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approximate income from residency to subspecialties

Discussion in 'Medical Students - MD' started by yobynaes, Jul 19, 2006.

  1. yobynaes

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    I know that the resident's income is usually about 40-50G a year. anyone has any knowledge of the approximate income during fellowship yrs, say cardiology fellowship. what about when one enters subspecialties, eg. interventional cardiology.

    thanks,
    yobynaes
     
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  3. Law2Doc

    Law2Doc 5K+ Member
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    Actually, from what I've seen, I think the range in residency is more like 35-45k for first year and increasing more by seniority (up to about $50k) than specialty. But I could be wrong. At any rate the difference between specialty is so insignificant, it should not play a role in any decisions. I have seen nothing about fellowships. But those salaries too are not comparable to private practice.
     
  4. The general data I got is you get about an additional 1.5k/yr regardless of whether you are in residency or in fellowship. For example, see the following link from AAMC (Jan 02): http://www.aamc.org/newsroom/reporter/jan02/medschooldebt.htm

    excerpt:
    By then, Dr. Gunter had already changed his mind about the fellowship, so he took a pediatrics private practice job, a field with starting salaries of approximately $80,000. Had he opted to get a fellowship, he would have received a stipend of no more than $40,000.

    Don't do it for the money! If you want $$$, go to Law or Business.
     
  5. sscooterguy

    sscooterguy Senior Member
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    I was surpised to find out fellows usually only make a little more than the senior residents, depending on where you are, that's upper 40's, low 50's usually. I don't know if the original questions was really about needing to make big cash to bling or whatnot, I think its a fair question. As one typically finishes residency at age 28-32 y/o, money DOES become a factor as children, and families are very often in the picture. I know this has influenced a few friends of mine, and rightfully so.

    sscooterguy
     
  6. yobynaes

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    hehe, thank, buddy. if i came for the money, i'd have gone for business long ago. no, i was just considering how much help i'll need from my family during those "tough" years. if anyone can find any stats, i'd really appreciate it.

    thanks,
    yobynaes
     
  7. I don't know if anyone has anything more useful but I think you will be looking at approx 40-70k/yr (depends on location and seniority) and not much more.

    See this link to the Ohio State COM Division of Cardiovascular Medicine fellowship page: http://www.internalmedicine.osu.edu/cardiovascular/3875.cfm

    Beth Israel Deaconess Medical Center link: http://www.bidmc.harvard.edu/display.asp?node_id=6138

    excerpt:
    Residents' *Salary Schedule for AY 05-06 and Proposed Salary for AY 06-07
    PGY Salary 2005-2006 Salary 2006-2007
    1 $45,148.30 $48,082.94
    2 $47,271.28 $50,343.92
    3 $49,393.19 $52,603.74
    4 $51,975.81 $55,354.24
    5 $55,187.86 $58,775.07
    6 $58,630.28 $62,441.25
    7 $62,072.69 $66,107.42
    *Fellowship salaries are determined by the individual Division.

    PGY-6 Orthopedics fellowship salary in UMass: http://www.umassmed.edu/orthopedics/fellowship/sports_medicine/Salaries.cfm

    Click around this UMass site and you will see similar data for other fellowships: http://www.umassmed.edu/dept_centers.cfm

    Orthopaedic surgery fellowship salary in Cincinnati Children's Hospital Medical Center: http://www.cincinnatichildrens.org/ed/clinical/fellow/orthopaedic/salary.htm

    If anyone has a more useful site on this topic, please share it.
     
  8. Brainsucker

    Brainsucker Senior Member
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    Bingo. From what I've read, it's pretty much institution and seniority that determine salary.
     
  9. Brainsucker

    Brainsucker Senior Member
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    Bingo. From what I've read, it's pretty much institution and seniority that determine salary.
     
  10. BAM!

    BAM! Senior Member
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    Of course. It's like that for almost any job. The OP was just looking for some ballpark numbers.
     
  11. Law2Doc

    Law2Doc 5K+ Member
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    As for ballpark numbers it's much closer to the attendance at a typical Devil Rays game than a Yankees game. Meaning very low.
     
