Having trouble deciding Gen Surg vs Ortho

[pd1112]

OP - I think you have to decide which life will be most rewarding, not which specialty or which lifestyle alone. No amount of fascination with your work is worth hell at home - unhappy/detached spouse, minimal involvement in the lives of your children, minimal time for personal leisure, etc. Likewise, no extent of lifestyle extravagance is worth going through the motions with zero enthusiasm for 60+ hours/week x30 years. I'm sure there are rare exceptions. Otherwise you have to find a way to pick which one will be most likely to give you the best balance between the two, and only you can know that.

Also, to the "average American family only has $x..." saintly posters - We are not average American families. There's nothing wrong with discussing different salaries within niches of an occupation as it pertains to lifestyle. It's extremely relevant to career choice and such discussions are commonplace in every other occupation, so why should we feel ashamed? Physicians have higher rates of divorce, substance abuse & suicide than any other occupation. Certain aspects of physician lifestyle absolutely contribute to those high rates. Money, without a doubt, is one contributor to lifestyle. If you haven't considered how it might affect your lifestyle and overall satisfaction with your career, you probably should.

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[Greenberg702]

Just out of curiosity, have you considered neurosurgery? Definitely not the most lifestyle friendly (especially during residency) but from what I've seen, people who want to go into orthopaedics typically don't want to deal with any life threatening conditions that potentially result in morbidity. I feel like it would offer you the interesting/high-risk pathology/medicine/vents that you're looking for combined with the higher compensation/job prospects.

 

[Moose A Moose]

No GS jobs?
Poor compensation?

Who the **** have you been talking with?

 

[Winged Scapula]

No. That's my combined family income and I can guarantee you I'd be happier in the house Winged Scapula has in my imagination than in my place with all the broken doorknobs. I also grew up a lot poorer than I am now and despite how much I loved jumping around open fire hydrants (#hoodsummer) I'd rather my kids have pool parties. I don't need 500k to make that happen but I also don't need a crystal ball to know I'll be less stressed with a little more money.

LOL...its probably not as grand as you imagine.

I live in a 3/2 condo on a golf course with mountain views which I bought when I moved out here on my (much) smaller employed surgeon salary. I have been too lazy to move although think about it from time to time as I need more room for my shoes, etc.

None of my door handles are broken, it is true.

 

[Jlaw]

I'm sorry....but how is making hundreds of thousands a year poor....

when you have to pay off a 250k education accumulating at 7% a year ($17,500 in interest/year) while making 65k a year before taxes for 5 years.

 

[RADjet]

Just out of curiosity, have you considered neurosurgery? Definitely not the most lifestyle friendly (especially during residency) but from what I've seen, people who want to go into orthopaedics typically don't want to deal with any life threatening conditions that potentially result in morbidity. I feel like it would offer you the interesting/high-risk pathology/medicine/vents that you're looking for combined with the higher compensation/job prospects.

I have considered neurosurgery, and while residency lifestyle isn't the biggest factor to me, I'm afraid the lifestyle after residency will be too much. I suppose it is something to still think about, but Im fairly sure I don't want to be a neurosurgeon.
Also, while this may seem silly., I don't think I connect very well with the people in neurosurgery. My personality fits better with ortho and general.

 

[RADjet]

No GS jobs?
Poor compensation?

Who the **** have you been talking with?

General surgeons.

 

[charmiedermie]

I have considered neurosurgery, and while residency lifestyle isn't the biggest factor to me, I'm afraid the lifestyle after residency will be too much. I suppose it is something to still think about, but Im fairly sure I don't want to be a neurosurgeon.
Also, while this may seem silly., I don't think I connect very well with the people in neurosurgery. My personality fits better with ortho and general.

You clearly want a good lifestyle in terms of hours , so why are you even considering General? Just because you think you like it?

 

[Kaustikos]

when you have to pay off a 250k education accumulating at 7% a year ($17,500 in interest/year) while making 65k a year before taxes for 5 years.

