Freaking Out Over Job Prospects!!

Discussion in 'Psychiatry' started by MajorAllday, Nov 24, 2017.

  1. MajorAllday

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    I don't know what's wrong with me. I'm at a small, non-big name psych program in Chicago. I want to to stay in the Chicagoland area, but I don't know if I'll be able to find a suitable income paying job. It seems illogical to me, but I worry that my program being not that well regarded will mean that I'll get stuck with a low paying job.

    I want to work in the northern Chicago suburbs (due to family reasons), and usually I would think I was OK, but I'm married now, with a kid on the way and with student loans, I need to make at least $250K annually to be OK. I don't know if I can do that and still live a decent lifestyle to see my family. Am I being illogical here? I guess I'm just looking for reassurance here.
     
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  3. splik

    splik Professional Cat at Large
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    Well the worst psychiatrists often make the most. There is no correlation between where you train and how much you make. Of course it is true that for certain jobs there is some elitism or competition but there is plenty of demand for psychiatrists that you should be able to paid well. It just probably won't be your dream job
     
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  4. MajorAllday

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    My dream job is working an OP or IP job in the northern Chicago suburbs, working 8-5pm (generally speaking), working with primarily affective disorders, possibly child population too.
     
  5. uname943

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    You need to make $250k to be "OK"?!? How much are your student loans? Raising a family can be expensive, but remember that the median household income is approximately $55k.

    If you want reassurance: Don't worry, the job market is great and making $250k is easy. Especially if you work with children. Employers are eager to hire just about any mental health prescriber.
     
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  6. MajorAllday

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    You don't realize how quickly expenses add up, especially when so much already goes to taxes and loans. Regardless, I guess my issue is the Chicagoland area in particular. I know you can make something like 280-300K in more rural communities, but I don't know how easy 250K jobs are in this area, particularly for the program I'm coming from.
     
  7. uname943

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    I have a pretty good grasp of how quickly expenses add up. That's why I asked how much your student loans are. Making 250K as an individual puts you in the 95th+ percentile of American household salaries.

    Have you asked your PD or previous graduates?
     
  8. TikiTorches

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    Have most households trained for 12 years in extremely rigorous conditions? Not made much money during that time, deferred income, and incurred at least 8 years of post secondary school loans that were deferred and accruing interest? No building up any retirement, or seniority, starting from the ground level after at least 12 years of education competing over and over again with americas best and brightest. High gpas, most difficult classes, Mcat, 3 usmle exams, clinical skills testing, Malpractice, medical boards, DEA, CMS, etc? How many average Americans do this?

    You said the median household income in the us is 55g. Thats top one percent of income in the world. So what?

    You are welcome to go to med school and then give all but 55g of your income to someone else if it makes you feel better.

    Your comparisons make no sense.
     
    #7 TikiTorches, Nov 24, 2017
    Last edited: Nov 24, 2017
  9. TikiTorches

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    Illinois is very expensive, the taxes all around are very high, the OPs family has been sacrificing so he can complete this standardized and difficult education. I am certain he has missed out on alot of quality time with his family and other family events.

    Working between 70 to 80 hours a week and overnight call. How many people do this?

    I drive a 2009 car. It's not like we are out there living outlandishly.
     
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  10. uname943

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    He's saying that he needs to make $250K for things to be "OK". Most Americans make do with much less. That's not the same as saying that he needs $250K in order to justify the efforts he has made.

    I've done that, in a state with higher cost of living and taxes. But there's no need to act entitled.
     
  11. IzumioH20

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    Yes, med is difficult, but to some other fields of study are harder. As a former Geophysicist, I can tell you that I found Physics and Math at the graduate level to have been the most conceptually difficult courses, hands down. In fact, I have a med student on my rotation who would have become a mathematician, but she couldn't handle the math even at the undergraduate level. I mean she could not get pass the first course in Calculus.
     
  12. TikiTorches

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    So nothing to say for the rest of it? Medicine keeps culling the herd, every level is another competition. It never ends. MOC, macra, etc

    And one med student who cant do calculus doesnt matter. She obviously was able to get thru all the other hoops. Physicians obviously dont have to take grad level physics and math. Where are you teaching?

    Geophysicists put in 12 years of what physicians do? Face constant threat of malpractice, board action, dea, audits? Service oriented field with people killing geophysicists?

    I dont begrudge anyone what they get out there and legally earn.

    Illinois also has no tort reform. So, good luck op.
     
