Is ID in worse shape than RO?

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Yes, how dare we advocate for our financial health. We takes what massah gives us and we likes it.

This is ridiculous. If you don't value yourself at 300/hr or more, why the hell should the money grubbing bean counters in the lavish offices treat you any differently than a hospitalist shift worker - you're replaceable, there's more coming every year, and frankly, "i don't give a damn" about your work/life balance or any other personal matters.

If we don't stand together and advocate, who do you think will? Lol. Get real. #750orGTFO

A few things to unpack here. I have no love for admins. I don't think they create value -at all. They only exist to suck resources from the system and grow -much like the scourge we all fight with RT.

I get the point of arguing that admins don't deserve most of our revenue -that's a matter of principle, but it is kinda silly to say that one needs 750k to be financially "healthy" -like a portly man at the buffet demanding a third portion, lest he STARVE.

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Not sure what you are implying by parking lot scuffling..lol. Come on now, we're not in high school. This is vectoring into some personal animosity it seems, lets unpack that shall we..
You're killing me. It was a reference to your own boxing reference! I'm sure (well I hope) that you are not parking lot scuffling.

Way to throw everyone under the bus. "You will be assimilated" (into the institution). No, and hell no.
This is all about choices. Not blaming you for what you do, but it's important that another viewpoint is heard.

In my position, the institution that I work for provides value to me in that I have a services contract, they pay for the machines and most staffing and referrals predominantly come through them.

They also provide some real value, like palliative care, nutrition and research services. They provide emergency services and are a longstanding brand in the community. They deliver babies.

Is there administrative bloat? Of course. It's terrible.

Is the quality better than if a bunch of independent docs just ran things where I am? I absolutely believe this to be the case and this reflects my experience with the type of doctors who are too independent to participate in the institution.

Does an institution require some buy in? Of course. Run your effing cases by tumor board. Seek consensus. Value your colleagues expertise. Don't imaging yourself as an island type of stuff.

Is my ego tied to my institution? Not at all. That is academic type stuff.

So that's the assimilation of a community doc and not independent practitioner for you. I believe it's a valuable role and I believe that care will suffer if all we can provide are locums docs who are neither tied to geography, community, institution or patient continuity.
 
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I'll tell you why. Because replacing me will cost you at least that much or more. And if that isn't enough, what about the millions (2? 3?) I earn in pure profit for the org?

So yeah, I'll go with intellectual analysis. Survey says? Pay for the economic value I generate at a minimum and if I can negotiate it, pay for the difficulty in replacing me, and yes.. the quality of the work (building referrals, participation in leadership, etc).

Time to choose: red or blue pill ?
Here's your problem...

I too generate millions and only work 3 days a week. You clearly make more than me. Couldn't they just replace someone like you with someone like me?

More importantly, do you think that lobbying to get 3x that of an ID doc is going to increase our compensation, or make someone at CMS start another crusade to see that we all make 1 x that of an ID doc? Maybe someone decides that work you do isn't actually worth millions... then POOF, your argument evaporates.

Personally, I think being grateful for our lots in life, and striving to make our field more valuable (to cement our current salaries, and potentially justify future pay rasies) is a better strategy than the whole Marie Antoinette act of simply demanding more when we already have more than most.
 
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Don't know if you've noticed, but the largest employers of Radoncs have hired so many of us that nobody can get the requisite volumes even at 75/wRVU - that is what I'm saying

Most just aren't that busy anymore and volume is capped even if you want more
750k at 75/wRVU is... 10K RVUs? If you're not that busy on a 4-5 day week clinic schedule, then yeah you probably don't deserve 750k. Tons of people clearing 10k RVUs not making 750k though....

But yes, if you're working 3 days a week, wouldn't expect to make 750k?
 
I can't follow your initial argument because yes, they can replace me with you, the only question will be.. as always.. how much are you going to accept? That is the question.

And as for the "call to virtue" .. uh, I'm laughing that one right out the building. There is no altruism when it comes to getting paid. There is no social contract. Your wife and kids don't chime "sure, I don't mind not going on a nice vacation this year.. because of the social contract." lol.

We need to stand together and advocate FOR our position, FOR our speciality, FOR our well being. Taking less "to look good" isn't on the agenda.
 