Wow. That's not even remotely close to the definition of poor.
Also, can we stop using the 250k education excuse? Not like you won't get a job that will pay for it.
Not to mention the countless majority of residents whom not only live okay with it but, OMG, have a family!

 

[Psai]

Wow. That's not even remotely close to the definition of poor.
Also, can we stop using the 250k education excuse? Not like you won't get a job that will pay for it.
Not to mention the countless majority of residents whom not only live okay with it but, OMG, have a family!

Where are you going to get back those years of stress and hard work?

 

[Kaustikos]

Where are you going to get back those years of stress and hard work?

So,
If you look at it like that, then I can see why people are like this. But it's the wrong way to look at it. Especially if you're in a specialty you enjoy and have a team you enjoy working with. It can make it less like a grind so you don't feel like you said.

 

[Moose A Moose]

General surgeons.

Hm. Dunno what to tell you, dude.

They must be salty about something..

Maybe they always pictured having a new Ferrari AND Lamborghini. I'd be pretty pissed too.

 

[username456789]

I'm going to go against the grain somewhat here. I understand that general surgeons and orthopedic surgeons probably don't have such a large divide between their average incomes. However, on the subject of a difference in income between 300 and $500,000, I don't agree that it is insignificant at all. Specifically, these days many students are graduating medical school with $250-$400,000 worth of debt ( with interest rates of 6.8% to 8.0%). The first 5 to 10 years following residency completion will likely take a noticeably different trajectory based on a difference of $200,000 per year. Particularly if one has a family.

 

[notbobtrustme]

I think someone @Stagg737 already pointed that out. It does not make that much difference in term of lifestyle, but it makes a huge difference in term of purchasing power i.e the ability to invest, which can substantially lower one's retirement age... Anyway, we are discussing 300k vs. 500k when the average household income in the country is 53-54k/year.... Even if we factor in loan/taxes, these incomes are 4-6 times more of what the average family make... I know, I know! we are special since we go thru 11-15 years of rigorous training and our job is a lot more demanding . People will definitely have some sympathy for us .

Average American thinks that the world was made 6000 years ago and that man lived with dinosaurs. We aren't average and we shouldn't compare ourselves to the average. Other high performing fields make similar money while having less training and often, but not always, having a better work-life balance.

 

[notbobtrustme]

I'm going to go against the grain somewhat here. I understand that general surgeons and orthopedic surgeons probably don't have such a large divide between their average incomes. However, on the subject of a difference in income between 300 and $500,000, I don't agree that it is insignificant at all. Specifically, these days many students are graduating medical school with $250-$400,000 worth of debt ( with interest rates of 6.8% to 8.0%). The first 5 to 10 years following residency completion will likely take a noticeably different trajectory based on a difference of $200,000 per year. Particularly if one has a family.

I think the point is that the things you buy on a 300k salary and a 500k salary aren't that much different. Sure, you might fly 1st class or buy a souped up corvette, but you aren't going to be buying yachts, royces, and 50 1k diamond necklaces. What a 500k job buys you is security and early retirement, but only rarely does it buy you most things.

The real big jump comes in around 3 to 5 million a year. At that point, you have ****-off money and you can do truly ridiculous things like rent out a whole floor of the Bellagio in Vegas and snort the finest Bolivian cocaine off the backs of sexually ambiguous Thai boys.

 

[NotTheBestUSMLE]

Here are the articles I referenced. So on average, even a FM doc should be able to be reasonably happy

http://time.com/money/2802147/does-money-buy-happiness/

http://www.huffingtonpost.com/2014/07/17/map-happiness-benchmark_n_5592194.html

http://content.time.com/time/magazine/article/0,9171,2019628,00.html

These articles all hinge on a (single? couple?) studies. Other studies exist that do not find the same conclusions. https://fortunedotcom.files.wordpress.com/2013/05/subjective_well_being_income.pdf

This article explains why all the lay press interpreted Kahneman's research sorta-wrong. http://www.controlyourcash.com/2014/01/08/that-75000-thing-is-a-crock-of-garbage/

 

[DokterMom]

Whatever -- Basically, all I'm saying is that your 'wants' can grow proportionate to your income, however high it gets, so if you're inclined to always want more than you can quite afford, you unlikely to every be happy. But if your aspirations are more modest -- financial security and a decent home, you'll be fine at any physician's salary.

