Save Cardiology - SOS Call

[kayrish]

Hey Guys,

We all know how incessant cuts by CMS and mindless increase in cardiology spots (Advocated by ACC by the 2010 article) is causing the beginning of the end of our field. Cardiology long enjoyed the reputation of being a very competitive field, which has started to wane away. Please don't discuss, about low reimbursement or Keynesian economies, my concern is not money, but the reputation of being in a competitive field that holds respect among other physicians. Also, the brightest 3rd year cardiology fellows out there are having real issues finding a respectable job. physician recruiting agency have over 900 GI spots for 400 graduating GI fellows. While, they have less than 180 job openings for 800 cards fellows.

The sharpest and smartest physicians I know are in cardiology. No other speciality has revolutionized Evidence based medicine by trials as much as we have. Given the high collective intellect present in our fields, I am sure we can save our beloved speciality. This is high time we approach the problem head on, we need to stop incessant expansion of cardiology spots in the face of a saturated market. We need to learn from nephrology and need to stop ACC/ APDIM advocated increase in spots. Small programs like guthrie, uic-Peoria, USA-mobile, Kettering Ohio, wright Gme, etcetera need to close down again. We can make a petition for this.
Also, please Suggest more interventions to better address these problems.
Sincere help from my intellectual colleagues.

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[kd649]

Hey Guys,

We all know how incessant cuts by CMS and mindless increase in cardiology spots (Advocated by ACC by the 2010 article) is causing the beginning of the end of our field. Cardiology long enjoyed the reputation of being a very competitive field, which has started to wane away. Please don't discuss, about low reimbursement or Keynesian economies, my concern is not money, but the reputation of being in a competitive field that holds respect among other physicians. Also, the brightest 3rd year cardiology fellows out there are having real issues finding a respectable job. physician recruiting agency have over 900 GI spots for 400 graduating GI fellows. While, they have less than 180 job openings for 800 cards fellows.

The sharpest and smartest physicians I know are in cardiology. No other speciality has revolutionized Evidence based medicine by trials as much as we have. Given the high collective intellect present in our fields, I am sure we can save our beloved speciality. This is high time we approach the problem head on, we need to stop incessant expansion of cardiology spots in the face of a saturated market. We need to learn from nephrology and need to stop ACC/ APDIM advocated increase in spots. Small programs like guthrie, uic-Peoria, USA-mobile, Kettering Ohio, wright Gme, etcetera need to close down again. We can make a petition for this.
Also, please Suggest more interventions to better address these problems.
Sincere help from my intellectual colleagues.

The supply of cardiologists relative to the population has been fairly stable for the past couple of decades. I think the combination of reimbursement cuts, attack on unnecessary PCI, and decreased incidence of MI's has led to a significant decrease in demand. I agree we may have too many fellows graduating but the demand may still catch up if you consider more baby boomers being eligible for medicare every year, the metabolic syndrome epidemic, and the fact that 40% of cardiologists are currently over 55 years old. It would be nice if we can get the number of fellows to around 600 like ortho but it's very difficult to close down fellowships once they are up and running. We'll see what happens in the future, either way I will still most likely be applying for a cards fellowship just because it is by far the most interesting IM subspecialty. I am just hoping I am not forced to move to some crappy rural town after all this schooling just to make a living.

 

[bronx43]

The supply of cardiologists relative to the population has been fairly stable for the past couple of decades. I think the combination of reimbursement cuts, attack on unnecessary PCI, and decreased incidence of MI's has led to a significant decrease in demand. I agree we may have too many fellows graduating but the demand may still catch up if you consider more baby boomers being eligible for medicare every year, the metabolic syndrome epidemic, and the fact that 40% of cardiologists are currently over 55 years old. It would be nice if we can get the number of fellows to around 600 like ortho but it's very difficult to close down fellowships once they are up and running. We'll see what happens in the future, either way I will still most likely be applying for a cards fellowship just because it is by far the most interesting IM subspecialty. I am just hoping I am not forced to move to some crappy rural town after all this schooling just to make a living.

I don't think demand has gone down significantly to account for such a tight market, despite the fact that it's true MIs have gone down due to better medical management. I think most of the squeeze in the market is due to older cardiologists not retiring, and an increase in productivity of existing cardiologists. 800 cardiologists per year is far too high a number to be pumping out. I don't expect there to be a decrease in fellowship spots either.

 

[IMDoc607]

Reimbursements increased this year on almost everything. I think you all need to calm down with the sky is falling attitude for cardiology.

 

[bronx43]

Reimbursements increased this year on almost everything. I think you all need to calm down with the sky is falling attitude for cardiology.

No one is talking about reimbursement. A 3% increase doesn't help you if you have to move to the boonies to get a job.

 

[IMDoc607]

No one is talking about reimbursement. A 3% increase doesn't help you if you have to move to the boonies to get a job.

Not sure where you are from but ANY specialty you choose its hard to get a job in the markets I think you are talking about. I am from NY and GI (your golden cow) is starting at low 200's. Its location for all specialties. Get over it and apply to another field.

 

[bronx43]

Not sure where you are from but ANY specialty you choose its hard to get a job in the markets I think you are talking about. I am from NY and GI (your golden cow) is starting at low 200's. Its location for all specialties. Get over it and apply to another field.

GI may be saturated in NY, but cardio is saturated everywhere. I'm from the Midwest (medium sized city), and our cardio fellows are having trouble finding a good gig, whereas our GI fellows are knee deep in offers.

