Are Physicians Being Squeezed?

[Jojojo]

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"An article in the Feb. 12 issue of the New England Journal of Medicine said the percentage of specialists in independent practice has declined 18.6 percent since the mid 1990s. Primary care doctors have also been migrating to larger groups or jobs as employees of hospital systems or HMOs.These trends are being driven by financial concerns as well as demographic factors. Older doctors want more security and fewer hassles. The growing number of female doctors, meanwhile, want work schedules compatible with family life. There has been little consideration of how these changes will affect access or quality of care"


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The tiny physician payment increases would be offset by 11% cuts in 2010 and 2011. Specialty societies report that the various cost-control schemes will pit physicians against each other—for example, it sets up an advisory panel to re-do Relative Value Units (RVUs) for “over-valued” services."

It seems like society lives on the stereotype that physicians are "rich." The reality is that while physicians do make good salaries, the median salary is about 160K a year according to payscale's well respected salary survey. Consider the 4 years of med school, 100K student loans, residency hell, 60 hour work weeks, stress, years of foregone earning time, malpractice, HMOs, etc. and the salary is not really that unfair....... Sure a few doctors make a lot, but that's a small minority. Realistically 80% of docs are making in the range of 120-190K a year, which is a lot less than a lot of corporate and Wall Street dudes make. There was a time when you had docs making 200/300K+ a year, but those times are gone. If the government goes ahead with the Medicare reimbursement cuts it plans, physician median pay could drop quite significantly.

If this keeps up, at some point people are going to be deterred away from medicine. Anybody else think this is unfair?

 

[Evergrey]

If I didn't have to deal with loans, I'd be extremely happy making 60k.

 

[JennaQ]

I might think about it after I get into medical school. $120-190 is more than enough for me to support a family. Also I really like entering a challenging field. And before you complain, someone is bound to bring up how much PhD's make. Which is usually a lot less than the average pay for Doctors. If you really feel you are getting shafted, then go to Law School and work for some labyrinth super company where you make $200k+ but are used as some pawn to perpetuate their corrupt business practices.

I don't see how playing the, "boo hoo look at us we're victims" really helps you in the long run. Every professions will complain that they get shafted in some way or form. And the people at Wall Street are probably creme de la creme of their field of expertise. If you want to make money and don't care for the unique education you're getting as a doctor or the ability to poke upon the human body, then please pick another profession.

There are too many ways that anything can go wrong. The only thing I know, is that I can only do my best to change myself and how I interact with the world around me. The rest is up to luck and chance.

I never thought that being a doctor was a "bling-bling" profession. People who think so are utter *****s and are social victims of the current economic recession. Think outside the box besides being another representation of American history. Six figures is more than enough for me. But then again I'm only a naive undergrad. Living in her academic bubble of solitude.

 

[DarknightX]

If I didn't have to deal with loans, I'd be extremely happy making 60k.

We'll see if you still think that way after 4 years of medical school and residency during which you worked/studied about 80 hours a week.

Meanwhile some teacher working 40 hours a week with a 4 year degree, or some cop with no education makes just as much as you do.

Ya, I'll bet you'd be thrilled.

 

[Gut Shot]

If I didn't have to deal with loans, I'd be extremely happy making 60k.

If that were 60K right out of college, with full benefits and matching 401K contributions, and no wife or kids, the prospect of regular raises and promotions, and maybe a company car, then yeah, that wouldn't be a bad gig.

 

[Law2Doc]

...If you really feel you are getting shafted, then go to Law School and work for some labyrinth super company where you make $200k+ but are used as some pawn to perpetuate their corrupt business practices....

In all fairness (and speaking from personal experience) most of the time you aren't working directly for the company, you are working for a law firm hired by the company, and in 99.9% of the cases they aren't using you to perpetuate corrupt practices. It is the very rare company who is corrupt -- you just hear about the rarities because their actions are so rare they are newsworthy. And it is rarer still that they get legal advice to be corrupt. Most of the time if the are corrupt they do it without knowledge or against advice of their lawyers. The lawyers' job is to keep the client out of court (and jail). So legal advice tends to be antithetical to corruption. So no, you won't be well paid to be a pawn for corruption. You will be well paid so companies don't accidentally take steps that will get their indicted.

 

[Law2Doc]

...Consider the 4 years of med school, 100K student loans, residency hell, 60 hour work weeks, stress, years of foregone earning time, malpractice, HMOs, etc. and the salary is not really that unfair....

Nobody has only $100k in loans anymore. The average is over $150k and many will come out owing a quarter mill or more.😱

But no, there will not be a deterrence of applicants to med school any time soon, even with declining net incomes. The fact that 50% of applicants don't get in and so many people who school abroad want to come here means that you can deter most med school applicants and still easily fill med schools. So don't expect any changes driven by this concern. Incomes will continue to go down and tuition debt will continue to go up -- we are nowhere near the breaking point.

 

[circulus vitios]

If I didn't have to deal with loans, I'd be extremely happy making 60k.

Have you ever paid bills, lived on your own, or even held a job?

 

[Gallix23]

The reality is that while physicians do make good salaries, the median salary is about 160K a year according to payscale's well respected salary survey.

