Graduating psych residents…Job offers

[Merovinge]

I may have exaggerated a bit I actually like a lot of the midwest midsized cities just not personally to live in. Are you truly seeing offers coming out of a "mid-sized" city in the midwest? Like 400+ for 30min OP f/u 60min new. without call or IP job where you aren't on call and covering an ED and consults? Also what is a mid sized city? Madison? Iowa City? Ann Arbor? Akron? I would be surprised if you are getting truly eye-opening jobs in most of those cities.

Feels like moving the goal posts a bit, I never mentioned 400k for that setup. There are sundry options for 300-350 with good lifestyles in relatively low cost of living cities in the midwest (some that you listed, others like St Louis, Milwaukee, etc). It's not for everyone but you don't need to be in a village with 70k people away from anything to make solid money with low CoL in the midwest.

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[deleted1153076]

Lol..you just throw that absurd number without any context..

Contractor work, its like locums but alot of it is tele and semi-permanent. Friend of mine works two different states(tele), see's about 15 patients a day between the two and brings in 2500-3000 a day for about 9 hours of work. Its sustainable, pretty reasonable stress level and you can travel with it if you wish. One is through a prison, another is crisis housing or something(not really sure). He told me the key is to find a place that pays per patient not per hour.

 

[psychmd03]

Feels like moving the goal posts a bit, I never mentioned 400k for that setup. There are sundry options for 300-350 with good lifestyles in relatively low cost of living cities in the midwest (some that you listed, others like St Louis, Milwaukee, etc). It's not for everyone but you don't need to be in a village with 70k people away from anything to make solid money with low CoL in the midwest.

I don’t believe goal posts were sent so I don’t think they can be moved🙃 It was a subjective measure of “good” job and the reference was to mentions of jobs that these really good jobs in small Midwest cities that would offer a lot of money to move to. 300-350 isn’t that good for the Midwest smaller cities. That’s average. That is barely over a 60k bump from VAs in larger cities. Milwaukee is also a metro with over a million people so hardly a small or medium city. I also asked for some of these great job offers and I don’t see specs offered because I’m truly curious and a little disappointed to not see the jobs you’ve confidently been stating are abundant.

Just to toss some recent offers from recruiters recently they are nice but not IMO enough to move to a medium sized city. But that is indeed an opinion.

- Outpatient Adult 100% Remote
- Schedule 1.0 FTE
- $300,000 Salary Guarantee
- $100,000 Signing Bonus
- Full Benefits
- Ability to obtain MN/WI Licenses
- Sponsors H1B Visas


- Keeping with Curative. I'm recruiting a full-time Psychiatrist for my client in central Illinois. $300k two-year guarantee, RVU bonus, $75k sign-on, $10k paid relocation, $150k student loan forgiveness

 

[Stagg737]

Yep. Wife works part-time as an MD and we make $520k combined and we feel upper middle-class (we afforded a townhouse but cannot afford a regular house). Median townhome price in our area is $1.4M; an actual house is $2M

Craziness. I live in a mid-size city in the midwest and we recently bought a 4,000 sq ft house for a little over your annual income. This is why I'd need a 7-figure income to live somewhere like NYC or much of Cali.

I may have exaggerated a bit I actually like a lot of the midwest midsized cities just not personally to live in. Are you truly seeing offers coming out of a "mid-sized" city in the midwest? Like 400+ for 30min OP f/u 60min new. without call or IP job where you aren't on call and covering an ED and consults? Also what is a mid sized city? Madison? Iowa City? Ann Arbor? Akron? I would be surprised if you are getting truly eye-opening jobs in most of those cities.

I don't consider any of those to be "mid-sized" cities other than maybe Madison, but looking up definitions of city sizes it looks like I could be wrong. I actually live in a suburb of what I consider a mid-sized city (pop ~500k) that's about the size of Akron. But yes, you can find offers like that in mid to larger cities in the midwest. Example job I interviewed for:

Inpatient averaging 18-20 patients a day. $250k base with significant RVU bonus (lowest paying physician in group was still clearing $450k, most clearing $500k). Weekend call Q4 weekends, full benefits and loan repayment. Position is still available. In midwest city of ~500k people with low CoL where I did residency. For reference, we rented a 4 bed 4.5 bath 3k sq ft house for ~$1700/mo.

Another example: Outpatient, inpatient, or mix. 30 minutes outside of the same city. 30/60 for f/up/new for outpatient. $325k base, $50k sign-on bonus, $150-200k guaranteed loan repayment. Full benefits. I did not interview or apply for that position, but a resident in the class under me signed on with them.

I also did med school in the same city I did residency and rotated through several psych facilities and offices there. The above was not unusual from those in the area I talked to.

 

[Psychresy]

When is the correct time to negotiate? Once receiving the offer letter or once the official contract is presented?