  12. vwhan

    vwhan Senior Member
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    LOL. I love your posts, Law2Doc. I think a fellow's salary is considered to be PGY last year of residency+1. Therefore, you are not making that much more than as a resident. Now, I think Chief Residents can make around $70,000.
     
  13. Brainsucker

    Brainsucker Senior Member
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    I mean that it seems like a family practice PGY2 at x hospital makes as much as an ortho PGY2 also at x.
     
  14. nighthawk3

    nighthawk3 Member
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    Are you serious? Doctors in private practice make far more money than most lawyers or businessmen. There are exceptions, of course, but my general practitioner is 35 years old and makes $500k per year. Essentially all of the specialists in my area live in houses that cost well over a million dollars and they all drive a car that is worth more than the annual salary during fellowship. It may just be a south Florida thing, but from what I've seen, doctors make bank.
     
  15. beachbunny

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    A GP making $500K a year?????? Are you serious?
     
  16. Whisker Barrel Cortex

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    Depending on the fellowship, there may be more moonlighting opportunities (and time) during fellowship which can increase income substantially (can get up to 10-40K from moonlighting depending on location and specialty).

    In general, fellows are paid according to their PG Year. I.E. First year cards or GI fellows get the same as a surgery 4th year resident.
     
  17. Lorrayne

    Lorrayne Senior Member
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    Yeah, I was going to say the same thing. Moonlighting can really add to income during fellowship. I know a 2nd year fellow who is able to make ~$1000 a week moonlighting in addition to base salary.
     
  18. Maybe 500k/yr is a lot for someone 35yrs old. However, we have to consider the time and opportunities factor. JD takes 3 yrs, MBA takes 2yrs and after that sky is the limit. 1st yr lawyer can make up to 125K/yr (see http://www.nalp.org/content/index.php?pid=147) My buddy who graduated from a top law school just got a sign on bonus that is more than my tuition+fees for 4yrs.
     
  19. chanx314

    chanx314 Member
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    When people always refer to moonlighting during residency, are they referring to specific types of jobs, or just anything you can do to churn out some more spending money?
     
  20. Law2Doc

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    Times have changed. Those who started practicing a few decades back had much higher incomes and ceilings than those minted today, and starting a lucrative practice had significantly fewer barriers. That's what accounts for those rich docs you know -- the so called "golden age" of medicine which has since ended. This isn't a pattern that exists as much any more. You will be comfortable, but won't likely be "making bank" outside of a few specialties. You were born about 15 years too late.
     
  21. sscooterguy

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    Whooooh, hold on, I find this hard to believe. Where in the US can a GP make $500k a year, even in the boonies. I have NEVER heard of this for a 35 year old, especially a GP. A well known Neurosurgeon in the 1980's MAYBE made that much, but even they can't make that much now. Spinal surgeons that make that much today are harder and harder to come by, unless they make partner...and that sure as heck isn't at 35 y/o. Don't mean to flame, but where did you get this figure, and where do GPs make that much money (so I can go there)?

    sscooterguy
     
  22. Blue Dog

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    First of all, guys, there are no "GPs" in the U.S. anymore. Family medicine became a board-certified specialty in the late 1960's. If you're going to work in the health professions, you might as well start using the correct terminology.

    It's certainly possible for a primary care provider (FM or general IM) to earn >$500K per year, but it's not the norm, as you well know. The average income for family physicians in the U.S. is in the $160K range, according to data from the MGMA.* Of course, that's the average, and there are people making far less as well as far more than that.

    It would be challenging to earn $500K after expenses from simply billing typical primary care E&M codes. You'd have to see a ton of patients, either very quickly, or by having long office hours (including nights, weekends, etc.) If one had access to a revenue stream from ancillary services (e.g., diagnostic laboratory, imaging center, etc.), did loads of procedures, had an ownership stake in a large practice, or received a sizable guaranteed salary to practice in an underserved area, I could see it, maybe. It's also possible to have income from sources outside the practice of medicine (investments, etc.), but for this discussion, I'm assuming that one generates all of their income from their practice.

    In a nutshell, it's possible, but these high-earners are going to be few and far between.

    * MGMA (Medical Group Management Association): Per the 2005 survey based on 2004 data, the mean compensation for non-hospital owned FPs was $158,721.
     
