Why the obsession with money?

[Psychdoc4755]

We are already in the top 99.9% of earners globally. Why all this obsession to become within the top 99.99%?

Psychiatrists have very high earning power relative to almost any other profession in any other country on the planet and yet here we are debating over who can earn more power/money/prestige when we already have more than any human could want or need.

Seems like people overcompensating for underlying insecurities. We should appreciate how lucky we are to never worry about money the way most on this planet do and yet here we are wondering whether a fellow colleague has a nicer car or slightly more successful business. Money controls the poor and the rich in this way. Only way to break the vicious cycle is to realize this.

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[anonperson]

We are already in the top 99.9% of earners globally. Why all this obsession to become within the top 99.99%?

Psychiatrists have very high earning power relative to almost any other profession in any other country on the planet and yet here we are debating over who can earn more power/money/prestige when we already have more than any human could want or need.

Seems like people overcompensating for underlying insecurities. We should appreciate how lucky we are to never worry about money the way most on this planet do and yet here we are wondering whether a fellow colleague has a nicer car or slightly more successful business. Money controls the poor and the rich in this way. Only way to break the vicious cycle is to realize this.

Not a psychiatrist but get outta here with that BS. It's talk like this that results in physicians getting paid less while worthless administration and incompetent mid levels make more with much less work and liability.

Physicians work hard and take a large amount of liability taking care of patients regardless of specialty.

It's not unreasonable to be paid well.

Like I told my colleagues during my last contract negotiation:

I feel appreciated at work with how much I'm paid. I don't care about Doctor's day or any other extraneous stuff. Pay me well and I will generally be happy about my work environment.

 

[Sushirolls]

...Money controls the poor and the rich in this way. Only way to break the vicious cycle is to realize this.

I disagree with your assertions.
There is no vicious cycle.
These assumptions are in opposition to capitalism, and it's one of the reasons America is awesome.

One can choose to pursue money less aggressively - and I am walking the talk. Go view my thread on my private practice.

However, pursuing money is important, and I applaud those who do, and have accrued more financial wealth than me.

But to possibly say that threads on here emphasize money a lot, yes, yes they do. But that's because SDN is more focused on the med students and residents who are 'early career' and have angst about their career choices and what their real earning potential is. Money is important, valued, and the only medium we valuate our services. So we should be talking about money.

 

[smalltownpsych]

What is this vicious cycle that you speak of? I enjoy working and I also enjoy nice things. Is there something wrong with that? How is trying to make more money a compensation for insecurity? I talk about narcisstic defenses against feelings of incompetence all the time, but making money is actually a measure of competence so not sure that fits. I’ve just started up a business and my goal is…to get rich or die tryin’!

 

[Sikrouf]

I feel like i have to make the most of my time

It is the same force that makes me spend hours on end reading articles to improve patient care

I just want to be efficient in everything i do, making money included

Being efficient is the real obsession, not the cash

 

[TheRightMedication]

I agree that we're allowed to want money, that capitalism is good, and that by and large money rewards competence.

I have a cash only private practice on the side, not a soup kitchen.

Still, I agree with the OP in that there's too much focus on money on these forums. So often the conversation is about grinding for a half a million bucks per year. Less often is the conversation about building other kinds of wealth - a good marriage, a strong family, time to prepare healthy meals and exercise, ect.

 

[Fan_of_Meehl]

Not a psychiatrist but get outta here with that BS. It's talk like this that results in physicians getting paid less while worthless administration and incompetent mid levels make more with much less work and liability.

Physicians work hard and take a large amount of liability taking care of patients regardless of specialty.

It's not unreasonable to be paid well.

Like I told my colleagues during my last contract negotiation:

I feel appreciated at work with how much I'm paid. I don't care about Doctor's day or any other extraneous stuff. Pay me well and I will generally be happy about my work environment.

What is this vicious cycle that you speak of? I enjoy working and I also enjoy nice things. Is there something wrong with that? How is trying to make more money a compensation for insecurity? i talk about narcisstic defenses against feelings of incompetence all the time, but making money is actually a measure of competence so not sure that fits. Imjust started up a business and my goal is…to get rich or die tryin’!

The productivity of those who 'pursue money' actually makes life better, in general, for everyone. Generally, they are pursuing productivity, excellence and (hopefully) customer service in order to be successful at their chosen profession (and to be appropriately rewarded for this).

