Can physicians survive in the future?

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DotheDo

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Declining salaries. Skyrocketing malpractice. Nurses gaining more practice rights. Tuition and debt growing. How can we afford to pursue what we love if we can't pay back loans, live a decent life. I am saying I need to a Net income of $300,000 but we should not have to struggle to make ends meet as physicians -- its becoming a joke. Please -- become involved in health care politics -- be aware of what is going on in this country. Otherwise it may become too late

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DotheDo said:
Declining salaries. Skyrocketing malpractice. Nurses gaining more practice rights. Tuition and debt growing. How can we afford to pursue what we love if we can't pay back loans, live a decent life. I am saying I need to a Net income of $300,000 but we should not have to struggle to make ends meet as physicians -- its becoming a joke. Please -- become involved in health care politics -- be aware of what is going on in this country. Otherwise it may become too late


What's a joke is that people are saying this while everywhere around me i notice physicians living in multimillion dollar houses, driving $100,000 cars, and sending their kids to private high schools and colleges. Btw, most malpractice is paid by your employer.
 
Ross434 said:
What's a joke is that people are saying this while everywhere around me i notice physicians living in multimillion dollar houses, driving $100,000 cars, and sending their kids to private high schools and colleges. Btw, most malpractice is paid by your employer.

What doctors have you been around? The average doctor makes aroun $180-190,000. If you think that's enough to afford a multimillion-dollar home, you're going to be in for a surprise. The only docs I can see making that kind of money would be Neuro, plastic, or cardiothoracic surgeons--and most likely in the midwest.

DotheDo, I agree. We need to become more aware of how our profession is getting screwed over. Ultimately we have all the power because no one else can do provide the skilled services that doctors can provide. Hopefully, we can become more active in these issues, as it is easy to become lost in our work, and not have time to think about our--and the profession's--future.
 
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DotheDo said:
Declining salaries. Skyrocketing malpractice. Nurses gaining more practice rights. Tuition and debt growing. How can we afford to pursue what we love if we can't pay back loans, live a decent life. I am saying I need to a Net income of $300,000 but we should not have to struggle to make ends meet as physicians -- its becoming a joke. Please -- become involved in health care politics -- be aware of what is going on in this country. Otherwise it may become too late

I think there is a "negative feedback" that will prevent it from getting too bad. People want good doctors and when there is a point where the best and the brightest avoid medicine, things will get better. However, I don't know how bad it will get before then i.e. paperwork, malpractice, etc.
 
UCSBMed1 said:
Ultimately we have all the power because no one else can do provide the skilled services that doctors can provide.
this sounds true, but i don't know that it is. i mean, if unioized factory workers think they're getting a raw deal, they go on strike to apply pressure to the establishment by withholding their services. the general public doesn't give a damn that 600 less people are making brake pads for a few months. doctors can't really withhold their services en masse like that, because our services are more vital, and the public wouldn't tolerate--or at the very least, symathize with--such action. they would just use the power of emotions>thinking and claim that we are being greedy and that we don't care about them enough, blah blah blah. the general public is full of small-minded pissants who already resent physicians for what they have, so the actual, real-world leverage physicians hold seems to me to be quite small.

anyone agree/disagree?
 
Ross434 said:
What's a joke is that people are saying this while everywhere around me i notice physicians living in multimillion dollar houses, driving $100,000 cars, and sending their kids to private high schools and colleges. Btw, most malpractice is paid by your employer.

:laugh:

I'll bet you most of the physicians living in the multimillion dollar houses have white hair. The older gen didn't have to deal with declining reimbursements, utilization reviews, Stark Antitrust laws....

However, they DO know how to invest...which all of us should do with our salaries.

PS Unless you will be a salaried employee of an HMO (Kaiser in Cali) or hospital, YOU are your employer...and that malpractice premium comes out of your take-home income. Of course, there are exceptions in high-need areas where orthos/neurosurg/obgyn will have their malpractice underwritten by hospitals in exchange for covering ER call...but I digress.
 
superdevil said:
this sounds true, but i don't know that it is. i mean, if unioized factory workers think they're getting a raw deal, they go on strike to apply pressure to the establishment by withholding their services. the general public doesn't give a damn that 600 less people are making brake pads for a few months. doctors can't really withhold their services en masse like that, because our services are more vital, and the public wouldn't tolerate--or at the very least, symathize with--such action. they would just use the power of emotions>thinking and claim that we are being greedy and that we don't care about them enough, blah blah blah. the general public is full of small-minded pissants who already resent physicians for what they have, so the actual, real-world leverage physicians hold seems to me to be quite small.

anyone agree/disagree?

I agree that a strike would not be effective or feasible, but I disagree on the leverage physicans have.

The AMA, is one of the most powerful lobbying institutions in this country, and only around 50-60% (don't quote me on this) of physicans are members of this organization. Just imagine what would happen if things got so bad, that physicians could actually unite and use this organization to make their demands heard.

There are not many groups in this country that work as hard for the money they earn as doctors do. Anyone who thinks otherwise is ignorant, or plain stupid. Once people stop going into medicine for all the reasons you mentioned, and the "baby boomers" realize there aren't enough *American* doctors to go around, the ball will start to roll. Look what has already happened with malpractice insurance. Doctors started protestin' and stuff started changin'. Medicine is a sleeping giant--and if MBAs and HMOs keep screwing the profession over, they will have to deal with our wrath.
 
