If you could go back in time, would you still choose psychiatry? If still psych, would you have done anything different about your career?

[luckybuck]

Alright. I think some of us just have different desires and different worldviews so this is going to be my last argument. I am going to give a simplified scenario as food for thought.

Lets take 2 people who each have 150k to invest per year over a 25 year long career. Person A takes what I will call the "safe route" and invests alll 150k into index funds. Lets assume a reasonable yearly return of 7% over that horizon. This person, assuming they started with nothing and don't receive a large windfall, will end up with ~9.5 million at year 25.

Now person B. This person takes what I will call the "courageous route" and allocates 2/3 of his funds in index funds at 7% and 1/3 into well researched yet riskier investments (real estate, business ventures, whatever). Scenario 1 is this person's 100k invested into index funds returns 7% and their 50k invested per year is an absolute failure. They lose every cent of it every year. At year 25 this person will have ~6.3 million. I would argue that there is not a significant difference in qol in retirement on 6.3 M vs 9.5 M that person A achieved. However, lets say person B was successful and achieved an average 20% return on his riskier investments, which is actually doable with research and due diligence. Person B will have roughly 29.8 million at year 25 or at least cash flows from investements that would extrapolate to that amount (ie the net present value would be equal). Or they could potentially stop investing earlier and retire/cut back on clinical work early if they choose.

I would personally rather swing harder and go for a home run knowing that even if I strike out i am not financially ruined rather than playing it safe and ensuring a life of mediocrity.

Sometimes we have to give up on good to get to great.

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[sloh]

which is actually doable with research and due

Risks aside, people underestimate how much additional time this takes. We are constantly exchanging both money AND time at the best exchange rates possible

 

[sloh]

If you are trying to kick an 8 figure inheritance to your kids (which would be needed to produce 500-1000k annually) then I agree that taking more risk is needed to meet that goal. I would be very interested to hear your thought process on why you want to do this. Most folks of affluence I know are aware of the data on what inheriting that type of money does to a person and are looking for ways to teach their kids how to make a go of it themselves rather than trust fund their way through life. Personal finance will always be personal, but as any good empiricist and parent, I would look to see what will actually maximize the outcomes you want for your children.

And a staggering 70 percent of wealthy families lose their wealth by the next generation, with 90 percent losing it the generation after that.

 

[Merovinge]

And staggering 70 percent of wealthy families lose their wealth by the next generation, with 90 percent losing it the generation after that.

Which is why I would argue that for wealthy individuals trying to maximize a trust fund is one of the worst uses of time. Certainly any amount of time or effort to teach your children the value of hard work, altruism, personal finance, and how 99% of the world lives will lead to a much more successful lineage if that's the sort of thing you are after.

I'll be honest and say that I come from no money, my inheritance will be essentially nothing, which is completely fine as I make plenty to support myself and my family. My wife comes from a moderately affluent family and I go out of my way to encourage her parents to spend their money in retirement. We don't need their money, they worked very hard to earn it, and they should spend it. It will not materially impact our lives as neither of us would stop seeing patient's just because we had more money in the bank. As I've seen both sides of things, the lessons my mother taught me are worth more than a 7 figure inheritance. I will likely end up giving my progeny a low 7 figure sum but I sure recognize that time spent together and teaching what really matters is much more important than a trust fund getting transferred on death.

 

[Merovinge]

Alright. I think some of us just have different desires and different worldviews so this is going to be my last argument. I am going to give a simplified scenario as food for thought.

Lets take 2 people who each have 150k to invest per year over a 25 year long career. Person A takes what I will call the "safe route" and invests alll 150k into index funds. Lets assume a reasonable yearly return of 7% over that horizon. This person, assuming they started with nothing and don't receive a large windfall, will end up with ~9.5 million at year 25.

Now person B. This person takes what I will call the "courageous route" and allocates 2/3 of his funds in index funds at 7% and 1/3 into well researched yet riskier investments (real estate, business ventures, whatever). Scenario 1 is this person's 100k invested into index funds returns 7% and their 50k invested per year is an absolute failure. They lose every cent of it every year. At year 25 this person will have ~6.3 million. I would argue that there is not a significant difference in qol in retirement on 6.3 M vs 9.5 M that person A achieved. However, lets say person B was successful and achieved an average 20% return on his riskier investments, which is actually doable with research and due diligence. Person B will have roughly 29.8 million at year 25 or at least cash flows from investements that would extrapolate to that amount (ie the net present value would be equal). Or they could potentially stop investing earlier and retire/cut back on clinical work early if they choose.

I would personally rather swing harder and go for a home run knowing that even if I strike out i am not financially ruined rather than playing it safe and ensuring a life of mediocrity.

Sometimes we have to give up on good to get to great.

