A thread with 71,000 hits

[jetproppilot]

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I wrote it a few years ago.
Very controversial. I believe it is

more important now than ever before.

The "elders" moved it to the

TOPICS IN HEALTHCARE

site.

A must read for med students in our current day society.

 

[cincincyreds]

Jet, good post, just read some of it.

I deal with a lot of medical students and anesthesia residents as they rotate through my room. They have no concept of money, no concept of debt, and no concept of what is wrong with medicine. They have no idea how debt compounds, no that a student loan has an interest rate of 6.8%.

It is sad. The medical schools teach nothing about personal finance. They just tell you to take out as much as allowable and everything will be okay.

I think we can teach medical students about debt and personal finance. Maybe we should have a separate forum. Whitecoatinvestor, who is an ER physician, has a wonderful website that discusses multiple concepts of personal finance from life insurance, 401ks, IRAs. I read the articles and have learnt plenty.

 

[scudrunner]

1) what thread is it?

2) why the f**k is Jet's account on hold again? The dude should be a mod himself.

 

[IlDestriero]

1) what thread is it?

2) why the f**k is Jet's account on hold again? The dude should be a mod himself.

http://forums.studentdoctor.net/showthread.php?t=509725

It's hidden by the mods and/or admin in the topics in health care forum, so it will quietly die. I guess some can't handle the truth. As to why he's on hold again, I would bet a coarsely worded pm to a mod re moving his thread or to the dude that called him an illiterate troll. Probably the latter.
The moderation around here isn't exactly uniform, and we have it pretty good.

 

[scudrunner]

I owed nearly 200K in student loans when I graduated from med school.

After deferring said loans in residency, that amount was a solid 200K.

Yep, like alotta you out there, I had to personally pay for my education.

As a fourth year med student, I thought pragmatically....

hmmm.....

I owe X amount.

Debt is an anchor.

I wanna pay off my debt, but still be happy.

BOOM!!!

A light goes off in my head. I'm gonna specialize.

Now 11 years into private practice.....student loans paid off years ago....money no longer an issue...

I wanna hear from the med students going into primary care with 200K in student loans.

What motivates a dude/dudette to go into a specialty where monetary reimbursement is less than some nurses?

Are there really philanthropic people left out there, concerned about societal issues in medicine?

If you are a med student reading this, do you think you'll think the same way after your residency is over?

Can one be comfortable with the fact that after 4 years of college, 4 years of med school, then residency, you've selected primary care as your profession which puts you behind the eight ball financially?

BTW....one of the most conflicting issues in marriages is....MONEY.

So, again, why would a med student select primary care?

(rich family prodigies out there, you dont count)

Five years outta residency your focuses will be different.....family.....hobbies....

I read a post in this FM section about personal finance.....went something like...."its OK to rent..."

WTF?

You're gonna endure pre-med/med school....business major colleagues are sittin' out by the pool while you're in the study lounge cramming for an organic chem final...or 1st year med school biochem....2nd year pathophys... endure 3rd year clinicals......then select a career where the reimbursement suks to the point where you haffta rent?

Cummon....

This post is not for the FP people who have already selected their fate.

This post is for med students reading this who are trying to figure out what they want to do with the rest of their lives....

I'm 11 years out of residency. Specialist. Love my job. Plenty of time off. Money not an issue anymore.

My student loans are long gone.

I didnt make the rules.....

....the rules are.....

...specialists make more than twice that of primary care docs.

And pick your specialty wisely, you'll make twice-bank with 9-12 weeks vacation.

So I'm wondering why med students would want to go into primary care.

Yep, an inflammatory thread.

But I wanna know, and YOU DESERVE TO KNOW WHAT YOUR MED SCHOOL ACADEMIC "ADVISORS"

aren't telling you, which is being saddled with 200k student loans and selecting primary care is FINANCIAL SUICIDE.

P.S. : If your dad has paid for college/med school/condo during residency, your opinion doesnt count.

 

[scudrunner]

Not really relavent to us since we are already sold on anesthesia.

 

[Postictal Raiden]

I know this may be off topic...

However, I could help but to realize that 200K of debt in 1997 is ~300K in today's money. I guess medicine IS worth 300K.

