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So? I never said that was a primary determinant of income amongst different fields. Within the same field, you usually do get paid more for working more/harder.
Epic Physician Income Thread
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Working more/harder is subjective.
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I'm sorry but WTF. How is it unreasonable to live off 200k pre-tax? I know most pre-meds come from well off families but the level of pretension in this thread is suffocating. As a doctor, no matter what you practice, you'll earn what takes most people half a decade to make.
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I am quoting the OP post in a way that I don't have to keep scrolling right and left to read it.
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But think about that 200K in context of how many hours you work, excluding grueling time spent in training, the importance/stress involved in practicing medicine, medical school debt, and the overhead involved in maintaining a practice (malpractice insurance, taxes, etc.).
When finance/i-banking guys are making way more than that, with much less training, stress and debt I don't think its asking to much to want to be well compensated.
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I haven't seen ANY posts in this thread directly saying it ISN'T good money. It's all relative. It's just a discussion of decreasing wages and increasing debt.
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People are still on this? Move on.
For all those that think 200k a year is just too little and they can't live off of such menial wages I have a simple advice: go do something else.
For all those that think 200k a year is just too little and they can't live off of such menial wages I have a simple advice: go do something else.
I had a flight training slot from afrotc, and left it prior to graduation, for an opportunity to pursue a post-bacc education, to one day be able to go to medical school and eventually practice medicine.
I don't regret it, and heck yea flying jets would've been cool (I probably would have gotten a heavier plane, not a fighter, still cool), but the impact I could have on others that a low ratio of 'training mission hours'/'actual combat mission hrs' is not as fulfilling as the real impact I could make on other ppls' lives on an everyday basis.
So yea, very subjective since it's IMO, but I think your job is way cooler
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I'm not trying to be a jerk, but you've missed the entire point of both discussion angles you address. No one has said that $200K is "too little," or that it's "menial wages." And the discussion is meant to be for people who have already decided NOT to do something else. It isn't a preemptive b!tchfest about not having enough money. It's just a discussion about how we think we might deal with the changes in the future. These two posts came before yours:
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To say that you won't make money or have an easy lifestyle as a physician is also kind of a loaded statement. Honestly I don't know any practicing physician (who or whom
Honestly even with my debt load I feel I can make quite a comfortable living for myself at ~$200000 per year.
Like a lot of people have said I am not going into medicine for the money,but it is a nice perk so to speak.
Also the real reason to go into medicine:
I think too many people feel physicians should be compensated due to the extensive training and "sacrifices" that pre-meds/med students/residents must make in order to become a BC physician. I think doctors will always be compensated relatively well because of the services they provide; doctors will always have relatively high "economic rent", for those economically inclined. There aren't many alternatives for quality medical care (DNP's aside
That brings me to your next point: how much is a six figure salary?
For argument's sake let's assume a $200k per year salary. I'm assuming this salary is not unattainable for any field in medicine. I'm also assuming that physician salaries will be unlikely to drop much lower than this point for most specialties.
$200,000 minus taxes (we'll assume 40%) gives us $120,000 per year take home pay, or $10,000 per month. Assuming $350,000 in loans at 6.8% interest over 10 years (monthly payment of $4000), leaves you with $6000 per month take home pay, or $72,000 per year. Not a lavish lifestyle, but you won't be living in a box eating ramen either.
Now, some will still posit that $200k is not a lot. I grew up on a slightly less than $200k household income. We don't own a boat, or a vacation home, or a Maserati....but both my parents drive luxury cars, myself and my 2 siblings have our own vehicles, I've never gone hungry and I've never been disappointed on Christmas at a dearth of presents under the tree. We took vacations as a family, not to Europe or 5 star resorts, but we did alright for ourselves. Basically, my parents made enough to provide a middle to upper-middle class lifestyle for themselves and their three children.
Now the next logical point would be: is it fair for a doctor who "sacrifices a decade" in training and several hundred thousand dollars of debt make only marginally more than a couple with bachelor's degrees?
I think this brings us back to the point so oft trumpeted around these forums: don't do medicine for the money...which is, I think, both true and false. As elucidated above, medicine hardly affords an opulent lifestyle (at $72k you'll be ballin on a budget) and I'm not sure it should. No other career path, save NBA player or rap mogul, guarantees the salary medicine does. Sure, their are outliers in every field and I know some idiot will post that a guy their friend's friend's cousin knows makes $XX,XXX,XXX doing some menial job, ipso facto: medicine sucks. Those who go into medicine EXPECTING that their medical degree should automatically entitle them to money and b!tches (which always follow money, clearly), as stated ad nauseum on these boards, will be thoroughly disappointed. And rightfully so, nobody is entitled to anything. Too often people consider medicine because "doctors make bank". Then they're told, don't do medicine, do dentistry: they work 3 days a week and make $250k a year. Check out DentalTown or other forums and see how many dentists are chasing the "million dollar practice" pipe dream. There are plenty of dentists that are hurting also, and dental school tuition is even worse than med school. You think $200k in debt is bad? Try $400k+. Nobody is going to hand you $$$ based solely on the letters after your name. A medical degree puts you in a position to maximize your income, but it's hardly, HARDLY a guarantee. I think too many people forget that.
That being said, I do believe there is, and always will be, money to be made in medicine. Business acumen and niche markets will determine who will make those coveted "half million dollar" salaries in the future. Things like concierge medicine, cash practices, and cosmetic procedures have already proven to be effective means of maximizing income. We have to assume that physician salaries (by virtue of insurance or government payments) will not rise. If anything, we're looking at significant decreases in many fields. Therefore, identifying and exploring such niche markets will be the name of the game in the future.
