Anesthesia peak of competitiveness?

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1) not familiar with that law. What do you mean?
2) 5 million dollars is too much for a physician to make based on some sort of procedure they are doing. I have zero problem with some hot shot plastics d-bag or some self aggrandizing ortho person who does PRP injections for cash charging whatever they want. Medicare reimbursement is SUPPOSED to be based on the the the skill/challenge of the procedure AND how long the procedure is supposed to take. If you are running some scum bag IC clinic where you’re stenting everything and driving up costs, yea it’s grotesque. I promise you this guys sole focus is $$. Not improving the health of the community he cares for. Also we are not bankers or real estate lawyers or tech entrepreneurs.
FMGs without a residency can now practice in Tennessee under the guise of “expanding access” when it’s really about driving down salaries. Spreading to other states too

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This is perfect financial advice for the ideal scenario, but rarely is it actually applicable to a lot of us who like to start living life now and not at age 65.

I’d rather spend a little bit more money, take a little bit less call, work a little longer, and have my family be comfortable for the next 30 years than frugally squirrel away every single penny of every single paycheck in the hopes that we start living at age 65, only to have a stock market crash or a global pandemic or a massive stroke.

Putting away 150k a year as a physician is going to be very dependent on the specialty you are in, but for anesthesia that should not be be difficult at all. Assuming you are making an average salary of 450k a year (for sh*ts and giggles let's say you live in California and your combined tax rate is 40% putting you at an average tax rate of 180k) that leaves you with 270k net income after taxes. If you put away 150k a year into retirement that leaves you with 120k net income for living expenses. If you can't live not only a comfortable life, but a good one on 120k net income (which doesn't include the possibility of your spouses income) then you have a spending problem and not an earning problem.
 
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FMGs without a residency can now practice in Tennessee under the guise of “expanding access” when it’s really about driving down salaries. Spreading to other states too
Started in Missouri years ago. 2016 or so I believe.

 
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Started in Missouri years ago. 2016 or so I believe.

Yes but in MO they can only become PAs, correct? These will be attending physicians
 
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This is perfect financial advice for the ideal scenario, but rarely is it actually applicable to a lot of us who like to start living life now and not at age 65.

I’d rather spend a little bit more money, take a little bit less call, work a little longer, and have my family be comfortable for the next 30 years than frugally squirrel away every single penny of every single paycheck in the hopes that we start living at age 65, only to have a stock market crash or a global pandemic or a massive stroke.
PeriopDoc is saving the required $$ each year. I suspect many are saving at least $100K per year, total including 401Ks, so let's see your plan. The idea you can have your cake and eat the whole thing without consequences is a lie. You need discipline to reach goals especially retirement. If you think saving $50K in retirement plans plus another $50K in after tax plans is too much then you need to rethink how you spend money. Those who plan now will be much better off later on if they do develop medical problems. It takes time to let the magic of compound interest do its work; the more you save and invest the bigger the multiplier effect when you hit age 50 then 55 then 60.

The fact is money is a tool to get to your desired goal. If you spend too much now you won't have enough to retire early and will be working well into your late 60's trying to catch up.
 
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If your risk tolerance is low, you’ll sleep best with a nearly 100% chance of having your money last a lifetime. You’re willing to give up potentially larger returns for lower volatility. If this sounds like you, you’re probably better off with an initial withdrawal rate of 3 to 3.33%. This requires a nest egg totaling 30 to 33 times your anticipated annual spending in retirement.
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30 x $200K per year is $6 million. I picked $200K because it's a modest figure for someone earning $450K+ today. $6 million. Everyone needs a plan to get there.



It’s all about mindset. Everything dollar you spend is a trade-off with something else. Do you want to ensure your financial future for yourself and your family or do you want a car that can go up to 200 mph even though you’ll never drive it that fast?

Budget and spend intentionally on the things that make you the happiest. Save and invest the rest.

Once you have this plan in place, you can rest easy and know that your financial future is secure. This will allow you to enjoy the present without worrying as much about the future. It will make you a better doctor and a better person.
 
