Why Make 150k When 450k Is Out There?

[George85]

Don't often drop into these forums. Was amused to see this post as I have brought this issue up before. I see that the usual empty arguments from primary care docs and wannabes are still there.

Just finished FM residency. Doing hospitalist at 200k while I sort out my licensing out for the UK. The work is exhausting and the hours are long. Friend of mine took a gas job in Atlanta, 300k, 8 weeks off, 50k sign on. A guy who was as IM intern when I was a FM intern is now starting as a PGY2/CA1 and he openly admits it's for the money.

While I was moonlighting in urgent care at $70/hr a rads PGY3 friend was making the same for just sitting around a surg center to "monitor" sedation - he got $140/hr to do readings - as a resident.

Jet is spot on. As I've pointed out before, primary care in the US is dying, it is being replaced by midlevels, while med school grads are becoming technicians instead of doctors. Nothing is going to change. Simply looking at the ACGME numbers shows that 6 specialists are produced for every primary doc - and FM programs are the ones that tend to close.

One big answer to Jets OP has not been touched on - many people go into primary care because their numbers are not competitive enough to do otherwise. My friend that just went from IMed PGY3 to CA1 was only able to do so because his board scores were excellent. Of course, this doesn't apply to everyone, but the same hold true for MD vs DO admissions. And, of course, this point will upset numerous readers, but it's simply fact - how many gas / rads / derm residents had to retake step1 or had a score below 200?

The bottom line - if you choose FM it's either because you're grateful to be a doctor at all, because you're misguided, or because you're selfless.

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[iatrosB]

Don't often drop into these forums.

That's not such a bad thing


As for the rest:

 

[andwhat]

Don't often drop into these forums. Was amused to see this post as I have brought this issue up before. I see that the usual empty arguments from primary care docs and wannabes are still there.

Just finished FM residency. Doing hospitalist at 200k while I sort out my licensing out for the UK. The work is exhausting and the hours are long. Friend of mine took a gas job in Atlanta, 300k, 8 weeks off, 50k sign on. A guy who was as IM intern when I was a FM intern is now starting as a PGY2/CA1 and he openly admits it's for the money.

While I was moonlighting in urgent care at $70/hr a rads PGY3 friend was making the same for just sitting around a surg center to "monitor" sedation - he got $140/hr to do readings - as a resident.

Jet is spot on. As I've pointed out before, primary care in the US is dying, it is being replaced by midlevels, while med school grads are becoming technicians instead of doctors. Nothing is going to change. Simply looking at the ACGME numbers shows that 6 specialists are produced for every primary doc - and FM programs are the ones that tend to close.

One big answer to Jets OP has not been touched on - many people go into primary care because their numbers are not competitive enough to do otherwise. My friend that just went from IMed PGY3 to CA1 was only able to do so because his board scores were excellent. Of course, this doesn't apply to everyone, but the same hold true for MD vs DO admissions. And, of course, this point will upset numerous readers, but it's simply fact - how many gas / rads / derm residents had to retake step1 or had a score below 200?

The bottom line - if you choose FM it's either because you're grateful to be a doctor at all, because you're misguided, or because you're selfless.

That's not such a bad thing


As for the rest:


It is about lifestyle. Do you really want zero patient contact for the rest of your life in other specialties that you depicted?


These days FM is doing much better -- but of course NOT NEARLY WHERE IT DESERVES TO BE, due partly to the fact that FM docs can use Hospitalists, and vice versa.
Salaries have improved, and are improving yearly.
Urgent Care is awful at some places -- but not all esp desirable locations, including San Antonio, Houston area -- my friend in Urgent Care makes a bit over 250 K no call no hospital.
There are several docs making over 200 K in Urgent Care also -- you have to have a year or two of seniority, and pick your spots correctly. Chicago area you can make about $135 per hour in Urgent Care.
Yes I will agree with you, in that there are places that will offer you even much lower than what you mentioned as low as 50 dollars per hour.
Opthalmology starts out at $180 K, does that mean that Opthalmologists are horrible? no. In our town, Opthalmologists do not make significantly more than that.
70 dollars an hour Urgent Care moonlighting -- yes there are indeed places that try this gimmick, and they are also severely short staffed -- and it has to do with the local politics.

Primary Care is NOT dying. As a matter of fact quite the opposite.
It is the people that NEED TO BE PAYING Primary Care docs more -- that are actually rescinding great doctors away from Primary Care.
Why do FM docs out of residency get up to and exceeding 5 job offers per day? If Primary Care was 'dying' then wouldn't it be difficult to get a well paying job -- exceeding 200K -- as an FM doc? It happens, but NOT NEARLY as often as it needs to.

Therefore is FM where it needs to be? OF COURSE not. Compensation needs to improve. 200K is my starting salary, not that bad.
Your argument is wholeheartedly legit,
WHY ISN'T PRIMARY CARE WHERE IT DESERVES TO BE ON THE MAP????
Because legislature is working extremely hard, and tirelessly, on taking money away from ALL docs, and not giving more to them.
MONEY is absolutely NOT following the supply and demand.
There is a shortage of every physician specialty, and there needs to be more residency programs. However all that I hear is more residency programs closing down. Its depressing.

 

[George85]

AndWhat - if you really did read my previous posts you would realise that I'm not "bashing" FM - I'm highlighting the problems. If you refuse to recognise the problems then you can't fix them. Neither am I about the money - but the current generation of residents and med students are - they also want "work life balance" - ie. short hours and lots of vacation to go with the high salaries. I actually believe in FM, and am happy with my choice - but if you bury your head in the sand then nothing will get fixed.