I appreciate your motivational speaker writing and there is certainly a logic behind what you are saying. Ultimately if you break it down, you are still stating that you want to add risk and spend time for it to reach a financial state that will be minimally meaningfully different. If your bank account reading 20 million is materially different to you then it reading 10 million, that it helps you achieve your life goals and actualizes you as a person, then I can definitely understand wanting to reach for that.

I suspect you will find that sustaining 20% returns annually is much more difficult than you anticipate, certainly over a multiple decade time horizon. If you do pull that off, you'll have been one of the most successful investors of all time, so I guess to that extent if you want to make the history books it does make some sense. Best of luck to you, I hope to read about this doctor who made 20% returns averaged over 25 years as I get ready to retire on a podcast and think "oh yeah, I remember that guy from SDN".

 

[clausewitz2]

Did you type this sipping your handcrafted tea in the middle of the student union with your laptop dramatically placed on top of a thick philosophy text while also making sure everyone can see your open First Aid for Step 1 book with a zillion tiny notes furiously scribbled in the margins?

Please, it's a tisane. Tea is so passe. I simply find Lacan intolerable without it.

 

[TheRightMedication]

I want to harp on the use of the term Epicurean here, as I think it's relevant to the conversation about wealth.

Epicureans sought to maximize pleasure and minimize pain. Did they become hedonistic?

No! They realized the pain of running the hedonic treadmill outweighed the pleasure of indulgence, and they practically were ascetics.

I don't judge you if you truly think getting rich is something you have to do for personal fulfillment, but I have to ask - do you read? Because it's been discussed by almost every world religion and philosophy through human history. And I don't recall any culture over time that said "get money" was the way to go.

And for the ubermenches out there, are you so sure the expression of the will to power is a life driven by accumulating a fiat currency?

 

[TexasPhysician]

Risks aside, people underestimate how much additional time this takes. We are constantly exchanging both money AND time at the best exchange rates possible

It also depends on your network. I enjoy being social and engaging with people. Through this I have met people that do a lot of real estate. There is only so much capital they can access on deals before they need investors to continue growing.

While there is risk in real estate, there is a hard asset that is insured and in my cases already generating cash flow. I rarely enter deals that don’t have good cash flow already.

A recent property that had an exit event: it generated a roughly 10-11% return over the 3 years we owned it. We sold it and each investor received slightly over double the initial investment.

At that point, we could all walk away with the money, but most elected to purchase another few buildings. We are leasing up the remaining spots and will soon receive quarterly checks again.

At the beginning and upon repurchase, there was some time spent on this. Otherwise it is all managed by other people. In the intermediate, I just drop checks in my account.

Evaluating the deal is the only time involvement. I met these people through an activity I already enjoy. It is quite possible to increase returns with little effort, but you’ve got to find access somehow.

 

[G Sheb]

I want to harp on the use of the term Epicurean here, as I think it's relevant to the conversation about wealth.

Epicureans sought to maximize pleasure and minimize pain. Did they become hedonistic?

No! They realized the pain of running the hedonic treadmill outweighed the pleasure of indulgence, and they practically were ascetics.

I don't judge you if you truly think getting rich is something you have to do for personal fulfillment, but I have to ask - do you read? Because it's been discussed by almost every world religion and philosophy through human history. And I don't recall any culture over time that said "get money" was the way to go.

And for the ubermenches out there, are you so sure the expression of the will to power is a life driven by accumulating a fiat currency?

I also had to chuckle a bit at someone describing themselves as "Epicurean" and then finding meaning in the pursuit of wealth through risk taking.
An Epicurean would do the complete opposite.
Epicureanism is about the pursuit of pleasure, but a mature form of lasting pleasure (rather than purely transient sensual pleasure), and Epicurus reasoned that, from experience and observation, you get there by minimizing anxiety and being content with the little material things you have in life. Chasing wealth would be a complete no no.
I am a big admirer of Epicurus, particularly his metphysics (he really was a pioneer of Empiricism) and I think there's a lot to learn from him.

 

[FlowRate]

And I don't recall any culture over time that said "get money" was the way to go.

恭喜发财
(gōng xǐ fā cái)

I don't know Mandarin, but I do know the Mandarin greeting for lunar new year.

 

[clausewitz2]

But regarding first bolded, I believe Chinese have historically been obsessed with money, and many western cultures perhaps most notably hip hop culture is as well.

This is the cultural soil that also gave us Laozi/Daoism, a philosophy that has generally seen most material things as pointless and distracting you from being in touch with the vital nature of reality.

China is also the country with more Buddhists than basically anywhere else in the world. And, as we all know from A Fish Called Wanda, the central message of Buddhism is not every man for himself.

 

[TheRightMedication]

Lucky buck, I have no better response to the role of wealth in Chinese culture than the above.