FM making >400k? I honestly cannot imagine how that is true (except for a rare special circumstance). They make about 210k. Psych is similar. PM&R is likely variable depending upon the practice (? working with a sports team).

Fact: Median US physician salary is <250k (my PCP makes significantly less than this -I know, because our salaries are searchable) We had a long thread going through all of the data a few months ago... too lazy to find it, but I am sure someone can link it below.

Yeah, and online salary surveys, BLS data, etc, all have physicians average "salary" at the levels you are talking about. These are all so disconnected from MGMA numbers, which themselves are even questionable. That's a lot of data going into those averages. When you really dig into it, you can see that there are opportunities to make 400k in primary care. Is your employed FM doc at your academic center who is in clinic 3 days a week making that much? No of course not, probably 200 like you said, and that's probably fair. But the busy rad onc there is making 350? Not right.

Example: The average salary for neurosurgeons employed in the United States is $528,514 a year according to data provided by Salary.com, and $383,925 a year according to salary information provided by Payscale.

We all know those numbers are ridiculous.
Be careful about "data"
 
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750k at 75/wRVU is... 10K RVUs? If you're not that busy on a 4-5 day week clinic schedule, then yeah you probably don't deserve 750k. Tons of people clearing 10k RVUs not making 750k though....

But yes, if you're working 3 days a week, wouldn't expect to make 750k?
The average true value (from pro rvenue only) of the wRVU is about $65, higher in some places. If you're generating 10k wRVU, you should be making at least 600k + benefits or 650k 1099. You "could" do 10k wRVU in 3 days a week. I do 15k in 4.

You should be getting 70+/wRVU to account for the added value you bring.

People who generate 10k wRVU but get paid 350-400 are getting robbed unless partnership track, and then probably still are.
 
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I KNOW I’m not the best with negotiations but please let me know how to approach the admins to pay me more. I’ve made power point slides with MGMA data, stole other rad onc’s W2’s (I’m kidding) and was still turned down.

Granted, I ended up walking but thus far I’ve been unsuccessful in getting anything more then like 10-20k above the offer.
 
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I KNOW I’m not the best with negotiations but please let me know how to approach the admins to pay me more. I’ve made power point slides with MGMA data, stole other rad onc’s W2’s (I’m kidding) and was still turned down.

Granted, I ended up walking but thus far I’ve been unsuccessful in getting anything more then like 10-20k above the offer.

You have to start at a place that gives a reasonable offer to begin with then honestly tell them what it will take for you to leave your current job.
If they offer 500 and you know the position is worth 700 but you come back and ask for 550 because you are scared of losing the offer and they offer 525 as a counter, then what have you accomplished? If they can get somebody to take it for 525, they will say no either way. Alternatively, it's a busy practice and you will be paid fairly based off of RVU bonus and will accept the lower base salary. You have to go somewhere where they can't find someone to take it. The reality of the rad onc job market is that it's unlikely you will convince and admin that you are "worth it" at 700 when someone else will take it at 500 as we are interchangeable cogs. In other words, you did nothing wrong and it's not your fault if this is occuring in even minimally competitive markets.
 
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You have to start at a place that gives a reasonable offer to begin with then honestly tell them what it will take for you to leave your current job.
If they offer 500 and you know the position is worth 700 but you come back and ask for 550 because you are scared of losing the offer and they offer 525 as a counter, then what have you accomplished? If they can get somebody to take it for 525, they will say no either way. Alternatively, it's a busy practice and you will be paid fairly based off of RVU bonus and will accept the lower base salary. You have to go somewhere where they can't find someone to take it. The reality of the rad onc job market is that it's unlikely you will convince and admin that you are "worth it" at 700 when someone else will take it at 500 as we are interchangeable cogs. In other words, you did nothing wrong and it's not your fault if this is occuring in even minimally competitive markets.
The sad thing is we have produced a lot of great radoncs over the past 20 years, so there are a lot of cogs to be had. Vast majority of radoncs (under 50) that I know in my local are good docs.
 
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FM making >400k? I honestly cannot imagine how that is true (except for a rare special circumstance). They make about 210k. Psych is similar. PM&R is likely variable depending upon the practice (? working with a sports team).