  23. beetlerum

    beetlerum Senior Member
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    Could you cite a source that doctors' salaries have decreased significantly in real terms?
     
  24. Blue Dog

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  25. beetlerum

    beetlerum Senior Member
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    Well, those two studies show mainly a decline in salaries of primary care physicians (10%). The decline in real terms for specialists was pretty small. I suppose it's some evidence, but I wouldn't say they support law2doc's reference to a lost "golden era" (for salary), certainly not enough to change the kind of house you could buy.
     
  26. Blue Dog

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    We're just here to lead you to the water. Whether you decide to drink or not is up to you. ;)
     
  27. beetlerum

    beetlerum Senior Member
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    Except those studies don't show the way to a stream.
     
  28. Law2Doc

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    Agree. If you don't like those sites you should definitely talk to older residents and those recently starting private practice. They will give you far more enlightenment as to current salary structure and prospects than the anecdotal atypical high numbers often touted on SDN.
     
  29. Law2Doc

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    No, they say the stream is running a little dryer these days. :laugh:
     
  30. Blue Dog

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    [Knocking on beetlerum's head] "Helloooo...McFly?!?" :rolleyes:
     
  31. Yes, I am here :)
     
  32. beetlerum

    beetlerum Senior Member
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    Then why don't the studies reflect that anecdotal evidence from talking to residents? Those links show that specialists saw their salaries decrease only 4%. Not exactly evidence that "bank" has become merely "comfortable." Even the 10% decrease for primary care specialists is not exactly a profound change.

    To be clear, I'm not saying it's good that salaries have gone down 4% for specialists or 7% overall. I just question your claim that salaries have decreased significantly, and those studies support my skepticism.
     
  33. nighthawk3

    nighthawk3 Member
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    I was a bit mistaken in saying that he is a GP, since he did a three year residency in internal medicine. However, having actually seen his tax returns, he is making very slightly under $500k a year before office expenses and taxes.
     
  34. Law2Doc

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    The articles actually say a decline of 7-10% in net income (not salaries) for the periods of 1995 to 2003. They were already down a little before that period and then have continued to decline (due to reimbursement reductions) the last three years. That's not insignificant. You can bet the decline in net income of medical practices get borne greater by the more junior physicians than the more senior, making those coming out of residency even harder hit. And tax rates are higher now than in the 80s. Not to mention personal expenses (gas, heating oil). Bottom line is that you will make a lower salary and it will not go as far as the generation of physicians that preceded. But you will still be comfortable. Just not living like a rockstar.
     
  35. nighthawk3

    nighthawk3 Member
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    Most of the ones I was referring to did indeed begin practicing a few decades ago, but even with a 50% reduction in income, they'd still be wealthy. Here are two examples:

    1. Thoracic surgeon: approximately 55 years old, went to a middle-tier med school, and has been practicing for 20 years. His ex-wife lives in a house that is worth about $1.5M, and he lives in a house that is worth about $1M. He has two yachts, a BMW SUV and a Volvo, two children at private universities who both attended an extremely expensive prep school for 13 years, and vacations about once a month. No family money and ex-wife never worked.

    2. Hand surgeon: approximately 40 years old, went to bottom-tier med school, and has been practicing for about 6 years. He is married with six children and two dogs, living in a house that would appraise at a little under $2M. Cars are the standard deal: Volvo SUV, Toyota SUV, Lexus convertible, plus a new Honda Civic for their live-in housekeeper. He has one yacht and vacations twice a year.

    I don't dispute that incomes are coming down, but they are still very high. I saw an orthopedist for a 20 minute office visit with no imaging tests and it was billed to insurance for $1,050. I suspect that living in south Florida has given me a very skewed opinion, however. Most people seeing these doctors will pay cash at the time of their visit, and will pay whatever the bill says regardless of fairness. But my main point is, even if these incomes are cut in half, these guys would still be wealthy, even the young example two. Also, doctors keep the world alive -- incomes will never fall too much because at the end of the day, the doctors still hold the cards.
     