As for the answer to the dilemma ol' Fred Nietzche, finding an answer is a heavy lift indeed! For me, the answer to the cultural death of God is God. I will spare you my testimony but any who desire proselytizing may message me.

 

[luckybuck]

I don't know. I don't really even understand what you're talking about. I believe the most important things in life are 1. your physical and mental health and 2. Money. You can't buy #1 but you can buy everything else

 

[G Sheb]

I don't know. I don't really even understand what you're talking about. I believe the most important things in life are 1. your physical and mental health and 2. Money. You can't buy #1 but you can buy everything else

Ironically enough, money can buy you #1. Get a better gym, trainer, therapist, food, dietician and health insurance. I think it would be foolish to think that money has no role in one's happiness. We live in a world predicated on ties of power and dominance between the haves and have nots. And the have nots are shackled just like peasants in serfdom.
The issue though is when it comes to making the pursuit of wealth your life priority. Most would disagree that it is a path conducive to happiness.

However, since we're in the philosophy mood, regardless of what the research says..etc, there's no clear truth about how one should conduct their lives. Even if you study human behavior and come to all the conclusions, you will ultimately end up with Hume's is/ought problem and the subjectivity of human values.

 

[tr]

I don't know. I don't really even understand what you're talking about. I believe the most important things in life are 1. your physical and mental health and 2. Money. You can't buy #1 but you can buy everything else

Huh???
Money can, to a large extent, buy you physical health - at least in the good old capitalist US of A, where lifespan and health disparities are among the worst in the developed world.

What it categorically cannot buy you is warm, connected interpersonal relationships, which are the #1 factor supporting health and longevity.

 

[forchinet121]

Huh???
Money can, to a large extent, buy you physical health - at least in the good old capitalist US of A, where lifespan and health disparities are among the worst in the developed world.

What it categorically cannot buy you is warm, connected interpersonal relationships, which are the #1 factor supporting health and longevity.

Well I think he might be sneaking this under “physical and mental health” which is so broad as to become useless

 

[allantois]

Huh???
Money can, to a large extent, buy you physical health - at least in the good old capitalist US of A, where lifespan and health disparities are among the worst in the developed world.

What it categorically cannot buy you is warm, connected interpersonal relationships, which are the #1 factor supporting health and longevity.

I would almost disagree with the later. Surely you cannot buy relationships with money, but people will flock to you if you are wealthy. By same reasoning, you may be healthier/more attractive and be able to afford therapy to improve interpersonal relationships. It is hard to maintain relationships when one has to worry about the roof about their head

 

[clausewitz2]

Huh???
Money can, to a large extent, buy you physical health - at least in the good old capitalist US of A, where lifespan and health disparities are among the worst in the developed world.

What it categorically cannot buy you is warm, connected interpersonal relationships, which are the #1 factor supporting health and longevity.

Cf. McCartney, Lennon, Starr and Harrison (1964).

 

[Tangerine123]

Perspective as a current Psych PGY2

I would not pick medicine again. Would have probably done Philosophy, Linguistics or History instead.

If I had to re-do medicine, then yes. Psych would be my only option (or something in the lines of Public Health and Policy Making).

As to what I would have done different. Get a masters in Ethics instead of my master in Genetics (basically useless for me now, wrapping up a PhD in neuroimaging). I now also wish I would have actually learned neurology in medical school correctly, instead of cramming stuff just to answer tests. And lastly, dedicate more time to myself, my physical health is terrible.

 

[luckybuck]

Would have probably done Philosophy, Linguistics or History instead.

Thats not one you hear too often

 

[tr]

I would almost disagree with the later. Surely you cannot buy relationships with money, but people will flock to you if you are wealthy. By same reasoning, you may be healthier/more attractive and be able to afford therapy to improve interpersonal relationships. It is hard to maintain relationships when one has to worry about the roof about their head

Want to live a happy life? Focus on your relationships

Harvard psychiatrist Robert Waldinger discusses how 80 years of research show relationships to be a critical part of a happy life.

bigthink.com

 

[dl2dp2]

Huh???
Money can, to a large extent, buy you physical health - at least in the good old capitalist US of A, where lifespan and health disparities are among the worst in the developed world.

What it categorically cannot buy you is warm, connected interpersonal relationships, which are the #1 factor supporting health and longevity.

Interestingly, I've been talking about this extensively with my patients in psychotherapy, and I have now a "new" theory around it.

I think you are right that money itself cannot buy you warm interpersonal relationships. However, *HONESTY ABOUT MONEY* is a requisite for developing such relationships, and often when you become more honest you are more willing to give money away or spend it, which then results in improved relationships. But honesty about money is VERY hard. It requires the proverbial psychodynamic insight. Large swathes of schema-identity driven insight-oriented/behavioral work have to do with restructuring people's attitude towards their money, their parent's money, [giving] their children's money away, and what they have to do to make money.