During interview season I saw many applicants with outstanding scores - but such applicants to FM are in the minority. And the overall applicant pool to FM is getting weaker - again, this is a modern issue, the older generation of FM docs were just as smart as anyone else - and as the modern applicant pool gets weaker then primary care drifts down to meet the midlevels.

Just look at the ACGME numbers. FM is 2636 out of 22,240. IMed is 4858 but how many actually go into primary care? And FM has an unfilled rate of 10%, only beaten by prelim surg at 30%.

Of course you can get multiple job offers - there's a shortage of primary care docs - but whatever happened to supply and demand pushing up salaries? It has done so hugely for anesthesia, but not very much for primary care - why is that?

So, as those jobs go unfilled what's going to happen? Midlevels will be used more and more, and the face of primary care in the US will change irreversably and to the detrement of American health care. This downward spiral has many factors and some will be difficult to change, such as Americans unreasonable expectations from the health care system. But greed, in the form of the insurance companies, is a very big factor.

The way forward is a national healthcare system with access for all, with no insurance, control of litigation, and a strong primary care system.

 

[NewmansOwn]

AndWhat - if you really did read my previous posts you would realise that I'm not "bashing" FM - I'm highlighting the problems. If you refuse to recognise the problems then you can't fix them. Neither am I about the money - but the current generation of residents and med students are - they also want "work life balance" - ie. short hours and lots of vacation to go with the high salaries. I actually believe in FM, and am happy with my choice - but if you bury your head in the sand then nothing will get fixed.

During interview season I saw many applicants with outstanding scores - but such applicants to FM are in the minority. And the overall applicant pool to FM is getting weaker - again, this is a modern issue, the older generation of FM docs were just as smart as anyone else - and as the modern applicant pool gets weaker then primary care drifts down to meet the midlevels.

Just look at the ACGME numbers. FM is 2636 out of 22,240. IMed is 4858 but how many actually go into primary care? And FM has an unfilled rate of 10%, only beaten by prelim surg at 30%.

Of course you can get multiple job offers - there's a shortage of primary care docs - but whatever happened to supply and demand pushing up salaries? It has done so hugely for anesthesia, but not very much for primary care - why is that?

So, as those jobs go unfilled what's going to happen? Midlevels will be used more and more, and the face of primary care in the US will change irreversably and to the detrement of American health care. This downward spiral has many factors and some will be difficult to change, such as Americans unreasonable expectations from the health care system. But greed, in the form of the insurance companies, is a very big factor.

The way forward is a national healthcare system with access for all, with no insurance, control of litigation, and a strong primary care system.

Nice post.

I think you've touched on the scariest part of all this -- once we shift to a midlevel-dependent brand of primary care delivery, it's going to be that much harder to create a preventative care based model which will save billions in healthcare costs and stop America from being a first world country with second world health statistics. The answer is not simply to have more professionals who can hand out erythromycin like candy -- it's to remove the sense of entitlement Americans feel they have for specialized care when they've already all but destroyed their bodies.

Authority really needs to rest comfortably in the hands of those most qualified to manage complex risk factors, handle multiple co-morbidities and refer promptly, judiciously and only when truly necessary. Family physicians can do this -- mid-levels essentially serving as PC triage nurses cannot. The latter are merely band-aids on the compound fracture that is modern healthcare.

If things really made sense, all the brightest doctors would be seeing you regularly and helping you live a healthier lifestyle -- those with lower scores would be relegated to doing skin biopsies as dermatologists. It's up to us to demand that and it's up to the government to follow through. I don't think you can blame America's best and brightest young doctors for following the money and cushy lifestyle -- they've earned it. We need to make sure the carrot on a stick they seek leads towards primary care.

 

[andwhat]

AndWhat - if you really did read my previous posts you would realise that I'm not "bashing" FM - I'm highlighting the problems. If you refuse to recognise the problems then you can't fix them. Neither am I about the money - but the current generation of residents and med students are - they also want "work life balance" - ie. short hours and lots of vacation to go with the high salaries. I actually believe in FM, and am happy with my choice - but if you bury your head in the sand then nothing will get fixed.

During interview season I saw many applicants with outstanding scores - but such applicants to FM are in the minority. And the overall applicant pool to FM is getting weaker - again, this is a modern issue, the older generation of FM docs were just as smart as anyone else - and as the modern applicant pool gets weaker then primary care drifts down to meet the midlevels.

Just look at the ACGME numbers. FM is 2636 out of 22,240. IMed is 4858 but how many actually go into primary care? And FM has an unfilled rate of 10%, only beaten by prelim surg at 30%.

Of course you can get multiple job offers - there's a shortage of primary care docs - but whatever happened to supply and demand pushing up salaries? It has done so hugely for anesthesia, but not very much for primary care - why is that?

So, as those jobs go unfilled what's going to happen? Midlevels will be used more and more, and the face of primary care in the US will change irreversably and to the detrement of American health care. This downward spiral has many factors and some will be difficult to change, such as Americans unreasonable expectations from the health care system. But greed, in the form of the insurance companies, is a very big factor.

The way forward is a national healthcare system with access for all, with no insurance, control of litigation, and a strong primary care system.

so question remains, what can people do? And the answer is nothing.
I would love to be able to recognize and fix problems in FM, but you have to realize that its Medicine as a whole that will suffer with all of the craziness going on.
I think that the older generation of FM was a bit smarter -- but in essence they do not care about doing anything -- because seems like they are almost into retirement. Newer generation has to know substantially more in my opinion -- in addition to the mess that is going on.
Supply and demand pushing up salaries -- and not at all happening, so unbelievably true. So so undeniably and completely true.
That is unbelievably frustrating. Politics.
The only way to get action seems like, is a massive walk out from Primary Care. I do believe that its closer to happening.
People are abandoning Primary Care to specialties for money. You are correct about that -- but again its a rarity.
Insurance companies and Lawyers run Medicine nowadays. This is reality.