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"My current net worth is $5.1 million, with $4.3 million of that being in investment accounts. The rest is equity in my primary residence and my lake cabin.
My goal now is to retire when I reach $15 million in my investment accounts. My net worth really means nothing to me. All I care about is how much I have invested. If things stay on course, I should be at $15 million in 12-15 years."

 
I would love to hear/read about your plan for retirement. These stories inspire me to read that others recognize the power of investing long term. For those who say it can't be done, my answer is they are wrong. Live modestly for 2 decades and you will reach your goals.
 
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Most of you need FAT FIRE and my numbers are different due to a 3.3% withdrawal rate.
 
I’ll tell you what I do.

I cry and say to myself - how come I am a highly skilled physicians that will need to work until the day I die. How did all these other people figure it out and I couldn’t? What is wrong with me?

For my funeral, I’m gonna have to request the day off. Maybe I can just take a half day.
You're gonna have to put that request about 6 months advance though
 
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In the United States, Chubby FIRE is retiring with between $2.5M to $7.5M in net worth. This is a starting guideline, and as mentioned, these amounts can be adjusted up or down depending on your situation.

Retiring early with $2.5M and a 4% withdrawal rate will enable you to spend $100,000 per year. And a net worth of $7.5M with a safe withdrawal rate of 3% allows you to spend $225,000 per year. In general, spendable amounts above and below these are typically considered a different category of FIRE.

 
The fact remains in the USA wealth is defined as at least $5million if not $10 million

Many people on this board will retire with total assets exceeding $5 million placing them in the top 2.79% of households.

What do we do with this information.
Nothing, nothing at all.


I love you Blade, but it's weird how you're more interested in how JP Morgan "defines" wealth, or in keeping score, than in what people actually need to retire in comfortable luxury.

$10M+ is an absurd goal - actually a counterproductive one if it means you need to be working into and beyond your 60s.
 
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That’s grotesque. No cardiologist should be making 5 million dollars per year.
Nothing wrong with making 5 million. I can tell you he’s hustling for that money.

Is gabe plotkin (the game stop fiasco hedge fund guy) hustling when he made 800 million in 2020?

The dude literally cheated in 2013 making insider bets to make it to the top.

Yet the same dude “lost 3 billion in GameStop in 2022”. But somehow he’s enough money to be the principal new owner of nba charlotte hornets basketball team.

Explain to me what’s grotesque here. The cardiologist or the lying cheating gabe plotkin. And no. It’s not a jealousy factor I have with gabe plotkin. Or the AIG main guy who caused the financial downfall in 2008



In the wake of the scandal, United States regulators and the United Kingdom Serious Fraud Office began investigating Cassano's dealings to determine whether they were just excessive and risky, or criminal.[14]

A two-year investigation by the U.S. Department of Justice ended in May 2010 with no criminal charges brought against Cassano, who was represented by lawyers Jim Walden and F. Joseph Warin of Gibson, Dunn & Crutcher.[15]

These are the guys who I have problems with. The gabe plokins of the world and Cassano get away with shady stuff. No consequences.
 
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Yes but in MO they can only become PAs, correct? These will be attending physicians
Oh dang I didn't realize. No they don't become PAs, but APs aka Assistant Physicians. Basically function like a PA or NP though.
 
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If you can't live not only a comfortable life, but a good one on 120k net income (which doesn't include the possibility of your spouses income) then you have a spending problem and not an earning problem.

You obviously don’t live in California (or another HCOL area) with a mortgage, childcare expenses, and student loans. All those combined can easily add up to $10k per month.
 
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The key is to live in low cost living area.

Also those who got out of residency after 2008/9 really haven’t felt what I felt and other older attendings have felt. Housing crash and stock market crash (or even 2-3 crashes 2008/2000/ (87/89).

It’s kinda of one sided seeing these docs fire physician start blogs saying I have x amount. The minute a doc mentions back door Roth IRA. I immediately know they finished after 2008.
 
