Advertisement - Members don't see this ad
German docs don't come out of med school with $500k+ of student loans either.
CRNAs - a blessing or a curse.... we have created a monster
Started by lotsapain
Get help with your application
Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.
The debt to annual income potential ratio matters.
500k debt sounds like a lot except the doc is making 500k starting in it these days That’s a 1:1 ratio.
Considering mortgage industry standard for decades have been 1:3 income to mortgage debt ratio. (And that’s with an average interest rate around 6% historically). The income to debt ratio was as high as 1:5 with interest rates hovering 2-2.5% for mortgage approval.
So physican debt isn’t as bad as you think. The issue is everyone wants everything now. Like new grad buying a 1 million dollar home who just started. I’m like wtf. And he claims he’s broke. He’s single. No kids. Just wants to impress people.
I didn’t even buy a new car till I was 3 years as an attending. I lived cheap especially my first 3 years as attending.
I made 260k as my first full year attending with 120k in student loans and still put 100k down on first home 1.5 years later.
Of course I lost it all in housing crash my downpayment was lost due to lost equity
But people don’t know how to live frugal. If you are making 500k after taxes that’s still 300k to spend. While still putting money into retirement.
You can still put 50k a year into the student loans and be done in 10-12 years. And still live comfortably.
You can find reasonable rents for $3-4k a month as well. Housing costs annual with 50k in 95% of the country.
What am I missing here?
You're not missing anything; people indeed do not know how to live frugally.
I know a couple new/recent grad hires, now with $1.5M+ mortgages at 6%+ rates, where they put around 5% down on their "dream, doctor house." It's taking up to a HALF of their monthly take home with payments that are over $12-14K. Hard to take a chunk out of your loans in that scenario, but they are banking on PSLF to take care of that for them...reasonable to that think that it will pay off, but I couldn't handle fixed expenses that were that high.
Advertisement - Members don't see this ad
The psfl really was meant for real govt services. Like teachers making 40k a year. Meaning. Working for a public county school system.
It was never meant for a 1 million dollar a year ep doc employed by the hospital (501c). It was meant for ep doc making 350k a year at a govt VA medical center.
501c hospitals are just as bad as for profit anesthesia true private groups in terms of profit. By that I mean hospital employee anesthesia docs
It’s more like crnas make 250k these days with 200-250k in student loans. So still a 1:1 ratio.
We have to compare apples to apples here
Outside of rich parents who pay for their kids post grad education, most high paying professionals will start out life with at least 150k in student loan debt.
Pretty sad I see many age 50 year olds with student loan debt. Even at 2-3%. Just get rid of that debt if you are 20 plus years out in practice.
Correct. And how much do RNs make in Germany? 40k?
And how much does average rn make in USA? 85-90k these days. Many make over 100k especially in blue states
Everything is relative.
D
deleted87051
Agree. But section 179 is really meant for work trucks, delivery vans, etc. It wasn’t really meant for doctors commuting to work in Range Rovers and Escalades. Whatever the rules, highly resourced people game the system the most.
Doctors.
I am anxious paying bills. Some people are ok with debt, which I think is crazy.
I don't think people should even buy a home that is > 2X than their income. This is how conservative I am.
The same folks in their 50s with low interest debt tell you they can beat that in the market, but instead of investing what they could use to pay off loans, they use to pay for expensive cars/vacations/etc. Math can help you, but only if you use it.
My philosophy was always to live large when I was younger and could enjoy it. I don't see the point of squirreling away money until your mid-60's and then you can't do anything. Eff that! I lived it up and wouldn't have done it any other way. Seen too many examples of people living frugally only to die before they could enjoy it.
Neither do 99% of US docs.
Somewhere out there are guys who borrowed $200K for undergrad at a private school and then another $200K for medical school at an expensive DO school and then accrued $100K in interest during residency. But they're not the norm.
The norm is more like under $50K of undergrad debt plus perhaps $150K of medical school debt for a total around $200K.
