A poll from an old timer -Why are young people still going into medicine?

[DaTruMD]

Seriously, I think physicians should make a lot of money ($200k even for FP/IM), but if you're going down the road of 150k+ not being very good money, you're never ever going to win that argument. Use a different argument to justify the salary, not that it isn't a good salary in America. People who work normal jobs will see that BS from a mile away, as will those of us going into medicine from a different career who magically avoided starving to death on a $60-$90k salary.

I guess it depends on the physician's life style to argue whether or not they are getting paid enough.

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[macgyver22]

This brings me to a question for Macgyver. What're your thoughts on PAs and NPs? I feel like their role (especially for NPs) is focused mostly on providing primary care. Will doctors become mid-level managers to make ends meet at the primary care level? Will MDs mostly be relegated to specialties where mid-levels fear to tread (if those exist)?

NP's and PA's are a bit of a problem for IM's, Peds, and FP's. They ae being given more and more autonomy across the country and it is hard to argue that you need a highly trained physician to treat the average sore throat, cold, or back pain - the problems that make up a big percentage of a primary care doctor's office schedule. Companies are looking for ways to cut medical costs for their employees and they are driving this trend to get the pubic to accept these substitutes for traditional medical care. The result will be that NP's and PA's will add to the supply of professionals offering certain types basic medical care. Wallmart is already offering these services in their stores and I believe other national store chains are soon to follow. Obviously as the supply of 'healthcare providers' increases we will have less leverage to negotiate for better conditions and fees.

This is a situation where I believe the weakness of the scientific method can sometimes be seen. Some studies have shown no difference in outcomes for patients who receive care from a NP compared to that given by a physician. The problem is that there will be a small subset of patients that may do very badly in the hands of an NP, but if the condition or situation is uncommon, it may not occur often enough to show up in the results of the study. I'm referring to things like the person with abdominal pain who is misdiagnosed by the NP with a GI bug when a physician might have considered the possibility of an aortic aneurysm and saved a life sending him for surgery.


(WARNING - the following is a generalization and by its nature, may not apply to all people in this category. There will be exceptions to everything I say here)
I don't want to knock NP's too much, but its hard not to take a cynical opinion of this as an attempt by some people to take a shortcut route to the position that doctors currently hold, and an equally underhanded attempt by large companies to lower their healthcare costs by passing off second rate care as the latest and greatest thing for consumers. The fact is that nurses don't have the same basic training in science and medical concepts that physicians do. Their understanding of the diseases and treatment they are using is far more basic. This is a critical problem when you are treating someone for a complex problem and you need to customize your approach. I find that they are far less sophisticated at evaluating and interpreting medical literature. They are far more likely to accept questionable claims by purveyors of alternative medicine products. Nurses are probably somewhat better than physicians at providing medical care that requires following strictly written protocols and doing things by rote.


NP's and PA's in places like Wallmart are 'cherry picking' the easiest cases. Physicians generally get paid the same whether an office visit takes 5 minutes or 25 minutes. You really can't get a higher level of reimbursement unless you can show that you spent 1/2 hr or more with a patient. Doctors therefor depend on a certain number of 5 minute visits every day for which they are probably a little overpaid, to make up for the 25 minute visits for which they are certainly underpaid. If NP's and PA's start seeing all the 5 minute visits then physicians will not be able to make up that difference and income will certainly drop off.

NP's and PA's are a real problem for the primary care physicians. Big industry will continue to use them as pawns to gain greater control over us and gain even more concessions. I think this is one area where organized medicine ( the AMA and other medical societies) needs to concentrate more effort to prevent further erosion of physicians' authority.

 

[moe_4eva]

I also find it hard to believe that with an after tax income of $39,000 and $140,000 in loans you were able to get a mortgage without some extremely creative financing or someone cosigning the loan for you. When we bought our first house 15 years ago we had a combined income of $150,000 at the time and about $200,000 in medical school loans for my wife and myself. Even with an income significantly higher than what you currently seem to have we were unable to find a bank that would loan us the money, until we paid down some of our loans and ultimately called in a favor from a friend who worked for a bank.

Just wanted to comment on this. I've now owned 2 different places without a whole lot of problem at my age. The first one was a condo, and I qualified for a loan making $9.63 an hour, although I did only have around $24,000 in debt at the time. That's well under $20,000 a year though for a salary.

After we sold the first place, we purchased a town home. I did so without actually having started a job, although I will admit it was one of the more difficult processes I've gone through. That did involve paying around $10,000 in debt, as well as putting 5% down. It didn't hurt that my credit score is well above 700 either. With my fiancee's student loans, our income amounts to about $28,000 a year, and we love our home. So it's definitely possible, although perhaps not on the east or west coast (we live in colorado).

There was no creative financing involved in either loan (both were/are conventional 30 year fixed-rate loans), so I feel that we've done pretty good given your standards

 

[macgyver22]

Just wanted to comment on this. I've now owned 2 different places without a whole lot of problem at my age. The first one was a condo, and I qualified for a loan making $9.63 an hour, although I did only have around $24,000 in debt at the time. That's well under $20,000 a year though for a salary.

After we sold the first place, we purchased a town home. I did so without actually having started a job, although I will admit it was one of the more difficult processes I've gone through. That did involve paying around $10,000 in debt, as well as putting 5% down. It didn't hurt that my credit score is well above 700 either. With my fiancee's student loans, our income amounts to about $28,000 a year, and we love our home. So it's definitely possible, although perhaps not on the east or west coast (we live in colorado).

There was no creative financing involved in either loan (both were/are conventional 30 year fixed-rate loans), so I feel that we've done pretty good given your standards

Banks use something called a 28/36 rule when deciding if you're a good risk for a mortgage. Some banks bent this rule a lot in the past few years when credit was lose ( That's part of the reason the banking industry and economy is in such a mess at them moment). The 28/36 rule can be explained as follows..

"Most lenders feel a family should spend no more than 28% of its income on housing costs, including the mortgage, insurance, and real estate taxes. Also, these housing costs plus your long-term debts (car loans, child support, minimum credit card payments, student loans, etc.) shouldn't exceed 36% of your income."

Because of this, individuals with relatively low incomes may qualify for a loan that higher income earners can not get if the higher income person has a large amount of debt - in this case student loans. If the mortgage is small enough however and property taxes are fairly low or there is a large downpayment then these rules may be waived to some degree. Its a bit more complicated than that, but that rule of thumb makes it difficult although not impossible for someone with an income of $39,000 and $140,000 in debt to get much of a mortgage from most banks. It might have been easier before the current mortgage crisis though.

 

[Nilf]

Nilf, a rebuttal in two parts:

1)
I guess I don't disagree with you that in NYC, SF, etc., doctors in general make less than lawyers and businessmen. But, you're only looking at one market. In big cities, docs have probably the lowest income because of their concentration, while lawyers and businessmen (forgive the gender specific) have higher earning potential because of the cluster of major, large-cap firms. So, citing major, metropolitan areas only is not applicable to the US overall. I think if you chose a totally random part of the country, you'd have a good chance of finding a location where physicians of almost every specialty made more than the average lawyer. This, I believe, is certainly true in NC where I am located.

2) I'm most certainly not going into medicine to make tons of money. If I were out to make the maximum bucks, I'd probably get an MBA, move to NYC, and work my a** of as an I-banker. Work 120 hours a week for 15 years and retire. That or get a JD, move to NYC, and work 120 hours a week until I made partner in a major corporate law firm. Retire in same 15 years. However, I think I'd want to shoot myself every one of those 15 years. I'm going into medicine in hopes of finding a career where I can spend at least half my workday enjoying what I do. Right now, I'm down around 5-10%, and I don't think I can tough that out for another 30+ years.

I'm merely playing devil's advocate here that physicians can make a healthy salary. I do not disagree with any of the New York story. There's a s***load of runaround that doctors have now that they didn't before, especially in primary care. I'm not denying that.