 

[clozareal]

When is the correct time to negotiate? Once receiving the offer letter or once the official contract is presented?

It should start at the interview, then when you get an offer letter, then again with the official contract if you didn't get everything you want. It took months sometimes between the verbal offer, the offer letter, and then the official contract when I was going through this process.

 

[Marasmus1]

Yup. I live in LA and this is spot on. I’d be out of here if I was making 300k only.

If 300k in semi desirable areas of Cali only gives you middle class lifestyle, then who are those upper middle class folks there? What jobs do they have ? Not all of them can be hedge fund managers or CEO of multimillion dollar company. If docs are middle class, not sure what the upper class is over there

 

[FlowRate]

When is the correct time to negotiate? Once receiving the offer letter or once the official contract is presented?

Negotiate what? Income is generally negotiated starting after they give you the first written number (edit: aka after they provisionally offer the job via letter or proposed contract.) Other, less directly monetary, things might be part of mutual screening even pretty early on to see if the job is the right fit.

 

[Psychresy]

Negotiate what? Income is generally negotiated starting after they give you the first written number. Other, less directly monetary, things might be part of mutual screening even pretty early on to see if the job is the right fit.

Negotiate pay, moving allowances, etc.

 

[psychmd03]

Craziness. I live in a mid-size city in the midwest and we recently bought a 4,000 sq ft house for a little over your annual income. This is why I'd need a 7-figure income to live somewhere like NYC or much of Cali.


I don't consider any of those to be "mid-sized" cities other than maybe Madison, but looking up definitions of city sizes it looks like I could be wrong. I actually live in a suburb of what I consider a mid-sized city (pop ~500k) that's about the size of Akron. But yes, you can find offers like that in mid to larger cities in the midwest. Example job I interviewed for:

Inpatient averaging 18-20 patients a day. $250k base with significant RVU bonus (lowest paying physician in group was still clearing $450k, most clearing $500k). Weekend call Q4 weekends, full benefits and loan repayment. Position is still available. In midwest city of ~500k people with low CoL where I did residency. For reference, we rented a 4 bed 4.5 bath 3k sq ft house for ~$1700/mo.

Another example: Outpatient, inpatient, or mix. 30 minutes outside of the same city. 30/60 for f/up/new for outpatient. $325k base, $50k sign-on bonus, $150-200k guaranteed loan repayment. Full benefits. I did not interview or apply for that position, but a resident in the class under me signed on with them.

I also did med school in the same city I did residency and rotated through several psych facilities and offices there. The above was not unusual from those in the area I talked to.

That’s more like what I was thinking. That is now pulling numbers in a geographical arbitrage area that will help you hit FI quickly enough. Otherwise why go from a large city or coast to the Midwest medium/small city. They should have to be well above the income you can generate else where and then also have solid benefits.

 

[psychmd03]

When is the correct time to negotiate? Once receiving the offer letter or once the official contract is presented?

I’d personally wait until you done an interview with them and there is some rapport there.

And remember you can negotiate so many things other than just salary. You can negotiate call days, doing extra coverage for extra pay, moving costs, make sure with a signing bonus it’s prorated so you don’t have to pay it all back if you move, RVU bonuses and level, vacation days, CME days, CME money. There are a lot of places you can get some movement.

 

[Stagg737]

If 300k in semi desirable areas of Cali only gives you middle class lifestyle, then who are those upper middle class folks there? What jobs do they have ? Not all of them can be hedge fund managers or CEO of multimillion dollar company. If docs are middle class, not sure what the upper class is over there

Most docs are going to clear $300k, in some fields they can do this very easily. Marry another doctor or other high income individual and clearing $300k is a given. Also, don't underestimate the income of the tech industry out there. Many positions in tech have base salaries in the 6 figures.

That’s more like what I was thinking. That is now pulling numbers in a geographical arbitrage area that will help you hit FI quickly enough. Otherwise why go from a large city or coast to the Midwest medium/small city. They should have to be well above the income you can generate else where and then also have solid benefits.

It's not just about salary. To get the same house I now have where I grew up (Chicago area) would likely cost me double. My parents still live there in a smaller, cheaper house than I have and their property tax is more than double what I pay. Gas there is about 30% more expensive, sales tax is ~3% higher, most utilities are 20-40% higher, etc. To live the same lifestyle there that I live now I'd have to make about double what I'm making. There's no need for income to be significantly higher as you can afford a lot more for the same income.

Some people just don't like living near the coasts or big cities. I strongly prefer living near a mid-size city and have hated the larger cities I've lived in. I do enjoy the coast, but there's not a lot there that can't be done where I'm at (short of taking a day trip to the ocean) and not having to worry about hurricanes is nice.

