Becoming a physician is not a ticket to the 1%

[doctalaughs]

I'm not contesting the salary survey. I'm just astounded by your peers. It sounds like most of your peers stayed in the high-stress, high-earning field which is not the norm at all. But if that is the case, you must be connected to some really influential people.

Are there a few who stay and make partner and make millions? Yes. But they are few. (Just as a few doctors will make millions.) The hierarchy is shaped like a pyramid and it is imperative for people to drop out for those on top to making high salaries.

You have to factor in attrition rate when you determine expected value. What percentage stays in the field and makes bank and what percentage exits the field and makes less. So 8th year big law makes over $500k / year. What percentage of lawyers can last that long?

You forget that most associates or non-equity partners that drop out of biglaw don’t go work at Starbucks. They make lateral moves for better hours.

Ie Many of my friends who decided fighting for the equity partner position (and a chance for millions/yr) instead after 5-10 years move to a client as in-house lawyer. The hours are better and the salaries are similar but no chance for that astronomical figure. Ie “settle” for 400-600k and 40 hours a week as chief legal officer at XYZ non-fourtune 500 company.

It’s similar for the big consulting firms and i banking firms. These guys that “dropped out” are doing well still - as well as top 25% of doctors for sure.

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[LeaveNoTrace]

You’re comparing apples and oranges here. Too law students vs all med students.

Firts, many grads from top law schools are NOT making over $500k as many are in public service/went into politics and otherwise are on government salaries. Perhaps they have investments/inheritances but that’s independent of the profession they chose. Plenty or artists have those as well, but it’s not a smart economic decision to go into art.

People go to Yale and Harvard law to either work for big government or to become a judge/public servant with power. And certainly decent pay, but not over $500k.

But those are the cream of the crop. The same cream of the crop group in medicine makes loads of money as well—they’re going into derm and ortho. They start at/above $500k as well, with a great lifestyle. Or they become Dr Fauci and get a government salary, but more power/influence.

Yes, there are more lucrative ways to make money than medicine, but none guarantee great financial renumeration the way medicine does. Nor do many offer the prestige/respect and job stability of medicine. I also have the joy of being able to go home at night and feel like I made a real difference in someone’s life, and didn’t just move some 0’s and commas around.

Yeah. I have heard it said that if you want to make money there are better careers than medicine. That being said, for those who can become doctors - roughly the top 10-20 percent of students in STEM degrees, as a rough ballpark estimate - I don't know what the median and median compensation and lifestyle are. For those who are good at math and/or programming, software engineering or quant work might be as good or better for compensation and lifestyle.

 

[Splenda88]

Investing 60k/yr with a 10% of return get you to ~10 mil after 30 yrs. That is close to being in the 1%. Most physicians can afford to do that. Unfortunately, most don't.

 

[doctalaughs]

Investing 60k/yr with a 10% of return get you to ~10 mil after 30 yrs. That is close to being in the 1%. Most physicians can afford to do that. Unfortunately, most don't.

I would say planning to consistently beat the market average of 8% over 30 years isn’t super realistic. The last 8 years of market returns are a freak anomaly.

Also 11 mill is today’s 1% net worth. If you want top 1% in 30 years, you are looking at an inflation-adjusted return of probably 6%, not 8%.

Thus you need to put away 135k/yr for 30 years to hit that. Which also SHOULD be doable by a lot of physicians, but not all (and likely less doable as salaries trend downward).

Right now I save about 160k / yr but if I were starting my career today I really doubt that would be possible.

 

[Splenda88]

I would say planning to consistently beat the market average of 8% over 30 years isn’t super realistic. The last 8 years of market returns are a freak anomaly.

Also 11 mill is today’s 1% net worth. If you want top 1% in 30 years, you are looking at an inflation-adjusted return of probably 6%, not 8%.

Thus you need to put away 135k/yr for 30 years to hit that. Which also SHOULD be doable by a lot of physicians, but not all (and likely less doable as salaries trend downward).

Right now I save about 160k / yr but if I were starting my career today I really doubt that would be possible.

The average return has been 8% for last 50+ yrs. Therefore, it's a good assumption to make.

Being on the top 1% of anything that is good means that you are exceptional. I will settle with being on the top 5% which is doable on any physician salary (200k+)

 

[Mman]

The average return has been 8% for last 50+ yrs. Therefore, it's a good assumption to make.

But if that's the average return, gotta at least acknowledge that is nominal and not real so it does not account for inflation. For apples to apples in terms of seeing what retirement nestegg you need, gotta use the real return stripping out inflation which usually averages out to 2-3%. So 8% nominal return becomes 5-6% real return.

 

[doctalaughs]

But if that's the average return, gotta at least acknowledge that is nominal and not real so it does not account for inflation. For apples to apples in terms of seeing what retirement nestegg you need, gotta use the real return stripping out inflation which usually averages out to 2-3%. So 8% nominal return becomes 5-6% real return.

This is correct. And 10% is a huge difference from 8%. Which is a huge difference from 6% (real returns)

If you are confident you can get 10% average over 30 years you should be a star money manager making billions, not a doctor.