The next time you go to the store (or search online) for a broken down part for your automobile, computer, or some other necessary appliance...if you actually find that part at a reasonable price so that you can get on with your enjoyment of life...thank someone who was 'pursuing money.'

The production of wealth through work (providing goods/services) is not a zero sum game. The chap next door who works his butt off to produce does not 'take' anything away from me by doing so. More often than not, the individual small business/practice owner is passionate about providing a quality service that--as a result of that quality and demand for the service--is maximally profitable. I think when all services are consolidated into the huge corporate operations or government systems is where you see the 'rot,' the inefficiency, and the thoughtless pursuit of 'numbers' and (pseudo)productivity in the form of making cells on an Excel spreadsheet move up/down to further the careers of the non-providers. In a mega-corp or government environment, poor customer service to a single customer is generally inconsequential. Customer service in a small private practice context is crucial to the survival of that enterprise and, therefore, the single-minded pursuit of maximizing profit (without consideration of quality)--something which I would oppose as well--is going to be 'punished' and may even cause the demise of the practice.

I have a next door neighbor who is a plumber who owns his own business. Guy is obviously doing very well financially. Has lots of expensive 'toys' and things and is making 'bank.' Online ratings of his business (customer service) are excellent. From what I can tell the guy is hard-working, humble, and really good to his employees (who work really hard for him). I had a minor plumbing issue and needed last-minute help one time and the service they provided was top-notch. I shudder to think what the service would have been like if this guy had worked for some Mc-plumbing megacorp operation rather than being self-employed.

Perhaps the only force more powerful (than the 'pursuit of money') and capable of possessing people to an obsessive degree is the drive to control the thoughts and actions of others.

 

[AD04]

Everyone wants money. That is how you incentivize people. The perceived obsession on this sub-forum (compared to other specialties) is due to a user that was recently banned whom kept bringing it up in an uncouth way. There are ways to frame things so it is more muted and thus more socially palatable. Kind of like how those in upper class tend to have refined manners compared to those in lower class, even though base nature are the same (e.g. desire for sex, money, power, prestige, etc.).

 

[randomdoc1]

I have mixed feelings and see both sides of this argument. But we should also be pursuing other forms of value in our life. Who we are as people, experiences, relationships. It is possible to be a top earner doling out benzos and stims in 10 min med checks. I find it is also possible to overdue the money talk. The interesting thing is, I’ve seen providers get hyper focused on money at the expense of their quality as a provider and patients sense that, making for poor patient retention and it ends up hurting financial productivity. Some of the best earners at this office are also some of the more awesome people who have great defenses, fund of knowledge and a passion for the field. Yes, they care about money too, but they are more balanced in their approach. I think that’s the sweet spot. The ones who are hyper focused are ironically shooting themselves in the foot.

But if you deliver awesome care and have good character to go with it. That ultimately is the ticket. Endless great referrals to last a lifetime and more power to name your price. Patients become more willing to work around your schedule and not vice versa. But you gotta earn this. I grew up working full time at my mother’s restaurant. It did awesome but it was grueling work to earn it. She always said there really is no literal secret ingredient. It’s you. Cheesy but very true and I carried it with me. Good service = efficiency = $$$$.

 

[Liquid8]

Recently I had a procedure done, and when I caught a glimpse of the theatre list left on the table before the operation I quickly calculated that the surgeon was earning in a day what I took home in a month, and the anaesthetist was also charging double my hourly rate. I would be lying if I didn’t have a momentary reflection and pause to contemplate on my career choices, but that passed over the next few days - probably made easier being someone who has always tried to run my own race and avoid comparing myself with others.

As someone who was always interested in psychiatry, I’d always known about the relative discrepancies compared to other medical fields. But I’m more than comfortable and not doing too badly at all. After effectively paying off my mortgage last year, all money earned since has just felt like a bonus. Every few months our finance team sends an email out noting unpaid patient accounts over a certain number of days – there are the occasional ones who do runners and end up being write offs, but more often it’s someone who has forgot to pay after a telehealth consult and will catch up at the next appointment. One time the total amount unpaid was significant, I realised I hadn’t missed the money or needed it and it was quite liberating.

