Cushiest specialties?

[Giovanotto]

300K student loans before interest , retired parents who need my financial support , starting a family (female , 33 now, engaged), private schools 12-25K a year for each kid, mortgage on east cost (Northern Virginia) is 350K min for a house that is 45 min commute from DC... how am I doing ?

you beautiful bastard

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[M&L]

you beautiful bastard

B*tch would be more accurate . Hahahahaha

 

[SDunkey]

300K student loans before interest , retired parents who need my financial support , starting a family (female , 33 now, engaged), private schools 12-25K a year for each kid, mortgage on east cost (Northern Virginia) is 350K min for a house that is 45 min commute from DC... how am I doing ?

More than doable on 200k, and that's not even assuming your husband will also be working. It's not like all the primary care doctors in say Los Angeles are sending their kids to public school and living off food stamps.

 

[M&L]

you beautiful bastard

Also - I am an immigrant . Mom is a high school biology teacher in another country , dad is low level government worker there . I am alone here in the US, so no doctor parents . I didn’t even go to high school here - moved by myself when I was 21

 

[M&L]

More than doable on 200k, and that's not even assuming your husband will also be working. It's not like all the primary care doctors in say Los Angeles are sending their kids to public school and living off food stamps.

My future husband never went to college , so variety of employment options for him are more limited . You are right - totally doable . And I decided that I will not consider finances as a factor when choosing a specialty - I know that as a doctor you will always make more or less enough . I want to discover what is it that I REALLY want . And actually one of the specialities I am considering is one of the lowest paid ones . That being said , I completely get the “finances “ aspect . I worry about it all the time .

 

[MEN2C]

What turns you off about Allergy my experience with it has been awesome the docs seem to have decent lifestyle and pay isnt horrible 300-400 i think? A lot of problem solving

I did a two week rotation and I was pretty much done after at 11am on my first day. I was bored out my mind. It’s all allergy management/shots with some random cool stuff thrown in. I even did it in a mixed clinic (eg peds and adults) where I saw a couple interesting immunodeficiencies. But I still couldn’t take the boredom of the office.

Of course, other people feel the same about my field too, so to each their own!

 

[M&L]

I did a two week rotation and I was pretty much done after at 11am on my first day. I was bored out my mind. It’s all allergy management/shots with some random cool stuff thrown in. I even did it in a mixed clinic (eg peds and adults) where I saw a couple interesting immunodeficiencies. But I still couldn’t take the boredom of the office.

Of course, other people feel the same about my field too, so to each their own!

When I was doing internship in a pathology lab , I asked a chief resident what was the best way to choose a specialty . Like , how do I know that I will make s right choice ? He said that you need to love the “boring” everyday routine . Every specialty has some exciting things once in a while , and everyone loves them. But you need to make sure you love the routine stuff, because that’s what you will be doing for the majority of time. I think this is probably the best advice I’ve ever received on the subject .

 

[VA Hopeful Dr]

More than doable on 200k, and that's not even assuming your husband will also be working. It's not like all the primary care doctors in say Los Angeles are sending their kids to public school and living off food stamps.

I mean yes... ish?

So let's start by withholding the maximum for a single 401k so that 200k now starts at 180k. That 180K in Virginia is 130k gross. 300k in loans at 6% is 40k/year. So already down to 90k/year.

350k mortgage at 4% is 20k/year. So now we're down to 70k/year. Take out the 25k/year (assuming the lowest rate in that range) for school for 2 kids and we're down to 45k/year. Let's say the job has fairly cheap health insurance for the family at 5k/year. Now we're at 40k/year. Property taxes on that house are going to be another 3k for the year. Now we're at 37k. So 3k/month for all other expenses. That's not bad, but its not great for starting out at age 30.

 

[M&L]

I mean yes... ish?

So let's start by withholding the maximum for a single 401k so that 200k now starts at 180k. That 180K in Virginia is 130k gross. 300k in loans at 6% is 40k/year. So already down to 90k/year.

350k mortgage at 4% is 20k/year. So now we're down to 70k/year. Take out the 25k/year (assuming the lowest rate in that range) for school for 2 kids and we're down to 45k/year. Let's say the job has fairly cheap health insurance for the family at 5k/year. Now we're at 40k/year. Property taxes on that house are going to be another 3k for the year. Now we're at 37k. So 3k/month for all other expenses. That's not bad, but its not great for starting out at age 30.

yeah, exactly. And if you are in my situation - you are also sending money to parents, and possibly supporting my brother and his family a little bit. Thats another 1000 a month that i want to be able to help them with. So, yeah.... now, what would help is not having huge student loans, so right now i am actually putting COA as one of the most important factors in choosing a medical school (not THE MOST important factor, but probably top 2).