Fact: Median US physician salary is <250k (my PCP makes significantly less than this -I know, because our salaries are searchable) We had a long thread going through all of the data a few months ago... too lazy to find it, but I am sure someone can link it below.

Either you believe in market economics or you don't. If you do, you will accept whatever pay the market affords you, accept that market values those admins higher than it does you, and be confident that everything is as it should be. If you don't believe in market economics, you have to me why you are worth > 3x that of the average family doc.

I am not a social justice warrior -just a fan of intellectual consistency
Rural FM can definitely make this. Also some savvy PP FM I’ve heard making this. “Geographic arbitrage” I guess for the rural folks.
 
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I KNOW I’m not the best with negotiations but please let me know how to approach the admins to pay me more. I’ve made power point slides with MGMA data, stole other rad onc’s W2’s (I’m kidding) and was still turned down.

Granted, I ended up walking but thus far I’ve been unsuccessful in getting anything more then like 10-20k above the offer.
Similar experience. But I stayed 🫠
 
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I KNOW I’m not the best with negotiations but please let me know how to approach the admins to pay me more. I’ve made power point slides with MGMA data, stole other rad onc’s W2’s (I’m kidding) and was still turned down.

Granted, I ended up walking but thus far I’ve been unsuccessful in getting anything more then like 10-20k above the offer.

You have to get a better offer elsewhere and be ready to leave. That's the only way.
 
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You have to get a better offer elsewhere and be ready to leave. That's the only way.
Sorry, I misunderstood and thought he was asking about how to get a good offer at a new job you are interviewing for. If you are trying to get your current employer to pay you more (more fairly), then yes, this.
 
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Yeah, and online salary surveys, BLS data, etc, all have physicians average "salary" at the levels you are talking about. These are all so disconnected from MGMA numbers, which themselves are even questionable. That's a lot of data going into those averages. When you really dig into it, you can see that there are opportunities to make 400k in primary care. Is your employed FM doc at your academic center who is in clinic 3 days a week making that much? No of course not, probably 200 like you said, and that's probably fair. But the busy rad onc there is making 350? Not right.

Example: The average salary for neurosurgeons employed in the United States is $528,514 a year according to data provided by Salary.com, and $383,925 a year according to salary information provided by Payscale.

We all know those numbers are ridiculous.
Be careful about "data"

My FM is at an academic center... and actually makes <200k. Agree that every NSG is likely making >500k, so long as they still operate. I do, however, think that most PCPs are making <250. I shadowed my hometown FM when I was in med school, and it is brutal. They have to see an insane number of patients just to keep the lights on. Specialties like endo, rheum are not much better, and it is even worse for peds.

It's really hard for specialties that aren't procedural, MO, or DR to crack 300k consistently.
 
Rural FM can definitely make this. Also some savvy PP FM I’ve heard making this. “Geographic arbitrage” I guess for the rural folks.
This could be true -I don't know much about rural salaries... but it is certainly not the "average" FM who is making this much money.
 
It's really hard for specialties that aren't procedural, MO, or DR to crack 300k consistently.

I don't know about this. Gas is making boatloads of cash these days. EM has always done better than this. I rarely hear psych under this number and they have options to juice their income way higher. Full time IM/hospitalist stuck in the 200s would be very suboptimal. IM subspecialties, even less procedural ones, seem to be doing very well.

If it's true that 300k is the expected annual income for most full-time physicians, then America has a problem as this is what it was 15 years ago when I was thinking about premed in college. The expected income for engineers back then was about 100k, now it's about 200k. Law associates started at 120k back then, they are 200k now (at age 25). Pilots were in dire straits back then, making under 100k was expected if they could even get a job and make it to captain. Now captains are making 500k. Why are people going to put themselves through the decade-long gauntlet of training when there are so many other career paths available now to that income level? There will be some that love medicine so much they will do it for any amount, but that's not enough to meet the demand the boomers are in the process of dumping on us. Percentage wise, physician income definitely hasn't kept with increases in nearly all other fields, but I don't think it has been exactly stagnant like you suggest (except in rad onc, whereas I would argue it has with the attainable ceiling actually significantly decreasing).
 
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Until the next major recession when suddenly, working your ass off for a predictable return seems tolerable. As the economy flies, so does the med school applications inversely.
 
