future of cards

[sanj238]

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Does this bode well for the future of cards?

http://www.newyorker.com/online/blog...-medicine.html

This is from the New Yorker after several articles were written against stents (Businessweek)

http://www.bloomberg.com/news/2013-0...ruse-seen.html

- I hate the NYTimes

They have an exceedingly powerful lens on the medical establishment. Mostly against doctors- as if we're a cabal of dangerous people (I'm just a med student)

Excerpted from the New Yorker:

The study found that those treated with medications lived just as long as those with stents. COURAGE is a super-star trial, the best of its kind. So why can’t we say, once and for all, that it’s inappropriate to use stents for patients with stable coronary disease?

The answer is that it’s because such a statement is a colossal oversimplification. The fundamental challenge of translating data into practice is what we call generalizability: Can we extrapolate the findings from a trial to real life? If you are a doctor who is trying to practice evidence-based care, the first thing you want to ask yourself is, Would my patient have been enrolled in the trial? Sun Kim would not have been eligible for the COURAGE trial, which excluded all patients with high-risk features—or nine out of ten otherwise eligible patients.
....

(If anyone can link to the study below much appreciated- cant find online)

Excerpted from New Yorker:

Last month, a study was published in the New England Journal of Medicine which will likely change clinical practice, as well as the constantly updated guidelines that define appropriateness. The study looked at patients, like Sun Kim, who at the time of a heart attack are also found to have chronic blockages. Half of the patients were managed conservatively, as I had managed Sun Kim. Half received stents for both their acute and chronic disease. The results were a surprise: stenting both the acute and chronic disease led to fewer deaths and fewer heart attacks. In fact, the benefit was so pronounced that the trial was stopped early. I have yet to read about this trial in the news.

 

[IMDoc607]

Does this bode well for the future of cards?

http://www.newyorker.com/online/blog...-medicine.html

This is from the New Yorker after several articles were written against stents (Businessweek)

http://www.bloomberg.com/news/2013-0...ruse-seen.html

- I hate the NYTimes

They have an exceedingly powerful lens on the medical establishment. Mostly against doctors- as if we're a cabal of dangerous people (I'm just a med student)

Excerpted from the New Yorker:

The study found that those treated with medications lived just as long as those with stents. COURAGE is a super-star trial, the best of its kind. So why can’t we say, once and for all, that it’s inappropriate to use stents for patients with stable coronary disease?

The answer is that it’s because such a statement is a colossal oversimplification. The fundamental challenge of translating data into practice is what we call generalizability: Can we extrapolate the findings from a trial to real life? If you are a doctor who is trying to practice evidence-based care, the first thing you want to ask yourself is, Would my patient have been enrolled in the trial? Sun Kim would not have been eligible for the COURAGE trial, which excluded all patients with high-risk features—or nine out of ten otherwise eligible patients.
....

(If anyone can link to the study below much appreciated- cant find online)

Excerpted from New Yorker:

Last month, a study was published in the New England Journal of Medicine which will likely change clinical practice, as well as the constantly updated guidelines that define appropriateness. The study looked at patients, like Sun Kim, who at the time of a heart attack are also found to have chronic blockages. Half of the patients were managed conservatively, as I had managed Sun Kim. Half received stents for both their acute and chronic disease. The results were a surprise: stenting both the acute and chronic disease led to fewer deaths and fewer heart attacks. In fact, the benefit was so pronounced that the trial was stopped early. I have yet to read about this trial in the news.

I think cardiologists have already embraced this. Where I train they always say stenting is not always the answer. They frequently suggest medical management. I think the future of all specialties are the same. Cuts are coming down the pike. However, cardiology has already been hit hard. I don't foresee it going much lower.

 

[Trifling Jester]

Courage is plausible deniability for cardiologists. If you don't want to stent it, cite courage. If you want to stent it tell them to go to the ER the next time they have chest pain and admit them as unstable angina and fix the lesion.

I believe the study you refer to is the PRAMI study. They stented both culprit and non culprit lesions in the setting of STEMI (against current ACC guidelines), and stented anything over 50%.

-Trifling Jester

 

[OptimusPrime]

Does this bode well for the future of cards?

http://www.newyorker.com/online/blog...-medicine.html

This is from the New Yorker after several articles were written against stents (Businessweek)

http://www.bloomberg.com/news/2013-0...ruse-seen.html

- I hate the NYTimes

Depends on what you mean with "cards"

If you mean the field of cardiology in general then it is as exciting of a time as any to be a cardiologist. Regardless of occasional sensation article or news piece about inappropriate this or that trying to sale papers or rev up viewership. Our knowledge of cardiovascular pathophysiology continues to expand, new medical therapy have improved quality of life and reduced mortality from wide range of disease pathology from much publicized ACS field to less appreciate PH population. We continue to lead the field of medicine with the most evidence based therapies and new exciting innovations changing the landscape of both interventional and pharmacological therapeutic options. Obviously many challenges remains but overall an exciting time for the field.

If you meant "cards" as in the field of private cardiology practice the answer is not as exciting. The problem is the private sector is stuck in a bad loop. Example new treatment "A" is introduced in the field. It actually does do good when applied to the appropriate population/situation. CMS (and hence private insurance) initially reimburse appropriately for treatment "A". Inevitably the private sector becomes greedy and starts applying treatment A at higher rates than perhaps clinically indicated to help increase their annual profit margins. Not all but enough percentage of private card docs take up such practice that it makes CMS take notice and reduce reimbursements. Now private docs are chasing their own tails needing to do even more of treatment A (again certain % inappropriately) to make year end profit margins and stay afloat. Occasionally new treatment comes along and everybody jumps ship to exploit the next treatment options (stents to nucs). Eventually you run out of treatments to jump to and CMS continues to cut reimbursement. Private practice groups who didn't plan appropriately (vast majority of them) start to go belly up and the big business that is running all these "for profit" hospitals starts buying up private groups and turns them into RVU slaves. Job market saturated, reimbursements no longer there, now in most big cities you have to wait forever to be let on hospitals "STEMI call" service where you take call "for free" only to get miniscule reimbursement if you come in at midnight to save a life. Go see how many other fields do "free hospital call".

Long story short things haven't boded well for private "cards" community for a while now (that goes for IC, EP or Gen cards... A good friend who is IC cards trained and part of a small private group in So Cal had to renew his IM license and start treating Gen Med patients to have ends meet). None of the upcoming changes will make things any better. So unless you went into it for all the right reasons you're up for a rude awakening.