 

[WisNeuro]

There is nothing wrong with getting paid for your work. One of the reasons that I've switched over a significant portion of my work to IME/forensic work. I happen to enjoy in immensely, but it also pays very well. I think the bigger issue I have with a small subset of posters here is that there are discussions about how to do the absolute barest minimum in patient care, to bill the maximum. The number of med checks+therapy/hour that some people seem to churn out is truly concerning, as there is almost zero chance that those patients are receiving adequate care. Luckily it seems to be a small number here, and the majority of discussions are about improving care. So, bottom line, get paid for your work, and try to get paid well. But, you still have to do what's best for the patient. Don't compromise that. Most of us here are highly intelligent individuals, and if all we wanted to do was to maximize our revenue in life, we could have found much better ways to do that than go into healthcare.

 

[smalltownpsych]

There is nothing wrong with getting paid for your work. One of the reasons that I've switched over a significant portion of my work to IME/forensic work. I happen to enjoy in immensely, but it also pays very well. I think the bigger issue I have with a small subset of posters here is that there are discussions about how to do the absolute barest minimum in patient care, to bill the maximum. The number of med checks+therapy/hour that some people seem to churn out is truly concerning, as there is almost zero chance that those patients are receiving adequate care. Luckily it seems to be a small number here, and the majority of discussions are about improving care. So, bottom line, get paid for your work, and try to get paid well. But, you still have to do what's best for the patient. Don't compromise that. Most of us here are highly intelligent individuals, and if all we wanted to do was to maximize our revenue in life, we could have found much better ways to do that than go into healthcare.

Agreed. Some people make money because they provide an efficient and effective service that is needed and that is balanced with the profit motive. Others make money by exploiting loopholes and people. I actually enjoy some aspects of my job more than making money. Figuring out what makes people tick and using that information to help them succeed/improve/be happy, etc. is a big part of that. That being said, I’m not going to do it for free and another aspect of my job that I enjoy is trying to see how much money I can make. I’m probably better at the former than the latter which is part of why I left the business world and got involved in this gig.

 

[whopper]

Psychdoc4755....​

I'm looking to hire a psychiatrist. I want that psychiatrist to generate about $500K a year. I'm going to take $200K of that money. About 1/3 of it goes to other administrative costs. You get to keep the rest.

Wait? You don't think I should take $200K of that money? But what about everything you wrote? You'll still be a top earner. You'll still be well above the 95% of earners.

You're being selfish. I also need you to bring in other like-minded psychiatrists with you. Same deal. I'll take about 35% of what they bring in and stuff it into my pocket.

Now come over here now and work for me. While you're at it make me a sandwich. Any complaints? You're a whiner. Why are you so concerned about money? Let me worry about it. Anytime you don't think you're earning enough I'm going to have Dr.'s Day that costs me about $30 in food. We'll have them about twice a year. I'll also make a very specific Psychdoc4755 day just for you where I spend another $15 on a t-shirt that has "WhopperMD LLC" emblazoned on it.

Let me help you unburden yourself of your need for money. Let me get you to the next level where not only do I take $200K, we'll up it to $250K and you get to learn the spiritual benefits of eating oatmeal, and my leftovers. You'll be at the next level of development and I get you a pin that has "WhopperMD Spiritual Technologies" on it that cost me $10. I'll personally teach you to make Pasta Mama. You grab old pasta and instead of throwing it out you make scrambled eggs with the pasta inside. What makes it so special is when you say "mama" you say it with an Italian accent. Then everyone knows this is high class and worthy of the extra $50K I'm taking.

 

[G Sheb]

Because enough is never enough in America.
There's always the bigger house with the pool, the luxury car, the better schools, ...etc. And so of course even a 99% percentile earning may still feel not enough.

 

[WisNeuro]

Because enough is never enough in America.
There's always the bigger house with the pool, the luxury car, the better schools, ...etc. And so of course even a 99% percentile earning may still feel not enough.

I have embraced good enough. We're a top 1-2% household most likely already. I'd rather have ample time to spend with family, gym, and hobbies than tack on an extra 10+ hours week to creep up another couple fractions of a percentile. I also don't give a f*ck about things like cars and other big ticket luxury items, so that helps.

 

[Stagg737]

Oh the irony...

