. I asked how much would get him to pick up shifts, and he said we would have to match the hospital at 120/hr=250K working 40hrs/wk. I am sure he was pulling in north of 500K picking up those extra shifts.

If you are OK being an NP/PA with less liability. Just get into the ER b/c there are some desperate ERs around and I bet the pay is close to $100/hr for some busy places.

Just curious, if you are making 400K and your wife 200K, would it not make more sense for you to work half time and let her retire? That is certainly what I would do.

Well, I'd be perfectly fine with part time. But honestly, I'm talking tongue in cheek because I wouldn't be ready to truly consider part time or full retirement for another 10 years or so. She on the other hand...is just not one of those women that's interested in quitting work. You know how some people handle many days off in a row with ease? She's not one of them. She goes stir crazy after a couple of days off and I sometimes worry how she will handle full retirement. Me on the other hand, I'm perfectly fine with absolutely nothing to do and can entertain myself with ease. Hell, I'd love to do nothing other than work out, play xbox and do investing all day. She'll probably be one of those types that continues to work clinic as long as she can, then part time as long as she can. She has zero interest in letting me take care of her 100% and living at home. Whenever I get there...I'd be perfectly happy taking on our financial investment management as my full time job. That being said, I got a late start in life with my retirement (previous career before medicine) and have been playing catch up. Her combined income and ability to work longer than myself would definitely help my/our long term retirement investment strategy though...

 

[Brigade4Radiant]

It's also hard dating so I can see why some people stay

 

[BoardingDoc]

Hell, I'd love to do nothing other than work out, play xbox and do investing all day.

Man, sounds like you should have been a finance bro.

 

[ER BlueBlood]

That was my reaction too. That's certainly a lot of money, but it's half of what I make.

For a lot less education and a lot less loans bud. A lot of us are closing in on $350-375k, it’s pretty dang close if you ask me.

 

[Kryptocoin]

A lot of doctors get married pretty young (20s) and then are divorced by their late 30s and 40s. I can understand why female doctors marry early due to their biological clock. Not sure why men rush into marriage early.

 

[WilcoWorld]

A lot of doctors get married pretty young (20s) and then are divorced by their late 30s and 40s. I can understand why female doctors marry early due to their biological clock. Not sure why men rush into marriage early.

I wasn't keen on the idea of having high schoolers in my 60's.

I also didn't think of it as "rushing in". That's probably a conclusion people come to in retrospect.

 

[BoardingDoc]

A lot of us are closing in on $350-375k, it’s pretty dang close if you ask me.

You and I seem to define "comparable income" differently.

350K, your low end number, is 155% of the listed 225k. I personally wouldn't say that I make "pretty dang close" to the same money as someone making 55% more than me.

 

[ER BlueBlood]

You and I seem to define "comparable income" differently.

350K, your low end number, is 155% of the listed 225k. I personally wouldn't say that I make "pretty dang close" to the same money as someone making 55% more than me.

Take taxes out and pay your loans bud and you are much closer than you think. But, whatever makes you feel better.

Would you say the difference between a person making 100k and 155k is large? No wonder docs are where we are…

 

[BoardingDoc]

Take taxes out and pay your loans bud and you are much closer than you think. But, whatever makes you feel better.

Would you say the difference between a person making 100k and 155k is large? No wonder docs are where we are…

Based on what I've written in this thread, I'm not sure why you think I need to "feel better" about my income.

And yes, literally any rational person who is making 100k would think that suddenly making 155k is a large difference.

 

[ER BlueBlood]

Based on what I've written in this thread, I'm not sure why you think I need to "feel better" about my income.

And yes, literally any rational person who is making 100k would think that suddenly making 155k is a large difference.

You still don’t get it, no worries.

Based on what I've written in this thread, I'm not sure why you think I need to "feel better" about my income.

And yes, literally any rational person who is making 100k would think that suddenly making 155k is a large difference.

Sounds good

 

[HemeOncHopeful19]

Based on what I've written in this thread, I'm not sure why you think I need to "feel better" about my income.

And yes, literally any rational person who is making 100k would think that suddenly making 155k is a large difference.

Maybe. But if it took an extra 7 years of nights, weekends and holidays to get to that 155k… maybe not.

 

[BoardingDoc]

Maybe. But if it took an extra 7 years of nights, weekends and holidays to get to that 155k… maybe not.

Of course not.

When comparing salaries, there are obviously going to be decision points for when the juice is actually worth the squeeze. NP at 100k or MD at 155k? NP, obviously.