OP

 

[sanj238]

Depends on what you mean with "cards"

If you mean the field of cardiology in general then it is as exciting of a time as any to be a cardiologist. Regardless of occasional sensation article or news piece about inappropriate this or that trying to sale papers or rev up viewership. Our knowledge of cardiovascular pathophysiology continues to expand, new medical therapy have improved quality of life and reduced mortality from wide range of disease pathology from much publicized ACS field to less appreciate PH population. We continue to lead the field of medicine with the most evidence based therapies and new exciting innovations changing the landscape of both interventional and pharmacological therapeutic options. Obviously many challenges remains but overall an exciting time for the field.

If you meant "cards" as in the field of private cardiology practice the answer is not as exciting. The problem is the private sector is stuck in a bad loop. Example new treatment "A" is introduced in the field. It actually does do good when applied to the appropriate population/situation. CMS (and hence private insurance) initially reimburse appropriately for treatment "A". Inevitably the private sector becomes greedy and starts applying treatment A at higher rates than perhaps clinically indicated to help increase their annual profit margins. Not all but enough percentage of private card docs take up such practice that it makes CMS take notice and reduce reimbursements. Now private docs are chasing their own tails needing to do even more of treatment A (again certain % inappropriately) to make year end profit margins and stay afloat. Occasionally new treatment comes along and everybody jumps ship to exploit the next treatment options (stents to nucs). Eventually you run out of treatments to jump to and CMS continues to cut reimbursement. Private practice groups who didn't plan appropriately (vast majority of them) start to go belly up and the big business that is running all these "for profit" hospitals starts buying up private groups and turns them into RVU slaves. Job market saturated, reimbursements no longer there, now in most big cities you have to wait forever to be let on hospitals "STEMI call" service where you take call "for free" only to get miniscule reimbursement if you come in at midnight to save a life. Go see how many other fields do "free hospital call".

Long story short things haven't boded well for private "cards" community for a while now (that goes for IC, EP or Gen cards... A good friend who is IC cards trained and part of a small private group in So Cal had to renew his IM license and start treating Gen Med patients to have ends meet). None of the upcoming changes will make things any better. So unless you went into it for all the right reasons you're up for a rude awakening.

OP

That sounds very depressing.

Are you a cardiologist? What do you like about academic cardiology? How are the hours. I like the research but what kind of difficulty do we face if we're not at a top tier program?

 

[CV student]

Long story short things haven't boded well for private "cards" community for a while now (that goes for IC, EP or Gen cards... A good friend who is IC cards trained and part of a small private group in So Cal had to renew his IM license and start treating Gen Med patients to have ends meet). None of the upcoming changes will make things any better. So unless you went into it for all the right reasons you're up for a rude awakening.

Very well said.

 

[OptimusPrime]

I'm an interventional fellow. The reduction in reimbursement is not so much depressing (because its been happening for a few years now) as the realization of job market saturation (new for me as I'm starting to actually look now). Again there still jobs out there and no surprise you get more offers and better package the further in middle of nowhere you look.

I'm going into private sector so academia not my bag of tricks. It has its positives (teaching, fellows/residents reducing some of your burden, recognition among your peers if you produce research/papers/etc) and its headaches (research funding/IRB, inter department politics, jumping hoops to go from assistant to associate to full professor, lower annual salary although as discussed earlier gap is reducing).

Top tier? If by that you mean can you get into a good academic position if you don't have a Duke/Cleveland/Mayo/etc background? Of course. Good research speaks for itself. Having a top tier background helps open doors getting you an academic position at other top tier programs for sure but you can still become well respected researcher in any field coming from any program (I understand this is perhaps an obvious statement) but I felt like it needed saying in answering your question.

OP

 

[ruralsurg4now]

You know, this thread exemplifies the entire problem with this forum. You either have it where threads in FM or Psychiatry are talking about people making $250-300K starting or IM hospitalists saying they get $250K for one-week-on-one-week-off, or it's like this where Interventional Cardiologists are talking about being broke. Could everyone just stop this? You're totally f**king up all the students and pre-meds who are coming on here and deciding to become physicians based on salary.

 

[OptimusPrime]

I'm not exactly sure what you're driving at my friend but I'm just answering someone's question to the best of my knowledge.

Although I agree monetary considerations should not be a primary reason why someone picks any line of career, goodwill and kindness toward mankind doesn't pay back your med school loans plus interest or cover rent. Furthermore in order to become a cardiologist especially IC and the length of training involved as well as the responsibilities that come to rest on your shoulders (lets be honest there are variety of different physicians being on call situations where most would agree STEMI call entirely different beast) and the stress associated... I think most people would like to know honestly what is the current job market and reimbursement/salary structure waiting for them once they finally arrive.

The bigger problem perhaps is if students/pre meds/etcs decided to come into this line of work thinking they will easily make 500+ K salary (based on stupid generalized physician salary surveys floating around the internet) only to finally truly realize how the field of private practice has changed after 7+ years of training. Sure those type of salaries are still possible but good luck finding an opening in any major city worth living in and I would even argue in order to generate that type of salary you would end up inevitably ordering studies and performing procedures that are perhaps borderline indicated at best and at worst... well you get the gist.

OP

 

[ruralsurg4now]

The bigger problem perhaps is if students/pre meds/etcs decided to come into this line of work thinking they will easily make 500+ K salary (based on stupid generalized physician salary surveys floating around the internet) only to finally truly realize how the field of private practice has changed after 7+ years of training.

That's what I'm driving at. The numbers that are thrown around on SDN aren't "real" numbers. People never qualify them by saying "I got this salary, but it was in New York City" or "I got this salary, but I was working like a dog." It's basically people bragging about how high their salaries are or lamenting that their former $500K salaries are now "only" $375K so they're now paupers. As a surgeon, for example, thanks to SDN, many people will go into it thinking they're going to come out and first year be commanding ridiculous salaries. I was told that in decades gone by, it used to be that surgeons "averaged" multi-million dollar salaries. Who cares? I don't even know if that's true, but why set yourself up for misery when you "only" get a few hundred thousand?

Cardiology is changing. Surgery is changing. Every medical field is changing. Most of us are seeing our salaries and reimbursements drop. I get it. But unless people are going to honestly represent their salary, then it just messes up people's heads.

 

[Silent Cool]

You know, this thread exemplifies the entire problem with this forum. You either have it where threads in FM or Psychiatry are talking about people making $250-300K starting or IM hospitalists saying they get $250K for one-week-on-one-week-off, or it's like this where Interventional Cardiologists are talking about being broke. Could everyone just stop this? You're totally f**king up all the students and pre-meds who are coming on here and deciding to become physicians based on salary.

Rural,

What would you say are realistic incomes for the above fields and also for general surgery?
Thanks
-sc

 

[Keg]

Rural,

What would you say are realistic incomes for the above fields and also for general surgery?
Thanks
-sc

I'm at $186 as an academic hospitalist, 7 on, 7 off, cap of 14 patients.