 

[andwhat]

Authority really needs to rest comfortably in the hands of those most qualified to manage complex risk factors, handle multiple co-morbidities and refer promptly, judiciously and only when truly necessary. Family physicians can do this -- mid-levels essentially serving as PC triage nurses cannot. The latter are merely band-aids on the compound fracture that is modern healthcare.

I don't think you can blame America's best and brightest young doctors for following the money and cushy lifestyle -- they've earned it. We need to make sure the carrot on a stick they seek leads towards primary care.[/QUOTE]

Money should DEFINITELY always be an issue. Comfortable lifestyle, student loans, you absolutely have to live comfortably.
These very good points you mentioned are not going to get changed anytime soon though -- that is what sucks.
Not at all man, I think that it is UNBELIEVABLY frustrating at times -- I have been offered as pathetic as 50 dollars per hour. After medical school and all of my hard work???? That is insanity.
Thank goodness that I landed a good job with a very good salary.
It wasn't as easy as I thought it would be.
Yes there is a desperate physician shortage in several places. No people are not willing to pay more money to physicians to make up for it.
Everyone including any specialty -- except for probably Ortho -- can get offered bad salaries, you just have to avoid terrible places like this.
Otherwise I am pissed more than anybody about the state of Health Care, notably Primary Care.

 

[NewmansOwn]

[QUOTE/]Money should DEFINITELY always be an issue. Comfortable lifestyle, student loans, you absolutely have to live comfortably.
These very good points you mentioned are not going to get changed anytime soon though -- that is what sucks.
Not at all man, I think that it is UNBELIEVABLY frustrating at times -- I have been offered as pathetic as 50 dollars per hour. After medical school and all of my hard work???? That is insanity.
Thank goodness that I landed a good job with a very good salary.
It wasn't as easy as I thought it would be.
Yes there is a desperate physician shortage in several places. No people are not willing to pay more money to physicians to make up for it.
Everyone including any specialty -- except for probably Ortho -- can get offered bad salaries, you just have to avoid terrible places like this.
Otherwise I am pissed more than anybody about the state of Health Care, notably Primary Care.[/QUOTE]



That's unbelievable. $50/hour when we're in a severe primary care shortage is beyond insulting and will only serve to make bright students even more skeptical of primary care. I hope that's merely a horrific anomaly and not the norm, and I'm glad you were able to find a job that pays you what you deserve.

 

[Dr McSteamy]

midlevels will move in if there is a need.

otherwise, FP MD group practices are doing quite well.

 

[andwhat]

[QUOTE/]Money should DEFINITELY always be an issue. Comfortable lifestyle, student loans, you absolutely have to live comfortably.
These very good points you mentioned are not going to get changed anytime soon though -- that is what sucks.
Not at all man, I think that it is UNBELIEVABLY frustrating at times -- I have been offered as pathetic as 50 dollars per hour. After medical school and all of my hard work???? That is insanity.
Thank goodness that I landed a good job with a very good salary.
It wasn't as easy as I thought it would be.
Yes there is a desperate physician shortage in several places. No people are not willing to pay more money to physicians to make up for it.
Everyone including any specialty -- except for probably Ortho -- can get offered bad salaries, you just have to avoid terrible places like this.
Otherwise I am pissed more than anybody about the state of Health Care, notably Primary Care.

That's unbelievable. $50/hour when we're in a severe primary care shortage is beyond insulting and will only serve to make bright students even more skeptical of primary care. I hope that's merely a horrific anomaly and not the norm, and I'm glad you were able to find a job that pays you what you deserve.[/QUOTE]

Thanks man... horrific yeah, I had bad dreams for days..... but then again you know what? Its about local politics, not so much supply and demand sometimes.
I got a very well paying job, that was not as easy as I thought that it would be.
Be careful of shady recruiters also.
It is possible to make very good money in FM, but you have to have a game plan, and be wise and careful each and every step of the way.
50 bucks an hour as a physician, that is the greatest insult to mankind.
It is NOT like the facilities are adequately staffed at all and whatsoever.
Its just crappy as hell pay and they think that somebody is really stupid.
Again it is local politics, and not so much the state of health care fortunately.
Horrific anomaly it certainly was. The man was serious, and my face dropped and I almost laughed because I thought that it was funny. He was serious though.

 

[Dr.Millisevert]

Nice post.

I think you've touched on the scariest part of all this -- once we shift to a midlevel-dependent brand of primary care delivery, it's going to be that much harder to create a preventative care based model which will save billions in healthcare costs and stop America from being a first world country with second world health statistics. The answer is not simply to have more professionals who can hand out erythromycin like candy -- it's to remove the sense of entitlement Americans feel they have for specialized care when they've already all but destroyed their bodies.

Authority really needs to rest comfortably in the hands of those most qualified to manage complex risk factors, handle multiple co-morbidities and refer promptly, judiciously and only when truly necessary. Family physicians can do this -- mid-levels essentially serving as PC triage nurses cannot. The latter are merely band-aids on the compound fracture that is modern healthcare.