 

[gutonc]

GI has definitely done a better job keeping a lid on the number of trainees each year than cards has done. Part of this is a systems issue frankly. Has anybody ever heard of a "door to colo" time as a quality measure? So you need to crank out more cardiologists to make sure you meet those metrics.

The converse is also true. GI's answer is usually "well they're too unstable, resus them and we'll scope in the morning" or "they're stable, we'll scope in the morning". The only patients too unstable to cath are being wheeled out of the ICU or ED under a sheet.

 

[Trifling Jester]

When you restrict training spots too much the market adapts and other specialties start doing your procedures. There are surgeons and family practitioners who do colonoscopies.

 

[chikaficarika]

I agree. Cardiology spots needs to reduced. To many cardiologist coming out every year. I was working as a Hospitalist before I joined cardiology and now i am regretting. I love cardiology field but currently job market sucks. I live in one of the larger metro city in midwest where Hospitalist starting salary is 2,20,00 with one week on and 2 weeks off and i am getting same amount or little more but 2 hours away from metro areas. Its sucks for my kids and my wife. I am getting jobs in towns where i can not even find Indian grocery store. If i take jobs in that kind of towns that my social life want be good and I am working harder for same amount of money.

In my opinion cardiology reputation went down tremendously in last few years. You can see current fellowship match results. This year highest FMG matched into Cardiology while AMG number is keep going down and down.

 

[chikaficarika]

I agree. Cardiology spots needs to reduced. To many cardiologist coming out every year. I was working as a Hospitalist before I joined cardiology and now i am regretting. I love cardiology field but currently job market sucks. I live in one of the larger metro city in midwest where Hospitalist starting salary is 2,20,00 with one week on and 2 weeks off and i am getting same amount or little more but 2 hours away from metro areas. Its sucks for my kids and my wife. I am getting jobs in towns where i can not even find Indian grocery store. If i take jobs in that kind of towns that my social life want be good and I am working harder for same amount of money.

In my opinion cardiology reputation went down tremendously in last few years. You can see current fellowship match results. This year highest FMG matched into Cardiology while AMG number is keep going down and down.

 

[kayrish]

Ok,
Bronx and kd, fellowship spots can be reduced, FYI, all small programs that got recognition in 2010 were active and running in 1990s, however They were shutdown due to stricter guidelines and oversupply.

For eg, Guthrie, started cards fellowship in 2011 but all faculty in the program including PD graduated from old guthrie fellowship in 90s before the fellowship was shutdown and restarted in 2011.

I am attaching the graph of cardiology spots , which is a proof of this statements.

Talk to old cardiologist before the PCI era and you will hear tales of fluctuation of spots

Also the graph is from the 2010 ACC ARticle that created false speculation about deficits in cardiology workforce and got so many spots recognition.

Bronx, you convey my concerns exactly

I don't fing care about money or reimbursements, I want to create demand for my field and I don't wanna work in boonies.

 

[kayrish]

http://content.onlinejacc.org/article.aspx?articleid=1140075

 

[Silent Cool]

Point to remember: these things come in cycles. One decade Cards will be hot; the next, GI. Keep in mind that GI is a one-trick pony, and if reimbursements are cut there or if virtual colonoscopy becomes the norm, then the field will become trash.

 

[bronx43]

Point to remember: these things come in cycles. One decade Cards will be hot; the next, GI. Keep in mind that GI is a one-trick pony, and if reimbursements are cut there or if virtual colonoscopy becomes the norm, then the field will become trash.

Or s***... sorry, couldn't resist.

 

[kayrish]

Well, that's what the graph depicts, cards had 800 spots which got reduced to 600 in a decade and are back up on 800.

The reason cards became hot again at the end of 90s decade was PCI. Something like this unlikely to happen, and we need to adress the oversupply.

 

[gutonc]

Well, that's what the graph depicts, cards had 800 spots which got reduced to 600 in a decade and are back up on 800.

The reason cards became hot again at the end of 90s decade was PCI. Something like this unlikely to happen, and we need to adress the oversupply.

Your crystal ball must be amazing. How do you know there's not another PCI-like breakthrough on the horizon in cards? I'm not arguing that there is, but your argument is specious at best.

 

[bronx43]

Your crystal ball must be amazing. How do you know there's not another PCI-like breakthrough on the horizon in cards? I'm not arguing that there is, but your argument is specious at best.

His statement was entirely valid. He stated that it was "unlikely" for another intervention of PCI magnitude to hit the market any time soon. It's a rare event for something of that caliber to come about, therefore, it's reasonable to assume that one isn't on the horizon in the near future, especially if there aren't already reports or trials right now.

 

[hotshotdoc]

The older folks need to call it a day and retire.

 

[IMDoc607]

The older folks need to call it a day and retire.

Smartest thing I have heard so far.

 

[DermViser]

Hey Guys,

We all know how incessant cuts by CMS and mindless increase in cardiology spots (Advocated by ACC by the 2010 article) is causing the beginning of the end of our field. Cardiology long enjoyed the reputation of being a very competitive field, which has started to wane away. Please don't discuss, about low reimbursement or Keynesian economies, my concern is not money, but the reputation of being in a competitive field that holds respect among other physicians. Also, the brightest 3rd year cardiology fellows out there are having real issues finding a respectable job. physician recruiting agency have over 900 GI spots for 400 graduating GI fellows. While, they have less than 180 job openings for 800 cards fellows.