Looking at OP's post history, they were the one who started the thread on how to make $1M+ first year out of residency and all their posts other than one are in that thread or ones like "psych is the new derm". Wondering if OP won the lottery in the past two years to be criticizing the forum about discussion of income.

OP also answered their own question in their million dollar thread:

"Before anyone asks, I have many dependents and tons of life responsibility outside of medicine so I am willing to push myself to help the people I love.

I've already been offered $290 per hour to work at a facility in Wyoming as an inpatient psychiatrist. I can easily work about 80 hours per week, possibly 90-100 on a very tough week, so let's average 85 hours per week working every week out of the year coming out to 52 x 85 x 290 = 1.28 million per year.

Is this realistic? Or would I be smarter to work in a more populated area and strike deals/contracts with hospitals with lack of psychiatric coverage to join on as an employee and be able to round on and bill individually for multiple 50+ patient units. Also, I'm considering nursing homes. Is this lucrative?

I have a significant other with severe debt and would like to help her out and my dependents as much as possible. Thank you for your help

And please don't mention that I'm going to get burned out. I know plenty of doctors and people from other professions who can work hours like that and be fine. Those rules don't apply to everybody and I am confident in my ability to stay focused and stay on task at all times."

Lots of other reasons to want to maximize income that have nothing to do with monetary obsession.

 

[G Sheb]

I have embraced good enough. We're a top 1-2% household most likely already. I'd rather have ample time to spend with family, gym, and hobbies than tack on an extra 10+ hours week to creep up another couple fractions of a percentile. I also don't give a f*ck about things like cars and other big ticket luxury items, so that helps.

I'm trying to tame my desire for a BMW.

 

[Bartelby]

I think Sushi makes a great point that SDN is geared toward medical students and residents. Keep in mind that almost all of us work pretty hard from age 18-30 while, typically, continuing to slide deeper and deeper into debt.

At age 30 it is typical to realize you have a six-figure debt that can only be discharged by payment or death, no retirement savings, no house, a beater car, and many of your college friends have homes, retirement, investment portfolios, etc all while having enjoyed a much better lifestyle than a resident (or medical student) the whole time. It's understandable that people realize they are playing catch up and want to know they can make this path worth it financially.

The good news is you can! Even a standard job provides a quite good standard of living in most of the country. And as long as the high earners don't compromise patient care (think cash pay high-end practice, not rounding on 80 inpatients per day) I feel okay cheering them on. The people pushing hard for good pay keep upward pressure on wages for all of us.

 

[SmallBird]

The pursuit of wealth is a very healthy value. I think the trouble is when other values are compromised. It is very important to me that I be kind, that I help patients, that I am the best psychiatrist I can be. With precedence to those values for the most part I will then try and make as much money as possible as it is the principle mechanism by which I can help my family and secure a set of experiences that make life very rich.

 

[Monocles]

Can't speak for others but for me money is a means to an end.

high compensation + high savings rate = financial freedom

I'm a 2nd year attending but have been aggressively saving and investing since residency (thus can live off passive income/savings for years if need to). This allows me to "punch above my weight" in terms of negotiations w/ employers and not have to accept exploitative work conditions.

 

[Candidate2017]

I agree there's a lot of greed in healthcare.

I suggest you make an appointment to meet with the local nonprofit hospital CEO to let them know how blessed they are to make 80 times what their employee psychiatrist makes, and they are overcompensating for underlying insecurities. Let us know how that goes.

 

[Geodont]

We are already in the top 99.9% of earners globally. Why all this obsession to become within the top 99.99%?

Psychiatrists have very high earning power relative to almost any other profession in any other country on the planet and yet here we are debating over who can earn more power/money/prestige when we already have more than any human could want or need.

Seems like people overcompensating for underlying insecurities. We should appreciate how lucky we are to never worry about money the way most on this planet do and yet here we are wondering whether a fellow colleague has a nicer car or slightly more successful business. Money controls the poor and the rich in this way. Only way to break the vicious cycle is to realize this Department of Education a mortgage-sized payment every month.

I agree there's a lot of greed in healthcare.

I suggest you make an appointment to meet with the local nonprofit hospital CEO to let them know how blessed they are to make 80 times what their employee psychiatrist makes, and they are overcompensating for underlying insecurities. Let us know how that goes.