 

[Silent Cool]

I'm at $186 as an academic hospitalist, 7 on, 7 off, cap of 14 patients.

Thanks, Keg.

 

[gutonc]

Not cards, hospitalist or gen surg but I'm at $180K + RVU bonus (after 1y I'm getting about $15K/quarter...do the math yourself) as an oncologist working 3 days/wk (my choice) with no nights or weekends in a highly desirable area.

 

[OptimusPrime]

Rural,

What would you say are realistic incomes for the above fields and also for general surgery?
Thanks
-sc

SC,

Although I'm sure people would appreciate specific numbers the cardiology/EP/IC market varies greatly from individual situations based on location/size and scope of practice/willingness to take call; and obviously in private sector the harder you're willing to work (ie less family/personal time) the more income. Speaking generally IC jobs can start anywhere from 200/250K in big cities (if you could find a good one) to 300-400K in smaller more rural locations. Job recruiters send us emails all the time for jobs in small cities w/ guaranteed 1st year salary 400+K not saying where exactly is the location (email will read "Lovely family friendly city only 2 hours drive to Little Rock/AR and 3 hours drive to St. Louis").

Even if you're willing to work in smaller towns you need to be careful w/ these guaranteed salary jobs (these so call private groups are usually owned/backed by the local hospital affiliates and after your 1st year you will need to meet certain bench marks to make your salary which means working harder and if you're not meeting these bench marks salary may drop drastically). I would also argue this may lead to certain practitioners making the news for getting into trouble for ordering/performing unnecessary procedures.

I'm from California and in an ideal world would have like to return to So Cal. I can tell you this much, good IC jobs (ie 100+ interventions/year, 300K+ salary) in so cal (LA/OC/San Diego county) are nonexistent, heck even bad ones are hard to come across in so cal.

IF you could find an IC job in southern california it likely be for ~250K (you will do 80% gen cards, if lucky get 30-40 interventions per year). The lack of interventions is due to saturation of the market and national decrease in ACS numbers and higher scrutiny on nonACS interventions. Also reimbursements for interventions has decreased to a degree that most of my IC friends tell me its not financially wise to be in cath lab (ie spend half a day and cath 2-3 person, maybe do 1 intervention or see 15-20 pts in clinic and generate further revenue (ETT/ESE/MPI/Holter/etc).

Furthermore in so cal (and likely most major metropolitan cities in US where IC folks are saturated) you will not be compensated for taking STEMI call if you don't come in (ie you can take weekend STEMI call where you need to be on standby to come in on seconds notice and have to stay close to hospital all weekend and if you don't come in you will not get one cent for your time).

I'll post more specific numbers once I actually go for some job interviews in the upcoming months.

OP

 

[ruralsurg4now]

working 3 days/wk (my choice) with no nights or weekends

Wow, you sure are dedicated to moderating! 😀

 

[ruralsurg4now]

What Optimus wrote is true. WHERE you practice influences your pay as much as WHAT you practice. If you want to be general surgeon in a large metropolitan area that is generally already saturated, prepare to cry when you get a paycheck. Even better is if you want to do that at an academic center.

 

[redlined]

As an Interventional guy in PP in a large metro area I echo what Optimus has said. He is spot on. I will add that it will only get worse.

 

[CanIMakeIt]

Yo

I'm at $186 as an academic hospitalist, 7 on, 7 off, cap of 14 patients.

u forgot to mention the 30K bonus 🙂 at the end of the year. I didn't know there was a cap of 14 for you guys now. That's nice 🙂

 

[hipopanonymous]

That's what I'm driving at. The numbers that are thrown around on SDN aren't "real" numbers. People never qualify them by saying "I got this salary, but it was in New York City" or "I got this salary, but I was working like a dog." It's basically people bragging about how high their salaries are or lamenting that their former $500K salaries are now "only" $375K so they're now paupers. As a surgeon, for example, thanks to SDN, many people will go into it thinking they're going to come out and first year be commanding ridiculous salaries. I was told that in decades gone by, it used to be that surgeons "averaged" multi-million dollar salaries. Who cares? I don't even know if that's true, but why set yourself up for misery when you "only" get a few hundred thousand?

Cardiology is changing. Surgery is changing. Every medical field is changing. Most of us are seeing our salaries and reimbursements drop. I get it. But unless people are going to honestly represent their salary, then it just messes up people's heads.

I'll just tell you now. Every reimbursement system can be gamed, and gamed very hard if desired. A lot of these high numbers come from extreme manipulation of the system, and any field can make money hand over fist in that type of situation. The only thing stopping it is each person's ethics. I'll say, in the midwest except chicago, I've not seen or heard of a cardiology job that was <300k starting. I don't know what your ceiling will be, but your floor is higher than most other specialties in cardiology unless you want to stay in NYC, LA, Chicago, Boston, and probably Philly.

 

[ruralsurg4now]

Yeah but "the midwest other than chicago" is basically no-name small cities. That's my point. A position in the midwest can often pay double what you get on the coasts AND comes with lower cost of living. But the price is living in a semi-rural or rural environment. And people are so opposed to that they will still take the job in nyc or la and be relatively poor.

 

[punk]

Yeah but "the midwest other than chicago" is basically no-name small cities. That's my point. A position in the midwest can often pay double what you get on the coasts AND comes with lower cost of living. But the price is living in a semi-rural or rural environment. And people are so opposed to that they will still take the job in nyc or la and be relatively poor.

There are often other considerations too. For example, as a physician couple, we would have loved to stay in a smaller city with its perks of relaxed lifestyle and less driving. However, both of us are highly specialized beyond the regular fellowships. We need large population centers to thrive. None of us was able to find two jobs together in a small city. At one small city that we found two jobs, our combined salaries were 175K less and jobs were more demanding than what we eventually found in a major city. The employers try to low-ball you if both husband and wife are trying to find position with same large employer.

 

[ruralsurg4now]

Hey, don't get me wrong. I'm not blaming anyone for choosing any job for any reason. As you can see by my name, I'm temporarily rural. I'm just about to start my job and I'm already trying to figure out the minimum amount of time I have to stay in order to not make it look bad (I just left a job in a large city after one year because the group sucked, so I can't keep switching out). I'm going to try to get back to a job in that same metropolitan area (non-compete clause is no problem). I'm thinking of doing one year here, then actively trying to look for jobs, which should take at least seven or eight months to get everything squared away.