UCSBMed1 said:
The AMA, is one of the most powerful lobbying institutions in this country, and only around 50-60% (don't quote me on this) of physicans are members of this organization. Just imagine what would happen if things got so bad, that physicians could actually unite and use this organization to make their demands heard.
i actually asked my family doc (a really smart dude) why this very thing that you described hasn't happened (i.e., doctors uniting, fortifying the AMA and becoming more politically agressive, etc). he said that so many doctors are considered employers, that this kind of organization would bring about the wrath of lawyers screaming "collusion!" and "price fixing!" etc etc etc. so i'm not even sure how feasible this would be.

but i agree with your final points. 👍
 
UCSBMed1 said:
What doctors have you been around? The average doctor makes aroun $180-190,000. If you think that's enough to afford a multimillion-dollar home, you're going to be in for a surprise. The only docs I can see making that kind of money would be Neuro, plastic, or cardiothoracic surgeons--and most likely in the midwest.
you guys get so worked up about money. if you make 180k. that's around 9k/month (conservative estimate). 5k on a house, thats a 1.8 million dollar mortgage. 4k/month in spending money is ridiculously large, btw.
 
you guys get so worked up about money. if you make 180k. that's around 9k/month (conservative estimate). 5k on a house, thats a 1.8 million dollar mortgage. 4k/month in spending money is ridiculously large, btw.

Who said I thought this wasn't enough? I'd be more than happy to collect my $180,000 after 11+ years of education AFTER my BS.

But its the fact that reimbursement has been decreasing steadily since the 1980s (and probably before then) and showing no signs of leveling out that causes alarm. How much is the average doc going to make when I'm done with school? $150? $120? $80? There's no way to tell when its going to stop, and I don't want to get out of residency/fellowship with $100,000 worth of loans and make a sh*tty $80 grand. I worked way to hard to get screwed like that, and I'll be dam*ed if I let HMOs and MBAs take that away.

Sure, reimbursement is "adequate" now, but how long is that going to last?
 
UCSBMed1 said:
But its the fact that reimbursement has been decreasing steadily since the 1980s (and probably before then) and showing no signs of leveling out that causes alarm. How much is the average doc going to make when I'm done with school? $150? $120? $80? There's no way to tell when its going to stop, and I don't want to get out of residency/fellowship with $100,000 worth of loans and make a sh*tty $80 grand. I worked way to hard to get screwed like that, and I'll be dam*ed if I let HMOs and MBAs take that away.
at some point supply and demand dynamics will exert their effects. i don't think you have to be worried about making less than 100k practicing any kind of medicine (well, unless you insist on doing OB/GYN in Bumblescum, West Virginia or some other impoverished area with no tort reform etc).
 
I think the important question is what do we do or what can we do NOW as students. Write letters, sign up w/ organizations. Anybody have some suggestions. We, the future physicians, are going to the be the generation to make or break our profession. We need caps on malpractice, lower insurance premiums and lawyers on our side getting reimbursment back up where it is suppossed to be. Or, more programs that reduce or cost of education.
 
UCSBMed1 said:
The AMA, is one of the most powerful lobbying institutions in this country, and only around 50-60% (don't quote me on this) of physicans are members of this organization. Just imagine what would happen if things got so bad, that physicians could actually unite and use this organization to make their demands heard.

I have always heard that the AMA is a really crappy lobbying institution that just thinks it’s good. I have a good friend who is a dentist and we talk about this stuff rather often. I feel the ADA does a much better job at lobbying than the AMA. Sadly, the ABA does the best job at lobbying and we are truly getting spanked by the lawyers.
 
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kenmc3 said:
I have always heard that the AMA is a really crappy lobbying institution that just thinks it’s good. I have a good friend who is a dentist and we talk about this stuff rather often. I feel the ADA does a much better job at lobbying than the AMA. Sadly, the ABA does the best job at lobbying and we are truly getting spanked by the lawyers.

They sure did a good job getting Dubya to take notice about what's happening to malpractice insurance. Sure, not as good as the ADA (they are better because dentists as a whole tend to be more monolithic and all pretty much do similar things, and therefore think alike) but they're getting the job done nonetheless.
 
superdevil said:
at some point supply and demand dynamics will exert their effects. i don't think you have to be worried about making less than 100k practicing any kind of medicine (well, unless you insist on doing OB/GYN in Bumblescum, West Virginia or some other impoverished area with no tort reform etc).

I'm not sure to what extent supply and demand will come into play or any sort of strike would ever work, because there are lots of other quasi-doctor professionals (NPs, CRNAs and PAs) increasingly being utilized and waiting in the wings to continue picking up the slack, and there are a lot of foreign trained doctors who would be more than happy to practice here if hurdles were lowered. Thus the AMA, etc. have a fine line in terms of how much they can push without damaging the monopoly doctors have. That being said, while I think the above poster (Ross) is somewhat overly optimistic about what kind of salaries the average physician can command (and his exposure to physicians seems perhaps to be limited to those who completed residency well over a decade ago, when times were different), I would think physicians will always be able to stay at a reasonably comfortable (albeit not extravagent) income.
 
Ross434 said:
UCSBMed1 said:
What doctors have you been around? The average doctor makes aroun $180-190,000. If you think that's enough to afford a multimillion-dollar home, you're going to be in for a surprise. The only docs I can see making that kind of money would be Neuro, plastic, or cardiothoracic surgeons--and most likely in the midwest.
you guys get so worked up about money. if you make 180k. that's around 9k/month (conservative estimate). 5k on a house, thats a 1.8 million dollar mortgage. 4k/month in spending money is ridiculously large, btw.

LOL - you don't get 9K/month with a 180K salary. Dude - have you ever heard the word "Taxes"?? 🙄
 
TripleDegree said:
Ross434 said:
UCSBMed1 said:
What doctors have you been around? The average doctor makes aroun $180-190,000. If you think that's enough to afford a multimillion-dollar home, you're going to be in for a surprise. The only docs I can see making that kind of money would be Neuro, plastic, or cardiothoracic surgeons--and most likely in the midwest.