There are a lot of mortgage-caliber student loan payments in (American) healthcare.

 

[whopper]

There's a balance between making money, providing excellent care, and keeping yourself mentally healthy.

Several current systems are playing the exact game I wrote in my post above. You get crap pay then they give you free headphones that cost them $10 with their company logo on it thinking it's going to prevent you from wanting your fair share of pay which could be tens of thousands of dollars.

I've always recommended and still recommend all new graduates work in academia for a few years. You'll earn less money but you will gain experience. I almost didn't leave academia What really got me to leave was the last institution I worked at was poorly run and the same headphone bull$hit was the same exact game they played on me.

And I just heard from someone in that same institution that pretty much around half or more of psychiatrists left the institution in the last few months. This will be the second time in 5 years the department imploded. If they can't figure out why yet, and are running the same bull$hit shell-game history will again repeat itself.

 

[comp1]

The OP asked for why it's a focus here. Well, medicine in general attracts Type A people who are go-getters, highly competitive and constantly comparing themselves to others. If they weren't, they wouldn't get into med school. Psych in general selects for this slightly less, but following SDN...brings you right up there well above average.

 

[Marasmus1]

We are already in the top 99.9% of earners globally. Why all this obsession to become within the top 99.99%?

Psychiatrists have very high earning power relative to almost any other profession in any other country on the planet and yet here we are debating over who can earn more power/money/prestige when we already have more than any human could want or need.

Seems like people overcompensating for underlying insecurities. We should appreciate how lucky we are to never worry about money the way most on this planet do and yet here we are wondering whether a fellow colleague has a nicer car or slightly more successful business. Money controls the poor and the rich in this way. Only way to break the vicious cycle is to realize this.

I am pretty sure depending on the location we are not within 99th percentile. 80-85th would be more realistic and it can go down to 50th in some locations in the USA. Although I understand the point of the post, we are practicing medicine in extremely capitalist corporate environment where any humble approach to compensation returns as exploitation.

 

[whopper]

The business of medicine more and more has become a scam of sorts. E.g. guy gets an IV bag that costs 50 cents but the hospital charged him $600 for it. Oh yeah a nurse did labor to put it in, about 10 minutes of labor. Then it turns out the guy didn't even need the IV bag to begin with and that all inpatients in the hospital are given IV fluids whether they want it or not, each being charged $600 a bag.

To point out doctors wanting more money is completely sidestepping the bigger and more serious problems. The bottom line is the usual supply/demand that keeps things in checks and balances doesn't work well in medicine in general. IF someone's dying and you have to make split second decisions you don't go cheap. Further patients don't know what they want and often times, inappropriately, they're not given options to decide upon, then on the flipside you got patients making decisions who don't know WTF they're doing. Add to the equation that hospitals must treat people even if those people can't pay their bill. If someone wants to truly be effective don't go after doctors unless those doctors are unethical/illegal in their attempts to get money, and go after the broken system itself.

So for someone, who worked almost 10 years (12 if you factor in college) and could have well over $500K in debt, who worked often times 80+ hours a week for years to want to make money, what's wrong with that so long as the person is providing good care? There's nothing wrong with it. Further the human resources aspect of this field-there's a nationwide shortage of physicians, more so psychiatrists and the system didn't correct itself which is why this problem is still ongoing.

 

[calvnandhobbs68]

I am pretty sure depending on the location we are not within 99th percentile. 80-85th would be more realistic and it can go down to 50th in some locations in the USA. Although I understand the point of the post, we are practicing medicine in extremely capitalist corporate environment where any humble approach to compensation returns as exploitation.

Lol uh no. It's hilarious how skewed a take people have of averages and medians when they're at the upper income levels just because all the people you know make 200K+.

Even in New York, $275K/year (pretty average if not low for psychiatry these days) puts you in 93rd percentile for households and 97th for individuals. More like 96-97% for household many Midwestern/Southern states.

Income by State: Statistics and Percentile Calculator

See income percentile comparison by state in the US in 2023 in a calculator and tables with summary income stats. Household and individual.

dqydj.com

 

[comp1]

There is EXCELLENT psychology literature demonstrating that people view success relative to their local peers, certainly not the global average (quite the opposite).

 

[Merovinge]

I'm trying to tame my desire for a BMW.