 

[doctalaughs]

I will settle with being on the top 5% which is doable on any physician salary (200k+)

I suppose. Although I think intellectually, academically and work-ethic wise physicians are in the top 1% of the population and should be rewarded with similar financial success.

Think of your high school class as maybe representative of the general population. If there were 500, you don’t think academically and work-ethic you were in the top 5? I do.

I’m any case, money is certainly not everything and life is not fair. It will sadly be less fair to physicians going forward.

 

[abolt18]

I suppose. Although I think intellectually, academically and work-ethic wise physicians are in the top 1% of the population and should be rewarded with similar financial success.

Think of your high school class as maybe representative of the general population. If there were 500, you don’t think academically and work-ethic you were in the top 5? I do.

I’m any case, money is certainly not everything and life is not fair. It will sadly be less fair to physicians going forward.

My high school class? Nah. I was coasting in high school man. Bare minimum. 3.6-3.7GPA. nowhere near top of my class. Now if in high school I had known how to work as hard as I learned to work in med school, then sure I probably could have been up near there. Top 1-2%.

 

[Splenda88]

I suppose. Although I think intellectually, academically and work-ethic wise physicians are in the top 1% of the population and should be rewarded with similar financial success.

Think of your high school class as maybe representative of the general population. If there were 500, you don’t think academically and work-ethic you were in the top 5? I do.

I’m any case, money is certainly not everything and life is not fair. It will sadly be less fair to physicians going forward.

I do get that. The lifestyle of someone with a net worth of 6 mil vs someone with 11 mil is not that far apart.

Also, many in the top 1% are people who are willing to take risk. On the other hand, physicians as a whole are risk averse and financially dumb.

I just graduated from residency and I was shocked to find out that 75%+ of my co-residents do not know what the S&P500 is. One of my colleagues told me retiring at 60 with a net worth of 3 mil would be a dream. She is making ~310k/yr and husband is making 120k+

 

[doctalaughs]

I do get that. The lifestyle of someone with a net worth of 6 mil vs someone with 11 mil is not that far apart.

After 150k/yr lifestyle doesn’t correlate to much with net worth until you hit ridiculous numbers, because people vary so much in their money management and savings. You can make a million a year and live paycheck to paycheck accumulating debt.

That being said, you always COULD have the capacity to change your lifestyle more securely by doubling your net worth. Ie stuff like always flying first class without impacting your finances (possible at both 6 M and 11 M, but more responsible at 11 M). If that is important to you. Same thing with having 2nd/3rd homes- not my thing and Possible at both net worths but easier at 11 M.

11 mill is also about twice as secure as 6 mill that any chosen lifestyle can be immune to happenstance.

 

[finalpsychyear]

After 150k/yr lifestyle doesn’t correlate to much with net worth until you hit ridiculous numbers, because people vary so much in their money management and savings. You can make a million a year and live paycheck to paycheck accumulating debt.

That being said, you always COULD have the capacity to change your lifestyle more securely by doubling your net worth. Ie stuff like always flying first class without impacting your finances (possible at both 6 M and 11 M, but more responsible at 11 M). If that is important to you. Same thing with having 2nd/3rd homes- not my thing and Possible at both net worths but easier at 11 M.

11 mill is also about twice as secure as 6 mill that any chosen lifestyle can be immune to happenstance.

6m invested is a great goal. Will be interesting to see where things go with cryptos, AI, autonomous driving. Those stocks and related ones may double or triple in the next 5 years and that may be very conservative and allow many to obtain numbers that were not possible elsewise.

 

[dpmd]

I do get that. The lifestyle of someone with a net worth of 6 mil vs someone with 11 mil is not that far apart.

Also, many in the top 1% are people who are willing to take risk. On the other hand, physicians as a whole are risk averse and financially dumb.

I just graduated from residency and I was shocked to find out that 75%+ of my co-residents do not know what the S&P500 is. One of my colleagues told me retiring at 60 with a net worth of 3 mil would be a dream. She is making ~310k/yr and husband is making 120k+

This is extremely common. I bet they have an expensive house and cars that in addition to the student debt load basically ensures they can save little money. And they probably look at you and pity you for how poor you are with your reasonable car and home and a net worth that is probably close to their dream goal except you reached it early in you career.

 

[MDMechEngr]

I would like to graduate from medical school and match into my very competitive specialty and pay off my loan within ten years after graduation. I could give a rats arsh about being in the top 5% of earners. LOL.

 

[NITRAS]

I would like to graduate from medical school and match into my very competitive specialty and pay off my loan within ten years after graduation. I could give a rats arsh about being in the top 5% of earners. LOL.

Oh medical student. Specialties are competitive because they make $$$.

If they don’t make any money, they become less competitive.

 

[Iamnew2]

and if you compare medicine to law, there are TONS of law school graduates making <$100K per year. Yes if you graduate from Harvard or Yale (or whatever other top 5/10/20 school) you will do great things. But there are all sorts of books and blogs about the "law school scam" and how schools inflate their graduate job placement numbers. I mean you can graduate a crappy law school and maybe have a 50/50 chance of having an actual 6 figure job as a lawyer. That's a lot of school and debt from a degree that might not get you anything. Here's a sort of old but still relevant article from The Atlantic by Paul Campos who does a great job tracking this sort of stuff. I mean you can actually attend and graduate from one of a few really bad law schools in this country and have maybe a 30% chance at finding a job as a lawyer! What a country!