Money is also about choice. When an older patient struggles with whether to give their savings away, a younger person struggles with spending their YOUTHS away making money or making the choice of doing something less remunerative. And often doing the latter impacts "interpersonal relationships" negatively, at least in their imagination. To make peace with these dualities and avoid being stuck in place is basically the core of any kind of insight-oriented treatment, whether formulated in terms of cognitive behavioral or Freudian frames.

And this is also not exclusively a rich person's problem, because even in those without [as much] money, there's this element of using your time as a substitute, or to prune your lifestyle in a suitable way [in order to grow, to take risks, to change identity, etc]. All of these are driven by identity and meaning, fear of death, etc. in addition to dynamic, episodic "biological" psychopathology.

And if you bring substance use disorder into this, you can imagine that my life's work is never dull...

 

[emergentmd]

Money can, to a large extent, buy you physical health - at least in the good old capitalist US of A, where lifespan and health disparities are among the worst in the developed world.

What it categorically cannot buy you is warm, connected interpersonal relationships, which are the #1 factor supporting health and longevity.

I grew up poor and was always told that Money can not buy you happiness. I think this is only true once you hit a certain threshold, and it all depends on the person/situation. Can you be happy living in poverty or low end of the financial spectrum? I don't think so b/c it comes with the added stress of being able to pay bills which is the biggest failures of marriage.

Money can not directly buy connected relationships but having money gives you more time to develop these relationships. I am financially set, just turned 50, work 6 dys a month so I have plenty of time to develop relationships. I can coach my kids basketball team, go to all their events, help them with their homework, take family trips, do game nights, watch movies, etc... If I were poor and had to work 2 jobs to keep the lights on, in no way could I develop the same relationships. You have to be present so money does not directly create relationships but takes a big stress factor out so you can have time to develop them.

Money can definitely buy you better health and longevity as it allows better nutrition, time to stay fit, and helps with mental health.

Obviously many rich people are unhappy and many poor people are happy. But with all things being equal, a rich person will be happier than a poor person. Logic tells me if you put the same person in a poor state and then a rich state, that rich person will more than likely have a happier life.

 

[emergentmd]

Alright. I think some of us just have different desires and different worldviews so this is going to be my last argument. I am going to give a simplified scenario as food for thought.

Lets take 2 people who each have 150k to invest per year over a 25 year long career. Person A takes what I will call the "safe route" and invests alll 150k into index funds. Lets assume a reasonable yearly return of 7% over that horizon. This person, assuming they started with nothing and don't receive a large windfall, will end up with ~9.5 million at year 25.

Now person B. This person takes what I will call the "courageous route" and allocates 2/3 of his funds in index funds at 7% and 1/3 into well researched yet riskier investments (real estate, business ventures, whatever). Scenario 1 is this person's 100k invested into index funds returns 7% and their 50k invested per year is an absolute failure. They lose every cent of it every year. At year 25 this person will have ~6.3 million. I would argue that there is not a significant difference in qol in retirement on 6.3 M vs 9.5 M that person A achieved. However, lets say person B was successful and achieved an average 20% return on his riskier investments, which is actually doable with research and due diligence. Person B will have roughly 29.8 million at year 25 or at least cash flows from investements that would extrapolate to that amount (ie the net present value would be equal). Or they could potentially stop investing earlier and retire/cut back on clinical work early if they choose.

I would personally rather swing harder and go for a home run knowing that even if I strike out i am not financially ruined rather than playing it safe and ensuring a life of mediocrity.

Sometimes we have to give up on good to get to great.

This is not a discussion of what is right or wrong. Sometimes people demonize others who has goals of making alot of $$$, create generational wealth, and pass it on to their kids. There is nothing wrong with working 30 yrs, putting it in safe investments, and retire on the money without much left. There is nothing wrong with working hard, and shoot for the moon.

I have been blessed to have good job opportunities, business opportunities that has allowed me to slow down at 50 while still shooting to bank 10M with the goal of having 20-30M when I call it quits in my 60's. I donate about 100K/yr so I am not just hoarding money but I see nothing wrong with passing down generational wealth while teaching them to continue generational wealth. I am against giving it away just to be wasted so its my job to teach my kids the values of money.

 

[FlowRate]

Get a masters in Ethics instead of my master in Genetics

Not sure if you're indicating that you're interested in having a career in Ethics. My dad has a PhD in bioethics and it is extraordinarily hard to get employed to do that work if ethics if your only credential. Hospitals mainly want JD's to do that work so they can come at it from the legal side, as well. Or they want clinicians who want to do ethics on the side/as one of their ancillary roles.

 

[Tangerine123]

Not sure if you're indicating that you're interested in having a career in Ethics. My dad has a PhD in bioethics and it is extraordinarily hard to get employed to do that work if ethics if your only credential. Hospitals mainly want JD's to do that work so they can come at it from the legal side, as well. Or they want clinicians who want to do ethics on the side/as one of their ancillary roles.

