Coming to terms with Being Middle Class

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gaspusher

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I didn't go into medicine purely for financial goals. I certainly didn't pick Anesthesia for the money, but at the time I was a little envious of my classmates matching into the six year integrated cardiothoracic / NSG / Ortho. As I progress through my 30s, I realize that at the end of the day, all of that doesn't matter. Physicians never have, and never will compete with the Finance Brahs or the tech folks (with the rare exception of those surgeons working day and night to pull 7 figures).

After getting outbid on house after house, I've come to realize that while Anesthesia can give you a comfortable salary in the $400-600k range with absolute gratification; tech and finance (the true upper class) will always beat us.

Google, NVIDIA, Amazon, Tesla, Microsoft, and especially Meta directors have been on a tear in the South Bay. I thought they also made similar to what I make, but my eyes were finally opened after the last two bidding wars (in a climate with increasing interest rates and largely over valued housing). These clowns make millions of dollars a year:


I cannot compete with someone making $2 million a year; nor did I ever know such things existed when I was in college or medical school. I knew about banking and finance, but I also knew about 2008 and losing it all. These tech, Venture Capital, Private Equity folks don't, and they have never seen their salaries during a real recession. So they get the bank to actually think their salary is $2 million and they are driving up the costs of housing even more when it's counter intuitive. I truly make my compensation, but they truly make $300,000 plus some made up RSU amount. It's extremely aggravating what capitalism has allowed to happen.

Then you have the corrupt Private Equity and Venture Capitalists riding what's left of the Covid boost knowing that they are one recession away from being solidly in the red on their over-leveraged lifestyles. It's a borrow now and worry about tomorrow attitude.

I'm not jealous of these tech or finance people; I just know they are doing it the wrong way and it ruins it for those of us doing it the right way - getting a good job, working hard, vetting in total index funds, saving up for a down payment and buying a correctly priced home. All physicians I know are conservative and these clowns just aren't and they ruin everything for everyone.

TLDR: I love Anesthesia, I love my current job. I'm so absolutely disgruntled with the amount of over leveraged "made up" money in South Bay it isn't funny.
 
You have a geography problem, not a class problem.

I feel for you, though. It would drive me nuts be surrounded by that making a “measly” 500k plus whatever your partner makes. And I am being sincere about that.

We’re looking for homes in a big Midwest city and are floored at what was once easily affordable on a physician salary could eat up almost half of monthly take home income. Sucks but it is what it is 🤷🏻‍♂️
 
Try making 110k w2 a year circa 1995-1998 in many metro places full call anesthesiologist

It’s been far worse. This is the best job market and pay for anesthesia docs since the 1980s (for those old enough to remember the 1980s). Considering you are on ur 30s. You weren’t even born.

There is always someone who’s gonna to make more than you. I made 1.25 million last year with 9 full weeks off. But my friend hit 2.15 million with 6 full weeks off (with stormy daniels stripper discounts off his business deduction). Both general anesthesia docs

But my ortho buddy who owns his own practice hit 2.7 million. I can’t compete with that. I worked like a dog in some of my weeks I worked (130-140 plus hours a week)

But most guys in California. The software engineers guys make around 300k. A few make 800-900k I know of in their early 30s. Google AI division.

Unfortunately you live in a very high cost area.

Move.

I lived in a super high cost area as well. I moved to Florida almost 20 years ago. I never looked back from California high cost of living. Walnut Creek was considering cheap to live compared to Netscape headquarter (yes. I’m old enough to remember Netscape’s original headquarters in Mountain View. You weren’t even born. Or stil in diapers
 
I didn't go into medicine purely for financial goals. I certainly didn't pick Anesthesia for the money, but at the time I was a little envious of my classmates matching into the six year integrated cardiothoracic / NSG / Ortho. As I progress through my 30s, I realize that at the end of the day, all of that doesn't matter. Physicians never have, and never will compete with the Finance Brahs or the tech folks (with the rare exception of those surgeons working day and night to pull 7 figures).

After getting outbid on house after house, I've come to realize that while Anesthesia can give you a comfortable salary in the $400-600k range with absolute gratification; tech and finance (the true upper class) will always beat us.

Google, NVIDIA, Amazon, Tesla, Microsoft, and especially Meta directors have been on a tear in the South Bay. I thought they also made similar to what I make, but my eyes were finally opened after the last two bidding wars (in a climate with increasing interest rates and largely over valued housing). These clowns make millions of dollars a year:


I cannot compete with someone making $2 million a year; nor did I ever know such things existed when I was in college or medical school. I knew about banking and finance, but I also knew about 2008 and losing it all. These tech, Venture Capital, Private Equity folks don't, and they have never seen their salaries during a real recession. So they get the bank to actually think their salary is $2 million and they are driving up the costs of housing even more when it's counter intuitive. I truly make my compensation, but they truly make $300,000 plus some made up RSU amount. It's extremely aggravating what capitalism has allowed to happen.

Then you have the corrupt Private Equity and Venture Capitalists riding what's left of the Covid boost knowing that they are one recession away from being solidly in the red on their over-leveraged lifestyles. It's a borrow now and worry about tomorrow attitude.

I'm not jealous of these tech or finance people; I just know they are doing it the wrong way and it ruins it for those of us doing it the right way - getting a good job, working hard, vetting in total index funds, saving up for a down payment and buying a correctly priced home. All physicians I know are conservative and these clowns just aren't and they ruin everything for everyone.

TLDR: I love Anesthesia, I love my current job. I'm so absolutely disgruntled with the amount of over leveraged "made up" money in South Bay it isn't funny.


We have a handful of customers per day. There is a global market for what they’re making and selling.
 
