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Family Med - salaries, sign-ons, loan payoffs, bonuses, etc

Discussion in 'Family Medicine' started by SpesMeaInDeoEst, 02.10.12.

  1. OneLeven

    OneLeven

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    Does anyone else have any experience with NHSC loan repayment programs after residency?
  2. engin33ring

    engin33ring

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    I have researched the topic to death because I am terrified about the loan I will have to pay back after med school. Here is why I decided to pass on it.

    1.
    PRO: A huge advantage is that they pay for med school and give you a stipend of between $1200-$2000 (depends on cost of living). Here is the math I came up with. Lets say med school is 45k/year and they give you the mean of $1600/month (only the 10 months you are in school). After four years, it adds up to $241k they give you.
    CON: I must go into primary care or I am charged up to 3x the amount of what they paid. HOW MUCH ???? $720k

    2.
    PRO: I don't have to worry about funds for the four years and I am pretty much guaranteed a job after residency
    CON: I might not have a complete choice of where to practice. If there aren't spots available in my area I need to move (at least for those 4 years)

    3.
    To me this was the kicker. If I decide to do primary care after the fact, I can still do their loan repayment program. in those 4 years, I can get up to 120k paid. You won't get the same amount of money as signing the contract before med school, but I had the freedom of going into another specialty if I ended up changing my mind.

    Also, with this new Obama health care, I feel that the demand for primary care will go up and the only way to attract more doctors is to increase the loan repayment options. Perhaps longer or more money per year. :D
  3. brats800

    brats800 cheesehead

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    Interesting article. The author (an ED Attending) frequently does math off of an "average primary care salary" of $200k and in this post his math gives a Primary Care Attending a take-home of $8,125/mo. My math has come out higher, closer to $10k/mo off of the $180-200k salary range. Anycomments (even just low/high/about right) from the attendings in the audience?
  4. cabinbuilder

    cabinbuilder

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    This entire thread answers your question. It's already been covered.
  5. brats800

    brats800 cheesehead

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    I read the whole thread. CabinBuilder, thank you for the quick response but I already knew your viewpoint. I was hoping for more viewpoints than yours (low end of spectrum?) and SnakeOil (higher end of spectrum?)....any other attendings able to give some real world info?
  6. Shinken

    Shinken Family Medicine

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    The article's author is more accurate than your calculations (in my own personal experience). His numbers are awfully close to my real take-home.
  7. cabinbuilder

    cabinbuilder

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    Ok, just checking. I think you are safe to expect the numbers to be within the range discussed because everyone has different W-9 and situations that eats up your paycheck.
  8. cabinbuilder

    cabinbuilder

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    ■1) Make less money
    ■2) Get married
    ■3) Have kids
    ■4) Be an employee (the employer pays for half your payroll taxes)
    ■5) Buy a huge house with a big fat mortgage and property taxes. Heck, buy two.
    ■6) Give money to charity
    ■7) Live in a state without state income tax
    ■8) Save money for retirement
    ■9) If self-employed, try to characterize every expense possible into a business expense

    Ok, this is the advice from the article. I have highlighted what pertains to me. WIll see how the taxman comes out this year. Last year I wrote a check for 37,000 (but most of my income was through locums and they don't take taxes out). This year I was an employee for half the year and locums for the other half.
  9. MJB

    MJB Senior Member Moderator Emeritus

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    I assume this is after having things like any life insurance, health insurance, 401K, etc...pulled?

    Most calculators I've used have it right around 9500-10500 take home after taxes, but don't account for other things that can be automatically withheld.

    I'm a big fan of states with no income tax.
  10. OneLeven

    OneLeven

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    i was referring to the programs after you are an attending (where youa re not an nhsc scholar). Cabinbuilder referenced that she has tried to get loan repayment several times but has been unsuccessful.

    Does anyone else have any stories to share about loan repayment programs, not an nhsc scholar, but applying after you are an attending?
  11. SpesMeaInDeoEst

    SpesMeaInDeoEst

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    That's essentially my ongoing question as well.
  12. Shinken

    Shinken Family Medicine

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    Absolutely, that's pretty accurate to my actual take home after everything is taken out. I'm also contributing the maximum amount I'm allowed to my 401(k).
  13. Slack3r

    Slack3r Sicker than your average

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    FM seems almost out of the question for someone with $400k in loans. :(
    Silent Cool likes this.
  14. Dotsero

    Dotsero Member

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    Why would you say that? If you made $200k/yr in a typical midwest state, married, after taxes you would take home about $11450/mo. If you did IBR your payment on 400K loan would be $2300/mo leaving you around $9000/mo to live on and pay the bills. That's plenty.