This brings me to a question for Macgyver. What're your thoughts on PAs and NPs? I feel like their role (especially for NPs) is focused mostly on providing primary care. Will doctors become mid-level managers to make ends meet at the primary care level? Will MDs mostly be relegated to specialties where mid-levels fear to tread (if those exist)?

Weldon,

So there really isn't much disagreement between us. Doctors in Podunks, OK probably make more than the lawyers there... only, what point does this prove, if nurses make more than pediatricians and FP in NYC?

Oh and I know of a regional Walmart manager who makes 100K. I also know a professional dog-walker who's breaking 200K. True story, but I'm transgressing my own rule of not using anegdotal evidence.

However, there a big piece of equation which you're not addressing: the opportunity cost incurred by medical educations. Law school takes what, 4 years? After 4 years, young lawyer makes 150K, he puts it into CDs which adds up over time. For finance and consulting, this opportunity cost is even higher. While his college buddy who went to medschool goes through over a decade of training, during which he makes significantly less.

 

[177983]

Weldon,

So there really isn't much disagreement between us. Doctors in Podunks, OK probably make more than the lawyers there... only, what point does this prove, if nurses make more than pediatricians and FP in NYC?

Oh and I know of a regional Walmart manager who makes 100K. I also know a professional dog-walker who's breaking 200K. True story, but I'm transgressing my own rule of not using anegdotal evidence.

However, there a big piece of equation which you're not addressing: the opportunity cost incurred by medical educations. Law school takes what, 4 years? After 4 years, young lawyer makes 150K, he puts it into CDs which adds up over time. For finance and consulting, this opportunity cost is even higher. While his college buddy who went to medschool goes through over a decade of training, during which he makes significantly less.

Nilf, I think we do pretty much agree. Law school is 3 years, and an MBA only 2 years. So, there is a built-in cost to med school where you're paying $30-40K a year while your friend is already earning good money.

I guess the main point of my original post was just to point out that while doctors are very rarely going to make >500K a year or be absolutely, stinking rich, if he/she is willing to relocate a bit, it's not hard for a physician to be well off relative to those around him/her. It's all in who you compare yourself to. Anyway, it's been fun discussing.

To MacGyver. I largely agree with you regarding NPs and PAs. However, I'd like to play devil's advocate here. Say I'm an employee at Walmart (or whatever lower paying job you want). I probably don't have health insurance, and therefore am loathe to visit a doctor if I can avoid it. Isn't the Walmart clinic exactly what I need? It's a low-cost alternative to an official office visit? I guess my thinking here is that while Walmart clinics depress the price of services, they simultaneously expand the health services available to the working poor. I mean, Walmart's got a bad track record on some things, but they do lower prices for people who otherwise might not be able to afford care. I guess I just don't know quite how I feel about access of care vs. quality of care. If you can't have both, isn't some access better? But, if that means driving primary care doctors out of business and therefore lowering the quality of everyone's care, is it? I don't have answers to these questions, but I'd be interested to hear your thoughts.

 

[macgyver22]

To MacGyver. I largely agree with you regarding NPs and PAs. However, I'd like to play devil's advocate here. Say I'm an employee at Walmart (or whatever lower paying job you want). I probably don't have health insurance, and therefore am loathe to visit a doctor if I can avoid it. Isn't the Walmart clinic exactly what I need? It's a low-cost alternative to an official office visit? I guess my thinking here is that while Walmart clinics depress the price of services, they simultaneously expand the health services available to the working poor. I mean, Walmart's got a bad track record on some things, but they do lower prices for people who otherwise might not be able to afford care.

Actually Walmarts motive here is to "avoid" paying for medical care offering these low cost medical clinics to their employees who have to pay out of pocket because Walmart doesn't give medical coverage to a large fraction of their workers. Employees actually were the ones to voice this complaint when the clinics first opened. That's motive number one. Motive number two I suspect is to make a profit on the clinic as well as the prescriptions which will then be walked over and filled at their own pharmacy. I don't think there is anything the least bit altruistic about what Walmart is doing.

I guess I just don't know quite how I feel about access of care vs. quality of care. If you can't have both, isn't some access better? But, if that means driving primary care doctors out of business and therefore lowering the quality of everyone's care, is it? I don't have answers to these questions, but I'd be interested to hear your thoughts.

Obviously you can have full access and no quality or full quality and no access, but the real world has to reside somewhere in between. Aside from Walmarts motive you raise an interesting point. Whether Walmart is doing it for Altruistic reasons or not isn't the question. What you are asking is, is this not a good thing for society that they are bringing down the cost of access to medical care? I guess it depends on who you are. If you are a minimum wage employee with no access to care at all then the answer is probably yes. However, If you are virtually anyone else and this trend leads to Internal medicine incomes that are not much different than what a nurse gets paid then the answer is a resounding no. Those people already have access to top quality physicians. If the process continues to the endpoint I described then that will no longer be the case. Anyone going to med school will avoid Internal Medicine and Peds like the plague. Those with health insurance will then have no choice but to go to NP's for their routine care and hope the NP's know what to do and when to make the appropriate referrals. The fact is that such a model might work fine for the most part but, and maybe I'm biased, but I wouldn't trust the lives of my loved ones to such a system. Some people may argue that the NP's can take care of the easy stuff and just refer on when something is more difficult, but that assumes that the NP will recognize a difficult case when he/she sees it. That's not going to always happen. Nurses are great at what they do but they're not doctors, they don't think like doctors, and they will never be a real substitute for a doctor. Tha's my opinion- obviously with a significant personal bias- but based on 2 decades of experience, I think it has merit.

Well that's the end of my lunch hour ( Er - 15 minutes). Will check back when I can.

 

[TRAMD]

I seriously doubt anyone can live "like a king" on $11,000 anywhere in this country unless someone else was paying some of the bills for them. According to U.S. Census Bureau the income that is considered poverty level for a single person in 2006 was $10,488. That's just not realistic unless living in a shoe box and eating macaroni and cheese every day meets your criteria of living like a king.

My definition of living like a king is being happy and having no financial worries. I lived in an apartment with a roommate with rent costing me $350. Then add a little for utilities. I had my car from high school so no car payments. I went out to eat a lot and had lots of parties where I provided the refreshments. I went to and bought lots of movies and spent all I wanted on video games, clothes, dates and a sweet mountain bike that I got to ride frequently. Scholarships paid for all my school expenses.

I also find it hard to believe that with an after tax income of $39,000 and $140,000 in loans you were able to get a mortgage without some extremely creative financing or someone cosigning the loan for you. When we bought our first house 15 years ago we had a combined income of $150,000 at the time and about $200,000 in medical school loans for my wife and myself. Even with an income significantly higher than what you currently seem to have we were unable to find a bank that would loan us the money, until we paid down some of our loans and ultimately called in a favor from a friend who worked for a bank.

I had no cosigner. My house cost me $130,000 (built in '83, 3 bd, 2 bth, nice house, very nice neighborhood, 2 mins from hospital) and I got a 30 year fixed at 6.75%. My credit score then (1.5 years ago) was 740. I had never used a credit card. I am deferring my school loans, however. I would NOT be able to afford to pay those too.

 

[Doublecortin]

Actually Walmarts motive here is to "avoid" paying for medical care offering these low cost medical clinics to their employees who have to pay out of pocket because Walmart doesn't give medical coverage to a large fraction of their workers. Employees actually were the ones to voice this complaint when the clinics first opened. That's motive number one. Motive number two I suspect is to make a profit on the clinic as well as the prescriptions which will then be walked over and filled at their own pharmacy. I don't think there is anything the least bit altruistic about what Walmart is doing.