Everyone I've had this type of discussion with have said that Payscale is one of the worst salary websites out there.

From what I have learned on these boards, you can't make assumptions about a physician's salary from any website, because there are just too many variables involved (who actually took the survey, their location, whether they are in private practice/work at a hospital, etc. etc)

 

[Law2Doc]

Everyone I've had this type of discussion with have said that Payscale is one of the worst salary websites out there.

From what I have learned on these boards, you can't make assumptions about a physician's salary from any website, because there are just too many variables involved (who actually took the survey, their location, whether they are in private practice/work at a hospital, etc. etc)

I agree that you can't buy into salary websites -- most are horribly flawed either because they have a motive (recruiters want you to call so they post inflated salaries), or because they are based on survey data (which tends to skew high because folks who aren't doing well don't complete surveys). And you always need to read the footnotes (some stats are compiled from folks in large group practices (eg cejka) which are thus going to be higher than an average,) and beware of sites that list absurd "maximum" salaries to get folks to call; those are salaries you will never see a fraction of. In general, since doctors don't get jobs through the internet, data found on the internet isn't good to rely on.

That being said the Bureau of Labor and Statistics, linked to a salary article on the front page of SDN (which admittedly is a few years old and based on survey data) does give a figure in the $150-160k range as the average, and this is the most impartial source of data you will find, and thus the least biased data you are going to get. So I'd say the OP's average is probably pretty close to average. Specialists will earn more, some primary care folks will earn less. And there are more primary care folks than specialists.

 

[maceo]

Nobody has only $100k in loans anymore. The average is over $150k and many will come out owing a quarter mill or more.😱

But no, there will not be a deterrence of applicants to med school any time soon, even with declining net incomes. The fact that 50% of applicants don't get in and so many people who school abroad want to come here means that you can deter most med school applicants and still easily fill med schools. So don't expect any changes driven by this concern. Incomes will continue to go down and tuition debt will continue to go up -- we are nowhere near the breaking point.

I think you are making assumptions too fast. In the late 80s the aamc was really worried only 26k people applied to medical school. I think people arent stupid, there has to be a decline in it. The profession is NOT attractive anymore, how can people possible sign up in droves when they can have a much better life doing something else.

 

[circulus vitios]

I think you are making assumptions too fast. In the late 80s the aamc was really worried only 26k people applied to medical school. I think people arent stupid, there has to be a decline in it. The profession is NOT attractive anymore, how can people possible sign up in droves when they can have a much better life doing something else.

I know you're an attending, but from my naive perspective I think it's still an attractive profession. Yeah salaries are declining, but doctors still earn good money. Where else can you earn $150-200k/year by going to school for 4 years + residency? The schooling and training is expensive and takes almost a decade, but how many unemployed/bankrupt doctors do you see?

 

[circulus vitios]

Yes it is still an attractive profession. Last night I was spending time with a few doctors and they were bitching about why they couldn't figure out why a certain patient was referred to them. They spent more time bitching about it than the amount of time they actually spent with the patient. A good chuck of doctors are just frustrated. I can understand that if all they have ever done with their life is go to school, go to medical school, and become a doctor. Having worked in the real world for several years I know what the "other side" is like and it isn't pretty. There is no other career path out there that a person can take that guarantees them the shot at a 6 figure salary starting. Sure there are jobs out there that pay a lot, but those are not direct entry jobs right out of your training/schooling.

I see that a lot on here. "Don't go into medicine for the money - be a lawyer, CEO, etc." Yeah, but you don't jump straight into a $200k/year job as a CEO. It takes years of learning and proving yourself. I guess it could be compared to going to medical school and residency, but you're more or less guaranteed $150-200k/year+ if you do everything right in medicine. There's still a huge possibility that you can do everything right in the business world and still earn no where near physician salaries (or worse - lose your job).

 

[Drogba]

I agree that you can't buy into salary websites -- most are horribly flawed either because they have a motive (recruiters want you to call so they post inflated salaries), or because they are based on survey data (which tends to skew high because folks who aren't doing well don't complete surveys). And you always need to read the footnotes (some stats are compiled from folks in large group practices (eg cejka) which are thus going to be higher than an average,) and beware of sites that list absurd "maximum" salaries to get folks to call; those are salaries you will never see a fraction of. In general, since doctors don't get jobs through the internet, data found on the internet isn't good to rely on.

That being said the Bureau of Labor and Statistics, linked to a salary article on the front page of SDN (which admittedly is a few years old and based on survey data) does give a figure in the $150-160k range as the average, and this is the most impartial source of data you will find, and thus the least biased data you are going to get. So I'd say the OP's average is probably pretty close to average. Specialists will earn more, some primary care folks will earn less. And there are more primary care folks than specialists.

I've heard this again and again, but according to the BLS this is incorrect.

Primary care (OB/GYN, Peds, FP, IM) physicians/total physicians (2005): 40.4%

http://www.bls.gov/oco/ocos074.htm#training

So if the current composition of physicians is a good indicator of future trends, you are more likely than not to become a specialist. Let me also note that while Ped, FP and IM fall between the 155-165k median income OB/GYN is at 240k, so while it qualifies as primary care it is far more lucrative.

