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Hey all, sometimes I feel like I'm "wasting" my potential and usually I wouldn't care but my debt burden sure does make me feel that way.

I've been interested in peds from the get-go (specifically heme/onc peds). However, by graduation I'll be 600k in debt. I go to a low-rank school, but am currently ranked #1 or close to it (we don't know our exact rankings but I've gotten a 100 on every pre-clin exam but one), and I killed Step 1 (265+), have decent research, work, leadership, etc.

My classmates more than likely think I'm a decent/above average student, and encourage my pediatric path but they are unaware of my debt burden and how competitive my profile actually is. Have any of you made different choices with your debt burden if you had the opportunity?

I was also pretty 50/50 between IM and Peds - would a Med/Peds path possibly help alleviate some of this debt burden (could work as a hospitalist and pay this bad boy down, for example). I also really do love the idea of the "complete" education a Med/Peds residency gives you.
 
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IMGASMD

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Have you done with all your rotations? I would say pick something you actually want to do and let the money sort it out. You don’t want to pick something for high earning quality then in 5-10 years hate it and wonder about “what if”

Anesthesia, ENT both can be more “lucrative” than straight up med/peds. But more procedure oriented.

Pick something you can stomach for a long time. You came in Med school KNOWING you’ll be in debt for a long time. You still choose to come, don’t forget that when you pick a speciality.
 
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What year are you? What rotations have you done? Hem/Onc would definitely help you pay down that debt. If you love peds, you could do peds ED, peds hospitalist, peds intensivist, peds cardiologist, etc. But don't try to make a decision until you have done your core rotations. You might fall in love with a different specialty entirely! Choose something you love, and plan to live below your means until that debt burden is erased (it isn't that hard to do).
 
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Well, tbh, with that debt burden, your best bet if you really wanna do med-peds or ped heme onc etc. is to definetly do PSLF. You have to be proactive about PSLF though, and I think the general consensus is you don't want to rely completely on it in case it doesn't work out and things go south. So knowing that, it's feasible to do pediatrics... but that risk is upto you to take.

IM + adult heme onc also pays like 3x as much as ped heme onc, so that's feasible to do and not worry about PSLF
 
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AMEHigh

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Get the thought out your mind that your’e wasting your potential. A neurosurgeon is no better than a primary care doctor. We’re all intelligent.

As far as debt goes, well yes I think that’s something that people should consider. Debt certainly does affect life choices such as retirement savings, where to live, if/when to have kids, etc.
With that said if being a pediatrician is the only specialty you enjoy then that’s what you should do.

I’m in a "low paying" specialty in a high cost of living location but I absolutely love what I do and wouldn’t change anything. Sure it’d be nice if I didn’t have to pay so much in loans every month, but at this point I just look at it like a necessary bill like my mortgage.
 
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Get the thought out your mind that your’e wasting your potential. A neurosurgeon is no better than a primary care doctor. We’re all intelligent.

As far as debt goes, well yes I think that’s something that people should consider. Debt certainly does affect life choices such as retirement savings, where to live, if/when to have kids, etc.
With that said if being a pediatrician is the only specialty you enjoy then that’s what you should do.

I’m in a "low paying" specialty in a high cost of living location but I absolutely love what I do and wouldn’t change anything. Sure it’d be nice if I didn’t have to pay so much in loans every month, but at this point I just look at it like a necessary bill like my mortgage.

Yeah, it's funny, everyone's general advice is "pick what you want", then you hear attendings hate on other specialties... I think the newer generation cares less about that, though.
 
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a lot of specialties have a peds fellowship so it's not like you HAVE to do a peds residency to work with children. You can do radiology -> peds radiology, anesthesia -> peds anesthesia, surgery -> peds surgery, psych -> adolescent/child psych, ortho -> peds ortho. Unless you are gung-ho on inpatient pediatrics or pediatric primary care, then you can definitely consider these other options and try to have your cake & eat it too.
 
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Thanks guys!