I bought a 2 series convertible 5 years ago and the car has been great. Outside of paying for 2 oil changes (first 3 years all maintenance is covered), 1 break fluid flush, the upcharge on 89 gas instead of 87, and 1 set of windshield wipers, there have been no other costs of ownership. I do drive less than most at around 6k miles/year as our other car is the family car for road trips, but it was well worth the 38.5k I paid at the time.

I will probably replace it with an EV in a few years (that acceleration is hard to come back from), but if you want to get a lower end BMW I think it's a very reasonable use of cash.

 

[FlowRate]

I'm trying to tame my desire for a BMW.

This is less true post-covid due to the spike in used car prices, but in regular times a CPO/lightly used luxury car is not a terrible financial choice. (Roughly comparable to buying a new non-luxury car from any mfr other than Toyota and Honda.) Let someone else take the 30-40% depreciation hit up front.

 

[Stagg737]

Lol uh no. It's hilarious how skewed a take people have of averages and medians when they're at the upper income levels just because all the people you know make 200K+.

Even in New York, $275K/year (pretty average if not low for psychiatry these days) puts you in 93rd percentile for households and 97th for individuals. More like 96-97% for household many Midwestern/Southern states.

Income by State: Statistics and Percentile Calculator

See income percentile comparison by state in the US in 2023 in a calculator and tables with summary income stats. Household and individual.

dqydj.com

Eh, kind of arguing semantics (which I enjoy, lol), but the point is that OP was claiming docs are in the top 0.1% globally, not just top 1% (in the US). You might think that considering things globally instead of nationally would just further emphasize the privilege of US physicians, but to be in the top 1% globally is actually harder than in the US ($824k globally for an individual vs. $358k for a US individual per your source). For a US household to hit top 0.01% like OP suggested would require an annual income of $2.9 million. US households in the top 1% have a net worth of >$11 million and 10% of US households actually have a net worth >$1 million.

What Is the Average Net Worth of the Top 1%?

An American household would need to be worth a minimum of $11.1 million to get into the 1% club. Here's a look at the super-rich in the U.S.

www.investopedia.com

Again, I realize it's semantics and OP was (hopefully) speaking in hyperbole, but just pointing out that people's perceptions of wealth and the "elite" or "top 1%" or however someone wants to talk about it are usually not in line with financial reality. Ie, the exponential growth curve of income and net worth once we get into the top 5ish % is far steeper than we typically perceive.

 

[voxveritatisetlucis]

You have to factor the opportunity cost of medical school + residency when determining in salary. If anything, salaries in other jobs have picked up much more than salaries in medicine. For example, Before switching to med school, I was making 100k+ and putting away about 50k per. Assuming even no salary growth (highly unlikely), that would be about 700k in the 10 years for medical school + GME. For people with loans, this figure is even larger. I agree it’s definitely not all about the money, but it’s an important factor for many

 

[calvnandhobbs68]

Eh, kind of arguing semantics (which I enjoy, lol), but the point is that OP was claiming docs are in the top 0.1% globally, not just top 1% (in the US). You might think that considering things globally instead of nationally would just further emphasize the privilege of US physicians, but to be in the top 1% globally is actually harder than in the US ($824k globally for an individual vs. $358k for a US individual per your source). For a US household to hit top 0.01% like OP suggested would require an annual income of $2.9 million. US households in the top 1% have a net worth of >$11 million and 10% of US households actually have a net worth >$1 million.

What Is the Average Net Worth of the Top 1%?

An American household would need to be worth a minimum of $11.1 million to get into the 1% club. Here's a look at the super-rich in the U.S.

www.investopedia.com

Again, I realize it's semantics and OP was (hopefully) speaking in hyperbole, but just pointing out that people's perceptions of wealth and the "elite" or "top 1%" or however someone wants to talk about it are usually not in line with financial reality. Ie, the exponential growth curve of income and net worth once we get into the top 5ish % is far steeper than we typically perceive.

The point was that I was responding to the quote I quoted, which was not the OP. I wasn't saying OP was correct in stating that US doctors are in the "top 1%" in terms of either income or wealth which is not true (due to the way averages work of course) but it's also not correct to state that US doctors are 80-85th percentile in terms of income or down to 50th percentile ANYWHERE in the US.