LOL - you don't get 9K/month with a 180K salary. Dude - have you ever heard the word "Taxes"?? 🙄


Federal tax on $180,000 for a single person is $47,400 according to the 2004 tax table. That is $180,000 x .33 minus $12,000. That gives you approx $11,000 net per month. Take out state taxes and $9000 is not unreasonable at all.
 
G0S2 said:
TripleDegree said:
Ross434 said:
Federal tax on $180,000 for a single person is $47,400 according to the 2004 tax table. That is $180,000 x .33 minus $12,000. That gives you approx $11,000 net per month. Take out state taxes and $9000 is not unreasonable at all.
You are leaving out big stuff like social security, FUTA?, i.e. all that other fun stuff you actually see deducted when you get a paycheck. 9k/mo seems a bit high for takehome on that salary.
 
G0S2 said:
TripleDegree said:
Ross434 said:
Federal tax on $180,000 for a single person is $47,400 according to the 2004 tax table. That is $180,000 x .33 minus $12,000. That gives you approx $11,000 net per month. Take out state taxes and $9000 is not unreasonable at all.
Not to mention that if you have kids or a mortgage, you get tax breaks for them too. Though, personally, I think it's dumb to spend 55% of your take-home income on housing no matter how much money you make. Plus, that $4k/month isn't going to be "ridiculously large" if you want to support a family, send your kids to college, or invest for retirement outside of whatever your practice provides.
 
Law2Doc said:
G0S2 said:
TripleDegree said:
You are leaving out big stuff like social security, FUTA?, i.e. all that other fun stuff you actually see deducted when you get a paycheck. 9k/mo seems a bit high for takehome on that salary.


True. SS and Medicare adds to about $13,764 for the year on $180,000. My last estimate minus these and state was approx $11,000 net/month. $24,000-$13,764 is approx $10,000 left to cover state, which is most likely closer to $20,000. So new adjusted income per month is $8,000 net.
 
G0S2 said:
True. SS and Medicare adds to about $13,764 for the year on $180,000. My last estimate minus these and state was approx $11,000 net/month. $24,000-$13,764 is approx $10,000 left to cover state, which is most likely closer to $20,000. So new adjusted income per month is $8,000 net.

Sorry to burst your bubble, but the social security and medicare tax totals about 7000 on this income. The max for social security is 5.5k, no matter WHAT you earn. And medicare is only 1.4% of your income total, anyway.
 
G0S2 said:
Law2Doc said:
G0S2 said:
True. SS and Medicare adds to about $13,764 for the year on $180,000. My last estimate minus these and state was approx $11,000 net/month. $24,000-$13,764 is approx $10,000 left to cover state, which is most likely closer to $20,000. So new adjusted income per month is $8,000 net.

Ok, I can buy that. And from this you are possibly going to be paying up to a couple grand per month on student loans, depending on how much you borrowed and how quickly you want to get out of debt. But to get the home Ross suggested, you would need to use 5k (62.5%) of this 8k take home amount on the mortgage. That sure doesn't leave much for other niceties like food, clothing, utilities, home maintenance. I think most people would spend closer to 25-30% of their income on their housing needs, but that sure won't get you anything close to a million dollar home.
 
Ross434 said:
Sorry to burst your bubble, but the social security and medicare tax totals about 7000 on this income. The max for social security is 5.5k, no matter WHAT you earn. And medicare is only 1.4% of your income total, anyway.


Please burst it. I am learning all of this. I stand corrected. I used an online net pay calculator that did not take into consideration the $90,000 cap on SS. So $9000/month is a conservative estimate.
 
You guys are complaing about $8,000 per month!!!! Last time I checked, 8K/mo after taxes is $96,000/yr..... That's a fantastic salary... Lose your ideals of being a multimillionaire and your salary will seem so much better.
 
WVmed said:
You guys are complaing about $8,000 per month!!!! Last time I checked, 8K/mo after taxes is $96,000/yr..... That's a fantastic salary... Lose your ideals of being a multimillionaire and your salary will seem so much better.

Who said we were complaining about $8000 per month? I think what myself, and a lot of others are concerned about is whether that 8 grand will still be there in 10 years. The way medicine is headed, that might be 5 or 4 grand. No one knows how far reimbursement is going to drop, and that is the issue here.

Get back to reality here, not many people truly think they are going to become a multimillionaire as a doctor. If you get off your high horse and realize that some people are worried they won't be making the money that they earned and deserve, then you wouldn't come here "attacking us" with your lofty ideas on how much money is enough.
 
If you get off your high horse and realize that some people are worried they won't be making the money that they earned and deserve, then you wouldn't come here "attacking us" with your lofty ideas on how much money is enough.

they earned and deserved? yes you deserve 100,000 per year. you are god's gift to humanity. thank god for you. my lofty ideas are very humble and respectable. You are the one multi-posting on a thread about "how much money are we going to make!!?? Oh no, it wont be over 6 figures after tax??? I need 6 figs!!"

Get over it, after taxes and insurance chances are you wont see any more than 80k/yr. But guess what, that's more than 97% of Americans. So please, shut your damn whining mouth
 
WVmed said:
they earned and deserved? yes you deserve 100,000 per year. you are god's gift to humanity. thank god for you. my lofty ideas are very humble and respectable. You are the one multi-posting on a thread about "how much money are we going to make!!?? Oh no, it wont be over 6 figures after tax??? I need 6 figs!!"