 

[Merovinge]

It's not just about salary. To get the same house I now have where I grew up (Chicago area) would likely cost me double. My parents still live there in a smaller, cheaper house than I have and their property tax is more than double what I pay. Gas there is about 30% more expensive, sales tax is ~3% higher, most utilities are 20-40% higher, etc. To live the same lifestyle there that I live now I'd have to make about double what I'm making. There's no need for income to be significantly higher as you can afford a lot more for the same income.

Some people just don't like living near the coasts or big cities. I strongly prefer living near a mid-size city and have hated the larger cities I've lived in. I do enjoy the coast, but there's not a lot there that can't be done where I'm at (short of taking a day trip to the ocean) and not having to worry about hurricanes is nice.

I appreciate your overall point but many expenses for CoL do not imput where you would need to make 600k to live in Cali vs 300k in Chicago. CoL is more designed to give you an idea how far your dollars will go with a more median income rather than a high income. State income tax clearly scales through all pay, but other expenses will not increase that dramatically. If you sent 1k on gas vs 1.3k on gas, extra 3k on electricity/utilities, these matter proportionally less for someone making 300k then someone making 100k.

For residents or anyone moving that has a high income you will want to compare your after tax (federal and state) take home and then estimate the delta on your total expenses. If a place is offering you 50k more (30k after taxes) and your total increase in spending on gas/electric/property tax/restaurants/services is 50k more a year, then the real price you are paying to live in that higher CoLA area is 20k in post tax dollars. There is the issue that higher CoL places tend to have very high property prices and how this will impact your budget or what type of dwelling you live in but in almost no circumstance as a physician would you need to make 600k to live anywhere compared to 300k in a low CoL area, it's just not how the math works out.

 

[sloh]

If 300k in semi desirable areas of Cali only gives you middle class lifestyle, then who are those upper middle class folks there? What jobs do they have ? Not all of them can be hedge fund managers or CEO of multimillion dollar company. If docs are middle class, not sure what the upper class is over there

We’d have to define semi desirable but I’d say 300k is not enough for Santa Monica, Beverly Hills, Malibu, San Diego, Calabasas, Pasadena, Newport Beach. Instead, they would move to somewhere like San Gabriel Valley or god forbid Central California. Plus, for married couples with kids, it’s not uncommon the wife/mother will want to scale back from full-time work.

 

[Stagg737]

I appreciate your overall point but many expenses for CoL do not imput where you would need to make 600k to live in Cali vs 300k in Chicago. CoL is more designed to give you an idea how far your dollars will go with a more median income rather than a high income. State income tax clearly scales through all pay, but other expenses will not increase that dramatically. If you sent 1k on gas vs 1.3k on gas, extra 3k on electricity/utilities, these matter proportionally less for someone making 300k then someone making 100k.

For residents or anyone moving that has a high income you will want to compare your after tax (federal and state) take home and then estimate the delta on your total expenses. If a place is offering you 50k more (30k after taxes) and your total increase in spending on gas/electric/property tax/restaurants/services is 50k more a year, then the real price you are paying to live in that higher CoLA area is 20k in post tax dollars. There is the issue that higher CoL places tend to have very high property prices and how this will impact your budget or what type of dwelling you live in but in almost no circumstance as a physician would you need to make 600k to live anywhere compared to 300k in a low CoL area, it's just not how the math works out.

Of course the higher your income the less basic CoL aspects will be a factor, but the point was just that $300k in earnings in one place can support a very different lifestyle than in others and that I'd need quite a bit more in other locales than I make now to live my current lifestyle. I wasn't comparing LA to Chicago, I was comparing where I currently live to Chicago. There's a bigger much bigger financial difference between living where I'm at now vs Chicago than there is between LA and Chicago.

The poster I responded to was also making references to the cost of buying a house/townhouse in Cali vs the midwest, so the property aspect is particularly relevant. More current example, my sister-in-law rents a mediocre 1200 sq ft apartment in downtown Chicago with 1 bed 1 bath with no in-unit laundry for about ~$1700/mo, which is the same my family paid to rent a 3000 sq foot house with 4-bed 3-bath house built 15 years ago 15 minutes from downtown where I did residency. If you value property it can make a huge difference on the order of hundreds of thousands of dollars. That being said, salary data also shows that psychiatrists generally make more in the midwest and south than on the coasts, so the smaller differences do also hold some relevance.

 

[Merovinge]

Of course the higher your income the less basic CoL aspects will be a factor, but the point was just that $300k in earnings in one place can support a very different lifestyle than in others and that I'd need quite a bit more in other locales than I make now to live my current lifestyle. I wasn't comparing LA to Chicago, I was comparing where I currently live to Chicago. There's a bigger much bigger financial difference between living where I'm at now vs Chicago than there is between LA and Chicago.