I think a lot of it just seeing my classmates, many who came from $$$ backgrounds live in their dope apartments, travel the world on breaks, etc., and I've never gotten to do that - never left my state, live far away from campus in a ****ty apartment, etc. I guess I was starting to get nervous that that would continue as a physician, but I just gotta understand even with that debt and a peds salary, I'll still be living 1000x better haha.

And yeah I still have some rotations to get through, the only thing I've truly excluded is surgery and what I absolutely need is longitudinal care and inpatient.

Thanks again <3
 
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deleted480308

Hey all, sometimes I feel like I'm "wasting" my potential and usually I wouldn't care but my debt burden sure does make me feel that way.

I've been interested in peds from the get-go (specifically heme/onc peds). However, by graduation I'll be 600k in debt. I go to a low-rank school, but am currently ranked #1 or close to it (we don't know our exact rankings but I've gotten a 100 on every pre-clin exam but one), and I killed Step 1 (265+), have decent research, work, leadership, etc.

My classmates more than likely think I'm a decent/above average student, and encourage my pediatric path but they are unaware of my debt burden and how competitive my profile actually is. Have any of you made different choices with your debt burden if you had the opportunity?

I was also pretty 50/50 between IM and Peds - would a Med/Peds path possibly help alleviate some of this debt burden (could work as a hospitalist and pay this bad boy down, for example). I also really do love the idea of the "complete" education a Med/Peds residency gives you.
Potential as a human or earning potential?
 
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Are you married? If your spouse is a high earner, this changes the equation. If not, I’d strongly consider a higher paying specialty with lifestyle friendly hours given your debt burden and intelligence (high)
 
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Are you married? If your spouse is a high earner, this changes the equation. If not, I’d strongly consider a higher paying specialty with lifestyle friendly hours given your debt burden and intelligence (high)

Not married, long-term partner is a zoologist (so not big $$) but hey her Twitch is starting to take off lmao.

We're both against having kids, which is at least helpful. I still have a year or so to make these decisions - what specialties should I be on the lookout for if I really enjoy Peds and to an extent behind peds, IM?
 
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If you don't mind discussing how did you rack up this much debt? - Did you take out over 300k in loans?

I second the PSLF suggestion, if you don't do that it seems like it could take 20 years to pay that off if you're a peds doc.
 
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$600,000 in debt, how?

If you don't mind discussing how did you rack up this much debt? - Did you take out over 300k in loans?

I second the PSLF suggestion, if you don't do that it seems like it could take 20 years to pay that off if you're a peds doc.

Undergrad + Grad + private MD school

Was a high MCAT / low uGPA applicant with only 1A when after applying so had no choice med school wise. Family was in a precarious position during my undergrad/grad years, and so a lot of my extra income went to them rather than to paying down loans outside of interest.
 
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AMEHigh

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Thanks guys!

I think a lot of it just seeing my classmates, many who came from $$$ backgrounds live in their dope apartments, travel the world on breaks, etc., and I've never gotten to do that - never left my state, live far away from campus in a ****ty apartment, etc. I guess I was starting to get nervous that that would continue as a physician, but I just gotta understand even with that debt and a peds salary, I'll still be living 1000x better haha.

And yeah I still have some rotations to get through, the only thing I've truly excluded is surgery and what I absolutely need is longitudinal care and inpatient.

Thanks again <3

Yes, that same kind of thing is going to keep continuing to happen once you’re an attending. There are always going to be people more rich and more "powerful" than you. With age typically comes wisdom and the realization that none of that matters. Don’t compare yourself to others.

Even with debt, physician salaries allow us to live a decent life. Of course it’s not the same as the "good ol days" and like I said many of us still have to make sacrifices, but it’s still a solid career.

People poo poo my speciality. But I really do not care one bit, I do not lose a half second of sleep over it.
 