As a personal interest

 

[mistafab]

Would pick psych 100 times over.

Who else gets paid this much to give advice? most people giving it away for free. I’m going to charge an arm and a leg for it.

Too much fun.

Sociopath? boom, discharge. Borderline? See you every 2 weeks forever. Depressed? Wow, interesting story, lets talk about nothing for 20 minutes so you feel better. Anxious? You’re beating yourself up (oh my god, youre right, thanks doc).

Leave the office and dunk on a patient. Blam. I got your message, ill call you back next week. Another 400 dollars. Blam, olanzapine in your gullet. Buspirone sprinkles in your hair. Depakote sprinkles in your soup. Bupropion sprinkles in your dextromethorphan. Buprenorphine dust on your OUD. Your cows was 12? yeah right, pupils are normal. Get out of my office.

too much fun

 

[Merovinge]

I grew up poor and was always told that Money can not buy you happiness. I think this is only true once you hit a certain threshold, and it all depends on the person/situation. Can you be happy living in poverty or low end of the financial spectrum? I don't think so b/c it comes with the added stress of being able to pay bills which is the biggest failures of marriage.

Money can not directly buy connected relationships but having money gives you more time to develop these relationships. I am financially set, just turned 50, work 6 dys a month so I have plenty of time to develop relationships. I can coach my kids basketball team, go to all their events, help them with their homework, take family trips, do game nights, watch movies, etc... If I were poor and had to work 2 jobs to keep the lights on, in no way could I develop the same relationships. You have to be present so money does not directly create relationships but takes a big stress factor out so you can have time to develop them.

Money can definitely buy you better health and longevity as it allows better nutrition, time to stay fit, and helps with mental health.

Obviously many rich people are unhappy and many poor people are happy. But with all things being equal, a rich person will be happier than a poor person. Logic tells me if you put the same person in a poor state and then a rich state, that rich person will more than likely have a happier life.

I don't understand why you are discussing like this a story based on old wives tales. There is an extensive body of literature on the relationship between money and happiness, even specifically based in the US, and virtually all the research shows that at lower income levels money does improve happiness. No one is arguing against this, it seems more like you arguing in your head against something that was erroneously told to you during a low income upbringing to try and make you feel better.

What is being argued is that higher levels of income do not buy happiness past a certain point. That point probably varies depending on where you live and CoL associated with it, the number of children you have, and other variables but it is in the low 6 figures. Daniel Kahneman did a fair amount of work here if you have interest in what the world's Nobel winning preeminent behavioral economist has shown. Not that anecdotes are proof of anything, but there are 14 divorces among the top 10 wealthiest people in the world. Even Giesel and Brady are shattering illusions now about what a picture perfect marriage between the uber elite, hardest working people in their fields, can lead to. Possibly over chasing returns in crypto of all things...

 

[FlowRate]

I don't understand why you are discussing like this a story based on old wives tales. There is an extensive body of literature on the relationship between money and happiness, even specifically based in the US, and virtually all the research shows that at lower income levels money does improve happiness. No one is arguing against this, it seems more like you arguing in your head against something that was erroneously told to you during a low income upbringing to try and make you feel better.

What is being argued is that higher levels of income do not buy happiness past a certain point. That point probably varies depending on where you live and CoL associated with it, the number of children you have, and other variables but it is in the low 6 figures. Daniel Kahneman did a fair amount of work here if you have interest in what the world's Nobel winning preeminent behavioral economist has shown. Not that anecdotes are proof of anything, but there are 14 divorces among the top 10 wealthiest people in the world. Even Giesel and Brady are shattering illusions now about what a picture perfect marriage between the uber elite, hardest working people in their fields, can lead to. Possibly over chasing returns in crypto of all things...

IIRC some of the very latest work on this is that more money is more happiness but, more important, is staying just ahead of the hedonic treadmill without hitting a point where it's impossible to continue seeing improvement. That is, most people are happier as long as they're doing better over time, on average.

 

[luckybuck]

Money can buy lots of things in life that lead to happiness. Obviously there are the material things but also experiences like vacations and such. Also due to hypergamy you are going to be able to attain higher quality women with more money/status

 

[D.O.noHarm]

I would choose psychiatry again. I might consider a fellowship like sleep medicine, or maybe palliative care to give some flexibility in job options. You may not really need palliative to get a hospice job. Now that my loans are paid off I sometimes think about going back for a fellowship year, but realize it's extremely frustrating to give up that amount of income after you've been an attending for awhile. And frustrated their aren't other routes to get into something like sleep medicine, or be board eligible in child psych, outside of completing fellowship. Fellowship should just pay a lot more honestly, going back for a year at $150 or 200K would actually be manageable, 60-70k not so much.