This was a promising thread before these two divas started catfighting
Just so I can steer the thread back on course, here are my two cents:
- Doctors will, in the foreseeable future, always have job security. Even if they are let go by a struggling hospital/practice, there is such a shortage of doctors nationwide that they will certainly be scooped up somewhere, so long as they are not picky.
- I think everyone has agreed on this point: 200k is not wealthy by any stretch of the imagination, but you will not have to worry about putting food on your plate, funding your kids' college, etc.
- If you go into ANY field for the money, you will likely be miserable for the next few decades, medicine is no exception.
How much is $200K/year, linked to the first post.
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Quoting discussion about debt to link in the OP.
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I think there's a lot of misunderstanding on this forum on what ibanking work entails. Starting out, there are probably less than 20,000 entry level positions worldwide. Typical hours for an entry analyst can exceed 80 hours a week. Indeed the pay is quite good (not that hard to hit six figures after one-two years) but the burnout rate is high, and there's not enough room for everyone to move on to associate, principal, director, or higher executive positions where the money comes in really really high. Somewhere in there throw in an MBA (which isn't that bad).
It's a rough life style and when there's a big client or case being handled your whole life stops. On top of that, if you want in a top firm, you better have stupid high grades, come from an Ivy, some slick connections, or the ability to network/sell yourself like a bag of crack. You've got competition coming everywhere, all very bright, all very driven, and no one gives a crap about fuzzy stuff like how you felt when your grandmother got sick or the first time you rescued a baby from the African jungle.
Like I was pointing out earlier, most people making serious cash have to work long hours. Upper working class citizens will rarely find an 8-hour a week job because the competition has exceeded that in this day and age. Doctors work a lot, but not excessively much compared to high level personnel at large corporations (we're not talking top execs), business owners, etc. If you want to get paid in this country, you gotta have great genetics, luck, contacts, or work ethic. Most of the individuals in medicine got where we are based on the latter--which is probably the most easily replicable out of them all and thus why the vast majority of us are replaceable. The fact that most medical school curriculum is standardized at this point is a testament to that.
And while we're at it, let's keep in mind that this $200,000 we keep throwing around only applies to certain portions of the medical field. There are some specialties that average nearly double that or more while many hover in the $300,000 range.
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Warning shot: Im going to link the rest of this threads discussion into the first post, make a few contributions that I said I would make, and then we can let it die. I wont be necrobumping my own thread after this.
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How much is $200K/year? tl;dr: $8000 a month.
Assuming a debt of $200K paid on a 20-year repayment plan, your monthly payment would be in the neighborhood of $1520 (http://www.finaid.org/calculators/scripts/loanpayments.cgi). Assuming a debt of $250K, your monthly payment would be around $1900 (http://www.finaid.org/calculators/scripts/loanpayments.cgi). Hilariously enough, that calculator says:
Assuming you want to save the most you can for retirement, you'll max out your 401K by putting in $16,500 of your pretax income each year. This will lower your taxable income in this hypothetical from $200K down to $183,500. If you maxed out an IRA each year it would be another $5,000 per year. If you owned your own practice there would be different contribution limits and tax implications; we won't go there in this hypothetical.
Your new pre-tax income is $183,500. The marginal tax bracket for federal income tax on that amount ranges from 18% - 25% depending on whether you file independently or with a spouse (http://www.dinkytown.net/java/TaxMargin.html). Well call it 21% for the sake of easy calculations. Tax burden varies by state, but the average is just under 9% (http://cfo.dc.gov/cfo/frames.asp?doc=/cfo/lib/cfo/09STUDY.pdf), so we're at 30%. 0.3 * 183,500 = $55,050. You'd be left with $128,450, but keep in mind you've already put $16K away for retirement.
This is $10,704 per month. If you decided to max out a Roth IRA that would require another $417 per month, leaving you with $10,287 per month.
Take out the loan payment of $1600 discussed above, and you have $8687 per month. For the 10-year repayment plan, taking out $2300 drops you down to $7987 per month. Your mileage may start to vary tremendously here, depending on your regional cost of living and the lifestyle choices you make.
Just for example, if you tried to buy a million-dollar home, with a 30-year mortgage at 5.5%, your monthly payment would be around $5978, leaving you with $2009 per month to pay for cars, gas, groceries, utilities, "saving for your kids' education," and whatever other expenses you have. Take the same mortgage terms on a $500,000 house and your payment is about $3000 per month depending on property taxes and home insurance (http://www.bankrate.com/calculators/mortgages/mortgage-payment-calculator.aspx). That could afford you a very comfortable house in many parts of the country, but I wouldn't expect it to go far in NYC. Either way, you are left with about $5000 per month.
Assuming you're willing to put $1000 per month toward a car or cars for you and your family (leaving you with $4000/month), you could afford $56,000 worth of vehicle (http://autos.msn.com/loancalc/newloan.aspx?calc=price&dp=5000&trm=5&int=120&pmt=290). This could be one fairly nice car, 2 x $23,000 cars, or any other combination. If you're willing to put $2000/month toward cars (leaving you with $3000/month for everything else), you could afford $108K worth of car. You could also put that extra money into a larger mortgage, so this is well past the point where the breakdown becomes highly individualized.
Basically, making $200K per year with a debt burden of about $200K, after maxing your retirement contributions and making the minimum monthly payment on your loans, you would be left with around $8,000 per month for mortgage/rent and living expenses, investment, or to otherwise allocate as you please. As has already been mentioned, you can live comfortably but this won't afford you a lavish lifestyle of vacation homes and Lamborghinis.