The poster I responded to was also making references to the cost of buying a house/townhouse in Cali vs the midwest, so the property aspect is particularly relevant. More current example, my sister-in-law rents a mediocre 1200 sq ft apartment in downtown Chicago with 1 bed 1 bath with no in-unit laundry for about ~$1700/mo, which is the same my family paid to rent a 3000 sq foot house with 4-bed 3-bath house built 15 years ago 15 minutes from downtown where I did residency. If you value property it can make a huge difference on the order of hundreds of thousands of dollars. That being said, salary data also shows that psychiatrists generally make more in the midwest and south than on the coasts, so the smaller differences do also hold some relevance.

I figured you knew, I was mostly posting for the other readers who may be confused by CoL stuff. I did the math when looking into where my family would move 2 years ago and was pretty surprised how relatively reasonable it is to be in higher CoL areas at the high incomes (my SO is also a MD). State income tax definitely hits hard in Cali/NYC. Property is interesting because while you get to live in a much bigger home in lower CoL areas, the value of property is also more likely to increase in places that will be desirable into the time frame you plan to sell (e.g. So Cal). Of course it's highly unlikely to beat out the total stock market for returns on the differential in costs, but could be a smidge less punishing than it looks.

 

[Stagg737]

I figured you knew, I was mostly posting for the other readers who may be confused by CoL stuff. I did the math when looking into where my family would move 2 years ago and was pretty surprised how relatively reasonable it is to be in higher CoL areas at the high incomes (my SO is also a MD). State income tax definitely hits hard in Cali/NYC. Property is interesting because while you get to live in a much bigger home in lower CoL areas, the value of property is also more likely to increase in places that will be desirable into the time frame you plan to sell (e.g. So Cal). Of course it's highly unlikely to beat out the total stock market for returns on the differential in costs, but could be a smidge less punishing than it looks.

All true, my problem with the housing aspect in places like Cali/NYC is the amount of bang for your buck you actually get while living there. From a purely monetary investment aspect where you live probably doesn't matter much as most places don't suddenly become so much more desirable or undesirable over the course of 10-15 years that individual housing prices would change an investment strategy. It's the difference in QoL in terms of the actual dwelling where I think the real investment is, as having the option to live in a nice, large house that one can own and afford whatever one's family needs/wants as opposed to more limited options d/t cost. I

 

[Splenda88]

Craziness. I live in a mid-size city in the midwest and we recently bought a 4,000 sq ft house for a little over your annual income. This is why I'd need a 7-figure income to live somewhere like NYC or much of Cali.


I don't consider any of those to be "mid-sized" cities other than maybe Madison, but looking up definitions of city sizes it looks like I could be wrong. I actually live in a suburb of what I consider a mid-sized city (pop ~500k) that's about the size of Akron. But yes, you can find offers like that in mid to larger cities in the midwest. Example job I interviewed for:

Inpatient averaging 18-20 patients a day. $250k base with significant RVU bonus (lowest paying physician in group was still clearing $450k, most clearing $500k). Weekend call Q4 weekends, full benefits and loan repayment. Position is still available. In midwest city of ~500k people with low CoL where I did residency. For reference, we rented a 4 bed 4.5 bath 3k sq ft house for ~$1700/mo.

Another example: Outpatient, inpatient, or mix. 30 minutes outside of the same city. 30/60 for f/up/new for outpatient. $325k base, $50k sign-on bonus, $150-200k guaranteed loan repayment. Full benefits. I did not interview or apply for that position, but a resident in the class under me signed on with them.

I also did med school in the same city I did residency and rotated through several psych facilities and offices there. The above was not unusual from those in the area I talked to.

Sorry, I gotta ask. Why do you need such a big home? What do you fill up all that space with?

We are a family of 4, and just moved into a single family home that is close ~2000 sqff (4BR/2BA) under air + 2-car garage... I am looking at my kitchen while writing this post and ~30% of the cabinet/pantry is empty, and I have an extra bedroom collecting dust.

I am always fascinated when a middle class (emphasis on middle class) family of 4 tells me that the size of their home is > 3000 sqft.

 

[Splenda88]

We’d have to define semi desirable but I’d say 300k is not enough for Santa Monica, Beverly Hills, Malibu, San Diego, Calabasas, Pasadena, Newport Beach. Instead, they would move to somewhere like San Gabriel Valley or god forbid Central California. Plus, for married couples with kids, it’s not uncommon the wife/mother will want to scale back from full-time work.

Property value in these cities is insane ... Out of curiosity, I was looking at 3BA/3BA home in Pasadena (built in the 1960s) the other day and the price was 1.6 mil. What kind of income does one has to have to purchase a regular home in a bad school district for 1.6 mil? This is insane!

I can literally get 6 brand new homes about the same size or a little bit bigger in the SE for that price... Having a $1700 vs. 7-8k mortgage is a huge difference in lifestyle for a family who makes 350-400k/yr.