The sharpest and smartest physicians I know are in cardiology. No other speciality has revolutionized Evidence based medicine by trials as much as we have. Given the high collective intellect present in our fields, I am sure we can save our beloved speciality. This is high time we approach the problem head on, we need to stop incessant expansion of cardiology spots in the face of a saturated market. We need to learn from nephrology and need to stop ACC/ APDIM advocated increase in spots. Small programs like guthrie, uic-Peoria, USA-mobile, Kettering Ohio, wright Gme, etcetera need to close down again. We can make a petition for this.
Also, please Suggest more interventions to better address these problems.
Sincere help from my intellectual colleagues.

:troll:

 

[kayrish]

This post is meant for cardiology fellows and cardiology attendings.
We need to take charge of our field.

Derm, this doesn't concern you, stay away and concentrate on rashes.

 

[josephf1]

not sure why u guys are all complaining
you know it sucks and yet you still want to go into it and then you complain it sucks
at least you know it sucks and arent having the rug pulled out from underneath you
look at ct surgery - they were million dollar a year rock stars, and the new technology hosed them to nothingness
cards is a victim of its own success especially internventional and ep - too many people doing it
so big deal move to the boonies for 5 yrs and make 500 grand, at least you have the ability to do that
dont cry - just pick a different specialty
gi will be crying soon too when scoping takesa back seat to dna testing and camera pills
what u gonna do?
maybe one day well regenerate dead myocardium with stem cells and then heart failure will no longer exist
stop moaning
be smart and pick a different field if u dont love it and think you will be underpayed
i wish now i picked reproductive endo or fetal echo or some coosh job like that that still makes a million a year without call
whatever
can always be a hospitalist and party 2 weeks a month so there

 

[IMDoc607]

not sure why u guys are all complaining
you know it sucks and yet you still want to go into it and then you complain it sucks
at least you know it sucks and arent having the rug pulled out from underneath you
look at ct surgery - they were million dollar a year rock stars, and the new technology hosed them to nothingness
cards is a victim of its own success especially internventional and ep - too many people doing it
so big deal move to the boonies for 5 yrs and make 500 grand, at least you have the ability to do that
dont cry - just pick a different specialty
gi will be crying soon too when scoping takesa back seat to dna testing and camera pills
what u gonna do?
maybe one day well regenerate dead myocardium with stem cells and then heart failure will no longer exist
stop moaning
be smart and pick a different field if u dont love it and think you will be underpayed
i wish now i picked reproductive endo or fetal echo or some coosh job like that that still makes a million a year without call
whatever
can always be a hospitalist and party 2 weeks a month so there

I agree Joseph but don't you think people are exaggerating alittle? Is it the old days where jobs were plentiful and paid amazing? No but I'm aware of that. But people are complaining about starting salaries between 250 to 350 depending on location. Don't you think that's alittle absurd? In fact, fellows from my program are going into smaller towns but not bumble and getting 400K. I guess I feel that perhaps we are being ridiculous. Most specialties will not make what we make ever and we don't see many of them complaining this much. Honestly, I'm willing to move to a mid size city (southern) for a starting salary of 300K and enjoy my job. I'll work my way up. At the end of the day it's not all about money but most of it is. That's why people should be thinking about income producing items besides their jobs.

 

[anbuitachi]

I agree Joseph but don't you think people are exaggerating alittle? Is it the old days where jobs were plentiful and paid amazing? No but I'm aware of that. But people are complaining about starting salaries between 250 to 350 depending on location. Don't you think that's alittle absurd? In fact, fellows from my program are going into smaller towns but not bumble and getting 400K. I guess I feel that perhaps we are being ridiculous. Most specialties will not make what we make ever and we don't see many of them complaining this much. Honestly, I'm willing to move to a mid size city (southern) for a starting salary of 300K and enjoy my job. I'll work my way up. At the end of the day it's not all about money but most of it is. That's why people should be thinking about income producing items besides their jobs.

Doesn't sound absurd to me... doctors are providing important service to the community, more important I say than the lawyers, yet we get paid less w much more years of training and loans. There's nothing wrong with demanding more. Besides, the more you allow this to happen, the more it will happen. If they see no opposition from cardiologists when their salaries are cut 15%, next time they'll cut another 15, and another 15. If our attitudes don't change, we will keep on getting bullied, and someday maybe we'll make as much as the nurses.

not sure why u guys are all complaining
you know it sucks and yet you still want to go into it and then you complain it sucks
at least you know it sucks and arent having the rug pulled out from underneath you
look at ct surgery - they were million dollar a year rock stars, and the new technology hosed them to nothingness
cards is a victim of its own success especially internventional and ep - too many people doing it
so big deal move to the boonies for 5 yrs and make 500 grand, at least you have the ability to do that
dont cry - just pick a different specialty
gi will be crying soon too when scoping takesa back seat to dna testing and camera pills
what u gonna do?
maybe one day well regenerate dead myocardium with stem cells and then heart failure will no longer exist
stop moaning
be smart and pick a different field if u dont love it and think you will be underpayed
i wish now i picked reproductive endo or fetal echo or some coosh job like that that still makes a million a year without call
whatever
can always be a hospitalist and party 2 weeks a month so there

Sorry but this is one of the dumbest things I've heard. So everytime something bad happens, we should just run away? Soon there'll be no where else to run to. It's not easy changing from Cardio to Gi or Derm. Instead of just accepting these changes ppl should be fighting back. The reason why doctors are always getting bullied is b/c we have no voice, one side says we shouldn't be treated this way, and the other half of the doctors say we should. Stop fighting w/ other docs and focus on a common goal. How often do you see lawyer/nurses taking this crap w/o fighting back?