Assuming a debt of $200K paid on a 20-year repayment plan, your monthly payment would be in the neighborhood of $1520 (http://www.finaid.org/calculators/scripts/loanpayments.cgi). Assuming a debt of $250K, your monthly payment would be around $1900 (http://www.finaid.org/calculators/scripts/loanpayments.cgi). Hilariously enough, that calculator says:
If your debt is $300K, it suggests you need a salary of $275K to comfortably make payments over 20 years. Let's just call the monthly payment amount $1600 for a debt amount close to $200K. If you wanted to pay it off in 10 years, you would have to pay $2300 per month.
Assuming you want to save the most you can for retirement, you'll max out your 401K by putting in $16,500 of your pretax income each year. This will lower your taxable income in this hypothetical from $200K down to $183,500. If you maxed out an IRA each year it would be another $5,000 per year. If you owned your own practice there would be different contribution limits and tax implications; we won't go there in this hypothetical.
Your new pre-tax income is $183,500. The marginal tax bracket for federal income tax on that amount ranges from 18% - 25% depending on whether you file independently or with a spouse (http://www.dinkytown.net/java/TaxMargin.html). Well call it 21% for the sake of easy calculations. Tax burden varies by state, but the average is just under 9% (http://cfo.dc.gov/cfo/frames.asp?doc=/cfo/lib/cfo/09STUDY.pdf), so we're at 30%. 0.3 * 183,500 = $55,050. You'd be left with $128,450, but keep in mind you've already put $16K away for retirement.
This is $10,704 per month. If you decided to max out a Roth IRA that would require another $417 per month, leaving you with $10,287 per month.
Take out the loan payment of $1600 discussed above, and you have $8687 per month. For the 10-year repayment plan, taking out $2300 drops you down to $7987 per month. Your mileage may start to vary tremendously here, depending on your regional cost of living and the lifestyle choices you make.
Just for example, if you tried to buy a million-dollar home, with a 30-year mortgage at 5.5%, your monthly payment would be around $5978, leaving you with $2009 per month to pay for cars, gas, groceries, utilities, "saving for your kids' education," and whatever other expenses you have. Take the same mortgage terms on a $500,000 house and your payment is about $3000 per month depending on property taxes and home insurance (http://www.bankrate.com/calculators/mortgages/mortgage-payment-calculator.aspx). That could afford you a very comfortable house in many parts of the country, but I wouldn't expect it to go far in NYC. Either way, you are left with about $5000 per month.
Assuming you're willing to put $1000 per month toward a car or cars for you and your family (leaving you with $4000/month), you could afford $56,000 worth of vehicle (http://autos.msn.com/loancalc/newloan.aspx?calc=price&dp=5000&trm=5&int=120&pmt=290). This could be one fairly nice car, 2 x $23,000 cars, or any other combination. If you're willing to put $2000/month toward cars (leaving you with $3000/month for everything else), you could afford $108K worth of car. You could also put that extra money into a larger mortgage, so this is well past the point where the breakdown becomes highly individualized.
Basically, making $200K per year with a debt burden of about $200K, after maxing your retirement contributions and making the minimum monthly payment on your loans, you would be left with around $8,000 per month for mortgage/rent and living expenses, investment, or to otherwise allocate as you please. As has already been mentioned, you can live comfortably but this won't afford you a lavish lifestyle of vacation homes and Lamborghinis.
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I used to care whether or not people chose medicine for the money. Now, I dont.
Myth #1: Caring about money is unethical.
It can be a slippery slope, but considering reimbursement (and how to maximize it) can be done from an ethical position, without a conflict of interest.
Myth #2: If you are getting into medicine for the money, youll hate your job.
Money-motivated physicians can end up being quite happy, as well as excellent and pleasant clinicians. Altruistic humanitarians who got into the game with pure hearts and little concern for money can end up miserable. And theres no clause about whether either side has to understand the opportunity cost ahead of time, but the people who are money-motivated usually do.
Myth #3: The opportunity cost of medicine is too high, considering what physicians are paid. Here, check out this spreadsheet that proves a UPS driver will end up with a higher net worth than a doctor.
Everyones opportunity cost is different. The 27 year-old first year med student with 2 kids had to make different sacrifices than the 22 year-old that came straight from college. People will take on varying degrees of debt, receive varying levels of fulfillment (money aside), and the spectrum of physician income is way too broad to make generalizations about whether or not its all worth it. You could make $120K a year, or $200K a year, or $400K a year based on specialty choice alone. Start talking about owning a practice or two (and putting in massive hours) in fields like plastics, optho or radiology, and netting $2 million a year doesnt sound out of the question. If youre going into medicine for the money and to you that means $150 - $200K per year, then I do wonder if youve adequately considered the opportunity cost. And I suppose part of the original point of this thread was to consider that the opportunity cost of a career in medicine is changing. On the whole, we are giving up more to make less in the future.
Myth #4: Medicine is virtually the only career that guarantees a six-figure salary and high job security.
This is a favorite around here. The fact is, if you took the (minimum) 7 years that you would devote to medical school and residency and invested them into a different career, you could find plenty of ways to make $100 - $250K. Its hard to argue with the job security physicians enjoy, especially considering the medical needs of the aging population and the obesity epidemic in this country. There arent other industries as a whole that can compete with the combination of security and a six-figure income, but to leave it at that ignores issues like length of training, hours worked per week, and liability, i.e. the probability that youll be sued and lose a huge chunk of money. There are, for lack of a better word, easier ways to make six figures that come with a different set of risks, one of which is often lower job security.
Myth #1: Caring about money is unethical.
It can be a slippery slope, but considering reimbursement (and how to maximize it) can be done from an ethical position, without a conflict of interest.
Myth #2: If you are getting into medicine for the money, youll hate your job.