 

[EdPierce]

I think that this is still a valid question for anyone graduating from medical school regardless of who paid. why on earth would someone go into primary care with all of the other higher paying options? I think most of these folks are:

women who want to work part-time for family reasons
and/or their income is not the sole income
and/or looking for a short and easy residency possibly in a competitive location
and/or a FMG who could not match into anything else they liked
and/or a man or woman who barely got into medical school and is not into the crazy study for a million hours game and is disheartened by the whole thing and just wants to be a "doctor" and get out

 

[leaverus]

and/or a man or woman who barely got into medical school and is not into the crazy study for a million hours game and is disheartened by the whole thing and just wants to be a "doctor" and get out

i dont think there are any people who "barely" get into med school. its way too competitive for that. you either get in or not. now getting out of med school is a different matter...

 

[smq123]

I think most of these folks are:

women who want to work part-time for family reasons

Single, no kids. No real desire to have children. No problem working 60 hours a week if I had to.

and/or their income is not the sole income

See above, but if you honestly cannot reasonably support a family of four on the average FM income, you're an idiot.

and/or looking for a short and easy residency possibly in a competitive location

Anesthesia's also a relatively short residency, as things go. And there are easier residencies than FM.

and/or a FMG who could not match into anything else they liked

Graduated from an MD school in Philadelphia.

and/or a man or woman who barely got into medical school and is not into the crazy study for a million hours game and is disheartened by the whole thing and just wants to be a "doctor" and get out

No....I studied pretty hard. Felt like that was all I did, sometimes.

I think that this is still a valid question for anyone graduating from medical school regardless of who paid. why on earth would someone go into primary care with all of the other higher paying options?

Ummmm....because I like it?

Because....it's not all about money?

Seriously, I enjoy my job. I like seeing patients in an office. There's an endless variety of problems, some small procedures. Dealing with insurances suck, but that's a problem in gen surg, psychiatry, cardiology, pulmonology, etc.

There's incredible geographic flexibility in FM. You can work in pretty much any type of setting, and there's a high demand all over the country.

My hours are regular. I'm pretty consistently done by 5. I don't work weekends. Call, which we take every 6 weeks, is a joke. I don't admit, I don't go anywhere at night, and I barely get called.

I don't have loans, thanks to federal primary care scholarships (and again, if you go into primary care and can't find someone to help defray your loan burden, you're also an idiot) and smart saving while a med student.

I never wanted to do anesthesia. It just never interested me. But I like my job, I like my patients, and I like what I do. There isn't another field that offers these kinds of regular hours with the same kind of variety and flexibility.

 

[doctor712]

I don't have loans, thanks to federal primary care scholarships (and again, if you go into primary care and can't find someone to help defray your loan burden, you're also an idiot) and smart saving while a med student.

I never wanted to do anesthesia. It just never interested me. But I like my job, I like my patients, and I like what I do. There isn't another field that offers these kinds of regular hours with the same kind of variety and flexibility.

Curious,

What did you earn/save during medical school? How many hours a week and during what years were you working?

Also, what about Hospitalist, I know a few people who went this route and are paid pretty well. 2 weeks on 2 weeks off...? I call that relatively flexible. Is Hospitalist considered primary care for repaying loans and gov subsidy?

D712

 

[Gern Blansten]

What did you earn/save during medical school? How many hours a week and during what years were you working?

I suspect he meant being frugal and not just taking the max student loans and maxing out credit cards like some tend to do.

Also, what about Hospitalist, I know a few people who went this route and are paid pretty well. 2 weeks on 2 weeks off...? I call that relatively flexible. Is Hospitalist considered primary care for repaying loans and gov subsidy?

Hopsitalist seems to be a pretty good gig, and I am, at times, a bit jealous of the schedule they have. Pretty fair reimbursement as well. I suspect you could have an entirely different job you could do on your two weeks off if you did not want that much time off.

One of the reasons I always hated the initial thread was because it was written on the family med forum with the intent to incite them. It did, and that is why it got so many hits (besides the fact that the original poster linked to it from other forums and brought it back from page 5 about every 3 months). I believe that the Family Medicine people are on our same team and to try and marginalize them in that way was wrong. There are better ways to get the intended message out without inciting a riot. The FM guys face similar issues as us in their battle against encroachment by mid-level providers (as does every specialty). Anesth and FM are just the most visible. It seems we should be on the same team instead of tearing each other down. Just my opinion.

