Switching from derm to IM late in med school -red flag?

[dozitgetchahi]

You bought a house for ONLY 200k!

You are doing extremely well, if your house cost 200k,and you make 525k/yr. You can literally pay off your place in 1 yr.

I know. And I put 20% down too, so the remaining mortgage is only $160k or so.

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[Splenda88]

I know. And I put 20% down too, so the remaining mortgage is only $160k or so.

I thought I was the cheapest doc in SDN since I bought mine for 280k. Nice to have a mortgage akin to a luxury car payment.

 

[bronx43]

Oh my gosh what did I start here lol.

Yeah shoutout to a couple of you guys on this thread, we're gonna have to agree to disagree here. Partly because we're straying too far from OP's initial point but also partly because I'm embarrassed we're even having this conversation in the first place (like holy s*** guys if the general public read some of these posts I think they'd have a f***ing fit about how out of touch doctors are financially and rightfully so). I'm not gonna deny that things have gotten untenably expensive and that this is a major issue and priority nation-wide, but I'm also not gonna try to justify my own lived experience to a bunch of randos on the internet. Bye-bye

Huh? There really isn't a "agree to disagree" point here.

This is simply a mathematics problem. To live a middle class lifestyle and own a single family house in the suburb of a tier 1 city requires at a minimum top 1% income. And we aren't talking the Joneses. Normal house. Normal cars. No private school. Etc.

If you disagree, please show us the math.

If you're saying that a physician should relegate himself/herself and family to renting for the rest of their lives, then fine. The math checks out.

 

[Splenda88]

Huh? There really isn't a "agree to disagree" point here.

This is simply a mathematics problem. To live a middle class lifestyle and own a single family house in the suburb of a tier 1 city requires at a minimum top 1% income. And we aren't talking the Joneses. Normal house. Normal cars. No private school. Etc.

If you disagree, please show us the math.

If you're saying that a physician should relegate himself/herself and family to renting for the rest of their lives, then fine. The math checks out.

This is a little bit over the top. The top 1% household income is close ~600k

Household Income Percentile Calculator, US - DQYDJ

Check your household income percentile vs. 2023's United States income distribution in this calculator. How does it rank: top 1%, median, or other?

dqydj.com

You dont need 600k to live a middle class lifestyle in a nice, for instance, Miami (or Fort Lauderdale) suburb. Most would consider Miami tier 1. I think 250k will do if one does not have big student loan. One can find a regular house for 650-750k in some of these suburbs

4263 SW 128th Ave, Miramar, FL 33027 | realtor.com®

4263 SW 128th Ave, Miramar, FL 33027 is for sale. View 39 photos of this 5 bed, 3 bath, 2637 sqft. single family home with a list price of $689900.

www.realtor.com

Also, some suburbs of Houston (arguably tier 1) are "affordable".

Barbosa Plan - 21114 Bella Coral Drive, Cypress, TX 77433 | realtor.com®

See new home construction details for Barbosa, a 4 bed, 3 bath, 2423 Sq. Ft. style home at 21114 Bella Coral Drive, Cypress, TX 77433.

www.realtor.com

There are few suburbs of tier 1or 2 cities (Fort Lauderdale, Atlanta, Houston, Dallas, Las Vegas, Phoenix, Philadelphia, Charlotte etc...) in the country where one can live a middle class lifestyle on a household income of 150k. Though, I must admit it's getting increasingly difficult.

It is actually a sad state of affair since 150k/yr put one's household income in the 78th percentile.

 

[hotsaws]

A lot of the math problem is that physician compensation hasn’t adjusted for inflation the way many fields have. Making 300k a year now is nothing like it was to make 300k say 10 years ago. It was said above but I’ll echo it. We get a late start. We go from racking up debt, to making a fixed (underpaid) resident salary without much reasonable ability to earn more during that time, to jumping right into life in our 30s. For many of us, we start cranking out kids, buy our first home, saving aggressively, and just generally try to catch up. I’m not comparing myself to the avg working Joe who makes 40-80k a year. I’m comparing myself to other professionals or people who work their butt off for 10+ years and have above avg ability that could have been directed at another career. The topic originally got tangential when discussing “physician” compensation. Ie things like should you prioritize a high earning field and what is the opportunity cost related to longer training. Along those lines, many of us are saying there’s a BIG difference between a 200k

 

[bronx43]

This is a little bit over the top. The top 1% household income is close ~600k

Household Income Percentile Calculator, US - DQYDJ

Check your household income percentile vs. 2023's United States income distribution in this calculator. How does it rank: top 1%, median, or other?

dqydj.com

You dont need 600k to live a middle class lifestyle in a nice, for instance, Miami (or Fort Lauderdale) suburb. Most would consider Miami tier 1. I think 250k will do if one does not have big student loan. One can find a regular house for 650-750k in some of these suburbs

4263 SW 128th Ave, Miramar, FL 33027 | realtor.com®

4263 SW 128th Ave, Miramar, FL 33027 is for sale. View 39 photos of this 5 bed, 3 bath, 2637 sqft. single family home with a list price of $689900.

www.realtor.com

Also, some suburbs of Houston (arguably tier 1) are "affordable".

