Future

[cbtk18]

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These CMS cuts are very daunting. As a MS4 I have really fallen in love with rads and pot committed to it in for applying in the the fall. I know that as a radiologist, I would love what I do and would be compensated well. But with the constant hammer being put down on medicine and radiology in particular, where is the incentive to do a strenuous 6 year train in program when I could do a 3 year one in EM or something and come out making the same?

 

[Medstudentquest]

These CMS cuts are very daunting. As a MS4 I have really false. In love with rads and pot committed to it in for applying in the the fall. I know that as a radiologist, I would love what I do and would be compensated well. But with the constant hammer being put down on medicine and radiology in particular, where is the incentive to do a strenuous 6 year train in program when I could do a3 year one in EM or something and come out making tube same?

Yep, this is what I keep saying. Although rads is an awsome field, if it keeps getting hammered like this and starts making crap, there is no reason people would continue busting their butts for year in a challenging field like this. Same with other fields that take years. Internists are starting at 300k at some places in high need. I guess the gov no longer wants radiologists and think PCPs can do everything with no specialists.

 

[shark2000]

Yep, totally agree.

Now I highly recommend you guys to switch out to ED or family practice and land your dream job of 300K. You can do it easily instead of wasting your time on an internet forum.

 

[cbtk18]

Yep, totally agree.

Now I highly recommend you guys to switch out to ED or family practice and land your dream job of 300K. You can do it easily instead of wasting your time on an internet forum.

Yeah man, we get it, "I would do rads if it paid FM salaries". We have heard your rhetoric to do something you love. But you know what? I don't think I would LOVE anything in medicine. Would I like it more than every other job in the world? Absolutely.

I think I would enjoy rads a little more then EM, but EM is a 3 year residency and rads is 6 and it will probably start approaching the same salary as EM (if it hasn't already). Do I think I like rads that much more to endure 3 extra years? At this point I don't know.


Specialties are not soul-mates.

 

[Medstudentquest]

Yeah man, we get it, "I would do rads if it paid FM salaries". We have heard your rhetoric to do something you love. But you know what? I don't think I would LOVE anything in medicine. Would I like it more than every other job in the world? Absolutely.

I think I would enjoy rads a little more then EM, but EM is a 3 year residency and rads is 6 and it will probably start approaching the same salary as EM (if it hasn't already). Do I think I like rads that much more to endure 3 extra years? At this point I don't know.


Specialties are not soul-mates.

Precisely this. I like rads, and think it's a great field. But if I will get paid the same as a hospitalist/EM person, then you really gotta wonder what's going on. And the sad thing is that cuts keep occurring. When do they stop? Now they are apparently bundling all scans done on same patient during same admission, and paying 100% for first read, and 50% thereafter. Seriously? That in addition to the cuts that have been happening and further cuts they just announced. I looked at salaries he other day and they are at around 300k, slightly up about 5-10 years out. When I looked maybe 2 years ago, they were in the 400/500s. Even fields like psych are making in the 300's in pp a few years out. It seems we are going down the same road as path man.

 

[cowme]

Precisely this. I like rads, and think it's a great field. But if I will get paid the same as a hospitalist/EM person, then you really gotta wonder what's going on. And the sad thing is that cuts keep occurring. When do they stop? Now they are apparently bundling all scans done on same patient during same admission, and paying 100% for first read, and 50% thereafter. Seriously? That in addition to the cuts that have been happening and further cuts they just announced. I looked at salaries he other day and they are at around 300k, slightly up about 5-10 years out. When I looked maybe 2 years ago, they were in the 400/500s. Even fields like psych are making in the 300's in pp a few years out. It seems we are going down the same road as path man.

so...don't apply in rads then. It seems like you are extremely concerned about salary, and we're all unanimously saying that it's going to keep going down. The problem for you, is any field you chase for salary is going to go downhill by the time you are out.