 

[siliso]

I mean yes... ish?

So let's start by withholding the maximum for a single 401k so that 200k now starts at 180k. That 180K in Virginia is 130k gross. 300k in loans at 6% is 40k/year. So already down to 90k/year.

350k mortgage at 4% is 20k/year. So now we're down to 70k/year. Take out the 25k/year (assuming the lowest rate in that range) for school for 2 kids and we're down to 45k/year. Let's say the job has fairly cheap health insurance for the family at 5k/year. Now we're at 40k/year. Property taxes on that house are going to be another 3k for the year. Now we're at 37k. So 3k/month for all other expenses. That's not bad, but its not great for starting out at age 30.

Now why are we buying a 350k house AND sending both kids to the private school? Perhaps our income doesn’t quite support this lifestyle.

 

[Mass Effect]

I mean yes... ish?

So let's start by withholding the maximum for a single 401k so that 200k now starts at 180k. That 180K in Virginia is 130k gross. 300k in loans at 6% is 40k/year. So already down to 90k/year.

350k mortgage at 4% is 20k/year. So now we're down to 70k/year. Take out the 25k/year (assuming the lowest rate in that range) for school for 2 kids and we're down to 45k/year. Let's say the job has fairly cheap health insurance for the family at 5k/year. Now we're at 40k/year. Property taxes on that house are going to be another 3k for the year. Now we're at 37k. So 3k/month for all other expenses. That's not bad, but its not great for starting out at age 30.

Except that there are people all over this country (including where that poster lives) making 3K a month after taxes without the 350K house and private school. Granted, they don't have the loans we do and likely not the years of schooling, but it's also worth noting that a lot of expenses in life are choices and that 300-400K labeled "not bad" would probably only ever fly on SDN.

Jumping in to add to the earlier posts about psychiatry not being as financially rewarding as other specialties. If you work the hours the other specialties work, it's absolutely comparable. I interviewed for jobs with 32-hour work weeks, no call, no weekends starting at or around 200K with (on average) 12 - 15 patients a day outpatient or 10 patients a day inpatient. Jobs that include more hours or more patients pay much more and in some cases, even 400K in more rural areas.

Say you take the 200K job for 32 hours/week and do locums work during the extra 10 - 20 hours you'd work in other specialties. Did you know you can make 3K - 5K for a single weekend moonlighting in psych (and we're talking 8-10 hours a day on Saturday and on Sunday; you can make much more if you work a 48-hour shift for the whole weekend)? Or you can open your own cash practice on the side and double your income. Or you can do weekend telepsych making $170/hour without leaving your house.

Me? I choose lifestyle. I will be happy working 32 hours with no call/weekends and if I'm saving up for something, I'll throw in a weekend or two to make a little extra.

 

[VA Hopeful Dr]

Now why are we buying a 350k house AND sending both kids to the private school? Perhaps our income doesn’t quite support this lifestyle.

Completely agree (there's a reason I live where I do), but it's possible that the poster in question is geographically limited. If so, in the area she mentioned, you can't find houses for less than that and I would absolutely not send my children to the local public schools there.

 

[VA Hopeful Dr]

Except that there are people all over this country (including where that poster lives) making 3K a month after taxes without the 350K house and private school. Granted, they don't have the loans we do and likely not the years of schooling, but it's also worth noting that a lot of expenses in life are choices and that 300-400K labeled "not bad" would probably only ever fly on SDN.

Yep, all true.

Do bear in mind that I'm one of those FPs who doesn't think the 200k I'm earning is unfair.

 

[MEN2C]

I’d rather pull my nails out with pliers than send my kids to private school.

 

[MEN2C]

But I do want a G6 and buy 50% of SpaceX. Why can’t I do that on my salary? Life is unfair. I mean if I didn’t do medicine, by the time I was 30, I would have just started a billion dollar company.

 

[M&L]

Completely agree (there's a reason I live where I do), but it's possible that the poster in question is geographically limited. If so, in the area she mentioned, you can't find houses for less than that and I would absolutely not send my children to the local public schools there.

Yeah, in northern virginia it can be hard to find a good public school. I personally would want my kids to go to a catholic school, even though i am not even catholic. The quality of education there is very strong, as well as values that they embrace and teach children.
As far as 350K house- yeah, i one bedroom apartment in an average apartment complex here will be around 200K (no luxury), thats about 30 min drive from DC. in DC 1 bedroom is about 350K in a "no so good" neighbourhood, for example, in SW in one of the older buildings (if anyone is not familiar, this is one of those "up and coming neighbourhoods" where 8 years ago you could not safely walk down the street after dark). So, yeah. I know that in TX for example (have friends there), or other parts of the country, you can buy a very nice house for 100K or 150K, but here you cannot even buy a studio for that money. So when i say 350K i am not being spoiled, this is seriously just the price. "nice" house with 3 acres of land here costs about 650K, but i am not even talking about buying that.