 

[Psychresy]

Property value in these cities is insane ... Out of curiosity, I was looking at 3BA/3BA home in Pasadena (built in the 1960s) the other day and the price was 1.6 mil. What kind of income does one has to have to purchase a regular home in a bad school district for 1.6 mil? This is insane!

I can literally get 6 brand new homes about the same size or a little bit bigger in the SE for that price... Having a $1700 vs. 7-8k mortgage is a huge difference in lifestyle for a family who makes 350-400k/yr.

500k a year would afford that.

 

[sloh]

Property value in these cities is insane ... Out of curiosity, I was looking at 3BA/3BA home in Pasadena (built in the 1960s) the other day and the price was 1.6 mil. What kind of income does one has to have to purchase a regular home in a bad school district for 1.6 mil? This is insane!

I can literally get 6 brand new homes about the same size or a little bit bigger in the SE for that price... Having a $1700 vs. 7-8k mortgage is a huge difference in lifestyle for a family who makes 350-400k/yr.

Yup COL is nuts here if you want to raise a family. I grew up in Southern California and have family here. Like I said, if I only made 300k (which is about what I made my first year out), I’d be out of here. No point in living here if you can’t enjoy it and retirement is nothing but a pipe dream.

 

[Splenda88]

500k a year would afford that.

Well, I would not buy a 1.6 mil home with a salary of 500k/yr. Needless to say I don't plan to move to a very HCOL anytime soon. The highest price I would be willing to go for with that salary is 1 mil.

 

[Psychresy]

Well, I would not buy a 1.6 mil home with a salary of 500k/yr. Needless to say I don't plan to move to a very HCOL anytime soon. The highest price I would be willing to go for with that salary is 1 mil.

Just for reference, that would be like a 9.8k mortgage (PITI). Ran 500k salary, filing married, through a CA tax calculator. You would easily be able to afford that while still putting away >20% gross salary into savings (combined pre, post tax accounts).

I get that a 1.6M house seems crazy to a lot of people. For myself and I'm sure others who grew up in the area, it's just the norm. And again, it's not even unaffordable if you're making 500k+.

 

[forchinet121]

Just for reference, that would be like a 9.8k mortgage (PITI). Ran 500k salary, filing married, through a CA tax calculator. You would easily be able to afford that while still putting away >20% gross salary into savings (combined pre, post tax accounts).

I get that a 1.6M house seems crazy to a lot of people. For myself and I'm sure others who grew up in the area, it's just the norm. And again, it's not even unaffordable if you're making 500k+.

Agreed

 

[clozareal]

Well, in CA before COVID allowed for remote work, you would compete with these kinds of salaries (attached) for homes. Doctors make an equal if not much less salary to those in tech. This is being redistributed across the US with remote work though. See home prices in Boise, Idaho for reference. There is no local industry in Boise, Idaho that can prop up those prices.

 

[Psychresy]

Well, in CA before COVID allowed for remote work, you would compete with these kinds of salaries (attached) for homes. Doctors make an equal if not much less salary to those in tech. This is being redistributed across the US with remote work though. See home prices in Boise, Idaho for reference. There is no local industry in Boise, Idaho that can prop up those prices.

That doesn't seem accurate. I worked in tech before med school and know people at those companies. They aren't making anywhere close to those salaries (including benefits)

 

[forchinet121]

That doesn't seem accurate. I worked in tech before med school and know people at those companies. They aren't making anywhere close to those salaries (including benefits)

Yeah I agree those incomes seem very inflated..

 

[calvnandhobbs68]

That doesn't seem accurate. I worked in tech before med school and know people at those companies. They aren't making anywhere close to those salaries (including benefits)

Yeah I agree those incomes seem very inflated..

Levels.fyi is probably the biggest compiler of this information in general and a site that many people in tech use to negotiate their salaries. What might be throwing you off is the stock options part which compiles a large portion of the manager salaries, here's google's for example (which basically shows the same thing, base salary for an engineering manager is in the 200s-300s but when you add in stocks and bonus, goes up to 500K+ pretty quick). Regular SWE are more in the 180s-300s but still, you're competing against a huge population of people across all these tech companies who are making somewhere in the 200K+ range/year for housing.

Google Software Engineering Manager Salary | $391K-$1.97M+ | Levels.fyi

Software Engineering Manager compensation in United States at Google ranges from $391K per year for L5 to $1.97M per year for L9. The median compensation in United States package totals $584K. View the base salary, stock, and bonus breakdowns for Google's total compensation packages.

www.levels.fyi

Google Software Engineer Salary | $195K-$2.6M+ | Levels.fyi

Software Engineer compensation in United States at Google ranges from $195K per year for L3 to $2.6M per year for L9. The median compensation in United States package totals $295K. View the base salary, stock, and bonus breakdowns for Google's total compensation packages.

www.levels.fyi

 

[Psychresy]

I also wonder how many are actually making those salaries..how many directors are there as an example.