I didn't go into medicine purely for financial goals. I certainly didn't pick Anesthesia for the money, but at the time I was a little envious of my classmates matching into the six year integrated cardiothoracic / NSG / Ortho. As I progress through my 30s, I realize that at the end of the day, all of that doesn't matter. Physicians never have, and never will compete with the Finance Brahs or the tech folks (with the rare exception of those surgeons working day and night to pull 7 figures).

After getting outbid on house after house, I've come to realize that while Anesthesia can give you a comfortable salary in the $400-600k range with absolute gratification; tech and finance (the true upper class) will always beat us.

Google, NVIDIA, Amazon, Tesla, Microsoft, and especially Meta directors have been on a tear in the South Bay. I thought they also made similar to what I make, but my eyes were finally opened after the last two bidding wars (in a climate with increasing interest rates and largely over valued housing). These clowns make millions of dollars a year:


I cannot compete with someone making $2 million a year; nor did I ever know such things existed when I was in college or medical school. I knew about banking and finance, but I also knew about 2008 and losing it all. These tech, Venture Capital, Private Equity folks don't, and they have never seen their salaries during a real recession. So they get the bank to actually think their salary is $2 million and they are driving up the costs of housing even more when it's counter intuitive. I truly make my compensation, but they truly make $300,000 plus some made up RSU amount. It's extremely aggravating what capitalism has allowed to happen.

Then you have the corrupt Private Equity and Venture Capitalists riding what's left of the Covid boost knowing that they are one recession away from being solidly in the red on their over-leveraged lifestyles. It's a borrow now and worry about tomorrow attitude.

I'm not jealous of these tech or finance people; I just know they are doing it the wrong way and it ruins it for those of us doing it the right way - getting a good job, working hard, vetting in total index funds, saving up for a down payment and buying a correctly priced home. All physicians I know are conservative and these clowns just aren't and they ruin everything for everyone.

TLDR: I love Anesthesia, I love my current job. I'm so absolutely disgruntled with the amount of over leveraged "made up" money in South Bay it isn't funny.
To be fair most of those jobs did not exist when you were in college and/or medical school.

Medicine has lost a TON of ground compared to other traditional "upper middle class" jobs over the past 2 decades, and especially as we have seen the rise of the tech sector over the past 1-2 decades. Extreme growth in the tech sector led to tons of money just sloshing around, probably similar to how CMS funding was in the late 80s/90s but I wasn't around for that. I can't speak to Anesthesia specifically as I know you guys have historically been reimbursed horrendously by medicare anyways, but in my mind there have been two major trends contributing to it:

1) Slashing of CMS reimbursement directly to physicians and shifting that money toward "facility fees" allowing an ever-growing number of people to find full-time employment leaching off of our work - this is the major one to me because hospital systems have become so huge that there is basically no way to reverse the trend as I would wager hospital systems are the #1 employer in a ridiculous % of congressional districts
2) (Closely related to #1) The demise of private practice

I agree with the other posters though that your only real "solution" would be to relocate geographically to a less tech-heavy area, and I would also be thankful your field has experienced a pretty good resurgence over the past few years.
 
The average salary for somebody your age in the most prosperous country/nation in the world **in the history of mankind** is $64,000 per year. I don't know about you, but I made close to 10x that last year. Throw in the benefits/vacation time and another $70-100k of real financial prosperity.

All I have to say is that I am incredibly grateful for my life and circumstances.
 
The chances of making 7 figure in finance or tech are probably just as slim as doing so in medicine. It’s extremely uncommon.
I agree with this but I don't think this is the issue - it's the chances of making a hospitalist salary in finance or tech that is really changing the ballgame for physicians in many areas of the country (not just in SF)
 
The chances of making 7 figure in finance or tech are probably just as slim as doing so in medicine. It’s extremely uncommon.
But opportunity cost being lost in medicine up to age 29-35.

That is real. My nephew hotly debated going to top
5-10 med school over working in California in tech. Facebook (meta) throwing a starter 120k job plus other bonus making it close to 200k a year for a 22 year old is temping

That’s starting salary

So even if they peak say at $300/350k for low level senior engineer. That’s a 7-10 year jump start.

But I think medicine is changing as well. With anesthesia it’s no longer consider standard to
Work 55 hrs as a regular job without extra compensation.

Most standard w2 hospital or group practice contracts were gentlemen’s agreements I would
Work on average 52 hrs a week. And 6 weeks off

Imagine telling a new grad you would be paid $425k based on 52 hrs a week these days. They would tell u gtfo.
 
You make a ****load of money. You are comfortably within the top 5% of earners in the US. Just for some perspective: I am PM&R Sports. I will never see $500k per year, nor will the overwhelming majority of pediatricians, rheumatologists, neurologists, nephrologists, family medicine physicians, etc…

EDIT: Just saw that you lived in the Bay Area. That’s tough. There’s no way I could afford to live there. Is moving out of the question?
 
I didn't go into medicine purely for financial goals. I certainly didn't pick Anesthesia for the money, but at the time I was a little envious of my classmates matching into the six year integrated cardiothoracic / NSG / Ortho. As I progress through my 30s, I realize that at the end of the day, all of that doesn't matter. Physicians never have, and never will compete with the Finance Brahs or the tech folks (with the rare exception of those surgeons working day and night to pull 7 figures).

After getting outbid on house after house, I've come to realize that while Anesthesia can give you a comfortable salary in the $400-600k range with absolute gratification; tech and finance (the true upper class) will always beat us.

Google, NVIDIA, Amazon, Tesla, Microsoft, and especially Meta directors have been on a tear in the South Bay. I thought they also made similar to what I make, but my eyes were finally opened after the last two bidding wars (in a climate with increasing interest rates and largely over valued housing). These clowns make millions of dollars a year:


I cannot compete with someone making $2 million a year; nor did I ever know such things existed when I was in college or medical school. I knew about banking and finance, but I also knew about 2008 and losing it all. These tech, Venture Capital, Private Equity folks don't, and they have never seen their salaries during a real recession. So they get the bank to actually think their salary is $2 million and they are driving up the costs of housing even more when it's counter intuitive. I truly make my compensation, but they truly make $300,000 plus some made up RSU amount. It's extremely aggravating what capitalism has allowed to happen.