 

[Gut Shot]

I've done all of what you mentioned and made half of that and I was happy. But I didn't own a house, didn't have a huge student loan bills and nor was I paying for an expensive car.

Done what I mentioned? What did I mention doing?

 

[maceo]

I know you're an attending, but from my naive perspective I think it's still an attractive profession. Yeah salaries are declining, but doctors still earn good money. Where else can you earn $150-200k/year by going to school for 4 years + residency? The schooling and training is expensive and takes almost a decade, but how many unemployed/bankrupt doctors do you see?

that is not the question you should be asking at your stage. Thats the wrong question. Income without time means nothing.

 

[Law2Doc]

I've heard this again and again, but according to the BLS this is incorrect.

Primary care (OB/GYN, Peds, FP, IM) physicians/total physicians (2005): 40.4%

http://www.bls.gov/oco/ocos074.htm#training...

This discussion came up earlier in the year, and an NRMP table was posted that showed that greater than 50% of spots are what most would categorize as primary care. I think there is some discrepancy in how certain fields are categorized, but I'd defer to the medical establishment over the BLS on this particular issue. You are also leaving out things like psych which have a well below average average. So no, you aren't more likely to be a specialist than not. And in fact that trend is going further the other way because there is a push to increase primary care spots in certain regions, but non-primary care spots, not so much.

 

[OncoCaP]

From what I can tell, medicine is decent in terms of income. Sure, there are ways to make more money than what a physician makes, but not just anyone can make that work out (and not just anyone can become a physician). Some physicians also leave clinical practice into other areas and become wealthy that way (by running a health insurance company, managing clinics from the business end, etc.). The options are endless. It is certainly possible that income of physicians will not keep pace with inflation. Anyone who goes into this field probably should be aware of that risk. At the same time, there is an increasing demand for medical services, an aging population, and many other factors that favor medicine as a career. Also, just because physicians go through an expensive, long, and difficult path does not "entitle" them to a high salary. In economics, it's often a question of supply, demand, and regulation. Right now, there is an oversupply of college students who want to become physicians, and thus there is really very little incentive for anyone to reduce the cost of medical school. The way things seem to be going is that mid-levels are taking over more of the work at a lower cost. Just because the journey was hard doesn't mean you'll find a pot of gold (or even bronze) at the end. Medicine isn't for everyone.

 

[Law2Doc]

...The schooling and training is expensive and takes almost a decade, but how many unemployed/bankrupt doctors do you see?

Tons. I've worked at a firm that represented numerous bankrupt doctors. In fact, folks in the medical field go bankrupt far more often than many other fields because they spend so much time in the sciences that they tend to be ignorant of all things financial. Becoming a successful doctor and successfully running a medical practice are often opposite skillsets. Some make Michael Vick seem like a financial genius. You'd be surprised how many doctors mismanage their firms, take out loans beyond their ability to repay, run afoul of the tax and insurance laws, and end up in financial ruin. I've met young doctors who ran up credit card bills by more than $100k without any ability to repay the absurd interest rates. And plenty of docs coming out of school these days are going to have over $200k in tuition debt, then assume a mortgage of similar size, and if they open a private practice and don't do really really well in the first couple of years, guess what -- they are bankrupt. There was an article about this in the last couple of months -- doctors who opened up chi-chi boutique practices in high end locations and couldn't get the relatively modest patient base necessary to support their leases, employees and income; partly due to low reimbursements, partly due to high expenses, and lack of marketing skillsets. So don't kid yourself into thinking that once you have that degree folks are going to throw money at you or that you are insulated from financial mishaps. You aren't.
You have a better than normal chance to find a lucrative position, but also a better than normal chance to make bad business decisions and squander it.

 

[Law2Doc]

From what I can tell, medicine is decent in terms of income. Sure, there are ways to make more money than what a physician makes, but not just anyone can make that work out (and not just anyone can become a physician). Some physicians also leave clinical practice into other areas and become wealthy that way (by running a health insurance company, managing clinics from the business end, etc.). The options are endless. It is certainly possible that income of physicians will not keep pace with inflation. Anyone who goes into this field probably should be aware of that risk. At the same time, there is an increasing demand for medical services, an aging population, and many other factors that favor medicine as a career.

The demand for physicians outstrips the supply, so finding gainful employment is easier in this career than many others, both because the schooling and training is so long, and because it is so clinician specific (your skillset is not widely applicable to other things). that being said, it is one of the worst launching pads for doing anything outside of the profession. You want to run an insurance company or work in pharmaceuticals, or do consulting, the path of least resistance is to start at the business or law side. Any non-physician path a physician obtains could be more easily obtained and with less schooling from another path. So only go to med school if you want to be a physician. For all else there is a better path.

 

[melanoleuca]

If I didn't have to deal with loans, I'd be extremely happy making 60k.

Please stop saying this. Not only will you not, repeat not, be happy making $60,000 per year when you are in your mid thirties and done with medical school and residency but your ridiculous and completely unfathomable desire to sell yourself short materially harms everybody else coming up around you. All an opportunistic politician, the Sun God Ra-Obama for example, has to do is find enough of you who are totally ignorant of what you are really worth, offer to pay for medical school, and in exchange snare you into working on some crappy indian reservation or with the Holy Underserved for $60,000 per year and then you are stuck as will be the rest of us because your crappy pay will be the new standard towards which all others will be driven.