Obviously you can have full access and no quality or full quality and no access, but the real world has to reside somewhere in between. Aside from Walmarts motive you raise an interesting point. Whether Walmart is doing it for Altruistic reasons or not isn't the question. What you are asking is, is this not a good thing for society that they are bringing down the cost of access to medical care? I guess it depends on who you are. If you are a minimum wage employee with no access to care at all then the answer is probably yes. However, If you are virtually anyone else and this trend leads to Internal medicine incomes that are not much different than what a nurse gets paid then the answer is a resounding no. Those people already have access to top quality physicians. If the process continues to the endpoint I described then that will no longer be the case. Anyone going to med school will avoid Internal Medicine and Peds like the plague. Those with health insurance will then have no choice but to go to NP's for their routine care and hope the NP's know what to do and when to make the appropriate referrals. The fact is that such a model might work fine for the most part but, and maybe I'm biased, but I wouldn't trust the lives of my loved ones to such a system. Some people may argue that the NP's can take care of the easy stuff and just refer on when something is more difficult, but that assumes that the NP will recognize a difficult case when he/she sees it. That's not going to always happen. Nurses are great at what they do but they're not doctors, they don't think like doctors, and they will never be a real substitute for a doctor. Tha's my opinion- obviously with a significant personal bias- but based on 2 decades of experience, I think it has merit.

Well that's the end of my lunch hour ( Er - 15 minutes). Will check back when I can.

hey McGyver,

thanks for all your insights. You probably have it the worst, being a primary care doc in New York City . . .

So I am starting med school this summer and although, I KNOW medicine is what I really want to do, this thread has scared the siht out of me . Anyway, I've been toying for some time with doing an MD/MBA (at my school it's a 5 year program). What do you think about that? Do you think having an MBA will empower me to have a better control of my practice and my financial situation. I also have an interest in health related venture capital, perhaps starting my own medical device companies, and I know I'll enjoy running things. I just don't want to spend all this time and effort and $$$ and end up being insurance companies' and government's btich. Do you think it's worth an extra year and a little more debt?

Thanks

 

[TRAMD]

However, there a big piece of equation which you're not addressing: the opportunity cost incurred by medical educations. Law school takes what, 4 years? After 4 years, young lawyer makes 150K, he puts it into CDs which adds up over time. For finance and consulting, this opportunity cost is even higher. While his college buddy who went to medschool goes through over a decade of training, during which he makes significantly less.

An anecdote from me . . .

I have a buddy. We are the same age, went to the same high school, the same undergrad, and the same school for med (me) and law (him). He started making a salary one year before me as law is a year shorter than med. His loans are also slightly less than mine with one less year. However, now I am in residency and we make about the same salary. In a few years I will finish residency and make much more than him.

There are certainly lawyers and business-types making more than physicians. A LOT more in some cases. The majority, however, make less, even in NYC. In a highly populated area the small percentage of people making the big bucks will make up a larger total number of people and stand out more. We also have lawyers in SD that make millions too.

You can put me on the list of people saying that complaining about $150,000 per year makes one a crybaby.

 

[177983]

Actually Walmarts motive here is to "avoid" paying for medical care offering these low cost medical clinics to their employees who have to pay out of pocket because Walmart doesn't give medical coverage to a large fraction of their workers. Employees actually were the ones to voice this complaint when the clinics first opened. That's motive number one. Motive number two I suspect is to make a profit on the clinic as well as the prescriptions which will then be walked over and filled at their own pharmacy. I don't think there is anything the least bit altruistic about what Walmart is doing.



Obviously you can have full access and no quality or full quality and no access, but the real world has to reside somewhere in between. Aside from Walmarts motive you raise an interesting point. Whether Walmart is doing it for Altruistic reasons or not isn't the question. What you are asking is, is this not a good thing for society that they are bringing down the cost of access to medical care? I guess it depends on who you are. If you are a minimum wage employee with no access to care at all then the answer is probably yes. However, If you are virtually anyone else and this trend leads to Internal medicine incomes that are not much different than what a nurse gets paid then the answer is a resounding no. Those people already have access to top quality physicians. If the process continues to the endpoint I described then that will no longer be the case. Anyone going to med school will avoid Internal Medicine and Peds like the plague. Those with health insurance will then have no choice but to go to NP's for their routine care and hope the NP's know what to do and when to make the appropriate referrals. The fact is that such a model might work fine for the most part but, and maybe I'm biased, but I wouldn't trust the lives of my loved ones to such a system. Some people may argue that the NP's can take care of the easy stuff and just refer on when something is more difficult, but that assumes that the NP will recognize a difficult case when he/she sees it. That's not going to always happen. Nurses are great at what they do but they're not doctors, they don't think like doctors, and they will never be a real substitute for a doctor. Tha's my opinion- obviously with a significant personal bias- but based on 2 decades of experience, I think it has merit.

Well that's the end of my lunch hour ( Er - 15 minutes). Will check back when I can.

I totally agree that Walmart's motive is to make more money. I think it's naive to assume that they do anything for any reason but to make money. My thinking is that Walmart will probably never give the vast majority of their workers health insurance, unless regulated by law to do so. It wouldn't earn them more money. So, Walmart is definitely guilty of taking advantage of its workers. I'm not saying we should give Sam Walton a hug (he's dead anyway and that would be gross.), but I am saying that if Walmart can lower the cost of health care for its employees (and other low-income, no insurance people) that's a good thing in my mind. If Walmart turns a profit on it to boot, well that's probably unavoidable.

My question regards the endpoint. In chemistry (you can tell I'm a pre-med...), reactions can reach an equilibrium whereby both product and reactant exist in certain proportions. I believe a certain segment of the population will always want to go to an MD regardless of illness, and moreover will be able to pay for that requirement. While NPs and PAs may become more prevalent, they'll never replace all doctors as PCPs. I see this happening with the "boutique" medicine I've heard about. For ~$100/month, you have access to your primary care doctor as much as you'd like. A panel size of 500 patients would pull in ~$600,000/yr. in this model. Now I could be wrong, but isn't the traditional panel size much closer to 2000 patients? So, even by lowering this to $50/month, you still have what seems to me a fairly solid amount of money to work with.

Anyway, I'm not sure quite why I got sidetracked by boutique medicine and panel sizes, other than to say that while I think NPs and PAs will become more prevalent, doctors as primary care providers aren't going to disappear completely. And I think that if more people get pressed harder to use NPs and PAs, some of those people will push back and find ways to stay with MDs. Some people probably won't push, and will end up going to an NP or PA. Is there much we can do about that? If there's a market for cheaper health care, who are we to say it shouldn't be filled?

 

[TRAMD]

I do believe that being a doc is a great career--financially and otherwise--but I also agree that there are some troubles ahead that deal largely with reimbursement. Insurance companies are a problem, HMOs are a problem, and general attitudes towards medicine and doctors are a problem. The solution is definitely not socialized medicine. I think it is a very complicated problem that will get worse before it gets better. It is important for people to know that physician salaries are not what they once were for many docs and are likely to decline more. I believe, however, that they will stay well above average for a long time. You might not be the richest person around but you will not struggle as a physician. If you do struggle it probably has more to do with your financial aptitude than your salary.

 

[drumdoc]

Medicine is enticing to me because of my mentors who still love it despite the changes they've experienced. I did research training w/ a heme/onc doc that was superb. Seriously, one of the most gifted and giving individuals I've ever met. My mother-in-law is a fine surgeon and still loves what she does. My current employer is a physician who is equally remarkable.

In my current work situation I'm intellectually challenged, but not enthused about the projects. I also miss having greater frequency of contact w/ people. For these reasons I've chosen medicine...

 

[maxbaner]

I totally agree that Walmart's motive is to make more money. I think it's naive to assume that they do anything for any reason but to make money. My thinking is that Walmart will probably never give the vast majority of their workers health insurance, unless regulated by law to do so. It wouldn't earn them more money. So, Walmart is definitely guilty of taking advantage of its workers. I'm not saying we should give Sam Walton a hug (he's dead anyway and that would be gross.), but I am saying that if Walmart can lower the cost of health care for its employees (and other low-income, no insurance people) that's a good thing in my mind. If Walmart turns a profit on it to boot, well that's probably unavoidable.