Then you have the corrupt Private Equity and Venture Capitalists riding what's left of the Covid boost knowing that they are one recession away from being solidly in the red on their over-leveraged lifestyles. It's a borrow now and worry about tomorrow attitude.

I'm not jealous of these tech or finance people; I just know they are doing it the wrong way and it ruins it for those of us doing it the right way - getting a good job, working hard, vetting in total index funds, saving up for a down payment and buying a correctly priced home. All physicians I know are conservative and these clowns just aren't and they ruin everything for everyone.

TLDR: I love Anesthesia, I love my current job. I'm so absolutely disgruntled with the amount of over leveraged "made up" money in South Bay it isn't funny.

Bay area is a completely different ball game. No one can really compete with the tech RSUs that companies throw around to employees. It's unfortunate for everyone else.

But at the end of the day, it's a matter of perspective. We have jobs that will allow us to amass millions of dollars with amazing job security.

If you are married to the Bay Area, this will be your struggle. Otherwise California is a huge state and the US is a huge country to find liveable areas.
 
But opportunity cost being lost in medicine up to age 29-35.

That is real. My nephew hotly debated going to top
5-10 med school over working in California in tech. Facebook (meta) throwing a starter 120k job plus other bonus making it close to 200k a year for a 22 year old is temping

That’s starting salary

So even if they peak say at $300/350k for low level senior engineer. That’s a 7-10 year jump start.

But I think medicine is changing as well. With anesthesia it’s no longer consider standard to
Work 55 hrs as a regular job without extra compensation.

Most standard w2 hospital or group practice contracts were gentlemen’s agreements I would
Work on average 52 hrs a week. And 6 weeks off

Imagine telling a new grad you would be paid $425k based on 52 hrs a week these days. They would tell u gtfo.

Your nephew is already elite if they're deciding between a FAANG job and a top 10 medical school.

Getting your foot in the door in a technical role at FAANG companies isn't easy either.

Most physicians aren't deciding between top 10 medical schools.
 
The chances of making 7 figure in finance or tech are probably just as slim as doing so in medicine. It’s extremely uncommon.
I don't want to burst your bubble but I know quite a few in our field making $1 million plus. Even an old guy like me brings in $700K with 12 weeks off and my main job is W-2. I was offered $1 million total in 2025 and turned it down because I want at least 12 weeks off. Next year my goal is $700K with 14 weeks off.

50 hours x 350=$17,500 per week x 42 weeks- $735,000

That's not even any premium rates or call pay in the schedule. Yes, I am still taking call to generate the $700K with the 12 weeks off. But, I know quite a few who are doing 40 hours during the week with one 24 hour (weekend) and 1 weekday call clearing $1 million. Do the math and you will see the money is there.

64 + 12 (weekday)= 76 x 350= $26,600 x 42 weeks=$1.12 million with 10 weeks off.

ANEFT easily cleared the $1 mil mark in 2024 and could have made $1.5 but wanted his weeks off.

I am looking for a new CPA as the taxes are killing me. But, I seriously doubt that I can call myself "Middle Class" any longer.
 
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Sure, but come to the Bay Area and your (like mine) $700,000 on your W2 taxed at 32% and 10% state is middle class. The issue is the RSU projected income makes the field not level and unfair because at the end of the day it won't come out what the past two years have projected. Also, the VC and PE still playing with money from a time when interest rates were basically free - leveraging to now is a recipe for disaster.

Also, $1 million for a general anesthesiologist is not attainable. Why, well you'd need a payor base giving you a mixed unit base near 100 bucks a unit and with generous hospital subsidy. That doesn't exist to the best of my knowledge in any desirable location.
 
You keep acting like you're jealous of these venture/tech bros but then talk about how their current situations and decisions are recipes for disaster. Wouldn't you say you're on a much stronger financial path than those guys?

As many others said your issues with the housing market is primarily based on where you have chosen to live, not necessarily the economy at large.

That being said, the exorbitant increase in housing costs has definitely shifted the type of house physicians can compete for, especially those like me only a few years out of residency without any equity.
 
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This is an incredibly pointless discussion. Yes, some places cost more than others. Yes, the fortunes of some places change such that once middle class areas become fabulously wealthy. Mayfair used to be a farm and is now some of the most expensive real estate in the world. Conversely, Baghdad was a rich Silk Road town but you wouldn’t want to be there now.

The Bay Area is also the highest concentration of ‘winners’ - there are many losers and startups who don’t make near that kind of money. They either keep trying or go somewhere else and make less.
 
I didn't go into medicine purely for financial goals. I certainly didn't pick Anesthesia for the money, but at the time I was a little envious of my classmates matching into the six year integrated cardiothoracic / NSG / Ortho. As I progress through my 30s, I realize that at the end of the day, all of that doesn't matter. Physicians never have, and never will compete with the Finance Brahs or the tech folks (with the rare exception of those surgeons working day and night to pull 7 figures).

After getting outbid on house after house, I've come to realize that while Anesthesia can give you a comfortable salary in the $400-600k range with absolute gratification; tech and finance (the true upper class) will always beat us.

Google, NVIDIA, Amazon, Tesla, Microsoft, and especially Meta directors have been on a tear in the South Bay. I thought they also made similar to what I make, but my eyes were finally opened after the last two bidding wars (in a climate with increasing interest rates and largely over valued housing). These clowns make millions of dollars a year:


I cannot compete with someone making $2 million a year; nor did I ever know such things existed when I was in college or medical school. I knew about banking and finance, but I also knew about 2008 and losing it all. These tech, Venture Capital, Private Equity folks don't, and they have never seen their salaries during a real recession. So they get the bank to actually think their salary is $2 million and they are driving up the costs of housing even more when it's counter intuitive. I truly make my compensation, but they truly make $300,000 plus some made up RSU amount. It's extremely aggravating what capitalism has allowed to happen.