NP at 225k or MD at > 450k? MD wins for me. Others might disagree. The comparisons are also going to be very user specific. While I'm content with the previous comparison, the NPs in my area sure as hell aren't making 225k. It's more like 150k. 150:450 feels like a reasonable ratio to me. Obviously things look very different when you start having high outlier NP numbers and lower end MD numbers.

 

[RustedFox]

Of course not.

When comparing salaries, there are obviously going to be decision points for when the juice is actually worth the squeeze. NP at 100k or MD at 155k? NP, obviously.

NP at 225k or MD at > 450k? MD wins for me. Others might disagree. The comparisons are also going to be very user specific. While I'm content with the previous comparison, the NPs in my area sure as hell aren't making 225k. It's more like 150k. 150:450 feels like a reasonable ratio to me. Obviously things look very different when you start having high outlier NP numbers and lower end MD numbers.

"The NPs that I know aren't worth the 150k that you cite."

... He said, as he was writing up a summary of the case that he admitted last week that is now going to peer review because the NP can't medicine.

 

[CoolDoc1729]

Of course not.

When comparing salaries, there are obviously going to be decision points for when the juice is actually worth the squeeze. NP at 100k or MD at 155k? NP, obviously.

NP at 225k or MD at > 450k? MD wins for me. Others might disagree. The comparisons are also going to be very user specific. While I'm content with the previous comparison, the NPs in my area sure as hell aren't making 225k. It's more like 150k. 150:450 feels like a reasonable ratio to me. Obviously things look very different when you start having high outlier NP numbers and lower end MD numbers.

The more NPs are paid, and the less physicians are paid, the less sense it makes to hire someone with so much less training. Job security? 🤦🏻‍♀️

 

[RustedFox]

The more NPs are paid, and the less physicians are paid, the less sense it makes to hire someone with so much less training. Job security? 🤦🏻‍♀️

Rethink that.

 

[VA Hopeful Dr]

Rethink that.

No I think there's wisdom in this. If you pay an NP let's say 150k and can pay a physician 175k, the physician starts to look a lot better. Higher throughput if literally nothing else.

My office has a full time NP. We work about the same number of hours per week. My RVU numbers are almost double hers.

 

[RustedFox]

No I think there's wisdom in this. If you pay an NP let's say 150k and can pay a physician 175k, the physician starts to look a lot better. Higher throughput if literally nothing else.

My office has a full time NP. We work about the same number of hours per week. My RVU numbers are almost double hers.

I see your point, but *BRUH* - do you see the numbers that you're using?
At that point, there's no point in attending medical school. Ever. By anyone.

 

[emergentmd]

If docs do not pay on avg 200K more than an NP/PA there are very little incentive to become a doc unless you need to be in an authority role which gets old anyhow.

If I am spending 250K more and 7 yrs post grad vs some accelerated nursing degree taking 4 yrs college + online 16 months. So around 5 yrs quicker.

 

[Groove]

So, I was supposed to take my SO shopping for rings today or basically to get an idea on settings that she liked... I've been working a ton, had today off and totally forgot about the date so when she came into my man cave to ask me if I was ready to go shopping, I was like "huh? shopping for what?". She burst into tears and now I'm in the dog house so maybe I'm not as good about keeping my lady happy as I let on earlier in this thread...

 

[DarkHorizon]

So, I was supposed to take my SO shopping for rings today or basically to get an idea on settings that she liked... I've been working a ton, had today off and totally forgot about the date so when she came into my man cave to ask me if I was ready to go shopping, I was like "huh? shopping for what?". She burst into tears and now I'm in the dog house so maybe I'm not as good about keeping my lady happy as I let on earlier in this thread...

A commitment ring or an engagement ring? I know you mentioned you don’t want children and are divorced. Not sure id wanna be married again if I didn’t want children.

 

[Groove]

A commitment ring or an engagement ring? I know you mentioned you don’t want children and are divorced. Not sure id wanna be married again if I didn’t want children.

Well, kind of a commitment ring more than anything else. I've got to make an appt with a local attorney for a consultation about a prenup. If I'm happy with the overall protection from a prenuptial agreement, then I would probably move forward towards a formal engagement and legal marriage. As it stands, luckily she's very understanding on my hesitancy surrounding legal marriage and really just wants the visual commitment that a ring would provide. I'm not opposed to marriage but I need to figure out if a prenup protects future retirement savings. If it doesn't...then I might be more inclined to have some sort of visual ceremony that's not a legal marriage. She's just tired of being the "live in girlfriend" and after this long...I do get it. I'm trying my best to meet her half way. She's not a gold digger and makes half my income just from being an NP. She's told me she'd sign any prenup that I drew up.