Even the bottom tier medical school graduates are still almost all employed as physicians earning 6 figure incomes.

I agree with this. In my area there are so many lawyers it's ridiculous. In comparison numbers wise, there are far less doctors than lawyers. Some lawyers make big $$, no doubt, but again SDN compares the very top to the typical. There are doctors who make big big money. Let's look at Dr. Oz, or Trevor from The Doctors, or celeb plastic surgeons. all those people are making millions. that's not the norm.

While med school is grueling, the path to 6 figs is stable. Law is much more variable.

 

[Iamnew2]

I’m not sure what to say - the articles above state it’s a fact that 8th year biglaw associates make 550k. You think they make less 15-20 years in?

HBS (and other top mba) grad starting salaries are 150-200k. And this is usually at age 23 or 24 when med students haven’t even started clinical rotations. You don’t think 15-20 years later they aren’t making north of 500k? Obviously there are exceptions for the “least successful”— just like doctors that drop out of medicine— but I’m talking averages.

Salaries don't increase indefinitely - money doesn't grow on trees. Reason why many people in business, finance, once they start making too much get fired - they cost too much, and a lot of their job can be done by someone 20 years younger for 1/3 of the price.

 

[goldsummer]

My goal is to get to a point where I don't have to work if I dont want to. I sometimes feels overwhelmed at work with the constant rat race and working non stop, getting pulled all directions, working from home in the evenings and on weekends to catch up. I would be nice to have enough streams coming in to the point where I could live a comfy life without working 60+ hours.

If I ever get there, I'd still probably work, it would just be easier without the pressure that I HAVE to. Not sure what percentage that would be. Def not the top 1% lol.

 

[Iamnew2]

My goal is to get to a point where I don't have to work if I dont want to. I sometimes feels overwhelmed at work with the constant rat race and working non stop, getting pulled all directions, working from home in the evenings and on weekends to catch up. I would be nice to have enough streams coming in to the point where I could live a comfy life without working 60+ hours.

If I ever get there, I'd still probably work, it would just be easier without the pressure that I HAVE to. Not sure what percentage that would be. Def not the top 1% lol.

You just have to find the right job and the right specialty. I think things in general need to change in medicine in order to not be so grueling but the right job can make a world of difference. For me it took multiple jobs to find this gig - I work M-F, get occasionally called to admit patients, etc. don't work weekends, have relatively low stress, and make more $ than I ever thought. Havent' worked 60 plus hours since residency.

 

[dpmd]

My goal is to get to a point where I don't have to work if I dont want to. I sometimes feels overwhelmed at work with the constant rat race and working non stop, getting pulled all directions, working from home in the evenings and on weekends to catch up. I would be nice to have enough streams coming in to the point where I could live a comfy life without working 60+ hours.

If I ever get there, I'd still probably work, it would just be easier without the pressure that I HAVE to. Not sure what percentage that would be. Def not the top 1% lol.

This was my goal too which is why I chose houses well within my budget in med school and residency as well as for my attending upgraded house. Also why I chose reasonable cars and drive them for a long time. I do splurge on certain luxuries, but it is a lot easier to get to financial independence if your yearly spending is lower. Plus I wasn't willing to out in crazy hours after residency to get to FI. I'm basically at FI now less than 10 years after finishing residency despite still having student loans (consolidated at the right time so the interest rate is 2% for a 20 yr term) and a mortgage (2.8% for 15 yrs) because of the growth in my investment and retirement accounts (and because I kept the med school and residency houses as rentals instead of selling). Had a head start because my high school (and college) job had 401k profit sharing that they included me in (though I didn't put in the employee portion because I needed the money). Partial scholarships and a spouse making good money in med school helped too.

 

[Splenda88]

This was my goal too which is why I chose houses well within my budget in med school and residency as well as for my attending upgraded house. Also why I chose reasonable cars and drive them for a long time. I do splurge on certain luxuries, but it is a lot easier to get to financial independence if your yearly spending is lower. Plus I wasn't willing to out in crazy hours after residency to get to FI. I'm basically at FI now less than 10 years after finishing residency despite still having student loans (consolidated at the right time so the interest rate is 2% for a 20 yr term) and a mortgage (2.8% for 15 yrs) because of the growth in my investment and retirement accounts (and because I kept the med school and residency houses as rentals instead of selling). Had a head start because my high school (and college) job had 401k profit sharing that they included me in (though I didn't put in the employee portion because I needed the money). Partial scholarships and a spouse making good money in med school helped too.

The temptation is hard to resist when most of your colleagues and friends live in 3500+ sqft homes and drive 80k+ cars.

Spouses also have to be on board if you are married because lifestyle creep is real. It's hard live in a working class neighborhood (average household income of 80-100/yr) when you are making 300k+/yr.

 

[dpmd]

The temptation is hard to resist when most of your colleagues and friends live in 3500+ sqft homes and drive 80k+ cars.