Money-motivated physicians can end up being quite happy, as well as excellent and pleasant clinicians. Altruistic humanitarians who got into the game with pure hearts and little concern for money can end up miserable. And theres no clause about whether either side has to understand the opportunity cost ahead of time, but the people who are money-motivated usually do.
Myth #3: The opportunity cost of medicine is too high, considering what physicians are paid. Here, check out this spreadsheet that proves a UPS driver will end up with a higher net worth than a doctor.
Everyones opportunity cost is different. The 27 year-old first year med student with 2 kids had to make different sacrifices than the 22 year-old that came straight from college. People will take on varying degrees of debt, receive varying levels of fulfillment (money aside), and the spectrum of physician income is way too broad to make generalizations about whether or not its all worth it. You could make $120K a year, or $200K a year, or $400K a year based on specialty choice alone. Start talking about owning a practice or two (and putting in massive hours) in fields like plastics, optho or radiology, and netting $2 million a year doesnt sound out of the question. If youre going into medicine for the money and to you that means $150 - $200K per year, then I do wonder if youve adequately considered the opportunity cost. And I suppose part of the original point of this thread was to consider that the opportunity cost of a career in medicine is changing. On the whole, we are giving up more to make less in the future.
Myth #4: Medicine is virtually the only career that guarantees a six-figure salary and high job security.
This is a favorite around here. The fact is, if you took the (minimum) 7 years that you would devote to medical school and residency and invested them into a different career, you could find plenty of ways to make $100 - $250K. Its hard to argue with the job security physicians enjoy, especially considering the medical needs of the aging population and the obesity epidemic in this country. There arent other industries as a whole that can compete with the combination of security and a six-figure income, but to leave it at that ignores issues like length of training, hours worked per week, and liability, i.e. the probability that youll be sued and lose a huge chunk of money. There are, for lack of a better word, easier ways to make six figures that come with a different set of risks, one of which is often lower job security.
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For the record, Pi, I agree with your sentiment.
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Linking to the first post; differences in pay across specialties.
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Linking discussion of cash practices to the first post.
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Illegal?
Let me beg the question here and for argument's sake agree that it is "illegal". What are they going to do arrest everyone? Who gives a **** if it's "illegal" or not? Don't go to work. See what happens.
Linking to the first post.
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Just to piggyback on this notion, this is sort of what I meant originally when I said if you acknowledge money as one of your biggest motivators, how can you think $200K is an ambitious goal?
Allow me to explain by way of fallacious tabulated data. The following is a caricature of a plan that could be hatched in an ambitious mind. It is meant to make a general point, not to serve as a recipe for wealth or as an example of what is absolutely possible in medicine.
Assumption #1: you are in medicine for the money, you are ambitious, competitive, and business savvy, and you match into plastics.
Assumption #2: your income in your first years as an attending, either academically or in someone elses practice, is $400K/year. Running a private cash-only practice, you are able to earn a pre-tax income of $900K/year (if a general surgeon can do 1.2 mil cash-only, a plastic surgeon can definitely do $900K)
Assumption #3: you could hire plastic surgeons as partners who dont want to do the dirty work of running a practice. They will also generate $900K in reimbursement but will be salaried at $500K. Some of the extra money goes in your pocket, some of it is pumped into expanding the practice.
Assumption #4: The first year you open a practice, it makes no money and you make no money.
Assumption #5: Just for fun, you wont make any money during residency, and your debt will be $1,000,000 by the time you pay it off.
So, years 1-7 after med school, total income = $0.00. Then:
----------$$$---
Year 8| $400K
Year 9| $400K
Year 10| $400K
Year 11| $400K
Open your own practice:
Year 12| $0
Year 13| $900K
Hire partner, pay $500K, retain the rest of his or her reimbursements; repeat for next 4 years
Year 14| $1.3 million
Year 15| $1.7 million
Year 16| $2.1 million
Year 17| $2.5 million
Open second practice, pay surgeon $500K, hire another surgeon each year for 5 years
--------1st Practice-|--2nd Practice--
Year 18| $2.5 million | $0
Year 19| $2.5 million | $400K
Year 20| $2.5 million | $800K
Year 21| $2.5 million | $1.2 million
Year 22| $2.5 million | $1.6 million
Year 23| $2.5 million | $2 million
Open third practice, rinse and repeat
--------1st Practice-|--2nd Practice-|--3rd Practice---
Year 24| $2.5 million | $2 million | $0
Year 25| $2.5 million | $2 million | $400K
Year 26| $2.5 million | $2 million | $800K
Year 27| $2.5 million | $2 million | $1.2 million
Year 28| $2.5 million | $2 million | $1.6 million
Year 29| $2.5 million | $2 million | $2 million
Yes, I realize this whole thing leaves out important details and is predicated on somewhat ridiculous assumptions, but the point remains: if you were going into medicine for the money, why wouldnt you try to make something like this work, instead of working to stretch $200K as far as you can? If money were really someones motivation, why would they settle for a net worth of $7 million at your death when you could potentially make that in a year?
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Gosh did you read his post?
I know you're just pointing something out but his point wasn't the exact numbers but the principle that much more could be made from a seemingly small starting income.
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Yes, it is overly simplified, and I appreciate the sentiment that gross income doesn't provide the whole picture, whether the gross is 6.5 mil or 200K. Narmerguy's right, I'm just pointing at the idea that more could be made; my focus is on the ambition and creativity to solve these problems, as I don't have the luxury of using exact figures here. I think it should also be noted that all ambitious premeds can't just snap their fingers and go into plastics, but this isn't supposed to be a road map for every premed to follow, it's just to discuss what's possible.