Then you have the corrupt Private Equity and Venture Capitalists riding what's left of the Covid boost knowing that they are one recession away from being solidly in the red on their over-leveraged lifestyles. It's a borrow now and worry about tomorrow attitude.

I'm not jealous of these tech or finance people; I just know they are doing it the wrong way and it ruins it for those of us doing it the right way - getting a good job, working hard, vetting in total index funds, saving up for a down payment and buying a correctly priced home. All physicians I know are conservative and these clowns just aren't and they ruin everything for everyone.

TLDR: I love Anesthesia, I love my current job. I'm so absolutely disgruntled with the amount of over leveraged "made up" money in South Bay it isn't funny.
Comparison is the thief of joy

Maximize your own situation. Cut spending, save, invest. Don't lease cars. Buy and keep your car for 10 years. Buy a used car if possible. Don't fly business class.

If you can't buy, then rent and save.

You'll get there.

If you make 600k, take home 400k after taxes, try to live off 200k in expenses and save the other 200k. A 3 bedroom apt on Zillow in Bay area says 7500 per month. That's 90k per year, which gives you another 10k per month in spending money. Plenty.

Save for 5 years and you'll have a million plus for whatever you need. Or invest.
 
Well we did a lot of that saving the past year. We've doubled our down payment amount and with a little family support now have $700,000 to put down on a house. The problem is being outbid and not affording what we want. It's easy to say keep renting and saving, but at some point you have to take that leap of faith and stop making the landlord wealthy, get into Prop 13, and get a fixed monthly for decades. Maybe now is just not the right time given interest rates, a non cooling market due to tech still paying out RSU with NASDAQ up, and looming recession. Maybe the only way into this market is a recession.

If this is $3.6 million today


God only knows what it will be in three / four years from now....unless we have a recession.
 
After getting outbid on house after house [...] in the South Bay.
theresyourproblem.jpg

You're lamenting that you're surrounded by tech bros making more money than you, in the one city on the planet that has the highest concentration of said tech bros.

GTFO

I knew about banking and finance, but I also knew about 2008 and losing it all.
Here's the thing with that ...

The next 2008 finance bro crisis is going to happen, at some point. Maybe it'll be next month. Or in 2 years, or 5 years. Who knows? But it'll happen.

There are significant odds that the Facebook/Meta "under uber vice director of marketing" is going to go the way of the MySpace "under uber vice director of marketing" when the social media landscape shifts again (and it will). Maybe the UUVDOM is going to slide into a comparable job at the new hot company, or maybe he'll just get laid off. These people don't really have any skills beyond schmoozing.

What are the odds that you, as an anesthesiologist, with all these Americans getting fatter and older, are suddenly going to be unemployed? That your skills are suddenly going to be irrelevant, or unnecessary? Approximately zero.

You've got at least two things none of those tech bros have: genuine job security and the comfort that comes with being a useful & non-cancerous member of society.

We're living a dream that none of use really dreamed about 10 years ago.

Here's what you should do: just decide to be happy. Live below your means. Do stuff you enjoy. If you measure your self worth and get upset because other people have more than you (especially if they don't deserve to have more than you, and especially especially the sociopaths who claw true wealth out of other people) you're in for a lifetime of heartburn.

Annual income twenty pounds, annual expenditure nineteen six, result happiness. Annual income twenty pounds, annual expenditure twenty pound ought and six, result misery.
 
Well we did a lot of that saving the past year. We've doubled our down payment amount and with a little family support now have $700,000 to put down on a house. The problem is being outbid and not affording what we want. It's easy to say keep renting and saving, but at some point you have to take that leap of faith and stop making the landlord wealthy, get into Prop 13, and get a fixed monthly for decades. Maybe now is just not the right time given interest rates, a non cooling market due to tech still paying out RSU with NASDAQ up, and looming recession. Maybe the only way into this market is a recession.

If this is $3.6 million today


God only knows what it will be in three / four years from now....unless we have a recession.

9fo034.jpg


🙂

I know it's not always easy, family is an issue, spouse has a job, the weather is nice, the Mexican food is top notch ...

Move.
 
Well we did a lot of that saving the past year. We've doubled our down payment amount and with a little family support now have $700,000 to put down on a house. The problem is being outbid and not affording what we want. It's easy to say keep renting and saving, but at some point you have to take that leap of faith and stop making the landlord wealthy, get into Prop 13, and get a fixed monthly for decades. Maybe now is just not the right time given interest rates, a non cooling market due to tech still paying out RSU with NASDAQ up, and looming recession. Maybe the only way into this market is a recession.

If this is $3.6 million today


God only knows what it will be in three / four years from now....unless we have a recession.
Yea. Interest rates make it very unpalatable.

Owning a home is good. But yea, some prices will dip. A bit or at least become more affordable with a 4-5% rate in a couple years.

You are also competing with people who have been working for longer, family money, etc.

Owning a home may or may not necessarily make financial sense. Run a couple scenarios. See what you end up with if you purchase (taxes, repairs, renovations etc) vs rent plus invest the remainder.

It may not be that owning is that advantageous, if at all, in the current market.

You could rent your own place and then buy a multifamily somewhere else for example
 
Well we did a lot of that saving the past year. We've doubled our down payment amount and with a little family support now have $700,000 to put down on a house. The problem is being outbid and not affording what we want. It's easy to say keep renting and saving, but at some point you have to take that leap of faith and stop making the landlord wealthy, get into Prop 13, and get a fixed monthly for decades. Maybe now is just not the right time given interest rates, a non cooling market due to tech still paying out RSU with NASDAQ up, and looming recession. Maybe the only way into this market is a recession.