Spouses also have to be on board because lifestyle creep is real.

Definitely need spouse on board. I don't get tempted by what others do. I do get tempted by fun experiences or nice vacation houses my husband finds. But we balance each other out so we don't buy the 2 million dollar vacation house but we also don't stay at motel 6 on vacation.

 

[goldsummer]

You just have to find the right job and the right specialty. I think things in general need to change in medicine in order to not be so grueling but the right job can make a world of difference. For me it took multiple jobs to find this gig - I work M-F, get occasionally called to admit patients, etc. don't work weekends, have relatively low stress, and make more $ than I ever thought. Havent' worked 60 plus hours since residency.

What is your specialty if I may ask?

I'm a PCP so im not sure any job would be less than 60+ hours. I'm not a fan of inpatient work though tbh. Would much rather work outpatient. I enjoy primary care, the problem is most of what I do isnt really medicine. Its dealing with insurance, paperwork, juggling a spectrum of patient personalities.

 

[VA Hopeful Dr]

What is your specialty if I may ask?

I'm a PCP so im not sure any job would be less than 60+ hours. I'm not a fan of inpatient work though tbh. Would much rather work outpatient. I enjoy primary care, the problem is most of what I do isnt really medicine. Its dealing with insurance, paperwork, juggling a spectrum of patient personalities.

You're kidding right?

I'm a PCP and I work 36 hours/week max, usually less.

 

[Iamnew2]

You're kidding right?

I'm a PCP and I work 36 hours/week max, usually less.

Well not all PCPs are that lucky. Our medicine docs definitely work more than 36hrs per week but I agree a lot of medicine is doing what the poster above mentioned.

 

[VA Hopeful Dr]

Well not all PCPs are that lucky. Our medicine docs definitely work more than 36hrs per week but I agree a lot of medicine is doing what the poster above mentioned.

I mean maybe I'm the luckiest PCP in history, but I've worked for 4 different hospitals systems in 3 different locations and had 36 hour weeks for all of them.

As for the rest of the previous post, hogwash. The majority of my day is "really medicine". I suspect this is a case of needing to re-frame the primary care mindset. We don't do surgery, we don't acutely save lives. What we do is prevent people from needing those things. Its still absolutely medicine, its just not as sexy.

 

[dpmd]

I mean maybe I'm the luckiest PCP in history, but I've worked for 4 different hospitals systems in 3 different locations and had 36 hour weeks for all of them.

As for the rest of the previous post, hogwash. The majority of my day is "really medicine". I suspect this is a case of needing to re-frame the primary care mindset. We don't do surgery, we don't acutely save lives. What we do is prevent people from needing those things. Its still absolutely medicine, its just not as sexy.

Are you counting the time you spend charting and other administrative tasks like prior auth and such? Because I think that is what the poster you are replying to is talking about filling much of the day and that is what isn't really medicine to them.

 

[VA Hopeful Dr]

Are you counting the time you spend charting and other administrative tasks like prior auth and such? Because I think that is what the poster you are replying to is talking about filling much of the day and that is what isn't really medicine to them.

I am. I arrive at work right at 8am. I rarely leave after 430. 90 minute lunch, I usually do work for about 20-30 minutes of that. Half day Wednesday. I do no work at home.

 

[dpmd]

I am. I arrive at work right at 8am. I rarely leave after 430. 90 minute lunch, I usually do work for about 20-30 minutes of that. Half day Wednesday. I do no work at home.

Have you just always looked for jobs that have adequate staff to do a lot of the paperwork stuff (my office staff generally takes care a lot of it too but I guess some places make the doctors do it) or made it part of your negotiations or what?

 

[VA Hopeful Dr]

Have you just always looked for jobs that have adequate staff to do a lot of the paperwork stuff (my office staff generally takes care a lot of it too but I guess some places make the doctors do it) or made it part of your negotiations or what?

Nope, this is just standard for SC outpatient primary care. At least everywhere I've been.

 

[goldsummer]

I mean maybe I'm the luckiest PCP in history, but I've worked for 4 different hospitals systems in 3 different locations and had 36 hour weeks for all of them.

As for the rest of the previous post, hogwash. The majority of my day is "really medicine". I suspect this is a case of needing to re-frame the primary care mindset. We don't do surgery, we don't acutely save lives. What we do is prevent people from needing those things. Its still absolutely medicine, its just not as sexy.