 

[hipopanonymous]

Yeah but "the midwest other than chicago" is basically no-name small cities. That's my point. A position in the midwest can often pay double what you get on the coasts AND comes with lower cost of living. But the price is living in a semi-rural or rural environment. And people are so opposed to that they will still take the job in nyc or la and be relatively poor.

Pshaw, typical east coast/west coast view. They forget Columbus, St. Louis, Minneapolis, Milwaukee, Indianapolis, Pittsburgh (more midwest than anything else), Kansas City, Detroit, and Cincinnati, all 1.5 mil+ metro areas. Then you've got all the smaller, cool type college towns like Madison and Bloomington and the smaller but sizable areas. I know it doesn't seem that way when you live in the glorious crowded squalor of a 500 square foot apartment in Manhatten that's 2k/month, but there's more than rabble rousing hicks in between New York and LA.

 

[ruralsurg4now]

Pshaw, typical east coast/west coast view. They forget Columbus, St. Louis, Minneapolis, Milwaukee, Indianapolis, Pittsburgh (more midwest than anything else), Kansas City, Detroit, and Cincinnati, all 1.5 mil+ metro areas. Then you've got all the smaller, cool type college towns like Madison and Bloomington and the smaller but sizable areas. I know it doesn't seem that way when you live in the glorious crowded squalor of a 500 square foot apartment in Manhatten that's 2k/month, but there's more than rabble rousing hicks in between New York and LA.

OK, first of all, let me apologize. I'm not one of those people who think that outside of New York City, it's just savages running around in loincloths. I actually hate NYC and laugh at how people from that area refer to it as "the city" (as in, there are no other cities worth mentioning anywhere). And I like the Midwest. I would love to practice in Chicago, if it weren't for the ridiculous malpractice environment. I would love to practice in the Detroit suburbs, if Detroit wasn't falling apart. I was in Indianapolis (just passing through) and was totally impressed by how clean it was and how the people were. But a lot of the Midwest IS small cities and semi-rural and rural areas. I get tons of fliers about "amazing job within 1 hour of major Midwest city!!" and you find yourself in a place where there are dirt roads and Google maps drops off. That's all I'm saying.

 

[sanj238]

What are we looking at for general cardiology? What if you're not interested in invasive cardiology/interventional? What type of income do these doctors look at?

I can understand the trepidation of discussing income but I think its a real and important issue. Every physician I have talked to has brought up the money issue without prompting. And all of them have discussed the difficulty of income as a doctor unless they are ROADS/Ortho/uro etc.

I can assure you that the discussion of money, while leaving a sour taste in everyone's mouth is an essential component of any decision making process. No one should go into a career simply for money, but it certainly should be an important factor.

For me, I cannot fathom myself doing certain careers (Dentistry, derm, path, etc)- I love medicine on its own, especially the intellectual aspect- but my questions, I think, are certainly legitimate.

 

[Postictal Raiden]

I was surfing the internet and came across this article so I decided to post it here for its relevance to the topic.
http://content.onlinejacc.org/article.aspx?articleid=1140075

The article mentions that 40% of general cardiologists are 55 years or older (this article was written in 2009). If I were to speculate, I would say that one-third of practicing cardiologist will be retiring within the next 10 years. The future may not be as it seems.

 

[OptimusPrime]

I was surfing the internet and came across this article so I decided to post it here for its relevance to the topic.
http://content.onlinejacc.org/article.aspx?articleid=1140075

The article mentions that 40% of general cardiologists are 55 years or older (this article was written in 2009). If I were to speculate, I would say that one-third of practicing cardiologist will be retiring within the next 10 years. The future may not be as it seems.

Don't hold your breath. You be surprise how long some physicians choose to keep practicing. It may not even be a monetary issue, some just don't like the idea of staying home and being "retired". Seeing patients in clinic and reading studies (echo/nuc/ekg/etc) doesn't require great deal of strength, the more seniors ones generally cut back on their call hours. And if you look at that article not surprisingly the highest concentration of cardiologist are in big cities; the demand for cardiologist will not be increasing in any of the major metropolitan areas across the country anytime in the foreseeable future.

As far as Sanj238 question regarding the exact numbers refer to my earlier post regarding more specifics of the numbers currently being thrown around for Gen cards and IC. If you can find a job you like in a city you like to the live in general the starting salary is higher than internist or some of the other medicine sub-specialties but I would argue Cards fellowship is a tougher fellowship training (schedule/call/etc) than most IM fellowships and once you do practice your "call schedule" and how busy you are also on average more rigorous so its not exactly you get paid more to work the same amount as a Rheum or ID doc.

Cards will take the grunt of the hits form CMS cuts for years to come (ie you'll have to work harder for lesser pay), which goes back to my point about make sure you love what you do otherwise you'll be miserable.

OP

 

[sanj238]

Don't hold your breath. You be surprise how long some physicians choose to keep practicing. It may not even be a monetary issue, some just don't like the idea of staying home and being "retired". Seeing patients in clinic and reading studies (echo/nuc/ekg/etc) doesn't require great deal of strength, the more seniors ones generally cut back on their call hours. And if you look at that article not surprisingly the highest concentration of cardiologist are in big cities; the demand for cardiologist will not be increasing in any of the major metropolitan areas across the country anytime in the foreseeable future.

As far as Sanj238 question regarding the exact numbers refer to my earlier post regarding more specifics of the numbers currently being thrown around for Gen cards and IC. If you can find a job you like in a city you like to the live in general the starting salary is higher than internist or some of the other medicine sub-specialties but I would argue Cards fellowship is a tougher fellowship training (schedule/call/etc) than most IM fellowships and once you do practice your "call schedule" and how busy you are also on average more rigorous so its not exactly you get paid more to work the same amount as a Rheum or ID doc.

Cards will take the grunt of the hits form CMS cuts for years to come (ie you'll have to work harder for lesser pay), which goes back to my point about make sure you love what you do otherwise you'll be miserable.

OP

As always thanks for your ever useful input.

Few things to consider- I contacted a physician recruiter (yes I know I'm a student but still) and he gave me some information. I dont see any reason for him to lie but its possible he's not completely knowledgeable about how things are.

He said in terms of jobs look for mid city markets in certain areas NC, Tennessee, Texas, Virginia (virginia beach) etc. this is fine- but he also said this:

Look for cal 5:1 in a midlevel size group (5-6 empoyees) in a mid size town/city. You can expect starting salary at 280k or so. Look for partnership track. In 3-4 years you can expect 350k salary or higher.

He also said that this is something readily feasible if you look hard enough.

None of these seem troubling to me. I don't mind 5:1 call with most of them being telephone for gen cards (this was for non invasive cardiology btw).

Whats your take on this? Too rosy a picture? pitfalls?

 

[gutonc]

This...