Barbosa Plan - 21114 Bella Coral Drive, Cypress, TX 77433 | realtor.com®

See new home construction details for Barbosa, a 4 bed, 3 bath, 2423 Sq. Ft. style home at 21114 Bella Coral Drive, Cypress, TX 77433.

www.realtor.com

There are few suburbs of tier 1or 2 cities (Fort Lauderdale, Atlanta, Houston, Dallas, Las Vegas, Phoenix, Philadelphia, Charlotte etc...) in the country where one can live a middle class lifestyle on a household income of 150k. Though, I must admit it's getting increasingly difficult.

It is actually a sad state of affair since 150k/yr put one's household income in the 78th percentile.

I guess the tiers are largely subjective but I was referring to the VHCOL coastal cities.

OP seems to be from Seattle so the original convo started there, then the poster I was responding to talked about living in OC, expensive areas of NYC with 200-250k.

im not sure most would consider Miami tier 1.

 

[hotsaws]

This is a little bit over the top. The top 1% household income is close ~600k

Household Income Percentile Calculator, US - DQYDJ

Check your household income percentile vs. 2023's United States income distribution in this calculator. How does it rank: top 1%, median, or other?

dqydj.com

You dont need 600k to live a middle class lifestyle in a nice, for instance, Miami (or Fort Lauderdale) suburb. Most would consider Miami tier 1. I think 250k will do if one does not have big student loan. One can find a regular house for 650-750k in some of these suburbs

4263 SW 128th Ave, Miramar, FL 33027 | realtor.com®

4263 SW 128th Ave, Miramar, FL 33027 is for sale. View 39 photos of this 5 bed, 3 bath, 2637 sqft. single family home with a list price of $689900.

www.realtor.com

Also, some suburbs of Houston (arguably tier 1) are "affordable".

Barbosa Plan - 21114 Bella Coral Drive, Cypress, TX 77433 | realtor.com®

See new home construction details for Barbosa, a 4 bed, 3 bath, 2423 Sq. Ft. style home at 21114 Bella Coral Drive, Cypress, TX 77433.

www.realtor.com

There are few suburbs of tier 1or 2 cities (Fort Lauderdale, Atlanta, Houston, Dallas, Las Vegas, Phoenix, Philadelphia, Charlotte etc...) in the country where one can live a middle class lifestyle on a household income of 150k. Though, I must admit it's getting increasingly difficult.

It is actually a sad state of affair since 150k/yr put one's household income in the 78th percentile.

Respectfully, I think your post just strengthens my point. You’re highlighting 2500sqft homes in the far suburbs of decent, large, but not VHCOL cities. This puts young doctors in the urban sprawl class. This used to be the type of home that a young say firefighter and teacher type of couple bought. You move to the outskirts of a city where there’s new builds, young families, chain restaurants, etc because you can’t afford to raise kids and have a yard for your dog in the actual city proper. This is the trend I see in my city and has been my experience…lots of young doc couples doing the same thing around me.

 

[dozitgetchahi]

This is a little bit over the top. The top 1% household income is close ~600k

Household Income Percentile Calculator, US - DQYDJ

Check your household income percentile vs. 2023's United States income distribution in this calculator. How does it rank: top 1%, median, or other?

dqydj.com

You dont need 600k to live a middle class lifestyle in a nice, for instance, Miami (or Fort Lauderdale) suburb. Most would consider Miami tier 1. I think 250k will do if one does not have big student loan. One can find a regular house for 650-750k in some of these suburbs

4263 SW 128th Ave, Miramar, FL 33027 | realtor.com®

4263 SW 128th Ave, Miramar, FL 33027 is for sale. View 39 photos of this 5 bed, 3 bath, 2637 sqft. single family home with a list price of $689900.

www.realtor.com

Barbosa Plan - 21114 Bella Coral Drive, Cypress, TX 77433 | realtor.com®

See new home construction details for Barbosa, a 4 bed, 3 bath, 2423 Sq. Ft. style home at 21114 Bella Coral Drive, Cypress, TX 77433.

www.realtor.com

There are few suburbs of tier 1or 2 cities (Fort Lauderdale, Atlanta, Houston, Dallas, Las Vegas, Phoenix, Philadelphia, Charlotte etc...) in the country where one can live a middle class lifestyle on a household income of 150k. Though, I must admit it's getting increasingly difficult.