If I could rewind to start of med school, I'd try to go military to have costs covered from the start, as I've spent many hours/days worried about the financial burden taken on. NHSC maybe as well, but I've heard horror stories of bad clinics holding doctors hostage with crazy patients loads because they know they can't leave before paying back their obligation.

I don't know if there is any other specialty I would prefer. Everything seems so locked into the hospital (surgeons, ED, anesthesia, hospitalist) or everyone is churning through patients 3 or 4 per hour in cognitive specialties. In psych getting an hour for a new patient 30 minutes for follow up feels almost luxurious in comparison, but is actually needed to do good work.

You could consider moonlighting during that 1 year of fellowship and make close to 150k.

 

[tr]

Money can buy lots of things in life that lead to happiness. Obviously there are the material things but also experiences like vacations and such. Also due to hypergamy you are going to be able to attain higher quality women with more money/status

I don't think it's possible to develop a loving, mutually supportive relationship if you view your partner as a commodity for purchase.

If a relationship with a RealDoll is what makes you happy, go for broke. But in that case I don't think psychiatry is the right field for you.

 

[psychmd03]

What's wrong with pushing myself to make as much money (in an ethically palatable) as possible?

What if I don't simply want "a good living"? What if I want a living that is quantifiably superior?

An empiricist would tell me that all I "need" to have a good life is 80k/yr salary, a healthy partner, weekly attendance at religion, 2.5 hours of exercise per week, and having a high degree of social connectedness.

I'm a combination of an Epicurean, a nihilist, and Type A overachiver.

I personally want to see what I am capable of. I don't want to make only 250k/yr, and just be satisfied with that.

I want the challenge of starting my own business, I want the excitement of at least attempting to shoot through the stratosphere, even if that means that I don't succeed, even if it means that I "fail" by other people's standards.

For me it's more about the journey than it is about the end result. I'm not doing this so that my kids live comfortably, I'm doing it because I can, and I deem it a worthy pursuit based on my own vision for my life, not what some scientific, case-controlled clinical trial tells me is good for myself.

Luckily in psych if you leverage your time and find the right combo of work you can reach the top 1-5% of earners and out earn 99% of docs across all specialties

 

[finalpsychyear]

Luckily in psych if you leverage your time and find the right combo of work you can reach the top 1-5% of earners and out earn 99% of docs across all specialties

I don't think this is specific to psych. I have FM/IM docs that all hustle and make 450-500k by working 2 jobs with some wknds and calls.
I think if your willing to work over 40 hours your going to make higher end. In non procedural specialties its much harder to hit those numbers by not working over 40 hrs. Rads/Anes/Derm are so good is they are all making 500-600 with 40 ish or under hours but the first 2 do have wknds and calls.

 

[psychmd03]

I don't think this is specific to psych. I have FM/IM docs that all hustle and make 450-500k by working 2 jobs with some wknds and calls.
I think if your willing to work over 40 hours your going to make higher end. In non procedural specialties its much harder to hit those numbers by not working over 40 hrs. Rads/Anes/Derm are so good is they are all making 500-600 with 40 ish or under hours but the first 2 do have wknds and calls.

I was talking about making more than 400-500k That isn’t the top 1% of physicians broadly. Psych is in a position to do more than that if you structure things well.

 

[vanfanal]

Luckily in psych if you leverage your time and find the right combo of work you can reach the top 1-5% of earners and out earn 99% of docs across all specialties

And how does one do that sensei?

I’m pretty frustrated these days with my accountant charging more for inflation but my fees haven’t changed…but I’m in Canada.

 

[psychmd03]

And how does one do that sensei?

I’m pretty frustrated these days with my accountant charging more for inflation but my fees haven’t changed…but I’m in Canada.

There have been some recent posts regarding job set ups and pay that have gone into a bit and honestly there are many ways. The way that I personally go about it is by finding inpatient jobs that have really good teams IE social workers and nursing that communicate well but also do many of the tasks that could be yours but IMO can easily be done by support staff like pharmacy follow ups, prior auth for dc meds ( I try to avoid this by knowing what insurance covers), dispo planning, first calls to family for collateral. Then you work on becoming a good and efficient doc. And you end up working a combo of jobs. Many Ip docs can finish up one IP unit in a half day. Then you choose a second job for the other half of the day personally I’d go a second Ip job it allows more flexibility that way it’s easier to cover issues from both hospitals because you’re not stuck in an OP schedule. Work towards getting a title like medical director, unit director which adds another stipend. Then you can add a few weekends of coverage at either hospital to add some more income and since it should only take a half day so it won’t ruin your day. Other ways would be to develop a good business around covering Nhs (not my thing) I know a handful of docs that do this with NPs and PAs and their income is wild. I wouldn’t be able to do that personally but it’s very possible.