Get over it, after taxes and insurance chances are you wont see any more than 80k/yr. But guess what, that's more than 97% of Americans. So please, shut your damn whining mouth

You get over it. Yes, I and many others do deserve a large salary, and there is nothing wrong with that. I expect to be compensated well for the years of training and hardship that I went through, and will not settle for less than I feel I am worth and the market dictates is acceptable. 100k is not a large sum of money for someone who has gone through the trouble of becoming a specialist. Anyhow, I do expect to become a multimillionare, but through investments and not salary. The reason physicians have some of the lowest wealth accumulation with the highest salaries is that they are notoriously bad investors. Anyhow, don't worry about those of us who want to make $500k + a year, you can go about your business and I am sure many will be eager to hire you at less than what you are worth 👍
 
WVmed said:
Get over it, after taxes and insurance chances are you wont see any more than 80k/yr. But guess what, that's more than 97% of Americans. So please, shut your damn whining mouth

I certainly agree that 80k/yr after taxes is a very comfortable income, and think that a number of people on this board will be a bit surprised when they realize that their million dollar mansion is going to be out of reach. I also believe the original premise of this thread that salaries could go down.

But I sort of disagree with the gist of your post, and have to point out that whether the figure you cited is still "more than 97% of Americans" isn't really relevant. The question is how it compares to people who have spent 4 years in graduate professional education, and then 4+ years of low salary medical residency training, because certainly the 97% of the population you cite haven't really paid the same kind of dues.
 
Law2Doc said:
But I sort of disagree with the gist of your post, and have to point out that whether the figure you cited is still "more than 97% of Americans" isn't really relevant. The question is how it compares to people who have spent 4 years in graduate professional education, and then 4+ years of low salary medical residency training, because certainly the 97% of the population you cite haven't really paid the same kind of dues.
agreed. 👍
 
The average doc makes 150k, not 180 or 190k so I dont know where you got those numbers.

The average FP makes about 120k and the average IM is about 130k.
 
WVmed said:
they earned and deserved? yes you deserve 100,000 per year. you are god's gift to humanity. thank god for you. my lofty ideas are very humble and respectable. You are the one multi-posting on a thread about "how much money are we going to make!!?? Oh no, it wont be over 6 figures after tax??? I need 6 figs!!"

Get over it, after taxes and insurance chances are you wont see any more than 80k/yr. But guess what, that's more than 97% of Americans. So please, shut your damn whining mouth

97% of Americans don't spend 4 years on an undergraduate degree, followed by 4 years of a professional degree followed by 3-7 years of post graduate training for crying out loud. So please stop the meaningless comparison.

I also agree that 80K after taxes is a decent income. But I strongly take issue with the fact that you seem to think its wrong for doctors to get compensated highly. Think of it this way - once you're a doctor, you're a doctor for life 24x7x365. You are always on call (kinda like a cop) and you are always a huge asset to society. Of course, cops don't have to bust their nuts for 11-15 years to become one.
 
TripleDegree said:
97% of Americans don't spend 4 years on an undergraduate degree, followed by 4 years of a professional degree followed by 3-7 years of post graduate training for crying out loud. So please stop the meaningless comparison.

I also agree that 80K after taxes is a decent income. But I strongly take issue with the fact that you seem to think its wrong for doctors to get compensated highly. Think of it this way - once you're a doctor, you're a doctor for life 24x7x365. You are always on call (kinda like a cop) and you are always a huge asset to society. Of course, cops don't have to bust their nuts for 11-15 years to become one.


No man, Docs deserve $150K/yr. After taxes and insurance that becomes $80K/yr. I'm just trying to say "get over it." It's life. Very few people after taxes make $100,000/yr. If they do, chances are they inherited a position in a business or are already over 40+ yrs old. A 32 yr old physician can clear after taxes $100,000, which is a phenomal salary. Also, the post graduate training is generally to the tune of about $45K/yr which is higher than the national average already. After 4-8 yrs of post-grad you multiply your salary by the number of years in post grad. After taxes, you clear anywhere from $80K to $200K. Either way, you aren't "Bling Bling" like the rappers. $200K doesnt buy **** in this world, so you can begin accepting your fate as a modest physician any time now.
 
WVmed said:
No man, Docs deserve $150K/yr. After taxes and insurance that becomes $80K/yr. I'm just trying to say "get over it." It's life. Very few people after taxes make $100,000/yr. If they do, chances are they inherited a position in a business or are already over 40+ yrs old. A 32 yr old physician can clear after taxes $100,000, which is a phenomal salary. Also, the post graduate training is generally to the tune of about $45K/yr which is higher than the national average already. After 4-8 yrs of post-grad you multiply your salary by the number of years in post grad. After taxes, you clear anywhere from $80K to $200K. Either way, you aren't "Bling Bling" like the rappers. $200K doesnt buy **** in this world, so you can begin accepting your fate as a modest physician any time now.

100k and above after taxes is a ****load of money. I know a friend making 30k a year after taxes (45k/year before), and he's driving a new mercedes. (Granted, he is single). 200k after taxes each year is EASILY enough to live in a million dollar house, drive a bentley, and support your family.
 
WVmed said:
No man, Docs deserve $150K/yr. After taxes and insurance that becomes $80K/yr. I'm just trying to say "get over it." It's life. Very few people after taxes make $100,000/yr. If they do, chances are they inherited a position in a business or are already over 40+ yrs old. A 32 yr old physician can clear after taxes $100,000, which is a phenomal salary. Also, the post graduate training is generally to the tune of about $45K/yr which is higher than the national average already. After 4-8 yrs of post-grad you multiply your salary by the number of years in post grad. After taxes, you clear anywhere from $80K to $200K. Either way, you aren't "Bling Bling" like the rappers. $200K doesnt buy **** in this world, so you can begin accepting your fate as a modest physician any time now.