It is actually a sad state of affair since 150k/yr put one's household income in the 78th percentile.

While I agree that the “conventional wisdom” is 3x income = mortgage amount (and thus a

Respectfully, I think your post just strengthens my point. You’re highlighting 2500sqft homes in the far suburbs of decent, large, but not VHCOL cities. This puts young doctors in the urban sprawl class. This used to be the type of home that a young say firefighter and teacher type of couple bought. You move to the outskirts of a city where there’s new builds, young families, chain restaurants, etc because you can’t afford to raise kids and have a yard for your dog in the actual city proper. This is the trend I see in my city and has been my experience…lots of young doc couples doing the same thing around me.

Also consider that a mortgage payment on a $750k house is about $5k a month. More if you don’t put 20% down. And even at $250k salary, that’s a lot of money if you don’t have student loan payments (and a LOT if you do). Plus I know a lot of Dr Joneses types who look like they’re killing it - nice house, cars, etc…but are actually paycheck to paycheck and one emergency away from real financial problems.

 

[Splenda88]

Respectfully, I think your post just strengthens my point. You’re highlighting 2500sqft homes in the far suburbs of decent, large, but not VHCOL cities. This puts young doctors in the urban sprawl class. This used to be the type of home that a young say firefighter and teacher type of couple bought. You move to the outskirts of a city where there’s new builds, young families, chain restaurants, etc because you can’t afford to raise kids and have a yard for your dog in the actual city proper. This is the trend I see in my city and has been my experience…lots of young doc couples doing the same thing around me.

The post I responded to did not say anything about VHCOL; it only mentioned suburbs of tier 1 cities. If you equate VHCOL to tier 1, that is a different story. I consider Atlanta as a tier 1 city but is not as expensive as LA/NYC etc...

You are moving the goalpost here. The main idea of your post was only the 1% can afford home in suburbs in tier 1 cities. I gave a couple of cities (Miami, Houston) in which one can afford a regular house if income is 250k.

It's unfortunate firefighters/teachers can no longer afford to live in these cities,. The argument was about what doctors making 250k/yr can afford in what you call tier 1 city

 

[Splenda88]

While I agree that the “conventional wisdom” is 3x income = mortgage amount (and thus a

Also consider that a mortgage payment on a $750k house is about $5k a month. More if you don’t put 20% down. And even at $250k salary, that’s a lot of money if you don’t have student loan payments (and a LOT if you do). Plus I know a lot of Dr Joneses types who look like they’re killing it - nice house, cars, etc…but are actually paycheck to paycheck and one emergency away from real financial problems.

You should not buy a house IMO if you can't put at least 10% down payment.

 

[bronx43]

The post I responded to did not say anything about VHCOL; it only mentioned suburbs of tier 1 cities. If you equate VHCOL to tier 1, that is a different story. I consider Atlanta as a tier 1 city but is not as expensive as LA/NYC etc...

You are moving the goalpost here. The main idea of your post was only the 1% can afford home in suburbs in tier 1 cities. I gave a couple of cities (Miami, Houston) in which one can afford a regular house if income is 250k.

It's unfortunate firefighters/teachers can no longer afford to live in these cities,. The argument was about what doctors making 250k/yr can afford in what you call tier 1 city

Not really moving the goalpost since the goalpost was never firmly established. There’s really no universally agreed upon definition of tier 1, but since the earlier conversations hovered around cities like Seattle, LA, and NYC, that’s where the goalpost was unofficially placed. If anyone is moving the goalpost it’s you.

If you want to broaden “tier 1” to include Houston, Miami, Philly etc then I would also agree that top 1% isn’t completely necessary if a doctor is ok with moving to the outskirts with questionable school districts.

 

[sloh]

Not really moving the goalpost since the goalpost was never firmly established. There’s really no universally agreed upon definition of tier 1, but since the earlier conversations hovered around cities like Seattle, LA, and NYC, that’s where the goalpost was unofficially placed. If anyone is moving the goalpost it’s you.

If you want to broaden “tier 1” to include Houston, Miami, Philly etc then I would also agree that top 1% isn’t completely necessary if a doctor is ok with moving to the outskirts with questionable school districts.

Oh lord. Philly schools haha. I would fear for my children’s lives.

