Attending Life

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I moonlighted as a resident. I’m fresh out as an attending. But yes I’m putting pretty much everything away. I’m renting and keeping expenses minimal. I could be 100% debt free right now if I wanted to be. I’m saving cash to invest at the moment
 
You’ve paid off $350k between residency moonlighting and being out since July? wtf
 
Shimmy8 said:
He started last July. Like 8 months ago.
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Still impressive. 350k in a year is ridiculous. I'll be proud getting rid of about 200k in two years. Granted, I am married with three kids.

If I was single, I bet I could get rid of 200k in a year easily. 350k in a year means an absurd income, zero percent credit card, or literally putting no money towards investments/retirement.

Sent from my XT1710-02 using Tapatalk
 
Shimmy8 said:
You’ve paid off $350k between residency moonlighting and being out since July? wtf
Click to expand...

I worked like a dog in residency. Paid most of it off there. It sucked and haven’t fully recovered from the burnout to be honest

It’s probably a bit patholigic how much I hate debt tho. I view it as holding me back from investing and living my life.
 
acidbase1 said:
I worked like a dog in residency. Paid most of it off there. It sucked and haven’t fully recovered from the burnout to be honest

It’s probably a bit patholigic how much I hate debt tho. I view it as holding me back from investing and living my life.
Click to expand...

Wow. Great job man.

And, yeah, I hear you on the debt thing. Hate it.
 
The Physician Philosopher said:
Hahahaha you guys are hilarious.

Unfortunately, medical school makes many uninformed people as it teaches nothing about wealth and wellness. You can pick it up on your own by putting the hours in, but many would rather learn "enough" to make smart financial decisions.

I don't fault anyone for going through medical school and focusing predominantly on becoming a good physician. That's what medical school teaches most med students... Then on their way out the door they say something like "oh, by the way, you should do something with all that debt we gave you."

Sent from my XT1710-02 using Tapatalk
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We actually did have an optional 1 credit financial planning class. I was skeptical of it's utility though and had my hands full with MS1 anyway.

I have a plan more or less: refinance, REPAYE, moonlight, and ***** myself out to the highest bidder immediately after I graduate. Don't care if I have to move to flyover country.

I'll sort out the details later. Still not sure if it makes more sense to put all money towards debt or max out retirement accounts and put the remainder toward debt. Or maybe I'll just put it all on black.

edit: apparently w horing is a no-no word
 
NightNight said:
How great is $275K when the cost of obtaining a medical degree can be in excess of $500K and you‘re losing a third of that $275K every year to Uncle Sam?
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This begs the question. For those medical students who had enough hubris to take on $500k worth of debt, what is the expected fair compensation/payoff. If 275 is s***, what number is fair? $500k/year? $1m/year? Do people actually run the numbers before diving into an expensive private medical school?

Educational debt is criminally easy to obtain. There is collusion between the banks and the schools, and the customers/prey are a group of extremely naive young people. How did we get to a situation where a 22 year old with no income can get a $300k loan? If the loans were not so easily available, the schools would have to find ways to become more affordable. Students don’t actually need multimillion dollar gyms and libraries and other Ritz Carlton style amenities. But the schools need them to seduce students and faculty and donors. It’s an arms race and the bill is footed primarily by students and taxpayers.

Like a business loan, lenders should make you show a clear plan to pay back student loans with a timeline of projected revenues, payments, and other expenses BEFORE the loan is funded.
 
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zero0 said:
We actually did have an optional 1 credit financial planning class. I was skeptical of it's utility though and had my hands full with MS1 anyway.

I have a plan more or less: refinance, REPAYE, moonlight, and ***** myself out to the highest bidder immediately after I graduate. Don't care if I have to move to flyover country.

I'll sort out the details later. Still not sure if it makes more sense to put all money towards debt or max out retirement accounts and put the remainder toward debt. Or maybe I'll just put it all on black.

edit: apparently w horing is a no-no word
Click to expand...
Just recently had a conversation with an adviser. I'm not sure why you list refinance first. anyways,
the basic very general advice was
Do repaye, paye, one of the ibr programs. pay as little as possible
contribute ~5k max to roth ira
graduate. refinance. pay off them loans
He said get disability insurance while in residency. im not so sure about that
 
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nimbus said:
This begs the question. For those medical students who had enough hubris to take on $500k worth of debt, what is the expected fair compensation/payoff. If 275 is s***, what number is fair? $500k/year? $1m/year? Do people actually run the numbers before diving into an expensive private medical school?