If things really made sense, all the brightest doctors would be seeing you regularly and helping you live a healthier lifestyle -- those with lower scores would be relegated to doing skin biopsies as dermatologists. It's up to us to demand that and it's up to the government to follow through. I don't think you can blame America's best and brightest young doctors for following the money and cushy lifestyle -- they've earned it. We need to make sure the carrot on a stick they seek leads towards primary care.

Excellent post. Couldnt agree more

 

[Dr McSteamy]

hopefully one day some stupid legislators will realize how valuable primary care is, then increase the reimbursement.
then everyone will want to go into FM etc.
we'll all be rich
$ka-ching$

 

[Doctor Grim]

When I was looking for a "real" job a few months ago at a place where they needed a geriatrician (100% geriatric clinic) because their medical director was leaving, I had a chance to meet the exiting medical director myself and asked him why he was leaving. He told me that he was leaving because he opened a concierge medical office.

He was doing such a good job with his elderly patients that most of them wanted their children to be his patients. And it was in an affluent area of the town where the median income was $140,000.

Well, he decided he would charge a retainer fee for those who wants to see him as a doctor and his fee was $300/mo with 24h access to him either by email, text message, or cell, and if necessary, he will see the patient in his office. The fee would include an anual physical with all necessary blood work, EKGs, CXR (in his office). He only sees patients with the age between 40-65 (people who are actually financially secure, white collar population). He ended up having 200 patients so that was $60K/mo. cash. Patients would need to have insurance to cover their meds or inpatient care..etc but he wouldn't charge them for clinic visits.

I just thought this was interesting.

 

[medicienne]

I just don't understand. Why do physicians fight among themselves to prove which specialty is the best/ who is the smartest, etc? Its immature and ridiculous. The world needs more doctors, it doesn't matter which specialty you are practicing. The truth is that we all have to co-exist together.

No wonder the insurance companies and managed care are laughing their way to the banks. Because Docs have no sense of unity and would rather massage their individual egos. Exactly the opposite of the principles of business guys who *make* people feel good about themselves, then laugh their way to the bank! Too bad the USMLEs don't measure EQ.

 

[secretwave101]

He ended up having 200 patients so that was $60K/mo. cash. Patients would need to have insurance to cover their meds or inpatient care..etc but he wouldn't charge them for clinic visits.

Good work if you can get it.

 

[PotentialDoctor]

I've followed this thread for a while (although I haven't been able to get past about 8 pages of it), but I thought I'd weigh in on this. I should probably say a bit about my background, as that was one of the major qualifying questions of the OP. I'm technically still a pre-med student, as I came into interest in the medical profession at the very end of my undergraduate career, and thus have to repeat a large portion of it in a more science-driven curriculum. Prior to developing an interest in medicine, I was considering either law or a PhD program in the humanities, with the possibility of just copping out and going business. My grades and standardized test scores were more than good enough to land me in any program of my choice nationwide (Ivy League and similarly ranked programs notwithstanding), with a good chance of receiving full tuition plus fairly generous stipends in several decently ranked programs.


With that in mind, my interest in medicine has absolutely nothing to do with money. I could very easily have went into a career with higher pay, better working conditions, or potentially both, and certainly while incurring no debt as a graduate/professional student. I entered medicine because I had a few wonderful shadowing opportunities that I landed in almost purely by chance following my Junior year of college, and I realized that the profession granted me the hands-on chance for positively affecting peoples' lives that I never could have obtained in the other careers I considered. In those careers, my best shot would be in influencing public policy in some vague and likely trivial fashion, and the fact that my life in such a career might not actually improve the condition of humanity (or even a small subset thereof) in a significant fashion kept me awake more than a handful of nights. Having not actually entered medical school, it is obviously too early to speculate at length regarding what my specialty might be, but my top possibilities include FM, IM, and ID, none of which are at the top of the salary food chain. I'm not trying to paint myself as some sort of monk, and I hope I have not come across that way.


The point is simply this: I came from a choice of numerous careers, all of which were, in every measurable objective sense, more desirable than medicine. Furthermore, I've forfeited my years of training toward those other career paths with virtually no benefit to myself. I made this sacrifice, and plan on making the sacrifice of entering a less lucrative specialty financially, because I simply feel that this is the career path that best suits my interests and my sense of what is truly important in life. It seems to me that a large percentage of the respondents here have answered more or less the same way, albeit in a less verbose manner.


The OP seems to earnestly believe that this is an important discussion to be had, and giving him the benefit of the doubt, I have to assume that he does so on the premise that at least some of the people who enter these less lucrative positions do so partially out of ignorance for the brute economics of the situation. I desperately hope this is not so, both because it bodes poorly for the happiness of the doctor involved and it reflects negatively upon some aspect of the pedagogy of medical school. Medical school is supposedly an incredibly advanced training program, and the idea that it fails to teach the basic analytical reasoning necessary to apply 7th grade math to one's personal situation is (to understate) troubling. I operate on the competing assumption that this shouldn't be a necessary part--formally or informally--of the med school curriculum because anyone who lasts long enough to get an MD behind his or her name ought to have developed those reasoning skills and know how to apply them to his or her own benefit. I think a lot of the people here agree with me, and that's why they believe the OP to be grandstanding or flame-baiting; they, like myself, just cannot fathom that this is the sort of thing that needs to be spoon-fed to intelligent, driven people.

In regard to the near flame-war sparked here, I recently had a minor medical procedure done, and I certainly remembered to personally thank both the specialist and the anesthesiologist both before and after the procedure. I appreciate what all of you guys are doing--regardless of specialty--and hope I have the perseverance to tough it out and join your ranks. And sorry about the generally sloppy and wordy prose.