With respect, shut your cake hole, get a little taste of what is going to be involved in your training, and then give away as much of your money as you like. Student loans are not that big a burden anyway. I consolidated the federal portion of mine at a low interest rate where I will be paying around $500 a month. Sure, I'll be paying this until I die but on the other hand, while I can't be too specific, I am going to be making enough starting in July where this is just chump change.

 

[melanoleuca]

Come on people, residency isn't that bad. Sure you can't really control your schedule as your boss will dictate that. That is how it works in the real world at every other place. Sure the pay is low when you take into account that you work close to 50 - 80 hours a week (depending on what residency you go into) and you still have to do your learning at home. Sure, depending on what residency you go into, you will be stuck working on the weekends at times. That's just how it goes. Just last night a bunch of residents that were not in surgery were out of the hospital before I got a chance to leave.

Nothing is that bad. But as jobs go, you will find that residency is an incredibly crappy one. During my intern year at Duke, for example, I did something like 80 nights of call. What this meant was that ten times a month (because I had a few non-call months) I stayed up, without sleep, for 30 hours straight. Not watching TV or just sitting around, you understand, but working, usually on my feet or rushing around the hospital to do this or that. So just on call days I worked what normal people work in a month...except I also had to work a normal schedule too.

As another example, in residency you are completely and firmly grasped by your gonads and are almost completely stuck at whatever program into which you match. They can mistreat you, treat you like crap, belittle you, deprive you of sleep, force you to do all kinds of asinine bureaucratic make-work and you have no recourse whatsoever. To quit is to essentially torpedo your own career and to match into a different specialty requires a whole year and is extremely difficult to do while working as a resident (I know because I did it). In the real world, by contrast, you can generally look for a different job if you are not happy where you are working. I did this several times when I was an engineer and it was ridiculously easy.

As for being stuck working on weekends "at times," between my intern year and my first year as an Emergency Medicine resident I probably got 15 weekends off in two years. I got some Saturdays and some Sundays but full weekends off were exceedingly rare. Same with Holidays. My schedule is better now, of course, but there will come a point in your residency training where you will realize that you are either always at work, studying, going to conference, or tired from work.

 

[Jojojo]

Payscale is actually pretty widely quoted and their salary claims seem to be pretty accurate in general. It is possible that overestimating med salaries, but it seems like they give lower medians than other surveys I've seen.

You all are correct that physicians salaries vary by location/specialty/experience and I think you make a good point that less successful doctors are less likely to fill out salary surveys. A lot of estimates of doctors salaries skew high (really high), so the public has a misleading view that docs are making 200/300K a year when realistically it might be quite a bit lower.

So really then, 160K median might be an overestimate. If that's the case, then the 22% medicare reimbursement cut is gonna be even more painful than the public realizes. I know money isn't a good reason to do a career, but let's face it. If salary drops, people are going to go into alternative fields.

Pharmacists make 100K a year and dentists make 120K a year median. People with the science aptitude/interest are going to go into those fields if physician salary drops close to that range. Plenty of pre meds will reason that they can do something that interests them by going these alternate routes, avoid the stress/residency/loans, and make almost the same salary as a doctor. I already know quite a few folks that are avoiding medicine because of the excessive stress, loans, and lowered salary. Where are they going? Dentistry and pharmacy.

Again, money is not a good reason to do anything but it realistically is an incentive for many. You take away that incentive, and demand/quality of docs will drop. Who does that hurt? Not so much doctors (they're earning okay salaries even with the salary cuts), but patients and the public.

 

[melanoleuca]

...I don't see how playing the, "boo hoo look at us we're victims" really helps you in the long run. Every professions will complain that they get shafted in some way or form. And the people at Wall Street are probably creme de la creme of their field of expertise. If you want to make money and don't care for the unique education you're getting as a doctor or the ability to poke upon the human body, then please pick another profession...

Look, people ask me if medical school and residency are hard. The answer is yes and part of the reason why physicians should be worth more than what a PA or plumber is paid. There is no "boo hoo" about this at all. Medical training is long, rigorous, and produces highly trained physicians who can be trusted with the lives of their patients, something that most people understand on a visceral level.

If you think a mid-level making a third of what a doctor makes justifies your quest towards a lower salary then you clearly don't know many Physician Assistants and Nurse Practioners, most of whom are severely lacking in medical knowledge and skill and many of whom are truly frightening.

So you see, you need to stick up for your future profession. It is particularly irritating to me, now that I have only 81 days left of residency, to hear pre-meds bragging about how little they care for making money. Good Lord, at least put a couple of years of medical school away before you start doing this. It would be hard to find any fourth year medical students with such a cavalier attitude and if you do, this attitude will not survive the first month of their intern year.

Why? Are we greedy? Are we stupid? Are we vain, selfish, or arrogant? Of course not, it's just that by the time you see what medicine is all about and that the physician is the most important part of the whole goat rodeo, you will appreciate your value.

