Going to be a doctor? Please be aware...

[circulus vitios]

My mommy and daddy aren't on a board of directors and I'm not smart enough to get an Ivy league education, so I guess medicine is as good as it's going to get.

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[Silent Cool]

This is kind of sad that in every other field you have to be a 'hotshot' (know your stuff and work hard) to be successful, yet in medicine you are successful by just being in the field at all. Seems kind of screwed up, huh? Maybe it's changing now. Maybe that's not bad. My point is that people aren't going to stop wanting to do it because it only pays 360k/year instead of 390k/year. They'd still do it for 80k/year. When the other option is unemployment and minimum wage. Most med students and doctors don't know how bad it can really be out there. 80k/year attracts people in every other career field for jobs that require 60-70 hour workweeks. It will do so in medicine as well if that's what it comes to. Working all day every day is not unique to medicine. The only thing that is propping up the incomes is the lobbying power setting the reimbursement rates and the pipeline keeping the supply tight. Take one or both away and watch the bottom fall out. We could drastically reduce healthcare spending by slashing payments to providers and opening the floodgates of residency to FMGs to fill the gaps. Just my opinion.

Bingo.

 

[thefritz]

No, his point holds no water. There is 0 thought given in a power company worker's life to whether or not someone will die if he messes up. Or a railroad worker. It's a horrible *****ic point. The fact that other jobs are integral to society is not relevant.

Spoken like a true arrogant physician. You might want to take a moment to think next time you step on an aircraft. Not just of the pilot who literally has your life in his hands, but of the air traffic controller keeping your jet from colliding with another at 400 mph, or the engineer who designed the redundancy on the avionics or lock nuts on the stabilizers. Or the mechanics that performed the inspections on the powerplant and airframe and signed it off as ok. Or the baggage handler that latched the door properly. Or the airline administrator who designed the policies to eliminate sources of human error. All of those people have resulted in enormously fatal crashes by failing to do their jobs. How brazen it is of you to imply that only doctors are the ones noble enough to give thought to the implications of their job on the lives of others?

No, you just sit smugly in your first class seat, without even paying a thought to how the airplane or the system at large works. Because you are above that. They are your servants. Another martini, stewardess. Oh, they need a doctor for someone on the plane? Now you stare at the floor in anger because now everyone will think you are not a physician lest you admit your profession and open yourself up to all sorts of liability, and we can't have that, can we?

 

[dismorfik]

Wow this thread has become a silly argument comparing apples and oranges. Waste of time to talk about what profession is more important or valuable to society.

Salary is all about supply and demand... I.e. an air traffic controller can be replaced more easily than a physician can be

 

[Wordead]

Spoken like a true arrogant physician. You might want to take a moment to think next time you step on an aircraft. Not just of the pilot who literally has your life in his hands, but of the air traffic controller keeping your jet from colliding with another at 400 mph, or the engineer who designed the redundancy on the avionics or lock nuts on the stabilizers. Or the mechanics that performed the inspections on the powerplant and airframe and signed it off as ok. Or the baggage handler that latched the door properly. Or the airline administrator who designed the policies to eliminate sources of human error. All of those people have resulted in enormously fatal crashes by failing to do their jobs. How brazen it is of you to imply that only doctors are the ones noble enough to give thought to the implications of their job on the lives of others?

No, you just sit smugly in your first class seat, without even paying a thought to how the airplane or the system at large works. Because you are above that. They are your servants. Another martini, stewardess. Oh, they need a doctor for someone on the plane? Now you stare at the floor in anger because now everyone will think you are not a physician lest you admit your profession and open yourself up to all sorts of liability, and we can't have that, can we?

Or the McDonald's worker who has to think carefully about washing his hands lest he begin a Neurocysticercosis epidemic that claims the lives of millions. Sure.

And why thank you.

 

[OCDEMS]

I disagree. If you put up a general poll, chances are any profession that earns more than 100k will be thought as being overpaid. CEOs, rap stars, basketball players and doctors have one thing in common; they make more money than the average person. When that income exceeds a certain threshold (I use 100k since it's a nice round number and frankly makes sense), then there will be a general sense that those people are overpaid, regardless of the difficulty, training and worth to society.



Again, I disagree. Doctors are highly respected throughout society. That respect have gone down a couple notches, but the profession, as a whole, is still one of the most trusted and most respected in the nation.

Valid points. On principle, I would agree with what you're saying. I wasn't trying to indicate that a plurality of people think that way, but rather that there are enough people who do think this way to be dangerous. I say all this from the standpoint of self-preservation as a profession, not necessarily from any point of moral superiority. It's pure marketing, especially in today's world. Yes, doctors do amazing things. Yes, they do still sit at the center of an amazingly complex system that produces great value to society. But, in the end, we also live a world that is far more interconnected than at any time in the past. Unfortunately, thoughts and feelings can all too easily overcome fact in today's age. This type of phenomenon exist in other places within our culture that are too numerous to count.

My point is that if the profession allows others to speak on their behalf, to set the tone of the discussion, then even the most respected professionals have the potential to lose ground. There is the dollars and cents value that physicians create for their customers (patients) and then there is the intrinsic, feel-good value that is hard to quantify. There are plenty of MBAs who are more than willing to quantify the value of an individual physician, but there is definitely a battle to still be fought on the latter.

 

[thefritz]

Or the McDonald's worker who has to think carefully about washing his hands lest he begin a Neurocysticercosis epidemic that claims the lives of millions. Sure.

And why thank you.

I knew you were going to go straight to the fast food argument. Let me break it down for you since this is so incredibly difficult for you to comprehend. There are other professions besides medicine that involve the saving of lives and prevention of dying. There are other professions besides medicine that carry equal amounts of responsibility. Lots of these professions don't pay nearly as much simply because they are subject to normal labor market forces, which physicians are largely exempt from. There are also jobs out there that require minimal responsibility, little if any critical thinking or reasoning, and virtually no skill. These jobs pay at or near minimum wage. Not every job outside of medicine is equivalent to mindless minimum wage labor. I am not sure if you are trolling or if you really are convinced that the world runs for you and without your professional services at $500/hr, it would crumble to pieces. Before I went through med school, I didn't think anybody could be that dense, but now I am seeing it more and more everyday.

 

[thefritz]

Salary is all about supply and demand... I.e. an air traffic controller can be replaced more easily than a physician can be

Keep on believing this. You can be outsourced in a second if it comes to that. Hundreds of thousands of mostly already trained foreign FMGs chomping at the bit in waiting.
Also, it takes about three years to put an ATC through the pipeline and in a tower alone. Residency is 3 years long. Last time I checked, there was no shortage of MDs applying to residency. Pipeline starts at residency, not med school. Make more residency spots you get more doctors. Make more med school slots, you get more non BE/BC MDs.

 

[notbobtrustme]

I knew you were going to go straight to the fast food argument. Let me break it down for you since this is so incredibly difficult for you to comprehend. There are other professions besides medicine that involve the saving of lives and prevention of dying. There are other professions besides medicine that carry equal amounts of responsibility. Lots of these professions don't pay nearly as much simply because they are subject to normal labor market forces, which physicians are largely exempt from. There are also jobs out there that require minimal responsibility, little if any critical thinking or reasoning, and virtually no skill. These jobs pay at or near minimum wage. Not every job outside of medicine is equivalent to mindless minimum wage labor. I am not sure if you are trolling or if you really are convinced that the world runs for you and without your professional services at $500/hr, it would crumble to pieces. Before I went through med school, I didn't think anybody could be that dense, but now I am seeing it more and more everyday.

It's not just responsibility. It's responsibility plus training. No other profession has this unique blend.

 

[thefritz]

It's not just responsibility. It's responsibility plus training. No other profession has this unique blend.

This couldn't be farther from the truth. Literally in any other industry where a job has a high level of responsibility, there will always be a commensurate level of training. In the real world, nuclear power plant safety inspectors are not homer simpson. When the result of not doing your job competently is a nuclear disaster, I promise there is an enormous amount of training and regulatory oversight from the government as there is in medicine.

 

[thefritz]

Reading comments in threads like these, it's so easy to tell who are the posters who have never worked full-time for a living before. Going straight through college to med school with finances paid for (whether by dad or the bank) leads to a fundamental ignorance about the infrastructure of modern society and the lives non-physicians live.