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As Jimmy Turner would say "Personal finance is personal." Can we go back to topic of anesthesia competitiveness ?
 
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Right… because things like food, cars, gas, utilities, entertainment, 529 plans, and everything else are free?

I think you should go re-read the post.
Like I said, if you can’t manage to do those things on a net income of 120k a year then you have a spending problem and not an earning problem. That net income amount already puts you well above the median household income even before taxes
 
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Like I said, if you can’t manage to do those things on a net income of 120k a year then you have a spending problem and not an earning problem. That net income amount already puts you well above the median household income before taxes

Dude where do you live? Honestly, the taxes on even modest homes <2500swft in desireable areas with good schools and things to do easily exceeds 25K and these being optimistic. 120K net just won’t cut it.

Even if you manage to save 100K/yr, it just doesn’t go very far at all.
 
Like I said, if you can’t manage to do those things on a net income of 120k a year then you have a spending problem and not an earning problem. That net income amount already puts you well above the median household income before taxes

And like I said, it seems you’re speaking from the perspective of someone who doesn’t live in a HCOL area with a young family. If I’m wrong, please feel free to share your breakdown.

The reality for a young family in HCOL areas is that housing is at least $4k, childcare for two kids is $3k, and if you have student loans then that’s at least another $1k. So you’re telling me that every other monthly expense (food, gas, insurance, phone/internet, college savings, etc) should add up to under $2k and that should be considered a comfortable lifestyle?

I’m not saying everyone needs more than $120k to survive. But for young physicians with a family these days, it’s not enough in certain areas. At least for the first few years, until the kids are older and the debts are paid off.
 
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Like I said, if you can’t manage to do those things on a net income of 120k a year then you have a spending problem and not an earning problem. That net income amount already puts you well above the median household income even before taxes
My student loans are 6k/ month. My mortgage on a house that is less than 1x my salary (total cost of the house, not just the mortgage) in an MCOL area is 2700. Disability and life insurance 500/ month. So I should be able to feed and clothe my family, pay for gas for my 14 year old car, heat my house, save for college, etc on $800 a month? Where exactly is my spending problem?
 
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What does retirement and senior anesthesiologists have to do with this thread? Simple. If you don't have enough money then you must keep working into your 60's or even 70's. Some of you are not saving enough to hit a realistic retirement goal.

As for this field being competitive again, yes it is now once again competitive. The job market is wide open and many are skipping fellowships even cardiac fellowships to make the cash. But, there are many lower tier programs these days giving even a weaker application a shot at as spot. My crystal ball is a bit cloudy but I don't see AI taking anesthesia jobs away circa 2033 unlike basic radiology. For the average med student, Anesthesiology is a good pick as is General Surgery or an IM subspecialty.
 
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My student loans are 6k/ month. My mortgage on a house that is less than 1x my salary (total cost of the house, not just the mortgage) in an MCOL area is 2700. Disability and life insurance 500/ month. So I should be able to feed and clothe my family, pay for gas for my 14 year old car, heat my house, save for college, etc on $800 a month? Where exactly is my spending problem?
There is really no medium cost of living area as it pertains to housing. I’m in medium cost of living area (supposedly) yet my area homes cost as much as most higher cost areas of the northeast and west coast cause of the housing bubble/low inventory.
 
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What does retirement and senior anesthesiologists have to do with this thread? Simple. If you don't have enough money then you must keep working into your 60's or even 70's. Some of you are not saving enough to hit a realistic retirement goal.

As for this field being competitive again, yes it is now once again competitive. The job market is wide open and many are skipping fellowships even cardiac fellowships to make the cash. But, there are many lower tier programs these days giving even a weaker application a shot at as spot. My crystal ball is a bit cloudy but I don't see AI taking anesthesia jobs away circa 2033 unlike basic radiology. For the average med student, Anesthesiology is a good pick as is General Surgery or an IM subspecialty.
The real issue I see is “hourly/shift work” mentality

The full time w2 with calls q5 and 2 weekends a month is getting very hard to recruit even at 500k a year and 50 hours a week. 4 years ago people would jump at that offer. Not anymore.