 

[VA Hopeful Dr]

I see your point, but *BRUH* - do you see the numbers that you're using?
At that point, there's no point in attending medical school. Ever. By anyone.

That's a whole different point than the one I was addressing.

I'd have still done it even with those numbers. I enjoy being a doctor and having the in-depth knowledge of medicine that no midlevels ever will is part of what keeps my day interesting.

 

[GonnaBeADoc2222]

Well, kind of a commitment ring more than anything else. I've got to make an appt with a local attorney for a consultation about a prenup. If I'm happy with the overall protection from a prenuptial agreement, then I would probably move forward towards a formal engagement and legal marriage. As it stands, luckily she's very understanding on my hesitancy surrounding legal marriage and really just wants the visual commitment that a ring would provide. I'm not opposed to marriage but I need to figure out if a prenup protects future retirement savings. If it doesn't...then I might be more inclined to have some sort of visual ceremony that's not a legal marriage. She's just tired of being the "live in girlfriend" and after this long...I do get it. I'm trying my best to meet her half way. She's not a gold digger and makes half my income just from being an NP. She's told me she'd sign any prenup that I drew up.

Sigh.

 

[CoolDoc1729]

Well, kind of a commitment ring more than anything else. I've got to make an appt with a local attorney for a consultation about a prenup. If I'm happy with the overall protection from a prenuptial agreement, then I would probably move forward towards a formal engagement and legal marriage. As it stands, luckily she's very understanding on my hesitancy surrounding legal marriage and really just wants the visual commitment that a ring would provide. I'm not opposed to marriage but I need to figure out if a prenup protects future retirement savings. If it doesn't...then I might be more inclined to have some sort of visual ceremony that's not a legal marriage. She's just tired of being the "live in girlfriend" and after this long...I do get it. I'm trying my best to meet her half way. She's not a gold digger and makes half my income just from being an NP. She's told me she'd sign any prenup that I drew up.

My husband and I got married when I had been an attg less than 1 year. The only important thing to me in our prenup was “no alimony”. I was fine giving him half of whatever we already had if it didn’t work out, but not a blank check For half of the rest of my life! This was no problem legally. Sounds like your situation may be somewhat different though.

 

[CoolDoc1729]

That's a whole different point than the one I was addressing.

I'd have still done it even with those numbers. I enjoy being a doctor and having the in-depth knowledge of medicine that no midlevels ever will is part of what keeps my day interesting.

I feel the same way. I would hate to have to report off complicated issues to someone else. I am also already a physician so the sunken costs are waaaay down there already. At least I want to maintain employment for another 10-15 years. I can’t really do anything about the larger forces at play.

 

[RustedFox]

That's a whole different point than the one I was addressing.

I'd have still done it even with those numbers. I enjoy being a doctor and having the in-depth knowledge of medicine that no midlevels ever will is part of what keeps my day interesting.

Name the numbers 300 and 325k and it makes your point worse.

 

[Groove]

My husband and I got married when I had been an attg less than 1 year. The only important thing to me in our prenup was “no alimony”. I was fine giving him half of whatever we already had if it didn’t work out, but not a blank check For half of the rest of my life! This was no problem legally. Sounds like your situation may be somewhat different though.

Interesting. Well....my predicament is that I had a first career before medicine where I didn't save anything and once I got out of residency and paid off my 400K loans, I've been aggressively trying to play "catch up" with retirement savings. So for instance, the amount of money I could put away in 5 or 10 years is substantial. In some ways, it doesn't seem fair that someone should have the power to leave me in 5-10 years and take half of those savings, extending my retirement by years overnight. Some might argue and say..."Well Groove, those are shared assets earned during marriage." But I would argue that if someone had an earning power of 200K before marriage and then your combined earning power is say....600K post marriage, that upon divorce....nobody with the ability to earn 200K themselves should be afforded a lifestyle/retirement account befitting 600K or even 400K. How is it fair that suddenly they are afforded half of what I have been aggressively saving? It seems far more fair to me to have 2 separate retirement accounts that are there hopefully for both of us upon retirement but in the event of divorce can be simply split between both persons. I just can't risk having half my assets peeled away on my timeframe as I near retirement. I should have much more in savings by now at my age than I actually do.