 

[GassiusClay]

The OP does make a valid point in a financial sense, which becomes more important as training continues on. Everybody wants to do FP at first. I personally think it would be ideal to see each patient for 30 min and talk to them and get a good idea about things surrounding their health rather than herd them thru the office.

Now why herd? Well, doctors have to apparently pay MINIMUM wages to their secretaries, nurses, whatever. Everybody else is protected while the doctor has to work harder to cut a decent profit for the many years of education. The bottom line does matter once you have family to support because hell, you want the best for your family, not a middle class cut.

The last poster should realize that the ideal part of medicine is being pulverized by HMO, MEDICARE aka politicians, lawyers, etc. They don't care about you while they make patients fight against you and make you out to be the enemy. A good reason why radiology has become popular. It's sort of insulated from all this. No angry patients calling you...

Anyway, FP deserves respect. It's nice to know that some docs out there can handle the BS thrown at them constantly or maybe are fortunate to have a good patients. But this personal part of medicine seems to be dying. However, I still think about doing primary care again many times.

 

[PotentialDoctor]

The last poster should realize that the ideal part of medicine is being pulverized by HMO, MEDICARE aka politicians, lawyers, etc. They don't care about you while they make patients fight against you and make you out to be the enemy. A good reason why radiology has become popular. It's sort of insulated from all this. No angry patients calling you...

What are the alternatives to medicine for the top-tier students at American universities? With law or business, you're more likely to be a part of the problem than the solution. At least with medicine, you get to know once you've gone home at the end of the day that you've done as much good as you possibly could, even if you know you could have done a lot more if there were not so many ungodly roadblocks in your way. A doctor, especially a PCP, even with both hands tied behind his back by HMOs and litigation, can still do more good than a dozen lawyers or mid-level businesspeople. That's the reason I suspect so many people go into medicine and FP, even if it is in no way as lucrative as it once was or should now be. Maybe I'm completely wrong. Maybe a large percentage of us jumping in the field right now are ignorantly doing it for money, or maybe we're just too shortsighted to realize that we ought to be prioritizing money higher than we actually are. I just hope I'm not.

 

[jetproppilot]

wow.

 

[MOHS_01]

What are the alternatives to medicine for the top-tier students at American universities? With law or business, you're more likely to be a part of the problem than the solution. At least with medicine, you get to know once you've gone home at the end of the day that you've done as much good as you possibly could, even if you know you could have done a lot more if there were not so many ungodly roadblocks in your way. A doctor, especially a PCP, even with both hands tied behind his back by HMOs and litigation, can still do more good than a dozen lawyers or mid-level businesspeople. That's the reason I suspect so many people go into medicine and FP, even if it is in no way as lucrative as it once was or should now be. Maybe I'm completely wrong. Maybe a large percentage of us jumping in the field right now are ignorantly doing it for money, or maybe we're just too shortsighted to realize that we ought to be prioritizing money higher than we actually are. I just hope I'm not.

I'll weigh in and say emphatically that you are wrong. The problem of being shortsighted is not unique to "the people now" -- this has been a problem for a long, long time. $$ does not have an appropriate meaning until one is responsible for paying off exorbitant debts (with after tax dollars, I might add), has a family to support, and realizes that "the job" is not what it was cracked up to be.

I will also argue (correctly) that, if a person truly wants to make a significant difference, he or she would go into business or law and help develop and new, better, and more efficient system rather than being an underpaid indentured servant to the current one.

If you stick with your medical career plans you will learn a lot, much of it will be disappointing.

 

[lowbudget]

I'll weigh in and say emphatically that you are wrong. The problem of being shortsighted is not unique to "the people now" -- this has been a problem for a long, long time. $$ does not have an appropriate meaning until one is responsible for paying off exorbitant debts (with after tax dollars, I might add), has a family to support, and realizes that "the job" is not what it was cracked up to be.

I will also argue (correctly) that, if a person truly wants to make a significant difference, he or she would go into business or law and help develop and new, better, and more efficient system rather than being an underpaid indentured servant to the current one.

If you stick with your medical career plans you will learn a lot, much of it will be disappointing.

Well... there goes my buzz. Who's taking me home?

 

[deleted87716]

I will also argue (correctly) that, if a person truly wants to make a significant difference, he or she would go into business or law and help develop and new, better, and more efficient system rather than being an underpaid indentured servant to the current one

Oh, puh-LEEZE.

As if 99.999% of the business and law drones in the world weren't mindless cogs in the wheels of commerce.

Get over this "grass is greener on the other side" crap. It isn't.

 

[NewmansOwn]

Oh, puh-LEEZE.

As if 99.999% of the business and law drones in the world weren't mindless cogs in the wheels of commerce.

Get over this "grass is greener on the other side" crap. It isn't.

This is absolutely true.

Another ubiquitous falsity: "Business is a much easier way to make loads of money." There is a thick glass ceiling in business and to break through it and make tons of money, you (almost) always have to kiss more ass and work more 100+ hour weeks than any self-respecting physician would ever endeavor to. That's not even considering the HIGHLY LIKELY probability that you will be asked (if not downright required) to engage in morally corrupt, if not outright illegal, activities.

MOHS, I agree that changing the system is the way to really make a difference. But at such a high level of change, the degree no longer matters -- it's just going to take a really special, driven individual and they could have anything from MD to JD to RN after their name; degrees don't limit people that motivated.