 

[luckybuck]

Huh???
Money can, to a large extent, buy you physical health - at least in the good old capitalist US of A, where lifespan and health disparities are among the worst in the developed world.

What it categorically cannot buy you is warm, connected interpersonal relationships, which are the #1 factor supporting health and longevity.

Having money isn't going to make you get off the couch and simply go on a walk or run or stop consuming donuts, french fries, sodas, etc every chance you get which is the biggest contributor to health, not the healthcare system. You don't have to have a fancy gym or all the best supplements, you just need to not be lazy and be somewhat disciplined. Not saying this accounts for all illness of course, but it is a major contributor.

 

[shoomer]

I was worried about "losing medicine." I still see plenty of medical issues, and they're not all the time so they're interesting when they happen. If there's too much medicine, it's not my job to have to deal with it. I'm operating as a consultant/specialist.

I was worried about "not being a real doctor." I'm still getting paid like one, so who gives a ****.

I was worried about "dealing with crazy people." The reality is, "crazy" is independent of psychiatric diagnoses. So it's not a unique problem to have.

I've enjoyed psych since day one, and I would pick it every single time if I did med school again. Now would I do med school again? I'm not entirely sure. But I also don't know what exactly I would do as an alternative.

 

[Candidate2017]

Wait why are your outpatients yelling at you or your staff? Why are you tolerating that?

I rent my labor to The Man, which is to say there is a high level of dysfunction at the systemic and individual level. Some would say I'm compensated very well for my troubles, others would say not enough. I'm not sure who's right.

My outpatients are actually mostly civil, and I don't get many sub seekers after cleaning up shop (i.e., Xanax 2 mg five times a day (I've no idea what is the Latin abbrev)). The occasional yellers are now new evals, for which I do terminate. But even if I had a boutique PP, there would still be 1-2 yellers slipping through q month instead of q week.

All in all, it is weird a random person off the street can get into a room alone with us, which we willingly do for money, and then yell at us as if we got their order of fries too slow and too cold.

 

[Merovinge]

All in all, it is weird a random person off the street can get into a room alone with us, which we willingly do for money, and then yell at us as if we got their order of fries too slow and too cold.

I don't think that is unique to doctors, you can pay to go into your accountant, lawyers, architect, or any other of a million professions and yell at them as well for not doing something as you want it. It does not mean they need to keep working with you (we don't either, baring ensuring patient abandonment does not occur). Part of this is dealing with people at the worst/dealing with their most difficult problems and part of this is people thinking that because they are paying for a service they are entitled to anything they want.

 

[Candidate2017]

I don't think that is unique to doctors, you can pay to go into your accountant, lawyers, architect, or any other of a million professions and yell at them as well for not doing something as you want it.

Actually, those are professionals who are paid directly, and a lot, by clients for their expertise. Except for public defender lawyers. They get paid by third party payors to serve people who may not appreciate their services and sometimes try to assault them.

That's sort of the problem... accepting third party payors to serve people who don't fully value our services. A Chipotle lunch costs more than the average copay. So yeah, it makes sense some people feel entitled to yell if they made an appointment, filled out 10 pages of forms, waited a month, paid $20, and didn't get the warm burrito bowl they expected.

 

[Anotherwin]

I'm not a millennial. I would not change anything about my life and how this has gone.

Psychiatry is doing very well. You can see that or get afraid of the future. What more could you possibly need to be encouraged to see a positive future? In my experience, I have been impressed with how much applicant's resistance to embrace of psychiatry has been driven by parental expectations. I get that, but you are on the edge of making the right or wrong decision.

Be selfish and do something for you and go for psychiatry. I get that this is a psychiatry forum so it is biased. I was fortunate not to have such bias. I have many psychiatrists in my family, but you can do well in psychiatry. You will make enough income to support your loved ones and be happy with your work life. Residency still sucks, but the outcome is still worth the pain. See the last three years as an opportunity and the world can be your ouster.

You don't know me, but I do want to give you good advice and I have done this for a long time and have some credibility in my narrow view. Don't go into psychiatry if you don't like it, but do go into it if you do despite your relative's criticisms of not being a real doctor. It is fun, and it does remain interesting, and it rocks.

Me

Reading this made me feel like I am hearing the words of a mentor. Thank you for your words

 

[finalpsychyear]

Fields like rads and gas would have allowed me to enjoy the idea of a longer career without the threat of midlevels and having to push myself. Rads is immune and gas has crnas but unlikely to be impacted in the next 10 years.

I was the last doc hired at one of my jobs and only mid levels come and go for 6 years now. Admin simply says why on earth would we hire anyone but np's as they can bill the same and cost half the amount.