 

[IMDoc607]

Doesn't sound absurd to me... doctors are providing important service to the community, more important I say than the lawyers, yet we get paid less w much more years of training and loans. There's nothing wrong with demanding more. Besides, the more you allow this to happen, the more it will happen. If they see no opposition from cardiologists when their salaries are cut 15%, next time they'll cut another 15, and another 15. If our attitudes don't change, we will keep on getting bullied, and someday maybe we'll make as much as the nurses.



Sorry but this is one of the dumbest things I've heard. So everytime something bad happens, we should just run away? Soon there'll be no where else to run to. It's not easy changing from Cardio to Gi or Derm. Instead of just accepting these changes ppl should be fighting back. The reason why doctors are always getting bullied is b/c we have no voice, one side says we shouldn't be treated this way, and the other half of the doctors say we should. Stop fighting w/ other docs and focus on a common goal. How often do you see lawyer/nurses taking this crap w/o fighting back?

Average lawyer salary as per labor: $130,880
Mean cardiology salary: $357,000

Most lawyers do pretty poorly given the cost of their education. You'll never make as much as a nurse. I think we need better political lobbying though but let's not get out of hand.

 

[anbuitachi]

not sure why u guys are all complaining
you know it sucks and yet you still want to go into it and then you complain it sucks
at least you know it sucks and arent having the rug pulled out from underneath you
look at ct surgery - they were million dollar a year rock stars, and the new technology hosed them to nothingness
cards is a victim of its own success especially internventional and ep - too many people doing it
so big deal move to the boonies for 5 yrs and make 500 grand, at least you have the ability to do that
dont cry - just pick a different specialty
gi will be crying soon too when scoping takesa back seat to dna testing and camera pills
what u gonna do?
maybe one day well regenerate dead myocardium with stem cells and then heart failure will no longer exist
stop moaning
be smart and pick a different field if u dont love it and think you will be underpayed
i wish now i picked reproductive endo or fetal echo or some coosh job like that that still makes a million a year without call
whatever
can always be a hospitalist and party 2 weeks a month so there

Average lawyer salary as per labor: $130,880
Mean cardiology salary: $357,000

Most lawyers do pretty poorly given the cost of their education. You'll never make as much as a nurse. I think we need better political lobbying though but let's not get out of hand.

thats uneven statistics. medicine if far more selective than law. anyone can get into law school. which is why the average for medicine is paid higher. and you are comparing cardiology, which is one of the more selective fields in medicine to all of lawyers..

 

[TheWeeIceMan]

thats uneven statistics. medicine if far more selective than law. anyone can get into law school. which is why the average for medicine is paid higher. and you are comparing cardiology, which is one of the more selective fields in medicine to all of lawyers..

Sure, but didn't you say that law paid more in general a couple post back? Even if you compared mid career earnings of lawyers attending t14 schools who landed biglaw to physicians, my guess is you'd still find that the average physician made more.

 

[kayrish]

Doesn't sound absurd to me... doctors are providing important service to the community, more important I say than the lawyers, yet we get paid less w much more years of training and loans. There's nothing wrong with demanding more. Besides, the more you allow this to happen, the more it will happen. If they see no opposition from cardiologists when their salaries are cut 15%, next time they'll cut another 15, and another 15. If our attitudes don't change, we will keep on getting bullied, and someday maybe we'll make as much as the nurses.



Sorry but this is one of the dumbest things I've heard. So everytime something bad happens, we should just run away? Soon there'll be no where else to run to. It's not easy changing from Cardio to Gi or Derm. Instead of just accepting these changes ppl should be fighting back. The reason why doctors are always getting bullied is b/c we have no voice, one side says we shouldn't be treated this way, and the other half of the doctors say we should. Stop fighting w/ other docs and focus on a common goal. How often do you see lawyer/nurses taking this crap w/o fighting back?

That is my thoughts exactly.
We need to take an initiative ASAP.
I suggest we make a petition signed by cardiology fellows, IM residents going in cards and practicing cardiologist, and forward it yo ACGME,AHA and ACC.
WE CAN PROPAGATE AND SHARE IT by social media to achieve required momentum.

And please let's try to stick to the cause, instead of discussing lawyer salaries. None cares about rabid dogs and lawyers .

 

[DIce3]

We need to take an initiative ASAP.

[From the movie Aliens (1986)] Newt: "It won't make any difference."

See the hundreds of posts on the pathology forum about this same issue.

 

[kayrish]

Pa

[From the movie Aliens (1986)] Newt: "It won't make any difference."

See the hundreds of posts on the pathology forum about this same issue.

A residency is starkly different than a fellowship interns of regulation of spots.

Pathology is different from cardiology, and derm, Gi! Law are also different.

 

[anbuitachi]

There needs to be strikessss. paper alone prob wont get anywhere. the # of cardiologists in this country is really.. not many.

 

[dragonfly99]

I don't think it is quite as bad as people are posting on here...although there is definitely downward pressure on cardiology salaries, as well as reimbursement cuts that have been made in the past few years to cardiac imaging (I was told on the order of 30% or so, to echo and nuclear studies, a couple of years ago, though I don't personally do the billing so that might be a little off). However, I do think that there are probably a few too many cardiology fellowship spots. I also think that with the recent economic slump the past 6 years or so, some of the older cardiologists avoided retiring but pretty soon some of those will, so perhaps things will get better. I do think the notion we'll "never" be at risk of making what a nurse makes is not necessarily true. Nurses have a very strong union. The NP @Local teaching hospital makes 140k for no nights, no call, no weekends ever. I've been getting productivity reports recently that say my projected salary is less than this, based on my purported level of productivity. Now, I'm not saying they will actually cut my salary to that level, but if they did I would make less than the NP and less than our primary care docs (I am pretty sure), who take no call, no nights and I believe no weekends either.