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I’ve thought about this a lot. Debt is a very real concern and the amount of debt you’re looking at is quite high. But here are a couple of considerations I have thought about.
1. you have to be interested in the work you are doing. If pediatrics is where your heart is - go for it and don’t look back. Sure there is more money to be made elsewhere but it isn’t worth it if you will be miserable. You will spend 40-70 hours per week doing your job - you may as well enjoy it.
2. you’ll be on IBR which will put an upper cap your payments. Assuming you are not pursuing PSLF, simply due to not being able to predict its longevity, you’ll make payments for 20 years and then have your debt forgiven. It’s not really forgiven as you will be taxed on that amount which will be quite substantial. However, with careful planning and a 20 year horizon it is possible to set money aside for that future tax bill.
3. you’ll still be able to live a good life without a high paying specialty. You’ll be able to buy a home, save for retirement, and enjoy your hobbies. You likely will not be able to spend the same way your peers without debt and high incomes will, but from my perspective, that’s fine.
 
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Not married, long-term partner is a zoologist (so not big $$) but hey her Twitch is starting to take off lmao.

We're both against having kids, which is at least helpful. I still have a year or so to make these decisions - what specialties should I be on the lookout for if I really enjoy Peds and to an extent behind peds, IM?

If you're not interested in having children I honestly wouldn't worry too much about the debt in your career decision

Ignoring pslf, if you pay on repaye, estimating a 200k household gross for you and your partner, you pay about 2k/mo for 25 years with 750k forgiven (taxed) at the end of that. You take home about 150k/yr, of which you subtract 24k/yr leaving 126k take home. You save with plans to pay the tax on your 750k forgiven after 25 years (about 340k). 340k/25 is about another 14k a year you have to save in anticipation of paying that. Brings your take home to 112/yr. This assumes you're literally just putting that 14k into savings and not investing and getting good return on it, which is what you should be, and those are crude numbers. But a couple taking home 112k/yr should be plenty comfortable with no plans for kids unless you want to live in a high CoL area. Kids are a huge financial drain to subtract from your equation

FWIW I did med peds with a substantial debt burden (though admittedly still only comes to about half of yours) with plans to do a peds subspecialty, and my wife and I plan on having kids. I'm hopeful for pslf but ultimately have no regrets. I was also probably in the top few in my class and had a strong step. Those things shouldn't be big determinants in your career decision (except to exclude specialties for which you won't match)

I will say peds h/o has a tight job market, but with how competitive you are if you put together a good research CV during school and residency you'll likely match a fellowship that makes you plenty competitive
 
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Marry another doctor, but make sure he is debt free or has low debt.

By the way, what are you doing tonight? :thinkies:
 
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Nobody goes into peds for the money. Even the lucrative peds specialties are paltry compared to their adult counterparts.

I went into peds because I would figuratively shoot myself in the face if I had to do anything else. I absolutely love what I do and I will end fellowship in a relatively lucrative peds specialty, but will top out at around $300k in the right job. But I don't envy the adult cardiologists, orthopods, and neurosurgeons making $600k+ per year because you couldn't pay me enough to enjoy those jobs.

so if you can see yourself really enjoying GI, but kind of like peds GI more, than do IM and go adult GI because you will make significantly more money and be pretty happy. But if you can't see yourself working with anyone but children, forget about wasting your potential and disregard the money aspect of things, because you will make enough.
 
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Not married, long-term partner is a zoologist (so not big $$) but hey her Twitch is starting to take off lmao.

We're both against having kids, which is at least helpful. I still have a year or so to make these decisions - what specialties should I be on the lookout for if I really enjoy Peds and to an extent behind peds, IM?

I agree with [mention]WheezyBaby [/mention] that if you don’t want children, what i said is less relevant.

That said, with a Step 1 of 265+, you’ve got the brains and work ethic for GI and Heme-Onc.
 
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Sadly, even with a 265+ and top of the class, I don't think top-tier pediatric residencies care that much (if that's what you're aiming for). All they see is *low-tier medical school*. So add that to your equation as well.
 