 

[pgg]

I think that this is still a valid question for anyone graduating from medical school regardless of who paid. why on earth would someone go into primary care with all of the other higher paying options? I think most of these folks are:

women who want to work part-time for family reasons
and/or their income is not the sole income
and/or looking for a short and easy residency possibly in a competitive location
and/or a FMG who could not match into anything else they liked
and/or a man or woman who barely got into medical school and is not into the crazy study for a million hours game and is disheartened by the whole thing and just wants to be a "doctor" and get out

Some people like being a person's doctor, seeing them in clinic, getting to know them over many years, maybe taking care of their family too. That's not what I want, but they are every bit the doctors we are. I would really, really struggle to stay on time in a clinic seeing a lot of patients sequentially without turning into an impatient jerk by 3 PM.

Salaries are 80% market forces and 20% deserved in just about every field of medicine.

 

[ED50]

Honest question for all the docs out there. How much is enough money? I will graduate with around 270k debt which works out to about 2k a month base payment back. I had always heard to not take out more then one year salary in debt so is 270 a good number to shoot for in any given area of medicine as a salary (I know this is impossible in certain areas). More or less? I'm interested in some practical advise from people who actually have paid or are paying down their debt now.

 

[yappy]

I'm not a doctor but let me give you my number. Based on the type of life I want to provide for my family, and the projected costs (less than your total education costs), my goal for "enough" money is 20k post tax in today's dollars / month. Shoot for 20k post tax in today's dollars per month and you will be fine.

Honest question for all the docs out there. How much is enough money? I will graduate with around 270k debt which works out to about 2k a month base payment back. I had always heard to not take out more then one year salary in debt so is 270 a good number to shoot for in any given area of medicine as a salary (I know this is impossible in certain areas). More or less? I'm interested in some practical advise from people who actually have paid or are paying down their debt now.

 

[pgg]

I'm not a doctor but let me give you my number. Based on the type of life I want to provide for my family, and the projected costs (less than your total education costs), my goal for "enough" money is 20k post tax in today's dollars / month. Shoot for 20k post tax in today's dollars per month and you will be fine.

You know that's below the poverty line, right?B (About $22K for a family of 4.)

ETA - never mind, I have a reading comprehension problem. Just saw you meant per month.

 

[smq123]

Curious,

What did you earn/save during medical school? How many hours a week and during what years were you working?

I didn't work. The Primary Care Scholarship came with a monthly stipend; I saved as much of that as I could and used it towards loans.

I know of some people who do pick up a few shifts as an EMT or an RN to help pay for med school. I also heard of one person who was a skilled poker player who would participate on online poker tournaments on weekends after exams, and used his earnings towards paying off his tuition. I was not one of these people.

Also, what about Hospitalist, I know a few people who went this route and are paid pretty well. 2 weeks on 2 weeks off...? I call that relatively flexible. Is Hospitalist considered primary care for repaying loans and gov subsidy?

Hospitalist medicine is not primary care. It is available to people who have completed traditionally primary care specialties (IM, FM), but it is not primary care.

I believe that the burnout rate is pretty high. Yeah, 2 weeks on, and 2 weeks off, is nice, but that means working every other weekend. If you don't have children, or if they're grown, no big deal. But for people who have young children, it can be a bit of a strain.

The pay is a bit higher than traditional primary care, but they are frequently the punting service for everyone and take a fair amount of abuse from the ER, nurses, ortho, surgery, etc. They're also at the mercy of hospital politics, which is another cause for burnout.

One of the reasons I always hated the initial thread was because it was written on the family med forum with the intent to incite them. It did, and that is why it got so many hits (besides the fact that the original poster linked to it from other forums and brought it back from page 5 about every 3 months). I believe that the Family Medicine people are on our same team and to try and marginalize them in that way was wrong. There are better ways to get the intended message out without inciting a riot. The FM guys face similar issues as us in their battle against encroachment by mid-level providers (as does every specialty). Anesth and FM are just the most visible. It seems we should be on the same team instead of tearing each other down. Just my opinion.

Well said. Totally agree. 👍

 

[deleted307836]

smq - thank you for providing this perspective on FM; it's one I haven't seen well represented on SDN so far. 👍

 

[Arch Guillotti]

one of the reasons i always hated the initial thread was because it was written on the family med forum with the intent to incite them. It did, and that is why it got so many hits (besides the fact that the original poster linked to it from other forums and brought it back from page 5 about every 3 months). I believe that the family medicine people are on our same team and to try and marginalize them in that way was wrong. There are better ways to get the intended message out without inciting a riot. The fm guys face similar issues as us in their battle against encroachment by mid-level providers (as does every specialty). Anesth and fm are just the most visible. It seems we should be on the same team instead of tearing each other down. Just my opinion.

qft.