 

[GadRads]

Reading comments in threads like these, it's so easy to tell who are the posters who have never worked full-time for a living before. Going straight through college to med school with finances paid for (whether by dad or the bank) leads to a fundamental ignorance about the infrastructure of modern society and the lives non-physicians live.

I have held a real job and I have friends who work real jobs. I know several who have been making $60K-$80K plus out of college. You talk as if the average person with the motivation and intelligence of a medical student is living on $20K per year. All my working friends are doing way better than myself. There was a Vegas trip planned that would have cost me $1000 and I couldn't afford it, but most of my friends could. Two of them currently drive Audi's.

Again, feel free to donate your salary when you become an attending. Talk is cheap.

 

[DrBodacious]

Yep, a lot of naive talk here. Reimbursements are already underpriced, plain and simple. I am a new attending this year (ENT), for perspective. Payers, including Medicare, target the high volume procedures to cut. I. E. Tonsillectomy, which has a 90 day global period makes from $180 to $300,http://www.entnet.org/HealthInformation/TonsillectomyFactsFromENTs.cfm depending on payor (excluding medicaid). Medicare pays just above $200, currently. This includes: any preoperative insurance authorizations, preoperative scheduling and other paperwork, 20-30 min of pre/postoperative discussion with pt and/or parents, 15-20 min surgery time, post-op orders/dictation/Rx, being on call and troubleshooting any parent questions, follow up appointment(s), possible middle of the night ER visit for bleeding (5% incidence for bleed). All of this plus covering the associated billing and staff overhead while you are performing these activities (keeping the lights on).

(As an aside/subrant, I didn't mention information technology costs: A contracted IT company makes about $85 to $100/hr, and every employee who works in an EHR system needs at least 1 dedicated computer. 10 employees = 10 computers at $1000 average with 5 yr lifespan, max. Plus expensive peripherals (printers/scanners/fax/camera) a server ($10k), or more long term cost for monthly cloud EHR fees. This is just a brief overview for those of you who think EHR offers cost savings. Yes, paper charts cost money, including more employee cost, but I would say EHR is equal or more $. )

So basically, the way I am making it work is by working 80+ hrs a week with a lot of chart reviewing outside of office hours to make my clinics super efficient. I spend a good 3-4 hours for the next day's 8hr clinic. I am seeing about 25 new patient visits a day, plus about 10 follow ups. I am pre writing notes, reviewing scans and labs, writing likely plans. (Frankly, I don't think all the people I went to medical school with are capable of high volume practice, so they will join a hospital to be salaried.) It is just disheartening to have the prices for what you do "fixed" at an amount that is lower than the fair market value. This pushes doctors in to a coding and cherry picking mentality where people want to only for the best paying things for the easiest patients. Or to put another way, it isn't good enough to just treat patients the way they should be treated, while ignoring the coding and insurance aspects, and expect to be paid fairly. Obviously, on the flip side, this is a mindset which is not helpful to patient care and I am constantly fighting off.

 

[dismorfik]

Keep on believing this. You can be outsourced in a second if it comes to that. Hundreds of thousands of mostly already trained foreign FMGs chomping at the bit in waiting.
Also, it takes about three years to put an ATC through the pipeline and in a tower alone. Residency is 3 years long. Last time I checked, there was no shortage of MDs applying to residency. Pipeline starts at residency, not med school. Make more residency spots you get more doctors. Make more med school slots, you get more non BE/BC MDs.

I hate comparing apples and oranges but I wanted to respond. Remember I'm not saying anything about a profession's importance or worth to society or how many lives a person saves...

Yes, the pipeline is small for air traffic controllers, and many make 100k+ a year because of it. But it's even smaller for physicians in terms of numbers of people capable of entering that pipeline. FMG supply may be high, but demand remains low. I realize that is changing

What is a BE/BC MD?

 

[calvnandhobbs68]

Yep, a lot of naive talk here. Reimbursements are already underpriced, plain and simple. I am a new attending this year (ENT), for perspective. Payers, including Medicare, target the high volume procedures to cut. I. E. Tonsillectomy, which has a 90 day global period makes from $180 to $300,http://www.entnet.org/HealthInformation/TonsillectomyFactsFromENTs.cfm depending on payor (excluding medicaid). Medicare pays just above $200, currently. This includes: any preoperative insurance authorizations, preoperative scheduling and other paperwork, 20-30 min of pre/postoperative discussion with pt and/or parents, 15-20 min surgery time, post-op orders/dictation/Rx, being on call and troubleshooting any parent questions, follow up appointment(s), possible middle of the night ER visit for bleeding (5% incidence for bleed). All of this plus covering the associated billing and staff overhead while you are performing these activities (keeping the lights on).

(As an aside/subrant, I didn't mention information technology costs: A contracted IT company makes about $85 to $100/hr, and every employee who works in an EHR system needs at least 1 dedicated computer. 10 employees = 10 computers at $1000 average with 5 yr lifespan, max. Plus expensive peripherals (printers/scanners/fax/camera) a server ($10k), or more long term cost for monthly cloud EHR fees. This is just a brief overview for those of you who think EHR offers cost savings. Yes, paper charts cost money, including more employee cost, but I would say EHR is equal or more $. )

So basically, the way I am making it work is by working 80+ hrs a week with a lot of chart reviewing outside of office hours to make my clinics super efficient. I spend a good 3-4 hours for the next day's 8hr clinic. I am seeing about 25 new patient visits a day, plus about 10 follow ups. I am pre writing notes, reviewing scans and labs, writing likely plans. (Frankly, I don't think all the people I went to medical school with are capable of high volume practice, so they will join a hospital to be salaried.) It is just disheartening to have the prices for what you do "fixed" at an amount that is lower than the fair market value. This pushes doctors in to a coding and cherry picking mentality where people want to only for the best paying things for the easiest patients. Or to put another way, it isn't good enough to just treat patients the way they should be treated, while ignoring the coding and insurance aspects, and expect to be paid fairly. Obviously, on the flip side, this is a mindset which is not helpful to patient care and I am constantly fighting off.

"Fair market value" doesn't mean anything. The only reason you think you're getting paid below "fair market value" is that tonsillectomy's used to be reimbursed at a higher rate and now they're being paid at a lower rate. You've never been subjected to market forces within the medical profession, "fair market value" has no meaning in the world of insurer payments.

 

[notbobtrustme]

Yep, a lot of naive talk here. Reimbursements are already underpriced, plain and simple. I am a new attending this year (ENT), for perspective. Payers, including Medicare, target the high volume procedures to cut. I. E. Tonsillectomy, which has a 90 day global period makes from $180 to $300,http://www.entnet.org/HealthInformation/TonsillectomyFactsFromENTs.cfm depending on payor (excluding medicaid). Medicare pays just above $200, currently. This includes: any preoperative insurance authorizations, preoperative scheduling and other paperwork, 20-30 min of pre/postoperative discussion with pt and/or parents, 15-20 min surgery time, post-op orders/dictation/Rx, being on call and troubleshooting any parent questions, follow up appointment(s), possible middle of the night ER visit for bleeding (5% incidence for bleed). All of this plus covering the associated billing and staff overhead while you are performing these activities (keeping the lights on).

(As an aside/subrant, I didn't mention information technology costs: A contracted IT company makes about $85 to $100/hr, and every employee who works in an EHR system needs at least 1 dedicated computer. 10 employees = 10 computers at $1000 average with 5 yr lifespan, max. Plus expensive peripherals (printers/scanners/fax/camera) a server ($10k), or more long term cost for monthly cloud EHR fees. This is just a brief overview for those of you who think EHR offers cost savings. Yes, paper charts cost money, including more employee cost, but I would say EHR is equal or more $. )

So basically, the way I am making it work is by working 80+ hrs a week with a lot of chart reviewing outside of office hours to make my clinics super efficient. I spend a good 3-4 hours for the next day's 8hr clinic. I am seeing about 25 new patient visits a day, plus about 10 follow ups. I am pre writing notes, reviewing scans and labs, writing likely plans. (Frankly, I don't think all the people I went to medical school with are capable of high volume practice, so they will join a hospital to be salaried.) It is just disheartening to have the prices for what you do "fixed" at an amount that is lower than the fair market value. This pushes doctors in to a coding and cherry picking mentality where people want to only for the best paying things for the easiest patients. Or to put another way, it isn't good enough to just treat patients the way they should be treated, while ignoring the coding and insurance aspects, and expect to be paid fairly. Obviously, on the flip side, this is a mindset which is not helpful to patient care and I am constantly fighting off.