Educational debt is criminally easy to obtain. There is collusion between the banks and the schools, and the customers/prey are a group of extremely naive young people. How did we get to a situation where a 22 year old with no income can get a $300k loan? If the loans were not so easily available, the schools would have to find ways to become more affordable. Students don’t actually need multimillion dollar gyms and libraries and other Ritz Carlton style amenities. But the schools need them to seduce students and faculty and donors. It’s an arms race and the bill is footed primarily by students and taxpayers.

Like a business loan, lenders should make you show a clear plan to pay back student loans with a timeline of projected revenues, payments, and other expenses BEFORE the loan is funded.
Click to expand...

Now it’s the students’ fault? Lol ok.
Your plan would basically ensure no one ever went into family medicine or any other low paying specialty. Also disincentivizes lending to people who plan to start families.
 
The paperwork for my home loan is like a short thesis compared to my one-time signatures for my student loans throughout medical school....insane.
 
NightNight said:
Now it’s the students’ fault? Lol ok.
Your plan would basically ensure no one ever went into family medicine or any other low paying specialty. Also disincentivizes lending to people who plan to start families.
Click to expand...

DINK with dogs is the new family of four...
 
acidbase1 said:
I worked like a dog in residency. Paid most of it off there. It sucked and haven’t fully recovered from the burnout to be honest

It’s probably a bit patholigic how much I hate debt tho. I view it as holding me back from investing and living my life.
Click to expand...

I worked part-time as a nurse throughout medical school to save myself $80-90K in loans. I think it was worth it but I’ll let you know the long term effects it left behind....
 
pocafx said:
Just recently had a conversation with an adviser. I'm not sure why you list refinance first. anyways,
the basic very general advice was
Do repaye, paye, one of the ibr programs. pay as little as possible
contribute ~5k max to roth ira
graduate. refinance. pay off them loans
He said get disability insurance while in residency. im not so sure about that
Click to expand...

Yes!!! You need to get disability in residency. One unexpected diagnosis or doctor visit can either make you uninsurable or very expensive to insure.
Do not skimp on this and get it ASAP; the older you are when you initiate the policy, the more expensive it will be.
Make sure you get a policy with a future benefit increase rider. This allows you to increase the policy when your income increases without medical underwriting.
 
I am totally with @nimbus on this one.

Why has tuition cost risen so rapidly over the past 20 years? Because the students can get easy government money. And obviously it’s an incentive for the schools to increase their tuition and fees because they know naive students will sign on the dotted line in order to try to achieve the American dream. I think it’s all collusion as well and someone needs to sue or people need to boycott these expensive colleges and do something else. Like trades or something.

I wonder how easy it was to obtain student loans in the 70s and 80s.

But thanksfully I am from TX where schools are (or at least used to be) cheaper than average. I am amazed at your much even the public schools in the East Coast are.
 
Man o War said:
Yes!!! You need to get disability in residency. One unexpected diagnosis or doctor visit can either make you uninsurable or very expensive to insure.
Do not skimp on this and get it ASAP; the older you are when you initiate the policy, the more expensive it will be.
Make sure you get a policy with a future benefit increase rider. This allows you to increase the policy when your income increases without medical underwriting.
Click to expand...
Yeah, solid advice. Just don't apply for it if you have any medical problems.

If you do have med problems, wait til residency and get the guaranteed policy first. If you apply and are denied you get to keep that. If you get denied from disability, you cannot even get the guaranteed disability offered for residents.

Don't ask me how I know.

Sent from my XT1710-02 using Tapatalk
 
It wasn’t easy based on my limited reasearch. The caps on amounts borrowed were lower than now. Much lower. All the colleges see is “mo’ money, mo’ money” so they jack up their fees.
And it ain’t going to professors since no one seems to want to give them full time jobs now, so where is it going? Guess it’s the fancy stadiums and gyms after all.

It’s BS. But students should start protesting this s hit too.
 
I'm willing to bet that popular graph showing rise of medical costs compared to the rise of physician salary vs administrator growth looks much the same as a graph based on the rise in college tuition.
 
NightNight said:
Now it’s the students’ fault? Lol ok.
Your plan would basically ensure no one ever went into family medicine or any other low paying specialty. Also disincentivizes lending to people who plan to start families.
Click to expand...


Yes they made the decision, they share the blame. Nobody is ever forced to attend medical school or have kids. Just as everyone on SDN says we should take stand against AMCs, we should take a stand against overpriced medical schools. People need to take some personal responsibility for their decisions and stop whining. Especially doctors. Talk about an entitled group.
 