Few things to consider- I contacted a physician recruiter (yes I know I'm a student but still) and he gave me some information.

...and this...

I dont see any reason for him to lie

show an impressive cognitive disconnect (or perhaps just lack of experience) on your part.

About the only thing you can count on a recruiter do reproducibly is lie.

 

[sanj238]

This...

...and this...

show an impressive cognitive disconnect (or perhaps just lack of experience) on your part.

About the only thing you can count on a recruiter do reproducibly is lie.

Not sure about the cognitive disconnect part.

I mentioned the lying part because I told him I'm just a medical student- so I felt, since I'm not about to be recruited he didn't really need to lie to me- what benefit for him. Not that he absolutely won't lie.

 

[Trifling Jester]

As always thanks for your ever useful input.

Few things to consider- I contacted a physician recruiter (yes I know I'm a student but still) and he gave me some information. I dont see any reason for him to lie but its possible he's not completely knowledgeable about how things are.

He said in terms of jobs look for mid city markets in certain areas NC, Tennessee, Texas, Virginia (virginia beach) etc. this is fine- but he also said this:

Look for cal 5:1 in a midlevel size group (5-6 empoyees) in a mid size town/city. You can expect starting salary at 280k or so. Look for partnership track. In 3-4 years you can expect 350k salary or higher.

He also said that this is something readily feasible if you look hard enough.

None of these seem troubling to me. I don't mind 5:1 call with most of them being telephone for gen cards (this was for non invasive cardiology btw).

Whats your take on this? Too rosy a picture? pitfalls?

Not sure what you mean by mid city markets. 280 would be for the bigger cities in those states like Houston, dallas, Austin, Memphis, Nashville etc etc. And I think 280 would be on the lower end of the pay scale. Call is totally variable and depends on location and practice type. Some places take call more often but never go in and never get called. Busier places have call less frequently but are always going in or getting called.

 

[sanj238]

Not sure what you mean by mid city markets. 280 would be for the bigger cities in those states like Houston, dallas, Austin, Memphis, Nashville etc etc. And I think 280 would be on the lower end of the pay scale. Call is totally variable and depends on location and practice type. Some places take call more often but never go in and never get called. Busier places have call less frequently but are always going in or getting called.

280 is on the low end for general cards (non-invasive/non-interventional?) What would a gen cards look at 3-4 years down the road? Or is the ceiling fairly low?

How about partnership- do PP still offer this? It seems like a quick glance over of available jobs shows significant number of existing and new PPs around the country- even though many are bought out by hospitals. Why do some still exist? Why haven't hospitals expanded into here- I guess what I really want to know is- will they still exist in 5-10 years?

 

[Trifling Jester]

280 is on the low end for general cards (non-invasive/non-interventional?) What would a gen cards look at 3-4 years down the road? Or is the ceiling fairly low?

How about partnership- do PP still offer this? It seems like a quick glance over of available jobs shows significant number of existing and new PPs around the country- even though many are bought out by hospitals. Why do some still exist? Why haven't hospitals expanded into here- I guess what I really want to know is- will they still exist in 5-10 years?

General cards. For the most part interventional only pays nominally more than general. You could make more money reading a bunch of normal nuc scans in the time I could do a complicated PCI. Your ceiling depends on how many reads you get, your referral base, if you own the scanners etc. You can't just throw out a number for something like that because there's too many variables.

I think any speculation about 5 years down the road is an educated guess at best. People don't really know what the ACO's and Obamacare will do. Most people I've spoken to think PP will become extinct and everyone will work for the hospital, but there are still PP hiring and offering "partnership." What partnership really means is a whole 'nother conversation. I don't think PP would be hiring if they were going out of business, but that's just my opinion.

 

[sanj238]

General cards. For the most part interventional only pays nominally more than general. You could make more money reading a bunch of normal nuc scans in the time I could do a complicated PCI. Your ceiling depends on how many reads you get, your referral base, if you own the scanners etc. You can't just throw out a number for something like that because there's too many variables.

I think any speculation about 5 years down the road is an educated guess at best. People don't really know what the ACO's and Obamacare will do. Most people I've spoken to think PP will become extinct and everyone will work for the hospital, but there are still PP hiring and offering "partnership." What partnership really means is a whole 'nother conversation. I don't think PP would be hiring if they were going out of business, but that's just my opinion.

I think the issue of PP being sold to hospitals may be a bit premature. I'm basing this not at all on the medical business world but on my own observations of business in this country. That PPs are being sold maybe more of a cyclical issue. It may be that poor business choices and over aggressive practices that did not take into account sudden drops in reimbursements may have accounted for the sales. I mean why do they sell? Most likely because the profitability was outweighed by a variety of cost factors (actual financial cost, increased time cost, fears of the future, retirements, etc.) I suspect that in the future, perhaps nimbler physicians who are training in this current environment may find a more financially feasible way to be profitable (smaller, lowered expectations etc).

In other words, for PP to go the way of the Dinosaur would imply that there are significant structural cost benefit issues weighing on the cost side. This is entirely possible- but it would mean that hospitals would be moving into every nook and cranny of the USA (where else would cardiologists work?). That means there would have to be some sort of ObamaCare type legislation that makes this substantially easier (rather than just reimbursement cuts). I'm not saying this won't happen- just that it seems a bit too extreme of a eventuality. My best guess from a purely economics standpoint is that financially what will happen is that as more physicians retire and as people become acclimatized to the current medical fiscal situation more nimbler PP services will start to rise again. I think the hospital way of doing business will start to reach roadblocks mainly due to the law of large sizes - many insurance companies are extremely wary of hospitals that command too strong a financial control in an area and can charge more than what they should. In fact, one of the strengths of PP until now was that many insurance companies had the price control due to a variety of options (and bargaining power as a result).

Don't forget that insurance and hospitals don't see eye to eye and it may be possible to realign interests in the favor of physicians down the road- especially in highly variable fields like cardiology where reimbursements have swung too far down and more and more physicians in CV are retiring- along with a significantly aging population.

 

[IMDoc607]

Don't hold your breath. You be surprise how long some physicians choose to keep practicing. It may not even be a monetary issue, some just don't like the idea of staying home and being "retired". Seeing patients in clinic and reading studies (echo/nuc/ekg/etc) doesn't require great deal of strength, the more seniors ones generally cut back on their call hours. And if you look at that article not surprisingly the highest concentration of cardiologist are in big cities; the demand for cardiologist will not be increasing in any of the major metropolitan areas across the country anytime in the foreseeable future.