Okay, so what would you be doing instead? Toil away in IT, earning 1/3rd - 1/5th the money for 40-60 hours/week? Become an investment banker? Work in a biology lab? Water treatment plant supervisor? What would your other career option if you didn't choose medicine which will stay pay you quite handsomely, even if it's not as much as your past peers. Nothing pays as much as your past peers. Your past peers in the '80s/'90s could land a 75k/year job with just a BS (which would be close to 130k today if you count in inflation). Your past peers in the '60s/'70s could have landed a 50k/year job with just a high school diploma (agian, closer to 75k/year if you factor in inflation). Your past peers could work a summer job and pay off their medical school tuition and still have money left over to buy a Chevy.

The 21st century is going to be a story of downward pressure on all professions. Medicine isn't unique nor immune, as much as we'd like it to be. However, it still remains the most stable, most lucrative job that the average person has access to. Are you NFL coach material? Nope. Are you high-powered investment banker material? Probably not. Are you a hotshot software engineer? Maybe, if you put in as much time and effort as you did in medicine. Do you have great business acumen? Maybe, who knows, but the typical business owner fails 2-3 businesses before being successful. In today's financial climate, do you have the resources to fail 3 times while still paying the bills and gaining enough investments for your next venture? Face it, for most medical students, average or high achieving, medicine is the best return on investment you can make, even in the face of declining salary because all other professions have the exact same story being played out. Other professions have an even higher barrier to success than medicine when you factor in earnings. If you want to drive the big cars, have that house on the hill and take those fancy vacations, very few professions will allow that kind of earning potential unless you are in the top 5% in that field.

 

[punkedoutriffs]

Okay, so what would you be doing instead? Toil away in IT, earning 1/3rd - 1/5th the money for 40-60 hours/week? Become an investment banker? Work in a biology lab? Water treatment plant supervisor? What would your other career option if you didn't choose medicine which will stay pay you quite handsomely, even if it's not as much as your past peers. Nothing pays as much as your past peers. Your past peers in the '80s/'90s could land a 75k/year job with just a BS (which would be close to 130k today if you count in inflation). Your past peers in the '60s/'70s could have landed a 50k/year job with just a high school diploma (agian, closer to 75k/year if you factor in inflation). Your past peers could work a summer job and pay off their medical school tuition and still have money left over to buy a Chevy.

The 21st century is going to be a story of downward pressure on all professions. Medicine isn't unique nor immune, as much as we'd like it to be. However, it still remains the most stable, most lucrative job that the average person has access to. Are you NFL coach material? Nope. Are you high-powered investment banker material? Probably not. Are you a hotshot software engineer? Maybe, if you put in as much time and effort as you did in medicine. Do you have great business acumen? Maybe, who knows, but the typical business owner fails 2-3 businesses before being successful. In today's financial climate, do you have the resources to fail 3 times while still paying the bills and gaining enough investments for your next venture? Face it, for most medical students, average or high achieving, medicine is the best return on investment you can make, even in the face of declining salary because all other professions have the exact same story being played out. Other professions have an even higher barrier to success than medicine when you factor in earnings. If you want to drive the big cars, have that house on the hill and take those fancy vacations, very few professions will allow that kind of earning potential unless you are in the top 5% in that field.

QFT, but here's a question. Wouldn't the price of those items (house on a hill, sports car, etc.) go down eventually? I mean, if they don't, then no one will be able to afford them. Are they just going to stay empty or in the showroom?

 

[Jemeni]

DEAR LORD WHAT WILL I EVER DO WITH $366k/year INSTEAD OF 390k/year? HOW WILL I SURVIVE??? OMG IS IT TOO LATE TO DROP OUT?

These kind of posts crack me up. But also they are very sad. So sad.

agreed

 

[DrBodacious]

"Fair market value" doesn't mean anything. The only reason you think you're getting paid below "fair market value" is that tonsillectomy's used to be reimbursed at a higher rate and now they're being paid at a lower rate. You've never been subjected to market forces within the medical profession, "fair market value" has no meaning in the world of insurer payments.

Your post doesn't "mean anything." I explained a general idea of how much cost goes in to the surgeon's fees for a tonsillectomy. In general, reimbursements for procedures correlate with the value, but right now most are below value. I'm trying to give some of you sophomoric medical students an idea of what it will like if you actually go out in practice, rather than pretend like you know something about medical economics and go in to some sort of administration role. Anyone who is complacent with declining fee schedules is a fool.

 

[notbobtrustme]

Your post doesn't "mean anything." I explained a general idea of how much cost goes in to the surgeon's fees for a tonsillectomy. In general, reimbursements for procedures correlate with the value, but right now most are below value. I'm trying to give some of you sophomoric medical students an idea of what it will like if you actually go out in practice, rather than pretend like you know something about medical economics and go in to some sort of administration role. Anyone who is complacent with declining fee schedules is a fool.

Okay, what's your alternative. How can I earn >100k in another field reliably, nevermind 200k or 300k? Lawyer? Yale law students are failing to find Big Law positions. Run a business? I don't have the time, the energy nor the resources to fail 2-3 times before hitting a successful business model. Like I said, you can't just stand from the pulpit and complain about declining reimbursements when you don't offer an alternative. What would you be doing if it weren't for medicine that earns even 1/2 as much? Probably nothing because those jobs are even harder to land. That's not to say you can't live comfortably on 80k/year, but it's not vacations in Italy, living in gated communities, kids attending private school, don't worry about retirement, and driving the big cars kind of money. Look at your peers. I'm assuming you're around 30-35, maybe pushing 40 if you were a non-trad. I'm 31 so I've seen where most of my friends have ended up. I know only 2 people who were more successful than me when I left my job to pursue medicine. The rest of stuck in middle-of-the-road jobs earning 45-50k, maybe pushing 60k. I left a 55k/year job with decent benefits for medicine because I want more than a small house with 2 dinky Hondas. My career path probably would not have allowed for that. Nevermind the personal motivations and desire to contribute to society; I'm talking from a pure financial point of view.

Admittedly this site is a bit watered down, but it does break down the top 10 highest earning fields.
http://www.therichest.com/business/salary/the-top-ten-highest-paying-jobs/

Healthcare professions are 3 of the 10. The other positions are definitely not "easy come" by any stretch of the imagination. The competition for those jobs (CEO, Marketing Manager, Engineering Manager, Scientist) make the competition in medicine look like a joke. You have hundreds of thousands, if not millions, of applicants competing for maybe a few thousand positions. Of that list, probably only the CEO and medical professions will have uncapped earning potential.

Your salary is going down. That sucks and I feel for you since I'll be in that boat in a few years too. The problem is that everyone else's salary is going down too. We just have to deal with it. The median wage in the US has been falling since 1999 when it was at 56k/year (closer to 70k if you take inflation int account). Why do you think so many people have to move back in with their parents? It's simply becoming too hard to make it by yourself. For everyone success story you read on the news (local teen invents "whatever" and earns 200k!) there are probably 10,000 people in the exact same situation who failed.

Medicine is the least ugly girl at the dance. Unless you want to entertain Rosy Palms and her 5 daughters, you don't really have a choice.

 

[KnuxNole]

80k would be considered very high class to the average American

 

[DrBodacious]

Okay, so what would you be doing instead? Toil away in IT, earning 1/3rd - 1/5th the money for 40-60 hours/week? Become an investment banker? Work in a biology lab? Water treatment plant supervisor? What would your other career option if you didn't choose medicine which will stay pay you quite handsomely, even if it's not as much as your past peers. Nothing pays as much as your past peers. Your past peers in the '80s/'90s could land a 75k/year job with just a BS (which would be close to 130k today if you count in inflation). Your past peers in the '60s/'70s could have landed a 50k/year job with just a high school diploma (agian, closer to 75k/year if you factor in inflation). Your past peers could work a summer job and pay off their medical school tuition and still have money left over to buy a Chevy.

