Doctors beware: There’s a $400,000 target on your back

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KeratinPearls

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Doctors beware: There's a $400,000 target on your back


President Joe Biden recently signaled that a multi-trillion-dollar spending plan for our country should be paid for by the rich corporations and wealthy individual Americans who make over $400,000. Doctors fit the latter category and should tune in.

Beyond the government, the unique qualities of doctors make us a target for many who want to access our high income and our business revenue. Our passivity to these poachers places us at great risk because they recognize that we lack the time and proficiency to avoid them. Add our financial illiteracy to this, and you have a recipe for stakeholders reaching into our paycheck every pay period and inconspicuously taking their share from us.

Let’s take a look at the stakeholders who are targeting us.

Corporate America



Employers want you, and they’ll give you a lot of love to hook up with you. But in reality, they want your patients. Be prepared to separate their business interest in you from their personal interest.

Health care corporations recognize that physicians are unique employee-assets who can generate revenue with a relatively large return on investment. For example, a physician whose salary and benefits cost them $350,000 will lead to as much as $2-3 million dollars in downstream revenue. Through physician alignment, corporations gain market share and thus voluminous clinical care that converts into cash for the system.

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And thus demonstrating my previously oft repeated statement: never believe the income survey and many people will poor mouth.
 
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And thus demonstrating my previously oft repeated statement: never believe the income survey and many people will poor mouth.
Mike,
Why do you think this? What is the incentive to lie on an anonymous internet survey? Are you thinking people understate their earnings, hoping the feds aren't secretly recording their entries, or overstating for some other reason I can't forsee?
 
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Mike,
Why do you think this? What is the incentive to lie on an anonymous internet survey? Are you thinking people understate their earnings, hoping the feds aren't secretly recording their entries, or overstating for some other reason I can't forsee?

For the same reason i live in the house i bought 33 years ago and liberally use “y’all “ in my communications. Just stay under the radar. If I am “gone”, I haven’t told my neighbors I’ll be at Cheeca Lodge in Islamorada catching some sails. People read the figures that get published, thus I poor mouth. What do you think the response of “joe blow” would have been if I told him in 1990 that I made $750k/yr? Outrage and jealousy and some crap about how physicians are overpaid.
It all makes me just fit in like everyone else. Life is easier when there are things folks don’t know about me. I know people who would be appalled ( current acquaintances) if they knew I am armed. So, if i was asked i would say “ certainly not”.
 
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You make it sound like paying more taxes is a bad thing...
 
You make it sound like paying more taxes is a bad thing...
I would venture that that is the prevailing opinion around here. I get a very...libertarian vibe from this forum.
 
I would venture that that is the prevailing opinion around here. I get a very...libertarian vibe from this forum.
I'd say it's the lack of confidence in who we pay our taxes to. Since congress has had perennially low popularity numbers now for awhile, it's kind of hard to trust them to make good decisions with the budget, or in general.
 
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I'd say it's the lack of confidence in who we pay our taxes to. Since congress has had perennially low popularity numbers now for awhile, it's kind of hard to trust them to make good decisions with the budget, or in general.
And a perfect example is that they are now GIVING our money to ignorant footstools who do not want to get the vaccine. I thought public health issues took precedent over someone’s personal preference not to get the vaccine. Hell, decades ago they confined typhoid Mary to some isolated place in NYC against her will for life I believe. I am tired of an ignorant population getting to call the shots on just about ANYTHING.
 
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Doctors beware: There's a $400,000 target on your back


President Joe Biden recently signaled that a multi-trillion-dollar spending plan for our country should be paid for by the rich corporations and wealthy individual Americans who make over $400,000. Doctors fit the latter category and should tune in.

Beyond the government, the unique qualities of doctors make us a target for many who want to access our high income and our business revenue. Our passivity to these poachers places us at great risk because they recognize that we lack the time and proficiency to avoid them. Add our financial illiteracy to this, and you have a recipe for stakeholders reaching into our paycheck every pay period and inconspicuously taking their share from us.

Let’s take a look at the stakeholders who are targeting us.

Corporate America



Employers want you, and they’ll give you a lot of love to hook up with you. But in reality, they want your patients. Be prepared to separate their business interest in you from their personal interest.

Health care corporations recognize that physicians are unique employee-assets who can generate revenue with a relatively large return on investment. For example, a physician whose salary and benefits cost them $350,000 will lead to as much as $2-3 million dollars in downstream revenue. Through physician alignment, corporations gain market share and thus voluminous clinical care that converts into cash for the system.

While not great a slight increase in taxes on earnings over 400 isn't really a game changer. GTFO of high income tax blue states will do much more for your income. We should all move to Florida or Texas.
 
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Doesn't that defeat the purpose of no state income tax, if you are not drawing income?

Qualified retirement plans sure as hell get hit by tax when you have to start taking them and have grown to millions.
But, from my retirement at 62 till now at 69 i have lived on dividends capital gains and interest and ssa and the taxes are almost trivial. but it will be painful at 71 1/2 yrs old.
 