 

[siliso]

Usual trade off here is buy a house in a more expensive area and get quality public schools, or buy a house in a less expensive area and pay for private (although actually there are fine public options either way). Anyway if you get a 350k house, private school, and apparently also a stay at home parent, and that’s all the luxuries you can afford on a 200k salary...it’s not bad. Not what to complain about. You can always want more and feel poor making almost any amount of money short of independent inexhaustible wealth.

Back to the original question, I’m a primary care IM physician and my working conditions are very pleasant, hours not strenuous except if I want them to be (I like to keep up on some inpatient), salary in the range being discussed and I’m satisfied. I could go work more and make more but I’ve got simple tastes and a family in the low cost middle of the country. Cushy is what you make of it.

 

[siliso]

Oh and, I could get to my cushy attending job and salary in 3 years after residency rather than 5 or 7. Personally I took 4 because I did a Chief year because I wanted to. But the time advantage is significant especially if you are older than average as I am.

 

[M&L]

Oh and, I could get to my cushy attending job and salary in 3 years after residency rather than 5 or 7. Personally I took 4 because I did a Chief year because I wanted to. But the time advantage is significant especially if you are older than average as I am.

my brother in law is finishing his second year of IM residency. and he is currently considering whether to do fellowship or not. It is my understanding that you decided to not do fellowship? Does it mean that you are a hospitalist? (i am sorry, if i am mixing up the terms, i am not sure how it works). so what are generally options work wise after IM residency if you decide to not do the fellowship?

 

[siliso]

You can do primary care and/or hospitalist. I do mostly primary care in an academic setting with residents and students, and 8 wks a year of teaching hospitalist. Most people not doing fellowship now do straight hospitalist - and if they don’t mind working a lot and want maximum bucks, nocturnist. Some people do this for a few years and then go to fellowship or outpatient. Primary care definitely a minority choice but I’m real happy with it. I have my set of patients who are mine and who count on me to look after them during and between visits and coordinate their care, and the longitudinal relationship and primary responsibility is very satisfying to me. And would be the exact things that would repel someone who isn’t meant for this line of work.

 

[Deecee2DO]

I did a two week rotation and I was pretty much done after at 11am on my first day. I was bored out my mind. It’s all allergy management/shots with some random cool stuff thrown in. I even did it in a mixed clinic (eg peds and adults) where I saw a couple interesting immunodeficiencies. But I still couldn’t take the boredom of the office.

Of course, other people feel the same about my field too, so to each their own!

Ahh i see. What field are you in?

 

[siliso]

I tried to like derm cause I had the stats for it but...no. No way. I like rashes in their context, but not rashes and AKs all day every day.

 

[M&L]

You can do primary care and/or hospitalist. I do mostly primary care in an academic setting with residents and students, and 8 wks a year of teaching hospitalist. Most people not doing fellowship now do straight hospitalist - and if they don’t mind working a lot and want maximum bucks, nocturnist. Some people do this for a few years and then go to fellowship or outpatient. Primary care definitely a minority choice but I’m real happy with it. I have my set of patients who are mine and who count on me to look after them during and between visits and coordinate their care, and the longitudinal relationship and primary responsibility is very satisfying to me. And would be the exact things that would repel someone who isn’t meant for this line of work.

so you actually do not have to do fellowship right after residency? you can do it later? is it only for IM, or it only applied to surgical specialties? do you think it is easier to get into fellowship right after residency or later (as far as how competitive you will be)?

BTW i definitely do not want to do primary care, such as IM, but i definitely understand what you are talking about. For example, i love pathology. Not even the clinical one, - i love the anatomical pathology. And one of the specialties i am considering is pediatric pathology (along a few other non-pathology routes that i want to explore in medical school). Almost everyone i talk to do not really understand why i would even consider pediatric pathology, but what i see in that specialty is very unique, and valuable to me personally. It is the type of relationship that i want to have with my patients and their families, and i am ok with the fact that 99% of ppl cannot see themselves doing it.

 

[Deecee2DO]

There was a post on here or reddit that mentioned how you could tell which posters grew up with physician parents.
As someone who's parents both make minimum wage, the potential 200k earnings sounds amazing to me.