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pocafx said:
Just recently had a conversation with an adviser. I'm not sure why you list refinance first. anyways,
the basic very general advice was
Do repaye, paye, one of the ibr programs. pay as little as possible
contribute ~5k max to roth ira
graduate. refinance. pay off them loans
He said get disability insurance while in residency. im not so sure about that
Click to expand...
So I should actually start contributing to my roth IRA in residency? Interesting. I knew 401k was off the table, because it's not like residents are full-time salaried workers, or even people for that matter, but I never even thought about roth IRA. Like I said, I haven't sorted out the details yet. I guess once you refinance you're no longer eligible for federal loan repayment programs, so that makes sense. I'd have to wait on attending paychecks.

As far as the runaway cost of all education in this country, not just medical, yeah it sucks big time but it's not like we have any other options. I was a non-trad before going into medicine and I thought long and hard before going down this road. To the best of my knowledge, virtually everything else has gone to crap. Law is saturated, so is veterinary medicine, dentistry, pharmacy (RIP), MBAs are being pumped out in record numbers, tech sounds good but it's a bum deal more often than not, and, yup, midlevels too are severely oversaturated. Part of the reasons they're fighting so hard to expand their scope is because they have no jobs, although ego, salary, and not wanting to be a midlevel into their late 50s is definitely a part of it. Hell, even some specialties are starting to feel the repercussions from the glut of new grads they pump out every year, which is why every time somebody gives a presentation about opening up new residencies I'm there shaking my head while everyone else claps away and has a merry old time. Dermatology has done a great job of controlling this part and we could all take a page from them.
 
nimbus said:
This begs the question. For those medical students who had enough hubris to take on $500k worth of debt, what is the expected fair compensation/payoff. If 275 is s***, what number is fair? $500k/year? $1m/year? Do people actually run the numbers before diving into an expensive private medical school?

Educational debt is criminally easy to obtain. There is collusion between the banks and the schools, and the customers/prey are a group of extremely naive young people. How did we get to a situation where a 22 year old with no income can get a $300k loan? If the loans were not so easily available, the schools would have to find ways to become more affordable. Students don’t actually need multimillion dollar gyms and libraries and other Ritz Carlton style amenities. But the schools need them to seduce students and faculty and donors. It’s an arms race and the bill is footed primarily by students and taxpayers.

Like a business loan, lenders should make you show a clear plan to pay back student loans with a timeline of projected revenues, payments, and other expenses BEFORE the loan is funded.
Click to expand...
That's the next subprime crisis.

To people who need financial advice, one link is enough: The White Coat Investor .
 
zero0 said:
So I should actually start contributing to my roth IRA in residency? Interesting. I knew 401k was off the table, because it's not like residents are full-time salaried workers, or even people for that matter, but I never even thought about roth IRA. Like I said, I haven't sorted out the details yet. I guess once you refinance you're no longer eligible for federal loan repayment programs, so that makes sense. I'd have to wait on attending paychecks.
Click to expand...

I wrote a post on just this topic recently (investing what you can during residency). If you can, it is a good idea for a number of reasons.
 
norwood said:
I'd much rather call it work-life balance, but sure. It's all about contentment. Some people in the medical world act like they're going to starve if they make 150k/year.
Click to expand...


Calling it surfer track or golfer track or model railroad track sounds more manly.

“I’m looking for a golfer track job in Scottsdale.”
 
zero0 said:
So I should actually start contributing to my roth IRA in residency? Interesting. I knew 401k was off the table, because it's not like residents are full-time salaried workers, or even people for that matter, but I never even thought about roth IRA. Like I said, I haven't sorted out the details yet. I guess once you refinance you're no longer eligible for federal loan repayment programs, so that makes sense. I'd have to wait on attending paychecks.

As far as the runaway cost of all education in this country, not just medical, yeah it sucks big time but it's not like we have any other options. I was a non-trad before going into medicine and I thought long and hard before going down this road. To the best of my knowledge, virtually everything else has gone to crap. Law is saturated, so is veterinary medicine, dentistry, pharmacy (RIP), MBAs are being pumped out in record numbers, tech sounds good but it's a bum deal more often than not, and, yup, midlevels too are severely oversaturated. Part of the reasons they're fighting so hard to expand their scope is because they have no jobs, although ego, salary, and not wanting to be a midlevel into their late 50s is definitely a part of it. Hell, even some specialties are starting to feel the repercussions from the glut of new grads they pump out every year, which is why every time somebody gives a presentation about opening up new residencies I'm there shaking my head while everyone else claps away and has a merry old time. Dermatology has done a great job of controlling this part and we could all take a page from them.
Click to expand...
What FFP said. Read WCI. A few hours of reading on that website will give you a great deal of helpful information.