 

[yappy]

NP. I figure... 10k to "live" on per month + 10k to invest per month in retirement would be a great lifestyle for my [future] family. The hard part is making it a reality - then the more challenging part will be keeping it a reality for a 40 year career.

You know that's below the poverty line, right?B (About $22K for a family of 4.)

ETA - never mind, I have a reading comprehension problem. Just saw you meant per month.

 

[BLADEMDA]

I'm not a doctor but let me give you my number. Based on the type of life I want to provide for my family, and the projected costs (less than your total education costs), my goal for "enough" money is 20k post tax in today's dollars / month. Shoot for 20k post tax in today's dollars per month and you will be fine.

That's impressive. You are correct about the $20K post tax to live a very nice lifestyle. In fairness, $15K post tax is enough to live well but $20K gets you that BMW and several nice vacations per year.

Now, here comes the kicker: How much money must you earn to generate $20K post Tax based on Obama's tax code in 2013? Remember, you must fund a 401K/IRA, pay health care plan/expenses, disability policy, etc.

I think you will be suprised to see how much pre-tax money (W-2) it takes to get $20K after deducting taxes (all taxes) and necessary expenses (health, 401K, disability)

 

[ED50]

I'm not a doctor but let me give you my number. Based on the type of life I want to provide for my family, and the projected costs (less than your total education costs), my goal for "enough" money is 20k post tax in today's dollars / month. Shoot for 20k post tax in today's dollars per month and you will be fine.

It's funny you put down 20k post tax a month since that is the number I have been running around in my head when I have been calculating out feasible payment options for my debt. If all goes according to plan post residency I will have 270k in debt. Payments will be 2k a month. 8k/month to live on 10k/month repayment for the first year, 7k/month for the second year and then 5k/mo after that.

It may be a bit too aggressive but if it is feasible then my debt will be eliminated in about three years. The question as Blade put it is, how much will yield 20k post tax.

I'm still very new to the investment game if I understand correctly, 401k, ROTH, the interest on my student loans, and mortgage are all tax deductible. The goal being to lower my taxable income to sub-250. At 20% interest rate my take home is 175 or 14.5k a month after my mortgage, retirement, and student loan interest is paid for.

Is this feasible or not?

 

[BLADEMDA]

It's funny you put down 20k post tax a month since that is the number I have been running around in my head when I have been calculating out feasible payment options for my debt. If all goes according to plan post residency I will have 270k in debt. Payments will be 2k a month. 8k/month to live on 10k/month repayment for the first year, 7k/month for the second year and then 5k/mo after that.

It may be a bit too aggressive but if it is feasible then my debt will be eliminated in about three years. The question as Blade put it is, how much will yield 20k post tax.

I'm still very new to the investment game if I understand correctly, 401k, ROTH, the interest on my student loans, and mortgage are all tax deductible. The goal being to lower my taxable income to sub-250. At 20% interest rate my take home is 175 or 14.5k a month after my mortgage, retirement, and student loan interest is paid for.

Is this feasible or not?

The interest on your student loans are deductible when you earn over $250K? I think not. Also, what makes you so sure Obama will allow you to deduct the full interest cost of your mortgage?

How do you generate $20K after tax income per month while lowering your income below $250 per year? The math just doesn't add up.

Realistically, you will need to earn $350-400K per year to take home $20K per month after taxes, retirement plan deduction, family health care, social security tax, Medicare tax (higher in 2013), state tax and federal income tax (? 39.6 percent for everything over ??).

I bet once you are earning that $400K but taking home $21k per month so millions of Americans can avoid working you won't be such a big Obama fan.

 

[yappy]

Blade, that is where I came up with that number. All the OMFS I shadowed were open with me about how their practices were performing and how much they had as a draw. I hope to emulate their success!

After ins - for 20k in my state with four dependents - I would need ~340k pretax to reach 20k at current tax rates. This is just a personal goal that I have... among others that are non-financial. I hope I can make it happen because this process has been a lot of hard work; although, rewarding thus far.

The interest on your student loans are deductible when you earn over $250K? I think not. Also, what makes you so sure Obama will allow you to deduct the full interest cost of your mortgage?

How do you generate $20K after tax income per month while lowering your income below $250 per year? The math just doesn't add up.

Realistically, you will need to earn $350-400K per year to take home $20K per month after taxes, retirement plan deduction, family health care, social security tax, Medicare tax (higher in 2013), state tax and federal income tax (? 39.6 percent for everything over ??).