The 21st century is going to be a story of downward pressure on all professions. Medicine isn't unique nor immune, as much as we'd like it to be. However, it still remains the most stable, most lucrative job that the average person has access to. Are you NFL coach material? Nope. Are you high-powered investment banker material? Probably not. Are you a hotshot software engineer? Maybe, if you put in as much time and effort as you did in medicine. Do you have great business acumen? Maybe, who knows, but the typical business owner fails 2-3 businesses before being successful. In today's financial climate, do you have the resources to fail 3 times while still paying the bills and gaining enough investments for your next venture? Face it, for most medical students, average or high achieving, medicine is the best return on investment you can make, even in the face of declining salary because all other professions have the exact same story being played out. Other professions have an even higher barrier to success than medicine when you factor in earnings. If you want to drive the big cars, have that house on the hill and take those fancy vacations, very few professions will allow that kind of earning potential unless you are in the top 5% in that field.

I see your point. There are limited resources in the world and an exponential economic growth curve is not sustainable. I like my job, and right now I am financially successful at it.

My point is that there really isn't much more room to cut payments. These people posting about $390 vs $366 don't get it. Doctors in any specialty generally do not make $390K without busting there tail and providing a large volume of services. If fee schedules keep dropping that is just going to lead to doctors resenting their patients. Right now I can justify continuing to see medicaid patients, but if private payors and medicare payments drop, that probably will not be able to continue. Medicaid payments pretty much cover overhead, that's it.

To spell it out another way for you guys: Lets say you want to work 60 hours a week, and you currently collect $650K working those hours. Your overhead is $400K. A 3% cut in reimbursements brings your collections down to $630K. This brings your take home from $250K to $230K, or an 8% decrease.

Also, I am a young doc who is willing to work 80-100 hrs a week. You then need to cut back your hours to 40/wk (health reason, family reason, etc). Many older doctors would rather work 40 hrs or even part time. Working 80 hours/wk is more efficient overhead than working 40 hours a week. Specifically, occupancy, malpractice, and other capital expenses (eg. blood pressure cuffs, AEDs, endoscopy equipment) are more efficient the more you work. If reimbursements tank, part time work as a doctor is going to become non-feasible. Wrosening the doctor shortage issue.

For those of you implying that greedy doctors should quit whining about getting a pay cut, I am trying to show you that is not the case, and that really declining reimbursements are going to negatively affect both access to care and quality of care. It's pretty plain and simple.

 

[Postictal Raiden]

Okay, what's your alternative. How can I earn >100k in another field reliably, nevermind 200k or 300k? Lawyer? Yale law students are failing to find Big Law positions. Run a business? I don't have the time, the energy nor the resources to fail 2-3 times before hitting a successful business model. Like I said, you can't just stand from the pulpit and complain about declining reimbursements when you don't offer an alternative. What would you be doing if it weren't for medicine that earns even 1/2 as much? Probably nothing because those jobs are even harder to land. That's not to say you can't live comfortably on 80k/year, but it's not vacations in Italy, living in gated communities, kids attending private school, don't worry about retirement, and driving the big cars kind of money. Look at your peers. I'm assuming you're around 30-35, maybe pushing 40 if you were a non-trad. I'm 31 so I've seen where most of my friends have ended up. I know only 2 people who were more successful than me when I left my job to pursue medicine. The rest of stuck in middle-of-the-road jobs earning 45-50k, maybe pushing 60k. I left a 55k/year job with decent benefits for medicine because I want more than a small house with 2 dinky Hondas. My career path probably would not have allowed for that. Nevermind the personal motivations and desire to contribute to society; I'm talking from a pure financial point of view.

Admittedly this site is a bit watered down, but it does break down the top 10 highest earning fields.
http://www.therichest.com/business/salary/the-top-ten-highest-paying-jobs/

Healthcare professions are 3 of the 10. The other positions are definitely not "easy come" by any stretch of the imagination. The competition for those jobs (CEO, Marketing Manager, Engineering Manager, Scientist) make the competition in medicine look like a joke. You have hundreds of thousands, if not millions, of applicants competing for maybe a few thousand positions. Of that list, probably only the CEO and medical professions will have uncapped earning potential.

Your salary is going down. That sucks and I feel for you since I'll be in that boat in a few years too. The problem is that everyone else's salary is going down too. We just have to deal with it. The median wage in the US has been falling since 1999 when it was at 56k/year (closer to 70k if you take inflation int account). Why do you think so many people have to move back in with their parents? It's simply becoming too hard to make it by yourself. For everyone success story you read on the news (local teen invents "whatever" and earns 200k!) there are probably 10,000 people in the exact same situation who failed.

Medicine is the least ugly girl at the dance. Unless you want to entertain Rosy Palms and her 5 daughters, you don't really have a choice.

I agree with you on everything, except for the part where you mentioned that physicians' salaries are dropping since 1999. I have done some detailed searching in this matter and found that, with the exception of few specialties, the median income has remained the same if not increased.

This study http://www.turner-white.com/pdf/hp_jan00_phycomp1998.pdf contains information regarding median salaries obtained from MGMA in 1999. Use the inflation calculator http://data.bls.gov/cgi-bin/cpicalc.pl and compare those salaries to those found in recent MGMA reports.

 

[DrBodacious]

Okay, what's your alternative. How can I earn >100k in another field reliably, nevermind 200k or 300k? Lawyer? Yale law students are failing to find Big Law positions. Run a business? I don't have the time, the energy nor the resources to fail 2-3 times before hitting a successful business model. Like I said, you can't just stand from the pulpit and complain about declining reimbursements when you don't offer an alternative. What would you be doing if it weren't for medicine that earns even 1/2 as much? Probably nothing because those jobs are even harder to land. That's not to say you can't live comfortably on 80k/year, but it's not vacations in Italy, living in gated communities, kids attending private school, don't worry about retirement, and driving the big cars kind of money. Look at your peers. I'm assuming you're around 30-35, maybe pushing 40 if you were a non-trad. I'm 31 so I've seen where most of my friends have ended up. I know only 2 people who were more successful than me when I left my job to pursue medicine. The rest of stuck in middle-of-the-road jobs earning 45-50k, maybe pushing 60k. I left a 55k/year job with decent benefits for medicine because I want more than a small house with 2 dinky Hondas. My career path probably would not have allowed for that. Nevermind the personal motivations and desire to contribute to society; I'm talking from a pure financial point of view.

Admittedly this site is a bit watered down, but it does break down the top 10 highest earning fields.
http://www.therichest.com/business/salary/the-top-ten-highest-paying-jobs/

Healthcare professions are 3 of the 10. The other positions are definitely not "easy come" by any stretch of the imagination. The competition for those jobs (CEO, Marketing Manager, Engineering Manager, Scientist) make the competition in medicine look like a joke. You have hundreds of thousands, if not millions, of applicants competing for maybe a few thousand positions. Of that list, probably only the CEO and medical professions will have uncapped earning potential.

Your salary is going down. That sucks and I feel for you since I'll be in that boat in a few years too. The problem is that everyone else's salary is going down too. We just have to deal with it. The median wage in the US has been falling since 1999 when it was at 56k/year (closer to 70k if you take inflation int account). Why do you think so many people have to move back in with their parents? It's simply becoming too hard to make it by yourself. For everyone success story you read on the news (local teen invents "whatever" and earns 200k!) there are probably 10,000 people in the exact same situation who failed.

Medicine is the least ugly girl at the dance. Unless you want to entertain Rosy Palms and her 5 daughters, you don't really have a choice.

It is true, medicine has always been an easy path to a good salary, but that means you have to compete to get through training and then work hard when you get out in practice. Don't sell yourself short. And a lot of my peers have good paying fun jobs, and since they are smart they are moving up in there companies and doing well.

Health care is different because people want high quality health care and are willing to pay for it when they need it, the government is just getting in the way. You want an alternative: someone had mentioned a tire shop. There is one in my neighborhood called "Discount Tires." I suspect their tires aren't sustantially cheaper than another tire shop's. That business models doesn't work very with health care, though. "Discount Ear Nose and Throat Clinic"??? Really, if I start resenting patient's because I am getting paid crap for providing very highly skilled and labor intensive services, I would just cut out the poor reimbursing plans and maybe open a tire shop, or maybe another small business in my free time.

 

[calvnandhobbs68]

Your post doesn't "mean anything." I explained a general idea of how much cost goes in to the surgeon's fees for a tonsillectomy. In general, reimbursements for procedures correlate with the value, but right now most are below value. I'm trying to give some of you sophomoric medical students an idea of what it will like if you actually go out in practice, rather than pretend like you know something about medical economics and go in to some sort of administration role. Anyone who is complacent with declining fee schedules is a fool.