I guess you were offended at my wording, which I can understand. Im a PCP, not trying to put primary care down, obviously we do medicine and help many people during the day. But we do a lot of other crud too. At least I do.
You're more experienced, and I just finished year 1, so maybe its just less than optimal efficiency on my part. I'll show you my day and maybe you can tell me where I'm going wrong:

Arrive at 7:00am, pre-chart review everyone on my schedule and begin building the note. I do this so I'll be familiar and know what to expect. Finish by 8am.
Start clinic at 8am
lunch 60min at 12pm
Resume clinic at 1pm.
End clinic at 5pm.
- I am never done with notes by the time I leave the room. I sometimes am able to spend 3-5 minutes finishing up the note before the next visit. I usually have maybe 5 notes to finish at the end of the day. Sometimes more, sometimes less depending on the day I had.
- During the day, messages build up. In my EMR inbox in a day, I get about 15-20 messages with 2 being "urgent", 20 documents to review, 10 new lab/images to review, 10 medication refills requests, 5 or so physical documents to review/sign/fill out in my inbox to read and review. If I take a day off from doing messages, it doubles by the next day.
-I usually go home at 5pm, do a few things, then finish my notes, and try to clear my inbox. I spend about 1 hour or so doing this, sometimes more. I often do not completely clear it out, and it carries over to the next day, and it all continues to pile up.
-On the weekends I try to finish off the EMR inbox and any residual notes. Depending on how much I did during the week, this can take a long time.

 

[finalpsychyear]

I guess you were offended at my wording, which I can understand. Im a PCP, not trying to put primary care down, obviously we do medicine and help many people during the day. But we do a lot of other crud too. At least I do.
You're more experienced, and I just finished year 1, so maybe its just less than optimal efficiency on my part. I'll show you my day and maybe you can tell me where I'm going wrong:

Arrive at 7:00am, pre-chart review everyone on my schedule and begin building the note. I do this so I'll be familiar and know what to expect. Finish by 8am.
Start clinic at 8am
lunch 60min at 12pm
Resume clinic at 1pm.
End clinic at 5pm.
- I am never done with notes by the time I leave the room. I sometimes am able to spend 3-5 minutes finishing up the note before the next visit. I usually have maybe 5 notes to finish at the end of the day. Sometimes more, sometimes less depending on the day I had.
- During the day, messages build up. In my EMR inbox in a day, I get about 15-20 messages with 2 being "urgent", 20 documents to review, 10 new lab/images to review, 10 medication refills requests, 5 or so physical documents to review/sign/fill out in my inbox to read and review. If I take a day off from doing messages, it doubles by the next day.
-I usually go home at 5pm, do a few things, then finish my notes, and try to clear my inbox. I spend about 1 hour or so doing this, sometimes more. I often do not completely clear it out, and it carries over to the next day, and it all continues to pile up.
-On the weekends I try to finish off the EMR inbox and any residual notes. Depending on how much I did during the week, this can take a long time.

I would think the 7am pre chart review will eventually phase out. You should be doing some or most of your notes during the encounter and lunch should be eating while finishing up notes and inbox/message review. This will add 2 hours of free time post work along with more sleep and maybe a morning workout.

 

[Splenda88]

I guess you were offended at my wording, which I can understand. Im a PCP, not trying to put primary care down, obviously we do medicine and help many people during the day. But we do a lot of other crud too. At least I do.
You're more experienced, and I just finished year 1, so maybe its just less than optimal efficiency on my part. I'll show you my day and maybe you can tell me where I'm going wrong:

Arrive at 7:00am, pre-chart review everyone on my schedule and begin building the note. I do this so I'll be familiar and know what to expect. Finish by 8am.
Start clinic at 8am
lunch 60min at 12pm
Resume clinic at 1pm.
End clinic at 5pm.
- I am never done with notes by the time I leave the room. I sometimes am able to spend 3-5 minutes finishing up the note before the next visit. I usually have maybe 5 notes to finish at the end of the day. Sometimes more, sometimes less depending on the day I had.
- During the day, messages build up. In my EMR inbox in a day, I get about 15-20 messages with 2 being "urgent", 20 documents to review, 10 new lab/images to review, 10 medication refills requests, 5 or so physical documents to review/sign/fill out in my inbox to read and review. If I take a day off from doing messages, it doubles by the next day.
-I usually go home at 5pm, do a few things, then finish my notes, and try to clear my inbox. I spend about 1 hour or so doing this, sometimes more. I often do not completely clear it out, and it carries over to the next day, and it all continues to pile up.
-On the weekends I try to finish off the EMR inbox and any residual notes. Depending on how much I did during the week, this can take a long time.

That does not sound like a good job if you are not getting paid 400k+/yr. You basically work 50+ hrs/wk

That is why I chose to do hopistal medicine. I get to work between 7-7:15am and leave at 6:15 pm and dont have to deal with finishing anything at home.

 

[VA Hopeful Dr]

I guess you were offended at my wording, which I can understand. Im a PCP, not trying to put primary care down, obviously we do medicine and help many people during the day. But we do a lot of other crud too. At least I do.
You're more experienced, and I just finished year 1, so maybe its just less than optimal efficiency on my part. I'll show you my day and maybe you can tell me where I'm going wrong:

Arrive at 7:00am, pre-chart review everyone on my schedule and begin building the note. I do this so I'll be familiar and know what to expect. Finish by 8am.
Start clinic at 8am
lunch 60min at 12pm
Resume clinic at 1pm.
End clinic at 5pm.
- I am never done with notes by the time I leave the room. I sometimes am able to spend 3-5 minutes finishing up the note before the next visit. I usually have maybe 5 notes to finish at the end of the day. Sometimes more, sometimes less depending on the day I had.
- During the day, messages build up. In my EMR inbox in a day, I get about 15-20 messages with 2 being "urgent", 20 documents to review, 10 new lab/images to review, 10 medication refills requests, 5 or so physical documents to review/sign/fill out in my inbox to read and review. If I take a day off from doing messages, it doubles by the next day.
-I usually go home at 5pm, do a few things, then finish my notes, and try to clear my inbox. I spend about 1 hour or so doing this, sometimes more. I often do not completely clear it out, and it carries over to the next day, and it all continues to pile up.
-On the weekends I try to finish off the EMR inbox and any residual notes. Depending on how much I did during the week, this can take a long time.