As far as Sanj238 question regarding the exact numbers refer to my earlier post regarding more specifics of the numbers currently being thrown around for Gen cards and IC. If you can find a job you like in a city you like to the live in general the starting salary is higher than internist or some of the other medicine sub-specialties but I would argue Cards fellowship is a tougher fellowship training (schedule/call/etc) than most IM fellowships and once you do practice your "call schedule" and how busy you are also on average more rigorous so its not exactly you get paid more to work the same amount as a Rheum or ID doc.

Cards will take the grunt of the hits form CMS cuts for years to come (ie you'll have to work harder for lesser pay), which goes back to my point about make sure you love what you do otherwise you'll be miserable.

OP

Who is to say cards will take the grunt of the hits? GI is bringing in close to that amount of money to. I think the huts will be equal across the board but cardiologists are just so pessimistic.

 

[OptimusPrime]

Who is to say cards will take the grunt of the hits? GI is bringing in close to that amount of money to. I think the huts will be equal across the board but cardiologists are just so pessimistic.

My friend its not pessimism. Its what is happening now. The field is under fire partially because bad apples among our midst gave the field a black eye (inappropriate stenting/nucs/etc) and the lovely SGR formula decided to drive PP into the ground. We have been getting hit every year since I started keeping track (~4 years now). Has GI been getting hit too? (not trying to sound sarcastic, I don't know about your field and would appreciate you enlightening me).

OP

 

[sanj238]

My friend its not pessimism. Its what is happening now. The field is under fire partially because bad apples among our midst gave the field a black eye (inappropriate stenting/nucs/etc) and the lovely SGR formula decided to drive PP into the ground. We have been getting hit every year since I started keeping track (~4 years now). Has GI been getting hit too? (not trying to sound sarcastic, I don't know about your field and would appreciate you enlightening me).

OP

Do you think this will continue indefinitely? I mean don't the powers that be realize the foolishness of driving away good physicians from Cardiology? Especially when there's such a high need....

 

[OptimusPrime]

Do you think this will continue indefinitely? I mean don't the powers that be realize the foolishness of driving away good physicians from Cardiology? Especially when there's such a high need....

Indefinitely? Maybe going too far but as long as we stay such a large CMS target (think of how many americans across the country currently have cardiovascular problems and carry medicare/medicaid alike) than yes reimbursements will be cut and scrutinized because everyone now realizes this country has been living on borrowed money and trying to balance the freaking budget. Hence government (CMS) sectors are trying to find ways to cut cost. When CMS looks at who is number cost offender year after year guess whose name shows up.

Don't get me wrong... most cardiologist make more than enough to live a comfortable life but they are working harder now for same or even less than they made 5-10 years ago (again this may also be true about other line of physicians).

"high need" This will never be addressed! Even if reimbursements were not being cut. This is just stupidity of this argument. Yes we need more cardiologist (as I'm sure can be said about more OB, more Rheum, more etc) but it has to do with population that lives in cities not otherwise desirable by the masses (ie the rural cities/towns). Trust me nobody in LA, Chicago, NYC (get the point) is saying we have too many patients and not enough cardiologist (or OB, Rheum, so forth). If a city is worth living (good schools/housing/seasons/things to do) than they have physicians of all kind on every block.

OP

 

[IMDoc607]

My friend its not pessimism. Its what is happening now. The field is under fire partially because bad apples among our midst gave the field a black eye (inappropriate stenting/nucs/etc) and the lovely SGR formula decided to drive PP into the ground. We have been getting hit every year since I started keeping track (~4 years now). Has GI been getting hit too? (not trying to sound sarcastic, I don't know about your field and would appreciate you enlightening me).

OP

Actually I am a cardiology fellow. However, given the recent spot light on colonoscopy and GI procedures I wouldn't be surprised in the least bit if GI was up next. I understand cardiology has been getting hit every year but so have many other fields. I follow reimbursement changes in most fields out of curiousity. They have been hit from the ASC standpoint. I understand what you mean when you say it is not pessimism. I also understand its actively happening, but I don't think it will last forever. I just came out of a PCI that lasted 3 hours. How can they expect physicians to work and perform such high level procedures and not pay? Am I advocating paying per stent or $5,000 per procedure? Absolutley not but I do feel that if you are an interventionalist or busy general cardiologist, you should not be making any less than $400,000. I guess I have a different view of things. If I was making $400,000 working long hours but doing something I enjoy I would be more than satisfied. I think people need to learn to diversify their income. The days are gone for most if not all jobs (not just medicine) where you can make it big from one solo job. Smart invesments, savings, and other endeavors can make your $400,000/year 10 years into practice go alot farther.

Thanks for your insight as its nice to hear from someone realistic as opposed to the high numbers all the time.

 

[OptimusPrime]

Actually I am a cardiology fellow. However, given the recent spot light on colonoscopy and GI procedures I wouldn't be surprised in the least bit if GI was up next. I understand cardiology has been getting hit every year but so have many other fields. I follow reimbursement changes in most fields out of curiousity. They have been hit from the ASC standpoint. I understand what you mean when you say it is not pessimism. I also understand its actively happening, but I don't think it will last forever. I just came out of a PCI that lasted 3 hours. How can they expect physicians to work and perform such high level procedures and not pay? Am I advocating paying per stent or $5,000 per procedure? Absolutley not but I do feel that if you are an interventionalist or busy general cardiologist, you should not be making any less than $400,000. I guess I have a different view of things. If I was making $400,000 working long hours but doing something I enjoy I would be more than satisfied. I think people need to learn to diversify their income. The days are gone for most if not all jobs (not just medicine) where you can make it big from one solo job. Smart invesments, savings, and other endeavors can make your $400,000/year 10 years into practice go alot farther.

Thanks for your insight as its nice to hear from someone realistic as opposed to the high numbers all the time.

I agree with everything you say. Last forever? Of course not. Nothing lasts forever. But it will significantly impact the field of practice during our practice career lifetime. You are able to do 3 hour procedures because you're a fellow in a teaching facility (I assume) and academia are salaried. They get paid same baseline regardless if they do 1 or 10 caths in a day. They have RVU and research base things but anyways. Private practice IC docs don't do 3 hour long complex interventions anymore. They refer to closest academic institution for complex intervention. Because the PP IC docs gets paid the same (pretty much) if the intervention took 15mins or 3 hours. You can see how as a PP guy they rather be in clinic seeing patients or readings studies etc.

Unfortunately CMS doesn't understand what exactly goes into cardiac procedures (time, risk, etc). It is a very heterogeneous bunch (even diagnostic caths can be straight forward or complicated depending on anatomy, access and so forth. But CMS just bundles it all into one coding. IR if I understand correctly bills for everything they use/do so forth so better reimbursement. Cards we get bundles.

