Advice for EM residencies

[DeadCactus]

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It's always the same thing. People who hate their career showing incredulous contempt toward people who take a lower salary to actually enjoy their career while making bad faith arguments about how they can't pay off hundreds of thousands of dollars in loans with only hundreds of thousands in income. They'll never make enough money to not regret their choices but they never take any steps to actually change anything. They'll give up millions in lifetime income to flame out and retire early but tell you how they can't give up a fraction of that to change careers all while showing they don't actually understand the realities or finances of the careers they are criticizing. They're Milton Waddams but have deluded themselves into thinking they are Peter Gibbons.

 

[dozitgetchahi]

I didn't have rich parents. I'm unclear why you insinuated this.

Took out loans. Like you.

Paid off all 400k (base + interest). Took 4 years. What's your excuse? Make better decisions.

So not interested in your whining on this, sorry. When you pay your loans off you tend to care less about others complaining about it, especially since you should have known the money needs repaid. I did. And I never once complained about loan payments, check my history. It's a responsibility to pay back what you owe. I did. You should too.

If all you care about is money you should have gone into finance. EM didn't work out for me but UM is. So I'm good now.

Big eye roll here.

My stuff is paid off too.

I’m going back to my original argument. It’s not wrong for doctors to want to be compensated properly for their work. Some arenas of medicine feature surprisingly low compensation for the time spent training for them. In IM, for instance, renal currently falls into that category. This is why renal hasn’t filled its training slots for several years, and has basically become as noncompetitive as EM.

 

[dozitgetchahi]

It's always the same thing. People who hate their career showing incredulous contempt toward people who take a lower salary to actually enjoy their career while making bad faith arguments about how they can't pay off hundreds of thousands of dollars in loans with only hundreds of thousands in income. They'll never make enough money to not regret their choices but they never take any steps to actually change anything. They'll give up millions in lifetime income to flame out and retire early but tell you how they can't give up a fraction of that to change careers all while showing they don't actually understand the realities or finances of the careers they are criticizing. They're Milton Waddams but have deluded themselves into thinking they are Peter Gibbons.

Ok, I’m out on this.

I’m actually a rheumatologist, BTW. So I have no dog in this EM discussion aside from pointing out why some folks may be choosing a different path.

I enjoy my job and feel I am compensated well for it. You’ve made a lot of assumptions about me that really aren’t accurate.

Over and out. I’m done with this discussion.

 

[Franzd'Epinay]

In medicine, I’ve seen the exact opposite happening.

A very large portion of academics in IM subspecialties either came from money or married a spouse with money. In my rheumatology department at fellowship, the majority of attendings fell into that category.

This is just confirmation bias. A large proportion of all physicians either came from money or married a high-achieving spouse. If you look at departments of high-earning specialties, you're also going to see tons of people with wealthy parents or people who married doctors/lawyers/bankers/etc. (For what it's worth, grouping the children of wealthy parents with the children of non-wealthy parents who happened married other high-achieving college classmates seems misguided, but it's the grouping strategy you chose, so I'll stick with it).

Like I mentioned, this is not an uncommon discussion topic on medical forums and people who hold the exact opposite opinion of you also authoritatively declare that their opinion is just "common sense" and aligns with what they've seen. Just pop into any discussion in which NYU's free tuition and student demographics comes up if you're curious.

 

[EctopicFetus]

People with no insurance/Medicaid see their pediatricians too - that’s why general peds (and peds subspecialties, which is what I was really referring to above, not peds EM) is paid so poorly relative to the rest of medicine.

Most kids have insurance.. it’s just Medicaid. In my experience pediatricians and doctors offices as a whole make no real effort to see these Medicaid patients. When most of your patients are Medicaid (be it peds em or regular peds) it’s gonna be tough to do well. It also makes little sense to go above and beyond for those patients. There is no competition on the provider side to see these patients, etc etc.

 

[WhatJobDoIPick]

I'm fine with people going whatever route they want to, just don't expect perks (loan forgiveness) because you wanted to mess around in la la academic land while the actual docs are generating RVUs.