On the other hand, I never complain about medical school debt because it's just not that big a problem for most medical students. It only looks like a problem because most of you have never worked for more than pretend money (Starbucks, McDonalds, and etc.) and when your only prior experience is $5.75 an hour, a couple of hundred thousand looks like a lot of money when, in fact, as an investement if your human capital, it is not.

www.studentdoctor.net/pandabearmd

 

[Gut Shot]

If that's the case, then the 22% medicare reimbursement cut is gonna be even more painful than the public realizes.

Medicare isn't going to get cut by 22%. This is something that comes up every single year, and every single year Congress nixes the 10-11% cut and institutes a small increase. This is due to the sustainable growth rate (SGR) formula that is supposed to be guiding reimbursement levels. The problem is that the formula is a POS, and so every year they have to skirt disaster once again by making a last minute save.

AMA sent me an update a few days ago, and the House Budget Resolution (passed May 25) "contains provisions that would facilitate the passage of legislation to replace the flawed sustainable growth rate (SGR) formula."

Unfortunately, these provisions are not in the Senate version.

 

[Law2Doc]

Nothing is that bad. But as jobs go, you will find that residency is an incredibly crappy one. During my intern year at Duke, for example, I did something like 80 nights of call. What this meant was that ten times a month (because I had a few non-call months) I stayed up, without sleep, for 30 hours straight. Not watching TV or just sitting around, you understand, but working, usually on my feet or rushing around the hospital to do this or that. So just on call days I worked what normal people work in a month...except I also had to work a normal schedule too.

As another example, in residency you are completely and firmly grasped by your gonads and are almost completely stuck at whatever program into which you match. They can mistreat you, treat you like crap, belittle you, deprive you of sleep, force you to do all kinds of asinine bureaucratic make-work and you have no recourse whatsoever. To quit is to essentially torpedo your own career and to match into a different specialty requires a whole year and is extremely difficult to do while working as a resident (I know because I did it). In the real world, by contrast, you can generally look for a different job if you are not happy where you are working. I did this several times when I was an engineer and it was ridiculously easy.

As for being stuck working on weekends "at times," between my intern year and my first year as an Emergency Medicine resident I probably got 15 weekends off in two years. I got some Saturdays and some Sundays but full weekends off were exceedingly rare. Same with Holidays. My schedule is better now, of course, but there will come a point in your residency training where you will realize that you are either always at work, studying, going to conference, or tired from work.

Very important post for premeds to read. Not news to folks who have done rotations in med school and have some degree of vantage point, but premeds seem to think of it as just another 9-5 job; it really isn't. It will be the hardest year of employment in your life (and that's coming from someone who has already worked in a long houred profession).

 

[DarknightX]

Please stop saying this. Not only will you not, repeat not, be happy making $60,000 per year when you are in your mid thirties and done with medical school and residency but your ridiculous and completely unfathomable desire to sell yourself short materially harms everybody else coming up around you. All an opportunistic politician, the Sun God Ra-Obama for example, has to do is find enough of you who are totally ignorant of what you are really worth, offer to pay for medical school, and in exchange snare you into working on some crappy indian reservation or with the Holy Underserved for $60,000 per year and then you are stuck as will be the rest of us because your crappy pay will be the new standard towards which all others will be driven.

With respect, shut your cake hole, get a little taste of what is going to be involved in your training, and then give away as much of your money as you like. Student loans are not that big a burden anyway. I consolidated the federal portion of mine at a low interest rate where I will be paying around $500 a month. Sure, I'll be paying this until I die but on the other hand, while I can't be too specific, I am going to be making enough starting in July where this is just chump change.

Well said.

 

[Gut Shot]

and that the physician is the most important part of the whole goat rodeo,

Good to have you back.

 

[Drogba]

This discussion came up earlier in the year, and an NRMP table was posted that showed that greater than 50% of spots are what most would categorize as primary care. I think there is some discrepancy in how certain fields are categorized, but I'd defer to the medical establishment over the BLS on this particular issue. You are also leaving out things like psych which have a well below average average. So no, you aren't more likely to be a specialist than not. And in fact that trend is going further the other way because there is a push to increase primary care spots in certain regions, but non-primary care spots, not so much.

Psych is included in the BLS data as specialist with 5% of the physician population. Also according the BLS, psych earns ~180k on average, which is above the oft-cited ~160k and would thus raise the average if you included it in any calculation. Also, as I stated OBGYN is routinely included in primary care and their avg salary is far above ~160k. Weighting for composition the average salary for primary care + psych is 172k and that is only 45.9% of the physician population.

Perhaps the data to which you allude significantly contradicts the BLS, but your last point notwithstanding, it still seems that you are more than likely not going to go into primary care, and even if you did, you more than likely would make more than ~160k a year.

 

[Evergrey]

Have you ever paid bills, lived on your own, or even held a job?

Yes, yes, and yes. I'm an extremely frugal person and I manage my money very well. And yes I know what it's like to work >80 hours (but not for more than a few weeks at once). Have any of you ever thought that perhaps what motivates other people may different? There's no archetypal "right way" to approach finances and compensation. Moreover, I wasn't even stating what I thought physician compensation should be, I was only expressing *the bare minimum* it would take for *me* to look past financial concerns and be proud that I'm alive, healthy and blessed with a family and grateful for all that I have been given in life (and every single one of us has been given much, much more than we can possibly realize).