  36. Law2Doc

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    I think the point is it's more difficult to even set up the kind of practices these folks did today. So we are not talking 50% reduction, we are talking about an inability to get to the same practice structure. You are dealing with insurance companies and funnelling of patients through PCPs today, and then having to submit paperwork for reimbursements -- it's no longer the same kind of free market.
     
  37. beetlerum

    beetlerum Senior Member
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    First of all, yes you are right that the figure is actually net income, but I really don't see why it matters for the significance of the figures. Second, the figures do not show a decline of 7-10%. They show 7% overall and 10% for pcps. it is misleading to say 7-10. I might also point out that the specialists were always the ones making the "bank" and their salaries were not largely affected. Third, could you please provide a source that salaries (or net income, if you can find that) had already declined? Fourth, I don't know how you conclude that younger physicians would be affected disproportionately, given that the typical cause cited is reimbursement rates, which drive most physicians' income. I suppose you could come up with a theory, but this is still speculative (unless you have a source).

    By the way, tax rates were higher at one point in the 80s and lower at another point. They were also a lot higher in part of the 70s, in the midst of the "golden era." They fluctuate. Furthermore, they affect all professions obviously. I mean, if you're going to bring in tax rates, you could start bringing in all kinds of economic issues, including the fact that the cost of a given standard of living has declined significantly in the last few decades in many ways.
     
  38. Law2Doc

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    You have the same access to google, medical literature databases and hopefully the same access to health professionals as I have. Talk to them. The truth is out there.
    If you think the increased insurance company involvement has not made a dent in physician income and salaries and practice structure and opportunities, and that folks are routinely coming out of residency and into salaries that permit mansions and Bentleys, that's great - believe what you want. Your world sounds more fun, anyhow. I'm not going to tell you Santa Claus doesn't exist either. :)
     
  39. MossPoh

    MossPoh Textures intrigue me
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    South Florida thing? My family left south florida because of the crap pay, lawsuits, expenses and what not...but I guess a million dollar house in south florida is not nearly as big as one in the midwest.lol Fact is though..my dad was worried about money while working around jackson memorial but moved to indiana and almost instantly our finances were ok.lol (He is a radiologist with a fellowship in cardiovascular radiology)
     
  40. beetlerum

    beetlerum Senior Member
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    Way to counter my arguments. I already provided evidence for my point. Well, actually, someone else provided it, but it is still evidence. Obviously I never said that they routinely get mansions and bentleys, but that's because they never did.

    If the truth is out there, it should be easy for you to support the point you make routinely on SDN, that physician income has dropped significantly (i.e. enough to go from making bank to just being comfortable). Please, shut me down with the study showing a 50% drop.
     
  41. nighthawk3

    nighthawk3 Member
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    Sounds like an exception to me. I don't think the finances became better because Indiana has significantly better opportunities, but rather because you can sell a very average house in Miami and buy a mansion in Indiana.
     
  42. mzeroapplicant

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    I disagree with the common Med school statement, "If I wanted to make money, I would have gone into business or law". First of all, the way BIGLAW works these days, you'll need to work 65-70 hours a week in order to make more than your reasonably successful doctors. There's the pressure to attain billable hours requirements, the need to fit into the culture of a corporate law firm, and the fact that you need to be willing to work all night even if you have a family if there's a big merger and you're responsible for the paper work. This doesn't change when you make partner, it only gets worse (except for the money, of course).

    In some cases business has better hours (in some cases it doesn't) but it's also a tremendously risky career regardless of what business school you go to. B-school gets you a job making 100K+, but whether you have that job in a couple years depends on your talent, whether your talent fits into the company, whether you're in the right place at the right time (i.e. luck), etc. It's not a guaranteed living the way an MD is, there are a lot of smart people who fail at it.

    In contrast, MDs make a salary they can live on during their residency and then are guaranteed either a comfortable living or a decadent living for the rest of their life (depending on specialty, region, etc.)
     
  43. Law2Doc

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    Sure the hours to earn 6 digits are high in both of those other options. But the MD salary doesn't start until after 4 years of school plus residency, and after paying down significantly higher loans than either of the other two options. Someone who earns 6 digits after just 3 years of school and invests wisely will have a pretty nice nest egg long before a physician starts earning. And that assumes the physicians's salaries stay where they are which is debatable in the face of increasing insurance company hindrance.
     