 

[username456789]

I think the point is that the things you buy on a 300k salary and a 500k salary aren't that much different.

They absolutely are different during the first 5+ years when you're making huge loan payments. That is my point, and often entirely overlooked when medical students start talking about this.

It's not as easy as saying "ok my pay is $400,000 per year and I owe $350,000 in loans so I can easily pay that off in 2 years."

 

[bc65]

I wouldn't recommend going into a specialty just for the money, but a $200,000 difference, or $100k after taxes, is very significant.

Let's assume an effective tax rate on 300k of 33%, and a marginal rate of 50% on the additional 200k.

The doc earning 300k would have 200k after taxes, and the 500k doc would have 300k. If each spends 100k per year on living expenses, the higher-paid doctor will be able to save twice as much and retire in half the years. You could work part time. You could take several month long vacations every year. Some of you may want to work until you're 70, but many of you will want to retire as soon as possible, once you've been in practice for a few years. If you're not interested in retiring earlier, look at it this way: You can pay off your student loans in 2 or 3 years. 100k a year will put two kids through college or grad school at the same time. It can buy you a new Lamborghini every 2 or 3 years. Whatever.

The real benefit of having a comfortable amount of money is the security it brings you. For most Americans, needing a major car repair, getting a traffic ticket, a hospitalization ( even with health insurance ) will be a major catastrophe. If you're careful with your money and save as much as you can, and live like a resident for a few years after residency, you will be financially comfortable and be able to weather many of life's challenges quite easily, as many of them are financial in nature. Plus, having your FU money will make dealing with work and difficult people a lot easier.

Some people will spend all the money they earn, no matter how high their salary, and go into debt, and will still not be happy. Just don't be that person.

Money can't buy happiness, but I'd rather be sad and rich rather than sad and poor.

 

[username456789]

.

 

[ChEMD]

And to think I thought this thread might actually lead to a good discussion about the pros and cons of general surgery versus ortho. Of course it turns into people arguing about money. I guess it's hard to compare the two though, since I doubt anyone on this board has actually practiced both specialties. And at the end of the day, the opinions of us med students really are pretty useless since we really have no idea what it's like to actually practice any given specialty and what kinds of opportunities are out there, regardless of how many attendings we claim to have talked to.

 

[bc65]

And to think I thought this thread might actually lead to a good discussion about the pros and cons of general surgery versus ortho.

That discussion took place above. The differences are pretty obvious. Mostly, it comes down to this:

If you want to fix bones and joints , go into ortho.
If you want to fix bowel and remove internal organs, go into general surgery.

If you like doing both, here's a longer answer:

If you want to fix bones and joints , use a lot of complex instrumentation, make a bit more money, and have a better lifestyle, and if you get sued, it will be for making people limp, or losing neurological function in their extremities, go into ortho. If you would rather work on bowel and internal organs, and don't mind a worse lifestyle,and somewhat less money, and if you get sued, it will be for killing people or failing to treat their cancer, then go into general surgery.

CAVEAT: There are lots of subspecialties or types of practices in each field that will change the parameters. e.g.: Hand surgery makes less than general ortho, spine surgery much more. But spine has a much worse lifestyle and much more stress and lots of lawsuits. You can do thyroid surgery or breast surgery and have a much nicer lifestyle than either ortho or general. You can do total joints and have a totally elective ortho practice. Etc.


But in the end, you will have to pick one or the other. We can't do that for you.