My question regards the endpoint. In chemistry (you can tell I'm a pre-med...), reactions can reach an equilibrium whereby both product and reactant exist in certain proportions. I believe a certain segment of the population will always want to go to an MD regardless of illness, and moreover will be able to pay for that requirement. While NPs and PAs may become more prevalent, they'll never replace all doctors as PCPs. I see this happening with the "boutique" medicine I've heard about. For ~$100/month, you have access to your primary care doctor as much as you'd like. A panel size of 500 patients would pull in ~$600,000/yr. in this model. Now I could be wrong, but isn't the traditional panel size much closer to 2000 patients? So, even by lowering this to $50/month, you still have what seems to me a fairly solid amount of money to work with.

Anyway, I'm not sure quite why I got sidetracked by boutique medicine and panel sizes, other than to say that while I think NPs and PAs will become more prevalent, doctors as primary care providers aren't going to disappear completely. And I think that if more people get pressed harder to use NPs and PAs, some of those people will push back and find ways to stay with MDs. Some people probably won't push, and will end up going to an NP or PA. Is there much we can do about that? If there's a market for cheaper health care, who are we to say it shouldn't be filled?

How common is boutique medicine? I don't think I've seen this around.

 

[ACE2Performance]

To give you the hard facts, I make about $140k/yr ( about $100K after taxes).

If you are paying $40K in taxes on $140K you are either

1. in need of better tax help
2. Not including write-offs like mortgage interest, retirement savings, etc. in your $140K
3. paying your wife's taxes out of your income and counting her income as pure take home, or
4. Lying to make your case.

Put simply you are either keeping something from us or just plain dumb in finances.

 

[decafplease]

If you are paying $40K in taxes on $140K you are either

1. in need of better tax help
2. Not including write-offs like mortgage interest, retirement savings, etc. in your $140K
3. paying your wife's taxes out of your income and counting her income as pure take home, or
4. Lying to make your case.

Put simply you are either keeping something from us or just plain dumb in finances.

Have you ever looked at a pay stub? 28% is not out of this world, especially depending on the state you live in.

Check out the tax bracket for $140K : It's 28%

http://en.wikipedia.org/wiki/Income_tax_in_the_United_States

 

[macgyver22]

If you are paying $40K in taxes on $140K you are either

1. in need of better tax help
2. Not including write-offs like mortgage interest, retirement savings, etc. in your $140K
3. paying your wife's taxes out of your income and counting her income as pure take home, or
4. Lying to make your case.

Put simply you are either keeping something from us or just plain dumb in finances.

First let me say one thing. Whether I have always succeeded or not is up to the readers of this forum to decide, but I have gone to great lengths to make sure that the responses I have made on this board are made with all due respect to the person I am responding to even on the rare occasion when that individual has been inappropriate or somewhat rude. If you have a question about any of the statements I have made, I request that you maintain the same level of respect for me and all others who are posting in this thread. For now I will chalk it up to your youth, and we'll leave it at that.

The tax figures posted are correct. The federal tax rate in that income bracket is 28%, New State Income taxes ( and I have checked this since I last posted to get a more accurate rate) is 6.5%, Social Security is 8.5% ( on the first $90,000) and Medicare adds another 1.5% ( on your full income). If the total is off by a few dollars please pardon my math, but the figures are pretty close. You are correct that mortgage interest deductions can lower you total tax burden, but in higher income brackets like this the AMT eliminates a significant portion of your deductions.

 

[dienekes88]

Have you ever looked at a pay stub? 28% is not out of this world, especially depending on the state you live in.

Check out the tax bracket for $140K : It's 28%

http://en.wikipedia.org/wiki/Income_tax_in_the_United_States

+ New York State income tax calculation

Edit: Macgyver responded about his taxes while I was typing a less in depth analysis. pwn'd.

 

[177983]

How common is boutique medicine? I don't think I've seen this around.

My understanding is that's it pretty rare still and that it's mostly concentrated in bigger cities where there's a critical mass of people who can drop ~$100/month on having a doctor on retainer.

 

[uzybear]

psychic powers say: this thread has run its course

 

[ACE2Performance]

Have you ever looked at a pay stub? 28% is not out of this world, especially depending on the state you live in.

Check out the tax bracket for $140K : It's 28%

http://en.wikipedia.org/wiki/Income_tax_in_the_United_States

Don't assume I am young OR inexperienced. People commonly misconstrue the meaning of a tax bracket. The 28% is not applied to the whole $140K, only that part above ~$78K is taxed at 28% (for a single person >$131K for married). If you will look at the chart listed on the wiki link you will find that the tax burden for $140 is less than 20% for married people and does not get up to 28% until a couple reaches ~$400,000.

I still don't think I am wrong about my list. Anyone making $140K and paying $40K in taxes is doing something wrong , is unaware of what they could do to lower their tax burden or is hiding something from you. So again, the doc is either making serious financial mistakes or he is leaving stuff out. For instance, he is either not including the tax deductible retirement and health benefits in his $140K stated income (which is a move to prejudice one against the practice of medicine as a career), or he is not taking advantage of them to reduce his tax burden. Neither of these are subject to punishment through the AMT.

 

[macgyver22]

psychic powers say: this thread has run its course

Agreed. I think what had been a fairly interesting give and take has spiraled down into a boring tax discussion. I don't think it serves the original purpose anymore.

I will no longer make regular posts or monitor this forum. But if any of you have any specific questions that I can help you with related to medicine please feel free to send a private message and I will respond as time permits. Its been a pleasure discussing these issues with you. Good luck to all.

 

[dienekes88]

Federal Tax
$77,100 - $160,850 Bracket: 15,698.75 + 28% of the amount over $77,100
$140,000 --> $33,310.75 in taxes

State Tax
Over $20,000 Bracket: 973 + 6.85% of the amount over $20,000
$140,000 --> $9,193.00 in taxes

Social Security and Medicare...
SS, Self-employed: 12.4% on earnings up to $102,000 --> $12,648
Medi, Self-employed: 2.9% on all earnings --> $4,060.00

I dunno... just plugging in the numbers, it looks like he's managing $19k in deductions. I'm no accountant, though... so I might've gotten something wrong.

The point of the discussion is to make people wary of going into medicine for the money. I think he has succeeded.

 

[johankriek]

In my current work situation I'm intellectually challenged, but not enthused about the projects. I also miss having greater frequency of contact w/ people. For these reasons I've chosen medicine...

medicine is not intellectually challenging.. variations on same theme..

 

[Gold 5]

Agreed. I think what had been a fairly interesting give and take has spiraled down into a boring tax discussion. I don't think it serves the original purpose anymore.

I will no longer make regular posts or monitor this forum. But if any of you have any specific questions that I can help you with related to medicine please feel free to send a private message and I will respond as time permits. Its been a pleasure discussing these issues with you. Good luck to all.

Thanks Macgyver for your time, this has been one of the best threads on the pre allo board in some time.

PS I live in a neighboring state and your tax calculations seem pretty close. You forgot though, if you are lucky enough to work in NYC, their is another 2% city tax. So work hard!

 

[makushin]

If you are paying $40K in taxes on $140K you are either

1. in need of better tax help
2. Not including write-offs like mortgage interest, retirement savings, etc. in your $140K
3. paying your wife's taxes out of your income and counting her income as pure take home, or
4. Lying to make your case.

Put simply you are either keeping something from us or just plain dumb in finances.

You guys are in for a great suprise when you start paying taxes. The OPs portrayal of 40% overall taxes in NYC is reality. And all those quotes of what doctors make in other countrys; I hope you realize they pay overall taxes of 40-50%. Sales tax in BC Canada is over 14%. Think about that.

 

[maxbaner]

You guys are in for a great suprise when you start paying taxes. The OPs portrayal of 40% overall taxes in NYC is reality. And all those quotes of what doctors make in other countrys; I hope you realize they pay overall taxes of 40-50%. Sales tax in BC Canada is over 14%. Think about that.

 

[macgyver22]

I haven't been back here in a while because I had nothing new to add, but I recently came across this article and thought it was worth sharing.