This post alone basically shows you have no idea what market value means in an economic sense. The barriers to entry to become a physician (especially for subspecialties such as ENT where we effectively artificially restrict residency spots to keep salaries up) and the insurance reimbursement model distort the healthcare "market" so much that it doesn't even remotely resemble a free marketplace.

I don't disagree that you may be getting paid under cost for some procedures given lower Medicare and private reimbursements. This has nothing to do with "fair market value".

 

[DrBodacious]

This post alone basically shows you have no idea what market value means in an economic sense. The barriers to entry to become a physician (especially for subspecialties such as ENT where we effectively artificially restrict residency spots to keep salaries up) and the insurance reimbursement model distort the healthcare "market" so much that it doesn't even remotely resemble a free marketplace.

I don't disagree that you may be getting paid under cost for some procedures given lower Medicare and private reimbursements. This has nothing to do with "fair market value".

If you want to quibble over ecomomics jargon, I think that should be a different thread. But practically speaking, you are wrong: there absolutely is supply and demand in the healthcare market. If a large specialty group opts to not participate with a insurance company because there reimbursement is poor, and there isn't another supply of doctors to provide services to the insurance companies patient population, they will come back and raise there allowable fees. This is why reimbursements are lower in urban areas relative to rural areas. The problem is, in most situations, the doctor doesn't have this kind of leverage, and the private insurance companies tend to follow medicare's RVU system. The RVU/RBRVS system itself is a panel driven process where a relative value is placed on the service or procedure, where the physician work, overhead and malpractice costs are weighed, which really is an attempt at mandating a "fair market value." The problem is that this is tied to the fact that our goverment wants to cap overall health care expenses, while expanding care to more people. This is politically popular, but really unreasonable. If medicare is planning on cutting or locking in payments, or abstractly deciding to cut payments for this specialty or that, it ruins the market place for doctors to be paid a fair amount. The end result of this is going to be worse access to care and worse quality of care, plain and simple.

 

[DrBodacious]

duplicate

 

[OCDEMS]

The 21st century is going to be a story of downward pressure on all professions. Medicine isn't unique nor immune, as much as we'd like it to be.

I think there is something to this statement. This country is going to be in for a prolonged period of tremendous economic and social change, particularly as this becomes more and more of a problem. Technological changes will concentrate power in ways we probably can not yet imagine. Either this will require a tremendous retooling of our economic production, which I think is possible but difficult, or there will be increasing pressure within our society to "redistribute." As a former member of the "working world," I saw this in my job on a regular basis. The most employable people will be those who are flexibly smart, i.e. capable of rapidly learning new skill sets, integrating them with increasingly sophisticated technologies, and creating new solutions on a near constant basis. I tend to agree with economist who show that there is a large portion of this country that simply lacks the necessary capabilities for the jobs of the future. Unfortunately, we've exacerbated this problem by creating unnecessary barriers to entry within large swaths of our economy. In the past decade, a bachelor's degree pretty much guaranteed you a job within the middle-management of virtually any company in this country. People were literally employed doing...stuff. The recession forced companies to downsize. Guess what? They found that entire parts of their production process were either redundant or unnecessary. Hiring never returned to normal. This same downward pressure has spread out to professions where the stakes are higher. In medicine, we don't make widgets, but it is awful easy, from the confines of a board room, to turn patients into widgets and apply these new lessons to all of the productive parts of that system. So, yes, it is happening to us too.

A lot of people are blind to this. They don't see the "downward pressure." This leads me back to my earlier comment about the near exalted status of the "self-employed" small business owner in this country. People have this idea that anyone can make it, so long as they're a "risk taker." The reality is that a large portion of small businesses fail and, as someone else said previously, making it big (net profit above overhead) can take years, even in eventually successful business models. One of the things that you'll find with quite a few of these "entrepreneurs" is that they have a safety net. It's a lot easier to start a company if mom and dad can bail you out or, even better, get you started without the hassle of obtaining a loan. Where I grew up, this was pretty much the way out for the wealthy or upper middle-class. These kids would get out of high school, maybe go off to university where they would major in something frivolous, and then come home, all cultured up, to parents willing to start the next lawn care, real estate, house-flipping, or food services company. If this pathway wasn't it, then mom and dad would float them an income for years while they brute forced their way into some cushy consulting, investment, or "creative" job. It's easy to start-up a new IT venture when you don't have to worry about the next meal. The super elite? They skip all these steps and make sure their kids go to the best schools, acquire the best contacts, and skip to the cushy consulting or investment job. This isn't to say that these businesses and services don't create value, but to call it "risk taking" is probably over doing it.

If you grew up in the 'burbs or middle America, then you know what I mean. I've noticed that there is this interesting stratification in medical school. After the truly wealthy (the ones who drive the 7 series BMW or Audi A5 to med school everyday, a minority, truly), the next largest percentage of students seem to come from working poor or solidly middle class families where the concept of an income around $200k sounds simply magical.

 

[thefritz]

Okay, so what would you be doing instead? Toil away in IT, earning 1/3rd - 1/5th the money for 40-60 hours/week?

This is a common theme I see here. A lot of pre-meds and med students are convinced that being a doctor is the only way to earn $200k+/year. This isn't true. There are people that pull in that income in every business sector. Unfortunately it is a big reason people come to medicine in the first place, not because it's the only place to earn that kind of money (which it is not -- you can do that well in IT with the right skills and experience). The difference is that no other job offers that much to start and 'salaries' typically don't go that high -- higher levels of income comes from contracts, bonuses, etc. Additionally no other job offers that income to people only interested in doing mediocre jobs and not trying very hard. Young people are short sighted about these things. If I had stayed in engineering, I would be making $100k/year by the time I finish residency. Over the 10 years it would take me from M1 to PGY6, I would have lost nearly $800,000. Add the cost of med school and it's $1 million. This is simply by staying the course in my first job, not by trying to climb the ladder or working on my side projects and consulting (which, when I quit, were making me nearly as much as my $70k/year salary). The opportunity cost of $2-3 million in these cases isn't really seen. People just see the entry level incomes of $250k or more in medicine and focus on that. 10 years with motivation and skill development in most other fields can lead to high incomes as well. But this data isn't published like it is for medicine. Of course, 10 years in career of being lazy, doing the bare minimum and surfing the web all day at work will not lead to this kind of success. Nor will staying in an underpaying job with no career development potential. So what does this lead to? People applying to med school because (1) they want to become very wealthy and bill as many of the highest paying procedures as possible or (2) they want a guaranteed moderately high income regardless without trying very hard at the careers (working part time or just simply being lazy and practicing bad medicine). If you're an awful doctor you can still get a 6 figure job most anywhere if you're BE/BC. If you're an awful IT guy, good luck even finding a job let alone holding it.

But even in terms of starting incomes, I know quite a few people out of college that go to consulting firms and start at $100k+ This is at age 22. I have one friend who just bought a new 4000 sq ft. home that he lives in alone. At 25. He went to a good college, but not top 10 good.

All this to conclude what everybody already knows: Money is a stupid criteria for choosing to become a doctor (or in this case, not to become one) but it is why the vast majority of people applied in the first place (whether or not it kept them there or not). And if you're not going to medical school, major in something useful in college (finance or engineering) and pursue a career that interests you where you will be motivated to work hard and the success will come to you. Hell, almost every skilled tradesman will do better than an English major. And perhaps, most importantly, you don't need $200k+/year to be happy and feel successful. When I was working before coming to medical school, it was literally all the money I could ever imagine needing. I never had to think about savings, spent whatever I wanted without ever budgeting, owned a house and a car, and still my bank account grew rapidly. Then I came to medical school and met people who literally told me they were there because they "needed 500k/year to afford the life they wanted and medical school was the only way to do it." Apparently people need to wear $5000 pieces of designer clothing and have multiple vacation homes to be happy in life. Who knew? I feel sorry for these people and am so lucky I can be happy on only $100k/year for the rest of my life.

These people posting about $390 vs $366 don't get it. Doctors in any specialty generally do not make $390K without busting there tail and providing a large volume of services.

I'm going to take a wild guess here and assume that you are not practicing in an under-saturated market. There is a huge problem in medicine, particularly the sub specialties, where people want both high incomes and desirable upper-class high cost of living locales in which to live and work. There is a huge need for sub specialists
in rural communities and your comments about supply and demand are definitely true in this regard.

Really, if I start resenting patient's because I am getting paid crap for providing very highly skilled and labor intensive services, I would just cut out the poor reimbursing plans and maybe open a tire shop, or maybe another small business in my free time.