    #11 TikiTorches, Nov 24, 2017
    Last edited: Nov 24, 2017
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  13. IzumioH20

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    You said most difficult courses. Follow the train of thought. Well, I am telling you that I have done both. I am talking about conceptual difficulty. Grad level physics etc was more conceptually difficult than med school. And my example of the woman meant that she couldn't do anything quantitative at a high level. Follow the thought. Sure, she jumped through the hoops in medicine, BUT Medicine does not require such high level math. Still, she couldn't jump through the beginning hoops to become a mathematician. If you can't follow this, I sure hope you are not doing therapy with your patients.

    It takes a long time to get a doctorate in physics, math, chem, etc. I have a doctorate in Geophysics and am a med student in rotations.
     
    #12 IzumioH20, Nov 24, 2017
    Last edited: Nov 24, 2017
  14. slappy

    slappy Neuropsychiatrist
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    Actually, it's your comparisons that make little sense. Firstly, the medical pathway isn't nearly the most difficult, nor are doctors "the best and the brightest." Secondly, who says difficult education should equal higher compensation? You only make more money because the healthcare system here is awful, and hospitals get to charge A LOT of money. You're enjoying the trickle-down effect. It's simple economics. Lastly, you can't compare incomes across different economic systems - it simply doesn't work that way.

    I'm with the other posters who said the OP is going to be "ok," even if he/she takes up a job paying at the lower end of the spectrum, which is still going to be more than what most people in the country make. You just need to spend less. If you think about it, because of taxes, it's easier to spend a dollar less than earn a dollar more. For more on this, read a book like the The Millionaire Next Door.
     
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  15. MajorAllday

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    Guys, can we please stay on topic? This isn't really helping with my anxiety, lol.
     
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  17. hamstergang

    hamstergang may or may not contain hamsters

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    You're a PGY-2 right? If you're this worried now I don't know that we can help calm you. But just in case: job market is great, do some networking through your rotations, you'll be fine.
     
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  18. Blitz2006

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    First of all, I agree with slappy. I never understand why doctors feel that just because you go through "12 years of hell", you "deserve fair compensation". What does that even mean? There are lots of people that go through 12 years of "hell". For example, being a janitor for 12 years is probably very hard work. But we don't see janitors complaining that they are not making 250k after 12 years? And yes, before you flame me and say "well janitors don't spend 300k on tuition, spend 4 years in the library, 4 years of on-calls, etc.", that doesn't matter. I personally don't understand why society has to be so sympathetic to our expensive loans. No one put a gun to our face and said, "go to medical school". We all knew what we signed up for.

    Anyways, back on topic with the OP. I'm getting slammed with job offers (non-academic) every day (4-5 emails/day), and a fair number of them in the Chicago Area (including Indiana and Wisconsin). I see lots of offers in Chicago suburbs (Inpatient/Outpatient) in the 250k range. I know a resident who was offered in Indiana suburbs (initially 240k, negotiated up to 280k, outpatient). And if you head an hour north to Wisconsin, you can hit 300k.

    So don't worry about making 250k in the Chicago area (non-academic). I'm guessing academic psych will pay a bit lower in Chicago (220k? +/- 10k).
     
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  19. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    The people who really have a right to complain about the disconnect between education time and compensation are PhD students. Even in biological sciences, you're essentially sentenced to a string of low-income postdocs before you can even hope to be an independent researcher and a slightly-less-low income junior faculty position...which is always susceptible to being cut before you can get tenure. Now THAT'S hell.
     
  20. Blitz2006

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    Agree 100%. My point was that there are several other jobs that people can complain about the disconnect, not just medicine.

    Sent from my SM-G955U using Tapatalk
     
  21. TikiTorches

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    Whats the level of accountability and responsibility for a janitor or phd? They always go after the deep pockets of the 1/3 mil malpractice insurance

    There is no personal responsibility on the patients part

    And no we didnt all know what we signed up because in all of med school and residency no one told me all that stuff or about the dea, med bd, malpractice, etc.
     
  22. Shikima

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    OP, for living in IL with student debt, figure out what that payment would be and then figure whatever W2 salary you get will end up with you losing about 10k/month to taxes and buying your benefits. $x = gross - 10k - student loans.

    It's a general rule - Hope this will help to put it in perspective.
     
  23. IzumioH20

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    Again, you don't get the point. ONE MORE TIME: I was talking about conceptual difficulty and also time. You don't save lives directly as a geophysicist (well, maybe disaster warnings etc), but it is still a long journey.

    But, there is a lot of complicated info in geophysics (physics, chem, meteorology, math). It was conceptually harder than medicine. Doing a doctorate meant taking hard courses, teaching, doing research, and preparing for comprehensive exams all at the same time. After comp exams there is the dissertation and you still teach. It never got easier. And it was a long fricken ride.