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Qualified retirement plans sure as hell get hit by tax when you have to start taking them and have grown to millions.
But, from my retirement at 62 till now at 69 i have lived on dividends capital gains and interest and ssa and the taxes are almost trivial. but it will be painful at 71 1/2 yrs old.
But again, we are talking about state income tax.... you'd get hit on your 401k deductions no matter where you lived.
 
You make it sound like paying more taxes is a bad thing...
As long as there is no balanced budget requirements paying higher taxes is a bad thing since politicians keep coming after you.
 
But again, we are talking about state income tax.... you'd get hit on your 401k deductions no matter where you lived.

No state in FL. Just fed. Makes a big difference on a mininum required withdrawal of hundreds of thousands.
 
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None of my friends and family live in TX or FL. So no point moving there just for money when the people in my life aren't there. Much more to life than saving on taxes.
 
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You’ll be working for HCA. I’ve been seeing a lot of jobs in Florida for HCA

I always see lots of HCA ads for pathologists. Either they are growing or they are churning and burning pathologists. Bets on the latter.
 
So true. HCA is accountable to their shareholders alone. The HCA board of directors has a fiduciary requirement to HCA shareholders. They have a duty to maximize profits and minimize expenses. Expenses include physician salaries. I imagine the work culture at HCA and IRL pathology reflect this fiduciary duty. If I worked at HCA I'd probably be signing out 150 cases a day and every single one of my diagnoses would be either a one-liner or a synoptic report only for resections. For every single case my microscopic examination would read "microscopic examination performed."

I must add that HCA shareholders have been handsomely rewarded, particularly in the last 2 years. See HCA's stock price over the past 5 years.

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So true. HCA is accountable to their shareholders alone. The HCA board of directors has a fiduciary requirement to HCA shareholders. They have a duty to maximize profits and minimize expenses. Expenses include physician salaries. I imagine the work culture at HCA and IRL pathology reflect this fiduciary duty. If I worked at HCA I'd probably be signing out 150 cases a day and every single one of my diagnoses would be either a one-liner or a synoptic report only for resections. For every single case my microscopic examination would read "microscopic examination performed."

I must add that HCA shareholders have been handsomely rewarded, particularly in the last 2 years. See HCA's stock price over the past 5 years.

View attachment 341436

View attachment 341437
Yeah I read that billionaire hedge fund manager Seth Klarman bought a lot of shares last year. I was wondering why. Now I know. Smart man.

Pardon my French, but we are becoming corporate’s b*tch.
 
I remember an older partner of mine who, a few decades ago said “ I don’t mind being a *****, I just expect to be a well paid *****.”
 
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None of my friends and family live in TX or FL. So no point moving there just for money when the people in my life aren't there. Much more to life than saving on taxes.
Sure there are, but life also changes alot in 25 years, including who is alive and who’s not. And FL and WA aren’t bad places to live anyway. I have no family in my current state and have turned down jobs in states with family because they paid half what I make now or were just too rural for the lifestyle I want for my family (educationally, socially, culturally, etc).
making life decisions about proximity to family isn’t always a good thing (this caveat is a requirement for entering pathology anyway).
So I’ll revise my (tongue in cheek) statement: I have a decent chance of moving to a state with no income taxes.
 
Sure there are, but life also changes alot in 25 years, including who is alive and who’s not. And FL and WA aren’t bad places to live anyway. I have no family in my current state and have turned down jobs in states with family because they paid half what I make now or were just too rural for the lifestyle I want for my family (educationally, socially, culturally, etc).
making life decisions about proximity to family isn’t always a good thing (this caveat is a requirement for entering pathology anyway).
So I’ll revise my (tongue in cheek) statement: I have a decent chance of moving to a state with no income taxes.
*and friends. To be honest I could move far away from my blood family and see them a couple times a year and be fine. But I've kept great friends since high school and college, and they're what keep me happy where I am. Plus our group here seems to be one of the better ones out there and the prospects for doing as well or better anywhere else look to be almost nonexistent. So, great friends and a great practice mean I won't be moving any time soon.
 
Sure there are, but life also changes alot in 25 years, including who is alive and who’s not. And FL and WA aren’t bad places to live anyway. I have no family in my current state and have turned down jobs in states with family because they paid half what I make now or were just too rural for the lifestyle I want for my family (educationally, socially, culturally, etc).
making life decisions about proximity to family isn’t always a good thing (this caveat is a requirement for entering pathology anyway).
So I’ll revise my (tongue in cheek) statement: I have a decent chance of moving to a state with no income taxes.
I would certainly prefer to live in a lower COL state like Florida or Texas, with the lower overall tax burden, compared to some other places.. for multiple reasons including the financial benefit. But it is also important to remember that our preferences only matter if we have options. If you come out of training and the only option is a job in some high tax, high crime dysfunctional dump, run by communists, that gets 15 feet of snow a year, then that is where you will be living. It is useful to choose a specialty where you will have some options as opposed to pathology.
 
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Don't let the no income tax fool you. Texas doesn't have such a low CoL. It's about middle of the pack.

 
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Don't let the no income tax fool you. Texas doesn't have such a low CoL. It's about middle of the pack.

There are ways to mitigate this. Texas has very high property taxes, so if you buy a very expensive home, you won't be much better off. But if you rent or by a smaller place, you can profit from the lack of state income tax.
 
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