This is how a lot of people become very wealthy. Owning multiple small businesses (or until recently, investment properties). A lot of MDs, however, feel that they are "above" owning things like tire shops and McDonalds. In my community, one of the wealthiest people in town literally owns a tire shop, which he expanded and now has 3 or 4 locations.

 

[Silent Cool]

This post alone basically shows you have no idea what market value means in an economic sense. The barriers to entry to become a physician (especially for subspecialties such as ENT where we effectively artificially restrict residency spots to keep salaries up) and the insurance reimbursement model distort the healthcare "market" so much that it doesn't even remotely resemble a free marketplace.

I don't disagree that you may be getting paid under cost for some procedures given lower Medicare and private reimbursements. This has nothing to do with "fair market value".

That's exactly right. There is no free market in health care.

 

[DrBodacious]

I'm going to take a wild guess here and assume that you are not practicing in an under-saturated market. There is a huge problem in medicine, particularly the sub specialties, where people want both high incomes and desirable upper-class high cost of living locales in which to live and work. There is a huge need for sub specialists
in rural communities and your comments about supply and demand are definitely true in this regard.

Actually, I live in a fairly underserved area. I like the area, it has some really nice features, but it is not economically thriving and it wouldn't be on most peoples' list of highly desirable places to live. There are no ENT subspecialists, and that is why I liked this area, because I can be busy, and do a broad range of things in my specialty.

 

[thefritz]

This leads me back to my earlier comment about the near exalted status of the "self-employed" small business owner in this country. People have this idea that anyone can make it, so long as they're a "risk taker." The reality is that a large portion of small businesses fail and, as someone else said previously, making it big (net profit above overhead) can take years, even in eventually successful business models. One of the things that you'll find with quite a few of these "entrepreneurs" is that they have a safety net. It's a lot easier to start a company if mom and dad can bail you out or, even better, get you started without the hassle of obtaining a loan.

A lot of your comments after this one are spot on, but you are wrong about successful small businesses. Most small businesses fail because people are attempting to go into business without any skills or anything unique to offer. Most people who do this are trying a get-rich-quick scheme and yeah, their business ventures fail. But if you have a unique skill or product to offer, your business will probably do well. If you up and decide to open a restaurant, dry cleaners, convenience store, used car lot, or something else one day where the barriers to entry are basically getting the money to start it, well good luck competing with the thousand other people with the same idea. If you work for a company in IT for 20 years, become an excellent programmer with knowledge of the industry and markets, write some software in your spare time that you see a potential market for, then start selling it, you'll probably do well. This is not, however, a get-rich-quick scheme. The other way to do well as someone who is self-employeed is offer good skilled labor. Plumber, electrician, carpenter, mechanic. It's feast or famine, but once you have your tools and a truck, it's basically all profit after that. And in my experience, you can be a lying scumbag who does crappy work and is addicted to drugs and still manage to find enough work to pull in $50-100k/year (most of which is cash because you are a scumbag and don't report it). Retail, overhead, and employees is how you fail and go out of business.

 

[thefritz]

If you grew up in the 'burbs or middle American, then you know what I mean. I've noticed that there is this interesting stratification in medical school. After the truly wealthy (the ones who drive the 7 series BMW or Audi A5 to med school everyday, a minority, truly), the next largest percentage of students seem to come from working poor or solidly middle class families where the concept of an income around $200k sounds simply magical.

I have noticed a stratification too, but not like you describe. Probably 40% come from wealthy families (most of whom are doctors). Probably another 40% come from college educated families, but not wealthy (i.e., both parents work but they can't afford to give their kids $60k/year for med school). The remainder are actually poor and have parents who don't really comprehend what medical school is. I imagine this is different at other schools. Med school is mostly for children of the well-off and simply unaffordable for anyone else unless they are willing to saddle themselves with insane amounts of debt or take a military scholarship. How else do you explain a student who has parents who make a combined $200k/year still being eligible for the maximum need-based aid package from the school? What a med school considers as in-need and what the general public does are vastly different.

 

[OCDEMS]

A lot of your comments after this one are spot on, but you are wrong about successful small businesses. Most small businesses fail because people are attempting to go into business without any skills or anything unique to offer. Most people who do this are trying a get-rich-quick scheme and yeah, their business ventures fail. But if you have a unique skill or product to offer, your business will probably do well. If you up and decide to open a restaurant, dry cleaners, convenience store, used car lot, or something else one day where the barriers to entry are basically getting the money to start it, well good luck competing with the thousand other people with the same idea. If you work for a company in IT for 20 years, become an excellent programmer with knowledge of the industry and markets, write some software in your spare time that you see a potential market for, then start selling it, you'll probably do well. This is not, however, a get-rich-quick scheme. The other way to do well as someone who is self-employeed is offer good skilled labor. Plumber, electrician, carpenter, mechanic. It's feast or famine, but once you have your tools and a truck, it's basically all profit after that. And in my experience, you can be a lying scumbag who does crappy work and is addicted to drugs and still manage to find enough work to pull in $50-100k/year (most of which is cash because you are a scumbag and don't report it). Retail, overhead, and employees is how you fail and go out of business.

Thanks. To clarify, I don't disagree that there are many people who read the market right, offer a valuable product, and do so in a way that takes some steel. I think my overall point is that, in my experience, when you really delve into a sizable enough (not necessarily a plurality) of "small business owners", you'll be surprised to learn that individual's background. I grew up in a place where the market for these service oriented businesses was insatiable. It seemed like every male from my high school owned a landscaping company five years post graduation. Many of them are viable, profit generating businesses. My point isn't that people fail or that their services are not valuable, but that they can afford to fail. Failing doesn't mean bankruptcy or not eating. With that in mind, it's a lot easier to make that leap to entrepreneurship.

 

[Mad Jack]

Yet he chooses to take the namesake of one of the biggest jokes of the 20th century.


Watch @ 27:50 = sociopath
30:00 = sociopath
"women's proper position is not to rule men"


34:00 = probably the best example of just how insane a megalomaniac she is.

Watching any of her interviews is almost as painful as watching the film adaption of atlas shrugged.
Yes, by all means lets elect someone who takes this person's name (yet curiously tries to deny it) and holds her philosophies in high esteem.

The reason he is no joke is because he has a very warped view of economics, and stands a very real chance of being the Republican frontrunner and being elected to the White House. Bush was a joke, Paul is terrifying.

 

[RadixLuminogen]

The reason he is no joke is because he has a very warped view of economics, and stands a very real chance of being the Republican frontrunner and being elected to the White House. Bush was a joke, Paul is terrifying.

Why is he terrifying?

Because he wants to stop creating terrorists by stopping drone strikes on children in Yemen? by not attacking Syria? by minding our own business?
Because he wants to balance the budget by not giving foreign aid to countries that are going to hate us anyway?
Because he wants to limit government and hopefully end NSA spying?
Because he is not a religious/militaristic nutjob like Bush?
Because he understand economics 101 and knows that capitalism works while communism doesn't?
Because he wants to return the country to how it was when the founding fathers made this country what it is?
Because he wants to end corporate welfare bail out of places like Goldman Sachs?

This country was founded by geniuses but is now run by idiots.

You Sir or Ma'am are still an uneducated pre-med so I understand your ignorance of politics.

 

[notbobtrustme]

This is a common theme I see here. A lot of pre-meds and med students are convinced that being a doctor is the only way to earn $200k+/year. This isn't true. There are people that pull in that income in every business sector. Unfortunately it is a big reason people come to medicine in the first place, not because it's the only place to earn that kind of money (which it is not -- you can do that well in IT with the right skills and experience). The difference is that no other job offers that much to start and 'salaries' typically don't go that high -- higher levels of income comes from contracts, bonuses, etc. Additionally no other job offers that income to people only interested in doing mediocre jobs and not trying very hard. Young people are short sighted about these things. If I had stayed in engineering, I would be making $100k/year by the time I finish residency. Over the 10 years it would take me from M1 to PGY6, I would have lost nearly $800,000. Add the cost of med school and it's $1 million. This is simply by staying the course in my first job, not by trying to climb the ladder or working on my side projects and consulting (which, when I quit, were making me nearly as much as my $70k/year salary). The opportunity cost of $2-3 million in these cases isn't really seen. People just see the entry level incomes of $250k or more in medicine and focus on that. 10 years with motivation and skill development in most other fields can lead to high incomes as well. But this data isn't published like it is for medicine. Of course, 10 years in career of being lazy, doing the bare minimum and surfing the web all day at work will not lead to this kind of success. Nor will staying in an underpaying job with no career development potential. So what does this lead to? People applying to med school because (1) they want to become very wealthy and bill as many of the highest paying procedures as possible or (2) they want a guaranteed moderately high income regardless without trying very hard at the careers (working part time or just simply being lazy and practicing bad medicine). If you're an awful doctor you can still get a 6 figure job most anywhere if you're BE/BC. If you're an awful IT guy, good luck even finding a job let alone holding it.