    You are making an arse out of yourself. You really don't know what you are blabbing about.
     
  24. heysexylady

    heysexylady SDN Bronze Donor
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    How many kids do you have.
    Do you have a partner that works?
    What type of lifestyle do you want....what stuff do you want to splurge on.
    How much are your student loans.
    Do you know how to save money.
    Do you need to live in the most expensive house, flashiest car, or latest designer clothes.
    Do you need to live in the nicest most expensive part of chicago.

    You will be fine unless you have 10 kids.

    There are a lot of physicians who make half a million and are living pay check to pay check because they are overextended and want the latest stuff.

    You will be making more than the average american and so you have more options. You really need to sit down and think about what is important. Paying off student loans or whatever.

    You should slap the person who told you that your salary will be tied to the prestige of your program. Like really hard.

    I have boatloads of student loans but i am not worried because I know that I will always have a high-paying job once I am done.
     
  25. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    This.
     
  26. MajorAllday

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    I honestly don't consider WI and Indiana Chicagoland. Due to family reasons, I'm legitimately constrained to the surrounding northern suburbs of Chicago.
     
  27. splik

    splik Professional Cat at Large
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    lol more likely mid 100s for academics
     
  28. Shikima

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    http://careermd.com/physicians/ViewListing.aspx?ListingID=289453057
    http://careermd.com/physicians/ViewListing.aspx?ListingID=289243330
    http://careermd.com/physicians/ViewListing.aspx?ListingID=289529997
    http://careermd.com/physicians/ViewListing.aspx?ListingID=289525450

    Stop freaking out OP. Time to beat the streets, contact physician recruiters at hospitals directly, etc
    Plenty of jobs in Chicago and surrounding burbs.
     
  29. MajorAllday

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    Appreciate the words of encouragement. Too bad none of those are in the northern suburbs. I get your point, though.
     
  30. Stagg737

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    You'll be fine. I just googled "psychiatry positions in northern Chicago" and literally found a couple dozen in 2 minutes paying well over 200k, some offering 300k+ as a starting point. Additionally, 250k is more than enough to be "okay" in the Chicago area (just under $180k after tax without claiming any deductions) unless you've got 7 figures of debt or are looking to move into a $800k house straight out of residency. Frankly, 250k is more than enough to live comfortably in that area even if you've got debt and a kid or two, and if people think it's not then they have a pretty skewed perspective of what "living comfortably" means.
     
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  31. slappy

    slappy Neuropsychiatrist
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    No.
    Agreed. Chicago has plenty of academic centers that pay very well. Private sectors pay even better, and there's of course tons of opportunity for private practice - from the affluent Chicago burbs to student mental health in Evanston. I know people doing some of each, and except for the person primarily doing the Evanston PP gig, they are all quite happy with the pay and work-life balance.

    Also, the best financial advice I can give to graduating residents is to continue living like a resident for a few years. It's natural to want to buy a house and expensive cars right out of residency (or in some unfortunate cases, before the end of residency). If you can avoid that mistake, you can have excellent financial freedom.
     
  32. SeniorWrangler

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    Yeah, start saving money and be very, very careful if you're thinking about buying a house. Being "house poor" on a 6 figure income sucks.
    Also, if you can, find a neighborhood with good schools so you don't have to jump into private schools for your kid right away... that can be as bad as a mortgage.
    If you can find a niche besides just being "general psychiatrist #1,457" that will help also, find some aspect of psychiatry that you like and can master, even without a fellowship. That will also make it easier to find a job IMO.
     
  33. slappy

    slappy Neuropsychiatrist
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    Excellent advice, especially the carving out a niche bit. It touches on the differentiation aspect of Porter's competitive advantage. We don't talk about it enough, and it annuls (or at least minimizes) several future threats like midlevel encroachment.
     
  34. Stagg737

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    Question about buying a house (slight derail, but relevant since OP is asking about finance) based on these.

    I realize that a resident making 50k who has 200k+ in debt looking to buy a nice 300k+ house isn't the best idea. Let's say you're a resident who will have a combined household income of 100-125k, minimal debt with interest (I'll have plenty of debt, but only about 40k collecting interest), and looking to buy a more reasonable house (200k, maybe 225k depending on income)? I've looked into how much the monthly mortgage would be for a 200k house, and it wouldn't be much more than $1,000/mo even with 0 down payment, which is around what we'd likely pay to rent. So wouldn't it be a better investment to buy in that situation than keep renting? Especially since you could probably easily refinance to a better 15 year rate once making attending salary?
     