People want to work 3 days a week for 500k even if it’s 48 hours a week so they have more time off.

I just got random text from fellow doc only wanting to work 2 days a week for 450k. People want time off or money and lots of money if they have to work 5 days a week. And I’m talking 700k and up.
 
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The real issue I see is “hourly/shift work” mentality

The full time w2 with calls q5 and 2 weekends a month is getting very hard to recruit even at 500k a year and 50 hours a week. 4 years ago people would jump at that offer. Not anymore.

People want to work 3 days a week for 500k even if it’s 48 hours a week so they have more time off.

I just got random text from fellow doc only wanting to work 2 days a week for 450k. People want time off or money and lots of money if they have to work 5 days a week. And I’m talking 700k and up.
Do you see this trend continuing? Are we finally getting paid what we're worth after all this inflation?
 
My student loans are 6k/ month. My mortgage on a house that is less than 1x my salary (total cost of the house, not just the mortgage) in an MCOL area is 2700. Disability and life insurance 500/ month. So I should be able to feed and clothe my family, pay for gas for my 14 year old car, heat my house, save for college, etc on $800 a month? Where exactly is my spending problem?
You guys are missing my point. When you’re a new attending and have to pay back your loans this is obviously a different situation, especially yours considering you are paying off your loans over a short period of time. I am referring to the fact that the average household earns far less than 120k gross income so thus it is more than feasible to live a comfortable life on 120k net income. I just think the majority of physicians are out of touch with reality and what normal families live off of.
 
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Do you see this trend continuing? Are we finally getting paid what we're worth after all this inflation?
It’s a cat and mouse game. Once your commercial insurance payor mix drops below 45% commercial in this day and age. It’s gonna to be tough without a subsidy.

So it’s a free for all if docs want hourly wages. And the hospital will have to cough up the money to subsidize anesthesia but want 24/7 services as well.

Or they be cheap like some community hospitals and ship everything out affer 5pm. That’s another way to survive
 
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You guys are missing my point. When you’re a new attending and have to pay back your loans this is obviously a different situation, especially yours considering you are paying off your loans over a short period of time. I am referring to the fact that the average household earns far less than 120k gross income so thus it is more than feasible to live a comfortable life on 120k net income. I just think the majority of physicians are out of touch with reality and what normal families live off of.
The average person doesn't have 300k in loans
 
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Temporarily. Next year it'll be back to $200/hr tops.
$200/hr isn’t bad w2 (420k?) as long as you aren’t doing any overnights and no weekends and with 10 weeks off with good benefits.

$200/hr x 2080 hours a year equals around 420k

Plus call out sick anytime u want and paid 12 holidays.
 
1) not familiar with that law. What do you mean?
2) 5 million dollars is too much for a physician to make based on some sort of procedure they are doing. I have zero problem with some hot shot plastics d-bag or some self aggrandizing ortho person who does PRP injections for cash charging whatever they want. Medicare reimbursement is SUPPOSED to be based on the the the skill/challenge of the procedure AND how long the procedure is supposed to take. If you are running some scum bag IC clinic where you’re stenting everything and driving up costs, yea it’s grotesque. I promise you this guys sole focus is $$. Not improving the health of the community he cares for. Also we are not bankers or real estate lawyers or tech entrepreneurs.
everyones job has a purpose. it doesnt make sense to say this job should make millions, and your job shouldnt. in fact, imo, doctors should make the most bc everyone says your health is the most important. so why arent you valuing that by paying the people who treat your health the most?

also this guy makes 5m supposedly is bc he does highly complex stuff with high success rate. he do procedures many others wont touch due to complexity, and he succeeds (or so i was told
 
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$200/hr isn’t bad w2 (420k?) as long as you aren’t doing any overnights and no weekends and with 10 weeks off with good benefits.

$200/hr x 2080 hours a year equals around 420k

Plus call out sick anytime u want and paid 12 holidays.