    If you started working at 30, in 25 years the loan would be forgiven. You'd be 55 with a good chunk of change in the bank. Completely doable as long as you are financialy wise.
  15. SnakeOil

    SnakeOil

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    Some people find the idea of being in debt until they are over 50 while making just over $100k/year after loans and taxes are paid a hard pill to swallow. I think FM is great but it would have been much harder for me to make the decision to go into FM if I had almost half a million in debt hanging over my head.
  16. GoodmanBrown

    GoodmanBrown is walking down the path.

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    That's the thing, though. You can be out from under the loans in as little as 10 years post med school. The IBR is a pretty sweet deal. IBR has you paying approximately 10%-12% of your federally adjusted gross income toward your loans. If you work in one of a large variety of "public service" jobs, after 120 monthly payments, the rest of your debt is relieved. This includes time in residency and being an employee hospital (as long as it's a non-profit).

    So, 3 years residency, paying approximately $5,000-$6,000/yr., then paying for 7 more years $15,000-$20,000, and you're done.
  17. Dharma

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    I'm skeptical about the realistic possibilities regarding these programs (skeptical of the government in general...). Anyone with any experience want to chime in? From what I've read, the NHSC scholarship and loan forgiveness are difficult to obtain, and access to loan forgiveness through employers is a bit shaky as well.
  18. Prncssbuttercup

    Prncssbuttercup Established Member -- OMSIII

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    The 10yr loan repayment is for public sector jobs isn't an application. You can do IBR and after you've made 120 payments working for a qualified PS job, your loans are forgiven. So, if you worked for the VA, a prison, blah blah... loans forgiven in 10yrs, no application. If we still have a government in 10+yrs I am sure it will still be around. It was started a while ago...

    http://studentaid.ed.gov/PORTALSWebApp/students/english/PSF.jsp
  19. GoodmanBrown

    GoodmanBrown is walking down the path.

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    While I agree you shouldn't base your entire life around a government program, there just aren't certainties in life sometimes. As the above poster said, the IBR is not a government program you apply to, it's just one method of loan repayment.
  20. Dharma

    Dharma

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    Yeah, I'm well aware of this, which is why I asked how often "loan forgiveness through employers" really happens (after I mentioned the NHSC scholarship and loan forgiveness programs; my wording was off, which may have confused you. I should've wrote NHSC loan repayment program. My bad.). I've read about 'em, but I'd like to hear about the experiences of those who have applied/searched for such jobs and what the outcomes were.
    Last edited: 03.04.12
  21. Dharma

    Dharma

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    It would be ludicrous to expect certainty (nor was there an allusion to such expectations). However, it is good to know the odds.
  22. Slack3r

    Slack3r Sicker than your average

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    Keep in mind that $400k is just principal. I'm likely looking at over half a mil once residency is done just with the interest alone.

    I'm also a bit skeptical about whether IBR will even be available in the next 30 years or so when I'd acually take advantage of it. Given the budget woes of this country, and the world really, in addition to the exploding cost of tuition (I'll likely be paying $48k/year:eek:) I sincerely doubt the government is going to be forgiving several hundred thousand dollar loans for professional students.

    Granted, it's still doable. A quick calculation has me paying ~$4000/month on a 20 year non-IBR payment plan (with just over a million in total payments! Yipee!) I wouldn't starve, but it still seems like a hard sell to be bringing home less than most of my friends are making now one year out of college for 20 years after nearly a decade of training.
    Silent Cool likes this.
  23. GoodmanBrown

    GoodmanBrown is walking down the path.

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    I totally understand the skepticism about IBR, but don't you have some skepticism about specialists making 2x-3x more than PCP in 30 years? Most other first world countries with more public healthcare don't pay specialists that much more than general practitioners.

    Another note about IBR, is that it's not just for medical student loans. So, many other professionals may not be working for non-profits/public service organizations in such large percentages (and thus not receive the 120 payment forgiveness). So, us medical grads may not be such a big consideration to the powers that be.

    For me, it still remains, do what you enjoy most and work the financial angle to the best of your ability.
  24. Dharma

    Dharma

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    :thumbup: YEP!
  25. MavCon

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    Seems like most have issues with the total amount of their student loans. Here is what I am doing because it is a mix of options. I am part of the Army National Guard, they have raised their loan repayment amount to $240k. However, I am not taking this, I took the STRAP during residency. Yes, I did deploy, but it was for 4 months and it was not bad- please understand that I am an outdoors person, so staying in tents in Afghanistan was not an issue.