 

[Splenda88]

Not really moving the goalpost since the goalpost was never firmly established. There’s really no universally agreed upon definition of tier 1, but since the earlier conversations hovered around cities like Seattle, LA, and NYC, that’s where the goalpost was unofficially placed. If anyone is moving the goalpost it’s you.

If you want to broaden “tier 1” to include Houston, Miami, Philly etc then I would also agree that top 1% isn’t completely necessary if a doctor is ok with moving to the outskirts with questionable school districts.

If Miami/Atlanta/Dallas/Houston are not considered tier 1 cities, where most young high earning professionals would not mind living), I frankly am not sure what is a tier 1 city.

 

[bronx43]

If Miami/Atlanta/Dallas/Houston are not considered tier 1 cities, where most young high earning professionals would not mind living), I frankly am not sure what is a tier 1 city.

it’s entirely arbitrary but I would think most people think of NYC, LA, SF to be tier 1.

These other cities are certainly desirable but if you ask a young high earning professional to rank cities he/she wants to live, NYC/LA/SF are easily going to be #1,2,3 in some order.
Those cities are where the financial, cultural, tech hubs are.

 

[TexasMed22]

it’s entirely arbitrary but I would think most people think of NYC, LA, SF to be tier 1.

These other cities are certainly desirable but if you ask a young high earning professional to rank cities he/she wants to live, NYC/LA/SF are easily going to be #1,2,3 in some order.
Those cities are where the financial, cultural, tech hubs are.

As a young person, I'd say NYC, LA, Chicago, and Miami are where most of my peers would list. FWIW

 

[bronx43]

As a young person, I'd say NYC, LA, Chicago, and Miami are where most of my peers would list. FWIW

I’m prob a bit older than you but my peers are skewed towards SF due to tech. Not sure what major high paying industry is in Miami. Chicago has a lot of younger yuppies (my consultant buddies lived there fresh outta undergrad) but the big finance money isn’t there. Bulge bracket banks and buy side finance are mostly NYC. The big 3 consulting firms are east coast as well.

 

[Splenda88]

it’s entirely arbitrary but I would think most people think of NYC, LA, SF to be tier 1.

These other cities are certainly desirable but if you ask a young high earning professional to rank cities he/she wants to live, NYC/LA/SF are easily going to be #1,2,3 in some order.
Those cities are where the financial, cultural, tech hubs are.

There are 15+ tier rank cities in the nation; though, some rank higher than others.

 

[bronx43]

There are 15+ tier rank cities in the nation; though, some rank higher than others.

Sure, but there’s some argument to be made for a tier list to be more granular than just tier 1 being all top 20 biggest cities. I think there’s clear difference between NY/SF/LA and Baltimore or Detroit metropolitan area.

 

[hotsaws]

I'm not gonna get into tiering because I think most of us are in agreement here. I think the cities you've mentioned are fine, let's tier 1.25 them.

What I'm pointing out is that a doctor making 250k a year probably can't afford to live in the "nice" parts of those tier 1.25 cities. I'm talking about the well established neighborhoods with character, probably close proximity to good restaurants and activities, maybe better schools (although burbs can have good schools because they are filled with young families). The docs are now sprawling out to the far reaches of cities because of cost. Cities like san diego, LA, etc aren't even in the cards for most docs if you want a 200sqft+ home, yard, garage, and also saving appropriately.

 

[dozitgetchahi]

it’s entirely arbitrary but I would think most people think of NYC, LA, SF to be tier 1.

These other cities are certainly desirable but if you ask a young high earning professional to rank cities he/she wants to live, NYC/LA/SF are easily going to be #1,2,3 in some order.
Those cities are where the financial, cultural, tech hubs are.

I would include at least Chicago in that category, as well as possibly Houston, Boston, Seattle and DC. San Diego, too.

The prices in the above cities certainly support the “tier 1” bit.

In reality, arranging cities by tiers strikes me as a bit ridiculous, though. For me, the only categories that really matter are urban, semi rural, rural. Maybe divide the “urban” category into “disgustingly overpriced”, “really overpriced”, and “overpriced”. City living in America in 2024 is almost universally an exercise in paying through the nose for things that are available in the rest of America for much cheaper.

Also, I think you have a very “urban centric” view of the world. Even when I lived in a city/suburbs and was choosing where to do training, I deliberately avoided those “tier 1” cities because I knew living there was going to be absurdly hard as a med student/resident etc. Afterwards, I briefly lived in a midsized midwestern city and then bailed out for flyover country. You literally could not pay me enough to go back and deal with urban living BS anymore (in the same way that you couldn’t pay me enough to deal with academic medicine BS, either).