 

[Splenda88]

Levels.fyi is probably the biggest compiler of this information in general and a site that many people in tech use to negotiate their salaries. What might be throwing you off is the stock options part which compiles a large portion of the manager salaries, here's google's for example (which basically shows the same thing, base salary for an engineering manager is in the 200s-300s but when you add in stocks and bonus, goes up to 500K+ pretty quick). Regular SWE are more in the 180s-300s but still, you're competing against a huge population of people across all these tech companies who are making somewhere in the 200K+ range/year for housing.

Google Software Engineering Manager Salary | $391K-$1.97M+ | Levels.fyi

Software Engineering Manager compensation in United States at Google ranges from $391K per year for L5 to $1.97M per year for L9. The median compensation in United States package totals $584K. View the base salary, stock, and bonus breakdowns for Google's total compensation packages.

www.levels.fyi

Google Software Engineer Salary | $195K-$2.6M+ | Levels.fyi

Software Engineer compensation in United States at Google ranges from $195K per year for L3 to $2.6M per year for L9. The median compensation in United States package totals $295K. View the base salary, stock, and bonus breakdowns for Google's total compensation packages.

www.levels.fyi

I wonder about the percentege of engineer out there that works for the big techs,

Almost everyone in medicine makes 200k+/yr. Specialtists like GI, Hemonc, Card and surgeons make 500k+/yr.

 

[hallowmann]

Yep. Wife works part-time as an MD and we make $520k combined and we feel upper middle-class (we afforded a townhouse but cannot afford a regular house). Median townhome price in our area is $1.4M; an actual house is $2M

Yeah, you must be in the Bay. There's plenty of CA even in better areas where you can get a nice house with a pool for $1-$1.4 million. Its not cheap, but its not as bad as what you're describing.

I agree though, if you're getting a job out here making <$350k, you better have a pension or something so you don't have to worry as much about retirement savings.

 

[clozareal]

That doesn't seem accurate. I worked in tech before med school and know people at those companies. They aren't making anywhere close to those salaries (including benefits)

The numbers I posted are managers and usually director level and above. People are often not truthful about their full compensation.

Base salary is one number which is what people often report to their friends in tech. What they don't mention is the bonuses they get start at 10% of your salary each year and I've seen as high as 40%, and those bonuses double or triple if you get above "meets expectations" performance review. Also, I've seen handsome signing bonuses, signing stocks (RSUs) that vest after a certain number of years, extra stocks that they give you each year on top of your initial RSUs, and % increase in salary each year.

A friend of mine gets double their annual salary each year in stock at one of these companies. He then uses these stocks as collateral loans (Securities-based line of credit) for real estate investing, even though he always has the cash capital to buy these properties outright.

 

[clozareal]

Yeah, you must be in the Bay. There's plenty of CA even in better areas where you can get a nice house with a pool for $1-$1.4 million. Its not cheap, but its not as bad as what you're describing.

I agree though, if you're getting a job out here making <$350k, you better have a pension or something so you don't have to worry as much about retirement savings.

A pension can be great for retirement if it is well funded but it can also be risky if the fund declares bankruptcy (see Detroit). It does not help build generational wealth since even if you can pass it to your spouse, and you can't pass it down to your children whereas a 401k and other traditional retirement accounts you can.

 

[Splenda88]

Yeah, you must be in the Bay. There's plenty of CA even in better areas where you can get a nice house with a pool for $1-$1.4 million. Its not cheap, but its not as bad as what you're describing.

I agree though, if you're getting a job out here making <$350k, you better have a pension or something so you don't have to worry as much about retirement savings.

Imagine saying something like that to the average American making 50k/yr...

 

[hallowmann]

A pension can be great for retirement if it is well funded but it can also be risky if the fund declares bankruptcy (see Detroit). It does not help build generational wealth since even if you can pass it to your spouse, and you can't pass it down to your children whereas a 401k and other traditional retirement accounts you can.

Pension plan bankruptcy is exceedingly rare, and is unlikely to happen in CA (unlike detroit/MI the state actual produces a ton). As for generational wealth, sure but I'd hope anyone making that money would be funding 401k fully also though.

Imagine saying something like that to the average American making 50k/yr...

The average American family barely saves for retirement (typically has <$75k in retirement accounts), plans to rely on social security benefits and they generally can't afford to have much in a savings account. Also, your median household income in LA county is like $72k and in the Bay its closer to $119k.