 

[josephf1]

its funny that doctors, and i am guilty of this as well, think that cause we took so many tests and did so well in college, and trained so long, that we come out (or feel like we should come out) making the most $$$ of any profession on earth. I love hearing how the rich people i know or the patients i see got rich. NONE of them are doctors. Some examples...
the lawyer friend i showed my future employment contract to (something in the low 3XX,XXX, which I thought was pretty descent) laughed at me and said you did 10 years of killer training for this? and hinted he made double that or more.
the traffic ticket lawyer I know who makes 50K a month and has a ferrari
the guy i know with 2 kiosks in the mall selling beauty creams makes 300K a year (my uncle does his taxes)
the guy who sells real estate in my neighborhood (commercial) who made 275K commission on ONE DEAL with a bachelors from a crappy college
the guy i know with a website that does coupon stuff who owns a mansion on a golf course, several commercial properties, and has an M6 convertible and full time live in help, college degree only
the guy i know with no schooling who refurbishes and flips houses and makes 1.5 million a year
the guy i know with 10 subway franchises who has yacht and is a multimillionaire
the examples i now go on and on
i dont know any doctor living these extravagant lifestyles, the real rich people i see are businessmen and real estate guys who dont do nights, weekends, partners in law firms living way higher on the hog then you or I ever will, and some internet dudes
others i know doing REALLY WELL and by that I mean 500K plus are the orthodontists, periodontists, some ENTs and orthopods, absolutely NOBODY that did any internal medicine related subspeciaity by the way
these are my real life stories
i got my butt kicked getting through fellowship to make 300K but it is what i do, i like it, and its enough $$$ for me, i am not after the yacht and plane and golf and horse and all that crap. i can get my used M3 for 30K and im happy. the rest im just gonna save and get out of this rat race early.
oh yaeh - 1 more tip - dont marry a princess

 

[foo]

its funny that doctors, and i am guilty of this as well, think that cause we took so many tests and did so well in college, and trained so long, that we come out (or feel like we should come out) making the most $$$ of any profession on earth. I love hearing how the rich people i know or the patients i see got rich. NONE of them are doctors. Some examples...
the lawyer friend i showed my future employment contract to (something in the low 3XX,XXX, which I thought was pretty descent) laughed at me and said you did 10 years of killer training for this? and hinted he made double that or more.
the traffic ticket lawyer I know who makes 50K a month and has a ferrari
the guy i know with 2 kiosks in the mall selling beauty creams makes 300K a year (my uncle does his taxes)
the guy who sells real estate in my neighborhood (commercial) who made 275K commission on ONE DEAL with a bachelors from a crappy college
the guy i know with a website that does coupon stuff who owns a mansion on a golf course, several commercial properties, and has an M6 convertible and full time live in help, college degree only
the guy i know with no schooling who refurbishes and flips houses and makes 1.5 million a year
the guy i know with 10 subway franchises who has yacht and is a multimillionaire
the examples i now go on and on
i dont know any doctor living these extravagant lifestyles, the real rich people i see are businessmen and real estate guys who dont do nights, weekends, partners in law firms living way higher on the hog then you or I ever will, and some internet dudes
others i know doing REALLY WELL and by that I mean 500K plus are the orthodontists, periodontists, some ENTs and orthopods, absolutely NOBODY that did any internal medicine related subspeciaity by the way
these are my real life stories
i got my butt kicked getting through fellowship to make 300K but it is what i do, i like it, and its enough $$$ for me, i am not after the yacht and plane and golf and horse and all that crap. i can get my used M3 for 30K and im happy. the rest im just gonna save and get out of this rat race early.
oh yaeh - 1 more tip - dont marry a princess

Gosh, you must also know some normal people, with middle class jobs, living a middle class dream without whining about their lives (or how much they make/not make). You must have read about poor people, that have been less fortunate; I assume you don't travel in those circles very often, or if you do, you might be thinking "wow, this is a ridiculous post, what a bunch of self-entitled complainers".

OK, but someone had to say this, sorry if I offended any one.

 

[bronx43]

its funny that doctors, and i am guilty of this as well, think that cause we took so many tests and did so well in college, and trained so long, that we come out (or feel like we should come out) making the most $$$ of any profession on earth. I love hearing how the rich people i know or the patients i see got rich. NONE of them are doctors. Some examples...
the lawyer friend i showed my future employment contract to (something in the low 3XX,XXX, which I thought was pretty descent) laughed at me and said you did 10 years of killer training for this? and hinted he made double that or more.
the traffic ticket lawyer I know who makes 50K a month and has a ferrari
the guy i know with 2 kiosks in the mall selling beauty creams makes 300K a year (my uncle does his taxes)
the guy who sells real estate in my neighborhood (commercial) who made 275K commission on ONE DEAL with a bachelors from a crappy college
the guy i know with a website that does coupon stuff who owns a mansion on a golf course, several commercial properties, and has an M6 convertible and full time live in help, college degree only
the guy i know with no schooling who refurbishes and flips houses and makes 1.5 million a year
the guy i know with 10 subway franchises who has yacht and is a multimillionaire
the examples i now go on and on
i dont know any doctor living these extravagant lifestyles, the real rich people i see are businessmen and real estate guys who dont do nights, weekends, partners in law firms living way higher on the hog then you or I ever will, and some internet dudes
others i know doing REALLY WELL and by that I mean 500K plus are the orthodontists, periodontists, some ENTs and orthopods, absolutely NOBODY that did any internal medicine related subspeciaity by the way
these are my real life stories
i got my butt kicked getting through fellowship to make 300K but it is what i do, i like it, and its enough $$$ for me, i am not after the yacht and plane and golf and horse and all that crap. i can get my used M3 for 30K and im happy. the rest im just gonna save and get out of this rat race early.
oh yaeh - 1 more tip - dont marry a princess

Hahaha, are you serious dude? I mean, really?