General surgery used to pay a lot; after cuts they are down to ~250.
Optho used to pay upwards of 750k; now they are down to 250k
Same for ENT.

Rad onc, cards, ortho, and rads are being hit now because they are the highest earners.

I'd bet good money derm and urology are next on the chopping block

 

[Substance]

so...don't apply in rads then. It seems like you are extremely concerned about salary, and we're all unanimously saying that it's going to keep going down. The problem for you, is any field you chase for salary is going to go downhill by the time you are out.

General surgery used to pay a lot; after cuts they are down to ~250.
Optho used to pay upwards of 750k; now they are down to 250k
Same for ENT.

Rad onc, cards, ortho, and rads are being hit now because they are the highest earners.

I'd bet good money derm and urology are next on the chopping block

What the heck is your professional organization doing!? The AMA and the ABR, WTF?!

Furthermore, why don't the docs pay 20 bucks a month towards having good lobbyist presence in Washington? The lawyers certainly do it! I know that the ABR did it back in the 60s when medicare was going through, and it worked for them then.

 

[Asp]

If salaries hit 250k across the board, expect a brain drain from medicine.

Medicine is already plagued by the problem of mediocre talent, even in its top echelons. Remember the amazing medical advancements made in the last 10 years? Yeah, I don't either. The best and brightest don't go into medicine anymore. Drop the ceiling salaries more.. Houston we have a problem.

 

[shark2000]

1- Medicine does not need to have the brightest. We are delusional and think medicine is hard. For practicing as a clinician in pp, you can train an average IQ person and make him the best doctor. Medicine is all about repetition.

2- Most of advancements in medicine does not have anything to do with physicians. Medical imaging is and was developed by physicists. Medications are developed by pharmacists. To me, those fields need smarter people than medicine.

3- Recently I was reading about general job market. While PHDs make 80K, engineers make 60-100K and .... 250K for a doctor is not really low. It is not a bad income and many will do it.

 

[Substance]

1- Medicine does not need to have the brightest. We are delusional and think medicine is hard. For practicing as a clinician in pp, you can train an average IQ person and make him the best doctor. Medicine is all about repetition.

2- Most of advancements in medicine does not have anything to do with physicians. Medical imaging is and was developed by physicists. Medications are developed by pharmacists. To me, those fields need smarter people than medicine.

3- Recently I was reading about general job market. While PHDs make 80K, engineers make 60-100K and .... 250K for a doctor is not really low. It is not a bad income and many will do it.

You're right about #3. 250 is great!

The issue is that the reason medicine gets paid so well is because the public trusts us very much. The pay is like their contract with us: they know we are trustworthy so they give us money, because each of them values their individual health more than anything in the world. They want to be safe knowing that very studious, hardworking smart people will figure out what's wrong with them and be able to treat it.

Lower the pay and you'll get regular people doing it. Yes, its all about repetition, and yes, the average IQ people can make good docs. But the public pays for the high IQs and the best. Once our money goes down they get average people, and once average people are there there's no reason to pay them so much or to trust them so much. This is one of the many reasons why nurses are being considered as equivalent to PCPs.

 

[cowme]

European docs make 1/4 what we make, and they seem to have just fine healthcare outcomes (and much better hours). Better pay does not equate to betters. It equates to higher standardized test scores, which we all know mean jack squat when in most specialties (excluding maybe rads and path, since pattern recognition is important)

 

[deleted103644]

If salaries hit 250k across the board, expect a brain drain from medicine.

Medicine is already plagued by the problem of mediocre talent, even in its top echelons. Remember the amazing medical advancements made in the last 10 years? Yeah, I don't either. The best and brightest don't go into medicine anymore. Drop the ceiling salaries more.. Houston we have a problem.

Right, because there are so many other careers out there that essentially guarantee six figures. *smh*

Medicine attracts risk averse people with at least a partial interest in the sciences. There aren't many good alternatives for this group that are as much of a sure thing.