As stated.

-Graduate from med school, consolidate loans and do RePAYE.
-Pay minimums during residency.**
-Try to Max your Roth IRA as a resident.
-Upon graduation from residency, refinance and pay off loans.

Simple, right?

** If you're on RePAYE, the government will pay up to half your interest each month while you make small to zero payments each month.
 
acidbase1 said:
I worked like a dog in residency. Paid most of it off there. It sucked and haven’t fully recovered from the burnout to be honest

It’s probably a bit patholigic how much I hate debt tho. I view it as holding me back from investing and living my life.
Click to expand...

Can you please make a post about how you did it all? I'm very interested to learn about how you moonlighted in residency, what PGY year(s), your schedule, and how you were able to do it while a resident.
 
OutRun said:
Can you please make a post about how you did it all? I'm very interested to learn about how you moonlighted in residency, what PGY year(s), your schedule, and how you were able to do it while a resident.
Click to expand...

Find some good EM moonlighting gigs in rural areas

Some pay really damn good. Spend all of your vacations moonlighting. Sometimes I’d pull 9 consecutive 24 hour shifts in a row and take home 30-40k

If you have three weeks vacation a year do the math. (I started CA1 year).

Lots of down time in small places to study, so you’re academics don’t suffer.

Again, it wasn’t glorious. Working like this will burn you out. I remember rolling in town many times at 0400am Monday morning to start a heart after working all weekend. But the opposite was going another 100-150k in debt. It’s sad this is what we have to resort to, but desperate times call for desperate measures I guess.
 
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Newtwo said:
1 - Can you guys in the states moonlight in emerg as anesthesia trainees?
2 - That is insane
3 - See 2 again!
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In many states you can get an unrestricted license after completing just a PGY1 year.

Then it's a matter of finding a place that will hire and credential you. (And staying off the radar of your residency program if it prohibits external moonlighting.)
 
pgg said:
In many states you can get an unrestricted license after completing just a PGY1 year.

Then it's a matter of finding a place that will hire and credential you. (And staying off the radar of your residency program if it prohibits external moonlighting.)
Click to expand...
Gotta be honest, that does not sound like it's worth the risk.
 
acidbase1 said:
Find some good EM moonlighting gigs in rural areas

Some pay really damn good. Spend all of your vacations moonlighting. Sometimes I’d pull 9 consecutive 24 hour shifts in a row and take home 30-40k

If you have three weeks vacation a year do the math. (I started CA1 year).

Lots of down time in small places to study, so you’re academics don’t suffer.

Again, it wasn’t glorious. Working like this will burn you out. I remember rolling in town many times at 0400am Monday morning to start a heart after working all weekend. But the opposite was going another 100-150k in debt. It’s sad this is what we have to resort to, but desperate times call for desperate measures I guess.
Click to expand...

9 straight 24s. Smells like BS.
 
MirrorTodd said:
Gotta be honest, that does not sound like it's worth the risk.
Click to expand...

Some programs enforce this much more strongly than others. My residency program would fire people straight up if they were found to do such shifts and I know of 2 in other specialties that were cut.

My fellowship is much more of a “don’t ask, don’t tell” attitude. Several fellows have rotated in this ED with success in the past. The night and weekend shifts made it more available than typical locums gigs as an anesthesiologist. The shifts can vary from dead to absolutely brutal, but most shifts I come away thankful it’s not my chosen specialty - I’d burn out super quickly. Plus we have to supervise pretty questionable midlevels, thankfully I can throw them in the “urgent care” area without much pushback.
 
D P356 said:
9 straight 24s. Smells like BS.
Click to expand...

I did 7 straight 24s last week. Of course, that was OR & OB anesthesia not an ER, and I spent easily 12-16 hours each of those days bored out of my skull in a hotel room across the street from the hospital. 🙂

It's the $4K paycheck for a 24 hour shift that includes enough down time to sleep that is astonishing about it. How does a resident get that moonlighting gig? There must be a dozen board certified FPs, internists, etc within rockchucking distance of me right now who'd drop what they were doing to sign up for that.
 
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pgg said:
And they pay $4K per day for that?
Click to expand...