If this is $3.6 million today


God only knows what it will be in three / four years from now....unless we have a recession.
For me to move to your area I would NEED a 1.2 Million salary with 8 weeks off. Plus, a lot of tax shelters to keep my money like the tech bros. Your cost of living is 2 x most other areas of the country. You need to recognize your unique situation for what it is and realize this IS a golden age for anesthesiology.
Things can also turn NEGATIVE in our field with the next administration. Is that likely? No. Is it possible? Yes, especially if a socialist wins the White House and they sweep Congress.
 
Well we did a lot of that saving the past year. We've doubled our down payment amount and with a little family support now have $700,000 to put down on a house. The problem is being outbid and not affording what we want. It's easy to say keep renting and saving, but at some point you have to take that leap of faith and stop making the landlord wealthy, get into Prop 13, and get a fixed monthly for decades. Maybe now is just not the right time given interest rates, a non cooling market due to tech still paying out RSU with NASDAQ up, and looming recession. Maybe the only way into this market is a recession.

If this is $3.6 million today


God only knows what it will be in three / four years from now....unless we have a recession.
You still haven't explained why you as an Anesthesiologist needs to live in the #1 most expensive part of the US.

Pinning your hopes on a 2008-style recession when most homeowners have 3-4% mortgages seems like a set-up for disappointment to me especially when our incoming President, like him or not, is very buddy-buddy with big tech and in his last term pumped up the money printer like never before seen in order to avoid one.
 
Finance, IB, tech etc are all high variance jobs. Sure, you may hit the jackpot, but it’s very easy (and more common than not) to be working more hours than doctors for less pay in those fields. Medicine is the only field where you’re guaranteed to make 6 figures unless you just are a complete screw up. I don’t feel like I work particularly hard or am particularly extraordinary compared to the next guy and still make right at 7 figures working 4 days a week. Grass is always greener, but it’s not like your field is drab.

Also move out of California yesterday. It will increase your effective income five-fold or more.
 
I’ll agree with everyone on here. Get out of California. I love California - I love Napa and Palm Springs. I’d never live there.

I also agree with blade - a million dollars in anesthesia is very doable. You will hustle for it - either in locums or by selling your soul to an extended care team AMC that’ll work you to death…. And neither of those is in California either.

As someone who just left a HCOL place really consider moving away. It’s better here. The people are nicer and the traffic is better…. It’s hard to be tense and type A in the south. Maybe getting away from the rat race would benefit you. It’s working for us so far
 
Well we did a lot of that saving the past year. We've doubled our down payment amount and with a little family support now have $700,000 to put down on a house. The problem is being outbid and not affording what we want. It's easy to say keep renting and saving, but at some point you have to take that leap of faith and stop making the landlord wealthy, get into Prop 13, and get a fixed monthly for decades. Maybe now is just not the right time given interest rates, a non cooling market due to tech still paying out RSU with NASDAQ up, and looming recession. Maybe the only way into this market is a recession.

If this is $3.6 million today


God only knows what it will be in three / four years from now....unless we have a recession.



If you want to buy, then buy what you can get. You won't get your dream home on the first go around but historically prices have continued to increase and I don't see that changing any time soon. Increased interest rates haven't really changed anything.

You will likely have to buy something that doesn't check all you boxes and as the house appreciates, flip and slowly move up.

Real estate in CA has been a stable investment for decades. Prices have only gone up because it is generally a nice place to live.

It's January and a sunny 64 degrees. That's cold for me and I need a light jacket when I went for a walk.

I will never live in the snow again.
 
The real issue is the op doesn’t want to commute more than 20-minutes.

People do it all the time. Expand your home search to 45 minutes out. Take a job that works 3 days a week instead of 5. The 5 day a week plus calls q4 anesthesia job is dead. Dont be a fool in this job market.

You will be able to afford a nice home. (That you like)

There are compromises in life. Very few people can have everything especially this early on in your career.
 
The vast, vast majority of tech bros are W-2 employees of large companies, and have no tax breaks beyond their mortgage interest. Their RSU income can almost never be used to help qualify for a loan as it is a single asset portfolio. At most, they might be able to borrow against it at a rate of 60 or 70%, but that’s only if they have proper stock options; RSU options Cannot be taken over by another bank in order to make that loan happen. Which isn’t to say that there aren’t a lot of rich people out here who have an advantage over doctors in terms of earnings, but most of them are wage slaves, just at a higher wage. The whole California, Bay Area, VHCOL discussion has been had to death, and people make the choices that they make. This area needs anesthesiologists, too. But don’t bitch about it. The idea that your middle class is ridiculous. Tell that to the janitor working at the same hospital you are.
 
The real issue is the op doesn’t want to commute more than 20-minutes.

People do it all the time. Expand your home search to 45 minutes out. Take a job that works 3 days a week instead of 5. The 5 day a week plus calls q4 anesthesia job is dead. Dont be a fool in this job market.

You will be able to afford a nice home. (That you like)

There are compromises in life. Very few people can have everything especially this early on in your career.
Yes, one can commute 45 minutes instead of 15 and increase rates substantially and work fewer hours. In most locales I’d say. Radius is key
 
You still haven't explained why you as an Anesthesiologist needs to live in the #1 most expensive part of the US.

That linked house is a mile from the Apple headquarters. 🙂

Yes, one can commute 45 minutes instead of 15 and increase rates substantially and work fewer hours. In most locales I’d say. Radius is key

Unfortunately 45 minutes doesn't buy you a lot of distance in these dense urban / sprawl areas. Commuting is usually OK when you're arriving at 6:30 AM but god help you if you leave between 3 and 6 PM ...

This area needs anesthesiologists, too.