Many are funded by their parents. A bunch more go into the military and have no (financial) debt. Most get significant tuition assistance from the government or the school or both.
Physician debt is not the crisis it's made out to be.
the '00s called they want their numbers back. When I was in med school around that time, the stat being bandied about by school admissions folk (and what I heard on here at the time) was that the average physician from that era would graduate with ~$250k in educational debt. In fact, if I had financed, instead of going military, mine would have been just under $200k, and that's with very cheap in-state undergrad tuition. Costs have gone up in the past 15 years. While $500k is probably still an outlier, I doubt it's by a lot.
Nothing wrong with that! Just don't tell me you have a mathematical reason for doing so and not pursue that plan.
Advertisement - Members don't see this ad
And that’s why I get annoyed when govt bails out gamblers. You do the right thing as a doctor. You should be able to be financially free by your early to mid 50s as anesthesiologists these days.
The super frugal ones can be financially free in mid 40s
The close to sure fire way to make good passive income is starting out with duplexes to rent. And build on that.
mosr of student loan defaults are not from real accredited 4 year universities.
Most of the defaults have and always been from shady barber beauty schools (1970s/1980s) to the rise of “for profit” universities in the 1990s and now to the online degree for profit schools.
I agree it’s wildly expensive now and people have crazy debt.
In my experience it’s a skewed distribution. There are a lot of people with rich parents and zero debt and then a lot with quite a bit of debt - usually in the 300K to 600K range.
I had a trainee recently who’s in the 600K range. It’s easy to see how that happens - cost of attendance for undergrad somewhere in the 50K range (x4 yrs) and med school in the 100K range (x4 yrs) and you’re at 600K… with a high interest rate at that.
I remember I had a family friend from long time ago who went to GWU med school (current cost of attendance is 110K/yr) and he fully paid for it by working at a local 7-11! I think he attended in the mid 1980s. Crazy to think you could go to med school and pay for it with a part time job back in the day, whereas now you commit to soul crushing levels of debt.
That’s the thing pgg talked about. The med school debt is independent of the total school debt. Many accumulate debt in college years.
GW has always been expensive. Vast majority of undergrad come from affluent families. Med school is 50/50 whether their parents will pay for med school.
Ok I won't.
It's not just GW, though. I just looked up all the medical schools (non-osteopathic) in my state. They were $35k, $40k, $50k and $55k a year for tuition alone (assuming in-state, out of state brought the first two up to the later levels). Cost of attendance was $65-75k at the cheapest, and the other three were all $85-95k a year. So, if one took out loans for the amount recommended by the schools' financial aid folk, it would be $280k at the cheapest, or $360k for the other three just for medical school alone today. I also just looked up current cost of attendance of my alma mater (which was the cheapest university in the state when I attended over twenty years ago), and it would be another $35-40k a year for undergrad. So yeah, that $500k total educational loan debt brought up earlier doesn't sound so made up now.
From the AMA-
The average medical school-related debt load for students in 2023 was $202,453, according to the Education Data Initiative. About 70% of medical students, per AAMC data, graduated medical school with some student debt in 2023. About 50% of medical students graduated with loan debt that was more than $150,000.
I had no debt thanks to my parents and then my own money and of course the American taxpayers that paid for my HPSP program. Lots of people had former jobs and/or had money that they saved like me. I don’t know anyone that had a job outside of a couple people that did side gigs coding or developing web sites. 30% with no debt sounds about right. My kids won’t have any debt. You can’t take it with you.
Easy, $500k with $500k in loans.
outside of some certain lucrative 60-65% true private ob services in the early 2000s who made 7 figures working what amounted to 45 hours a week
There were very few 7 figure anesthesiologists working those little hours MD only
The only 7 figure anesthesiologists working 45 hrs with 6-7 weeks off were heavy ACT models who used pyramid schemes partnership tracks plus crnas plus srna.
Hours and compensation wise. 7 figures/45 hrs a week average. Doesn’t happen in an MD only model even when reimbursements were higher.