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Sadly, even with a 265+ and top of the class, I don't think top-tier pediatric residencies care that much (if that's what you're aiming for). All they see is *low-tier medical school*. So add that to your equation as well.

For sure. We've had people match into places like CHOP each year so I'm not /too/ worried but it is certainly taken into consideration.
 

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Sadly, even with a 265+ and top of the class, I don't think top-tier pediatric residencies care that much (if that's what you're aiming for). All they see is *low-tier medical school*. So add that to your equation as well.

I disagree. Med school name matters without a doubt but I interviewed several top tier med peds programs without that pedigree and many of our graduates did into other fields as well. Meaningful research or other "distinguishing features" are definitely important beyond stats though
 
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I felt the same way, feeling like I was settling for less compared to some of my friends.

However, I realized I am going to be the one working my specialty for the rest of my life, not my peers who say I can "make more doing x". At the very end, which one are you going to look at: what you did or what you earned?
 
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Radiology should be your 'calling' with that debt burden...
 
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Radiology should be your 'calling' with that debt burden...

I feel like rads is more stressful and demanding than what us non-rads usually think


"What I think non-radiologists don't understand about radiology is intensity-level that we perform at consistently (on-call). It's not uncommon to have a call shift where, other than getting up to pee and maybe answering phones calls, we're reading a huge stack of acute cases. 80-100 acute cross sectional cases where the radiologist's input directly drives patient care. Baseline that's like a 7-8 out of 10 on the stress scale.

I remember clinical medicine calls; in my opinion, people wildly underestimate just how much time they spend doing low-intensity activities: calling consults, walking to see a patient, putting in orders, writing notes, waiting for a trauma patient to arrive, doing the closure on a surgery, etc.... I would liken radiology to doing the most intensive part of a surgery, some sort of delicate anastamosis, for 8-10 straight hours. Or running 8 codes in 8 hours. That's gonna be mentally fatiguing.

Ever escalating volumes and responsibility despite stagnant pay (though in the grand scheme of things it is still good pay). By responsibility I mean the fact that the ability for diagnoses to be made or excluded primarily on imaging (and a bit of history) has grown exponentially because of improved technology, availability of technology, and/or an improved understanding of how to interpret imaging by radiologists.

I am at a high-end academic medical center, and our IR residents and fellows compare their IR call to their general radiology call. IR call is busy without too much time downtime since there are few fellows covering a large health system; despite this, they almost always consider IR call a bit of a break when compared to general diagnostic radiology call. Some of the IR residents/fellows partake in ICU/SICU rotations, and DR work to them is relatively more intense, especially on a per unit of time metric.

My co-residents all felt more mentally tired working 50-60 hours a week in radiology compared to internal medicine or surgery intern year where many of us routinely worked 70-80+ hours/week. The closest analogy is focused non-stop driving for 10-12 hours, but this not an apt comparison since diagnostic radiology requires even more mental focus/intensity, or else miss rates go up.

Medicine is not easy and every specialty is important for good patient care, however radiology is probably the most misunderstood specialty. When I tell people I am in radiology, many times I get responses suggesting that the work/workload is easy. This assumption, in part, leads to unrealistic expectations from our more clinical colleagues."
 
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For sure. We've had people match into places like CHOP each year so I'm not /too/ worried but it is certainly taken into consideration.
Why not ENT? A ton of their patient panel is peds. (Of course that probably depends on where you are) but in my rotation there were a ton of peds patients
 
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Splenda88

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I feel like rads is more stressful and demanding than what us non-rads usually think


"What I think non-radiologists don't understand about radiology is intensity-level that we perform at consistently (on-call). It's not uncommon to have a call shift where, other than getting up to pee and maybe answering phones calls, we're reading a huge stack of acute cases. 80-100 acute cross sectional cases where the radiologist's input directly drives patient care. Baseline that's like a 7-8 out of 10 on the stress scale.