 

[t3705]

I read that article as bad for patients, but maybe future opportunities for primary-care doctors. A shortage of primary care doctors may shake up the system.

Macgyver22, I appreciate the time you spent on this thread.

 

[Jonassen]

and also it's funny how you guys bitch about how someone with your intelligence isn't getting paid $500,000 a year when more intelligent and more contributing to society PhD scientists don't make $20,000.

And most of these PhD students are foreign immigrants on F1 visa from China, India and Latin America, where $20,000 is still better than $2000 a year.

Go to ANY of the top 20 math/science/engineering PhD programs in the US, and you will see the majority of the students are foreign. Why do you think that is so? Are you praying the future of American healthcare to be in a similar situation? where the brightest and most motivated American students all shun medicine?

Get a clue or soon we'll all be calling DPNs and RNs "doctors", and then you can also kiss that prestige goodbye.

 

[Excelsius]

Wow, what a thread! I for one did not know about these problems in medicine, at least not to this extent. This thread is like a book, but I still managed to read over 50% of everything here.

The responses range from the clueless cynic, the staunch egotist, the partially informed, and the attending to the problem.

I have been through various disciplines: law, medicine, and science. All fields have their problems. In law, you have a certain amount of shallowness and hypocrisy. In science, you have that person next to you who is older and is pissed at you that you are able to do the same job without a BS degree and is trying to make your life miserable. It is tough in every field and the root cause of everything is human psychology. Ego is a huge problem in USA and I could see why some Buddhistic qualities would help not just the health care industry, but the country in general. It doesn't matter how smart the person is or what school he went to because the old adage always wins: garbage in, garbage out. This applies to doctors, plumber, patients, and all the shades of marmalade and feces in between.

Some of the posts in here made me furious about the system in USA, others made me see several paths to a solution. First, a few clarifications:

http://www.physiciansalary.net/physician-salary-data.php

The above link, along with many others, state the average income of the physicians. You can notice that some specialties are worth much less in the east coast than the west. Also that West coast, which is not rural by any means, has, on average, the highest salaries. I know that some of you say that this is not fair because it is the average, but that's not exactly true. For every income that deviates too much from the average towards the bottom, there must be an equal and opposite income that is towards the top. So if some neurosurgeon is really making only 200K a year, there is someone else who is making 600K a year. I know a few that make over a million a year and own an entire building in a hospital., but these are not too common for us to jump and say "That's why neurosurgeon's average income is high."

http://www.physiciansalary.net/physician-job-outlook.php

This link provides the correct observation that the number of retirees is increasing far faster than the number of doctors. In countries like Germany and France the number of geriatric patients already far outnumber the young ones. Same is happening in USA. Through simple economics, there will always be more demand for doctors than there is supply - I don't expect doctors to become poor any time soon.

From the wealth of information present these days, I think that the only way for a doctor to screw up is basically to either have too high of expectations and not plan accordingly or plan to go into specialty and not be able to get into the given residency (as mentioned by Macgver). This last scenario could be a disaster, at least for some of us, but looking at the match data, it seems that US seniors match at over 80% rate even in a competitive program like neurosurgery. In 2001 that figure was over 91% (granted, you need to pass through the filter before being able to rank).

Sure, there are outliers, but there are outliers in everything. Why should we disregard the doctor who makes above average and only pay attention to the one who makes below? The difference between these two docs will not be how good of a doctor they are, but how well-rounded they are. If you don't know a thing about economics, finances, management, business, etc, you sure will not do well. If your taxes are too high, then it might be profitable to buy a house even if you have debts to pay because buying a property can decrease your taxes a lot. You may want to get married, maybe to a wife that has the right connections in the medical fields (opening a hospital sometimes entails marrying the right partner to deal with the business). You may also choose to open a "side-business" just so that you can make a lot of deductions (that's what I do) or buy a car for "business." Hell, smarter people even publish books if not as much for the best content but for the tax breaks they'll get. Every idiot publishes a book these days anyway.

 

[Excelsius]

And finally, some awareness. This is yet again where your well-roundedness will come across. If you have spent all your undergrad and med-school studying your subjects, you probably have no humanity left in you. I once asked an MD what was the most difficult, challenging aspect of her education and career, she said "Maintaining my humanity." It took me some time before I even understood how she could have said that instead of how tough the classes in medschool were. Take a look here:
http://medicaleconomics.modernmedicine.com/memag/Medical+Malpractice%3A+Lawyers/Doctors-who-became-lawyers-What-they-want-you-to-k/ArticleStandard/Article/detail/505787?contextCategoryId=44475

The source of the article was recommended to you by Macgyver in a previous post. The theme of the article is that Doctors who became Laywers (MD+JD) say that the most important factor in deciding whether you will be sued or not is independent of you quality as a doctor but has to do with the way you communicate with your patients. I already knew this because my life does not consist only of science books. In fact, if you have time, I would suggest you read Blink by Malcolm Gladwell.

To whet your appetite, go to http://www.scribd.com/doc/3011915/BLINK-Malcolm-Gladwell and start reading page 19, Listening to Doctors. I can tell you right now guys, those of you who have spent all of your time working your ass of at Berkeley maintaining close to 4.0 (like that asian guy from UCB singing Ricky Martin on SDN thread), your probability of getting sued is going to be pretty high, even if you are a best in your field. If you read the book carefully, you'll realize that even if the PCP (or another specialist) screws up, you're going to be the one to be sued if your patient doesn't like the way you treat them. I will also add that unfortunately looks will matter as well. So if your appearance is not that great to begin with, I suggest you start making up for it - kind of thing that unattractive boys and girls have to do to get a mate. But I digress...

My final point is instead of bailing out, how about getting pissed and deciding to do something about all this? When I have the privilege to attend medical school, I had already made a few plans to solicit interest groups in congress. My problem is that if the rest of you guys can't get your act together and be more active in the community, nothing will change. Doctors still are one of the highest compensated professionals. Additionally, they are supposed to be at least somewhat intelligent. If we can't fix this ****, then who the hell will? Complaining all the time about this and that is not going to change anything. And this: http://medicaleconomics.modernmedic...Article/detail/516916?contextCategoryId=44475
is not a solution. Don't you get it? The insurance companies press the doctors, doctors put their goddamn tail between their legs and press the patients, the patients end up hating the doctors and now the public support disappears. When you have both the public and the special interest groups against you, you know you're screwed.

For so many years docs have been doing the same thing over and over again. Einstein used to say that insanity is doing the same thing over and over again and expecting a different outcome. Macgver, what have you done for yourself, your children, your peers, your patients, and ultimately for this country to help the cause? Have you tried anything other than explaining the situation to pre-meds and making sure that they think hard before going into medicine? You know, instead of posting anonymously on the webpage maybe you could start informative programs where dissatisfied doctors teach medical and pre-medical students about healthcare problems. Maybe you could publish a book and one day get on CNN or something similar. I personally thank you for the information, but at the same time I feel this disappointment that you have done absolutely nothing for this cause. And no, calling your insurance company on case-by-case basis is exactly what you described - a waste of your time. We need a bigger picture here.

This is getting too long. It's just that it's 1:30am and I realize that I am really mad about this entire situation. If all of us pre-meds going into the field and knowing about these problems are going to be just as impotent as our previous generation docs, and if I am the only one who is sick and angry about this, then matters will certainly get worse. Maybe I too had too high of an opinion about doctors...

 

[da8s0859q]

...

My final point is instead of bailing out, how about getting pissed and deciding to do something about all this? When I have the privilege to attend medical school, I had already made a few plans to solicit interest groups in congress. My problem is that if the rest of you guys can't get your act together and be more active in the community, nothing will change. Doctors still are one of the highest compensated professionals. Additionally, they are supposed to be at least somewhat intelligent. If we can't fix this ****, then who the hell will? Complaining all the time about this and that is not going to change anything. And this: http://medicaleconomics.modernmedic...Article/detail/516916?contextCategoryId=44475
is not a solution. Don't you get it? The insurance companies press the doctors, doctors put their goddamn tail between their legs and press the patients, the patients end up hating the doctors and now the public support disappears. When you have both the public and the special interest groups against you, you know you're screwed.