God you are such an idiot. First off most people with similar levels of education are compensated at equal or higher levels. You say that post grad training is $45k a year, above the mean, yet you fail to break that down by hour. Guess what, after busting your ass 80-90 hours a week as a resident for your measly $45k a year, you end up earning less than $10 an hour. I made more than that with a high school diploma. Not to mention the work was much easier both physically and mentally than that of a physician. In addition to this fact, you have $150k in student loans accumulating interest all the way through residency. Take those into account and you aren't compensated well at all until after residency. Physicians provide a valuable and needed service to society, and healthcare is a business. There is limited supply and a huge demand for our services, and I for one expect to be compensated. There is nothing at all wrong with this mindset, and whether or not $80k a year take home is a reasonable living salary is not the point. But as I said before, i will refuse to work for less than I feel I am worth, and will go into practice for myself. You can go get a salaried job making half of what many will because you won't ask for more. I'm sure people won't have a problem hirig you for less than your market value, as I said before. I think that the younger generation of physicians will recognize that theyt do DESERVE more than physicians have been traditionally paid and will drive salaries up, not down. I for one know that i will not tolerate drug companies, reps, and insurance companies taking millions of dollars that should be mine in the end. I think a lot of poeple are starting to realize this.

http://www.newyorker.com/printables/fact/050404fa_fact
 
Ross434 said:
100k and above after taxes is a ****load. I know a friend making 30k a year after taxes (45k/year before), and he's driving a new mercedes. (Granted, he is single). 200k after taxes each year is EASILY enough to live in a million dollar house, drive a bentley, and support your family.

If he is buying a luxury car on a 45k salary (even if single), he is making a lifestyle choice and choosing that toy over other things most people consider more important (like a nice place to live, future savings/investment, etc). It may seem like a decent amount for someone yet to enter the workforce, but a 45k salary doesn't really go that far unless you really like living with multiple roomates and eating PB&J. Depends a lot on the cost of living in the city you are in though.
Again, regarding the 200k after tax figure, I think you are seriously overestimating your future medical salary, or you hope to do really well investing, if you plan on a million dollar home and a bentley. You sound like all the folks I went to college with who swore they would be millionaires by the time they hit 30 (none made it), and are probably setting yourself up for disappointment.
But if you can achieve this level of success, more power to you.
 
Law2Doc said:
If he is buying a luxury car on a 45k salary (even if single), he is making a lifestyle choice and choosing that toy over other things most people consider more important (like a nice place to live, future savings/investment, etc). It may seem like a decent amount for someone yet to enter the workforce, but a 45k salary doesn't really go that far unless you really like living with multiple roomates and eating PB&J. Depends a lot on the cost of living in the city you are in though.
Again, regarding the 200k after tax figure, I think you are seriously overestimating your future medical salary, or you hope to do really well investing, if you plan on a million dollar home and a bentley. You sound like all the folks I went to college with who swore they would be millionaires by the time they hit 30 (none made it), and are probably setting yourself up for disappointment.
But if you can achieve this level of success, more power to you.

I dont understand how people can't see how that works out. lets say you make 350k before taxes- a common enough salary for somebody in a subspecialty. Now, lets say you own a million dollar house (and deduct the interest). You'll be making about 190k after taxes. thats fricking $15,500/month. 6k/month towards a house will buy you a million dollar house, fully furnish it, and pay your utilities and property taxes. This leaves you with, whoa, $9,500 left over!! Lets say you spend 3500/month on a car, which will buy you a brand new $150,000 lamborghini, and pay for all your gas and insurance. **** son, you still have 6,000 left! Maybe 1000 on food at a ridiculous $250/week. and Then, leave the rest for retirement, spending money, or whatever else, which leaves you with $1250/week of spending money. This is FRICKING INSANE! . How do you not agree with me?
 
Ross434 said:
I dont understand how people can't see how that works out. lets say you make 350k before taxes- a common enough salary for somebody in a subspecialty. Now, lets say you own a million dollar house (and deduct the interest). You'll be making about 190k after taxes. thats fricking $15,500/month. 6k/month towards a house will buy you a million dollar house, fully furnish it, and pay your utilities and property taxes. This leaves you with, whoa, $9,500 left over!! Lets say you spend 3500/month on a car, which will buy you a brand new $150,000 lamborghini, and pay for all your gas and insurance. **** son, you still have 6,000 left! Maybe 1000 on food at a ridiculous $250/week. and Then, leave the rest for retirement, spending money, or whatever else, which leaves you with $1250/week of spending money. This is FRICKING INSANE! . How do you not agree with me?


I don't disagree. If you make $350/yr before taxes then maybe you can have that lifestyle. I don't know if you subtracted out the insurance costs, but I guess you are right. If you make that much, after taxes $190K breaks down to a damn good living. However, Pink M.D. is dillusional. You don't have any power of drug companies, HMOs, or insurance reps. You are a doctor, not a member of the board of govs in a fortune 500 company. Get ready for a rude wake up call when you finally recognize your position on the food chain.
 
WVmed said:
I don't disagree. If you make $350/yr before taxes then maybe you can have that lifestyle. I don't know if you subtracted out the insurance costs, but I guess you are right. If you make that much, after taxes $190K breaks down to a damn good living. However, Pink M.D. is dillusional. You don't have any power of drug companies, HMOs, or insurance reps. You are a doctor, not a member of the board of govs in a fortune 500 company. Get ready for a rude wake up call when you finally recognize your position on the food chain.