It's one thing if you've been an anesthesiologist there since 2005. Quite another for a new grad or early career person who wants to fill silicon valley's need for anesthesiologists.
 
I didn't go into medicine purely for financial goals. I certainly didn't pick Anesthesia for the money, but at the time I was a little envious of my classmates matching into the six year integrated cardiothoracic / NSG / Ortho. As I progress through my 30s, I realize that at the end of the day, all of that doesn't matter. Physicians never have, and never will compete with the Finance Brahs or the tech folks (with the rare exception of those surgeons working day and night to pull 7 figures).

After getting outbid on house after house, I've come to realize that while Anesthesia can give you a comfortable salary in the $400-600k range with absolute gratification; tech and finance (the true upper class) will always beat us.

Google, NVIDIA, Amazon, Tesla, Microsoft, and especially Meta directors have been on a tear in the South Bay. I thought they also made similar to what I make, but my eyes were finally opened after the last two bidding wars (in a climate with increasing interest rates and largely over valued housing). These clowns make millions of dollars a year:


I cannot compete with someone making $2 million a year; nor did I ever know such things existed when I was in college or medical school. I knew about banking and finance, but I also knew about 2008 and losing it all. These tech, Venture Capital, Private Equity folks don't, and they have never seen their salaries during a real recession. So they get the bank to actually think their salary is $2 million and they are driving up the costs of housing even more when it's counter intuitive. I truly make my compensation, but they truly make $300,000 plus some made up RSU amount. It's extremely aggravating what capitalism has allowed to happen.

Then you have the corrupt Private Equity and Venture Capitalists riding what's left of the Covid boost knowing that they are one recession away from being solidly in the red on their over-leveraged lifestyles. It's a borrow now and worry about tomorrow attitude.

I'm not jealous of these tech or finance people; I just know they are doing it the wrong way and it ruins it for those of us doing it the right way - getting a good job, working hard, vetting in total index funds, saving up for a down payment and buying a correctly priced home. All physicians I know are conservative and these clowns just aren't and they ruin everything for everyone.

TLDR: I love Anesthesia, I love my current job. I'm so absolutely disgruntled with the amount of over leveraged "made up" money in South Bay it isn't funny.

The salary you need to be considered middle class in every U.S. state—it’s close to $200,000 in 2 of them

"For many people, being “middle class” goes beyond a certain income level, says Brad Klontz, a certified financial planner and expert in financial psychology and behavioral finance.

“Our financial wellbeing is not an objective number,” he says. “It’s subjective and based on who we are comparing ourselves to.”

That’s why you may not feel “middle class” even if your income falls within a certain range. Especially if you’re comparing yourself to people on social media who may portray a wealthy lifestyle.

“The more we get exposed to people who seem to have more than us on social media is the worst because everyone looks so happy, which makes us feel even more miserable,” Klontz says. “We feel deprived even when we may not actually be deprived.”"


TLDR: You may be miserable, envious, and out of touch, but you are definitely not middle class.
 
The real issue is the op doesn’t want to commute more than 20-minutes.

People do it all the time. Expand your home search to 45 minutes out. Take a job that works 3 days a week instead of 5. The 5 day a week plus calls q4 anesthesia job is dead. Dont be a fool in this job market.

You will be able to afford a nice home. (That you like)

There are compromises in life. Very few people can have everything especially this early on in your career.
Yes, one can commute 45 minutes instead of 15 and increase rates substantially and work fewer hours. In most locales I’d say. Radius is key
This doesn't really apply to lots of the desirable places in California. For instance, in SoCal extending a 45 minute commute out doesn't move the needle much as @pgg said. You'd have to look into Central California such as Bakersfield. Bakersfield is 111 miles and 157 miles from Los Angeles and Irvine (OC), respectively. 2-2.5 hr commute 1 way WITHOUT traffic.
 
Try making 110k w2 a year circa 1995-1998 in many metro places full call anesthesiologist

It’s been far worse. This is the best job market and pay for anesthesia docs since the 1980s (for those old enough to remember the 1980s). Considering you are on ur 30s. You weren’t even born.

There is always someone who’s gonna to make more than you. I made 1.25 million last year with 9 full weeks off. But my friend hit 2.15 million with 6 full weeks off (with stormy daniels stripper discounts off his business deduction). Both general anesthesia docs

But my ortho buddy who owns his own practice hit 2.7 million. I can’t compete with that. I worked like a dog in some of my weeks I worked (130-140 plus hours a week)

But most guys in California. The software engineers guys make around 300k. A few make 800-900k I know of in their early 30s. Google AI division.

Unfortunately you live in a very high cost area.

Move.

I lived in a super high cost area as well. I moved to Florida almost 20 years ago. I never looked back from California high cost of living. Walnut Creek was considering cheap to live compared to Netscape headquarter (yes. I’m old enough to remember Netscape’s original headquarters in Mountain View. You weren’t even born. Or stil in diapers

I have very little sympathy for people who make decisions which put them in unhappy situations and then who complain about the situation—which is still a better situation than 99% of everybody else on this planet.

Exactly!

So I’m not an anesthesiologist. I’m a rheumatologist who finally managed to find a unicorn PP job after several tries. I’m located in the semi-rural Midwest. First year, I made about $540k. This year (my second year) I made partner and brought in about $775k. (And I’m still building the practice - I could probably pull $850k+ once I get everything totally ramped up.)

Now I get that I don’t live in the Bay Area, which is ridiculously expensive - in fact, my current income is somewhere around 10x the local median income. But still…here in America, $500-750k is a lot of freaking money! $750k puts you damn near the 1% nationally (in some states like WV, 1% income is less than $500k). And at this point, I’m literally making more in one year than I would have made in THREE years working my crappy first hospital job. So I’m pretty happy with how things are going right now.