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  35. hamstergang

    hamstergang may or may not contain hamsters

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    Monthly mortgage should be cheaper than monthly rent or else the person renting out the place wouldn't make any money. The added costs come in from the down payment, a whole bunch of other expenses a house has that you don't realize until they pop up, and needing an emergency fund should something go wrong. Also owning a home requires some flexibility in schedule for when work needs to be done at the house.

    That said, 2 months after fellowship I bought a $60k car, and another 6 months after that I bought a $600k house (my long term boyfriend provided the down payment and has the flexible schedule, though he contributes very little to our income). I'm not saving as much for retirement right now as others would recommend, but I have plenty of money flowing in even after paying towards $150k+ of student loans.
     
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  36. st2205

    st2205 Attending

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    It depends. Many people will tell you not to buy a house. We bought and it worked out great. Sold our house 4 years later for nearly 30k more. But our situation was more unique. Other things to consider is what property taxes are in your state. Since we were in Texas, property taxes were outrageous. As a home owner, that property tax (like 35% of our monthly payment) is tax deductible. Renting, you’re still paying the equivalent but without any tax savings in property taxes or interest. You may live in an area where this doesn’t matter as much. If you know you’re going to stay in the house, however, I’d say better to buy. If you end up in a tight market to sell, it could be added stress if you’re looking to move at the end of residency — getting place ready, showing it, dealing with realtors who are out for their own best interest and not necessarily yours, etc.

    There are a number of variables that may make purchasing the right choice. As a general rule everyone will say don’t buy — but I argue that’s not universal and really depends on your goals. If you’re in a crappy market, though, and your home doesn’t appreciate much, you’ll pay a lot of realtor fees that you may not come out ahead.
     
    #34 st2205, Nov 26, 2017
    Last edited: Nov 26, 2017
  37. MajorAllday

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    How sensible is it for a couple making $420K a year to buy a $800K house with 20% mortgage?
     
  38. hallowmann

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    You'll be fine. You could easily get a license in neighboring states as well and throw on some Telepsych as well. Tons of people need psychiatric care, and everyone I know is getting offers at $250k and above for OP with very few IP responsibilities depending on the area.

    If you have time, I'd moonlight in 3rd or more likely 4th yr. You'll see how much you can make pretty quickly, you'll gain confidence in independent practice, and you'll make connections and get potential job offers.

    There's a lot more going into a house than just the mortgage. Maintenance and things going wrong can really cost you money. In even a house in good shape, I'd expect to spend $2-$3k a year on it. You'd be better off buying a smaller house.

    Alternatively, you could also rent for a year, figure out the best areas to buy in terms of appreciation/cost, and then buy after paying off that $40k. Sure, you'll lose that equity, but you won't have that school loan interest over your head.

    I wouldn't do it straight out of residency. Put away something for retirement first (like in the $100-$200k range and then have a lower maintenance deposit monthly). You'd be better off buying smaller/cheaper and putting more into retirement than buying an expensive house that you plan to "grow into" over 10yrs right off the bat.
     
  39. slappy

    slappy Neuropsychiatrist
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    No, because:
    1. Attendings don't live in resident houses. Within 1-2 years of being an attending, you're going to want to move to a bigger house. And that's where you're going to lose on a lot of fees - realtor commission, mortgage payoff, closing costs, transfer taxes, etc. Just between closing costs and realtor commission, you could lose about 10% of value.
    2. House prices are unlikely to go up in the short-term (4-6 years), or at least unlikely to go up enough to justify the costs of buying and selling.
    3. As a resident, you're not going to have enough time to maintain the house or do the necessary repairs. You're most definitely going to notice a lot of niggles in your new house in your first year of ownership as you get used to it. You might also want to upgrade some things to make the house "livable" for you. These expenses will add up.
    4. Property taxes.
    5. Cap rate. In your example, you're saving 1k a month on rent. So your NOI for the year would be 12k - property taxes (say 3k) - repairs/upgrades (say 3k, being very optimistic) = 6k. That's a cap rate of 3% on the 200k house, which is pretty terrible. And that isn't even accounting for the fees associated with the eventual sale, the return on your original investment, home owner insurance costs (which tend to be more than renter's insurance), and the fact that you have actually paid close to 390k in today's money for a 200k house with 0 down and 30-year-4% mortgage.

    So financially, it makes little sense to buy that house if you could rent it for 1k a month. However, there are intangibles associated with owning a house - like the emotional attachment to it, the satisfaction knowing you actually own the house and the land you live in (which is kind of a farce because the government can take them at any time if you don't pay the property taxes for example), etc. Only you can evaluate what those are worth.