It’s simple math unless you are taking the money off someone else’s hard earned labor. Mostly crnas.
There were very few 7 figure anesthesiologists working those little hours MD only
The only 7 figure anesthesiologists working 45 hrs with 6-7 weeks off were heavy ACT models who used pyramid schemes partnership tracks plus crnas plus srna.
Hours and compensation wise. 7 figures/45 hrs a week average. Doesn’t happen in an MD only model even when reimbursements were higher.
It’s simple math unless you are taking the money off someone else’s hard earned labor. Mostly crnas.
Let's look at why the system is faulty and can be gamed. You went the military route to save the money on tuition and basic living expenses.
I propose the better way to scam the system is to a do residency and make the required payments followed by 5-6 years at a qualifying institution earning $500K+. Then all your remaining tuition debt is forgiven. But you had to make a subpar salary serving your country to avoid that debt.
I know 2 IMGs with 400K tuition debt who are on the free loader plan where you all pay off their student loans. Welcome to America.
"Yes, payments made during a medical residency can count towards the 10-year Public Service Loan Forgiveness (PSLF) requirement, provided you work for a qualifying employer (government or nonprofit) and repay your loans under an Income-Driven Repayment (IDR) plan."
D
deleted87051
Musk is pretty good at gaming the system to the tune of $38B from the federal government.
38 billion is $1000 per American! That’s an extraordinary grifting by conman Elon from the American people. And here we are groveling for pennies (eg whether we can get 1% more for CMS reimbursement).
The top 0.1% will always win the way the system is designed.
Meh -
In his defense he's sold a whole lot of very useful and cost-effective services to the government.
Its not really fair to call the contracts SpaceX has won grifting or a con.
I'll go further and say that NASA's SLS program really should be scrapped, all its components dumped into the nearest landfill or ocean in shame, and its tasks contracted out to Falcon Heavy or Starship.
Musk is a turd, sure.
A ceo like Steve ballmer likely bankrupts Tesla.
There are bad ceo and good ceo.
Musk knows what he’s doing (in the private world). Unfortunately changing the us govt is a different beast
but it’s worth a shot to do something different.
This is now a struggle between executive brand and judicial branch.
Congress shockingly can change the judical powers but has elected to stay on the sidelines
Advertisement - Members don't see this ad
What's your point?
You think the contracts were undeserved? Maybe should've gone to Boeing?
@aneftp as always you hijacked yet another thread into your financial ramblings that are unsupported by data but its all good..
For the rest we did it to ourselves the specialty will be dead in 15-20 years... it will be a nurse taking care of you when you are old accept it.
For the rest we did it to ourselves the specialty will be dead in 15-20 years... it will be a nurse taking care of you when you are old accept it.
D
deleted1130227
You should read the history of Anesthesia. The nurses were the primary practitioners for decades. Physicians were late to the game. We Never achieved full control. We fought in the courts and lost more than once. Has there been plenty of laziness/greed among the docs? Sure. Not sure we can say we created the monster. Just never slew it or completely controlled it would be a better description.
Anesthesiologists have made it safer especially the transition in the 1970s-1980s era (before most of our times)
Technology has made it safer during that time period. (1970s) end tidal came 1982 I think.
Than the next great advancement was videoscope in mid 2000.
It’s become more technical field the last 20 years.
Whatever you say chief... I have considerably more operational knowledge and financials access and I can assure you if there are no further interventions things will get waay worse. Unlike physicians CRNAs are still nurses they did not get the same direction in terms of dedication to the singularity of the patient like doctors did in medical school. Nursing school's tenant is "see it report it up the chain" the religion is that of going for the next higher paid gig - or advance as quickly as possible to not touch a patient. CRNA salaries are above what doctors made just 10-12 years ago. With continuous work force attrition, lack of increased ACGME spots for physicians, CRNAs not being interested in call and only shift work and generaltion Alpha or whatever they call the these days having no commitments... wait and see what happens.
A la carte employment, with a mobile, mercenary workforce? Or did you have a different scenario in mind, with overworked physicians taking all the nights/weekends for no pay?