I remember clinical medicine calls; in my opinion, people wildly underestimate just how much time they spend doing low-intensity activities: calling consults, walking to see a patient, putting in orders, writing notes, waiting for a trauma patient to arrive, doing the closure on a surgery, etc.... I would liken radiology to doing the most intensive part of a surgery, some sort of delicate anastamosis, for 8-10 straight hours. Or running 8 codes in 8 hours. That's gonna be mentally fatiguing.

Ever escalating volumes and responsibility despite stagnant pay (though in the grand scheme of things it is still good pay). By responsibility I mean the fact that the ability for diagnoses to be made or excluded primarily on imaging (and a bit of history) has grown exponentially because of improved technology, availability of technology, and/or an improved understanding of how to interpret imaging by radiologists.

I am at a high-end academic medical center, and our IR residents and fellows compare their IR call to their general radiology call. IR call is busy without too much time downtime since there are few fellows covering a large health system; despite this, they almost always consider IR call a bit of a break when compared to general diagnostic radiology call. Some of the IR residents/fellows partake in ICU/SICU rotations, and DR work to them is relatively more intense, especially on a per unit of time metric.

My co-residents all felt more mentally tired working 50-60 hours a week in radiology compared to internal medicine or surgery intern year where many of us routinely worked 70-80+ hours/week. The closest analogy is focused non-stop driving for 10-12 hours, but this not an apt comparison since diagnostic radiology requires even more mental focus/intensity, or else miss rates go up.

Medicine is not easy and every specialty is important for good patient care, however radiology is probably the most misunderstood specialty. When I tell people I am in radiology, many times I get responses suggesting that the work/workload is easy. This assumption, in part, leads to unrealistic expectations from our more clinical colleagues."
Can't be more stressful than IM, and most surgical specialties
 
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stickgirl390

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$600,000 in debt, how?
Careful, your privilege is showing.

OP: I know you mentioned you don’t like surgery. Just anecdotal, the peds cardiac surgeon at my hospital makes over $600k a year.
 
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When you are considering "potential", remember that your potential happiness is at least as important as your potential income, or your potential prestige.

Another point: whatever your specialty, private practice (even in a small town) will pay more than academics. If you're willing to forego the prestige of practicing in a university setting, you may find a position at double the salary.
 
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Thanks guys!

I think a lot of it just seeing my classmates, many who came from $$$ backgrounds live in their dope apartments, travel the world on breaks, etc., and I've never gotten to do that - never left my state, live far away from campus in a ****ty apartment, etc. I guess I was starting to get nervous that that would continue as a physician, but I just gotta understand even with that debt and a peds salary, I'll still be living 1000x better haha.

And yeah I still have some rotations to get through, the only thing I've truly excluded is surgery and what I absolutely need is longitudinal care and inpatient.

Thanks again <3
With the accumulation of interest over another three years, you're going to be about $725,00 in debt at the end of a peds residency. If you pursue pediatrics with that debt load you will need to take the highest paying job you can get in a low cost of living city. Pediatric salaries vary widely from state to state. Forget about living on the coasts and forget about serving the poor. You and your partner will have to live like school teachers for a decade.

I think the pediatric ENT suggestion is brilliant. Those guys make bank and they deal with kids 24/7. You could be out of debt in five years after a five year residency and 1 year of fellowship. Then you can live wherever you want.
 

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Consider Med-Peds. It's one extra year but you've the option to go adult hem/onc, GI or cardiology if you like adult medicine during residency. It keeps your options. I'm not a fan of Med-Peds but someone in your situation will the right candidate for it.
 

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I'm going to come at this from a different angle.

I think people work harder and longer at jobs they like doing. Which means you will probably make more money in the long run.
You can find jobs that make really good money in peds. You can find jobs that make really good money in IM. Medicine is weird in that the supply of physicians is inversely proportional to the income. Meaning that high demand areas (read large, popular cities) will pay less.

That being said, you have a very large debt, and you need to be deliberate in how you plan your future. Otherwise, you could look up and be in a bad place. That doesn't mean you should go be a pediatric cardiac surgeon because they make $600k/year (lol silly medical student). But. . . being an academic making $150k/year in a high cost of living area is not an option you should choose.