Now I get that there are some docs/Silicon Valley types/etc out there making seven figures. Who cares? Maybe I could pull that off if I really put my nose to the grindstone - but do I really want to? No. I probably took 6-7 weeks off this year and could see myself taking more off in the future.

I don’t get the continual “penis measuring” urge that some doctors seem to have. No, I don’t make as much as some Silly Con (pun intended) Valley MBA idiot does. I don’t care. I don’t make quite as much as some ortho doc does somewhere. I don’t care. I can’t put $250 million into a presidential election like Elon Musk just did. I don’t care. I’m making 7 times as much as my parents did growing up, I’m making 3x more than I did when I was underpaid at a hospital system, and I live in a cheap area where I bought a decent house with a $1000/month mortgage payment. Life is damn good right now.

If you don’t like the COL of where you live, move.
 
The salary you need to be considered middle class in every U.S. state—it’s close to $200,000 in 2 of them

"For many people, being “middle class” goes beyond a certain income level, says Brad Klontz, a certified financial planner and expert in financial psychology and behavioral finance.

“Our financial wellbeing is not an objective number,” he says. “It’s subjective and based on who we are comparing ourselves to.”

That’s why you may not feel “middle class” even if your income falls within a certain range. Especially if you’re comparing yourself to people on social media who may portray a wealthy lifestyle.

“The more we get exposed to people who seem to have more than us on social media is the worst because everyone looks so happy, which makes us feel even more miserable,” Klontz says. “We feel deprived even when we may not actually be deprived.”"


TLDR: You may be miserable, envious, and out of touch, but you are definitely not middle class.

Classic current example of showy instagram “wealthy” people.

Eventually it catches up to them. They crash and burn and commit suicide.

At least doctors will always have a stable source of income.

Many of the software engineers depend on stock options and year end bonuses.

The average Google engineer makes 300k ish “total compensation “ not just salary.

I love reading Reddit. There is a ton of truth (from real people). Of course some may embellish and tell half truths.

 
This doesn't really apply to lots of the desirable places in California. For instance, in SoCal extending a 45 minute commute out doesn't move the needle much as @pgg said. You'd have to look into Central California such as Bakersfield. Bakersfield is 111 miles and 157 miles from Los Angeles and Irvine (OC), respectively. 2-2.5 hr commute 1 way WITHOUT traffic.
Nah. My brother and sister (another sister, the semi rich one, not the super rich sister) both work in downtown LA as anesthesiologists as well. My sister lives in downtown so doesn’t have a commute.

But my brother is 35 minutes from his house near seal beach to downtown LA in am since he’s at work early. Now Friday traffic going home is a different beast. Can be 1-1.5 hr commute home. That’s one of the reasons he didn’t buy another home in Newport Beach years ago because it’s another 15 miles. But 15 miles in Southern California can mean another 40 min in traffic.
 
There is truly an insane amount of wealth flowing around in tech right now, even as the market sucks for new grads. Facebook stock is up 70% in the last year alone for example. With return to office many people are having to return, even if many hate the area for being too expensive. The thing is they have to live there or they take a 50+% salary cut. It’s hard to be an anesthesiologist in the Bay Area, just like Manhattan. The nice thing is if you don’t feel it’s worth it, and it seems you don’t, you can just leave. Go practice anywhere else in the country. The tables have turned. Tech bros have to be in the office in the bay area, and you can go wherever you want!

By the way those tech workers create plenty of value too. These companies generally are hiring the best of the best and because of their scale if an engineer can make Google search 0.3% more efficient they’ve saved the company tens of millions. Why shouldn’t they be paid a few million then?
 
Speaking of San Francisco and the Bay Area. Most people know I network like crazy. It's all about networking. ER doc who's in his mid 40s in my neighborhood. We have common friends plus his wife is ER doc at one of the hospitals I cover. Anyways, just chit chatting on the tennis courts this morning. And he told me he only did 2 ER shifts last year! I"m like wtf are you doing these days. We were comparing our cybertrucks. So he's telling me he's been 18 months into a remote AI job for 6 billion startup in San Francisco. So he works remotely from east coast home.

He just reviews YouTube videos all day. And now analyzes TikTok videos. So there is some AI algorithm. You can't make this stuff up. His "salary" is in the low 200s but that's just his salary. He's got stock options and year end bonus. He was over 800k last year. So it's crazy the amount of money out there. And he gets to work remotely. He flies to SF 2 times a month. But he lives in Florida in my neighborhood. He still officially chief at one of HCA's hospital in town.

But barely works for them. Me and my ortho buddy (he makes a couple of million a year) are just saying that's the life to have. To be able to work remotely and and just chill.
 
Speaking of San Francisco and the Bay Area. Most people know I network like crazy. It's all about networking. ER doc who's in his mid 40s in my neighborhood. We have common friends plus his wife is ER doc at one of the hospitals I cover. Anyways, just chit chatting on the tennis courts this morning. And he told me he only did 2 ER shifts last year! I"m like wtf are you doing these days. We were comparing our cybertrucks. So he's telling me he's been 18 months into a remote AI job for 6 billion startup in San Francisco. So he works remotely from east coast home.

He just reviews YouTube videos all day. And now analyzes TikTok videos. So there is some AI algorithm. You can't make this stuff up. His "salary" is in the low 200s but that's just his salary. He's got stock options and year end bonus. He was over 800k last year. So it's crazy the amount of money out there. And he gets to work remotely. He flies to SF 2 times a month. But he lives in Florida in my neighborhood. He still officially chief at one of HCA's hospital in town.

But barely works for them. Me and my ortho buddy (he makes a couple of million a year) are just saying that's the life to have. To be able to work remotely and and just chill.

Curious what the clinical requirements are for periodic staff reprivileging or board recertification, working two shifts per year.
 
