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Very encouraging for us applying for residency right now. Awesome.
Gloomerific threads like this strike me as odd, to say the least.
If you have a mountain of debt in the mid-six-figures range, a job that only pays $250K can result in a disappointing and decidedly median lifestyle. But to be talking about exit strategies from a $250K job?
A fellowship might make one more competitive in a slow job market, or open doors in a competitive market. Worthwhile? Probably.
Be geographically flexible, at least until your debt's paid off, and take a deep breath. If anesthesia pay crashes through $400K on its way to a realistic worst-case floor of $250K, take a deep breath and get on with living your life. If that happens, you're not going to step into something better than $250K. You might be able to take a pay cut to $60-70K/year for 4-5 years and do a 2nd residency, but the forces that pushed anesthesia pay down to $250K poverty levels aren't going to leave other specialties untouched.
The truth is that $400-500K+ salaries of the last decade were probably as much an anomoly as the sub-$200K salaries of the horrible 90s. The expectation bar is perhaps a little unreasonable for the long term.
Somehow the guys in primary care are getting by, and so will you. You couldn't pay me enough to be a surgeon or do primary care. Pick a specialty you like and fit your lifestyle into whatever it pays.
Anybody have plans for moving on when this profession goes sour?
Non-clinical work?
Pain?
Icu?
Re-train in another specialty?
Move abroad?
What other specialties would be good bets financially and would also make sense for an anesthesiologist to leave their career to retrain in?
To leave anesthesia and retrain? That's rough. You'd have to walk away from still-high pay for 4-5 years of resident pay (still have loans compounding in the background?) to start anew in another specialty, mid-late career with fewer earning years left. And still come out ahead? That's rough.What other specialties would be good bets financially and would also make sense for an anesthesiologist to leave their career to retrain in?
Gloomerific threads like this strike me as odd, to say the least.
Good luck finding those types of specialties as well. Hospitals, especially in urban areas, are buying up practices right and left. We don't just have IM hospitalists - we have them in GI, general surgery, vascular surgery, cardiology, colorectal surgery...the list goes on.For younger docs, partnership is becoming a thing of the past. If the 'partners' will be making 250k, where does that leave the newer guys?
Close to exit strategy time-that's where.
Don't just pick the specialty you like. Pick a specialty you like with negotiating power. That means a specialty where they are your patients, see you in your office, and will follow you to whatever hospital you recommend.
Pick a specialty where if the older generation tries to exploit you, you can start your own practice.
In anesthesia, you have a daily risk of losing your job, and that will weigh on you. A surgeon could talk **** every day and the hospital will bend over backwards to keep his business. An anesthesiologist can get fired for minimal incidents. It's not that hard to avoid confrontation, but it sucks to have your livelihood in jeopardy every day.
If Europe is any indication i can assure you that you will not make less the 200k in the future. Plus there will always be a demand for private practice medicine.
I guess this approach works if ONLY wealth is the goal. The work-life balance of i-banking is HORRIBLE. Worse than medicine. There is HIGH turnover rate in banking95% of MDs regardless of speciality are not "wealthy". Comfortable. Yes. Absolutely.
But there is a huge distinction between wealthy and EARNING a lot of money.
Docs for the most part have to work for their money. Even physician owners of surgery centers work. Of course there are a few of them who have done well and branched off and owned multiple centers and rarely practice. And there are those who own national practices.
But if you want to get wealthy. And the key word is get wealthy quick.
1. Attend Ivy League undergrad. (Doesn't matter what you major in). Trust me on this one.
2. Work as govt employee for the Fed (usually in treasury dept)
3. Attend MBA school at the usual top schools after working exactly 2 years at the fed. (this is where your Ivy League under grad degree will get you a leg up)
4. Once you get MBA. Join X firm as banker
That's how you get wealthy quickly (besides being super bright and doing your own thing early).
But the above 4 steps are routinely taken by many I bankers.
Good luck finding those types of specialties as well. Hospitals, especially in urban areas, are buying up practices right and left. We don't just have IM hospitalists - we have them in GI, general surgery, vascular surgery, cardiology, colorectal surgery...the list goes on.
I wish this were true, but ESA did a study about wages in Europe - PubMed link is http://www.ncbi.nlm.nih.gov/pubmed/17608964
Admittedly this was in 2007, and I'm sure things have changed to some extent. But the brain drain from the poorer EU lands in the east has kept a pretty sharp upper limit on wages.
Here's an SDN thread where a Danish doc posted. Anesthesia in Europe? He offered that he was normally making 80-100k USD per year, then paying high Danish taxes on it.
Don't get me wrong - I love Europe as a place to visit. But the taxes there are unbelievable. VAT in Denmark (their equivalent of our sales tax) is 25%. Tax on a new car there is 180%.
I went to school with some folks who became investment bankers or other finance careers who made it really big. They were all exceptionally bright, strong interpersonal and communication skills, and worked like dogs (as bad as residency). I also knew a few wannabes who fell just a little bit short for one reason or another who wound up with a fraction of financial success of what the highly successful ones attained. They were no less bright and also worked like dogs. There is a huge "winner take all" component to those careers which has certainly cropped up in medicine over the last twenty years.