Will number of IC docs drop over the next decade... I'm guessing yes. Exactly for reason you mentioned. How can they expected people to do long complicated procedures and take the risk and not be appropriately compensated. The problem is I don't think CMS cares or knows exactly the repercussion of their decisions. EP procedures (ablations) are also getting bundle (hence reduced reimbursement).

Will there be a shift in the policy. Yes. Will it happen over the next 5-10 years. Don't hold your breath.

Finally as I mentioned earlier all physicians (Cards doc) included are a fortunate bunch and make more than enough to get by and live a relatively comfortable lives. Again the paradigm has shifted and you have to work harder for the buck. That's all.

OP

 

[IMDoc607]

I agree with everything you say. Last forever? Of course not. Nothing lasts forever. But it will significantly impact the field of practice during our practice career lifetime. You are able to do 3 hour procedures because you're a fellow in a teaching facility (I assume) and academia are salaried. They get paid same baseline regardless if they do 1 or 10 caths in a day. They have RVU and research base things but anyways. Private practice IC docs don't do 3 hour long complex interventions anymore. They refer to closest academic institution for complex intervention. Because the PP IC docs gets paid the same (pretty much) if the intervention took 15mins or 3 hours. You can see how as a PP guy they rather be in clinic seeing patients or readings studies etc.

Unfortunately CMS doesn't understand what exactly goes into cardiac procedures (time, risk, etc). It is a very heterogeneous bunch (even diagnostic caths can be straight forward or complicated depending on anatomy, access and so forth. But CMS just bundles it all into one coding. IR if I understand correctly bills for everything they use/do so forth so better reimbursement. Cards we get bundles.

Will number of IC docs drop over the next decade... I'm guessing yes. Exactly for reason you mentioned. How can they expected people to do long complicated procedures and take the risk and not be appropriately compensated. The problem is I don't think CMS cares or knows exactly the repercussion of their decisions. EP procedures (ablations) are also getting bundle (hence reduced reimbursement).

Will there be a shift in the policy. Yes. Will it happen over the next 5-10 years. Don't hold your breath.

Finally as I mentioned earlier all physicians (Cards doc) included are a fortunate bunch and make more than enough to get by and live a relatively comfortable lives. Again the paradigm has shifted and you have to work harder for the buck. That's all.

OP

This may be wishful thinking but I think that for someone like myself and you we are coming into medicine at a time of change. For good? Doubt it. For bad? Depends who you speak to. With that being said, at least we are not seeing the money being dragged from our hands. I believe that things are cyclical. Once cardiology stops being #1 in cost, you will have radiology or GI take over. Radiology is constantly getting hit just like cardiology. Then you will see a shift in the reimbursement cuts. Either way, if I am working hard and "only" pulling it $400,000 to $450,000 then I'll be thrilled. I don't need more than that. In addition, I pay attention to things outside of medicine that many in our field just don't. I am a firm believer of making income via different avenues. I have no problem taking risk and investing in things that could fail. (eg real estate, stocks, options, etc) It's all about balancing out risks versus benefits. Most doctors I know who are financially successful arn't just doing medicine. They take what they make and use it appropriately.

Regarding the saturation of the field, I think that will change over the next 5-10 years.

What a way to drag this thread off topic! lol

My bad

 

[sanj238]

This may be wishful thinking but I think that for someone like myself and you we are coming into medicine at a time of change. For good? Doubt it. For bad? Depends who you speak to. With that being said, at least we are not seeing the money being dragged from our hands. I believe that things are cyclical. Once cardiology stops being #1 in cost, you will have radiology or GI take over. Radiology is constantly getting hit just like cardiology. Then you will see a shift in the reimbursement cuts. Either way, if I am working hard and "only" pulling it $400,000 to $450,000 then I'll be thrilled. I don't need more than that. In addition, I pay attention to things outside of medicine that many in our field just don't. I am a firm believer of making income via different avenues. I have no problem taking risk and investing in things that could fail. (eg real estate, stocks, options, etc) It's all about balancing out risks versus benefits. Most doctors I know who are financially successful arn't just doing medicine. They take what they make and use it appropriately.

Regarding the saturation of the field, I think that will change over the next 5-10 years.

What a way to drag this thread off topic! lol

My bad

This is a perfectly appropriate comment for this thread. My question was about the future of cards as much as about the economic climate associated with medicine.

I feel that there needs to be something done to protect physicians. If you had to look back and say hey you know what, I wish I had done x y and z or the cardiology people had done X Y an Z to protect us better or explain our position better what would it be?

No need to bash the AMA- we know they haven't helped much- I'm just trying to look into the future and identify what can be done to help our generation.

I know people say lets band together or people need to stand together etc. But I'm looking for something deeper. Any thoughts? Where to begin, etc?

 

[Silent Cool]

This may be wishful thinking but I think that for someone like myself and you we are coming into medicine at a time of change. For good? Doubt it. For bad? Depends who you speak to. With that being said, at least we are not seeing the money being dragged from our hands. I believe that things are cyclical. Once cardiology stops being #1 in cost, you will have radiology or GI take over. Radiology is constantly getting hit just like cardiology. Then you will see a shift in the reimbursement cuts. Either way, if I am working hard and "only" pulling it $400,000 to $450,000 then I'll be thrilled. I don't need more than that. In addition, I pay attention to things outside of medicine that many in our field just don't. I am a firm believer of making income via different avenues. I have no problem taking risk and investing in things that could fail. (eg real estate, stocks, options, etc) It's all about balancing out risks versus benefits. Most doctors I know who are financially successful arn't just doing medicine. They take what they make and use it appropriately.


Regarding the saturation of the field, I think that will change over the next 5-10 years.

What a way to drag this thread off topic! lol

My bad

+1

 

[dragonfly99]

280k quoted by the recruiter to the medical student...I think that is a fair ballpark of what you may get in the nonsaturated areas but in a decent city or town where some people would "want" to work but not everyone. I assume people are getting screwed over in places like Chicago, LA, NYC, simply because more cardiologists, in particular interventionalists, are not really needed there. I got 270k 1.5 years ago, in an employed position (plus get some CME allowance, etc., and small bonuses periodically so 280k would be a good estimate of my compensation). This is for general cards (invasive). But you will have to work fairly hard for that money - all the cardiologists I know work more hours than outpatient primary care, renal, hospitalists, etc.

 

[IMDoc607]

280k quoted by the recruiter to the medical student...I think that is a fair ballpark of what you may get in the nonsaturated areas but in a decent city or town where some people would "want" to work but not everyone. I assume people are getting screwed over in places like Chicago, LA, NYC, simply because more cardiologists, in particular interventionalists, are not really needed there. I got 270k 1.5 years ago, in an employed position (plus get some CME allowance, etc., and small bonuses periodically so 280k would be a good estimate of my compensation). This is for general cards (invasive). But you will have to work fairly hard for that money - all the cardiologists I know work more hours than outpatient primary care, renal, hospitalists, etc.