For so many years docs have been doing the same thing over and over again. Einstein used to say that insanity is doing the same thing over and over again and expecting a different outcome. Macgver, what have you done for yourself, your children, your peers, your patients, and ultimately for this country to help the cause? Have you tried anything other than explaining the situation to pre-meds and making sure that they think hard before going into medicine? You know, instead of posting anonymously on the webpage maybe you could start informative programs where dissatisfied doctors teach medical and pre-medical students about healthcare problems. Maybe you could publish a book and one day get on CNN or something similar. I personally thank you for the information, but at the same time I feel this disappointment that you have done absolutely nothing for this cause. And no, calling your insurance company on case-by-case basis is exactly what you described - a waste of your time. We need a bigger picture here.

You make a valid point - really, you do - but I think you're jumping on him a little prematurely. I'm not sure you have any way of knowing what the OP has done to better the profession for his generation of docs as well as ours.

Besides, you've got the benefit of pre-MS1 idealism. He's been through the game and has been in practice for years.

 

[Excelsius]

You make a valid point - really, you do - but I think you're jumping on him a little prematurely. I'm not sure you have any way of knowing what the OP has done to better the profession for his generation of docs as well as ours.

Besides, you've got the benefit of pre-MS1 idealism. He's been through the game and has been in practice for years.

Just to make it clear, I really respect Macgyver for taking his time and revealing the issue. If some of my comments sound acerbic, I apologize. These are not directed at Macgyver, but at all doctors in general. Also, maybe Macgyver has tried something to help the situation. That's why I asked him if he has. He probably hasn't, but it is very admirable that he spent the time to patiently explain the situation.

I am not an idealist, but I realize that I have nowhere near as much experience as the poster. At the same time I realize that if we do not bring some sort of the exuberance, well-roundedness, and maybe even fury from pre-med youth and try to make it stay afloat through MS1 and residency, then our field and the numerous patients who die in this country every year will never change for the better. A few months ago I heard of a very sad case where a young child died because the insurance company didn't approve the procedure until the child was almost lifeless - the approval was too late. It was heart breaking to see the parents talk. I know insurance companies maybe pigs, but they are not the only ones to blame and the public criticizes the doctors - rightly so. Who do you think can stand up to insurance companies? Politicians who know nothing about medicine? Or patients who are nowhere near as educated? What about lawyers? They can't do a thing without active participation and support of doctors. Depending on who's the next president, we might have a real shot at changing some things in this country, but I am unable to sense any waves that the doctors are planning to create.

It was mentioned that a union is illegal. You don't have to from a labor union to achieve something. Nor do you need strikes. How can a doctor go on a strike anyway? Think about it. Are you willing to stand by and let an innocent patient die just because you don't like the insurance company? That's unethical and against the Hippocratic oath (hypocritic?). There are many ways around this and one of them is forming a tightly knit professional/political/legal association. Nothing illegal about interest groups.

 

[macgyver22]

Here's an interesting article. A poll done by a physician recruiting firm and sent to 270,000 primary care doctors and 50,000 specialists. It more or less repeats some of what I have been saying, but with the hopefull statement that politicians may now be paying attention. For any of you considering primary care this is something worth reading.

The original survey results can be downloaded here

 

[phospho]

Here's an interesting article. A poll done by a physician recruiting firm and sent to 270,000 primary care doctors and 50,000 specialists. It more or less repeats some of what I have been saying, but with the hopefull statement that politicians may now be paying attention. For any of you considering primary care this is something worth reading.

The original survey results can be downloaded here

I've been going through this thread. Thank you very much for taking the time to write here. It helps a lot.

My apologies for some of the rude posters you had to come across. They do not represent us.

 

[phospho]

Just to make it clear, I really respect Macgyver for taking his time and revealing the issue. If some of my comments sound acerbic, I apologize. These are not directed at Macgyver, but at all doctors in general. Also, maybe Macgyver has tried something to help the situation. That's why I asked him if he has. He probably hasn't, but it is very admirable that he spent the time to patiently explain the situation.

I am not an idealist, but I realize that I have nowhere near as much experience as the poster. At the same time I realize that if we do not bring some sort of the exuberance, well-roundedness, and maybe even fury from pre-med youth and try to make it stay afloat through MS1 and residency, then our field and the numerous patients who die in this country every year will never change for the better. A few months ago I heard of a very sad case where a young child died because the insurance company didn't approve the procedure until the child was almost lifeless - the approval was too late. It was heart breaking to see the parents talk. I know insurance companies maybe pigs, but they are not the only ones to blame and the public criticizes the doctors - rightly so. Who do you think can stand up to insurance companies? Politicians who know nothing about medicine? Or patients who are nowhere near as educated? What about lawyers? They can't do a thing without active participation and support of doctors. Depending on who's the next president, we might have a real shot at changing some things in this country, but I am unable to sense any waves that the doctors are planning to create.

It was mentioned that a union is illegal. You don't have to from a labor union to achieve something. Nor do you need strikes. How can a doctor go on a strike anyway? Think about it. Are you willing to stand by and let an innocent patient die just because you don't like the insurance company? That's unethical and against the Hippocratic oath (hypocritic?). There are many ways around this and one of them is forming a tightly knit professional/political/legal association. Nothing illegal about interest groups.

I totally agree with you.

I don't mean to sound like an ass, but what if a few patients die if doctors go on strike? At least maybe our society will start helping us get rid of the hassles and limitations that are making doctors' lives a living hell, and will help us to ultimately save lives on the long run. Maybe if we put our altruistic crap aside for a second, and simply fought for our rights, we'd get further (or at least somewhere). Obviously this is just hypothetical. But it does make me think.

I can't think of a plumber who will give two craps if a home is getting flooded - he will not come and fix anything if he won't get paid fairly.

At the end of the day, medicine is just another job, and we deserve to get compensated fairly, just like everyone else.

 

[macgyver22]

I totally agree with you.

I don't mean to sound like an ass, but what if a few patients die if doctors go on strike? At least maybe our society will start helping us get rid of the hassles and limitations that are making doctors' lives a living hell, and will help us to ultimately save lives on the long run. Maybe if we put our altruistic crap aside for a second, and simply fought for our rights, we'd get further (or at least somewhere). Obviously this is just hypothetical. But it does make me think.

I can't think of a plumber who will give two craps if a home is getting flooded - he will not come and fix anything if he won't get paid fairly.

At the end of the day, medicine is just another job, and we deserve to get compensated fairly, just like everyone else.

I sympathize with your anger phospho, but obviously this can never happen. Aside from the fact that private practitioners can't unionize without breaking the law, as you said "people could die". While this is a job/business, I would like to think that most of us go in to this to help people.

The solution to the problem is to make yourself heard. I think that's actually happening little by little. I am begining to get a feeling from my patients at least that the public has some sense of what's happening to the local family doctor. It is a slow process, but its the only method we have. Going on strike will not win any hearts in this battle and we need all the allies we can get.

 

[OncoCaP]

...

Sorry if you have answered this already. If you had to do it all over again, and you were really quite interested in medicine and its various aspects, what would you do differently knowing what you know now? Would you simply not even consider medicine (perhaps address medicine only from the business side as an MBA, etc.)? Are there certain specialties you would be more likely to consider?

 

[enjoydrywax]

I hope our generation of doctors (i.e us premeds) will find away to organize our collective intelligence and use it to affect some change. I would hate to sit idly through medical school and residency slowly watching the field of medicine go to (even more) **** for both us and our patients. I cannot believe the system is set up so that shareholders' wallets get fatter as our patients are neglected care.