The jobs will be there but you will see a shift in salaries to 175-200k ish for employed positions by 2030 and essentially be forced to supervise multiple nps but likely they r all autonomous by then. Future is fine for getting a job but inflation adjusted expect 200k ish as upper limit going forward.

 

[sloh]

Fields like rads and gas would have allowed me to enjoy the idea of a longer career without the threat of midlevels and having to push myself. Rads is immune and gas has crnas but unlikely to be impacted in the next 10 years.

I was the last doc hired at one of my jobs and only mid levels come and go for 6 years now. Admin simply says why on earth would we hire anyone but np's as they can bill the same and cost half the amount.

The jobs will be there but you will see a shift in salaries to 175-200k ish for employed positions by 2030 and essentially be forced to supervise multiple nps but likely they r all autonomous by then. Future is fine for getting a job but inflation adjusted expect 200k ish as upper limit going forward.

You ever consider forensic work? Stuff like QME. Can’t be encroached on by mid levels

 

[finalpsychyear]

You ever consider forensic work? Stuff like QME. Can’t be encroached on by mid levels

I haven't really. Med dir now for a CMHC so I feel better. I think they are required to have one. Also need to do probate, SSI/SSD evals, exper eval etc so that part requires an MD only. My 1.5 day PP is 12 hours no break so probably closer to 2 days for most. Its not about being busy. I just don't get the mental satisfaction of super high job security that I thought I would esp compared to 5-6 years ago when I felt the mid level issues were concerning but not quite what it is now. Also i probably got multiple recruiters a day then now a few a week. I'd rather think the worst and be prepared and it helps me work harder otherwise I could get very lax.

That being said. Reaching FI has been my solution to the problem. Depending on the market 5-7 years should get me where I could go PT. 2030 will be interesting to see what changes for me.

 

[luckybuck]

Fields like rads and gas would have allowed me to enjoy the idea of a longer career without the threat of midlevels and having to push myself. Rads is immune and gas has crnas but unlikely to be impacted in the next 10 years.

I was the last doc hired at one of my jobs and only mid levels come and go for 6 years now. Admin simply says why on earth would we hire anyone but np's as they can bill the same and cost half the amount.

The jobs will be there but you will see a shift in salaries to 175-200k ish for employed positions by 2030 and essentially be forced to supervise multiple nps but likely they r all autonomous by then. Future is fine for getting a job but inflation adjusted expect 200k ish as upper limit going forward.

How much do you make right now?

 

[MacDonaldTriad]

Reading this made me feel like I am hearing the words of a mentor. Thank you for your words

Thank you Anotherwin,

Just to be clear, I'm likely older than your parents and the point is that they will be doing their best to steer you into the direction they see as helpful and has your interests at heart. Getting into medical school and doing well is a big level of their helpful steering. What their advice looks like after that is another level you need to evaluate. You have more data to make this decision than they do unless you happen to be someone like me, which is very peculiar and unlikely true for most of you.

This is your life and you need to understand that you have already failed to disappoint your family. You may even have siblings that reinforce this, but that doesn't change the importance of this decision. This is the best moment that you can individuate and do what is right for you. There will never be a better tipping point to see this is true and do something selfish. This is what you need to do to be both proud and happy with the rest of your life. Psychiatry rocks and has been the best thing I have ever pushed against medical school culture/biases. You decide, but make sure you are the one deciding.

 

[dl2dp2]

Reading this made me feel like I am hearing the words of a mentor. Thank you for your words

My parents also actively tried to discourage me from going into psychiatry. Debating neurology at the time and for awhile I was swearing of going into psychiatry (also didn't like inpatient psych).

Interestingly, doing the neurology rotation made me realize that I hated inpatient neurology even more. To the degree that I didn't think I can handle a neurology residency. So at the end of neurology I was all of a sudden debating between psych and heme/onc. Heme/onc is still super interesting and I find myself reading papers in that field sporadically, but on a per-hour basis, I now make more money and have a much better lifestyle, and intellectually very stimulating as well, just in a different way.

In going into psych you do have to make the concession that you are now a doctor of problems that go way beyond medicine, into psychosocial and even existential management. Now this concession could become a passion, because once you get INTO this, it's really interesting, just on the face of it. So that is a surprise.

Looking in hindsight: 1. my parents have NO idea what they were talking about--and at some point you have to grow up, and that point might as well be now. 2. focus on more proximal choices: if you can't enjoy residency in specialty X *at all*, I can't imagine you'd enjoy practicing in specialty X. The practice of specialty X is generally better than the residency of specialty X, so logically, if you enjoy specialty X in residency, it means you made the right decision.

These days it's pretty clear that I'm doing spectacularly well, but my parents are still struggling to wrap their head around how that is possible for a "career path" that they didn't approve of. So it's pretty clear that it's their problem, not mine.

 

[TheRightMedication]

"Make sure you are the one deciding." -MacDonaldTriad

Hear, hear.