LOL, didn't take long for the inevitable "I coulda been an ibanker" to rear its ugly head ... 🙂
Any government job with a pension would be better than anesthesia financially, in work schedule, and in job security.
Anybody have plans for moving on when this profession goes sour?
Non-clinical work?
Pain?
Icu?
Re-train in another specialty?
Move abroad?
I have called around to a few companies that do medical tourism, and all of them told me that they hire their anesthesia on site.Medical tourism.
I have called around to a few companies that do medical tourism, and all of them told me that they hire their anesthesia on site.
Goes back to revenue generator vs. necessary overhead
There's only so much one can cut skilled labor income.
Remember you got lots of federal folks with barley bachelors degrees making easy 100k money by age 28-30 years old.
I've lived in DC area for half my life.That's because the government doesn't care about qualifications or quality. You just enter the job and stay there and get regular raises that are timed. There was a story about some guy in New York who was involved in a scandal where they had women strip for work in the Parks Department and he makes over $100K. And I bet whether he retired or was fired, he got a sweet lifetime pension, courtesy of the taxpayers. I'd be surprised if he had more than a high-school education.
http://www.nydailynews.com/new-york/women-parks-dept-stripped-better-jobs-sources-article-1.1357067
If I recall correctly, the average government employee makes close to six-figures, if you include their benefits. It's why the richest counties in America are generally located in Washington, D.C. and nearby Virginia and why there was no impact on that area during the recession. Don't bother comparing your job to those guys, it'll just make you angry.
I've lived in DC area for half my life.
Trust me. Many are on pins and needles if any cut backs in federal spending. Especially contractors.
Cut 5% of defense spending the housing market there can snowball very quickly like it did in the late 80s.
But getting back to medicine and income. People won't continue to go into medicine if salaries are considered not offsetting their debt load and time spent getting trained.
I've lived in DC area for half my life.
Trust me. Many are on pins and needles if any cut backs in federal spending. Especially contractors.
Cut 5% of defense spending the housing market there can snowball very quickly like it did in the late 80s.
But getting back to medicine and income. People won't continue to go into medicine if salaries are considered not offsetting their debt load and time spent getting trained.
I'm not too sure about that blade.Med Students are, in general, ignorant of the economics of the field. Most have a poor grasp of the cost of the education vs. after tax take home pay of their chosen specialty. Many falsely believe that income doesn't matter as long as one is a Physician. Unfortunately idealism doesn't pay the bills or allow one to live an upper middle class lifestyle.
Hence, Med Schools will continue to be highly competitive for the foreseeable future regardless of Physician income.
If you've lived in DC for that long, then you know there are never any cuts. There are decreases in the rate of increase.
Cut 5% of defense spending the housing market there can snowball very quickly like it did in the late 80s.
But getting back to medicine and income. People won't continue to go into medicine if salaries are considered not offsetting their debt load and time spent getting trained.
But getting back to medicine and income. People won't continue to go into medicine if salaries are considered not offsetting their debt load and time spent getting trained.
I disagree. Every medical school will fill every class, forever.
Exhibit A
Exhibit B, look at what the lawyers have done to themselves. Ridiculous overproduction by law schools. Ridiculous tuition. Absolutely horrendous job market for 95% of graduating lawyers. And yet ... there's no shortage of people who think going to law school is a terrific idea.
And people hate lawyers.
Doctorin' is still a noble profession and doctors are still mostly respected.
Exhibit B, look at what the lawyers have done to themselves. Ridiculous overproduction by law schools. Ridiculous tuition. Absolutely horrendous job market for 95% of graduating lawyers. And yet ... there's no shortage of people who think going to law school is a terrific idea.
And people hate lawyers.
Doctorin' is still a noble profession and doctors are still mostly respected.
There will be cuts. It's only a matter of time especially defense contractors. There is a ton of money and even a 5% cut will make a huge dent in that economy.
People know it in that area. Many are mortgage up to the max. 2 income couple making 200-250k combine owning 700-800k home.
They got hit with a "small decrease" in spending after Cold War. It hit the housing market very hard and most of rest of the country didn't feel it at all
Agree with pgg that med schools will fill every slot for the foreseeable future. Whether they get the same share of the students with the most options ( twenty somethings with top grades from name brand colleges) will depend on how medicine looks compared to the rest of the options. Nothing looks promising. Right now for an ambitious young bright person.
I think there are only about 30 (?) vet schools in the United States. I don't know how many seats that works out to, but there's a pretty tight supply constraint there.And to further support this, look at veterinary medicine. MD-sized debt load with a high-five-figure salary when done, and it's still very competitive.
I'll believe it when I see it. So, basically, I'll never believe it.
BRAC happened. It happened. It really did. Wikipedia says so. Why don't you think it won't happen again?
(Incidentally, we're a year into sequestration right now.)
And Anesthesiologists are kind of like doctors.Doctorin' is still a noble profession and doctors are still mostly respected.