 

[stevesteve123]

shame on all of you in this thread

you know that anything you make above 70k/year is wasted

i know this because i read that study on the interwebs

 

[operaman]

Was doing some research this morning for an article on an unrelated topic and stumbled across this little gem that made me think of this thread:

(Regarding a salary survey conducted by the AMA)

"One of the most interesting facts, and most useful to young men planning to enter the medical profession, is that the largest annual gross incomes are earned by physicians who have had ten or more years of preparation. Orthopedic surgery seems to be the most lucrative of the specialties. The highest incomes are reached in centres of a million or more population."
The New York Times
January 18, 1932

 

[Greenberg702]

Average American thinks that the world was made 6000 years ago and that man lived with dinosaurs. We aren't average and we shouldn't compare ourselves to the average. Other high performing fields make similar money while having less training and often, but not always, having a better work-life balance.

Bingo. It pisses me off so much when people tout the "average". Less than A THIRD of Americans even have a Bachelor's degree. Top 5 law schools have an average GPA of like 3.72-3.8, top business schools have even lower averages. Those + coding are our peers. In those fields you can earn general surgery money about 10 years before you could do so as an attending. If you're at a ~top 50 MD school, chances are you probably could have broken into one of those fields. If you're competitive enough for ortho (which means you really busted your ass all through med school and are at the top of your class), you could potentially have been near the top of another field. People have to start comparing apples to apples.

 

[Psai]

I think the point is that the things you buy on a 300k salary and a 500k salary aren't that much different. Sure, you might fly 1st class or buy a souped up corvette, but you aren't going to be buying yachts, royces, and 50 1k diamond necklaces. What a 500k job buys you is security and early retirement, but only rarely does it buy you most things.

The real big jump comes in around 3 to 5 million a year. At that point, you have ****-off money and you can do truly ridiculous things like rent out a whole floor of the Bellagio in Vegas and snort the finest Bolivian cocaine off the backs of sexually ambiguous Thai boys.

I understand what youre saying. The level is similar. However, one takes home significantly more home than the other after taxes, loans, expenses. Saying the level is similaer is very different from saying that there is no difference and you should be content with less. I don't understand the justification as if making less is more moral than making more or something?

 

[notbobtrustme]

I understand what youre saying. The level is similar. However, one takes home significantly more home than the other after taxes, loans, expenses. Saying the level is similaer is very different from saying that there is no difference and you should be content with less. I don't understand the justification as if making less is more moral than making more or something?

My comment was more about choosing what you like doing over money at that price point. I'd rather do cards than ortho, even though ortho can pay 500k. In contrast, I'd do ortho if my only choice was peds because the jump from 150k to 500k is way more than the jump from 300k to 500k.

 

[bc65]

In those fields you can earn general surgery money about 10 years before you could do so as an attending.

No, not really. Law: only top graduates of top 14 schools get big law salary of 160k, and there are very few of those. Most of those are pushed out. Few make partner, for the real money, and these days, fewer than before. Average law salary was in the 50k's and probably lower now. Not many law jobs anymore.

Coding: Around 80-120 k.

Business: Most MBAs are in middle management.

Sure, some top 5 business graduates make millions. Some coders make billions, but those are the exception. The average doctor makes more than the average anything else.

 

[Krukenberg]

Get off your high horse, saintly Pre-medical student. The ortho average income is ~500 and the general surg average is ~300.
The free market dictates that working 10 years as an orthopedic surgeon is worth the same as a general surgeon working for 16.7 years. That is a huge difference, plus the fact that living on 300K/year + putting 200K/year in the bank is a massive difference in lifestyle than a general surgeon.

If money doesn't mean anything to you, hike over to family medicine and go be content there. Unfortunately for most people, especially those with loans, the average starting salary can be and should be a serious factor to keep in mind when choosing a specialty to practice for the next 20-30 years.

I would hardly call insurance reimbursements a free market. You do know that Medicare reimbursement is based in part on a formula invented several decades ago, right?

 

[Greenberg702]

No, not really. Law: only top graduates of top 14 schools get big law salary of 160k, and there are very few of those. Most of those are pushed out. Few make partner, for the real money, and these days, fewer than before. Average law salary was in the 50k's and probably lower now. Not many law jobs anymore.