    If you work for a non-profit ( I work for a Catholic Health System) or military then you will qualify for income based student loan repayment that allows you to make a reduced monthly payment based on family size and income. After 10 yrs what ever is left over is written off. I also live in rural Alaska (yes I live here because I absolutly love it), I get the SHARP program which is $35k per year. Plus a salary over $200k, most salaries are about $180-210k up here where ever you are.

    So for someone who likes to hunt, fish, ski, crab, ride ATV, snowmachines, live in a log cabin on the ocean, and have a view of the ocean with bears, eagles and deer from his office... it can be tough, but I manage OK ;)

    So it all depends on what you want out of your practice
  26. Dotsero

    Dotsero Member

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    You deployed after residency right?
  27. MavCon

    MavCon

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    Yes, after residency.
  28. Dharma

    Dharma

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    I never thought I'd say this... but Alaska sounds awesome! I wouldn't mind the same gig but someplace with decent surf. Cold water is ok... I'd bust out the full suit for good waves (although Alaska is prob a bit too chilly. :D )

    Anyhow, what is the SHARP program?
  29. MavCon

    MavCon

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    The SHARP program is a rural Alaska student loan repayment plan that you have to qualify for, but my job applied for me and it was approved, I simply had to give them my student loan information. If you like surfing Yakatat is the place, I believe they are looking for a Doc. Big long run on black sand, I have not been there, but have heard it is awesome. Plus no white sharks...just sea lions and killer whales.... Ocean temp there is approx 50 degrees, depending on the season.

    If you come up, pack heavy... I came up for a rotation in Medical School and had to come up for residency and never see myself leaving the state... But then again, I would always choose to hike a mountain or glacier vs a mall.... ;)
  30. qtipp

    qtipp

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    Too cool.
  31. Dharma

    Dharma

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    I second that!
  32. cabinbuilder

    cabinbuilder

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    Yes, LOTS of opportunity in Alaska. I would be back home in a minute if I didn't have kids who are settled in school and an ex-husband who still lives there. Maybe someday. Will see.....
  33. MavCon

    MavCon

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    I have to put in a disclaimer, Alaska is fantastic for some people.... You have to understand that there are a lot of people here without running water, some without electricity. They are a different type of people, and you have to understand that they live this way because they want too. Lots of people live off the land and do not have lots of nice things, just practical useful things. So to some, it may seem third world in parts. There are parts (ie Anchorage, Wassilla, and Eagle River), that do have access to malls, movies, etc... However, once you leave the road system, things get isolated quickly. Know your limitations, if you are a dedicated outdoors person (ie would rather spend your time, hunting, fishing, riding, building, skiing, snowshoeing, ect) than inside playing xbox or at the mall or the show, then consider it or consider the Anchorage area. Even saying that, most Alaskans leave the state once or twice a year to go do something like go to the mall or fancy shows or dinner (I say this, but the only time I've left in the last 4yrs was to go to Afghanistan,,,, Hawaii this fall though).

    What I can tell you is that there is nothing better than the look on your kids face when he pulls in his first salmon or halibut or shoots his first animal. I'd stay here ten years, just for the look and the smile they have as your sitting around the dinner table and they know that's their fish your eating, or their deer or their bear. Sorry PETA people, but we eat what we kill and consider it God's grocery store...
  34. cabinbuilder

    cabinbuilder

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    Very nicely said. With Alaska you either really love it or really hate it. Most guys love it but have wives who wouldn't touch it with a ten foot pole. I agree for anyone who is looking to do the Alaska adventure, visit first before making that leap. I grew up there and have lived without running water so understand the personal challenages and rewards it offers.
  35. MJB

    MJB Senior Member Moderator Emeritus

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    The numbers I quoted are for a clinic in NE KS.

    Granted, the folks work very hard, but their NP's and PA's take a lot of the call load as well
  36. cabinbuilder

    cabinbuilder

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    Yikes, your wife was seriously screwed. I was offered a job in Iowa that started at 220K! Just know that every contract can be gotten out of. Even with the loan repayment her salary should have been at least 160K or higher. PM me if you need a great contract lawyer - I have mine on speed dial.
  37. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    What are your wife's duties? Does she deliver babies? Does she see patients in the evenings and the weekends? How many days a week does she work?