Do you really think traffic lawyers make $600k and guys who "flip" houses make 1.5 mil? I'm not saying there aren't people out there making that much, but those are OUTLIERS and not the norm (not even close.) And for some strange reason, they all know you... just saying. Talk to anyone in law and ask them if the typical traffic lawyer makes anywhere near 50k/month. That, along with murder, low end divorce law, immigration comprise of the s*** end of the business. As far as flipping houses, it's a decent market right now as private equity firms are eating up the real estate market given the lack of other reliable asset classes, but do you remember what happened in 2008? The people flipping houses got royally effed in the A. They were literally caught with their pants down when their properties dropped by 50% overnight. Another thing boys and girls, flipping houses is a TOUGH business that is volatile - something you'd expect from a business where you can theoretically make money with no capital on hand. I'm not even going to address the rest of this post, but this is ridiculous to even insinuate that these other lines of work are somehow the road to El Dorado. You obviously can make it big in other businesses, but it's the same reason you don't tell your kids not to go to college because the founders of Facebook and Microsoft didn't get their four year degree.

The financial aspects of being a physician isn't limited to the dollar amount. It's the dollar amount in the setting of the kind of stability that NONE of the other lines of work provides. The bankers in 2008 took a big hit and haven't been the same since. A lot are still doing well but even more were on the verge of committing suicide. Why don't you hear about that? What happened to the physicians during this period? Their 401k dropped significantly (and has rebounded since), but that was it. They were still employed, still making 200-500k.

However, I do agree with your last piece of advice. A princess will leave your ass broke.

 

[IMDoc607]

Hahaha, are you serious dude? I mean, really?

Do you really think traffic lawyers make $600k and guys who "flip" houses make 1.5 mil? I'm not saying there aren't people out there making that much, but those are OUTLIERS and not the norm (not even close.) And for some strange reason, they all know you... just saying. Talk to anyone in law and ask them if the typical traffic lawyer makes anywhere near 50k/month. That, along with murder, low end divorce law, immigration comprise of the s*** end of the business. As far as flipping houses, it's a decent market right now as private equity firms are eating up the real estate market given the lack of other reliable asset classes, but do you remember what happened in 2008? The people flipping houses got royally effed in the A. They were literally caught with their pants down when their properties dropped by 50% overnight. Another thing boys and girls, flipping houses is a TOUGH business that is volatile - something you'd expect from a business where you can theoretically make money with no capital on hand. I'm not even going to address the rest of this post, but this is ridiculous to even insinuate that these other lines of work are somehow the road to El Dorado. You obviously can make it big in other businesses, but it's the same reason you don't tell your kids not to go to college because the founders of Facebook and Microsoft didn't get their four year degree.

The financial aspects of being a physician isn't limited to the dollar amount. It's the dollar amount in the setting of the kind of stability that NONE of the other lines of work provides. The bankers in 2008 took a big hit and haven't been the same since. A lot are still doing well but even more were on the verge of committing suicide. Why don't you hear about that? What happened to the physicians during this period? Their 401k dropped significantly (and has rebounded since), but that was it. They were still employed, still making 200-500k.

However, I do agree with your last piece of advice. A princess will leave your ass broke.

Your best post ever.....I think if we met and set down we would agree on close to everything. I won't even address Joseph's post as it sounds so ridiculous coming from a future attending cardiologist. Cardiologist/cardiology fellows are amongst the biggest complainers, myself included. Look at the freaking medscape and MGMA reports. Yes, I know that MGMA seems to be inflated. However, if your first year package is a total of $400,000 (Salary, benefits, etc) then I'll ask you where you can find a guaranteed job like that. I know the current job market is tough but even still find ANY profession that gives you that guarantee/stability then let me know. The older doctors WILL retire soon and Bronx I wouldn't let the current climate discourage you from applying. If you are a second year IM resident, you still have 5 more years till you even graduate. Things will be different.....both for good and bad.

 

[dragonfly99]

I don't think you are going to get any starting package for 400k...unless maybe you are starting out in interventional in a small town in the South or Midwest, with a very adverse call schedule? I don't think there is enough money in the medical system to keep paying cardiologists and other docs those big salaries, so now that most of us are employed , they (the big hospital systems, Kaiser, etc.) are not going to pay us those salaries. You can probably expect in the 200-300k range though, which is still a lot of money. But I do worry about those med students with 300-400k of debt at 6.5% or whatever it is, and going into lower paying specialties...

 

[anbuitachi]

I don't think you are going to get any starting package for 400k...unless maybe you are starting out in interventional in a small town in the South or Midwest, with a very adverse call schedule? I don't think there is enough money in the medical system to keep paying cardiologists and other docs those big salaries, so now that most of us are employed , they (the big hospital systems, Kaiser, etc.) are not going to pay us those salaries. You can probably expect in the 200-300k range though, which is still a lot of money. But I do worry about those med students with 300-400k of debt at 6.5% or whatever it is, and going into lower paying specialties...