I'm completely aware that I want to go into a field where I will have to work my butt off just to even have a chance at working hard to become a physician. I'm the kind of person that is going to work hard anyway, even if it's a low-paying dead-end job where there's no hope of getting a raise or promotion. Maybe to others that means I'm stupid, but I won't stop them from having your own opinion about it. I don't do it for the compensation, and I certainly don't do it for respect or admiration, I do it because at the end of the day that's what will make me content on my deathbed and able to say "I lived the way I wanted to." If you'll allow me to be nihilistic for a moment -- working so that we'll be satisfied before we die is a very commonly shared goal. I just have a different preference for how to tackle it.

 

[WannaBePreMed]

Well if money's what you want you're in the wrong profession.

 

[circulus vitios]

that is not the question you should be asking at your stage. Thats the wrong question. Income without time means nothing.

What should I be asking?

 

[Riboflavin]

Well if money's what you want you're in the wrong profession.

I don't think it is ALL about wanting to make money, but as many have mentioned above, it is about being compensated for you hard work and time. So, caring whether or not you bring in a good salary is important. I would be heavily distraught and disappointed if I knew all my hard work and all the loans I had to take out was going to get me just as far as I could've got with a teaching degree or something else. Saying you "don't care about the money", or saying "it is not about the money" is not a good approach.

Yes, their are those of you who say you can live frugally, and maybe you do now, but honestly if can say "I don't care what I make, I just want to be a doctor," well, you are crazy. With any job a big concern is salary, like it or not you need it survive.

 

[Evergrey]

like it or not you need it survive.

Everyone posting in this thread has FAR more than we need to survive. And we've all had it since birth.

 

[Riboflavin]

Everyone posting in this thread has FAR more than we need to survive. And we've all had it since birth.

Then get off the internet and go live in the woods. Or you can not be a smart-ass and over analyze what I said and make it more than what it is suppose to mean, cause you know what I mean.

 

[Riboflavin]

I'm completely aware that I want to go into a field where I will have to work my butt off just to even have a chance at working hard to become a physician. I'm the kind of person that is going to work hard anyway, even if it's a low-paying dead-end job where there's no hope of getting a raise or promotion. Maybe to others that means I'm stupid, but I won't stop them from having your own opinion about it. I don't do it for the compensation, and I certainly don't do it for respect or admiration, I do it because at the end of the day that's what will make me content on my deathbed and able to say "I lived the way I wanted to." If you'll allow me to be nihilistic for a moment -- working so that we'll be satisfied before we die is a very commonly shared goal. I just have a different preference for how to tackle it.

I will admit, that is a fine way to go about life; however, you think anyone cares about your respect, how hard you work, that you are doing right to your fellow man, etc...maybe some, but do you think that will help pay for your house, your debt, your food, your children, and their future? The point is this isn't how it was back then anymore, and today nobody cares. So let me be narcissistic, if you will, and let you know it is important to be passionate about what you are doing and love what you are doing because that will matter to most when they die. Just let me know how important it is when you have to take out a second mortgage, or have to eat bread and soup broth (and see your children do the same.) Yes, people do it everyday, even less, even nothing at all, but why would you want that? Do you think they want that? Don't you think someone living on the streets wouldn't want something more? Being admirable and passionate can only get you so far in this world today. I'm not bashing you and calling you stupid that you think about life this way at all. Just maybe you should open your eyes a little wider and realize the world you are living in. How are you going to help people when you aren't even going to be able to help yourself?

 

[Pedsbro]

Yes, yes, and yes. I'm an extremely frugal person and I manage my money very well. And yes I know what it's like to work >80 hours (but not for more than a few weeks at once). Have any of you ever thought that perhaps what motivates other people may different? There's no archetypal "right way" to approach finances and compensation. Moreover, I wasn't even stating what I thought physician compensation should be, I was only expressing *the bare minimum* it would take for *me* to look past financial concerns and be proud that I'm alive, healthy and blessed with a family and grateful for all that I have been given in life (and every single one of us has been given much, much more than we can possibly realize).

I'm completely aware that I want to go into a field where I will have to work my butt off just to even have a chance at working hard to become a physician. I'm the kind of person that is going to work hard anyway, even if it's a low-paying dead-end job where there's no hope of getting a raise or promotion. Maybe to others that means I'm stupid, but I won't stop them from having your own opinion about it. I don't do it for the compensation, and I certainly don't do it for respect or admiration, I do it because at the end of the day that's what will make me content on my deathbed and able to say "I lived the way I wanted to." If you'll allow me to be nihilistic for a moment -- working so that we'll be satisfied before we die is a very commonly shared goal. I just have a different preference for how to tackle it.

Ah, that sweet scent of raw idealism...🙄

 

[DarknightX]

Well if money's what you want you're in the wrong profession.

Why? Because that's what med schools want to hear?

Why can't I help people and be compensated financially for all my years of hard work and training? I don't understand why you can't have one and not the other.

 

[Riboflavin]

Why? Because that's what med schools want to hear?

Why can't I help people and be compensated financially for all my years of hard work and training? I don't understand why you can't have one and not the other.