    It really also depends on the clinic. Some non-profit clinics are run well and can afford to pay a reasonable salary. Others are not.
  38. Prncssbuttercup

    Prncssbuttercup Established Member -- OMSIII

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    Slp,
    Did the nhsc put her in this position or did she choose it? If she chooses to leave make sure the nhsc isn't going to nail you for defaulting... But considering she's not even making what many NPs & PAs are making, she got screwed for sure....
  39. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    If it's loan repayment, she probably chose the site.

    At least it's a FQHC, so if she leaves she's not responsible for her malpractice tail.
  40. cabinbuilder

    cabinbuilder

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    Bonus of $800/month? Dang, I wouldn't even stand for that. Should be getting that per patient. She should be getting extra for call, extra for OB. I would be starting another job search ASAP. However, if she likes it and you guys are surviving may be better off just finishing since you only have 9 months to go. WOW, I would seriously get a lawyer, 60K take home is less than a PA, I made more than that in residency.
  41. MavCon

    MavCon

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    I agree, that is by far the lowest that I have seen. Is she board certified? The only folks I know of are GMO's that get paid that, and they do not allow those anymore in Alaska.
  42. cabinbuilder

    cabinbuilder

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    We had lectures on how to start a practice and general costs to do so, angles to look at to be funded and general pay scales.

    If you do a general job search on any of the physician job sites you will get some idea of range of pay. I would say most that I have seen range from 130K (super low) to 220K starting depending on location and whether it's just outpatient which will be lower than the outpatient/inpatient scenario. Also, the contract should have a base pay guarantee for say the first 3 years that lessens overtime as your patient base builds and then you get paid by RVU's so the more you work, the more you make. My contract lawyer is very saavy and has been in the business for many years. He also works for my pathologist friend. So my lawyer reviewed the contract and let me know if it was competitive for that area and what I should ask for as far as perks. Right now that family practice physicians are few and far between you really should be able to write your own ticket. IMO, the 60K in loan repayment does not counteract the severely low base pay. You can make 60K in cash doing locums in about 10 weeks and more than that doing rural OB. I know because I have done it and I don't deal with OB at all.
  43. cabinbuilder

    cabinbuilder

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    OK, so I just did some random job search in Kansas for a permanent position for family practice on locumtenens.com This is what I came up with. There are about 40 jobs listed. Give you some idea.


    Hutchinson, KS – Family Medicine
    Multi Specialty Group
    FAMILY PRACTICE PHYSICIAN JOB DESCRIPTION

    Join physician-owned, 70 physician multi-specialty group in Hutchinson, KS.
    • Group recently acquired a smaller group in the area and is in need of additional family medicine physicians to support the increase in volume.
    • Group currently has 14 family medicine physicians.
    • Mon thru Fri practice with normal office hours.
    • See around 25 physicians per day.
    $190K compensation + comprehensive benefit package + $25K signing bonus+ partnership option after 18 months. Nice community with population of 45K, just 45 minutes from Wichita, KS!

    PROFESSIONAL DETAILS - FAMILY PRACTICE JOB

    Titles DO, MD Location Kansas Specialty Family Practice Job Type Permanent Board Certification Negotiable On Call Negotiable Compensation Permanent($190,000) Telemedicine No Government No



    There a many others listed that also include 60K student loan repayment that is added to the 180K. As a recruiter told me once, ALL numbers are negotiable. You have to see yourself as the hot commodity. They will bend over to get an FP to sign, don't sell yourself short and get the maximum while in the throws of negotiating and ALWAYS have your contract lawyer review everything before you sign.
  44. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    Well, some sites on the internet say $126,000 is average for FQHCs across the country. I can't say for sure how accurate that is, but my gut feeling is to say that that's probably not too far off.

    Keep in mind that local FQHC salaries will vary based on reimbursement patterns in the area. Still, I really feel that your wife is probably getting paid quite a bit less than she could working elsewhere in that geographic area. :(
  45. docmd1234

    docmd1234

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    Hi, I have a few quick questions

    1) What are the best websites to look for jobs as a FM doc?
    Also, few of the ones I've looked at do not post salary, only say "competitive"

    2) What is you take on FM docs working in the ER? I've heard salaries range around 200K-360K. What are the pro's & cons of FM docs working in the ER?

    3) I am a first year resident and my program does not give us "classes" per say on what to do after finishing residency.. ie. looking for jobs, opening a practice etc.
    so after residency, do recruiters normally find you or do you have to do all the job hunting yourself?