Agreed. student loans are now 100% unsubsidized 6.8% interest and 7.9 for direct plus loans.. which is ridiculous since for most students unsubsidized loans can't cover the entire bill

 

[IMDoc607]

I don't think you are going to get any starting package for 400k...unless maybe you are starting out in interventional in a small town in the South or Midwest, with a very adverse call schedule? I don't think there is enough money in the medical system to keep paying cardiologists and other docs those big salaries, so now that most of us are employed , they (the big hospital systems, Kaiser, etc.) are not going to pay us those salaries. You can probably expect in the 200-300k range though, which is still a lot of money. But I do worry about those med students with 300-400k of debt at 6.5% or whatever it is, and going into lower paying specialties...

What's wrong with working in a smaller town that you travel to? I drive 40 minutes to an hour to work now. I found an interventional position in a state I want to move to for starting of 450,000 plus production. It's a hospital employed position. I have family in the vicinity and they told me it's possible to commute there in 30 to 40 minutes from the popular city down there. I don't see how that's so bad personally.

 

[gutonc]

What's wrong with working in a smaller town that you travel to? I drive 40 minutes to an hour to work now. I found an interventional position in a state I want to move to for starting of 450,000 plus production. It's a hospital employed position. I have family in the vicinity and they told me it's possible to commute there in 30 to 40 minutes from the popular city down there. I don't see how that's so bad personally.

Commuting sucks. You're basically working an extra 60-90 minutes for free because of the commute time. As long as you're aware of that and take it into account in your financial calculations though, whatever you can tolerate is fine.

Also, make sure your contract doesn't require you to be within X minutes of the hospital(s) when you're on home call. Our invasive cardiologists (the hospital employed ones) have to live within 20 minutes of the hospital...part of the contract. Same with the MICU attendings.

 

[bronx43]

Commuting sucks. You're basically working an extra 60-90 minutes for free because of the commute time. As long as you're aware of that and take it into account in your financial calculations though, whatever you can tolerate is fine.

Also, make sure your contract doesn't require you to be within X minutes of the hospital(s) when you're on home call. Our invasive cardiologists (the hospital employed ones) have to live within 20 minutes of the hospital...part of the contract. Same with the MICU attendings.

Yeah, I would be surprised if there isn't a proximity requirement for interventional, or at least on your call days. So if you're covering STEMI call Q4, then you'll probably have to find an apartment to rent that's close to the hospital. The other three nights you can probably stay home.

 

[IMDoc607]

Commuting sucks. You're basically working an extra 60-90 minutes for free because of the commute time. As long as you're aware of that and take it into account in your financial calculations though, whatever you can tolerate is fine.

Also, make sure your contract doesn't require you to be within X minutes of the hospital(s) when you're on home call. Our invasive cardiologists (the hospital employed ones) have to live within 20 minutes of the hospital...part of the contract. Same with the MICU attendings.

I do it everyday in fellowship and this drive is way more tolerable. 75mph highways which my understanding experiences limited traffic.

However, you bring up a good point regarding requirements regarding distance to the hospital. Honestly, I would rent a ****ty apartment in the area and that's it. I would rather be closer by anyway. I'll figure it out.

 

[circulus vitios]

its funny that doctors, and i am guilty of this as well, think that cause we took so many tests and did so well in college, and trained so long, that we come out (or feel like we should come out) making the most $$$ of any profession on earth. I love hearing how the rich people i know or the patients i see got rich. NONE of them are doctors. Some examples...
the lawyer friend i showed my future employment contract to (something in the low 3XX,XXX, which I thought was pretty descent) laughed at me and said you did 10 years of killer training for this? and hinted he made double that or more.
the traffic ticket lawyer I know who makes 50K a month and has a ferrari
the guy i know with 2 kiosks in the mall selling beauty creams makes 300K a year (my uncle does his taxes)
the guy who sells real estate in my neighborhood (commercial) who made 275K commission on ONE DEAL with a bachelors from a crappy college
the guy i know with a website that does coupon stuff who owns a mansion on a golf course, several commercial properties, and has an M6 convertible and full time live in help, college degree only
the guy i know with no schooling who refurbishes and flips houses and makes 1.5 million a year
the guy i know with 10 subway franchises who has yacht and is a multimillionaire
the examples i now go on and on
i dont know any doctor living these extravagant lifestyles, the real rich people i see are businessmen and real estate guys who dont do nights, weekends, partners in law firms living way higher on the hog then you or I ever will, and some internet dudes
others i know doing REALLY WELL and by that I mean 500K plus are the orthodontists, periodontists, some ENTs and orthopods, absolutely NOBODY that did any internal medicine related subspeciaity by the way
these are my real life stories
i got my butt kicked getting through fellowship to make 300K but it is what i do, i like it, and its enough $$$ for me, i am not after the yacht and plane and golf and horse and all that crap. i can get my used M3 for 30K and im happy. the rest im just gonna save and get out of this rat race early.
oh yaeh - 1 more tip - dont marry a princess

Start buying and selling real estate on the side. You think these people got to where they are by only working 60 or 70 hours a week?

Oh and...

Talk to all of the lawyers making $35k/year doing document review or $45k/year slaving away at some ****law job. Or the commercial real estate agent who made $275k on one deal, but makes one deal every 7-8 years because selling a property worth tens of millions of dollars is difficult because the market is so small. Maybe the guy who once made hundreds of thousands a year with a coupon or advertising website, but now makes a couple hundred bucks a month because his popularity took a nosedive.

(It sucks that you aren't making millions. Everyone, me included, wants to be rich. But you can't expect to be rich by taking a safe route. These lawyers, real estate agents, businessmen, advertisers, etc. all took significant risk -- just take a look at the number of losers in these respective fields, the ones who are barely making a living. You took the 'guaranteed quarter million dollar a year salary' route. No risk, comparatively speaking, so your reward is lower.)