I think it is all about finding a balance between the both, but yeah, I think there is nothing wrong with wanting to be compensated financially. I'm not even in med school and just from my friends I see the sacrifice and tolerance needed to get by.

 

[maceo]

I know you're an attending, but from my naive perspective I think it's still an attractive profession. Yeah salaries are declining, but doctors still earn good money. Where else can you earn $150-200k/year by going to school for 4 years + residency? The schooling and training is expensive and takes almost a decade, but how many unemployed/bankrupt doctors do you see?

4 years of school and residency.. 150k.. why didnt you say so? that sounds easy as ****.. sign me up.

The real question you should be asking is whether or not medicine satisfies you not whether or not its a stable job. If you go into it for the latter you are going to be one miserable (expletive starting with mother). you will be almost suicidal, i promise you that.

 

[WannaBePreMed]

Why? Because that's what med schools want to hear?

Why can't I help people and be compensated financially for all my years of hard work and training? I don't understand why you can't have one and not the other.

No, not because that's what medical schools want to hear but because it's the truth. You should realized that no amount of money can compensate for the sacrifices you'll make. You'll only be truly compensated if you find joy and self-fulfillment in being a doctor.

 

[maceo]

Nothing is that bad. But as jobs go, you will find that residency is an incredibly crappy one. During my intern year at Duke, for example, I did something like 80 nights of call. What this meant was that ten times a month (because I had a few non-call months) I stayed up, without sleep, for 30 hours straight. Not watching TV or just sitting around, you understand, but working, usually on my feet or rushing around the hospital to do this or that. So just on call days I worked what normal people work in a month...except I also had to work a normal schedule too.

As another example, in residency you are completely and firmly grasped by your gonads and are almost completely stuck at whatever program into which you match. They can mistreat you, treat you like crap, belittle you, deprive you of sleep, force you to do all kinds of asinine bureaucratic make-work and you have no recourse whatsoever. To quit is to essentially torpedo your own career and to match into a different specialty requires a whole year and is extremely difficult to do while working as a resident (I know because I did it). In the real world, by contrast, you can generally look for a different job if you are not happy where you are working. I did this several times when I was an engineer and it was ridiculously easy.

As for being stuck working on weekends "at times," between my intern year and my first year as an Emergency Medicine resident I probably got 15 weekends off in two years. I got some Saturdays and some Sundays but full weekends off were exceedingly rare. Same with Holidays. My schedule is better now, of course, but there will come a point in your residency training where you will realize that you are either always at work, studying, going to conference, or tired from work.

80 nights on call.. thats it.. I did q 3 nights on call for the whole year in 99. 4 weeks off. No post call days off. SO i was staying in the hospital 30-36 hours at a clip every third night. and those nights on call were covering 4-5 services plus the ER and the SICU.and in the morning i had to present all the patients in the ICU usually 8-11 patients. The nights on call my beeper would go off about 7-10 times per hour until about 9 pm. From 9-midnite it would go off about 4-6 times an hour and midnite to 6 am about 3-4 times an hour. That year I tool 106 over night calls like this. I have all the call schedules. Now when you work like this... trust me. you aint gonna be idealistic. you are in survival mode. thats it. That was slave labor. I was treated like a slave. My fellow interns and I were looked at sternly if we were sitting enjoying our lunch. IT was terrible. My residency was bad too.. but not as bad as internship. Internship was A living nightmare.

 

[Riboflavin]

No, not because that's what medical schools want to hear but because it's the truth. You should realized that no amount of money can compensate for the sacrifices you'll make. You'll only be truly compensated if you find joy and self-fulfillment in being a doctor.

Okay, so what about the other stuff: loans, other bills, food, clothes, housing, car payments, insurance, gas, etc etc. Or how about just treating yourself out to an enjoyable night and catching a movie or something? You guys speak as if all your problems will go away once you become a doctor, that you have closed Pandora's box. What you think Shangra-la is waiting for you at the end of all of this? Grow up you guys, seriously! I'm not talking down on becoming a doctor, I think it is a great job; however, given I will be taken care of financially and will be able to continue my practice because I have the money to do so. Unless, all of you are coming straight out of med school debt free, and will never be sued in your life, then you can think that way. I mean I don't see how you guys want to struggle month to month paying bills with the money you don't have. I don't it all just sounds silly to me.

 

[Jojojo]

I didn't bring this topic up to justify paying docs more because it helps them. My view is that docs might make enough, but salary cuts are going to hurt patients. As I said before, people are motivated by money. Like it or not, lower pay for docs means more people leaving medicine for dentistry and pharmacy.

Also, I've always noticed that job listings for physicians and dentists seem to list much lower salaries than the salary surveys. So I think the people here that claim doctors make a lot less than surveys indicate are probably right.

Now I think it'd be reasonable to assume docs make on average make somewhere in the 100-200K range, depending on the speciality. That seems fair. If salaries drop quite a bit from that range, then I fear people are going to start to avoid medicine. Should you go into medicine for the money? No. Is money one of the motivators for pre-meds? Yes. In my opinion, docs don't need to be any richer but huge cuts in salary will be detrimental to the healthcare system.