Also, medical advancements are almost never made by MDs. That's what the PhD's are for (they're also much cheaper than us).

 

[henge]

Right, because there are so many other careers out there that essentially guarantee six figures. *smh*

Medicine attracts risk averse people with at least a partial interest in the sciences. There aren't many good alternatives for this group that are as much of a sure thing.

Also, medical advancements are almost never made by MDs. That's what the PhD's are for (they're also much cheaper than us).

Yup👍

 

[Dermpath]

Right, because there are so many other careers out there that essentially guarantee six figures. *smh*

Medicine attracts risk averse people with at least a partial interest in the sciences. There aren't many good alternatives for this group that are as much of a sure thing.

Also, medical advancements are almost never made by MDs. That's what the PhD's are for (they're also much cheaper than us).

You do realize that PhDs are free and phd students are paid for their training right?? Also they make 100kish in academia where they have no weekend, call or lawsuits. In industry they can make more. Also most are not revolutionizing much of anything.

 

[deleted103644]

You do realize that PhDs are free and phd students are paid for their training right?? Also they make 100kish in academia where they have no weekend, call or lawsuits. In industry they can make more. Also most are not revolutionizing much of anything.

The odds of matching Derm from the Caribbean are better than the odds of actually getting an academic position from a biology PhD. (Haven't crunched the precise numbers, so this may be slightly exaggerated, but not by much.)

Most PhD grads have to spend up to a decade earning far less than a resident physician with far less guaranteed return.

You really don't know what you're talking about. (And PhD's aren't really free - you're spending most of your time as cheap labor for the university doing things of little if any educational value.)

I considered both paths, and there was no question which one is the better deal.

 

[Dermpath]

The odds of matching Derm from the Caribbean are better than the odds of actually getting an academic position from a biology PhD. (Haven't crunched the precise numbers, so this may be slightly exaggerated, but not by much.)

Most PhD grads have to spend up to a decade earning far less than a resident physician with far less guaranteed return.

You really don't know what you're talking about. (And PhD's aren't really free - you're spending most of your time as cheap labor for the university doing things of little if any educational value.)

I considered both paths, and there was no question which one is the better deal.

I don't think you are correct. A PhD full time takes about 4 years, and being married to someone who has one, I can corroborate this. Further, we don't get ANY $$ while we are in med school, while PhD students get a stipend. It's not much (about 30k/yr) but we don't get anything during those 4 years. Also, there is no cost to get a PhD, while an MD is 150k or so plus. So in those 4 years alone, they are winning when compared to us. Then, they have no residency, we have a 3+ year residency, where we make about 50k. A PhD from a good institution can start making 90k+ from the get go. So again, they are winning in that again. Sure, getting tenure and going up more than a regular 3% or so raise for inflation is not all that easy, but they graduate with no debt, and basically making double what we make from the get go. I don't think it's a bad investment. They also don't have to ever be concerned with getting sued, being on call, they get over 3 months off during the summers/holidays if tenured as profs, etc. and their pay goes up significantly once tenured. So again, PhD's are not a bad investment.

 

[deleted103644]

I don't think you are correct. A PhD full time takes about 4 years, and being married to someone who has one, I can corroborate this. Further, we don't get ANY $$ while we are in med school, while PhD students get a stipend. It's not much (about 30k/yr) but we don't get anything during those 4 years. Also, there is no cost to get a PhD, while an MD is 150k or so plus. So in those 4 years alone, they are winning when compared to us. Then, they have no residency, we have a 3+ year residency, where we make about 50k. A PhD from a good institution can start making 90k+ from the get go. So again, they are winning in that again. Sure, getting tenure and going up more than a regular 3% or so raise for inflation is not all that easy, but they graduate with no debt, and basically making double what we make from the get go. I don't think it's a bad investment. They also don't have to ever be concerned with getting sued, being on call, they get over 3 months off during the summers/holidays if tenured as profs, etc. and their pay goes up significantly once tenured. So again, PhD's are not a bad investment.