I am pretty sure depending on the location we are not within 99th percentile. 80-85th would be more realistic and it can go down to 50th in some locations in the USA. Although I understand the point of the post, we are practicing medicine in extremely capitalist corporate environment where any humble approach to compensation returns as exploitation.

Percentiles would not be location dependent in the US if we were talking about global comparisons either.

 

[G Sheb]

I bought a 2 series convertible 5 years ago and the car has been great. Outside of paying for 2 oil changes (first 3 years all maintenance is covered), 1 break fluid flush, the upcharge on 89 gas instead of 87, and 1 set of windshield wipers, there have been no other costs of ownership. I do drive less than most at around 6k miles/year as our other car is the family car for road trips, but it was well worth the 38.5k I paid at the time.

I will probably replace it with an EV in a few years (that acceleration is hard to come back from), but if you want to get a lower end BMW I think it's a very reasonable use of cash.

I have my eyes on the i4. But I'll probably settle for less.

 

[Monocles]

For example, Before switching to med school, I was making 100k+ and putting away about 50k per. Assuming even no salary growth (highly unlikely), that would be about 700k in the 10 years for medical school + GME.

Yikes holy mother of opportunity costs!

Doing some back of the napkin math using historical S&P data, this comes out to about 1.1 million dollars from 2011 to 2021... ugh this is painful.

How do you feel about the choices you've made now?

 

[forchinet121]

I have my eyes on the i4. But I'll probably settle for less.

You’re an attending and you can’t afford a 60k vehicle?

 

[voxveritatisetlucis]

Yikes holy mother of opportunity costs!

Doing some back of the napkin math using historical S&P data, this comes out to about 1.1 million dollars from 2011 to 2021... ugh this is painful.

How do you feel about the choices you've made now?

Honestly, I feel great about it, but there are several factors that might not make this the case for everybody. I’m not paying for med school due to scholarship (only living expenses) so it helps in terms of debt worries and despite the stress of medicine, I actually think the stress of the corporate world is worse. Constantly looking one’s shoulder about the possibility of being fired. That 1.1 million calculation assumes no layoffs which is never really a guarantee. Losing a job can really eat into that savings and therefore compound interest.

I think that more people who didn’t work before pursuing medicine are likely to have regrets/what if thoughts because they tend to glamorize corporate life

 

[Monocles]

Honestly, I feel great about it, but there are several factors that might not make this the case for everybody. I’m not paying for med school due to scholarship (only living expenses) so it helps in terms of debt worries and despite the stress of medicine, I actually think the stress of the corporate world is worse. Constantly looking one’s shoulder about the possibility of being fired. That 1.1 million calculation assumes no layoffs which is never really a guarantee. Losing a job can really eat into that savings and therefore compound interest.

I think that more people who didn’t work before pursuing medicine are likely to have regrets/what if thoughts because they tend to glamorize corporate life

Fair enough. Power to ya and I hope all goes well!

 

[G Sheb]

You’re an attending and you can’t afford a 60k vehicle?

I know I shouldn't feed the troll, but FWIW, a car in NYC (especially a luxury one) is more of a nuisance and 60K isn't exactly pocket change.

 

[FlowRate]

You’re an attending and you can’t afford a 60k vehicle?

Most docs "can" afford all sorts of things. That doesn't make those things a good use of money. Buying a brand new luxury car is a great way to make $10k vaporize from a few months of depreciation and mileage.

 

[finalpsychyear]

Most docs "can" afford all sorts of things. That doesn't make those things a good use of money. Buying a brand new luxury car is a great way to make $10k vaporize from a few months of depreciation and mileage.

I cringe at the types of purchases my colleagues make which is fine but they will be working into their early 60s wanting to have retired years earlier. Need some financial literacy courses in med school but maybe they worry everyone would retire too early.

 

[psychmd03]

I bought a 2 series convertible 5 years ago and the car has been great. Outside of paying for 2 oil changes (first 3 years all maintenance is covered), 1 break fluid flush, the upcharge on 89 gas instead of 87, and 1 set of windshield wipers, there have been no other costs of ownership. I do drive less than most at around 6k miles/year as our other car is the family car for road trips, but it was well worth the 38.5k I paid at the time.

I will probably replace it with an EV in a few years (that acceleration is hard to come back from), but if you want to get a lower end BMW I think it's a very reasonable use of cash.