Yep, a lot of these rural hospitals are massively subsidized by the gov. (Critical access hospitals). Going rate is 150-200/hr. I saw a lot of FPs make a fortune doing this full time. One making 80k/mo
 
AdmiralChz said:
Some programs enforce this much more strongly than others. My residency program would fire people straight up if they were found to do such shifts and I know of 2 in other specialties that were cut.

My fellowship is much more of a “don’t ask, don’t tell” attitude. Several fellows have rotated in this ED with success in the past. The night and weekend shifts made it more available than typical locums gigs as an anesthesiologist. The shifts can vary from dead to absolutely brutal, but most shifts I come away thankful it’s not my chosen specialty - I’d burn out super quickly. Plus we have to supervise pretty questionable midlevels, thankfully I can throw them in the “urgent care” area without much pushback.
Click to expand...

What fellowship are you doing?
 
AdmiralChz said:
Cardiac. We had a lot of internal moonlighting in residency but not much in fellowship, and with starting a family in fellowship it's been nice to have some income on the side.
Click to expand...

No question. I didn’t have a family but it’s worth the opportunity cost
 
acidbase1 said:
Yep, a lot of these rural hospitals are massively subsidized by the gov. (Critical access hospitals). Going rate is 150-200/hr. I saw a lot of FPs make a fortune doing this full time. One making 80k/mo
Click to expand...
Jesus. That’s insane.
What part of the country is this? I am going back to fellowship and looking at moonlighting options.
 
acidbase1 said:
Yep, a lot of these rural hospitals are massively subsidized by the gov. (Critical access hospitals). Going rate is 150-200/hr. I saw a lot of FPs make a fortune doing this full time. One making 80k/mo
Click to expand...
So, hypothetically speaking, what's stopping a young bachelor stud from doing a PGY1 year and just transitioning to doing this kind of work full-time for 10-15 years, buying a small house in the Caribbean, and saying goodbye to this whole Godforsaken profession?

Hypothetically speaking or course...
 
zero0 said:
So, hypothetically speaking, what's stopping a young bachelor stud from doing a PGY1 year and just transitioning to doing this kind of work full-time for 10-15 years, buying a small house in the Caribbean, and saying goodbye to this whole Godforsaken profession?

Hypothetically speaking or course...
Click to expand...

It’s inconsistent. Hospitals close, get taken over by new management companies, living in the middle of nowhere, long commutes, mid levels are moving in... Same crap different story.

Although, sometimes I ask myself why I don’t get back into the ED game when I see what pain reimbursements are...

It’s a good hustle for a few years but not sustainable long term
 
zero0 said:
So, hypothetically speaking, what's stopping a young bachelor stud from doing a PGY1 year and just transitioning to doing this kind of work full-time for 10-15 years, buying a small house in the Caribbean, and saying goodbye to this whole Godforsaken profession?

Hypothetically speaking or course...
Click to expand...
I actually know a FM doc that did something like that... He is in his 40 working 2-3days/week now after making tons $$$ doing rural EM in midwest... According to him, he got his net worth over 3 mil, paid cash for a home in FL where he lives now. Wife is a RN and also works 2 days/week.
 
anbuitachi said:
Regarding loans, it's hard to compare today's world vs when some of you did med school. Tuition skyrocketted in the past decade. Competition is fiercer than ever. Many people only get into 1 med school so you are forced to take it or quit medicine.. At the same time college tuitions are going up as well. Many of us went to Ivy/equivalent schools, and those are expensive.
Click to expand...
I'm gonna echo what @anbuitachi said. I went to undergrad on a scholarship, got accepted into 1 med school with 0 debt. My parents didn't go to college and are far from wealthy, but they set me up the best that they could. They couldn't pay for my cost of living let alone for my tuition. I'll be graduating med school with $380k in debt. I know it's my choice, but sometimes it's our only choice. A biomed degree wasn't going to land me a decent job, so it was either become a physician or face an uncertain, low-paying, future.

Sometimes we make the best with what we have. It's really brutal out there, especially if you don't come from a rich family and you're trying to build something from nothing.
 
W19 said:
I actually know a FM doc that did something like that... He is in his 40 working 2-3days/week now after making tons $$$ doing rural EM in midwest... According to him, he got his net worth over 3 mil, paid cash for a home in FL where he lives now. Wife is a RN and also works 2 days/week.
Click to expand...
Yeah I'm wondering how feasible this is for someone who isn't boarded though, seems like it would get harder and harder to find gigs over time, like how it's become much harder for FM boarded docs to find full-time Em jobs to take them.

And I guess it's not the most stable life, but some people might not mind that.
 
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