  44. Law2Doc

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    Another poster gave a laundry list of millionaire doctors he knows. My bad.
     
  45. mzeroapplicant

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    A nest egg doesn't matter when there's a high rate of burnout/failure. We're talking about lifetime earning potential, and trust me that in law or busieness, it's not at all guaranteed regardless of where you went to school. There are very few people who are really willing to work 65-70 hours a week UNTIL THEY RETIRE. And yes, at least in law, it really is that bad. So your income in law and many areas of business would drop off at about the same time that MDs would be catching up. In terms of loans they are higher for MDs, but not as much as you would think (the average after an MD is 120k, and I believe it's approaching 100k for law).

    Dentistry, nursing, or other health professions would be much better comparisons because they require a shorter education, have less loans, and have a guaranteed income as long as they are willing to work in their field. I just think people mention law or business because thsoe fields sound attractive without thinking of the actual risks involved.
     
  46. Law2Doc

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    Thank you for educating me on law practice, student loans for law school and the like -- I had no idea. :laugh: I think your post is more wishful thinking than reality. Burnout happens, but the rate is pretty low. Golden handcuffs, big mortgages, children etc. keep people at the firms a whole lot longer than you seem to think. And law school loans are lower than you think -- its a year shorter and summer income earning potential is much more significant (necessitating less borrowing).
     
  47. Blue Dog

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    That has nothing to do with income. There is no insurance carrier that will reimburse a routine ambulatory E&M code (even for an orthopod) anywhere close to that amount. He could've billed $1,000,000 for the visit...it doesn't really matter. If insurance pays $100 (which is probably a lot closer to what he'll get than what he billed), that's all he's going to net. He can't bill you for the difference, either.
     
  48. mzeroapplicant

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    This isn't wishful thinking, most people who graduate from a good law school get a BIGLAW job and leave BIGLAW within 5-6 years. Yes, after this they make more than 100K, but it's more like they work 55 hours a week and make 110K. My friend who just graduated from NYU Law is a good example: it's his first year at a V100 firm, and he's making making 145K (if you include the bonus). He'll work 18 hours straight many days and it's incredibly tedious work ("document review"). He'll probably be able to stand this for 2-3 more years and then will take a position in MIDLAW or an in house position. He'll make less, and he'll still work a lot more than most doctors.

    If you want to do research go ahead, but at least 60% of associates leave BIGLAW within 5 years. That doesn't include all the people who quit after they realize they won't make partner. Read this Vault profile, especially the comment Vault makes at the end about their own research:

    http://www.vault.com/nr/main_article_detail.jsp?article_id=18584114&cat_id=0&ht_type=1
     
  49. Blue Dog

    Blue Dog Fides et ratio.
    Physician Gold Donor SDN Advisor Classifieds Approved 10+ Year Member

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    Well, that's a different matter entirely. When most people talk about personal income, they're referring to net income after business expenses, but before taxes. If his overhead is around 60%, like the average primary care practice, that would leave him with $200K before taxes.
     
  50. Law2Doc

    Law2Doc 5K+ Member
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    I guess I don't understand your point. And don't really need to do research -- I already lived it - which is why I'm amused that you are trying to tell me what's what so adamantly (albeit somewhat incorrectly).
    Professionals work long hours. You will in medicine too. I see nothing in the Vault profile about burn out or moving to a midlaw or in house position. But frequently if you move from a big firm to a mid law position after a decent number of years, you get some form of equity or credit for whatever book of busines you bring. So you may not actually get so bad a cut in salary - you often have decent leverage and seniority.
     
  51. mzeroapplicant

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    I was making the point that for my friend to work 50-55 hours in midlaw or in house he would have to take a paycut, I agree with you that someone who has made a lot of contacts and done reasonably well would not necessarily take a paycut as long as they didn't want to work signficantly less.

    Part of my point is to correct misconceptions, such as saying "Professionals work long hours. You will in medicine too." Assuming you do a relatively benign residency, it wouldn't be difficult in most specialities to make a comfortable living working 45 hours a week and taking 4-5 weeks vacation every year. If you tried to do this in law or business, it would be much more difficult and would probably involve taking a paycut.
     

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