I dont have physician parents and after all the schooling loans and nights of studying no sleep and having (almost) no life for most of my twenties and part of my 30s anything less than 300 doesnt sound good to me at all but thats just me. everyones different

 

[MEN2C]

Ahh i see. What field are you in?

NICU

 

[siliso]

I don’t know anything about surgical specialties. It’s my impression that you make your choice there when you enter residency, but maybe there are alternate paths. In IM it’s not unusual at all to take a couple years working between residency and fellowship, either to make money or strengthen your app or waive your J1 visa requirements for the FMGs.

 

[mybluedog]

Can anyone explain why endos are compensated low?

 

[Deecee2DO]

Can anyone explain why endos are compensated low?

No procedures? Im guessing but that wouldnt explain why pulm allergy and rheum get paid slightly more. Maybe an Endo or someone going into endo can elaborate

 

[siliso]

Compensation under the current scheme is heavily skewed toward procedures over evaluation and management. It doesn’t have to be that way and no reason to think it always will be. Once upon a time derm was low status. Things change.

Pulm allergy and rheum all have procedures.

 

[siliso]

Primary care has procedures too if you want to learn and be credentialed in them. Injections, cryo and snipping, i&d, toenails...

 

[SLC]

I work 8-4, 4 days a week for $300k, all outpatient. All call is voluntary and adds to the bottom line.

But most here wouldn’t consider it “cushy”, and it has no prestige.

But my bank account and hobbies don’t care about that stuff.

 

[Deecee2DO]

Primary care has procedures too if you want to learn and be credentialed in them. Injections, cryo and snipping, i&d, toenails...

Yes this is true. There are definitely ways to make more money in PC if you want am I right @siliso ?

 

[Deecee2DO]

I work 8-4, 4 days a week for $300k, all outpatient. All call is voluntary and adds to the bottom line.

But most here wouldn’t consider it “cushy”, and it has no prestige.

But my bank account and hobbies don’t care about that stuff.

Damn. what specialty is this?

 

[MEN2C]

Compensation under the current scheme is heavily skewed toward procedures over evaluation and management. It doesn’t have to be that way and no reason to think it always will be. Once upon a time derm was low status. Things change.

Pulm allergy and rheum all have procedures.

Yeah, it's really difficult to know how the compensation will work throughout your career if you're starting out. No one can predict how everything will turn out in the future. One thing most people agree on is that reimbursement by how we do it now ($$ for procedures, even simple ones while much less money for thinking through a differential and complex management) is terrible - it's just that it's difficult to come up with an alternative that people agree with and that is better.

I certainly think compensation will go down, and more importantly, will change in terms of how and what is reimbursed. But what that means for a particular specialty in particular? I have no clue. Even though I am only a fellow, I actually look forward to going to work when I wake up in the morning. Absolutely can't beat that. And somehow, shockingly, I have a house (a modest one) and kids and somehow managing it on a fellow's salary (though my wife works and makes slightly less than I do). Don't tell medicare this, but if you told me I'd be at a fellow's salary forever, with increases just for COL (and a few grand more a month when loans kick in), I'd still do this for my life. Not that I think that's what I WANT to make forever, but I am happy.

Money is important. Lifestyle is important. But if you're gonna be miserable at work, you're likely not going to be happy outside work. And you've spent too much time and too many years of your life living and breathing this thing to do something you're not excited about. When you're 80 and looking back, you might wish you spent more time with your wife and kids. Or you might wish you REALLY did endocrinology instead of Pain because that was what you really loved. But most likely your regret won't be that you had a house that was a few hundred grand more.

 

[Deecee2DO]

Compensation under the current scheme is heavily skewed toward procedures over evaluation and management. It doesn’t have to be that way and no reason to think it always will be. Once upon a time derm was low status. Things change.

Pulm allergy and rheum all have procedures.

What procedures do pulm allergy and rheum do?

 

[mybluedog]

I work 8-4, 4 days a week for $300k, all outpatient. All call is voluntary and adds to the bottom line.

But most here wouldn’t consider it “cushy”, and it has no prestige.

But my bank account and hobbies don’t care about that stuff.

Sweet, what area or type of hospital system do you practice at?

 

[siliso]

So I’ve been told. I work in VA on a salary and like it that way and learn procedures so I can serve my patients better and faster. From money motivated PCPs I’ve heard setting up Procedure Afternoon is remunerative.

 

[siliso]

What procedures do pulm allergy and rheum do?