I did think about the debt required to start each practice; I made other changes to the numbers to [sort of] account for this, which I will point out in a second. The baseline cost of opening a surgical practice can vary tremendously, but doesn't have to be egregious. At a minimum you need an office space to see patients outside of the OR, which doesn't really need to be expensive.
Your practice overhead starts with that, the cost of your space. It would pay large dividends to hire administrative staff as well, which would eat say $50K out of your alloted $900K. But if it that frees up enough of your time to perform 5 or 6 more major augmentations over the year, then the admin salary pays for itself. Same thing goes for paying an accountant. They free up enough of your time to pay for their services, not to mention that the money they save you by finding every deduction, depreciation, write-off, etc. should exceed what you're paying them.
Depending on how and where you procure OR time, admitting privileges, and malpractice insurance, large portions of the cost of running a surgical practice are fronted or subsidized by the hospitals where you operate, and billed directly to insurance, Medicare/Medicaid, or included in your cash fees.
I have experience working with a surgical practice (not plastics) where the surgeons pay for nothing in the OR. They operate in several different community hospitals; the hospitals own all of the surgical equipment, provide all of the medical supplies, pay the wages of the scrub techs, nurses, surgical assistants, and medical billers, and the hospital's way of recouping this cost billing (insurance et. al) for it. The surgeons come in, perform the case, manage the patient, rinse and repeat. The hospital bills for the case and pays the surgeons their portion of the reimbursement. This is grossly oversimplified, again, but the point is you're not going a billion dollars in debt to start a practice.
Since it's difficult to put an exact numerical figure on that cost, here's what I did:
- Zeroed income for the first year of each practice. If you want to zero it for two years, it wouldn't change anything because you could just start each practice a year earlier (i.e. 2nd practice starts in year 17 and makes $0 for years 17 and 18). Hell, you could zero it for 3 years with the same strategy and it doesn't affect the end result. This is the real joy of these fallacious spreadsheet discussions.
- $900K is low-balled. If I wanted to be obnoxious I would have said each surgeon generates 1.2 million a year (like the GS in Gawande's book). So your margin on each partner would be $700K instead of $400K. If you tabulate the data this way, the revenue in year 29 changes from 6.5 million to 10.7 million. I know it's imperfect but I think I've offset the costs of starting each practice. Just in case,
- I assumed $1,000,000 in student loans and $0 of income during all 7 years of residency, and this scenario still comes out pretty far ahead of the $200K/year scenario.
Like I said, this isn't a recipe for success, it's an invitation to consider the possible spectrum of physician income and how extremely broad it can be. The range that is typically discussed is $150K - $400K per year which is broad by itself, but still belies the breadth of what's actually possible. In any event, the costs of opening a practice are on the radar, however imperfectly.
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Zealot nobody is saying that you can't make money in business, thats the name of the game. I think everyone is freaking out about the salaried jobs in medicine. The major of doctors are too engulfed in science to get business or have the motivation to pursue it. Therefore, if you are good at business + medicine you will make far more than the average doctor.
I think most people are mad bc the golden million dollar 9-5 job isn't waiting for them at the end of residency.
Also I think you overestimate the ease of starting a business. To be an effective small business owner you better be dam good at wearing several hats. If you can't excel at medicine, marketing, HR, legal issues, management, sales, etc....your model will crash and burn.
I think most people are mad bc the golden million dollar 9-5 job isn't waiting for them at the end of residency.
Also I think you overestimate the ease of starting a business. To be an effective small business owner you better be dam good at wearing several hats. If you can't excel at medicine, marketing, HR, legal issues, management, sales, etc....your model will crash and burn.
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Yes, that is the entire point of the thread. Compensation is changing, and perhaps will not be as great as we would like. Discuss.
Here are the Cliff's for what people said:
- Don't do medicine for the money
- Run a cash practice
- Rely heavily on your spouse's income
I knew that it might be interpreted that way, but I'm not estimating the ease of starting a business. There are 5 or 6 instances where I acknowledged that what I presented is NOT a business model, it's a chart full of fallacy. The point is, a business model could be built around the goal of owning multiple practices.
While it would be nice to excel at marketing, HR, legal issues, and sales on top of medicine, it's much more feasible to recognize it when you are weak in an area, and judiciously contract those responsibilities out to other professionals. If a doctor (or dentist, or whatever) had to master all of those skills by him or herself to run a successful group of practices, it would never happen, and there wouldn't be contract companies that handle other people's accounting, HR, sales, marketing, etc.
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I disagree...thats the difference between a small and medium size business. If it was as easy as hiring out to professionals small businesses would never fail.
I am speaking from the prospective of having started and own a small business. If you think you can hire everything out initially, thats not realistic.
If you have 5 million in starting capital then go for it and hire a bunch of support staff (and someone who has experience managing them). However, 99.9% of the people who graduate med school in debt will have to figure out how to do it themselves.
Yes I realize many practices use lets say billing services, but some of the highest paid doctors I see either have no support staff or run a big enough practice where the support staff is distributed across the income of many physicians. This is the very reason by the time we are doctors most practices will be large.....costs are rising.
My point is you are telling a way of making money through business not medicine. Which isnt what people signed up for.
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Actually, we don't disagree and we're speaking from similar levels of experience. I'm not advocating hiring everything out; I said that I would start with one administrative employee and an accountant. There's not a lot of HR skill needed to handle that. As you stated, needs change as businesses grow, but bigger business can diffuse the cost differently. Sure, you have to figure it out on your own initially. But initially, there's less to figure out. You don't start by contracting everything out to other professionals because there's not much to contract out; you'd be paying them for nothing, or at best for things you should be able to figure out.
Regarding small vs. medium business, the point is that you start small (with much less to manage in the way of HR, marketing, and overhead) and eventually grow it into a medium-sized business.