D
deleted1130227
My comment on the history of anesthesia is accurate. I invite you to spend a few minutes researching number of physicians providing anesthesia vs number of nurses providing anesthesia over the 20th century....Also number of formal residency programs in anesthesia over the years...
I do agree with your analysis of things being as good as they are likely to get. At the end of the day our best friend is likely to be fear of the blood sucking plaintiff attorneys.
This made the national news today:
9-year-old girl dies after going under anesthesia for dental procedure at San Diego office
The March 18 procedure was done at Dreamtime Dentistry. A dentist at the office had been investigated after a patient nearly died in 2016.
www.nbcnews.com
Wtf happened to that girl, discharged from the office and PACU after never “waking up” from GA and found still asleep / dead at home?My comment on the history of anesthesia is accurate. I invite you to spend a few minutes researching number of physicians providing anesthesia vs number of nurses providing anesthesia over the 20th century....Also number of formal residency programs in anesthesia over the years...
I do agree with your analysis of things being as good as they are likely to get. At the end of the day our best friend is likely to be fear of the blood sucking plaintiff attorneys.
This made the national news today:
9-year-old girl dies after going under anesthesia for dental procedure at San Diego office
The March 18 procedure was done at Dreamtime Dentistry. A dentist at the office had been investigated after a patient nearly died in 2016.
Did he load her up with narcotics and she obstructed as well? We complain about the lawyers here a lot but that’s clearly malpractice.
That bad. How much training does dental anesthesia get? 36 months I looked up some programsMy comment on the history of anesthesia is accurate. I invite you to spend a few minutes researching number of physicians providing anesthesia vs number of nurses providing anesthesia over the 20th century....Also number of formal residency programs in anesthesia over the years...
I do agree with your analysis of things being as good as they are likely to get. At the end of the day our best friend is likely to be fear of the blood sucking plaintiff attorneys.
This made the national news today:
9-year-old girl dies after going under anesthesia for dental procedure at San Diego office
The March 18 procedure was done at Dreamtime Dentistry. A dentist at the office had been investigated after a patient nearly died in 2016.
So that’s adequate training
I’d like to see a picture of this 9
Year old face and make sure it’s not obesity and osa.
D
deleted87051
Why does that matter? If that was the case, they should have been screened out of office surgery.
D
deleted87051
FWIW, nurse anesthetists largely predate anesthesiologists in the United States. The Mayo brothers worked exclusively with nurse anesthetists until they recruited an anesthesiologist in the 1920s. The first blue babies getting B-T shunts at Hopkins were anesthetized by nurse anesthetists. So it’s not correct to say “we have created a monster”. They were around before us.
I was not questioning your history lesson I am well aware of the historical background. That is ancient history once the need for an anesthesiologist has gained ground (ie 1970s)... there was a clear period of doctor delivered care until relatively recently (ie 1980s - early 1990s)... of course let us not forget the Hilary Clinton era... that nearly killed the specialty..... In regards to attorneys, the true root of the problem will likely be never learned especially with nurses calling themselves doctors (ie DNPs are now diem a dozen in the CRNA world) - once that term is blended doctor will be used interchangeably and applied as a blanket statement... once the word lawyer comes into play the public suddenly becomes unsophisticated.My comment on the history of anesthesia is accurate. I invite you to spend a few minutes researching number of physicians providing anesthesia vs number of nurses providing anesthesia over the 20th century....Also number of formal residency programs in anesthesia over the years...
I do agree with your analysis of things being as good as they are likely to get. At the end of the day our best friend is likely to be fear of the blood sucking plaintiff attorneys.
This made the national news today:
9-year-old girl dies after going under anesthesia for dental procedure at San Diego office
The March 18 procedure was done at Dreamtime Dentistry. A dentist at the office had been investigated after a patient nearly died in 2016.