So being that soon out of residency is the big one. All of your patients are new to you. As time goes on and you get to know them, visits go more quickly and notes can get shorter. Same with results/messages.

Depending on your EMR you could probably benefit from some templates and/or macros.

Some people do lots of the note while the patient is talking.

 

[Splenda88]

Definitely need spouse on board. I don't get tempted by what others do. I do get tempted by fun experiences or nice vacation houses my husband finds. But we balance each other out so we don't buy the 2 million dollar vacation house but we also don't stay at motel 6 on vacation.

I am kind of like you in that aspect. I don't mind spending 10k to have a nice vacation with the family. But having a 3k+/month mortgage scares the bejesus out of me.

How much house is enough for a family of 4? Just purchased a ~2000 sqft home under air, and a couple of physicians that I am friend with think it's too small. I have realized that many docs are not financially smart.

 

[dpmd]

I am kind of like you in that aspect. I don't mind spending 10k to have a nice vacation with the family. But having a 3k+/month mortgage scares the bejesus out of me.

How much house is enough for a family of 4? Just purchased a ~2000 sqft home under air, and a couple of physicians that I am friend with think it's too small. I have realized that many docs are not financially smart.

Maybe they hate their family and need space to get away from them?

 

[RangerBob]

I am kind of like you in that aspect. I don't mind spending 10k to have a nice vacation with the family. But having a 3k+/month mortgage scares the bejesus out of me.

How much house is enough for a family of 4? Just purchased a ~2000 sqft home under air, and a couple of physicians that I am friend with think it's too small. I have realized that many docs are not financially smart.

Our house is 1500 sq ft. (In CA, so unfortunately mortgage with taxes/ins is over 3k for physician loan but not by much).

We have a whole extra unused bedroom. And still lots of docs tell me it’s too small. Most of those who say so only have one more kid and their homes are all over 3,000 sq ft.

You only need as much space as you want/need. You only need to drive what you want/need to drive. It’s bad enough sometimes we feel the urge to keep up with the Joneses, but when they actually tell us we need to keep up with them it puzzles me. Just let us live and spend how we’d like to!

 

[Splenda88]

Our house is 1500 sq ft. (In CA, so unfortunately mortgage with taxes/ins is over 3k for physician loan but not by much).

We have a whole extra unused bedroom. And still lots of docs tell me it’s too small. Most of those who say so only have one more kid and their homes are all over 3,000 sq ft.

You only need as much space as you want/need. You only need to drive what you want/need to drive. It’s bad enough sometimes we feel the urge to keep up with the Joneses, but when they actually tell us we need to keep up with them it puzzles me. Just let us live and spend how we’d like to!

You gotta resist that urge.

1500 sqft home is enough space for a family of 4. We lived in a 1488 sqft townhome before and we did not feel like we were on top of each other.

I just don't get the obsession of US middle class families with big house.

 

[VA Hopeful Dr]

Our house is 1500 sq ft. (In CA, so unfortunately mortgage with taxes/ins is over 3k for physician loan but not by much).

We have a whole extra unused bedroom. And still lots of docs tell me it’s too small. Most of those who say so only have one more kid and their homes are all over 3,000 sq ft.

You only need as much space as you want/need. You only need to drive what you want/need to drive. It’s bad enough sometimes we feel the urge to keep up with the Joneses, but when they actually tell us we need to keep up with them it puzzles me. Just let us live and spend how we’d like to!

People can spend their money, or not, how they want. It doesn't affect me so I've never seen why I should insert myself into the situation.

If you're a car person and don't go bankrupt indulging, go get that fancy assed car.

We are a very homebody family so we spent a decent bit on a large house that we love.

Another doctor couple we know loves vacations and they go on pricey ones regularly.

 

[RangerBob]

People can spend their money, or not, how they want. It doesn't affect me so I've never seen why I should insert myself into the situation.

If you're a car person and don't go bankrupt indulging, go get that fancy assed car.

We are a very homebody family so we spent a decent bit on a large house that we love.

Another doctor couple we know loves vacations and they go on pricey ones regularly.

Agree--I was trying to allude to that in my post but it may not have been clear. I like my small (by American standards) house. But I don't fault those who want a bigger home, fancy car, etc. Life is short--spend your time and money however you prefer, ideally without influence/pressure from others.

 

[mvenus929]

I am kind of like you in that aspect. I don't mind spending 10k to have a nice vacation with the family. But having a 3k+/month mortgage scares the bejesus out of me.

How much house is enough for a family of 4? Just purchased a ~2000 sqft home under air, and a couple of physicians that I am friend with think it's too small. I have realized that many docs are not financially smart.