How am I dillusional? If anything, most people on here underestimate the money that is to be made in medicine. So many people eitehr don't care to fight for the salary they deserve or don't work hard enough to achieve the financial success that is at such a high level. Just go to www.physicianrecruiting.com and check out real jobs posted today available. There are tons of poistions for multiple specialties in the above $300k bracket. You may not want to work hard enough to achieve ths, or may not se what your work is worth, but to cal me dillusional is idiotic. how can you argue with facts. The fact is that averages are just that, average. Not to mention your $150k average includes many specialties that don't pay well, and you have no clue on what specialty I or anyone else will go into. Additionally, if you check out the jobs posted for a given specialty, plenty of them pay in excess of $300k and include insurance and other benefits. There are also plenty of GP jobs posted at the >$150k level. So no, I am not dillusional, I have done my research and am fully aware of the value of my future work. Additionally, I believe salries will rise at a greater rate than inflation, not decline as some here believe. Of course this is only speculation so is only equally as valid as the oposing viewpoints.
 
Ross434 said:
I dont understand how people can't see how that works out. lets say you make 350k before taxes- a common enough salary for somebody in a subspecialty. .... How do you not agree with me?

I understand how you would get to your conclusion if you accept the premise of that salary. But I question the likelyhood you will have that salary, and dispute the notion that it is "common" and will continue to be. 🙄 It is FAR above the average MD salary. But if you ultimately end up with it, congrats.
 
There are two things that are not mentioned in all of this...first, while every single other aspect if medicine is declining financially (in terms of decreasing reimbursements, reducing the number of procedures/studies that patients need in the eyes of insurance companies, declining physician salaries, etc.), the one thing that is universally rising without any check is medical school tuition (sure, malpractice may be rising in numerous areas of the country, but i would argue that physicians do not bear the brunt of the insurance cost and there is some legislative action in several states that may provide a ceiling to this), and second, as residents, a minimal amount of money is earned while interest on our debts continue to increase (sure, the interest is tax-deductable, but this clearly does not cancel each other out). I understand the arguments that the money is good in our profession, and I am not going to argue that. But in the context of the investment (both financially and timewise) made into our careers, I do think that either salaries must increase or more reasonably, tuitions must go down (of course, much easier said than done.)
 
Its important to keep in perspective the reality that in many places in the world, including within the United States (in abusive illegal labor organizations such as sweatshops), people earn amounts on the order of pennies to a several dollars a day at most, and sometimes the amount earned is insufficient in making ends meet or to feed the mouths of children. Physicians can survive in the future, if at least in the context of American socio-economics. It is a privilege to think of survival in the context in which it was posed in the original post. Food for thought...
 
DrChandy said:
Its important to keep in perspective the reality that in many places in the world, including within the United States (in abusive illegal labor organizations such as sweatshops), people earn amounts on the order of pennies to a several dollars a day at most, and sometimes the amount earned is insufficient in making ends meet or to feed the mouths of children. Physicians can survive in the future, if at least in the context of American socio-economics. It is a privilege to think of survival in the context in which it was posed in the original post. Food for thought...


Good post. Physicians will always be doing well in our social structure. It will be interesting to see how any future possibility of socialized medicine works out. Let's hope if it happens it doesn't hurt wages too much, but at the same time we need to remember that everyone deserves health care! Even the poor bums on the street who can't think straight to stop drinking, etc. Good luck finding your happy medium everyone.
 
I will solve this problem for everyone. Please follow.

There are two sides to this debate... there are the ones that are correct and there are the socialists. America is a capitalistic society, therefore, you pay for what you want. If you want healtchare, it is going to cost you. It is a privilege to have good healtchare, not a right... this is the correct view for a capitalistic society... if you disagree you are wrong. Living in America entitles us only to have it available, not entitles us to receive it.

Now that we have cleared that up. The next thing we need to talk about is insurance. Don't carry it. This is a simple enough thing. You will see that plenty of people will pony up the cash to get better. Those that can't pony up the money probably aren't useful members of society, and we will passively remove them from the American gene pool. Again, there will be the socialist type that act pro-bono or receive healthcare... but they can only do so much and their schedules will be so backed up that if someone doesn't want to wait 9 months to see a doc, they'll find the cash to come to you.

We accept that people pay $5K for season tickets... we accept that athletes make $5 million a YEAR... we accept that people drive cars without the means to pay in full... we accept all these things, yet the socialists disagree with doctors receiving large sums of money. I don't know, but i think a physician provides a better service than A-Rod... but the socialists are socialists... and more importantly they're stupid and short-sighted... and even more importantly than that, they are un-american.

I see the socialist attitude in the majority of the class. Most of them are not from wealthy families and they can't relate to how professionals are supposed to live. They also fail to understand that most people in life are looking for the free ride... and these socialists are more than happy to give in because they're too stupid to realize that they're being played by the masses. It really all comes down to fact that the socialists incorrectly believe that healthcare is a right (which is fine in socialism but they confuse free-market with steal-from-the-rich-and-give-to-the-poor). Once we make these ignoramuses clear on this issue, all others will fall in line and physicians as a group will be fine.

These thoughts are the only correct thoughts on the matter. If you agree, then you are correct. If you disagree, you are probably grew up poor or your father beat your mother or your mother drank while you were in the womb... in other words, you are probably a stupid individual and i don't expect you to understand such complexities as solving these problems.
 
typeB-md said:
I will solve this problem for everyone. Please follow.

There are two sides to this debate... there are the ones that are correct and there are the socialists. America is a capitalistic society, therefore, you pay for what you want. If you want healtchare, it is going to cost you. It is a privilege to have good healtchare, not a right... this is the correct view for a capitalistic society... if you disagree you are wrong. Living in America entitles us only to have it available, not entitles us to receive it.

Now that we have cleared that up. The next thing we need to talk about is insurance. Don't carry it. This is a simple enough thing. You will see that plenty of people will pony up the cash to get better. Those that can't pony up the money probably aren't useful members of society, and we will passively remove them from the American gene pool. Again, there will be the socialist type that act pro-bono or receive healthcare... but they can only do so much and their schedules will be so backed up that if someone doesn't want to wait 9 months to see a doc, they'll find the cash to come to you.