I couldn't possibly be "telling a way of making money through business, not medicine," because that's a false dichotomy. The idea would be to make money through medicine and business. The two aren't mutually exclusive, and you couldn't set up this business as some random entrepreneur with no medical credentials.
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cowme
Not up to date on this thread, but if maximizing income is the #1 priority, I would add: work in a rural area to this list. If you scour the ads of physician openings, you can add a good 200-300K to your annual income if you are a specialist, especially one with low supply (like orthopods, ENT, Urology, derm, etc) in a place like northern Michigan
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I agree having the medical degree is essential when it comes starting a successful practice. Here is my point, 95% of the people on this thread and pre-meds in general are not pursing medicine with this interest.
The problem is you spend 4 years of undergrad + 4 years of med school + 3+ years of residency none of which even tangentially prepares you to run a business. Unless you have outside experience or get lucky it probably will not work as well as most would hope.
There is TONS of money in medicine but its not made by you seeing patients.
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If you guys want to make money, I suggest you look at dentistry. It shouldn't be more than a couple of years now that dental school admission will be more difficult than med school admission.
http://www.wsjclassroomedition.com/a...re_dentist.htm
Why Dentists Are Smiling
They Now Average Higher Incomes Than Some Physicians
By Mark Maremont
Staff Reporter of The Wall Street Journal
Randy Bryson and his brother-in-law Larry Fazioli are both medical professionals in their 40s who practice in Pennsylvania. The similarity ends there.
At Dr. Bryson's office near Philadelphia, a fountain burbles in the reception area, and patients are offered cappuccino or paraffin-wax hand treatments while they wait. Dr. Bryson works four days a week, drives a Mercedes, and lives in a 4,000-square-foot house. Together, he and his wife, who works part-time in the same practice, take home more than $500,000 a year.
At Dr. Fazioli's busy practice near Pittsburgh, patients crowd a utilitarian waiting room, and his cramped office is piled high with records awaiting dictation. Dr. Fazioli says he works between 55 and 80 hours a week, and his annual income of less than $180,000 has been stagnant or down the past few years. He drives a Chevrolet.
The key to their different lives: Dr. Bryson is a dentist, and Dr. Fazioli is a family-practice physician.
Sharp Turnaround
Once the poor relations in the medical field, dentists in the past few years have started making more money than many types of physicians, including internal-medicine doctors, pediatricians, psychiatrists, and those in family practice, according to survey data from the American Dental Association and American Medical Association.
On average, general dentists in 2000, the most recent year for which comparative data are available, earned $166,460-compared with $164,100 for general internal-medicine doctors, $145,700 for psychiatrists, $144,700 for family-practice physicians, and $137,800 for pediatricians. All indications are that dentists have at least kept pace with physicians since then.
Those figures are a sharp contrast to 1988, when the average general dentist made $78,000, two-thirds the level of the average internal-medicine doctor, and behind every other type of physician. From 1988 to 2000, dentists' incomes more than doubled, while the average physician's income grew 42% (slower than the rate of inflation). Factor in hours worked-dentists tend to put in 40-hour weeks, the ADA says, while the AMA says physicians generally work 50 to 55 hours-and the discrepancy is even greater.
"I feel so bad for Larry," says Dr. Bryson of his brother-in-law. "Especially when he's on call, he puts in some pretty long hours. Physically, it's really taking a toll on him."
Dr. Fazioli says he still gets a lot of satisfaction out of being a doctor and earns a comfortable living. But he admits he'd steer his children away from primary-care medicine as a career. Of his three sons, he adds, two might be interested in dentistry instead. "They see that Randy is doing OK," he says.
Many specialist physicians, such as cardiologists and radiologists, continue to rake in large incomes, generally exceeding those of specialist dentists such as oral surgeons and periodontists. But specialist dentists, too, have seen their paychecks increase at a much faster rate than their physician counterparts.
Why? In part, it's because dentists have avoided being flattened by the managed-care steamroller, and many have turned into upscale marketers. Dental care makes up less than 5% of the overall U.S. health bill, and hasn't been a major focus of cost-cutting.
Most private dental insurance is still paid on a fee-for-service basis. Many optional procedures aren't covered by insurance, leaving dentists free to charge whatever the market will bear. About 44% of all dental care is paid by patients out of their own pockets.
In competing for patients' dollars, dentists have become more entrepreneurial. Many dental offices display ads for everything from $400 whitening treatments to $1,200-per-tooth veneer jobs. There are even $30,000-plus full "smile make-overs" offered by dentists specializing in high-end cosmetic procedures.
Dentists also have taken advantage of new technology, some of it controversial even within the profession. One major advance was the invention of porcelain veneers, which are wafer-thin shells of material that are bonded to the fronts of teeth to repair chips or misalignment. Unlike older surfacing materials, porcelain resists staining and looks like a natural tooth surface. "Today, you can create a smile" from materials that people "can't tell are not real teeth," says Joe Barton, a Jacksonville, Fla., dentist who specializes in cosmetic procedures. He says he typically charges from $12,000 to $14,000 to put veneers on 10 front teeth, requiring about 3µ hours of his time.
Some dentists use sophisticated software-imaging programs to show patients virtual before-and-after photos of what their teeth could look like with cosmetic help. Others use intra-oral video cameras, tiny pen-shaped devices that can be used to display images of the inside of a patient's mouth. The cameras have little clinical use-but there's nothing like an up-close video of unsightly teeth to convince a patient that something needs to be done.