I bought a used M240 3y old when I got it. I am very happy with it. Bought in full.

Not sure why some would really see a car that is 40-60k as a massive burden to finances on an attending salary (outside of NYC like a post stated which is a pain to own any kind of car in). If you're driving the car daily and actually have to do some driving might as well have your transportation be comfortable and maybe even fun. Where I personally cannot support is someone going for the 100K plus car where they have to fully finance it because that is the only way they can afford it. Now that person is likely buying something they should just look at. But we never got any talks about money in school and it takes some reading and learning outside to get a handle on it.

 

[psychmd03]

Interesting thread I think money is demonized too much and that in turn makes it hard for many to know their own worth. It is very hard to get a good discussion about earning going and so many doctors seem to be afraid to learn how to bill and code properly to actually make the money they deserve because they did the work. They under code or miss code frequenlty and then are well underpaid for the work. There is nothing wrong with learning what you are worth and learning how to maximize the billing for the work you are doing.

An interesting read on game theory as in healthcare or other areas that are improperly incentivized. Meditations On Moloch

 

[docksan]

Big difference between being paid what you're worth and being paid obscenely more than you need to be.

 

[FlowRate]

I cringe at the types of purchases my colleagues make which is fine but they will be working into their early 60s wanting to have retired years earlier. Need some financial literacy courses in med school but maybe they worry everyone would retire too early.

One of my colleagues lives paycheck to paycheck and celebrates hitting FICA limits because she ends up with some wiggle room. She also bought a brand new tesla, a $1.1M home, and her sig other is fond of restoration hardware furniture that she put on her credit cards to furnish new digs. Plus alimony to her ex... Yeah, she can afford all those things, but who wants the stress of living paycheck to paycheck and contributing minimally to retirement?

 

[medium rare]

A bit of an aside, but a good equation for how much of an automobile one can afford is 10% of your net income multiplied by the number of years you plan to keep the vehicle divided by the number of vehicles owned.

Following this equation has worked well for me over the years.

 

[thepoopologist]

I like money, I also like psychiatry. Or is it the other way around.

 

[smalltownpsych]

One of my colleagues lives paycheck to paycheck and celebrates hitting FICA limits because she ends up with some wiggle room. She also bought a brand new tesla, a $1.1M home, and her sig other is fond of restoration hardware furniture that she put on her credit cards to furnish new digs. Plus alimony to her ex... Yeah, she can afford all those things, but who wants the stress of living paycheck to paycheck and contributing minimally to retirement?

On the other hand, you can’t take it with you. I try to strike a balance between the ant and the grasshopper, if you know the fable. Truth is that on a docs salary you can enjoy some good things in life and have a secure future. I am making that happen with a significantly lower salary than a psychiatrist and getting started a bit late in the game since I was over 40 by the time I got my license. Some of the med students worry a bit much about money. I spent a lot more years of my adult life in the lower 25 percentile and it wasn’t that bad. I have a more reliable car and a nicer house and I get to travel a little more now and can eat at upscale restaurants a bit more often. Other than that, half the stuff I do for fun is cheap or free. Heck, even when I was young I could afford to ski and that is my most expensive passion.

 

[calvnandhobbs68]

A bit of an aside, but a good equation for how much of an automobile one can afford is 10% of your net income multiplied by the number of years you plan to keep the vehicle divided by the number of vehicles owned.

Following this equation has worked well for me over the years.

This only works if you plan to not keep cars for very long.

If you plan to keep the vehicle for 10 years (actually lower than the avg age of cars on the road now), it’s equal to 100% of your net income, yet I doubt anyone would think it’s a good financial decision to get a 200K (or two 100K) car….

 

[docksan]

A bit of an aside, but a good equation for how much of an automobile one can afford is 10% of your net income multiplied by the number of years you plan to keep the vehicle divided by the number of vehicles owned.

Following this equation has worked well for me over the years.

This equation doesn't appear to make a lot of mathematical sense. If your net income is $200k (approximate average), %10 of that is is $20k, and if you plan to keep a car for 20 years you should spend $400k on it.

From an investment perspective, having bought multiple cars myself in my life, this is not the way. Cars are a unique investment that have diminishing returns on value, which is why folks typically trade in and up.