A PhD full time can take up to 7 years or more, it all depends on your thesis and how your research goes.

And considering you didn't mention the word "postdoc", I still don't think you know what you're talking about.

As a lab technician, I made almost as much money right out of college as all of the PhD's in the lab short of the actual PI. Many of those postdocs were in their 40s, a couple in their 50s.

Working for pharma can be lucrative, but the job stability there isn't anywhere near what it is in medicine (and only the top salaries approach medicine averages).

Short of tenure or a patent, the PhD route is a mistake.

 

[Dermpath]

A PhD full time can take up to 7 years or more, it all depends on your thesis and how your research goes.

And considering you didn't mention the word "postdoc", I still don't think you know what you're talking about.

As a lab technician, I made almost as much money right out of college as all of the PhD's in the lab short of the actual PI. Many of those postdocs were in their 40s, a couple in their 50s.

Working for pharma can be lucrative, but the job stability there isn't anywhere near what it is in medicine (and only the top salaries approach medicine averages).

Short of tenure or a patent, the PhD route is a mistake.

While I respect your opinion, unfortunately I don't agree. Not all phd's need a post doc either-my husband doesn't have one and is doing quite well, some of his phd colleagues who did do post-doc for were doing so for 80k+, so it's not too bad. A 7 year PhD is a little excessive. most people who do it full time and are with it finish much before that. No point in arguing here, but suggesting that PhD's are these poor beings is a little like the idea the public has of nurses being soooo overworked and underpaid.

 

[Asp]

Medicine at 250k will remain a good deal for the average smart person, no question. I agree that it would be difficult for anyone posting in this thread to make that kind of money elsewhere.

But we're talking about attracting top talent here, the kind of people who can rise to the top in any field. These guys can make 7-8 figures on Madison Avenue, Wall Street, or in Silicon Valley. Why would they go to medical school and residency in return for a job that doesn't even land them in the 1% in NY/LA/SF?

Also, pharmacists being innovators? This would be exceedingly rare. Can you even name me one drug that had its intellectual genesis in a practicing pharmacist? Not some PharmD working quality assurance for big pharma, but a practicing pharmacist who actually had the idea for something new? If it sounds ridiculous it's because it is -- pharmacology schools are filled with lesser intellects even when compared with medicine. You don't need to be von Neumann to dispense pills.

On the other hand, physician innovators aren't all pure academic researchers. We have grass roots innovation, because medicine still attracts a small (but ever decreasing) amount of top grade talent.

See for instance--
http://content.healthaffairs.org/content/27/6/1532.full

"There were 26,158 patents granted in the nineteen medical device patent classes identified by the U.S. Patent and Trademark Office from 1990 through 1996, which collectively received more than 344,000 citations. Of these medical device patents, 5,051 (19.3 percent) had at least one inventor who was a licensed physician. Hence, nearly one in five of the patented inventions in this field were invented by doctors or with the participation of doctors."

"Consistent with the idea that physician-inventors are often practicing physicians, almost 60 percent of physician-inventors with identified affiliations worked either in a group practice, two-physician practice, or solo practice (Exhibit 1&#8659😉. In addition, sizable portions work in more complex institutional settings that include medical practice, including medical schools, nongovernment hospitals, and a range of other hospital venues. The core point is that practicing physicians in a wide range of U.S. medical settings commonly engage in medical device inventive activity."

This is the kind of activity that keeps medicine relevant and vital. And enables those of us who are average in comparison and just want a well-paying job, the lifestyle we are afforded.

 

[Silent Cool]

A PhD full time can take up to 7 years or more, it all depends on your thesis and how your research goes.

And considering you didn't mention the word "postdoc", I still don't think you know what you're talking about.

As a lab technician, I made almost as much money right out of college as all of the PhD's in the lab short of the actual PI. Many of those postdocs were in their 40s, a couple in their 50s.