    Thanks for the help
  46. MT Headed

    MT Headed snow, PBR, and bears Lifetime Donor

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    I know the $60K salary quoted is after taxes, and it doesn't take into account any loan repayment, but I just wanted to say one thing:

    $60K a year / 60 hours a week = $20 per hour
  47. Dotsero

    Dotsero Member

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    Are you saying this is a good or a bad thing? Because a RN with a 2 year degree makes between $22-32/hr.
  48. cabinbuilder

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    1) What are the best websites to look for jobs as a FM doc?locumtenens.com
    goldfish.com
    comphealth.com
    deltalocums.com
    martinfletcher.com
    MDjobs.com
    arthurmarshall.com
    onyxmd.com
    merritthawkins.com
    staffcare.com

    That's what I know off the top of my head, many are both locums and permanent job listings as I have done both. My advice is to pick 2 or 3 companies to work with other wise your phone will never stop ringing and you will have too many choices to pick from and you cannot possibly go on all the potential job interviews. My husband and I had a poster where I did a grid that had location, contact, phone number, salary, package, etc as he was the person at home all the time to answer the phone. That way he knew which job was on the line at any given time.
    Also, few of the ones I've looked at do not post salary, only say "competitive" : Competitive to me is in the 180K range or higher.

    2) What is you take on FM docs working in the ER? There is nothing wrong with it as long as you are confident and qualified. I have worked ER and many of my FP friends have also worked ER. Usually it's in smaller hospitals in the rural setting.

    I've heard salaries range around 200K-360K. What are the pro's & cons of FM docs working in the ER? Not sure the nature of this question. Comes down to the training and competance, and confidence of the individual doctor. I'v seen some really bad ER trained docs who kill people and really great FM docs in the ER.

    3) I am a first year resident and my program does not give us "classes" per say on what to do after finishing residency.. ie. looking for jobs, opening a practice etc.
    so after residency, do recruiters normally find you or do you have to do all the job hunting yourself?
    Towards the end of the year you should get some type of lecture about job recruitment. One of the residents asked one of our attendings who is very successful come talk about business do's and dont's and partake some of his knowledge on us for future.

    Recruiters do not find you. You have to post your CV on a website and then they will call. You will need to find a way to control the barage of folks fighting to place you. See my answer to question number one.


    When you go to an interview and you really want the job be sure you obtain a letter of intent at the interview if they hint that they are interested in you and offer you the position. Many time it takes weeks to get the actual contract from their lawyers so that LOI is a binding contract and closes the job. Be sure you have the contract reviewed by a contract lawyer, invest in the $300 to make sure there are no loopholes. Also be sure you have a way to quit or resign without having to pay the malpractice tail coverage - this is a huge thing. Sometimes if you resign you have to pay back the moving, sign-on, etc.You want to be able to walk away clean without owing anyone any money. I learned that the hard way. I had one job where I had to pay back $8000 and was given 60 days to do it. I went on a locum job over a holiday weekend, paid back the money and moved on.
    Last edited: 03.14.12
  49. Blue Dog

    Blue Dog Avec caféine. Gold Donor SDN Advisor

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    Physician SDN 7+ Year Member
    You have to compare pre-tax income to pre-tax income. Most people who say, "I make $xx per hour" are talking about pre-tax income, just as people who discuss salary (a fixed wage regardless of hours worked) are usually talking about pre-tax income (e.g., $100K/yr.) This makes sense, because taxes vary depending on the individual, where they live, deductions allowable, etc. Technically, $100K per year (assuming 4 weeks of vacation, so 48 weeks working 60 hours/wk.) works out to closer to $35/hr.

    Still, not great for a physician.

    FWIW, the docs I know who only earn $100K/yr. are working part-time (around 20 hours per wk).

    Keep in mind also that salary does not take into account the value of any additional benefits, such as retirement, disability or malpractice insurance, health insurance, CME, etc. Most employers provide their employees with most or all of these perks. If you're self-employed, most of that will come out after taxes. So, don't be confused by inflated income figures for locums or independent contractor jobs.
    Last edited: 03.14.12
  50. cabinbuilder

    cabinbuilder

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    Physician SDN 7+ Year Member
    I have to agree with this. Working locums is pure cash in hand, they do not take out anything for taxes, there is no retirement, and no health insurance. The only thing provided is malpractice coverage, travel, and housing so you have to be sure to fund your own IRA, buy your own health insurance, etc. Seems like more work and some would rather have the extras included in their job. For me I am too much of a gypsy and would rather not have to be under the thumb of some administrator. I've had too many bad things happen to me I'm just not ready to jump back into a contract job.

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