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Sorry, I misunderstood and thought he was asking about how to get a good offer at a new job you are interviewing for. If you are trying to get your current employer to pay you more (more fairly), then yes, this.
Actually I was asking for both situations.
 
Until the next major recession when suddenly, working your ass off for a predictable return seems tolerable. As the economy flies, so does the med school applications inversely.

What you mean I can't get rich from selling plastic **** on Etsy and putting my profits in NFTs or stay highly employed at Twitter/Meta doing nothing all day?
It's true that being recession proof is maybe the nicest thing we have, even if incomes haven't come close to keeping up with everyone else.
So many doctors in the FIRE crowd were able to do that because they had a nice fat consistent income stream (when no one else did) to invest in stocks, real estate, and businesses in 2008-2012 and multiplied their net worths many times over. Maybe we will get that chance in the next few years. It's looking like it anyway.
 
My FM is at an academic center... and actually makes <200k. Agree that every NSG is likely making >500k, so long as they still operate. I do, however, think that most PCPs are making <250. I shadowed my hometown FM when I was in med school, and it is brutal. They have to see an insane number of patients just to keep the lights on. Specialties like endo, rheum are not much better, and it is even worse for peds.

It's really hard for specialties that aren't procedural, MO, or DR to crack 300k consistently.
my wife makes 200k base as a pediatrician with some bonus pay that gets her to 250k or so. granted she works 3 12 hr shifts per week in a urgent care type setting. its actually quite nice from a flexibility standpoint. she could have make 300-350k as a PCP but she did that previously and it is a GRIND. not sustainable in a 2 physician household and not worth it to us.

the comical thing at this point is that my parents are engineers. my dad makes more than my wife and me. i sometimes have to remind him of that. he takes lots at naps during the day, works from home, etc.

grew up in a typical southeast asian family where there was a push to become a doctor/lawyer. im happy with my choice...but clearly there are other ways to do well financially in 2022.
 
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Anyone ever watch Fleishman is in Trouble with Jesse Eisenberg and Claire Danes?

Danes’s character has social climbing aspirations in Manhattan, whereas her husband Jesse eisenberg is a lowly hepatologist.

He expects people to be impressed and adoring when he tells them what he does, but everyone he meets in her social sphere is like “aww, aren’t you cute” in a pitying way and suggest he finds a new job that pays “real” money.

Spoiler: she leaves him.

It hit hard.
 
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working out new years GIF by Rough Sketchz
 
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agree, it seems that station for a physician is not what it was supposed to be 20 years ago
 
agree, it seems that station for a physician is not what it was supposed to be 20 years ago
The real heroes are the bros moving other people’s money from one place to another.
 
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Anyone ever watch Fleishman is in Trouble with Jesse Eisenberg and Claire Danes?

Danes’s character has social climbing aspirations in Manhattan, whereas her husband Jesse eisenberg is a lowly hepatologist.

He expects people to be impressed and adoring when he tells them what he does, but everyone he meets in her social sphere is like “aww, aren’t you cute” in a pitying way and suggest he finds a new job that pays “real” money.

Spoiler: she leaves him.

It hit hard.

Lol isn't that the truth. We docs are the working stiffs at our country club. I will say that all the incredibly rich capitalists, however, are very respectful about physicians in general and oncology specifically, and say the opposite of what that movie portrays. Probably different in NYC, though, from my part of the country, and my wife grew up in a trailer so her perspective is more grounded to say the least.
 
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social climbing aspirations in Manhattan
Well, we are not in that group. Nor in DC. That's top 0.1% stuff and connected and with a sense that you are of global importance.
We docs are the working stiffs at our country club.
This is so true. Dammit we need more working stiffs. Even among docs, the trend is to get away from doing the work (which if you are doing research, I understand, as that is also the work).

I do have working stiff pride, however. We all should.
 
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Lol isn't that the truth. We docs are the working stiffs at our country club. I will say that all the incredibly rich capitalists, however, are very respectful about physicians in general and oncology specifically, and say the opposite of what that movie portrays. Probably different in NYC, though, from my part of the country, and my wife grew up in a trailer so her perspective is more grounded to say the least.

Country club? In HCOL areas most docs are not members of a country club. I can't even afford a house here ($2.5M minimum) let alone a country club membership.
 