I'm not really sure what's so outrageous about what I'm saying. We aren't talking about the average American family, we're talking about a physician that is expected to be saving 20-30% of their income for retirement. HCOL areas turn <$350k income into <$250k compared with other cities. Everything is more expensive. Plus there are quite a bit of inherent costs associated with being a doctor.

My point is that if you are paying loans, paying for a family, and maxing out deferred retirement contributions for you and your spouse, you don't have much more to save in these areas. It doesn't mean you're not better off than the average American household, it just means that you're not getting to FI anytime soon unless your salary is much higher. The extra savings, 529s, HSAs, RE, investments, etc. that other docs are saving to FI just isn't there.

 

[Meyer-Overton]

Plus there are quite a bit of inherent costs associated with being a doctor.

Could you elaborate on these?

 

[sloh]

Imagine saying something like that to the average American making 50k/yr...

The average family also didn’t train for as long as us or have debt.

 

[sloh]

My point is that if you are paying loans, paying for a family, and maxing out deferred retirement contributions for you and your spouse, you don't have much more to save in these areas. It doesn't mean you're not better off than the average American household, it just means that you're not getting to FI anytime soon unless your salary is much higher. The extra savings, 529s, HSAs, RE, investments, etc. that other docs are saving to FI just isn't there.

It’s amazing how many physicians I know in SoCal who don’t even max out their tax deferred retirement contributions, much less have money left over to contribute to index funds.

 

[Splenda88]

It’s amazing how many physicians I know in SoCal who don’t even max out their tax deferred retirement contributions, much less have money left over to contribute to index funds.

That is scary.

It's hard for some people to leave when they have family ties in these HCOL areas. In addition, I was told California is beautiful. Plan to visit maybe this year.

 

[clozareal]

It’s amazing how many physicians I know in SoCal who don’t even max out their tax deferred retirement contributions, much less have money left over to contribute to index funds.

This is common in high earners. Their spending and expenses are excessive. After years of toiling away in residency/fellowship for low pay and limited time to use the money, and then having a >3x pay bump immediately, it makes sense that lifestyle creep happens quickly, especially with limited financial education or time to invest in learning it.

I know doctors making $200-300k doing just fine in CA. They don't need to FIRE or be at the top % of income earners. They're just comfortable feeling as though they are middle class in terms of cost of living and opportunities they can afford just to live in CA. They tell me they wouldn't be happy being in the top % of income earners to live in a much LCOL place. To each their own, I guess.

 

[finalpsychyear]

It’s amazing how many physicians I know in SoCal who don’t even max out their tax deferred retirement contributions, much less have money left over to contribute to index funds.

Its the same situation regardless of geography. Docs are not great at finances period. I get people needing to be in SoCal for family or those type of situations. Aside from the 1% of docs doing cash or cosmetics that having high end cliental make it worthwhile, everyone else is paying a huge premium for location and weather.

Docs living in So Cal will face keeping up with the jones's, lifestyle creep, and insanity in gas, houses, and how much wasted time on the 405 due to traffic lol. Of all places, your least likely to be maxing out 401k's or investing leftover funds rather you need that new model s/x as that's the culture a bit in that area no judgement I am just saying. You want to save money move to TX or FL. You want the weather and location your going to pay more than most realize.

Lots of wealthy family in CA. Wife's friend out there and husband have never worked and have 3 kids socal.. Their parents are oversees working into their late 60s building generational wealth so their grandkids children are taken care of. These type of folks don't cook and uber eats 3 meals/day...but these people are not very happy sadly and utilize marijuana/smoke excessively and some have health issues sadly in their 30s..
work is a requirement for optimal function imo.

 

[Stagg737]

Sorry, I gotta ask. Why do you need such a big home? What do you fill up all that space with?

We are a family of 4, and just moved into a single family home that is close ~2000 sqff (4BR/2BA) under air + 2-car garage... I am looking at my kitchen while writing this post and ~30% of the cabinet/pantry is empty, and I have an extra bedroom collecting dust.

I am always fascinated when a middle class (emphasis on middle class) family of 4 tells me that the size of their home is > 3000 sqft.

Me personally or anyone in general?

General reasons: In general, there's a difference between necessities of living and comfortable living. Some people are more comfortable in smaller homes, many are not. Being able to allow everyone in the family to have personal space or socialize without constant disturbances is nice. Sharing a bathroom can be an absolute nightmare, I did it most of my life and I never want to be forced to do this again. A lot of people underestimate just how much...stuff... accumulates as their children grow up and I'm sure we won't be an exception. Some people are great with organization, most are not and could easily fill up that space if it was available. Many people have a family larger than 4, which may necessitate more space.