But even in terms of starting incomes, I know quite a few people out of college that go to consulting firms and start at $100k+ This is at age 22. I have one friend who just bought a new 4000 sq ft. home that he lives in alone. At 25. He went to a good college, but not top 10 good.

Sure, for engineers, the calculus might not work entirely, although that is debatable. How about the rest of us? I ain't good with math, so engineering was out of the question. The vast majority of us can't be engineers, let alone top engineers. Most of us can't land 100k consulting jobs out of college, which is the extreme exception I might add, not the norm. What's left is a small list of viable, successful careers, which will never guarantee the types of income medicine will.

My premise is simple and two-fold. Medicine remains the most viable way to earn 6 figures for the average person. Every career is facing downward pressure on salaries, not just medicine. Therefore, in terms of money and security, medicine still remains the best option for the vast majority of students.

This is how a lot of people become very wealthy. Owning multiple small businesses (or until recently, investment properties). A lot of MDs, however, feel that they are "above" owning things like tire shops and McDonalds. In my community, one of the wealthiest people in town literally owns a tire shop, which he expanded and now has 3 or 4 locations.

Good on him, but you're only looking at the success story. He's the only one who succeeded and thus could open several more locations while a dozen in his spot failed. It's not as simple as opening a tire shop and then print money. The average business owner fails 3 times before making money. We aren't talking super rsiky things either, like tech or restaurants. Just opening a convineant store at the corner will fail more likely than it will succeed. And that's for people with business acumen. Most of us don't have business acumen.
Sure, for engineers, the calculus might not work entirely, although that is debatable. How about the rest of us? I ain't good with math, so engineering was out of the question. The vast majority of us can't be engineers, let alone top engineers. Most of us can't land 100k consulting jobs out of college, which is the extreme exception I might add, not the norm.

 

[Bryan O’Blivion]

Medicine is an investment in time, but yields pretty consistent financial rewards. The consistency of medicine makes the comparison difficult. IT... Yes, good jobs for people with 4 year degrees, but usually the great jobs like software architecture require a significant amount of experience. Aviation.. Take a look around the airport next time you walk through and see how many strapping 30 year olds are wearing four captain's stripes on their epaulets. Most of them (for major airlines) are weary looking silver foxes. The regional airlines pay horribly, and often have hours that compare to a surgical residency. And you can spend 10 years in them, before getting an interview with the majors, in some (unfortunate) cases before upgrading to captain. Imagine being in the ED and hearing "paging the R-9, paging the R-9", and waiting to see what shell of a human being responds. Engineering... My college roommate majored in petroleum engineering, and has done very very well. Would I want his job? Very lucrative, but also to me quite boring. And there are lots and lots of engineers working similarly boring jobs, and not making anywhere close to the money a physician makes. You can find lots of examples of wealthy successful engineers, and maybe a solid median income, but also a wide amount of variation.

All in all, medicine is a well compensated career that is for the most part, really interesting.

Do I think that physicians are overpaid? No. If you cherry pick different trades, you can find plumbing contractors that make more that some physicians. And what's more, there really is no societal expectation of plumbers to perform services for persons who can't pay. You really don't see any news stories of plumbers without borders pulling out of southern Sudan due to personal risk.

That being said, being part of a culture that routinely provides a service to people who really need it is a privilege. Beyond having a comfortable life, having a job that you feel actually matters is a reward unto itself. Depending on what you do with it, medicine can really be this.

If you really want to accumulate wealth with little personal investment, the OP is on to something: Alternative medicine. Chiropractors... Many schools do not even require a 4 year degree. And they rake it in... Acupuncture... Short, quasi regulated training program. Minimal overhead, think of a suite in a strip mall, with a few fountains and wind chimes, recorded music of some kind, a naive receptionist that you pay hourly (and don't pay health insurance for, maybe discounted "services"), and four rooms that one moves between, spending 8 minutes placing needles in a patient, and then rotating to the next room to place the next set of needles, while the patient lies there for 45 minutes. Charging $100 per session per patient, (the patient will of course need several), it adds up fast. Chiropractors have a similar model. Before they leave, don't forget to get your patients started on a few supplements, maybe an exotic juice product, that they too can become distributors of, in a multi-level marketing strategy that benefits you the most as the regional distributor.

*Edited to change the tone, as I do not wish to disparage alternative medicine, only to criticize the business practices, and encourage some self regulation in the profession*

 

[notbobtrustme]

you know what they call alternative medicine that actually works? medicine.

 

[Mad Jack]

Why is he terrifying?

Because he wants to stop creating terrorists by stopping drone strikes on children in Yemen? by not attacking Syria? by minding our own business?
Because he wants to balance the budget by not giving foreign aid to countries that are going to hate us anyway?
Because he wants to limit government and hopefully end NSA spying?
Because he is not a religious/militaristic nutjob like Bush?
Because he understand economics 101 and knows that capitalism works while communism doesn't?
Because he wants to return the country to how it was when the founding fathers made this country what it is?
Because he wants to end corporate welfare bail out of places like Goldman Sachs?

This country was founded by geniuses but is now run by idiots.

You Sir or Ma'am are still an uneducated pre-med so I understand your ignorance of politics.

Uneducated premed? Look kid, I'm probably a few years your senior, and am very well versed and also involved in politics. You've probably never been exposed to the real world, just the inside of classroom after classroom where people have assured you that you're a good boy since you were six or less years old. You also have probably never lived in poverty, nor known real hardship. You have likely never worked and had to pay your own bills without the help of your parents or student loans, nor have you been married, nor is it likely that you have known any real semblance of love. Basically, you (probably) don't know what real life is like in any capacity, and yet you claim to know the one true way of politics.

I've worked in an intensive care unit for three years, and in emergency medical services for two before that. I had many other jobs prior, in many other fields- I've been a cook, a laborer, a janitor, a repair technician, a salesman, a network technician, amongst other things, each of them providing different insights into people and the way my world functions. I've travelled the world, and seen death, hunger, poverty, violence, even a revolution. I've seen a lot of good things in my day too, acts of charity, kindness, sacrifice, and conviction. My view of politics has been shaped by interacting with the people that policy affects, and seeing how the policies of other countries have affected their populations.

I highly doubt sitting inside a classroom receiving lectures on biochemistry and anatomy and physiology have greatly expanded your views upon humanity. Rather, you've probably become even more withdrawn from the people of ordinary society, as you are rarely exposed to them in any normal capacity and are completely immersed in the culture of medicine. I would love for you to elaborate on how being a medical student rather than a premed has somehow brought you enlightenment in the area of politics. More likely you'll be like many of the kids that I deal with during their residencies that are 27 years old and have the emotional maturity of a teenager secondary to their never having been outside of the white tower of academia. I'll be in medical school in seven months, I doubt I'll suddenly have some libertarian epiphany the second my boots hit the campus, but I'd love to know by what magic it happens.

I agree with Rand Paul on small business issues, the place of the local government in education, foreign policy, government reform, gun control, immigration, social security privatization, affirmative action, school choice, lobbying, and drug policy.

I disagree with Rand Paul on abortion, the place of the federal government in education, general economics (his views are ideologically based and completely contrary to accepted economic theory and observation), environmental protection, tax reform (it needs to be reformed, but his idea of tax reform reduces all taxes on the wealthy and increases taxes across the board for the middle and lower class), ending all federal funding for medicaid, and ending all federal funding for SNAP benefits.