Bronchoscopy, immunotherapy, joint injections

 

[siliso]

And for rheum, biologic infusions might also be part of it. Although I know the cash cow of selling and administering drugs for oncs has dried up some

 

[Deecee2DO]

And for rheum, biologic infusions might also be part of it. Although I know the cash cow of selling and administering drugs for oncs has dried up some

Would you go as far as to say ID Nephro and Endo are the lowest paid fellowships

 

[siliso]

Probably, but I wouldn’t say they’re not worth it. If that’s where your true passion and calling lies, and you’d be comparatively miserable trying to do primary care or hospitalist, then you should still do as you’ll get comparable money for doing something that’s actually in line with your vocation and preference.

 

[siliso]

But renal has dialysis, another procedure. And income stream if you supervise chronic dialysis. What’s lowest? Maybe ID, palliative, geriatrics. But the latter two also have side income possibilities.

 

[Candidate2017]

There was a post on here or reddit that mentioned how you could tell which posters grew up with physician parents.
As someone who's parents both make minimum wage, the potential 200k earnings sounds amazing to me.

Hospital CEOs love people like you and nurses would laugh if you think $200k as a doc is amazing: 'nurse' search results | Transparent California

 

[Chibucks15]

Hospital CEOs love people like you and nurses would laugh if you think $200k as a doc is amazing: 'nurse' search results | Transparent California

California is the absolute worst place to use as an example. There are tear down houses being sold for over a million. Cmon now. Cali and NYC are not representative of 98% of the country and using it as an example is asinine

 

[MEN2C]

Hospital CEOs love people like you and nurses would laugh if you think $200k as a doc is amazing: 'nurse' search results | Transparent California

That doesn’t have anything to do with anything. Obviously, you should negotiate for the best offer you can. Obviously if you’re accepting $180k as a full time neurosurgeon, you’re doing a bad job negotiating. But you’re also not gonna be able to hold out for a $800k job as a pediatrician. There is a general range, depending on your specialty and what you do in terms of how much you’re gonna get paid in a salary position, and that’ll depend on what the reimbursement is based on your work. Right now that means procedures generally pay more. Tomorrow? Who knows.

What we are talking about is taking into account other things besides money when PICKING a specialty.

Obviously once you pick your specialty, you should clearly do your best to maximize your contract (whether that’s money, schedule, benefits, time off, malpractice, CME, etc etc).

 

[Neopolymath]

California is the absolute worst place to use as an example. There are tear down houses being sold for over a million. Cmon now. Cali and NYC are not representative of 98% of the country and using it as an example is asinine

His point stands. His initial point was that administrators' mouths water at the thought of someone who says "yeah that's enough money not to ever starve." You don't pay a mechanic $1500 to change your rod bearings because it takes him 10 hours. You pay him that money because he is the only guy you know in town that has the skills/abilities to do it. People who say that 200k is more than enough blah blah blah are intellectually lazy and portraying others as being selfish/whiny etc.

Even if the job isn't hard, the barrier to entry means that physicians should be getting paid more not less and people like Mr. you are spoiled are just unconsciously fighting the entire profession on the inside so they can stand on top with moral superiority.

 

[Deecee2DO]

Hospital CEOs love people like you and nurses would laugh if you think $200k as a doc is amazing: 'nurse' search results | Transparent California

Thank you. 200K after all that sacrifice and training is pretty bad. Especially since some midlevels that go to school for half the time have potential to make around that

 

[MEN2C]

Thank you. 200K after all that sacrifice and training is pretty bad

And yet, the people who make around that (geriatricians and pediatricians), tend to always rank amongst the happiest specialties in medicine. Why do you think that is?

 

[Chibucks15]

His point stands. His initial point was that administrators' mouths water at the thought of someone who says "yeah that's enough money not to ever starve." You don't pay a mechanic $1500 to change your rod bearings because it takes him 10 hours. You pay him that money because he is the only guy you know in town that has the skills/abilities to do it. People who say that 200k is more than enough blah blah blah are intellectually lazy and portraying others as being selfish/whiny etc.

Even if the job isn't hard, the barrier to entry means that physicians should be getting paid more not less and people like Mr. you are spoiled are just unconsciously fighting the entire profession on the inside so they can stand on top with moral superiority.

As does my point? The numbers wont match up so throwing a blanket statement is, in fact, intellectually lazy. See the post above yours. I'll listen to the resident on this one

 

[siliso]

What sacrifice did you sacrifice, I’m asking? I’ve known the world of work and the world of trying to live on less than the area median income for everyone. Medical school and residency are challenging in a purposeful way but compared to my other options were better and not worse. Even in the immediate term - I always had the option to continue as a medical resident vs quit and do something else - and continuing as a medical resident was by far my best and most preferred option, and paid more than the median whole household income at the same time.