As an example, I'm an adult hospitalist who did IM. I currently make over $300k working 22.5 weeks a year. I could work another 12 weeks and make $400k (really pre-COVID). I have friends that cover a SNF for another $100k/year. I work at a large hospital in a relatively small town. The point is that I like my job, and I can make good money. If I hated my job it would be miserable. I'd "burn out".

My opinion (not shared by many here mind you) is that depending on PSLF and IBR is an extremely dumb idea. You should plan to pay it off.

If you really are 50:50 IM vs. peds, I'd choose IM hands down. IM makes more and has more options. Most of the MedPeds people I know practice only adult medicine (granted I probably have a biased view as I work with adult hospitalist).

I find it odd that you and your partner are against having kids and want to practice with kids.
 
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I find it odd that you and your partner are against having kids and want to practice with kids.

I hear that a lot. I like working with kids, and I get the most fulfillment out of it. Raising kids is very different from working with / treating kids. In terms of having kids, I've more been on the neutral side while my partner is against it (she'd also have difficulties having a child and wouldn't want to adopt) so it makes sense for us to just not have kids.

I'll definitely consider your words, though. We're both from NYC (so high CoL) and we do plan to continue to live here. I love it here, my friends and family are here, and her career is here.

I'll definitely consider Med/Peds for the training/keep my options opening -> IM or just straight IM.
 
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I’m 41 just starting medical school and I had no choice but to rule out low income earning specialties. I’ll have $400k in debt with 6 kids to put though college + save for retirement. I just can’t do that in the little years I have left. It sucks but that’s the real world. Since that’s the case, I have to look at careers with incomes in my target range then choose from there. I completely understand what you’re dilemma is. If you crunch your numbers and you can’t afford to live COMFORTABLY (not luxury) on the income, I’d look to a different field that you would also like, although you may like it a little less.
 
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1- try to find something you truly enjoy. This is the hardest task as you won’t know until your knee deep. Doesn’t have to be the thing you enjoy most. Has to be a field that you enjoy in theory and where the work/life balance is to your liking.

2- nothing wrong with picking a specialty that you *think* will pay you well. Changes happen all the time and your compensation might be much higher or lower than you think by the time you’re done. That’s why #1 is most important

3- keep an open mind. The notion that there’s only one specialty you can enjoy is prolly not true. If by the end of third year there’s a handful of things you can see yourself enjoying, pick the best lifestyle/money field. Why not.

4- do NOT pick a field just based on money or lifestyle because #2 above and because that’s not a great way to spend 40+hours a week
 
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Yeah, it's funny, everyone's general advice is "pick what you want", then you hear attendings hate on other specialties... I think the newer generation cares less about that, though.

in my experience people who bash on other specialties are probably battling their own insecurities. If you hate what you do money helps in the beginning but eventually you’ll still hate what you do and money won’t matter unless medicine is just a job and you work to live not live to work, in which case pick something that pays a lot and get out early and enjoy your life. If medicine is a passion then really truly just pick what you love. I switched out of a very lucrative specialty to do a not as but still well paying one and I practically skip to work every day and it’s been 10 years since the switch (residency/fellowship etc) and foresee it will persist til I retire. Definitely took a long term income potential hit, but got lucky with loans (not a lot and already paid off).
Not having kids will help you. If you do Peds subspecialty and go to an area that needs someone like you you could negotiate a decent chunk of that loan away. Plus areas like that tend to have a lot of work for a zoologist
 
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readmypostsMD

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Hey all, sometimes I feel like I'm "wasting" my potential and usually I wouldn't care but my debt burden sure does make me feel that way.

I've been interested in peds from the get-go (specifically heme/onc peds). However, by graduation I'll be 600k in debt. I go to a low-rank school, but am currently ranked #1 or close to it (we don't know our exact rankings but I've gotten a 100 on every pre-clin exam but one), and I killed Step 1 (265+), have decent research, work, leadership, etc.