If Rand Paul were elected, far more people would suffer than benefit. You have probably never lived in a community in which people work full time jobs but are still so poor that they cannot afford food for their children. I have. Ending federal food programs would result in millions of children and hard-working but poor people going hungry. Ending federal medicaid funding would result in massive loss of insurance coverage among many of our most vulnerable citizens- the disabled, children, and pregnant women. His cuts to federal programs would also result in millions of people losing their jobs. And if he had his way on the gold standard, the economy would basically implode due to massive deflation. Student loans would only be available to those who already have established credit, making them inaccessible to all but older students or those from wealthy backgrounds. All of these things combined would result in a society that is good for no one, as desperation in the lower classes would lead to massive increases in violence and theft, creating an unstable society in which to live. The poor and middle classes would have less money, less social mobility, a decreased ability to obtain a postsecondary education, diminished health outcomes, and decreased support in the event of disability or job loss.

Even we would suffer. Ending federal Medicaid and Medicare payments and privatizing them would completely gut GME, likely exacerbating the coming residency shortage. He would also abolish the DoE and end all federal student loans. While there are issues with the way we finance education, that would be catastrophic. How many of your fellow medical students would be in attendance if loans were not available to them? Good luck making your six figures without a Medicare or Medicaid funded residency position, and good luck even finishing medical school without any student loans. If you want a country where the rich are well off and the poor and middle class are downtrodden, take your pick- Mexico, Brazil, Russia, Ukraine- and feel free to move there.

 

[TeddyBoomBoom]

What stings for me is the TIME. Yes, physicians make money, but unlike the lawyer/bond trader/engineer/etc, they took 4 years for a degree, + 4 years for med school, + 3 years residency as a minimum. And that time is necessary for adequate training to..you know... not kill someone. I have no second thoughts, but I can see where it hurts a little.

 

[Trogghunter]

Jack--- 'Your view of politics has been shaped by interacting with the people that it affects?'

You've met 20million people? You're putting everyone into a category based on n=1, 2, 3 yet you know nothing about 99.999% of them. We need the SNAP and society safety nets, I agree, but these things have to be regulated and enforced or they get out of control and they are defiled.

 

[Mad Jack]

Jack--- 'Your view of politics has been shaped by interacting with the people that it affects?'

You've met 20million people? You're putting everyone into a category based on n=1, 2, 3 yet you know nothing about 99.999% of them. We need the SNAP and society safety nets, I agree, but these things have to be regulated and enforced or they get out of control and they are defiled.

Everyone's views are obviously shaped by those they meet, befriend, and work along side. And you don't need to meet everyone to get a good feel for what the average of a population is like, as anyone who has taken a statistics course is well aware. Yeah, there are people that abuse the system. But the majority don't. Yeah, things should be done differently to keep those that would otherwise be honest from becoming parasites. But that wasn't my point. My point was that Rand Paul was crazy because he's willing to shove literally millions our most vulnerable citizens under that bus all so those at the top can have it even better. I'm going to be at the top, but I'm not going to trample the working poor, the elderly, single mothers, and children that were unfortunate enough to be born to irresponsible parents to get there. I don't need to. What Rand Paul proposes is to kick those that are already down, making already bad situations considerably worse, and further limiting any hope that people living in poverty will ever escape it.

There's about 46 million people living in poverty in this country. 16.1 million of those people are children, many of whom couldn't eat without the programs republicans are so cheerful to cut. 10.4 million are people that work full time but still don't make enough to break above the poverty line. They aren't leeches, they just don't have marketable skills, and they can't afford to get marketable skills because they have to be able to afford to eat, pay for their children, and have a roof over their head. This doesn't leave a whole lot of money or time for one to invest in education. There's another roughly 19 million in there that don't work at all. Some are honest people that can't find work, others are mothers that, were they to work, would be unable to pay for child care for their children, as it would cost more than their entire salary with the skills they possess. There's millions of people of this remainder that just collect a check and don't care, but they are a minority of the poor, not the majority.

Yes programs should be modified to make abuse less likely. There are some eligibility rules to SNAP that could be tightened. But its elimination would be devastating, and that was my point. The same rules basically apply to Medicaid, which, by the way, is -hard- to qualify for in most states. Drive a car worth more than $2,000? Make more than the federal poverty limit and have no children? Then forget about Medicaid in my state. I tried getting it when I was working as a tech in the E.R. back in the day, it was just about impossible to qualify for unless you had children or lived in absolute poverty.

I grew up poor, spent 3 years where I was so poor I was technically homeless but managed get a roof over my head by paying 200 bucks a month to sleep on various people's couches in the ghetto (even working, I couldn't afford food, a vehicle to get to work with [jobs won't hire you if you don't have a car, the bus isn't considered "reliable transportation"], my medical bills, and my college tuition in addition to rent with my near-minimum wage job), lived in a poor area when I finally finished my associate's degree, and spent 5 years working in an inner city hospital. In all that time I never met more than a handful of people that were legitimate drains on the system. Most people are just trying to get by any way they can. Moving up in life is hardly a thought when you're barely managing to make ends meet to begin with. Trouble is, people with money that have never lived life at the bottom or seen what it is like just look at the budgets for all of these programs, and think, "well it isn't so hard to get an education and a job, we should cut those budgets and let these people fend for themselves!" Thinking like that leads to people choosing between buying food or their medications, or worse yet, leaves them desperate enough to resort to crime.

 

[Amazingmuzmo]

WTF is going on here. Chiropractors are up 12%? Instead of putting that money into primary care to attract more FM/IM/PEDS for the physician shortage they're crying about, they ****ing give it to chiropractors?

 

[Elisabeth Kate]

What stings for me is the TIME. Yes, physicians make money, but unlike the lawyer/bond trader/engineer/etc, they took 4 years for a degree, + 4 years for med school, + 3 years residency as a minimum. And that time is necessary for adequate training to..you know... not kill someone. I have no second thoughts, but I can see where it hurts a little.

Not to mention debt.

 

[circulus vitios]

WTF is going on here. Chiropractors are up 12%? Instead of putting that money into primary care to attract more FM/IM/PEDS for the physician shortage they're crying about, they ****ing give it to chiropractors?

You actually believed the human garbage, talking-mouth scum in Washington.

 

[Amazingmuzmo]

You actually believed the human garbage, talking-mouth scum in Washington.

I never wanted this in the first place. I don't know how they could **** it up so badly when they finally got their way though.

 

[DrBodacious]

I'm going to be at the top, but I'm not going to trample the working poor, the elderly, single mothers, and children that were unfortunate enough to be born to irresponsible parents to get there.... They aren't leeches, they just don't have marketable skills, and they can't afford to get marketable skills because they have to be able to afford to eat, pay for their children, and have a roof over their head.... I grew up poor, spent 3 years where I was so poor I was technically homeless but managed get a roof over my head by paying 200 bucks a month to sleep on various people's couches in the ghetto (even working, I couldn't afford food, a vehicle to get to work with [jobs won't hire you if you don't have a car, the bus isn't considered "reliable transportation"], my medical bills, and my college tuition in addition to rent with my near-minimum wage job), lived in a poor area when I finally finished my associate's degree, and spent 5 years working in an inner city hospital. In all that time I never met more than a handful of people that were legitimate drains on the system. Most people are just trying to get by any way they can. Moving up in life is hardly a thought when you're barely managing to make ends meet to begin with. Trouble is, people with money that have never lived life at the bottom or seen what it is like just look at the budgets for all of these programs, and think, "well it isn't so hard to get an education and a job, we should cut those budgets and let these people fend for themselves!" Thinking like that leads to people choosing between buying food or their medications, or worse yet, leaves them desperate enough to resort to crime.

The fact that you are presenting your experiences as unique is at least somewhat immature, I think. Not that it isn't an interesting story, but it sounds like a med school admission essay, not a well rounded view of life.

Lets take a step back and look at the human condition. Life is short, too short for some, and just plain miserable for many. The fact is: not everyone is equal, and life is a competition. But, we have made great progress over the last 200 years. There are all kinds of ways that we even the playing field as a society, today. As physicians and surgeons we have the privilege of being able to directly do that for the patients we treat and sometimes cure (with surgery), but lets be honest there aren't enough resources to treat 7 billion people, and diluting the quality of health care by shortchanging doctors' pay isn't going to help society. There is no reason to "self-flagellate" and say that we are overpaid. Especially when you don't have any real perspective on providing health care and the costs involved in providing health care.

As an aside, I think the saying, "If you are 20 and a republican, you don't have a heart. If you are 30 and a democrat, you don't have a brain." holds a lot of truth. At least for guys and gals going straight through college and medical training.

 

[denn206]

Primary care is going to go down first in the midlevel argument. It's the easiest (least scary) to break into and the hardest to compare outcomes for.