I bet once you are earning that $400K but taking home $21k per month so millions of Americans can avoid working you won't be such a big Obama fan.

For the record I'm not a fan of Obama now. lol.

 

[BLADEMDA]

Blade, that is where I came up with that number. All the OMFS I shadowed were open with me about how their practices were performing and how much they had as a draw. I hope to emulate their success!

After ins - for 20k in my state with four dependents - I would need ~340k pretax to reach 20k at current tax rates. This is just a personal goal that I have... among others that are non-financial. I hope I can make it happen because this process has been a lot of hard work; although, rewarding thus far.



For the record I'm not a fan of Obama now. lol.

$340 based on 2012 tax rates may mean $360 based on 2013 tax rates.

 

[ED50]

The interest on your student loans are deductible when you earn over $250K? I think not. Also, what makes you so sure Obama will allow you to deduct the full interest cost of your mortgage?

How do you generate $20K after tax income per month while lowering your income below $250 per year? The math just doesn't add up.

Realistically, you will need to earn $350-400K per year to take home $20K per month after taxes, retirement plan deduction, family health care, social security tax, Medicare tax (higher in 2013), state tax and federal income tax (? 39.6 percent for everything over ??).

I bet once you are earning that $400K but taking home $21k per month so millions of Americans can avoid working you won't be such a big Obama fan.

Correct me if I am wrong but, retirement, student loans, mortgage and business related expensive are all deductible right off the top of my income. For me, that could easily equal 60k or more. I guess the 20k a month and below 250 taxable income is not too practical. It is either that or IBR which is looking pretty appealing but somewhat uncertain.

Oh, and I'm confident the mortgage deduction will be around since this is one of the largest middle class tax cuts.

 

[IlDestriero]

Correct me if I am wrong but, retirement, student loans, mortgage and business related expensive are all deductible right off the top of my income. For me, that could easily equal 60k or more. I guess the 20k a month and below 250 taxable income is not too practical. It is either that or IBR which is looking pretty appealing but somewhat uncertain.

Oh, and I'm confident the mortgage deduction will be around since this is one of the largest middle class tax cuts.

Student loan deductions are minimal and phased out by income. You will probably qualify in residency, but not as an attending.
Retirement contributions are limited as well, though are more generous if you're self employed.
There is no reason that they couldn't phase out the mortgage deduction completely based on income, or limit it to a set amount (say up to $25,000).
Or they could limit all deductions to a set amount, regardless of income. (again, maybe around $30,000)
That would shaft us, the professionals, and protect the "middle class".
Some business expenses are deductible, but again, it varies greatly depending on your employment status and is subject to change or phasing out by income in the future.
IBR is great if you qualify and they don't change things on you in the future. I wouldn't count on it in my retirement planning.
There's no magic about getting your income below $250k either.

 

[ED50]

Student loan deductions are minimal and phased out by income. You will probably qualify in residency, but not as an attending.
Retirement contributions are limited as well, though are more generous if you're self employed.
There is no reason that they couldn't phase out the mortgage deduction completely based on income, or limit it to a set amount (say up to $25,000).
Or they could limit all deductions to a set amount, regardless of income. (again, maybe around $30,000)
That would shaft us, the professionals, and protect the "middle class".
Some business expenses are deductible, but again, it varies greatly depending on your employment status and is subject to change or phasing out by income in the future.
IBR is great if you qualify and they don't change things on you in the future. I wouldn't count on it in my retirement planning.
There's no magic about getting your income below $250k either.

Thanks for clearing some of that up. I didn't know about the student loan deduction phase out. I just looked it up and you are correct, most physicians won't qualify <175k a year if filing jointly. Well, it's a learning process I guess

 

[yappy]

It is a learning process... what I'm finding is that every loop hole, strategy, or assumption I make has already been thought of as I discover a law or policy that directly negates it. For example, growing up as a lower middle class kid, I had all these assumptions about writing off student loan interest, home loan, etc. till I learned about the income threshold that currently exist. Also, there was a thread earlier on this forum that discussed setting up a corp and paying yourself a low salary; however, that will get you in trouble with the IRS. It's as if they've thought of every way to screw middle/upper-middle class families.

Thanks for clearing some of that up. I didn't know about the student loan deduction phase out. I just looked it up and you are correct, most physicians won't qualify <175k a year if filing jointly. Well, it's a learning process I guess