Personal reasons: Right now a good part of our house is empty, but we do have longer term plans which will require more space. My spouse works from home, and part of the house is a pretty nice office space that is now hers. She also has a side business that requires a separate area where she can work/create and depending on the direction of my career we may renovate an area to make a second office space. Until then I'm using one of the extra guest rooms as a more private office (I share an office at work). I've always wanted a nice kitchen as I enjoy cooking a lot. Cooking in small spaces is doable, but having more space to work is definitely helpful, so that's been something we've been working towards. I've also always wanted to have a small in-home gym area, which does have structural needs if you're going to use any significant amount of weight. Our nearest family is over 7 hours away, and d/t circumstances when they visit it requires either 2 guest rooms or hotel rooms, so having the space for them to stay when they visit is important to us, meaning at least 4 bedrooms for us currently. We'd also like to have some social gatherings and I'd like to be able to host residency/department events which is very difficult to do with smaller spaces.

Other than that, this particular house was an investment. We got it at a fair amount less than what it assessed for and then had the original roof replaced without cost to us, so we already have a little head start in equity. In our state there's also pretty strong homestead laws so it's a form of asset protection.


TL;DR is that we don't need a big home, but it's a good investment that we can easily afford on our household income (~$300k) while still maxing out tax-deferred retirement, investing extra in retirement/going toward paying down mortgage principle, and still have enough monthly "fun money" to live comfortably.

 

[psychmd03]

Imagine saying something like that to the average American making 50k/yr...

But we are in a forum talking about people that have the opportunity cost loss of 4 years post grad and another 3-8 years of basically lost income on top of taking on massive amounts of debt. That already separates this discussion to something different.

 

[clausewitz2]

The average family also didn’t train for as long as us or have debt.

That's not really how most job markets work. Vets (woof woof not bang bang) take on tremendous amounts of debt and spend a lot of time in training to make fairly underwhelming salaries most of the time. Sure, most PhD students get incredibly modest stipends, but they might spend 5-7 years in training in order to wind up barely piecing together multiple adjunct positions to squeak past $40k. It would be nice if time in training had a linear relationship with income always and everywhere, but it just ain't so.

We have to recognize we are incredibly fortunate that at this moment in history we are scarce enough to consistently demand a large premium. Nobody owes us just 'cause we decided to train for years or take on crushing debt.

 

[psychmd03]

That's not really how most job markets work. Vets (woof woof not bang bang) take on tremendous amounts of debt and spend a lot of time in training to make fairly underwhelming salaries most of the time. Sure, most PhD students get incredibly modest stipends, but they might spend 5-7 years in training in order to wind up barely piecing together multiple adjunct positions to squeak past $40k. It would be nice if time in training had a linear relationship with income always and everywhere, but it just ain't so.

We have to recognize we are incredibly fortunate that at this moment in history we are scarce enough to consistently demand a large premium. Nobody owes us just 'cause we decided to train for years or take on crushing debt.

I don’t believe these were the average families that were being discussed.

 

[clausewitz2]

I don’t believe these were the average families that were being discussed.

Sure, I was challenging the idea that there is any intrinsic link between "I trained a long time" and "therefore I make a lot of money."

 

[psychmd03]

Sure, I was challenging the idea that there is any intrinsic link between "I trained a long time" and "therefore I make a lot of money."

Fair enough. I agree those other ones have very poor ROI and people should think about that and accept if that’s what they want to do. Also many careers in medicine broadly and psychiatry can also give you poor ROI so again hopefully forums and people doing their research can make sure they make an appropriately informed decision and accept the positives and negatives.

 

[pyrrion89]

I know doctors making $200-300k doing just fine in CA. They don't need to FIRE or be at the top % of income earners. They're just comfortable feeling as though they are middle class in terms of cost of living and opportunities they can afford just to live in CA. They tell me they wouldn't be happy being in the top % of income earners to live in a much LCOL place. To each their own, I guess.

That's exactly right. I'd love to move to the Pacific NW and live like a king in a rural/suburban setting, have my own shed and workshop for crafts and woodworking, some chickens and goats, but my wife hates the weather, loves the California sunshine and all the Asian food, diverse culture, diverse hiking trails, and all her family is here. So we stay here being middle class, as dual-income physician household with no kids. I don't mind since I grew up poor and we're both frugal and still save quite a bit of cash. We both drive used Hyundai hybrids and like to eat at home.

 

[yoloswagpoop42069]

Miami 200/HR 1099 locums work 9-5, 45 min news, 30 min follow ups, lunch break from 12-1, no call no weekends. Standard outpatient stuff

I agree guy who posted 300+/hr needs to post location, expectations of work, etc.

Only listings I have seen for 300+hr are upstate NY. Haven’t been able to find many correctional jobs.

 

[clozareal]

I've been getting messages from recruiters on LinkedIn telling me $175-225/hr for 16-40 hours a week of doing outpatient adult or CAP, some including TMS. I've also gotten messages for $250-325/hr at correctional facilities (Napa, San Quentin, Stockton, Sacramento in CA).