Working for pharma can be lucrative, but the job stability there isn't anywhere near what it is in medicine (and only the top salaries approach medicine averages).

Short of tenure or a patent, the PhD route is a mistake.

Johnnydrama,

I completely agree. A PhD is generally a terrible investment, especially today. I, too, know of people who have hit their 40's and are on their third or fourt post-doc fellowship. And as far as income, even in the private biotech/drug sector (where I used to work), a good starting PhD job at a large company is probably around 100K, plus a yearly bonus and some stock, so maybe more like 130K annual comp. These jobs, however, are very hard to get. Getting an MD was definitely the way to go. With biotechnology and medicine being the next great revolution in science, the absolute best education and background to have will be a medical degree. Hands down. Many people who work in industry are physicians, and it is much easier to get a job there managing clinical research or being a consultant than as a PhD. In general, it is tough to match the higher end incomes in medicine unless you are the VP level or higher. Good luck with that--those people are generally industry veterans or people who spent many years in academic research and published 100's of papers, wrote books, gave talks, patented, etc..--the whole nine yards. There is no way in hell the average doc is capable of this. In short, there are many opportunities that one has with a medical degree and a very high level of job security. I really can't think of any career that, overall, offers a better combination of compensation, professional opportunity and autonomy than medicine.

😎

 

[shark2000]

Medicine at 250k will remain a good deal for the average smart person, no question. I agree that it would be difficult for anyone posting in this thread to make that kind of money elsewhere.

But we're talking about attracting top talent here, the kind of people who can rise to the top in any field. These guys can make 7-8 figures on Madison Avenue, Wall Street, or in Silicon Valley. Why would they go to medical school and residency in return for a job that doesn't even land them in the 1% in NY/LA/SF?

Also, pharmacists being innovators? This would be exceedingly rare. Can you even name me one drug that had its intellectual genesis in a practicing pharmacist? Not some PharmD working quality assurance for big pharma, but a practicing pharmacist who actually had the idea for something new? If it sounds ridiculous it's because it is -- pharmacology schools are filled with lesser intellects even when compared with medicine. You don't need to be von Neumann to dispense pills.

On the other hand, physician innovators aren't all pure academic researchers. We have grass roots innovation, because medicine still attracts a small (but ever decreasing) amount of top grade talent.

See for instance--
http://content.healthaffairs.org/content/27/6/1532.full

"There were 26,158 patents granted in the nineteen medical device patent classes identified by the U.S. Patent and Trademark Office from 1990 through 1996, which collectively received more than 344,000 citations. Of these medical device patents, 5,051 (19.3 percent) had at least one inventor who was a licensed physician. Hence, nearly one in five of the patented inventions in this field were invented by doctors or with the participation of doctors."

"Consistent with the idea that physician-inventors are often practicing physicians, almost 60 percent of physician-inventors with identified affiliations worked either in a group practice, two-physician practice, or solo practice (Exhibit 1&#8659😉. In addition, sizable portions work in more complex institutional settings that include medical practice, including medical schools, nongovernment hospitals, and a range of other hospital venues. The core point is that practicing physicians in a wide range of U.S. medical settings commonly engage in medical device inventive activity."

This is the kind of activity that keeps medicine relevant and vital. And enables those of us who are average in comparison and just want a well-paying job, the lifestyle we are afforded.

You guys get seizures just to think 6 years from now you may not be able to find your 400K job in the middle of Chicago. Just thinking that you may make 200K in a small town 7 years from now or doing 2nd fellowship 5 years from now which gives you around 90-100K gives you arrhythmia. On the other hand you are talking about Wall-street or Madison Avenue. Can you even imagine you can lose all your life in a day or so in those markets?

Medicine is the field of conservatives. It provides you with job security in the long run, but the trade off is the lack of multi-million income and also being under control of government which may decide to decrease your 500K income to 200K in 2-3 years.