 

[EctopicFetus]

I'm fine with people going whatever route they want to, just don't expect perks (loan forgiveness) because you wanted to mess around in la la academic land while the actual docs are generating RVUs.

I think the self importance of the ivory tower people particularly in EM is pretty funny. I wish each practicing EM doc the best. I truly do. That being said decisions have consequences and don’t expect me to feel bad about the repercussions of your decisions including the ones that get changed on the fly.

 

[dozitgetchahi]

I'm fine with people going whatever route they want to, just don't expect perks (loan forgiveness) because you wanted to mess around in la la academic land while the actual docs are generating RVUs.

Exactly.

 

[Tenk]

I know this may sound like a shock to you

But many of us graduated with hundreds of thousands of dollars in debt and don’t have a set of rich parents or spouse who are going to pay it off.

We need a plan to pay our ****

And training to do medicine is a long, hard road

Some of us actually want a good return on investment for all the blood sweat and tears (and years) that went into it.

There’s nothing wrong with this

We need to stop chastising doctors for wanting to actually be paid properly (and for choosing to avoid avenues where they will be paid a lot worse).

Go to almost any other country outside the US and like the UAE and look at what doctors make. It’s only downhill from where we are.

 

[EctopicFetus]

Go to almost any other country outside the US and like the UAE and look at what doctors make. It’s only downhill from where we are.

This is an interesting discussion. Other things they dont have.. The crazy hours, DTC pharma advertising, patient satisfaction, crippling student loans, many countries the path from HS to MD is shorter

As a non burnt out EM doc I do think medicine even with all the pain is the one clear path to guaranteed wealth in America. “Law”, “business” etc come with no promises. I also think medicine as a career shines when the economy tanks. We have been doing pretty well for a while (since 2008). Covid hurt lower wage workers but not most white collar workers.

 

[Tenk]

This is an interesting discussion. Other things they dont have.. The crazy hours, DTC pharma advertising, patient satisfaction, crippling student loans, many countries the path from HS to MD is shorter

As a non burnt out EM doc I do think medicine even with all the pain is the one clear path to guaranteed wealth in America. “Law”, “business” etc come with no promises. I also think medicine as a career shines when the economy tanks. We have been doing pretty well for a while (since 2008). Covid hurt lower wage workers but not most white collar workers.

There’s really no such thing as “crippling student loans.” We’re talking orders of magnitude higher salary. I made more as a resident than some of the ED attendings in Beijing. Then my salary multiplied by almost 10 when I graduated.

Most developed nations also have significantly higher taxes than the US. They make less money and get taxed more. So even if you’re putting 5k+ post tax money a month towards student loans to pay them off in less than 5 years like I did (paid off 400k, 350k for me and 50k for wife’s loans), you’re still making way more money than other physicians and then at the end of five years you get a huge monthly bonus.

There’s nothing crippling about our debt. In fact, it’s our greatest ally. We use it to justify higher pay. Take it away and have free medical school and watch our salary plummet. Guaranteed.

 

[EctopicFetus]

There’s really no such thing as “crippling student loans.” We’re talking orders of magnitude higher salary. I made more as a resident than some of the ED attendings in Beijing. Then my salary multiplied by almost 10 when I graduated.

Most developed nations also have significantly higher taxes than the US. They make less money and get taxed more. So even if you’re putting 5k+ post tax money a month towards student loans to pay them off in less than 5 years like I did (paid off 400k, 350k for me and 50k for wife’s loans), you’re still making way more money than other physicians and then at the end of five years you get a huge monthly bonus.

There’s nothing crippling about our debt. In fact, it’s our greatest ally. We use it to justify higher pay. Take it away and have free medical school and watch our salary plummet. Guaranteed.

I agree here. We use debt as leverage.

I owed 450k when i finished residency. Crippling is real. You can make 300k and live in california, have your debt at 7% and owe 450k. Suddenly, the debt is chewing up half of what you bring home? Throw in trying to save for retirement or for a down payment.. its crippling. I managed my situation differently and it was good for me but man oh man.. paying 7k a month for student loans is not a joke if you want to be debt free in 5 years. Again, you dont have to work for low rates and low hours. Then again its doable. Painful but doable.