'Pennies on the Dollar'
The turnabout in fortunes has made some dentists pity their physician colleagues. Robert H. Gregg, a dentist in Cerritos, Calif., says he had an operation for a snapped Achilles tendon a few years ago, which required him to go under anesthesia for more than an hour. He was amazed that his insurer paid just $2,000 to his surgeon for the procedure. "I get about $3,000 for a three-unit bridge," Dr. Gregg says. "He's getting pennies on the dollar to what his skill level was."
Dr. Fazioli says if he had to do it all over again, he'd still consider being a primary-care doctor, but "I'd look hard at other areas, other states." As for his brother-in-law the dentist, Dr. Fazioli says, "Randy certainly did his homework. People who come to him want his service. He can charge as much as he can."
Dr. Fazioli recently went to a local dentist to get a bridge put in. The procedure, he says, took about 1µ hours over two visits. The bill: $1,200, all of which he had to pay out of pocket. "I was thinking, 'How many people do I have to see to get that?'" Dr. Fazioli says. "If I made $200 in that amount of time, I'd be lucky."
http://www.wsjclassroomedition.com/a...re_dentist.htm
Why Dentists Are Smiling
They Now Average Higher Incomes Than Some Physicians
By Mark Maremont
Staff Reporter of The Wall Street Journal
Randy Bryson and his brother-in-law Larry Fazioli are both medical professionals in their 40s who practice in Pennsylvania. The similarity ends there.
At Dr. Bryson's office near Philadelphia, a fountain burbles in the reception area, and patients are offered cappuccino or paraffin-wax hand treatments while they wait. Dr. Bryson works four days a week, drives a Mercedes, and lives in a 4,000-square-foot house. Together, he and his wife, who works part-time in the same practice, take home more than $500,000 a year.
At Dr. Fazioli's busy practice near Pittsburgh, patients crowd a utilitarian waiting room, and his cramped office is piled high with records awaiting dictation. Dr. Fazioli says he works between 55 and 80 hours a week, and his annual income of less than $180,000 has been stagnant or down the past few years. He drives a Chevrolet.
The key to their different lives: Dr. Bryson is a dentist, and Dr. Fazioli is a family-practice physician.
Sharp Turnaround
Once the poor relations in the medical field, dentists in the past few years have started making more money than many types of physicians, including internal-medicine doctors, pediatricians, psychiatrists, and those in family practice, according to survey data from the American Dental Association and American Medical Association.
On average, general dentists in 2000, the most recent year for which comparative data are available, earned $166,460-compared with $164,100 for general internal-medicine doctors, $145,700 for psychiatrists, $144,700 for family-practice physicians, and $137,800 for pediatricians. All indications are that dentists have at least kept pace with physicians since then.
Those figures are a sharp contrast to 1988, when the average general dentist made $78,000, two-thirds the level of the average internal-medicine doctor, and behind every other type of physician. From 1988 to 2000, dentists' incomes more than doubled, while the average physician's income grew 42% (slower than the rate of inflation). Factor in hours worked-dentists tend to put in 40-hour weeks, the ADA says, while the AMA says physicians generally work 50 to 55 hours-and the discrepancy is even greater.
"I feel so bad for Larry," says Dr. Bryson of his brother-in-law. "Especially when he's on call, he puts in some pretty long hours. Physically, it's really taking a toll on him."
Dr. Fazioli says he still gets a lot of satisfaction out of being a doctor and earns a comfortable living. But he admits he'd steer his children away from primary-care medicine as a career. Of his three sons, he adds, two might be interested in dentistry instead. "They see that Randy is doing OK," he says.
Many specialist physicians, such as cardiologists and radiologists, continue to rake in large incomes, generally exceeding those of specialist dentists such as oral surgeons and periodontists. But specialist dentists, too, have seen their paychecks increase at a much faster rate than their physician counterparts.
Why? In part, it's because dentists have avoided being flattened by the managed-care steamroller, and many have turned into upscale marketers. Dental care makes up less than 5% of the overall U.S. health bill, and hasn't been a major focus of cost-cutting.
Most private dental insurance is still paid on a fee-for-service basis. Many optional procedures aren't covered by insurance, leaving dentists free to charge whatever the market will bear. About 44% of all dental care is paid by patients out of their own pockets.
In competing for patients' dollars, dentists have become more entrepreneurial. Many dental offices display ads for everything from $400 whitening treatments to $1,200-per-tooth veneer jobs. There are even $30,000-plus full "smile make-overs" offered by dentists specializing in high-end cosmetic procedures.
Dentists also have taken advantage of new technology, some of it controversial even within the profession. One major advance was the invention of porcelain veneers, which are wafer-thin shells of material that are bonded to the fronts of teeth to repair chips or misalignment. Unlike older surfacing materials, porcelain resists staining and looks like a natural tooth surface. "Today, you can create a smile" from materials that people "can't tell are not real teeth," says Joe Barton, a Jacksonville, Fla., dentist who specializes in cosmetic procedures. He says he typically charges from $12,000 to $14,000 to put veneers on 10 front teeth, requiring about 3µ hours of his time.
Some dentists use sophisticated software-imaging programs to show patients virtual before-and-after photos of what their teeth could look like with cosmetic help. Others use intra-oral video cameras, tiny pen-shaped devices that can be used to display images of the inside of a patient's mouth. The cameras have little clinical use-but there's nothing like an up-close video of unsightly teeth to convince a patient that something needs to be done.
'Pennies on the Dollar'
The turnabout in fortunes has made some dentists pity their physician colleagues. Robert H. Gregg, a dentist in Cerritos, Calif., says he had an operation for a snapped Achilles tendon a few years ago, which required him to go under anesthesia for more than an hour. He was amazed that his insurer paid just $2,000 to his surgeon for the procedure. "I get about $3,000 for a three-unit bridge," Dr. Gregg says. "He's getting pennies on the dollar to what his skill level was."