 

[circulus vitios]

Another ubiquitous falsity: "Business is a much easier way to make loads of money." There is a thick glass ceiling in business and to break through it and make tons of money, you (almost) always have to kiss more ass and work more 100+ hour weeks than any self-respecting physician would ever endeavor to. That's not even considering the HIGHLY LIKELY probability that you will be asked (if not downright required) to engage in morally corrupt, if not outright illegal, activities.

I'd like to expand on this...

To those of you saying that there are 'much better ways to make money than medicine'...what are they? The average lawyer salary is somewhere in the $65k range (with $100k in law school debt). Those $160k/year figures that are thrown around here are very, very difficult to achieve (top of your class in a top-14 school). 'Become a hedge fund manager/i-banker'? Investment bankers might pull in $150k/year with a bachelors degree but they work 100 hours a week...and their job security is terrible! Miss a monthly quota a few times (or even once), and you're done for.

Medical school might be expensive and working eighty hours a week during residency for chump change sucks, but it does pay off. Even terrible students in med school can get into family medicine and 'only' bring in $125k/year. Even nurses make out well. The average RN salary is $50-60k/year with just a bachelors. I'd like to see someone find a job that comes close to the earning potential and job security of medicine.

 

[Futuredoctr]

You know... I'm a MS2 and I have absolutly no idea what field I would like to go into, but I can tell you this, when I make my decision in a few years I will consider family pracitice but only with a skewed angle.

I mean, it occurs to me by the shear volume from the OP that the money from FP is a VERY touchy subject. This is a red flag in my mind, because it shows that we (med students, residents, and doctors) are scared about the reimbursement levels, and frankly the future of the practice. No one wants to buy stock from a company on the brink of bankruptcy, and no one wants to make a career in something that is or will be shrinking in reimbursements or autonomy.

Now I've heard, and read, the arguments about the incredible need for FP, and I do not for one minute argue with this. However, as a MS2, how can I or any medical student be exicted about the possiblity* (not fact, just possiblity) that the 8 years of schooling that I just endured might end up being a disappointment.

I don't know, maybe things will change by the time I get there, but reading these posts, kind of makes me discouraged.

 

[texasfamilymd]

That's not such a bad thing


As for the rest:


It is about lifestyle. Do you really want zero patient contact for the rest of your life in other specialties that you depicted?


These days FM is doing much better -- but of course NOT NEARLY WHERE IT DESERVES TO BE, due partly to the fact that FM docs can use Hospitalists, and vice versa.
Salaries have improved, and are improving yearly.
Urgent Care is awful at some places -- but not all esp desirable locations, including San Antonio, Houston area -- my friend in Urgent Care makes a bit over 250 K no call no hospital.
There are several docs making over 200 K in Urgent Care also -- you have to have a year or two of seniority, and pick your spots correctly. Chicago area you can make about $135 per hour in Urgent Care.
Yes I will agree with you, in that there are places that will offer you even much lower than what you mentioned as low as 50 dollars per hour.
Opthalmology starts out at $180 K, does that mean that Opthalmologists are horrible? no. In our town, Opthalmologists do not make significantly more than that.
70 dollars an hour Urgent Care moonlighting -- yes there are indeed places that try this gimmick, and they are also severely short staffed -- and it has to do with the local politics.

Primary Care is NOT dying. As a matter of fact quite the opposite.
It is the people that NEED TO BE PAYING Primary Care docs more -- that are actually rescinding great doctors away from Primary Care.
Why do FM docs out of residency get up to and exceeding 5 job offers per day? If Primary Care was 'dying' then wouldn't it be difficult to get a well paying job -- exceeding 200K -- as an FM doc? It happens, but NOT NEARLY as often as it needs to.

Therefore is FM where it needs to be? OF COURSE not. Compensation needs to improve. 200K is my starting salary, not that bad.
Your argument is wholeheartedly legit,
WHY ISN'T PRIMARY CARE WHERE IT DESERVES TO BE ON THE MAP????
Because legislature is working extremely hard, and tirelessly, on taking money away from ALL docs, and not giving more to them.
MONEY is absolutely NOT following the supply and demand.
There is a shortage of every physician specialty, and there needs to be more residency programs. However all that I hear is more residency programs closing down. Its depressing.

Yes, I see the American Medical News rag that says FM = $140k/yr etc.
I can't believe it, unless they're happy in a slow practice, or are in a public health type setting.

I started 7 yrs ago at $160. Took 3 years to build a practice and have grown the income level to around 300-350K by the past 2 years. No, I'm not getting the kind of vacation schedule that "Jet" is. But I did get my first jet aircraft type rating this year (Jet Provost/BAE Strikemaster).

I did not have $200k debt--only $30k, thanks to the US Air Force. I chose to do a transitional year and pay back my commitment as a flight surgeon and had the time of my life. Yes, I only made $60,000 annually those four years, but the $10,000/hour estimated value of 300 hours in the F-15E made it well worth my while.

I chose family medicine for my own family reasons (in addition to enjoying it.) I could finish my residency in two years instead of three, four or five. With two small children, that made sense to me. I knew I would have no geographic limitations and now I am quite happy with 20 acres in the country, house will be paid off in 5 or 6 years, SEP IRA account growing nicely, etc.

Money truly isn't everything.

I too am concerned about the quality of applicants to family medicine. I don't see many that I would classify as top of their classes. I see way too many programs going unfilled if it weren't for IMG's. All this means to me is that the future of true medicine in our country is in a world of hurt. But I should be sitting pretty, because there will always be a need for my services.

 

[lilnoelle]

well, n=1, but my preceptor at a nearby FM clinic (semi rural Kansas) says of the 5 partners none make less than $350K a year. The greatest earner makes ~$500K a year. And he works normal hours, no call.