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Country club? In HCOL areas most docs are not members of a country club. I can't even afford a house here ($2.5M minimum) let alone a country club membership.

Nice areas are pretty much out of reach unless you are willing to basically live in a **** box for a mil.

If you aren’t a member of the criminal finance class or own a lucrative business then you ain’t even in the club
 
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My FM is at an academic center... and actually makes <200k. Agree that every NSG is likely making >500k, so long as they still operate. I do, however, think that most PCPs are making <250. I shadowed my hometown FM when I was in med school, and it is brutal. They have to see an insane number of patients just to keep the lights on. Specialties like endo, rheum are not much better, and it is even worse for peds.

It's really hard for specialties that aren't procedural, MO, or DR to crack 300k consistently.

Most PCPs do not work at an academic center. A PCP making < 200k (including any potential bonus) is working 4 or less days in clinic a week, or lives in San Francisco (where I believe UCSF was paying peds < 100k a year and were still getting people to sign up for it).

FM or IM PCP... can pick up UC shifts, ED shifts, hospitalist shifts, tons of things to supplement income. Not so in Rad Onc, unless you want to burn one of your 4 weeks of vacation to go locums somewhere.
 
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There's a difference from metropolitan vs rural in PCP, psych, endo, rheum, etc. Rural they put the doc higher on the RVU ladder, either more $ per RVU or lower RVU target for base salary. As soon as you get into larger metro areas the health systems know they don't have to pay as much because you aren't leaving for Iowa.

Smaller cities and rural, a 4 day/week PCP, busy at 20-24 patients per day (3 per hour), is going to be close to or at 300K just based on RVUs and work a 5th day and add 30-40K to that. In metro area it's likely a ****ty salary in low 200s. The smaller towns have to pay more to attract and keep docs. In big cities, the smart move is running your own practice. Cash only for psych, DPC for family med/IM.

The PCPs, psych, etc, making 400K+ are churning patients, typically providing sketch care (quick visits despite sick patients), or cherry picking relatively healthy patients so they can see more per day (and less crisis management, same day urgent appointments, etc) and maxing out billing despite lower acuity.
 
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.

The PCPs, psych, etc, making 400K+ are churning patients, typically providing sketch care (quick visits despite sick patients), or cherry picking relatively healthy patients so they can see more per day (and less crisis management, same day urgent appointments, etc) and maxing out billing despite lower acuity.
Heard a story of one hospitalist who would bill inpt visits at 11:59p and 12:01a
 
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Heard a story of one hospitalist who would bill inpt visits at 11:59p and 12:01a
Saw this first hand during internship. Wrote two incomprehensible 3-line notes two minutes apart, and was unreachable for the remaining 47:58. The night intern would stake out the paper chart every two nights to get a plan on the difficult patients.
 
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Most PCPs do not work at an academic center. A PCP making < 200k (including any potential bonus) is working 4 or less days in clinic a week, or lives in San Francisco (where I believe UCSF was paying peds < 100k a year and were still getting people to sign up for it).

A board certified doctor working full time for less than 100k in SF? Literally what? Do they live paycheck to paycheck in rent controlled housing? How do you even afford to educate your children let alone feed them on that in SF?

You did something really wrong in life if you spent 4 years in college, 4 years in med school, and 3 years in residency, and passed a whole bunch of pointlessly difficult examinations to make less than a plumber, which required none of that. Just wow.

My only assumption is 100% of these people have significant family money if what you say is true.
 
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The real heroes are the bros moving other people’s money from one place to another.

Americas finest really. We cannot begin to comprehend the magnitude of such a job.

I can easily thing of more than 10 people where this was literally the goal of going to Stanford or Harvard was to finally warm a chair in Manhatten pushing money around
 
Americas finest really. We cannot begin to comprehend the magnitude of such a job.

I can easily thing of more than 10 people where this was literally the goal of going to Stanford or Harvard was to finally warm a chair in Manhatten pushing money around
I'm personally a fan of writing bits of code to spy and steal personal data to target ads on social media if we want to talk about ways to make 6 figures without contributing anything meaningful to society. This is basically all of big tech.
 
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I'm personally a fan of writing bits of code to spy and steal personal data to target ads on social media if we want to talk about ways to make 6 figures without contributing anything meaningful to society. This is basically all of big tech.