Coding: Around 80-120 k.

Business: Most MBAs are in middle management.

Sure, some top 5 business graduates make millions. Some coders make billions, but those are the exception. The average doctor makes more than the average anything else.

The average allopathic (definitely top 5o) medical school matriculant is on the academic level of a Top 14 law school one. You can't compare doctors to lawyers because there are so many more lawyers that tier comes into play (some law schools have an average GPA of 2.0, definitely not the case for MD schools).

I don't know about "very few", but over 50% of top law school grads score NLJ250 firms and the median starting pay clears 160,000.
http://abovethelaw.com/2014/02/best-law-schools-for-getting-a-biglaw-job-2014/

This 160,000 is usually accompanied by bonuses. I agree that very few make partner but partners at BigLaw clear several million and are probably not comparable to physicians anyway. http://www.abajournal.com/news/article/wachtell_partners_make_by_far_the_most_448m_on_average/

Since matching orthopaedics or any other competitive specialty usually requires being at the top (definitely top half if not quarter) of one's medical school class, it's not unreasonable to extrapolate that those individuals would be in the 50% who score the biglaw gigs.

Same thing with business. "Business" is such a broad term that includes so many programs that are not comparable to MD caliber matriculants. The average GPA at Harvard Business School, for example, is 3.67. Most MBA grads were <3.0 and not comparable to MD students. Obviously in business, grades are definitely not everything, but I stand by my thought that comparing physicians' (and especially surgeons') pay to the average American household (2/3 of whose members don't have undergraduate degrees) doesn't make any sense. Small/moderate differences in pay shouldn't play a role in choosing your career, but it's tiring to see so many people compare MD pay to averages and not academic/professional peers.

 

[bc65]

The average allopathic (definitely top 5o) medical school matriculant is on the academic level of a Top 14 law school one. You can't compare doctors to lawyers because there are so many more lawyers that tier comes into play (some law schools have an average GPA of 2.0, definitely not the case for MD schools).

Lets look at some numbers. I'll guess that the average law school has classes of about 200. So, all the T14 schools combined x 1/2 gives 1400 graduates entering big law each year, most of whom won't stay in big law. So, perhaps 500 or fewer graduates each year will make big law salaries for life, vs 18,000 med school graduates each year.

Plus, I don't believe that LSAT scores correlate to overall MCAT scores. So, yes, some med students might do well on the LSAT and get into a top law school. But some who do well on the MCAT will do very poorly on the LSAT and on the GMAT. I know of examples of both.

So, I will agree that some doctors will get in, but by no means all, and probably a small minority who will crack top schools.

Getting an MBA from Harvard will not guarantee you a high salary. You still need connections and luck. I know some Harvard MBAs with mediocre middle management jobs. You only read about the success stories.

But I agree, some med school applicants will be able to get into top law schools. I took the LSAT on a bet, did well, and got into two top 5 schools, so I know that some of us can do it. But my score on the GMAT was mediocre.

 

[W19]

All the practicing general surgeons in this thread please standup.

I thought so.

$300,000 would be at the low-end for a general surgeon. I don't know anyone making that little except perhaps as a starting employee who signed up that contract.

Most of us make significantly more than that, even without fellowship, and some of us even make more than those numbers quoted above for orthopedic surgery.

#dontbelievesalarysurveys

Do these surgeons work 80+ hrs/wk?

 

[Winged Scapula]

Do these surgeons work 80+ hrs/wk?

Nope. I work nowhere near that, nor do my partners or any of the guys I know in practice.

 

[W19]

Nope. I work nowhere near that, nor do my partners or any of the guys I know in practice.

These salary surveys are way off then...

 

[Winged Scapula]

These salary surveys are way off then...

As I said...

 

[Psai]

These salary surveys are way off then...

Salary surveys are not even close to the real thing. When I say I'm going into anesthesia 90% of people are like "is it for the money?" I don't even know what to say