The problem is that things get messy if one person gets hurt/disabled and can't earn an income and/or save for retirement. What to do if you both get divorced in one of those situations? How to protect the person that has lost their income potential so that they are not unfairly treated in a divorce? It's all very depressing honestly to think about. Having to analyze, plot and strategize my own best interests so that I can commit myself to a woman "till death do us part". How decidedly...unromantic.

 

[sloh]

How to protect the person that has lost their income potential so that they are not unfairly treated in a divorce? It's all very depressing honestly to think about. Having to analyze, plot and strategize my own best interests so that I can commit myself to a woman "till death do us part". Decidedly...unromantic.

I think two people who can go through pre-nup negotiations level-headed and in a reasonable manner says a lot about how the relationship/marriage will go in general especially when conflicts arise.

 

[VA Hopeful Dr]

Name the numbers 300 and 325k and it makes your point worse.

You're still not getting my point. Everywhere I've ever worked (and many EDs from what y'all say here), physicians earn more RVUs/time than midlevels.

If the pay difference between the 2 is minimal, why wouldn't you hire physicians of they are significantly more productive?

 

[RustedFox]

You're still not getting my point. Everywhere I've ever worked (and many EDs from what y'all say here), physicians earn more RVUs/time than midlevels.

If the pay difference between the 2 is minimal, why wouldn't you hire physicians of they are significantly more productive?

Oh, no.
I got your point. Crystal.

It's just dumb. Admin DGAF because they'll pocket the cost savings, no matter how small (as they've already demonstrated) and crack the whip harder (as they've already demonstrated).

For your hypothetical to work, it would require the MLP to be... (1.) competent, lol. (2.) productive, and (3.) truly independent.

Sure, then we would be a smart hire.

But if you take those three items above together you have....

Anybody?

 

[GonnaBeADoc2222]

I think two people who can go through pre-nup negotiations level-headed and in a reasonable manner says a lot about how the relationship/marriage will go in general especially when conflicts arise.

The prenup can get tossed by the judge at a whim. Have you considered that?

It will also cost thousands defending the validity of the prenup, if challenged, before you even get to the meat and potatoes of the divorce.

 

[VA Hopeful Dr]

Oh, no.
I got your point. Crystal.

It's just dumb. Admin DGAF because they'll pocket the cost savings, no matter how small (as they've already demonstrated) and crack the whip harder (as they've already demonstrated).

For your hypothetical to work, it would require the MLP to be... (1.) competent, lol. (2.) productive, and (3.) truly independent.

Sure, then we would be a smart hire.

But if you take those three items above together you have....

Anybody?

You clearly don't.

If you pay me 50k more than a mid-level but I'm twice as productive than I am much more valuable purely from a monetary perspective. Heck it doesn't even have to be that much more.

Let's say that the mid-level results in 600k in collections per year. You pay them 150k. The hospital keeps 450k.

I on the other hand bring in 700k in collections while being paid 200k. The hospital keeps 500k.

Which one of us makes more sense to employ purely based on money?

 

[ER BlueBlood]

So, I was supposed to take my SO shopping for rings today or basically to get an idea on settings that she liked... I've been working a ton, had today off and totally forgot about the date so when she came into my man cave to ask me if I was ready to go shopping, I was like "huh? shopping for what?". She burst into tears and now I'm in the dog house so maybe I'm not as good about keeping my lady happy as I let on earlier in this thread...

Groove I like your style man, keepin it 1000 with the forum

 

[ER BlueBlood]

Of course not.

When comparing salaries, there are obviously going to be decision points for when the juice is actually worth the squeeze. NP at 100k or MD at 155k? NP, obviously.

NP at 225k or MD at > 450k? MD wins for me. Others might disagree. The comparisons are also going to be very user specific. While I'm content with the previous comparison, the NPs in my area sure as hell aren't making 225k. It's more like 150k. 150:450 feels like a reasonable ratio to me. Obviously things look very different when you start having high outlier NP numbers and lower end MD numbers.

Sorry Boarding, I didn’t mean to be a jerk. Been one of those weeks. Thanks for your reply.

 

[cyanide12345678]

I’ve been married 5 years. The secret to marital success was finding a low maintenance wife who derives her own happiness from giving to others.

She has only asked for 2 things in our life together. One was an SUV instead of a sedan when she had moved to the US and we were buying a second car. Second she wanted a forever home so that she wouldn’t have to move again - she didn’t want to buy a starter home last year when we were moving after she finished her residency.