I actually predict that by next month the prevailing rate will sadly be only 100/hr.
 
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Putting away 150k a year as a physician is going to be very dependent on the specialty you are in, but for anesthesia that should not be be difficult at all. Assuming you are making an average salary of 450k a year (for sh*ts and giggles let's say you live in California and your combined tax rate is 40% putting you at an average tax rate of 180k) that leaves you with 270k net income after taxes. If you put away 150k a year into retirement that leaves you with 120k net income for living expenses. If you can't live not only a comfortable life, but a good one on 120k net income (which doesn't include the possibility of your spouses income) then you have a spending problem and not an earning problem.

i feel like this get talked all the time. its not just high tax rate that goes with states like california or nyc, its also high cost of living.


thats in denver. 22k a year on childcare is cheap in nyc and probably california too.

my 1300 apartment in a 1960 building, in outer area of nyc, cost 72000$ per year. my daycare/nanny cost for 1 child is 36000 a year. Im already at 108k post tax. i have not added insurance for family, car cost, garage cost, food, clothing, vacation, etc.

i dont really think i have a spending problem... its just the cost of living here is high
 
You guys are missing my point. When you’re a new attending and have to pay back your loans this is obviously a different situation, especially yours considering you are paying off your loans over a short period of time. I am referring to the fact that the average household earns far less than 120k gross income so thus it is more than feasible to live a comfortable life on 120k net income. I just think the majority of physicians are out of touch with reality and what normal families live off of.
i think if physicians made 60k, the median household income, then no one would be physicians. you are ignoring all the other aspects of being a physician and only focusing on the money. well im required to be a certain distance from the hospital for call, this decreases where i can live, and its expensive around here. i also leave for work at 6am, which is pretty avg among colleagues imo, but far earlier than 'normal' families. i also get home at like 5 to 530 if not on ccall, and it is not predictable. this means i cant drop off my kid or pick him up, meaning i have to hire someone to do so unless my wife is available. im also on call on weekend and nights some times, wihch also means i need to hire coverage. i work way more than normal families, so i often buy takeout, and hire someone to help with stuff, childcare or grocery shopping etc.

basically my expenses are way way up bc of my lack of time as a physician. i make more than average but that came w 10 years of lost wages, a ton of loans, and less time even after starting job as attending, compared to your 'normal' families. i also qualify for NO government benefits despite being in tons of loans, and with no savings as a 32 year old.

a first year teacher in nyc is expected to make 73k, first year, and over 100k after 8 years. and they get lots of time off; pension and healthcare after retirement. meanwhile i may make 450k, but i work more, have way more debt, have no pension so i need to SAVE aggressively bc i started late to pay for my own retirement and own healthcare later.

most physicians who make it to attending, are not your 'average folks' in terms of IQ or work ethic or whatever. if these people worked in other fields, their median income probably wont be 60k either. most of my college/hs friends are in stem/finance, and i make pretty average among time, and my wealth is far far lower. if i had to chose a group to compare, why should i compare to avg americans and not my peers who graduated w me? why not go a step further and compare to rural africa then?
 
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I get your point but I find these graphs misleading. What is the rate of growth in this particular chart ? I’ve seen some snow a 12 percent growth rate which is extremely unrealistic. Even 7 percent is optimistic. It’s probably much closer to 4-6 percent growth. If you consider inflation you have to subtract 3 percent. Just trying to be realistic. We start making money later , usually in higher tax bracket , and start with loans. We have a lot of fincancial barriers that work against us

View attachment 373209

Stop making excuses and start saving as much as you can towards retirement. There is a multiplier effect over time with your money invested.
 
Food and entertainment expenses can be readily controlled. I know food prices up. But with the family gone last week and house to myself. I literally spent. Less than $10/day eating. And that’s with me not eating hospital food that’s nasty most days.