 

[macgyver22]

Sorry if you have answered this already. If you had to do it all over again, and you were really quite interested in medicine and its various aspects, what would you do differently knowing what you know now? Would you simply not even consider medicine (perhaps address medicine only from the business side as an MBA, etc.)? Are there certain specialties you would be more likely to consider?

I have answered it before but this thread is very long and quite old so I don't mind answering it again. Forgive me if my answer differs somewhat from my original answer. This is a theoretical question and so is my answer.

If I had to do it all over again I might avoid medicine all together. Medicine was a bit of a sell out for me. It was a safe choice. My first love is science, but I didn't want to struggle to make ends meet if I went into research and didn't make "the big discovery". Now that medicine isn't the financial "sure thing" anymore I realize the wisdom when older people told me to "do what you love". If you do what you love you may never get rich but you will usually still be happy. You can get that in medicine, but the aggravation of fighting with insurance companies, the government, lawyers, and the occasional difficult patient shifts the risk reward ratio a little more to the negative side each day.

If I were to choose medicine again I would probably choose a specialty. Its the only sensible thing to do these days. A student can't possibly pay off $250,000 in school loans on an internist or pediatricians salary and expect to support a family on $150,000/yr in any of the major metropolitan areas. There's a lot of self sacrifice, delayed earnings, and strained relationships. Some of your fellow students have argued with me on this point, but I think its hard to justify all that sacrifice without some sort of reward. Those rewards, both financial and professional, have been dramatically reduced over the past 10-15 years, and hence the reason for this thread.

 

[jbg]

Try to get a real feel for what the job is like and don't be shy about asking professionals in the field how they feel about their job. You will get very different answers depending on the specialty, whether they are part time or full time. hospital based or private.

Ever since I've gotten negative responses from the four doctors that I asked about their job, I stopped asking altogether. I asked my family physician (I switched from her about 2 years ago) a few questions about her job for my research paper, she just kept repeating to me how she hates it and that she never gets a break.

The others that I asked just didn't want to talk about it. They seemed to ignore the question or answer it without really answering it. So, I never really got to know how THEY felt about it.

Btw, thank you for your post and advise.

 

[OncoCaP]

I have answered it before but this thread is very long and quite old so I don't mind answering it again. Forgive me if my answer differs somewhat from my original answer. This is a theoretical question and so is my answer.

If I had to do it all over again I might avoid medicine all together. Medicine was a bit of a sell out for me. It was a safe choice. My first love is science, but I didn't want to struggle to make ends meet if I went into research and didn't make "the big discovery". Now that medicine isn't the financial "sure thing" anymore I realize the wisdom when older people told me to "do what you love". If you do what you love you may never get rich but you will usually still be happy. You can get that in medicine, but the aggravation of fighting with insurance companies, the government, lawyers, and the occasional difficult patient shifts the risk reward ratio a little more to the negative side each day.

If I were to choose medicine again I would probably choose a specialty. Its the only sensible thing to do these days. A student can't possibly pay off $250,000 in school loans on an internist or pediatricians salary and expect to support a family on $150,000/yr in any of the major metropolitan areas. There's a lot of self sacrifice, delayed earnings, and strained relationships. Some of your fellow students have argued with me on this point, but I think its hard to justify all that sacrifice without some sort of reward. Those rewards, both financial and professional, have been dramatically reduced over the past 10-15 years, and hence the reason for this thread.

This makes a lot of sense. I'm older (40), married with kids, and in my second year of medical school. I had a great career doing what I loved (engineering business), but I became very concerned about what was happening in medicine here in the U.S. I looked at a lot of ways to address the problem and finally decided to go to medical school. I'm having a good time right now and look forward to working more with patients as time goes by. I did mostly paperwork in my former job so that doesn't bother me. Legal stuff doesn't bother me. Rude people don't bother me. I realize that physician pay is going down and I hope that I can pay back the amount of money I put into tuition. I don't need to earn a lot of money because of my financial situation although I hope I'm not paying to do this in the end.

I'll be looking for ways to better apply technology in medicine. I know that there are significant barriers to improving medicine in the U.S. and that we spend more on health care than on food in this country. I know that one person can only do so much, but I like what I'm seeing right now in terms of opportunities to make a difference. There is so much at stake here.

 

[nevercold]

Ever since I've gotten negative responses from the four doctors that I asked about their job, I stopped asking altogether. I asked my family physician (I switched from her about 2 years ago) a few questions about her job for my research paper, she just kept repeating to me how she hates it and that she never gets a break.

The others that I asked just didn't want to talk about it. They seemed to ignore the question or answer it without really answering it. So, I never really got to know how THEY felt about it.

Btw, thank you for your post and advise.

However, as we all know, anecdotal evidence is not very good evidence at all. Most of the physicians I speak with are exceptionally happy with what they do. You should pursue what you love. If you don't, you're short-changing yourself. There was never a point in medicine where it was just an easy job.

As for making ends meet:
Assume married + two children...
Yearly salary - $150000
Monthly salary in CA after tax - $8665
Monthly payment 10yr $250000 loan, 6.8% - $2877
Monthly salary after loan payment & tax - $5788
Equivalent yearly salary before tax - $89850

For 10 years, you have to support a family of four on almost $90k/year. It's not extravagant, but it's easy. After the loan payoff, you'll experience a roughly 67% increase in effective salary.

 

[macgyver22]

However, as we all know, anecdotal evidence is not very good evidence at all. Most of the physicians I speak with are exceptionally happy with what they do. You should pursue what you love. If you don't, you're short-changing yourself. There was never a point in medicine where it was just an easy job.

As for making ends meet:
Assume married + two children...
Yearly salary - $150000
Monthly salary in CA after tax - $8665
Monthly payment 10yr $250000 loan, 6.8% - $2877
Monthly salary after loan payment & tax - $5788
Equivalent yearly salary before tax - $89850

For 10 years, you have to support a family of four on almost $90k/year. It's not extravagant, but it's easy. After the loan payoff, you'll experience a roughly 67% increase in effective salary.

I did the math on this much earlier in this thread. It got quite contentious for some reason so I'm not going to do all the calculations again. Suffice it to say that income after tax and loan payments of $69,000/yr ( using your numbers) would be unacceptable to most people given the sacrifice and deferred earnings that physicians have to go through to get to that point. Even the most modest home in your area is going to cost $500,000, and unless you can put up a seizable down payment, few banks are going to give such a loan to someone with that kind of income these days.

We've been through this whole discussion above if anyone is interested. Like I said it got a bit heated. There are certainly some people who will be happy with that income, but I strongly suspect that many of those people who say they would will change their tune when they try to meet the responsibilities of raising and providing for a family.

If this site still exists ten years from now I would love to see someone resurrect this thread and have some of the original posters back to discuss how their views and expectations had changed or stayed the same. Either todays students are far more altruistic than when I went to medical school, or there is just a simple lack of life experience which will dissolve when faced with the reality of living in today's world. The latest figures show a 50% drop off in in the number of American medical schools grads applying for primary care over the past ten years, so I think the superior altruism argument is a bit hard to make. It would be interesting to see how you all feel in another decade, but then of course the world will change and so will all of us.

 

[OncoCaP]

I did the math on this much earlier in this thread. It got quite contentious for some reason so I'm not going to do all the calculations again. Suffice it to say that income after tax and loan payments of $69,000/yr ( using your numbers) would be unacceptable to most people given the sacrifice and deferred earnings that physicians have to go through to get to that point. Even the most modest home in your area is going to cost $500,000, and unless you can put up a seizable down payment, few banks are going to give such a loan to someone with that kind of income these days.

We've been through this whole discussion above if anyone is interested. Like I said it got a bit heated. There are certainly some people who will be happy with that income, but I strongly suspect that many of those people who say they would will change their tune when they try to meet the responsibilities of raising and providing for a family.

If this site still exists ten years from now I would love to see someone resurrect this thread and have some of the original posters back to discuss how their views and expectations had changed or stayed the same. Either todays students are far more altruistic than when I went to medical school, or there is just a simple lack of life experience which will dissolve when faced with the reality of living in today's world. The latest figures show a 50% drop off in in the number of American medical schools grads applying for primary care over the past ten years, so I think the superior altruism argument is a bit hard to make. It would be interesting to see how you all feel in another decade, but then of course the world will change and so will all of us.