Skewed perspective, maybe. I grew up in a home that was 1840 sqft or so with two significantly younger siblings (8-10 years younger) and I had plenty of space. As an adult, I would've liked a larger kitchen (or at least, differently oriented), but me and each of my siblings had our own bedroom, plus there was a nice master suite, a family room, and a living room. It was plenty of room.

 

[wamcp]

No career is ever a “ticket” to the 1%. But I would say on “average”, embarking on a physician career has the highest probability of getting to the 1%. As long as you get get that medical school acceptance, your chances are much better than other professions of getting there.

Ignoring inflation and speaking only in nominal terms and conservatively no income bump/raises over time, suppose the average fulltime doc makes 250K. Let’s say, married, sole earner, two kids. If they take advantage of tax advantaged accounts that may be available to them (401k, 403b, employer matches, ira, hsa, 457b etc), suppose that’s 50k a year.

After these deductions and taxes, take home pay maybe 150K a year.

Perhaps living expenses (including student loan payments) are 100K a year. That leaves 50K of take home pay to save/invest.

So, suppose a total of 100K a year going into index funds. A nominal rate of return of 10% a year, for 30 years of a career, gets you to $17M of net worth.

Now the real question: is $17M still going to be within the top 1% in 30 years??

 

[PikminOC]

Disagree with this take to a degree ... certain specialties of medicine is absolutely a ticket to being in the top 1% net worth if you are able to use your income and find sources of additional cash flow. Whether it is real estate or starting any sort of side business or investing in the stock market, hardest aspect to generating true wealth is needing an initial and consistent source of cash flow ... which physicians have. Requires a little luck of course. But overall, spend responsibly and you should be finding ways for your money to make you more money, even while you sleep.

Biggest issue is that physicians are simply content with their salaries and have no motivation to seek out such additional endeavors. They're simply the mouse running in a golden wheel and they're happy for the most part.

Disclosure: 34 year old full time hospitalist, current net worth roughly $2M. Got lucky with 2020 with stocks and crypto rocketing and majority of investment is long term capital gains, own 1 rental property generating 1600/month in cash flow, planning to have 3-5 total in next 10 years.

Did you sell in 2020 or is all your crypto worth very little now?

 

[emergentmd]

Top 1% US income 600K - I would say 10% of docs avg this
Top 1% net worth 11M - Achievable for most docs becoming attendings around 30 yrs.

30 Yr old doc makes 350K and 300K debt. 250K take home. Take 100K/yr and enjoy. 100k pay off loan. 50K savings for home
34 Y old doc now has debt paid off, 150K savings. Keep living on 100K/yr. Put 150K into market, use 150K down on a 500k home.
Market historical return S&P 10%, so 7 yrs to double your money. Investment Calculator - SmartAsset
55 yr old doc (20 yrs of savings) putting 150K/yr into market will have right at 10M.
Just remember to close your eyes, ignore the market, and don't over react during bear markets.

Problem is most people do not have the willpower to keep putting in money regardless of market conditions. Problem is docs are not willing to live on 100K/yr a year. Problem is docs get married, have kids and 100K/yr is hard to live on. Problem is docs get divorced.

I am not an advocate of docs living on 100k/yr b/c I know I could not. If you want to live on 200k/yr, then increase your income to 450K/yr with extra work/side hustles.

Bottom line is, save 150K/yr x 20 yrs and you are top 1% net worth by 55. Do it til your 65 and you are at 27M. Don't put another dime in after 55 yrs old and you have 40M at 75.

Time is your friend. Start Early and put alot in early. Think the above is too hard, then try this. If you put 150K/yr x 10 yrs and do nothing else at age 45, then at 65 you will have 21M. Still too hard? Put in 150K x 10 yrs and do nothing else at age 40, then at 65 you will have 12.5M. Still too hard? Put in 150K x 2 yrs you still have 5M at retirement and can live comfortably.

If any doc can't have 10M at age 65 starting at 30 yrs old making 350K, then they have made poor financial or personal decisions. A few divorce will kill your net worth no matter what you do.

 

[emergentmd]

The Top 1 Percent: What Jobs Do They Have?

Explore the occupations and industries of the nation's wealthiest households.

archive.nytimes.com

this actually amazes me that doctors have the best chance to become top 1% than any other field. This is what I sense and eventhough there are lots of bankers who makes over 1M, many never reach that or burn out trying. Same with athletes. For every NFL/NBA/MLB/NHL millionaires, there are far more MLS/All women sports/VB/T&F/All minor sports pro athletes who need to work during the off season to survive.

 

[Splenda88]

Top 1% US income 600K - I would say 10% of docs avg this
Top 1% net worth 11M - Achievable for most docs becoming attendings around 30 yrs.

30 Yr old doc makes 350K and 300K debt. 250K take home. Take 100K/yr and enjoy. 100k pay off loan. 50K savings for home
34 Y old doc now has debt paid off, 150K savings. Keep living on 100K/yr. Put 150K into market, use 150K down on a 500k home.
Market historical return S&P 10%, so 7 yrs to double your money. Investment Calculator - SmartAsset
55 yr old doc (20 yrs of savings) putting 150K/yr into market will have right at 10M.
Just remember to close your eyes, ignore the market, and don't over react during bear markets.