Of course, they do more than just see patients. They own a lab/imaging clinic and it would appear they have been very smart with their money. They also have a pretty strong monopoly over the area. Their situation is definitely unique.

 

[deleted87716]

I should be sitting pretty, because there will always be a need for my services.

That's the point that many seem to be missing.

I don't toss personal income figures around here because I'm not anonymous on this forum, and I'm bound by a confidentiality agreement. That being said, the numbers you've quoted don't surprise me.

 

[MOHS_01]

Oh, puh-LEEZE.

As if 99.999% of the business and law drones in the world weren't mindless cogs in the wheels of commerce.

Get over this "grass is greener on the other side" crap. It isn't.

I may not have gotten across what I had intended... and that still leaves 1 in 100,000 that can make a difference

First, I will go on record and say that it is "easier" (read more likely) to make $250-500k in medicine than in business or law for that matter -- but I will stick by my assertion that, if one's goal is to truly make a meaningful change, it would be better to either go into the business world and effect change from within (example, coming up with the Wal Mart $4 prescription drug plan) or law and ultimately politics.

I have lived both sides of the business / medicine debate. They each have their distinct advantages and problems. Each has its high points, but they both require a great deal of personal sacrifice for success. Most everyone will have to work hard to get their just rewards.

 

[lowbudget]

To those of you saying that there are 'much better ways to make money than medicine'...what are they?

Oil.

Period. Exclamation mark.

 

[circulus vitios]

Oil.

Period. Exclamation mark.

There are ~300,000 physicians in the United States. There are probably only a couple thousand high paying executive jobs in oil.

 

[deleted87716]

I may not have gotten across what I had intended... and that still leaves 1 in 100,000 that can make a difference

Hence the saying, "99% of lawyers give the rest a bad name."

I will stick by my assertion that, if one's goal is to truly make a meaningful change, it would be better to either go into the business world and effect change from within (example, coming up with the Wal Mart $4 prescription drug plan) or law and ultimately politics.

If you're trying to say that lawyers run the world, I agree. Of course, their profession has become a punchline, and for good reason (read Philip K. Howard's "The Death of Common Sense").

Most of us prefer to be able to sleep at night.

 

[MOHS_01]

Yeah, lawyers rule the world, but that really was not the point that I was trying to make. I actually thought, growing up, that I would do law... until I came to the conclusion that I preferred a different peer group (trying not to be too inflammatory toward our reformed lawyer friends on the board).

I enjoy my profession, and I believe that I made either the best or second best decision for me personally; what really grates on me, however, is the incessant devaluation of our services year in and year out, with no forseeable change to that trend in the future. I do not like the trend, and I remain concerned regarding the outlook for practitioners going forward. Until physicians are able to regain control of the healthcare discussion, we are destined for problems.

 

[MOHS_01]

There are ~300,000 physicians in the United States. There are probably only a couple thousand high paying executive jobs in oil.

Try just shy of 1,000,000

 

[deleted87716]

Try just shy of 1,000,000

The Bureau of Labor & Statistics estimated the number of physicians employed in the U.S. in 2006 at 633,000 (link here). Only 40% of those are working in primary care.

 

[MOHS_01]

The Bureau of Labor & Statistics estimated the number of physicians employed in the U.S. in 2006 at 633,000 (link here). Only 40% of those are working in primary care.

I saw that... US Today quoted 800,000 physicians in the United States in 2005 as part of a "physician shortage" article... while the WHO places the number north of 1mill.

Quoted from web on the topic:

The World Health Organization states that there are 1.5 million
physicians in the US
(http://www.who.int/globalatlas/dataQuery/default.asp), yet all my
other sources show that there are @ 800,000, including the Department
of Labor and USA today
http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm.

and

According to the AMA publication ?Physician Characteristics and
Distribution in the U.S. - 2004 Edition? there are 853,187
physicians in the United States.
https://catalog.ama-assn.org/Catalog/product/product_detail.jsp?productId=prod10002


Table 1.9 gives the total number of physicians by specialty and
activity (182 Specialties).

Download Table 1.9 here:
https://catalog.ama-assn.org/MEDIA/ProductCatalog/m270018_PCD_04_table_1.9.pdf


Now I really don't know what the true number is, but it is probably lies somewhere between the figures given... in any event, it is multitudes greater than the 300k estimate above.

 

[circulus vitios]

I got the ~300k figure from here. Either way, it is much easier to make good money in medicine than any other field.

 

[Dr McSteamy]

after i get my MD, i will study part time for an MBA.

then i will see if the grass is really greener.

i'll report back here in, oh....... 10 years or so

 

[soonereng]

Oil.

Period. Exclamation mark.

I came out of the oil industry working in R&D for the USA VPs old company. Most of my immediate managers were making @ 150K and those above them were in the 200K-300K range (and those aren't really even midlevel managers). So it's definitely doable without being an exec, however, it's pretty cut-throat to get there. One must do much a** kissing, always be a yes-man, and move at the drop of a hat to some of the most God-forsaken places on this planet (which seems to be where oil and gas always is for some reason).

I didn't want to be that person, so for that reason and a myriad of others, I made a career change. In the long run medicine will be at best a break even proposition when the opportunity cost is evaluated, but I didn't switch to medicine to get rich. So it's FM or Med-Peds for me, because that's what I want to do, not because I think I can make a boatload of money.