It's easy from the outside looking in to just tell someone to pick up and move. Yes, everything involves some leap of faith, but these things are much more difficult if you have spouses (especially picky ones), family, etc. I also love how everyone outside of CA seems to be a million dollar general anesthesiologist that takes 3 months off a year and also happens to be saving all their money and traveling the world like Rick Steves. I'm sure some of you are but there are many more factors involved than what's being presented here.

I think every non-tech exec/VC/pro-athlete/A-B list actor has this conversation with themselves at some point and starts to put that Powerpoint presentation together to their spouse selling rural NC (I have nothing against NC) but it's just not as easy as calling the movers as some of you make it. And let's be real, there are social factors as well no matter how Kum-Bye-Yah we claim our country is today. I in particular move to certain parts of this country and try to be a million dollar anesthesiologist, the numbers may not work out for various reasons, despite my patting myself on the back and thinking I'm pretty good at this job. It's just sad that certain comforts that living in certain areas provide comes at a price.
 
Speaking of San Francisco and the Bay Area. Most people know I network like crazy. It's all about networking. ER doc who's in his mid 40s in my neighborhood. We have common friends plus his wife is ER doc at one of the hospitals I cover. Anyways, just chit chatting on the tennis courts this morning. And he told me he only did 2 ER shifts last year! I"m like wtf are you doing these days. We were comparing our cybertrucks. So he's telling me he's been 18 months into a remote AI job for 6 billion startup in San Francisco. So he works remotely from east coast home.

He just reviews YouTube videos all day. And now analyzes TikTok videos. So there is some AI algorithm. You can't make this stuff up. His "salary" is in the low 200s but that's just his salary. He's got stock options and year end bonus. He was over 800k last year. So it's crazy the amount of money out there. And he gets to work remotely. He flies to SF 2 times a month. But he lives in Florida in my neighborhood. He still officially chief at one of HCA's hospital in town.

But barely works for them. Me and my ortho buddy (he makes a couple of million a year) are just saying that's the life to have. To be able to work remotely and and just chill.
That's "Who You Know" Type stuff. You can't get a setup like that from Linkedin.
 
It's easy from the outside looking in to just tell someone to pick up and move. Yes, everything involves some leap of faith, but these things are much more difficult if you have spouses (especially picky ones), family, etc. I also love how everyone outside of CA seems to be a million dollar general anesthesiologist that takes 3 months off a year and also happens to be saving all their money and traveling the world like Rick Steves. I'm sure some of you are but there are many more factors involved than what's being presented here.

I think every non-tech exec/VC/pro-athlete/A-B list actor has this conversation with themselves at some point and starts to put that Powerpoint presentation together to their spouse selling rural NC (I have nothing against NC) but it's just not as easy as calling the movers as some of you make it. And let's be real, there are social factors as well no matter how Kum-Bye-Yah we claim our country is today. I in particular move to certain parts of this country and try to be a million dollar anesthesiologist, the numbers may not work out for various reasons, despite my patting myself on the back and thinking I'm pretty good at this job. It's just sad that certain comforts that living in certain areas provide comes at a price.
Yes. Lots of moving parts. I don’t know if op spouse works or has a hard to relocate job

But the time to move is before kids get school age. And it doesn’t seem like op has school age kids.

It’s personal decision where one lives. I felt uneasy about living in the Bay Area. That’s why I aborted buying a house there in 2007 (thank god). I was in similar position as OP. Been out of training a few years. Stock market at its peak. Housing maket had just peaks as well.

I decided to head to Florida in 2008. It’s the best financial decision I made (for me). We knew zero people in Florida. Zero. But made a life here for 16 plus years.
 
I don't want to burst your bubble but I know quite a few in our field making $1 million plus. Even an old guy like me brings in $700K with 12 weeks off and my main job is W-2. I was offered $1 million total in 2025 and turned it down because I want at least 12 weeks off. Next year my goal is $700K with 14 weeks off.

50 hours x 350=$17,500 per week x 42 weeks- $735,000

That's not even any premium rates or call pay in the schedule. Yes, I am still taking call to generate the $700K with the 12 weeks off. But, I know quite a few who are doing 40 hours during the week with one 24 hour (weekend) and 1 weekday call clearing $1 million. Do the math and you will see the money is there.

64 + 12 (weekday)= 76 x 350= $26,600 x 42 weeks=$1.12 million with 10 weeks off.

ANEFT easily cleared the $1 mil mark in 2024 and could have made $1.5 but wanted his weeks off.

I am looking for a new CPA as the taxes are killing me. But, I seriously doubt that I can call myself "Middle Class" any longer.
How much of this is W2? The other question I have is why? You have always seemed very financially savvy and so I gotta think you have enough $$ to do whatever you want at this point.
 
How much of this is W2? The other question I have is why? You have always seemed very financially savvy and so I gotta think you have enough $$ to do whatever you want at this point.
1. I like what I do
2. My retirement is just around the corner where I have promised myself 1 week per month or less (1099 work around 40-45 hours per month)
3. I typically give money to my adult children who still need help
4. I like to buy stuff and deduct it saving 37%
5. 2/3 of my income is W-2 and 1/3 1099 (just extra money)

I am old school and I can assure you I will retire earlier than the generation before me did. As for my financial status, I am completely set for the remainder of my life (however long or short that may be). My faith in our LORD reassures me daily that this time on Earth is just a short stint for our souls (John 6:47)
 
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It's easy from the outside looking in to just tell someone to pick up and move. Yes, everything involves some leap of faith, but these things are much more difficult if you have spouses (especially picky ones), family, etc.
I agree BUT... if you have family that has already put down roots in San Francisco, LA etc. then congrats you're probably gonna do just fine when you inherit their house that has been appreciating under proposition 13. If you have a spouse who has to live in SF/LA/Seattle for work then congrats you are married to a tech worker and are gonna be doing just fine. If you DON'T have one of those two things then I think being geographically flexible (or I would argue a better phrase is geographically realistic) is something to consider.
 
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