I concur with this. Basically the above individual would need to marry another physician or other high income professional just to survive or move someplace with a low cost of living. California would be a tough place to eke out a living on a primary care physician's salary, even without the loans unless living out of an old RV gets you excited.

 

[macgyver22]

I concur with this. Basically the above individual would need to marry another physician or other high income professional just to survive or move someplace with a low cost of living. California would be a tough place to eke out a living on a primary care physician's salary, even without the loans unless living out of an old RV gets you excited.

Its good to get your input OncoCap. I've enjoyed the discussions I've had on this thread, but most of the students obviously are quite young. I think its important for them to hear from some "old folks" ( just kidding) other than me. You tend to have a different perspective on things when you've been paying the bills for a few decades.

 

[Excelsius]

I have answered it before but this thread is very long and quite old so I don't mind answering it again. Forgive me if my answer differs somewhat from my original answer. This is a theoretical question and so is my answer.

If I had to do it all over again I might avoid medicine all together. Medicine was a bit of a sell out for me. It was a safe choice. My first love is science, but I didn't want to struggle to make ends meet if I went into research and didn't make "the big discovery". Now that medicine isn't the financial "sure thing" anymore I realize the wisdom when older people told me to "do what you love". If you do what you love you may never get rich but you will usually still be happy. You can get that in medicine, but the aggravation of fighting with insurance companies, the government, lawyers, and the occasional difficult patient shifts the risk reward ratio a little more to the negative side each day.

If I were to choose medicine again I would probably choose a specialty. Its the only sensible thing to do these days. A student can't possibly pay off $250,000 in school loans on an internist or pediatricians salary and expect to support a family on $150,000/yr in any of the major metropolitan areas. There's a lot of self sacrifice, delayed earnings, and strained relationships. Some of your fellow students have argued with me on this point, but I think its hard to justify all that sacrifice without some sort of reward. Those rewards, both financial and professional, have been dramatically reduced over the past 10-15 years, and hence the reason for this thread.

Even though you did not really address my questions, I think your post makes it clear why you are unhappy. You basically went into medicine mainly because of the income. There is nothing wrong with choosing a profession based on income, but it has to be only ONE of the factors. You basically left research that you really loved simply because you thought that you wouldn't make enough money there. What I usually see on SDN is the opposite - people leaving higher paying jobs to go into medicine because that's what they love. Obviously, you are not going to be happy. And you also will not be a doctor to advocate for patient or doctor rights. That takes a certain level of passion as a pre-requisite.

One thing that surprises me is this: since your main intention for choosing medicine was the income, and since you mentioned that you did calculations even before you went to med school, how come that in your calculations you were unable to figure out that you need to choose only certain specialties in order to receive the highest income? Don't you think that it is a huge miscaclulation to choose the lower paying field - primary care? If you were unable to match into any other specialty, I can understand. But otherwise, this just seems to be a major error. And the argument that in the past doctors used to get paid more doesn't really work because PCP has never been on top of the list in terms of compensation. My explanation for your choice (since I think you would be intelligent enough to not make such a gargantuan miscalculation) is that you chose PCP because it was the easiest route to becoming a doctor. Because you didn't like medicine much, you tried to pick the shortest geodesic shortcut in terms of your effort required in med school and the duration of residency.

Finally, income is not only specialty-dependent, but individual-dependent as well. These days it takes certain business acumen to make money. Almost no one relies on salary alone to build wealth, no matter how high that salary is (yes, even hedge fund manager salaries). In some states you can pay up to 45.3% tax (happens to be CA). If at the bare minimum you can't figure out ways to avoid at least part of the taxation, then right there half of your income is gone. I know PCPs who are very happy with their job. I also knew a surgeon who made good money but he hated his life and had no family. The nurses hated him too and always talked behind his back. What makes you think that if you had gone into specialty you would fare better? Maybe the income would be higher, but with no love whatsoever for what you do, can you imagine being on the job almost every hour of every day? I don't think you'd like that. The issue is not just income here.

Your story should be a good warning to anyone who goes into medicine only for compensation or hoping that primary care will be "good enough." It is also probably not a good idea to concentrate only on medicine and know nothing else. There is more to the world than medicine. If you have no idea about economics, whatever money you make, you'll squander it. I was told about a gardener who had a very modest salary. In a decade or so, this person had accumulated about 200K and quit his job. I don't know the rest of the story, but it shows that salary is only part of the big picture.

 

[badasshairday]

Its good to get your input OncoCap. I've enjoyed the discussions I've had on this thread, but most of the students obviously are quite young. I think its important for them to hear from some "old folks" ( just kidding) other than me. You tend to have a different perspective on things when you've been paying the bills for a few decades.

You are right on many things. Spot on. The youngsters will realize soon enough.

 

[badasshairday]

Even though you did not really address my questions, I think your post makes it clear why you are unhappy. You basically went into medicine mainly because of the income. There is nothing wrong with choosing a profession based on income, but it has to be only ONE of the factors. You basically left research that you really loved simply because you thought that you wouldn't make enough money there. What I usually see on SDN is the opposite - people leaving higher paying jobs to go into medicine because that's what they love. Obviously, you are not going to be happy. And you also will not be a doctor to advocate for patient or doctor rights. That takes a certain level of passion as a pre-requisite.

One thing that surprises me is this: since your main intention for choosing medicine was the income, and since you mentioned that you did calculations even before you went to med school, how come that in your calculations you were unable to figure out that you need to choose only certain specialties in order to receive the highest income? Don't you think that it is a huge miscaclulation to choose the lower paying field - primary care? If you were unable to match into any other specialty, I can understand. But otherwise, this just seems to be a major error. And the argument that in the past doctors used to get paid more doesn't really work because PCP has never been on top of the list in terms of compensation. My explanation for your choice (since I think you would be intelligent enough to not make such a gargantuan miscalculation) is that you chose PCP because it was the easiest route to becoming a doctor. Because you didn't like medicine much, you tried to pick the shortest geodesic shortcut in terms of your effort required in med school and the duration of residency.

Finally, income is not only specialty-dependent, but individual-dependent as well. These days it takes certain business acumen to make money. Almost no one relies on salary alone to build wealth, no matter how high that salary is (yes, even hedge fund manager salaries). In some states you can pay up to 45.3% tax (happens to be CA). If at the bare minimum you can't figure out ways to avoid at least part of the taxation, then right there half of your income is gone. I know PCPs who are very happy with their job. I also knew a surgeon who made good money but he hated his life and had no family. The nurses hated him too and always talked behind his back. What makes you think that if you had gone into specialty you would fare better? Maybe the income would be higher, but with no love whatsoever for what you do, can you imagine being on the job almost every hour of every day? I don't think you'd like that. The issue is not just income here.

Your story should be a good warning to anyone who goes into medicine only for compensation or hoping that primary care will be "good enough." It is also probably not a good idea to concentrate only on medicine and know nothing else. There is more to the world than medicine. If you have no idea about economics, whatever money you make, you'll squander it. I was told about a gardener who had a very modest salary. In a decade or so, this person had accumulated about 200K and quit his job. I don't know the rest of the story, but it shows that salary is only part of the big picture.

IM and general surgery were among the most competitive specialties 20-30 years ago. They also got compensated best. Also, money can make you like your job more. Sure I like seeing patients and helping them with their health, but I will like it more if you pay me well for it. Also I'll like it even more if I don't have to worry about lawyers and insurance/government taking my hard earned money. Things have changed, so I can see why macgyver feels the way he does. What if you go into a subspecialty of surgery because you can pay off your debt and you enjoy it... but lets say 20 years from now your compensation drops by 50% while your malpractice insurance goes up, wouldn't you be a little annoyed? Sure you may still like what you do, but you might like it less.