We accept that people pay $5K for season tickets... we accept that athletes make $5 million a YEAR... we accept that people drive cars without the means to pay in full... we accept all these things, yet the socialists disagree with doctors receiving large sums of money. I don't know, but i think a physician provides a better service than A-Rod... but the socialists are socialists... and more importantly they're stupid and short-sighted... and even more importantly than that, they are un-american.

I see the socialist attitude in the majority of the class. Most of them are not from wealthy families and they can't relate to how professionals are supposed to live. They also fail to understand that most people in life are looking for the free ride... and these socialists are more than happy to give in because they're too stupid to realize that they're being played by the masses. It really all comes down to fact that the socialists incorrectly believe that healthcare is a right (which is fine in socialism but they confuse free-market with steal-from-the-rich-and-give-to-the-poor). Once we make these ignoramuses clear on this issue, all others will fall in line and physicians as a group will be fine.

These thoughts are the only correct thoughts on the matter. If you agree, then you are correct. If you disagree, you are probably grew up poor or your father beat your mother or your mother drank while you were in the womb... in other words, you are probably a stupid individual and i don't expect you to understand such complexities as solving these problems.

typeB you are right that docs need to be very well payed. In fact they deserve far more than A-Rod or any baseball team combined for that matter. But you're right, the masses are trying to control the situation. I still think everyone deserves health care. I am from a moderately wealthy family, however my sister has made poor decisions and lives in a state-supported housing and her health care is all paid for by our taxes. Sadly, she is a lazy and unwilling to work due to her mental problems.. For that reason, I can see how disgusted most physicians would be to treat her (essentially pro bono).

But typeB, you must begin to sympathize with some of these people! They are foolish, and we as future doctors are the ones that know best about health. Let's not tear them down, try to build them up. Good luck, typeB
 
typeB-md said:
I will solve this problem for everyone. Please follow.

There are two sides to this debate... there are the ones that are correct and there are the socialists. America is a capitalistic society, therefore, you pay for what you want. If you want healtchare, it is going to cost you. It is a privilege to have good healtchare, not a right... this is the correct view for a capitalistic society... if you disagree you are wrong. Living in America entitles us only to have it available, not entitles us to receive it.

Now that we have cleared that up. The next thing we need to talk about is insurance. Don't carry it. This is a simple enough thing. You will see that plenty of people will pony up the cash to get better. Those that can't pony up the money probably aren't useful members of society, and we will passively remove them from the American gene pool. Again, there will be the socialist type that act pro-bono or receive healthcare... but they can only do so much and their schedules will be so backed up that if someone doesn't want to wait 9 months to see a doc, they'll find the cash to come to you.

We accept that people pay $5K for season tickets... we accept that athletes make $5 million a YEAR... we accept that people drive cars without the means to pay in full... we accept all these things, yet the socialists disagree with doctors receiving large sums of money. I don't know, but i think a physician provides a better service than A-Rod... but the socialists are socialists... and more importantly they're stupid and short-sighted... and even more importantly than that, they are un-american.

I see the socialist attitude in the majority of the class. Most of them are not from wealthy families and they can't relate to how professionals are supposed to live. They also fail to understand that most people in life are looking for the free ride... and these socialists are more than happy to give in because they're too stupid to realize that they're being played by the masses. It really all comes down to fact that the socialists incorrectly believe that healthcare is a right (which is fine in socialism but they confuse free-market with steal-from-the-rich-and-give-to-the-poor). Once we make these ignoramuses clear on this issue, all others will fall in line and physicians as a group will be fine.

These thoughts are the only correct thoughts on the matter. If you agree, then you are correct. If you disagree, you are probably grew up poor or your father beat your mother or your mother drank while you were in the womb... in other words, you are probably a stupid individual and i don't expect you to understand such complexities as solving these problems.
what a post...at times intriguing, at times unecessarily insulting, and at times exactly 100% perfectly true.

i wanted to expand on the two bold segments.

1) i couldn't agree more. there are pro athletes who are still being paid up to and over 10M per year who are actually retired due to injury or being straight-up cut from their team (this happens a lot in baseball and basketball--pro football contracts are not guaranteed). anybody remember mo vaughn? albert belle? their knees went bad and they still collected 8-figure salaries. where was the public outcry? if anyone in our society "deserves" (and i hate even using that word) big salaries, its your local trauma surgeon or oncologist. i often see MTV's Cribs...i see one-hit wonder rappers who i've never even heard of with 4th grade educations living in 5 bedroom houses with 3 range rovers in the drive way. why is this so acceptable to society?

2) ah yes, "steal-from-the-rich-and-give-to-the-poor". i often wonder how much more self-reliant and independent our society would be if not for the quintessential fable of Robin Hood. this whole idea that it is acceptable, or even valiant, to take other people's money/stuff because someone else doesn't have as much is baffling. it perpetuates the whole "us against them" anti-rich attitude seen in our culture. why did so many people cry out against george bush lowering the uppermost tax bracket (from the 44% clinton imposed to the slightly less crazy 39%, i believe. i could be wrong about those numbers. hell, i'm not rich, f**k off!). i'm really tired of our society showing so much resentment towards people who have more than they do. personally, i don't care that A-Rod makes 22M this year. good for him!
 
Heh, an interesting thread.

Money in a nutshell?

1) Indigent (Homeless), reliant on charity/govt for survival (<5%)

2) Below Poverty/Subsistence level -- Barely scraping by, not homeless, on govt aid (10-15% ALOT!!, esp in urban areas)

3) Lower than avg (<$25,000/household -- maybe 20-30%) -- Lots of people, prob a normal house in a not so good area, or a small one in a fair area

4) Around avg (~$45,000/household -- 40%) -- Most people, normal house in a fair area or small house in a very good area.