 

[Mad Jack]

its funny that doctors, and i am guilty of this as well, think that cause we took so many tests and did so well in college, and trained so long, that we come out (or feel like we should come out) making the most $$$ of any profession on earth. I love hearing how the rich people i know or the patients i see got rich. NONE of them are doctors. Some examples...
the lawyer friend i showed my future employment contract to (something in the low 3XX,XXX, which I thought was pretty descent) laughed at me and said you did 10 years of killer training for this? and hinted he made double that or more.
the traffic ticket lawyer I know who makes 50K a month and has a ferrari
the guy i know with 2 kiosks in the mall selling beauty creams makes 300K a year (my uncle does his taxes)
the guy who sells real estate in my neighborhood (commercial) who made 275K commission on ONE DEAL with a bachelors from a crappy college
the guy i know with a website that does coupon stuff who owns a mansion on a golf course, several commercial properties, and has an M6 convertible and full time live in help, college degree only
the guy i know with no schooling who refurbishes and flips houses and makes 1.5 million a year
the guy i know with 10 subway franchises who has yacht and is a multimillionaire
the examples i now go on and on
i dont know any doctor living these extravagant lifestyles, the real rich people i see are businessmen and real estate guys who dont do nights, weekends, partners in law firms living way higher on the hog then you or I ever will, and some internet dudes
others i know doing REALLY WELL and by that I mean 500K plus are the orthodontists, periodontists, some ENTs and orthopods, absolutely NOBODY that did any internal medicine related subspeciaity by the way
these are my real life stories
i got my butt kicked getting through fellowship to make 300K but it is what i do, i like it, and its enough $$$ for me, i am not after the yacht and plane and golf and horse and all that crap. i can get my used M3 for 30K and im happy. the rest im just gonna save and get out of this rat race early.
oh yaeh - 1 more tip - dont marry a princess

You do realize that because you are a physician, you have the extra capital necessary to make any of the same investments many of those people made, right? That, if you cut your expenses and used some of your cash to start a side business, anything from a franchise to rental properties to some internet endeavor, you could make just as much money as those guys or more, but without the risk because you have a backup career that pays you hundreds of thousands of dollars if your business goes under? Just a thought. It's never too late to start bringing in income on the side. And I hope to god you didn't marry a princess type, that's a fate worse than death.

 

[drk]

Time is the difference between medicine and business. Doctors have to be present for everything they are paid for. All the offers of 300-350k may seem low but I'm sure if you busted your ass and worked more hours at other hospitals, covered other cardiologists, went in to cover procedures for private cardiologists etc you probably would hit 400-500k easily. That would be your peak though. Businesses can operate 24/7, you can own multiple, you can have other people run it. The only equivalent of this in medicine are machine operated testing which cardiology has a fair abundance of..echos, thallium. holters etc...though I guess this applies if you own these machines in your private practice, however the reports also need to be read/watched by you eventually and the capital required is fairly high but like a business you make it back pretty fast without you needing to be there.

 

[Greenberg702]

Does program prestige play a significantly greater role in saturated markets/specialties? I only ask because I know that last year's Sinai fellows started at around 350-400 in NYC. In specialties with tighter job markets (rads also comes to mind here), would it make sense to sacrifice location/how much you like a program in favor of a big name?

 

[IMDoc607]

On a sidenote, I was told during a PCI today by a rep that interventional procedures are going to get a big boost in payment. Sure enough, I looked this info up and found the following:

For cardiovascular-specific procedures, the non-weighted average outpatient proposed payment rates from Table 1 are:

• •  Interventional Cardiology increase by 49%.
    
    
  •  Peripheral Intervention increase by 2%
    
    
  •  Rhythm Management increase by 10%
    
    Interventional Cardiology
    
    Proposed comprehensive APCs will positively affect the level of reimbursement for Percutaneous Coronary Intervention (PCI) procedures.
    
  • Drug-eluting stent procedures with atherectomy, CTO, AMI, or BMS with atherectomy have proposed payment rate of $14,759. This compares to a range of CY2014 rates for these procedures of $6,364 to $7,714.
    
    
  • Drug-eluting stent with PTCA, bare metal stent procedures, or atherectomy without stent proposed payment rate of $9,549 compared to a range of $6,364 to $8,843.
    
    
  • When DES is part of CTO, AMI, atherectomy, or most second main coronary vessel procedures, the procedures will group to the higher paying APC 0319 as a ‘Complexity Adjusted APC.’
    
  Source: Boston Scientific

 

[sacrament]

Unless you own the lab, you're not seeing any of that. The physician fee changes are not even keeping pace with inflation.

DES & BMS stent payment proposed to increase by 0.3% to $625.
CTO and DES/BMS stent with atherectomy proposed to increase 0.2% and 0.3% respectively to $700.
AMI PCI proposed to increase 0.3% to $701.

 

[IMDoc607]

Unless you own the lab, you're not seeing any of that. The physician fee changes are not even keeping pace with inflation.

DES & BMS stent payment proposed to increase by 0.3% to $625.
CTO and DES/BMS stent with atherectomy proposed to increase 0.2% and 0.3% respectively to $700.
AMI PCI proposed to increase 0.3% to $701.

If you work for a hospital, like many of us do or will, there is no excuse for your salary to budge lower than it currently is. I realize that is what the hospital receives. However, if the hospital is making money so are you as the physician. If anyone signs a contract knowing that reimbursements are increasing 50% and their salary is actually lower or not increased than they are a fool. Thats where a good healthcare attorney comes into play. I have seen it work for other physicians and cannot believe how much they get paid.