My classmates more than likely think I'm a decent/above average student, and encourage my pediatric path but they are unaware of my debt burden and how competitive my profile actually is. Have any of you made different choices with your debt burden if you had the opportunity?

I was also pretty 50/50 between IM and Peds - would a Med/Peds path possibly help alleviate some of this debt burden (could work as a hospitalist and pay this bad boy down, for example). I also really do love the idea of the "complete" education a Med/Peds residency gives you.

wait how do u have 600kin debt?
 

VA Hopeful Dr

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wait how do u have 600kin debt?
Undergrad + Grad + private MD school

Was a high MCAT / low uGPA applicant with only 1A when after applying so had no choice med school wise. Family was in a precarious position during my undergrad/grad years, and so a lot of my extra income went to them rather than to paying down loans outside of interest.
 
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Angus Avagadro

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I feel like rads is more stressful and demanding than what us non-rads usually think


"What I think non-radiologists don't understand about radiology is intensity-level that we perform at consistently (on-call). It's not uncommon to have a call shift where, other than getting up to pee and maybe answering phones calls, we're reading a huge stack of acute cases. 80-100 acute cross sectional cases where the radiologist's input directly drives patient care. Baseline that's like a 7-8 out of 10 on the stress scale.

I remember clinical medicine calls; in my opinion, people wildly underestimate just how much time they spend doing low-intensity activities: calling consults, walking to see a patient, putting in orders, writing notes, waiting for a trauma patient to arrive, doing the closure on a surgery, etc.... I would liken radiology to doing the most intensive part of a surgery, some sort of delicate anastamosis, for 8-10 straight hours. Or running 8 codes in 8 hours. That's gonna be mentally fatiguing.

Ever escalating volumes and responsibility despite stagnant pay (though in the grand scheme of things it is still good pay). By responsibility I mean the fact that the ability for diagnoses to be made or excluded primarily on imaging (and a bit of history) has grown exponentially because of improved technology, availability of technology, and/or an improved understanding of how to interpret imaging by radiologists.

I am at a high-end academic medical center, and our IR residents and fellows compare their IR call to their general radiology call. IR call is busy without too much time downtime since there are few fellows covering a large health system; despite this, they almost always consider IR call a bit of a break when compared to general diagnostic radiology call. Some of the IR residents/fellows partake in ICU/SICU rotations, and DR work to them is relatively more intense, especially on a per unit of time metric.

My co-residents all felt more mentally tired working 50-60 hours a week in radiology compared to internal medicine or surgery intern year where many of us routinely worked 70-80+ hours/week. The closest analogy is focused non-stop driving for 10-12 hours, but this not an apt comparison since diagnostic radiology requires even more mental focus/intensity, or else miss rates go up.

Medicine is not easy and every specialty is important for good patient care, however radiology is probably the most misunderstood specialty. When I tell people I am in radiology, many times I get responses suggesting that the work/workload is easy. This assumption, in part, leads to unrealistic expectations from our more clinical colleagues."
Couldnt agree more. My wife wants to retire, but with covid, no traveling, limited dining, etc, she figures if she is going to be miserable, might as well be at work.
 
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mvenus929

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If you really are 50:50 IM vs. peds, I'd choose IM hands down. IM makes more and has more options. Most of the MedPeds people I know practice only adult medicine (granted I probably have a biased view as I work with adult hospitalist).

I'm in peds, so most of the Med/Peds people I know either work exclusively in peds, do something that bridges the gap (I had an attending in residency and one of our current peds cards fellows who do/will do congenital heart disease, so will take care of both adults and children), or a mix. One of the jobs I'm applying to has a Med/Peds trained person who focuses on transition care (the peds people see patients up through age 26, but she'll continue to follow them after that), and they're looking to hire another one in the next few years. I'm perhaps a little biased because we have a med-peds program here, so feed a lot into our own institution, but the Med-Peds PD works in the general peds clinic mostly, and there's a Med-Peds clinic at the adult hospital next door.