5) Above avg/well to do ($60,000-150,000 -- 10-15%) -- Engineer or regular lawyer, academic doc -- decent pay, good std. of living, but limits on children education, college expenses and real estate options -- normal house in a very good area, also some perks like a nice car and maybe private school for children

6) Wealthy ($150K-400K/yr -- ~5%) -- High level lawyer, top 10% business/finance people, avg non academic doc -- Enough to both live in a great house in a great area and have multiple options for children and material perks (like intl vacations). However not enough to make major investments (5-15 M range) or major philanthropic work.

7) Rich (1-2 M/yr -- 1:1000) -- Top paid doc (surgeons?), top exec, entrepreneur, professional athlete?? 🙂 -- Same as above except able to a) make major investments to greatly magnify assets, b) make small philanthropic gifts which affect community, c) local/state politics

8) High level rich (30-50 M/yr -- 1:100000) -- Inherited wealth, top of the top companies, entrepreneur -- Same as above but sufficient wealth to be a major national political influence -- can run for major national office for example. Regional philanthropy.

9) Top wealth in the country (> 300M/yr -- less than 1000 ppl) -- Similar to above -- enough money to fund national campaigns --national philanthropy, international phil organizations.

----

In any event, having 200k/yr keeps you far far behind the truly "rich" but it is extremely high relative to the population. The salary of a doc is tricky for a few major reasons:

a) Loans are an annoying cost of business (~10-15% lost income/yr)

b) Academic jobs are inherently less lucrative (1/3 the salary of private practice)

c) A single male (or female) has far far fewer expenses than a family. Children are one big reason; so is real estate aquisition. A single male may not mind living in a cheap apt. indefinitely -- but it's less appopriate for a family. The expected quality of living goes up, so the increase in salary means less.

d) inflation is going to be a major factor in the next 15 years due to the national debt (10 trillion I think) -- the interest payments are now bigger than the dept. of defense budget, and only are smaller than medicare and social security. So this may have a drastic or mild effect on private practice salaries. Also investment will be key to maintaining one's asset value.
 
I think it's hilarious that some of you think that you're going to be living in a million dollar house and living like the stars on a doctor's salary. If you go into any primary care field, you're going to probably max out at $200,000 (and that's for OBs, who do procedures). My father has been a practicing internist for 27 years (and doesn't take insurance, typeB!) and usually makes around $200,000 a year. I recall my folks paying close to $100,000 in taxes one year, along with all the usual business expenses, etc. They have been living in the same house for all 27 years my dad has been in practice (worth...drum roll...$200,000!). They both have nice cars, but they ain't Bentleys. They managed to pay for our college educations, but it didn't leave a whole lot left over. They don't have a tremendous amount of retirement. They can't make major investments. They never go on vacation because my dad can't afford to take off work. And he's 59! Matter of fact, he's on call this weekend and had 15 people admitted to the hospital and gets paged at 3:30am, 4am, 5am, etc and has to go and round on all these people for around 6 hours both days of the weekend! Woohoo! It's a rich man's life, I tell ya!

Unless you guys are going to be incredibly business savvy or make tons of money as a subspecialist, you better abandon these dreams of living as a millionaire. Go get your MBA and become a CEO, it's a crapload easier than being a doctor.
 
Elysium said:
I think it's hilarious that some of you think that you're going to be living in a million dollar house and living like the stars on a doctor's salary. If you go into any primary care field, you're going to probably max out at $200,000 (and that's for OBs, who do procedures). My father has been a practicing internist for 27 years (and doesn't take insurance, typeB!) and usually makes around $200,000 a year. I recall my folks paying close to $100,000 in taxes one year, along with all the usual business expenses, etc. They have been living in the same house for all 27 years my dad has been in practice (worth...drum roll...$200,000!). They both have nice cars, but they ain't Bentleys. They managed to pay for our college educations, but it didn't leave a whole lot left over. They don't have a tremendous amount of retirement. They can't make major investments. They never go on vacation because my dad can't afford to take off work. And he's 59! Matter of fact, he's on call this weekend and had 15 people admitted to the hospital and gets paged at 3:30am, 4am, 5am, etc and has to go and round on all these people for around 6 hours both days of the weekend! Woohoo! It's a rich man's life, I tell ya!

Unless you guys are going to be incredibly business savvy or make tons of money as a subspecialist, you better abandon these dreams of living as a millionaire. Go get your MBA and become a CEO, it's a crapload easier than being a doctor.


That's why you shouldn't go into IM or FP...........anesthesia all the way baby!!!!!!!!!!!!!!!!!!!!
 
I think the idea of an MBA is great, but not to become CEO. I think part of the reason that doctors salaries have been shrinking is because many don't know the "business" world as well as they know the medical world (and rightfully so). I think that doctors would be better off if we had at least a little business training (finance, investing, negotiations, etc). As a whole, I think doctors are very trusting, so when the insurance companies and lawyers started screwing doctors, the mds just let it happen because they did not know any better.

I double majored in business and physiology and plan on getting an MBA too. Even if my salary may not be as much as it would have been 10-15 years ago I will know how to invest and will make sure that in my practice, I don't get screwed by lawyers or insurance companies. Perhaps if all of us as the next generation mds did the same we could get somewhere.

As a side note, I do think that supply and demand will be increasingly working in our favor, but at the same time this means that we will have more patients, more hours, and who knows if the pay will increase at the same rate. I realized a long time ago that if you are in medicine for the money, then you are delusional, it is just not what it used to be.
 
Alexander Pink said:
How am I dillusional?
well, for one, youre already calling yourself MD despite not even starting med school yet.

And don't YOU forget to finish your Filet-O-Fish!
 
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