    If you mean a 20% downpayment, 2x your annual income is pretty reasonable, assuming you get good mortgage rates, understand that you're most likely not going to see a good return on your investment after you account for inflation (unless real estate prices go up dramatically - they often do not), and you calculate the cap rate and see that it is in fact cheaper to buy than rent (or you value the intangibles enough to not care).
     
  40. WingedOx

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    It should also be noted for @MajorAllday that property taxes in the northern burbs of Cook County are pretty high too. However, the assessment system is a corrupt mess and generally rewards wealthy homeowners while screwing poorer ones. Our place got assessed for like 60-70% of what it could sell for tomorrow and our condo board still managed to successfully appeal it down further.
     
  41. PSYDR

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    At $250k, your take home is like $160-170. Less retirement contributions. Less student loans. Less kids college fund contributions. Which means you should spend around 500k on a mortgage, assuming you have some money for a down payment.

    I've taken care of physicians who retired in mansions, and physicians who retired to trailer parks. Specialty didn't matter. What did seem to matter was how good these people were at either managing their own money, or more realistically; finding a well educated and qualified professional to do so .
     
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  42. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    Everyone's needs and expectations will be different, every market is different, what passes as "resident house" vs "attending house" is different. Answering these questions for someone in Milwaukee or St.Louis based on a Bay Area or Seattle perspective is ridiculous.
     
  43. SeniorWrangler

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    Also, the Congress may or may not cut the cap for Mortgage deductions in half this year, which will knock maybe 10-15% off the value of high end homes...
     
  44. slappy

    slappy Neuropsychiatrist
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    Not really. It almost always makes little financial sense to buy a house as a resident. The only exception is if you lived in a city with limited real estate and can confidently predict the prices will go up in the next 4-6 years (i.e. LA/SF/NYC). But even then, there's a natural check as people move out to the suburbs when prices get expensive, preventing real estate prices to continue rising linearly for ever. Robert Shiller has written extensively about this, and all of this is very well written about in economics. It is really, really hard to make a convincing argument for why residents should buy houses unless it includes intangible reasons. As a PD, how many attendings over 3 years out of training have you seen living in the same house they lived in as a resident?

    I don't recommend James Dahle's book, but here are some other practical reasons why residents shouldn't buy a house: 10 Reasons Why Residents Shouldn’t Buy A House
     
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  45. QueenJames

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    IDK about y'all, but all this talk about taxes and rent make me plan on moving back in with my parents once I become an attending.

    #Noshameinmygame

    #Ma...theMEATLOAF?!
     
  46. AD04

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    Admit it, this is the real reason you're moving back home ...

    Hey girl,

    I'm a doctor. Why don't we head back to my room. You should really check out my PARENT'S crib.

    #Noshameinmygame
     
  47. Bartelby

    Physician

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    Rent v buy is complicated, take a look at a calculator like this: (Is It Better to Rent or Buy?). A few things to keep in mind:

    -When you sell, you will pay 6-10% in fees depending on your area (6% realtor fee, taxes, other costs including repairs move etc). This means buying a house for just a couple years rarely comes out ahead financially.
    -If your home gains value, it can gain a lot; if it loses value, it can lose a lot. For instance, a $1 million home that increases 15% in value (like happened in the Bay Area last year) adds $150k in equity in a year. A similar fall in value would be a big loss.

    Pros of renting:
    -They handle repairs, etc; it saves you time and stress.
    -You are not paying mortgage interest, property tax.
    -You can move out much more easily, at worst paying a fee to break the lease.
    -In expensive areas, your monthly payment is often lower than buying.
    -You can invest any would-be down payment money, and any money you save month-to-month.

    Pros of buying:
    -You can (for now) deduct mortgage interest and property taxes, cutting the sticker-price monthly cost. The new tax bill may eliminate this.
    -Home appreciation is leveraged and can add a lot of equity.
    -Your mortgage payment is "locked in" (aside from adjustable interest rates), meaning as prices go up around you your deal just keeps getting sweeter.
    -You can make any changes you want to the home, you don't have to ask permission for every little thing (pets, changing the interior, etc).

    In brief, if you are going to stay in a place for a long time buying is more likely to win out. It really comes down to your local rent v buy numbers.

    As for the original post, you should be fine finding a job in the range you specify. If you don't, moonlight! From a financial perspective, if you can work out an ability to live on less that is even better (in that tax bracket, spending one more dollar means you need to earn almost two more dollars, depending on state income tax levels).
     
  48. st2205

    st2205 Attending

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    I’d say this is a con. You are paying mortgage interest and property tax in the increased rate of your rent, but you’re not getting any tax advantage for doing so (your landlord is).
     

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