Fair enough…if you do interventional you'll probably start at least 300K. Who is to say a cardiologist is worth more than that to start? People in medicine need to realize (not saying you don't…..your experience is lightyears ahead of ours) that our society does not value the medical profession. All the way up from the RN to the physicians…There is only so much they will pay physicians. If you read articles about physician pay you will see the comments from people regarding our compensation. Some of the things being said will be…"ungodly salaries"…"extreme compensation", etc

Personally, if I start at 300K as an interventionalist I'll be happy. Is that the way it use to be? No and I understand that. However, I will not only rely on interventional procedures. Who is to say you can't contract with a PCP who does echoes in his office? Read all his studies for him? That could bring in some extra cash if he's a busy. I will do cardiology for a nice salary and enjoyment. Will my attitude change? Probably lol but we'll see.

Thanks for your insight dragon.

 

[Trifling Jester]

Keep in mind that recruiters usually offer the positions that have more trouble filling. The best spots I heard of were from word of mouth, who you know etc. If you have a good rep your name will get passed along to groups looking to hire new people.

 

[sanj238]

280k quoted by the recruiter to the medical student...I think that is a fair ballpark of what you may get in the nonsaturated areas but in a decent city or town where some people would "want" to work but not everyone. I assume people are getting screwed over in places like Chicago, LA, NYC, simply because more cardiologists, in particular interventionalists, are not really needed there. I got 270k 1.5 years ago, in an employed position (plus get some CME allowance, etc., and small bonuses periodically so 280k would be a good estimate of my compensation). This is for general cards (invasive). But you will have to work fairly hard for that money - all the cardiologists I know work more hours than outpatient primary care, renal, hospitalists, etc.

How many hours are we talking about? 80 hours? 70? 60?

 

[OptimusPrime]

Personally, if I start at 300K as an interventionalist I'll be happy. Is that the way it use to be? No and I understand that. However, I will not only rely on interventional procedures. Who is to say you can't contract with a PCP who does echoes in his office? Read all his studies for him? That could bring in some extra cash if he's a busy. I will do cardiology for a nice salary and enjoyment. Will my attitude change? Probably lol but we'll see.

Is 300K alot of money? Yes. But lets put that in perspective. Just one example the summer of my junior year of high school I worked part time at TraderJoes. I honestly can't remember the hourly wage but probably little more than minimum wage. By the end of that summer my work ethics had impressed the manager where I was offered a raise as well as a promotion up their chain. I turned it down as it was only part time and I was off to college. Now if I was in it for the money I could have stayed and within 6-7 years could have been promoted up the chain to store manager (salary ~120-140K).

Now the path I chose: college (4 years), med school (4 years), med residency (3 years), cardiology fellowship (3 years), now IC fellowship (1 year... although trend is heading toward 2 if you want peripheral or structural as coronary numbers/reimbursement down). So roughly 15-16 years after high school I'm finally ready to join the actual work force. Most people in my situation that don't come from family wealth also have some where between 75K-100K up to as high as 200+K (if you went to alot of private schools) in loans which have been accruing interest during your residency/fellowship (6-7 years) to also pay off once you do finally get a job.

In comparison the TraderJoe personality has made somewhere in ball park of $850K over the past 7 years. That is assuming I didn't move further up their chain of command and stayed at 120K a year.

Food for thought when you say 300K is alot of money.

Generally speaking physicians make more than the average American but than again most physicians have sacrificed more and continue to do so on daily basis so the salary is justified in my mind. These polls and stories saying physicians make too much ("ungodly salary") never show the path and sacrifices it took to get there or what we must live with every day. Most of these people would piss their pants if its 3AM and they're the ones in the room with someone actively trying to die from acute ant wall STEMI in cardiogenic shock and everyone in the room from the nurses/techs/ED attending looking at you to QB this thing and get this patient to live to morning. Tell the crooked wallstreet personalities that gambled millions of americans savings based on their greed and still get paid 7 figure salaries that "we" the physicians make "ungodly salary".

In my mind we hardly get paid our actual value except for the crooks in this field that do way too many unnecessary procedures and over the recent years have given our field a black eye.

OP

 

[IMDoc607]

Is 300K alot of money? Yes. But lets put that in perspective. Just one example the summer of my junior year of high school I worked part time at TraderJoes. I honestly can't remember the hourly wage but probably little more than minimum wage. By the end of that summer my work ethics had impressed the manager where I was offered a raise as well as a promotion up their chain. I turned it down as it was only part time and I was off to college. Now if I was in it for the money I could have stayed and within 6-7 years could have been promoted up the chain to store manager (salary ~120-140K).

Now the path I chose: college (4 years), med school (4 years), med residency (3 years), cardiology fellowship (3 years), now IC fellowship (1 year... although trend is heading toward 2 if you want peripheral or structural as coronary numbers/reimbursement down). So roughly 15-16 years after high school I'm finally ready to join the actual work force. Most people in my situation that don't come from family wealth also have some where between 75K-100K up to as high as 200+K (if you went to alot of private schools) in loans which have been accruing interest during your residency/fellowship (6-7 years) to also pay off once you do finally get a job.

In comparison the TraderJoe personality has made somewhere in ball park of $850K over the past 7 years. That is assuming I didn't move further up their chain of command and stayed at 120K a year.

Food for thought when you say 300K is alot of money.

Generally speaking physicians make more than the average American but than again most physicians have sacrificed more and continue to do so on daily basis so the salary is justified in my mind. These polls and stories saying physicians make too much ("ungodly salary") never show the path and sacrifices it took to get there or what we must live with every day. Most of these people would piss their pants if its 3AM and they're the ones in the room with someone actively trying to die from acute ant wall STEMI in cardiogenic shock and everyone in the room from the nurses/techs/ED attending looking at you to QB this thing and get this patient to live to morning. Tell the crooked wallstreet personalities that gambled millions of americans savings based on their greed and still get paid 7 figure salaries that "we" the physicians make "ungodly salary".

In my mind we hardly get paid our actual value except for the crooks in this field that do way too many unnecessary procedures and over the recent years have given our field a black eye.

OP

Awesome post that I would't argue with one bit. I agree that we are underpaid and under appreciated. However, I have come to accept that our society does not value the medical field. With that being said, I love this stuff and will look for alternative sources of income so I can enjoy it and not be bitter.

Again, you're 100% on the mark and I am not trying to imply you are or were ever wrong.