Otherwise she’s very easy going. Time spent together makes her happy. A thoughtful note or text makes her happy. Talking on the phone with family makes her happy. Eating out makes her happy, doesn’t even have to be anything fancy, we barely go to very high end restaurants. And usually when i pull my weight in taking care of our daughter, that makes her happy.

We also have a maid every 3 or so weeks, i think that makes her life much easier. She would probably be a lot more angry if we didn’t have that.

 

[ER BlueBlood]

I’ve been married 5 years. The secret to marital success was finding a low maintenance wife who derives her own happiness from giving to others.

She has only asked for 2 things in our life together. One was an SUV instead of a sedan when she had moved to the US and we were buying a second car. Second she wanted a forever home so that she wouldn’t have to move again - she didn’t want to buy a starter home last year when we were moving after she finished her residency.

Otherwise she’s very easy going. Time spent together makes her happy. A thoughtful note or text makes her happy. Talking on the phone with family makes her happy. Eating out makes her happy, doesn’t even have to be anything fancy, we barely go to very high end restaurants. And usually when i pull my weight in taking care of our daughter, that makes her happy.

We also have a maid every 3 or so weeks, i think that makes her life much easier. She would probably be a lot more angry if we didn’t have that.

Safe to say she is not American? Prob the best move 😂 their expectations and focus are nonsense - not sure why, must be too much Disney brainwashing

 

[cyanide12345678]

Let me guess, this is not an American woman lol 😂

Nope. Born and raised in pakistan and moved to the US after marriage at age 25 ish. So yeah…she’s pretty much lived in a culture where society expects women to be fairly compromising, especially in marriages.

 

[ER BlueBlood]

I see your point, but *BRUH* - do you see the numbers that you're using?
At that point, there's no point in attending medical school. Ever. By anyone.

You’d be surprised. There are tons of people lining up for dentistry, vet school, garbage law schools to go make that kind of money while incurring lots of debt.

 

[FutureInternist]

Happy wife, happy life

Happy spouse, happy house

 

[DarkHorizon]

Safe to say she is not American? Prob the best move 😂 their expectations and focus are nonsense - not sure why, must be too much Disney brainwashing

I don’t know, I am a first generation immigrant and I married a small town Midwest Scandinavian farm girl. She’s pretty low key, and probably more frugal than myself. I got lucky for sure and have three kids. I wouldn’t get married if I didn’t want kids though. I see no point.

 

[sloh]

I don’t know, I am a first generation immigrant and I married a small town Midwest Scandinavian farm girl. She’s pretty low key, and probably more frugal than myself. I got lucky for sure and have three kids. I wouldn’t get married if I didn’t want kids though. I see no point.

Midwest

 

[WilcoWorld]

Lifelong partnership is attractive to me, seems like a reason to get married without procreating. Obviously not a decision to be taken lightly, but it's not nonsensical IMO.

 

[GonnaBeADoc2222]

Lifelong partnership is attractive to me, seems like a reason to get married without procreating. Obviously not a decision to be taken lightly, but it's not nonsensical IMO.

Tell us how it is sensical for a person who generates 300 - 500k / yr to marry someone who makes 0 - 150k / yr.

Divorce rate 50% give or take. Flip that coin.

bUt PrEnUpPpPpPp!!!!.

Ok. Spend 10k (at least) on lawyer to draft, lawyer #2 to represent you, lawyer #3 to represent future spouse. Then, have to incorporate some degree of "reasonableness" because if you write "zero alimony" a judge will say nah bro and toss it out. Why do I have to pay all these lawyers? Because if spouse doesnt have separate representation in the process, the agreement will get tossed.

Then, if the divorce happens spend another 50k fighting over the legitimacy of the agreement before the divorce part.

I'm actually legit asking.

 

[VA Hopeful Dr]

Tell us how it is sensical for a person who generates 300 - 500k / yr to marry someone who makes 0 - 150k / yr.

Divorce rate 50% give or take. Flip that coin.

bUt PrEnUpPpPpPp!!!!.

Ok. Spend 10k (at least) on lawyer to draft, lawyer #2 to represent you, lawyer #3 to represent future spouse. Then, have to incorporate some degree of "reasonableness" because if you write "zero alimony" a judge will say nah bro and toss it out. Why do I have to pay all these lawyers? Because if spouse doesnt have separate representation in the process, the agreement will get tossed.

Then, if the divorce happens spend another 50k fighting over the legitimacy of the agreement before the divorce part.

I'm actually legit asking.

Its only around 30% of first time marriages that end in divorce.