 

[Riboflavin]

I didn't bring this topic up to justify paying docs more because it helps them. My view is that docs might make enough, but salary cuts are going to hurt patients. As I said before, people are motivated by money. Like it or not, lower pay for docs means more people leaving medicine for dentistry and pharmacy.

Also, I've always noticed that job listings for physicians and dentists seem to list much lower salaries than the salary surveys. So I think the people here that claim doctors make a lot less than surveys indicate are probably right.

Now I think it'd be reasonable to assume docs make on average make somewhere in the 100-200K range, depending on the speciality. That seems fair. If salaries drop quite a bit from that range, then I fear people are going to start to avoid medicine. Should you go into medicine for the money? No. Is money one of the motivators for pre-meds? Yes. In my opinion, docs don't need to be any richer but huge cuts in salary will be detrimental to the healthcare system.

Oh, you couldn't be more right. I mean the money help attracts you in, it comforts the person and shows that can have a secure life. If the salary drops anymore I wouldn't doubt seeing less and less people applying to med schools with the can just as easily go into engineering or something. I'm not arguing that doctors should get paid more and more, but just that you need enough to equate what it takes to become a doctor.

 

[WannaBePreMed]

Okay, so what about the other stuff: loans, other bills, food, clothes, housing, car payments, insurance, gas, etc etc. Or how about just treating yourself out to an enjoyable night and catching a movie or something? You guys speak as if all your problems will go away once you become a doctor, that you have closed Pandora's box. What you think Shangra-la is waiting for you at the end of all of this? Grow up you guys, seriously! I'm not talking down on becoming a doctor, I think it is a great job; however, given I will be taken care of financially and will be able to continue my practice because I have the money to do so. Unless, all of you are coming straight out of med school debt free, and will never be sued in your life, then you can think that way. I mean I don't see how you guys want to struggle month to month paying bills with the money you don't have. I don't it all just sounds silly to me.

Doctors make enough for the "other stuff", I haven't seen a homeless doctor yet. Also for someone like me who's had struggles his whole life, living modestly would be perfectly fine. It's not about the money it's about being happy, and if money makes you happy find another job because medicine isn't just money.

 

[maceo]

Doctors make enough for the "other stuff", I haven't seen a homeless doctor yet. Also for someone like me who's had struggles his whole life, living modestly would be perfectly fine. It's not about the money it's about being happy, and if money makes you happy find another job because medicine isn't just money.

man would i love to be your employer!!

me: the job as a dr. pays 20 dollars an hour.

wannabepremed: It's not about the money it's about being happy; ill take it

me: great. what a sucker! Im gonna make a killing on this guy. ill pay him 20 bucks an hour and pocket the difference.

 

[Riboflavin]

Doctors make enough for the "other stuff", I haven't seen a homeless doctor yet. Also for someone like me who's had struggles his whole life, living modestly would be perfectly fine. It's not about the money it's about being happy, and if money makes you happy find another job because medicine isn't just money.

Okay, maybe you are missing my point. I am not even going to continue on with this. Read my previous posts, if you haven't already. Plus, saying all you care about is becoming a doctor, and the money has nothing to do with it doesn't earn you any brownie points. But honestly even if people love the idea of being a doctor, you think anybody is going to want to be one if doctors keep losing out on their salary? As much as I want to be a doctor if they started taking bigger pay-cuts, I would choose something else. Call me what you will, but honestly I will have enough to worry about I don't want the fact that I cannot pay off my debt and have to live in a one bedroom apt with my family be apart of it. I don't see why you guys wouldn't want something better. Is it pride? Do you want to be glorified above the rest of use who actually care about making some money? Please, maybe someone can explain it a little better than you guys have been doing.

 

[circulus vitios]

4 years of school and residency.. 150k.. why didnt you say so? that sounds easy as ****.. sign me up.

The real question you should be asking is whether or not medicine satisfies you not whether or not its a stable job. If you go into it for the latter you are going to be one miserable (expletive starting with mother). you will be almost suicidal, i promise you that.

I like medicine itself (or at least I think I do). I was going more along the lines of all other things considered, it's a stable job relative to other high paying careers that have much greater turnover rates.

 

[circulus vitios]

80 nights on call.. thats it.. I did q 3 nights on call for the whole year in 99. 4 weeks off. No post call days off. SO i was staying in the hospital 30-36 hours at a clip every third night. and those nights on call were covering 4-5 services plus the ER and the SICU.and in the morning i had to present all the patients in the ICU usually 8-11 patients. The nights on call my beeper would go off about 7-10 times per hour until about 9 pm. From 9-midnite it would go off about 4-6 times an hour and midnite to 6 am about 3-4 times an hour. That year I tool 106 over night calls like this. I have all the call schedules. Now when you work like this... trust me. you aint gonna be idealistic. you are in survival mode. thats it. That was slave labor. I was treated like a slave. My fellow interns and I were looked at sternly if we were sitting enjoying our lunch. IT was terrible. My residency was bad too.. but not as bad as internship. Internship was A living nightmare.

That's really ****ed up. I know the 80 hour limit didn't exist back in '99, but was there anything against an insanely excessive work schedule? No one could argue that what you went through was the least bit beneficial, productive, or healthy.