Let’s talk Lets chat - let’s have a discussion as Hill once said

I absolutely am looking to supplement my income. Contribution to social well being is not a factor in that decision anymore. I’ve already seen where that gets you
 
Let’s talk Lets chat - let’s have a discussion as Hill once said

I absolutely am looking to supplement my income. Contribution to social well being is not a factor in that decision anymore. I’ve already seen where that gets you

How do you feel about shortening the lives and extending the misery of patients with cancer?

Evicore is hiring people to act as shills to justify not paying for suckers who signed up for Medicare advantage plans. They will conviently schedule peer-to-peer calls in-between OTVs at your regular job and tell the ashole doctor trying to give SBRT to two lung nodules instead of one (metastatic, give the patient some morphine) it's the only option.

You can buy (edit: qualify for a loan on) a slightly bigger McMansion/boat.
 
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How do you feel about shortening the lives and extending the misery of patients with cancer?

Evicore is hiring people to act as shills to justify not paying for suckers who signed up for Medicare advantage plans.

You can buy (edit: qualify for a loan on) a slightly bigger McMansion/boat.

Hey if top tier ROs could rationalize such a choice don’t see why I can’t.

Also who wants to buy up life insurance policies? I had read a few years back that is quite profitable. You pay them a fraction of the policy and pocket the difference when they die.

Hate to say it but we have the best access to the data regarding this.
 
I absolutely am looking to supplement my income. Contribution to social well being is not a factor in that decision anymore. I’ve already seen where that gets you

On a serious note, just sell plastic crap on Amazon and learn how to swing trade stocks. When the real estate market takes a massive S&it in 6-18 months, buy a few duplexes after interest rates crater and hire someone else to deal with your tenants. You're welcome.
 
A board certified doctor working full time for less than 100k in SF? Literally what? Do they live paycheck to paycheck in rent controlled housing? How do you even afford to educate your children let alone feed them on that in SF?

You did something really wrong in life if you spent 4 years in college, 4 years in med school, and 3 years in residency, and passed a whole bunch of pointlessly difficult examinations to make less than a plumber, which required none of that. Just wow.

My only assumption is 100% of these people have significant family money if what you say is true.
Part of your pay is prestige. Your assumption about the people that take (and especially stay in) academic jobs like that is correct, at least in my experience. It’s a lot easier to raise a family on that salary when your mom/dad are bankers/lawyers/old radoncs.
 
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Part of your pay is prestige. Your assumption about the people that take (and especially stay in) academic jobs like that is correct, at least in my experience. It’s a lot easier to raise a family on that salary when your mom/dad are bankers/lawyers/old radoncs.

I was always impressed by the number of people at top tier institutions whose last name sounds like they came over on the mayflower that take these instructor level jobs for like 220K a year and a manage to live in the nicest parts of town. Until you find out they come from a long line of famous attorneys or their wife runs a ducking company.
 
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median salary at Facebook is 295K and even at Twitter it was 250K IMO
 
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A board certified doctor working full time for less than 100k in SF? Literally what? Do they live paycheck to paycheck in rent controlled housing? How do you even afford to educate your children let alone feed them on that in SF?

You did something really wrong in life if you spent 4 years in college, 4 years in med school, and 3 years in residency, and passed a whole bunch of pointlessly difficult examinations to make less than a plumber, which required none of that. Just wow.

My only assumption is 100% of these people have significant family money if what you say is true.

Definitely not saying I understand it (or would ever fathom it) but just saying it's out there.

I mean almost all of the whole 'want to live in SF' crowd gives me a similar feeling to bolded, but they all gotta get back to the ****ty weather part of California for exorbitant prices or something, but that's a topic for another thread.
 
Definitely not saying I understand it (or would ever fathom it) but just saying it's out there.

I mean almost all of the whole 'want to live in SF' crowd gives me a similar feeling to bolded, but they all gotta get back to the ****ty weather part of California for exorbitant prices or something, but that's a topic for another thread.
SF and Cali in general seeing a big domestic exodus, not sure that's true anymore honestly.

Bottom line is though, that you're probably going to do better as a rads gu or ent in SF trying to find a job than looking as an RO, like in many traditionally sought after big cities
 
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