But a normal family of 4 consumes $70-100 a day in food. That’s before entertainment. So we talking around $2100-3000 a month in food. Housing $2000-3000 a month

So food and housing is 6k a month on the low end. So you need to make at least 100k pretax a year with family of 4. That’s why Obamacare 400% of poverty healthcare subsidies for family of 4 begins around 100k.

I suspect 50% of posters here have no kids because once you have a family. And as they get older it’s gets expensive
 
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thats in denver. 22k a year on childcare is cheap in nyc and probably california too.
That article made me laugh.

Alternative title "34 year old librarian is shocked to discover that moving away from family to one of the trendiest cities in the United States comes with a high cost of living"
 
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That article made me laugh.

Alternative title "34 year old librarian is shocked to discover that moving away from family to one of the trendiest cities in the United States comes with a high cost of living"

Gen Zers and millennials say they can't afford to have families​



Yes it’s difficult but not impossible.

Cut tv/Netflix /Hulu/Disney etc. that saves $100 easy. Maybe $200 if they have YouTube tv/cable as well.

Cut Amazon prime as well, instacart, Uber eats. Tons of markup with these delivery services. Well Amazon prime Probabiy better value than instacart 30% markup.
 
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But a normal family of 4 consumes $70-100 a day in food.

Come on, man

A normal family of four isn't spending $25,000 - $36,500 a year for FOOD. They're just not. They're not spending half that. They're maybe spending a quarter of that. Maybe.
 
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Come on, man

A normal family of four isn't spending $25,000 - $36,500 a year for FOOD. They're just not. They're not spending half that. They're maybe spending a quarter of that. Maybe.
Check out ur grocery bills. Even at Costco or Publix. Each week is at min $250 a month that’s at min. That’s $1000 and that’s being cheap.

Food prices are through the roof. 3 gallons of milk each week is $12 already and that’s not the organic type each.

Add kids lunches at schools $3-5 a day.
 
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Check out ur grocery bills. Even at Costco or Publix. Each week is at min $250 a month that’s at min. That’s $1000 and that’s being cheap.

Food prices are through the roof. 3 gallons of milk each week is $12 already and that’s not the organic type each.

Add kids lunches at schools $3-5 a day.

When it comes to conscientiously raising kids there really is not cheap alternative. You’re paying somewhere along the line
 
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I actually predict that by next month the prevailing rate will sadly be only 100/hr.
There will actually be an even bigger shortage of anesthesia providers at that rate than there is now! Those of us who have already cashed in will sit back on our stacks of $$.
 
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Gen Zers and millennials say they can't afford to have families​



Yes it’s difficult but not impossible.

Cut tv/Netflix /Hulu/Disney etc. that saves $100 easy. Maybe $200 if they have YouTube tv/cable as well.

Cut Amazon prime as well, instacart, Uber eats. Tons of markup with these delivery services. Well Amazon prime Probabiy better value than instacart 30% markup.

I don't disagree many services are marked up and there is room for savings, but lets be real freeing up $2k/year will not help anyone have children. Having a kid for many means upgrading apartment from a 1br to a 2br. In my MCOL area that is going from $1200 rent to $1700 rent. That is $6000 more per year in rent alone. This is just living space, not even a discussion of actual child expenses. Netflix savings will not get you there.

The reason Gen Z and millenials can't afford families is not because of convenience services. It is because the astronomical cost of housing, childcare, medical care, and stagnant wages that have not kept to inflation in the last 20-30 years.
 
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I don't disagree many services are marked up and there is room for savings, but lets be real freeing up $2k/year will not help anyone have children. Having a kid for many means upgrading apartment from a 1br to a 2br. In my MCOL area that is going from $1200 rent to $1700 rent. That is $6000 more per year in rent alone. This is just living space, not even a discussion of actual child expenses. Netflix savings will not get you there.

The reason Gen Z and millenials can't afford families is not because of convenience services. It is because the astronomical cost of housing, childcare, medical care, and stagnant wages that have not kept to inflation in the last 20-30 years.

No worries. We will just import poorer people who have no qualms about living on less. Anything is an upgrade from where they came and so they are more than comfortable reproducing.
 
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