That is a relatively accurate analysis of what is already happening. 1099 has it's own pitfalls (ie you cannot blend it with w2 unless you do very early tax projections as I have sadly learned).... a la carte employment will come with it's own set of caveats with hospitals playing games of who they like today and dislike tomorrow because a nurse in the OR did not like the fact that you brought your own lifesaving airway equipment that did not go a month long scrutiny by biomed (real examples) - you overestimate the IQ of OR nursing leadership who are there to get themselves a better position so they dont have to come to work every day. A $25 dollar an hour difference savings will translate into hiring someone who either is incompetent or has personality issues.......
Dental anesthesia residents do do a 3 year program... they don't do abdominal cases but everything above the clavicle pretty much and someone of them are better then medical residents... without knowing the details here hard to say. Doing peds in free standing centers is always a gamble IMHO. Freestanding centers for anything are dangerous regardless of your skillset due to paucity of resources. There is only that much you can do in a case of say accidental major vessel puncture - no one is bringing your PRBCs, nor helping you resuscitate a kid who has an undiagnosed cardiac condition.
These kind of threads and debate are exactly why physicians are the losing the battle vs mid levels, hospital admin, insurance, the public, etc.
We spending time arguing about the minutia while they all go on the offensive.
Democratization of knowledge has eroded physician leverage, yet nearly no one acknowledges this—or has a strategy to mitigate it.
We spending time arguing about the minutia while they all go on the offensive.
Democratization of knowledge has eroded physician leverage, yet nearly no one acknowledges this—or has a strategy to mitigate it.
Advertisement - Members don't see this ad
Democratization of knowledge? are you proposing repeal of the first amendment?
Your comment is the reason "partnership" practices have caused the demise of private anesthesia practice... fat partners who have controlled the flow of knowledge turned away young providers who had to wait for 4-5 years to see if they are worthy while the partners filled up their pockets knowing full well they will never make the younglings partners and stringing them along..... perhaps you should consider living in North Korea.
Medical knowledge is meant to be shared - pharmaceutical companies continue controlling the flow of medications because well - who needs healthy patients how would "we make money if we cure cancer." Controlling knowledge is not a viable strategy promoting excellence, lobbying in Washington (which AMA, ASA and all the other Associations have failed to do) is what get you places (look at orthopds) you sir are an idiot...
It matters. Chubby girl? We all know some offices do a poor job screening out patients.
I’ve done tons of peds dental cases recently. (Ages 4 and up) mainly Medicaid. Any chubby kids or developmental challenged kids. We send to the main or. But we had a couple slip through the crack and had to re schedule to the main or.
What does this mean lol
Physicians should gatekeep knowledge so that only we know how to effectively treat patients? I just want to be sure I’m understanding you before I call you names
I’ve worked with some very dumb and dangerous providers in my career with a variety of credentials. I’ve also made my share of embarrassing mistakes myself.
While I agree that the team structure should always include a physician directing mid levels for complex cases, ultimately what I care about is whether you’re sharp and can do the job. I’ve had to can both physicians and CRNAs from my cardiac team.
Personally I think the promise of our AI systems coming online is precisely the democratization of knowledge and targeted clinical decision support that will make a larger number of providers with varied credentials able to make consultant level decisions at the point of care. if it means that we lose our hold on things and more providers are able to function at the level of physicians and our salaries come down… I’m ok with it. I just want patients to be safe.
While I agree that the team structure should always include a physician directing mid levels for complex cases, ultimately what I care about is whether you’re sharp and can do the job. I’ve had to can both physicians and CRNAs from my cardiac team.
Personally I think the promise of our AI systems coming online is precisely the democratization of knowledge and targeted clinical decision support that will make a larger number of providers with varied credentials able to make consultant level decisions at the point of care. if it means that we lose our hold on things and more providers are able to function at the level of physicians and our salaries come down… I’m ok with it. I just want patients to be safe.
Last edited:
“Medical knowledge is meant to be shared” is why the crNas have gotten their way. Anesthesiologists and other real PhDs in labs have created such safe anesthesia practices that anyone thinks they can do it now.