OP, regardless of what you decide, you need to get some financial education ASAP. With a debt burden like that, you need to know how to do a budget very well, and know what options are available to you going forward. Sure, PSLF would be nice, but as someone above stated--you shouldn't count on it (even if it still exists at that point for you, you have a mix of loans, so I don't know if all of them would qualify). Develop a plan and strongly consider refinancing at least a portion of your loans so they stop gaining so much interest.
 
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yungspleen

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Peds is going to feel like a drag in 10 years just like any other specialty will. Why not do something that pays 2-3x as much (which you easily can with your scores) so that you can cut your hours back and not feel like you're going to slave away into your 70s just to pay off your debt? You could cut back to like 70% of the peds hours in something like ENT and make like twice as much and use that extra free time enjoying life outside of work. Unless your insanely passionate about peds which it doesn't seem you are.
 
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sloh

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Peds is going to feel like a drag in 10 years just like any other specialty will. Why not do something that pays 2-3x as much (which you easily can with your scores) so that you can cut your hours back and not feel like you're going to slave away into your 70s just to pay off your debt? You could cut back to like 70% of the peds hours in something like ENT and make like twice as much and use that extra free time enjoying life outside of work. Unless your insanely passionate about peds which it doesn't seem you are.

Unpopular opinion to be voiced among physicians but....

"Pick something you love and you'll never work another day in your life!" —Usually fails to take into account that tying something you love up with your livelihood can sometimes detract from its enjoyment. An argument can also be made for working a job that is 3-4/10 enjoyment with much better hours and compensation rather than a job that is 8/10 enjoyment with longer hours and lower compensation. Take that extra time and money to indulge in whatever passions/hobbies that are 10/10 for the individual
 
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I'm in peds, so most of the Med/Peds people I know either work exclusively in peds, do something that bridges the gap (I had an attending in residency and one of our current peds cards fellows who do/will do congenital heart disease, so will take care of both adults and children), or a mix. One of the jobs I'm applying to has a Med/Peds trained person who focuses on transition care (the peds people see patients up through age 26, but she'll continue to follow them after that), and they're looking to hire another one in the next few years. I'm perhaps a little biased because we have a med-peds program here, so feed a lot into our own institution, but the Med-Peds PD works in the general peds clinic mostly, and there's a Med-Peds clinic at the adult hospital next door.

OP, regardless of what you decide, you need to get some financial education ASAP. With a debt burden like that, you need to know how to do a budget very well, and know what options are available to you going forward. Sure, PSLF would be nice, but as someone above stated--you shouldn't count on it (even if it still exists at that point for you, you have a mix of loans, so I don't know if all of them would qualify). Develop a plan and strongly consider refinancing at least a portion of your loans so they stop gaining so much interest.

I have talked to my advisor, all my public loans should fortunately qualify for PSLF (obviously still not to count on PSLF doh). I have private loans which I've been paying down since hard since grad school. I work right now as a private MCAT tutor and make a real nice amount an hour, I plan to have my private debt paid off fully by the time I graduate.

And thanks for that further insight into Med-Peds, because what you just described is exactly what I want to do.
 
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redpointmd

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I think that's an incredibly tough situation to be in. 600K is a lot of money, they say you should never let debt guide your career choice, but it's tough when you have the option to do something that earns a significant amount of money and have significant debt. You will never feel free until that 600K is paid off, but at the same time, if you pick a career that works you 70 hours a week after a 7 year long residency + fellowship you won't have much time to enjoy your financial freedom. Just be cautions, consider the finances, but also consider longevity and how much of an investment that is.
 
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dr_kateb

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Careful, your privilege is showing.

OP: I know you mentioned you don’t like surgery. Just anecdotal, the peds cardiac surgeon at my hospital makes over $600k a year.

Being in debt doesn't necessarily mean lack of privilege

*cough* trump *cough*
 
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