Problem is most people do not have the willpower to keep putting in money regardless of market conditions. Problem is docs are not willing to live on 100K/yr a year. Problem is docs get married, have kids and 100K/yr is hard to live on. Problem is docs get divorced.

I am not an advocate of docs living on 100k/yr b/c I know I could not. If you want to live on 200k/yr, then increase your income to 450K/yr with extra work/side hustles.

Bottom line is, save 150K/yr x 20 yrs and you are top 1% net worth by 55. Do it til your 65 and you are at 27M. Don't put another dime in after 55 yrs old and you have 40M at 75.

Time is your friend. Start Early and put alot in early. Think the above is too hard, then try this. If you put 150K/yr x 10 yrs and do nothing else at age 45, then at 65 you will have 21M. Still too hard? Put in 150K x 10 yrs and do nothing else at age 40, then at 65 you will have 12.5M. Still too hard? Put in 150K x 2 yrs you still have 5M at retirement and can live comfortably.

If any doc can't have 10M at age 65 starting at 30 yrs old making 350K, then they have made poor financial or personal decisions. A few divorce will kill your net worth no matter what you do.

600k might be for household income. I think for individual is closer to 400k.

Income Percentile Calculator for the United States

The income percentile calculator for individual US income in 2024. See average, median, and top 1%. What percentage of earners were you?

dqydj.com

 

[emergentmd]

Correct its for a family

 

[finalpsychyear]

Top 1% US income 600K - I would say 10% of docs avg this
Top 1% net worth 11M - Achievable for most docs becoming attendings around 30 yrs.

30 Yr old doc makes 350K and 300K debt. 250K take home. Take 100K/yr and enjoy. 100k pay off loan. 50K savings for home
34 Y old doc now has debt paid off, 150K savings. Keep living on 100K/yr. Put 150K into market, use 150K down on a 500k home.
Market historical return S&P 10%, so 7 yrs to double your money. Investment Calculator - SmartAsset
55 yr old doc (20 yrs of savings) putting 150K/yr into market will have right at 10M.
Just remember to close your eyes, ignore the market, and don't over react during bear markets.

Problem is most people do not have the willpower to keep putting in money regardless of market conditions. Problem is docs are not willing to live on 100K/yr a year. Problem is docs get married, have kids and 100K/yr is hard to live on. Problem is docs get divorced.

I am not an advocate of docs living on 100k/yr b/c I know I could not. If you want to live on 200k/yr, then increase your income to 450K/yr with extra work/side hustles.

Bottom line is, save 150K/yr x 20 yrs and you are top 1% net worth by 55. Do it til your 65 and you are at 27M. Don't put another dime in after 55 yrs old and you have 40M at 75.

Time is your friend. Start Early and put alot in early. Think the above is too hard, then try this. If you put 150K/yr x 10 yrs and do nothing else at age 45, then at 65 you will have 21M. Still too hard? Put in 150K x 10 yrs and do nothing else at age 40, then at 65 you will have 12.5M. Still too hard? Put in 150K x 2 yrs you still have 5M at retirement and can live comfortably.

If any doc can't have 10M at age 65 starting at 30 yrs old making 350K, then they have made poor financial or personal decisions. A few divorce will kill your net worth no matter what you do.

Sometimes its a matter of delayed timing that makes the 100k/yr tough to live on. I was frugal and did the whole live like a resident for 5 years as an attending but since i got married a year ago even though she is also frugal and finding deals and we r right at that 100k mark now and this is without loans, kids, or a house.

Monthly Example:
Rent: 2400
2 cars: 1600 total will be paid off in 3 yrs and no plans to upgrade
Health ins/utilities: 1000
Credit cards combined: 2500-3000 includes vacations averaged out.
Roughly 8k/month on average but realistically 100-110k yearly.

In my area to get a 3000-4000 sq ft (excluding basement) home since we both will be working 75% from home your looking at 700-800k if you want something built within the last `10 years. That right there is $4400/mo ish with mortgage, property tax, home ins, which will bring us to 120k/yr till cars are paid off in 3 years.

The 100k/yr is def possible as a couple especially if you have paid off cars and you want a 700k ish house. No idea expenses with kids included but obviously having paid off cars and less house should make it possible as well.

 

[emergentmd]

If you are confident you can get 10% average over 30 years you should be a star money manager making billions, not a doctor.

The historical average yearly return of the S&P 500 is 10.46% over the last 50 years, as of end of June 2022. This assumes dividends are reinvested.

Seems like 50 Years is a huge amount of data, so I don't see 10% being a reach, and 8% should have some great confidence.

 

[emergentmd]

The 100k/yr is def possible as a couple especially if you have paid off cars and you want a 700k ish house. No idea expenses with kids included but obviously having paid off cars and less house should make it possible as well.

if you put in 50K in the market starting at 30 x 10 years. Do not do anything from age 40, you will have about 10M in the bank at 65.

Time matters more than amount assuming you are putting in a good amount 50K+