Dr. Fazioli says if he had to do it all over again, he'd still consider being a primary-care doctor, but "I'd look hard at other areas, other states." As for his brother-in-law the dentist, Dr. Fazioli says, "Randy certainly did his homework. People who come to him want his service. He can charge as much as he can."
Dr. Fazioli recently went to a local dentist to get a bridge put in. The procedure, he says, took about 1µ hours over two visits. The bill: $1,200, all of which he had to pay out of pocket. "I was thinking, 'How many people do I have to see to get that?'" Dr. Fazioli says. "If I made $200 in that amount of time, I'd be lucky."
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I definitely agree with you on that. Also it would end stupid turf wars in terms of who gets to do certain procedures because of $. Also more students would really choose what they like instead of letting money influence their decision.
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I completely agree with you, and I think there is plenty of good discussion that could be had by the 95% who are more interested in salaried positions than in running a business. That is what I had originally hoped for with this thread, but I overestimated the level of interest there would be in such a discussion.
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cowme
I'm pretty sure it's impossible to overestimate the level of interest in an income thread...unless your estimation was infinity posts.
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I can only speak for myself: I'm interested, but I lack the knowledge to be able to participate productively. Also, I'm being attacked by wee turtles.
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Ugh. This is pretty scary, since I'm going to a 80k/yr med school. But I'm really grateful that you laid it out like this. Doable, but scary.
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ftp://ftp.mgma.com/survop/glacierpublishing/Completed Projects/AU 2010/AU_2010 internal.pdf
This is the true Physician compensation survey.
This is the true Physician compensation survey.
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That was my original prediction but I think I divided by zero somewhere in the original post, kind of threw things off a little.
I appreciate the interest, and I guess we'll see what happens. I never knew you were a grounds-keeper, maubs.
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The halls of ivy league business schools are littered with the corpses of wannabe i-bankers. Good luck with that. Let me know how it tuns out.
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Ya, everyone is interested in money, but the problem is med schools dont give you any experience in starting or running a business hence why most doctors are "bad" with business/money/investment.
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If you want to make money i'd suggest looking at orthopedic spine surgery, i don't think I will see the day when the average dentist exceeds this salary.
However, I think my point to this thread is if you want to make a lot of money, it isnt in a salaried position.
C
cowme
These numbers are wayyyyy offf. But hey, I'll be pleasantly surprised if they turn out to be true.
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Indeed. I once got an F on a test. I turned out just fine. Ach, that's a nasty clog...
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Based on what? This is a survey of 60,000 physicians and this doesn't include non cash bonuses.
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Dentists make as much as they do because most of dental procedures are fee-for-service or cash-based. It's also a procedural specialty, so comparing it to a "thinking" specialty like FM is a bit disingenuous. Notice how they focus on cosmetic type procedures? A more apt comparison would be something like cosmetic dermatology vs dentistry rather than dental vs. FM.
As we've pointed out in the thread already, cash-based practices are entirely plausible in medicine, even for the non-procedural specialties. Having patients pay cash and then letting them fight for reimbursement with their insurance is already feasible.
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MGMA numbers are generally regarded among physicians as accurate. The government numbers are the fantasy. I wouldn't take a no call 4 day a week job for what they say anesthesiologists average. Surgical subspecialists make more than we do.
The linked "recruiter" numbers discarded as fantasy are also realistic. That's a fact, Jack.
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There is way more stress in ibanking.
They don't have any 80 hour caps. Working 100 hours a week as an ibanker isnt uncommon and if you don't make associate (most won't), you're gone after 3 years.
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I'm not arguing at all, but this is what I could find for methodology in the PDF:
I think what's confusing is that the first numbers you come across aren't income numbers, they are average department revenue divided by the number of physicians in that department, and are quite a bit higher than the income numbers reported later.
The actual data in the report is a lot more sophisticated than this, showing fluctuations from 2005 to 2009, but the '09 figures for income are:
ftp://ftp.mgma.com/survop/glacierpublishing/Completed Projects/AU 2010/AU_2010 internal.pdf
The difference in median income between primary care and some amalgamation of all "specialty care" by region:
Just something interesting that's also in the report:
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I'm glad you said this; I didn't think they were far off, but what do I know? I knew I was going to catch **** no matter what figures I posted but I didn't think those would be the first ones to get blown off by any of the physicians posting here.
Regardless, now there are numbers from 4 sources in the thread so if people want to put their faith in the government figures I'm not going to stop them. I'd rather look at the Medscape and MGMA surveys, as the answers came from a range of practicing physicians and not someone with a different agenda.
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I'm not arguing at all, but this is what I could find for methodology in the PDF:
I think what's confusing is that the first numbers you come across aren't income numbers, they are average department revenue divided by the number of physicians in that department, and are quite a bit higher than the income numbers reported later.
The actual data in the report is a lot more sophisticated than this, showing fluctuations from 2005 to 2009, but the '09 figures for income are:
ftp://ftp.mgma.com/survop/glacierpublishing/Completed Projects/AU 2010/AU_2010 internal.pdf
The difference in median income between primary care and some amalgamation of all "specialty care" by region:
Just something interesting that's also in the report:
The survey I linked was MGMA academic and faculty income (medschool) i.e low end of the physician salary. I posted it because it was more accurate than Medscapes which has about 18% of its FP physicians working part time. The initial survey I posted was for researchers and professors.
This is the 2010 MGMA survey with 60,000 physicians
http://www.google.com/url?sa=t&sour...sg=AFQjCNEsyP-SQuW5uzNPuLdF3-837Jf01g&cad=rja
This is the 60,000 physician report of physicians who do not work in academia.
