Well, it's very easy to make these kinds of moral arguments but they add nothing to the discussion. They don't address the issue of the ridiculous cost of medical education. They don't address the abysmal salaries of PCPs when you look at the costs (both real and opportunity) to become one. It adds nothing to the discussion other than inserting your own thinly veiled moral superiority. So while that statistic is an interesting one, it has no relevance on what is being discussed.
With respect to your comment above - the one I didn't reply to - you're making so many assumptions that really are questionable or even wrong. A partner that makes six figures (I know my partner doesn't make six figures, most med students that are in relationships don't have partners that make six figures, and most med students aren't even in relationships based on my experience)? IBR as a worst-case scenario (not even true if your loans aren't federal loans - IBR applies only to government-guaranteed loans)? Your loan payments being tax deductible (not even true, and even then, the tax deduction is limited to $2500)? Being a dirty beggar? Once again, these things do nothing to further the discussion and really detract from it by artificially setting up a black-and-white argument and making the choice one or the other.
How about this: I know you're going into medicine because you really want to save those lives and really want to help people. There - now can we have some actual discussion?
Alright, alright. I was going a bit overboard. You're right, the limit is $2,500, which I wasn't aware of, as I have never gone through the process before. So that means you get to deduct $2,500 from that and likely 2/3 of a 30 year mortgage payment. If you're making 10k of payments, that means you're deducting 25%, along with 67% of your mortgage, which will likely equal a good sum of your total taxes without factoring in any other expenses. Anyone who uses private loans for medical school is foolish, and they are getting what they agreed to when they get screwed in the end. And fine, your spouse might not make six figs, but even if they make 50-60k, your income just got a substantial boost and you are doing pretty well for yourselves. For any further arguments though, I'm ignoring tax deductions and assuming we're just pissing our money away and not using them.
And the 1.2% was not a moral argument. It was an objective, mathematical argument. How good do you need to be doing to feel okay about your life? Better than 1 in 1,000 people? 1 in 10,000? How your income correlates to the income of others is what has been shown to be the biggest factor in happiness, not the amount of income itself. That is why I used this measure, not for moral reasons. What do you need your compensation to buy you to feel happy with your life? That is what you need to ask yourself. Do you need a million dollar home, a yacht, private school for both kids, etc? Or do you need a home that is decently sized for you and your family, in a nice neighborhood with good schools, a decent luxury car, and a good vacation once or twice a year? What are you looking for that 2ook cannot buy you, that's what I would like to know. Where I come from, 200k a year could buy you basically everything- private school, the nicest house in the area (literally- it has a market value of about 500k), vacations, etc, with plenty of money left over. I actually ran the numbers once and calculated that you could get a good 250k home, a used Robinson R22 helicopter, a new Ferarri California, and a smaller used luxury yacht on an income of about 250k, so if you and your spouse pool your money, you can have it all for a fairly reasonable sum if you pick your location carefully. Only in the big cities is 200k not enough, and that is the sacrifice you make for choosing to live in them. 100k is where it gets dicey for medicine- I would leave the field if incomes got that low, but they likely never will.
People always assume that my arguments are moral. Let me just lay it out for you- if medicine didn't pay over 130k a year, I would never, ever go into it. You can't take care of other people if you don't take care of yourself first. The closest thing I have to a moral argument in this is that I think people are obsessively materialistic, and that to many people, medicine is just a road by which they acquire useless shiny crap. I don't understand why people purchase, say, a new 4 bedroom home that costs 500k versus one that costs 250k, so long as both are safe and in nice neighborhoods. To me, they're both more than adequate for a family of four. I don't get why people need to buy $10,000 80 inch LED TVs, when you can get a decent and quite large LCD for $2,000. I can't fathom why someone would buy a 2 million dollar sports car when they can get a car that will go faster than they will ever drive for 100-150k. I don't get why people live lifestyles that cost more than they earn, when if they cut back, they could retire at 45 instead of working like slaves to pay for a bunch of **** they don't need till they're in their 70s. All this fancy crap that they sell to you, every brand, every luxury product that costs you a fortune, all that perceived value is in your head and doesn't make a damn bit of difference in the grand scheme of things. A house is a house, a fridge is a fridge, a car is a car, etc. I make upwards of 70k a year and even now don't know what to do with it because I've got everything I need, so I just save it and occasionally go on long vacations. I can't even imagine what I'll do with an income that's 3-5x what I make now. So money isn't as big a factor for me, but not because of the moral side of things. I just don't see any utility in making a whole lot more money than I do now. There really isn't anything I can do with it that I don't already. The only reason I want an income of over 130k is so I can save money faster and retire significantly earlier while living a very modest lifestyle.
We were talking about finances in the future of medicine, not how unfair primary care is. That's a whole different discussion that requires a lot of policy talk that I don't have the time for today.
Surviving on 250k a year (200k physician+50k partner, 250k physician, whatever you want, mix it up):
After Tax Income in My Home State: $183,000
Monthly After Tax: $15,250
Ferrari California Payment: $3,038
Used Small Luxury Yacht, Priced 375k, Payment: $3,175
Robinson R22 Helicopter, Used, Priced 100k, Payment: $1,520
Mortgage, 250k starting balance, 30 year: $1,230
Student Loan Payment with IBR: $1,667
Ascot and Luxury Flippy Floppies: $150, one time expense
Total After Taxes Per Month: $4,620
Total After Taxes Cash Per Year: $55,400
Truly, a horrid life awaits us if physician salary drops to 200k across the board. If things get really tight, you could always cut out the yacht and helicopter, then downsize that Ferrari to a BMW or Audi and save yourself around $6,000 per month, pushing your total disposable income after taxes and expenses well beyond 100k. If you can't live off 200-250k, you're pretty bad at finances.