 

[sophiejane]

Just wanted to say, for you doubters....just got back from a recruiting fair for FM. The numbers batted around were between $185K to start (guarantee only, likely more after your first year) and $370K for someone who had been in practice about 5 years. Several mentioned easily doubling your guarantee after a few years.

These are 4-4.5 day weeks with home call and no ER coverage, about 1 in 6-one in 10. This is not anywhere near 80-90 hours a week.

All's I'm sayin' is, it's out there. And I intend to cut myself a nice fat piece of that pie.

And I'm not at all bitter about my loans because everyone I spoke to was ready to deal on loan repayment as well.

This is the truth, as it stands today in the FM marketplace, not hearsay from an anesthesiologist. Enough said.

 

[Leukocyte]

Honestly, if the system was fair, FM docs SHOULD be the highest paid docs. I mean come on, seriously. Is managing ONE problem like managing/coordinating the management of EVERY problem the patient has?

Honestly, I hate FM, but I have MORE respect for an FM doc than an Anesthesiologist, Dermatologist, or any specialist for that matter. Part of the reason I find FM to be so difficult is because FM docs need to have a very wide knowledge base. I do not care what people think, but knowing 1 organ system really well is easier in my book than haveing to manage every problem the patient has.

 

[sophiejane]

Honestly, I hate FM

Mind me asking why you are doing an FM residency, then?

 

[Leukocyte]

Mind me asking why you are doing an FM residency, then?

Ahhhh, long story Sophie. Long story. I have multiple posts regarding this, and I hate to be a broken record. Anyways, I am in FM (for now), and I am stuck. Transfering to another specialty at this time is very risky. However, I will do a second residency after I graduate.

In summary, I went through a huge period of severe depression in medical school that f@cked me hard. I have NO support system, and at one time I was going to be homeless, even before graduating from medical school. How I graduated from medical school is a Miracle from God. Add to that, that I am an IMG. You do the math.

Thanks for asking though.

 

[sophiejane]

Ahhhh, long story Sophie. Long story. I have multiple posts regarding this, and I hate to be a broken record. Anyways, I am in FM (for now), and I am stuck. Transfering to another specialty at this time is very risky. However, I will do a second residency after I graduate.

In summary, I went through a huge period of severe depression in medical school that f@cked me hard. I have NO support system, and at one time I was going to be homeless, even before graduating from medical school. How I graduated from medical school is a Miracle from God. Add to that, that I am an IMG. You do the math.

Thanks for asking though.

I'm sorry. Hope things are getting better for you. Maybe you will grow to hate FM just a little less as the years pass.

 

[iatrosB]

Ahhhh, long story Sophie. Long story. I have multiple posts regarding this, and I hate to be a broken record. Anyways, I am in FM (for now), and I am stuck. Transfering to another specialty at this time is very risky. However, I will do a second residency after I graduate.

In summary, I went through a huge period of severe depression in medical school that f@cked me hard. I have NO support system, and at one time I was going to be homeless, even before graduating from medical school. How I graduated from medical school is a Miracle from God. Add to that, that I am an IMG. You do the math.

Thanks for asking though.

Dude that sucks...sorry to hear. Good luck bro.

 

[jp104]

Just wanted to say, for you doubters....just got back from a recruiting fair for FM. The numbers batted around were between $185K to start (guarantee only, likely more after your first year) and $370K for someone who had been in practice about 5 years. Several mentioned easily doubling your guarantee after a few years.

These are 4-4.5 day weeks with home call and no ER coverage, about 1 in 6-one in 10. This is not anywhere near 80-90 hours a week.

All's I'm sayin' is, it's out there. And I intend to cut myself a nice fat piece of that pie.

And I'm not at all bitter about my loans because everyone I spoke to was ready to deal on loan repayment as well.

This is the truth, as it stands today in the FM marketplace, not hearsay from an anesthesiologist. Enough said.

Out of curiousity...what region are these jobs located in? 185k in NYC or LA isn't too great, but 185k in Texas is .

 

[deleted87716]

the reason I find FM to be so difficult is because FM docs need to have a very wide knowledge base...knowing 1 organ system really well is easier in my book than haveing to manage every problem the patient has.

[Shrugs] That's why I enjoy it.

 

[sophiejane]

Out of curiousity...what region are these jobs located in? 185k in NYC or LA isn't too great, but 185k in Texas is .

$240K to start was one offer. BUT that's a one-doc town with a 15 bed hospital in rural west TX, an hour from Midland-Odessa and pretty much any kind of civilization.

$185K guarantee was in a town of 10K with OB. Most surpass guarantee after first year.

$370K after 5 years of practice was in a town of 10K, 45 minutes from a major metropolitan area, full scope FM with inpatient, outpatient, scopes and OB. 4.5 day work-week. One in 6 call.

 

[jp104]

$240K to start was one offer. BUT that's a one-doc town with a 15 bed hospital in rural west TX, an hour from Midland-Odessa and pretty much any kind of civilization.

$185K guarantee was in a town of 10K with OB. Most surpass guarantee after first year.

$370K after 5 years of practice was in a town of 10K, 45 minutes from a major metropolitan area, full scope FM with inpatient, outpatient, scopes and OB. 4.5 day work-week. One in 6 call.

That is not bad at all ! Thanks for the info Sophiejane

 

[michaelrack]

Just wanted to say, for you doubters....just got back from a recruiting fair for FM. The numbers batted around were between $185K to start (guarantee only, likely more after your first year) and $370K for someone who had been in practice about 5 years. Several mentioned easily doubling your guarantee after a few years.
.

Be careful about putting too much faith into salary guarantees. Salary guarantees are usually loans that have to be paid back.