Peach Newport

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I'm talking about the DOs with student loans above 300k (most of them) and primary care salaries well under $170k (most of them).

At my school, my total student loans will be $400,000, which by the end of residency, has compounded to $650,000.

This means that, with a $150k salary (realistically), ill owe $60k/year in taxes and 65k in student loans, leaving $25k, which doesn't take into account malpractice insurance (which often exceeds $25k). These numbers aren't adding up. It seems to me that not only can you not pay off student loans as an attending, but being a doctor will actually cost you money every year.

What am I missing?
 

BorntobeDO?

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I'm talking about the DOs with student loans above 300k (most of them) and primary care salaries well under $170k (most of them).

At my school, my total student loans will be $400,000, which by the end of residency, has compounded to $650,000.

This means that, with a $150k salary, ill owe $60k/year in taxes and 65k in student loans, leaving $25k, which doesn't take into account malpractice insurance.

What am I missing?
Primary care (unless you mean general peds) isn't as low as you think 45 per an RVU (approx. 225 thousand) is the median. 40 an RVU was the 5 percentile in 2014 for FM. Your interest will not compound that fast during residency if you use REPAYE (will pay half of any interest above your minimum payment), and most primary qualify for a decent amount of loan forgiveness (gen 100 to 200kish). So that's how.
 
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Peach Newport

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Primary care (unless you mean general peds) isn't as low as you think 45 per an RVU (approx. 225 thousand) is the median. 40 an RVU was the 5 percentile in 2014 for FM. Your interest will not compound that fast during residency if you use REPAYE (will pay half of any interest above your minimum payment), and most primary qualify for a decent amount of loan forgiveness (gen 100 to 200kish). So that's how.
Aren't those programs being abolished?
 

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BorntobeDO?

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Aren't those programs being abolished?
Not the state based or the NHSC ones. PSLF maybe capped at some point (likely), but that's not a primary care thing. REPAYE will not go away, but your loans count as income the year they are forgiven. If its Peds in a popular city is usually low, especially without call or nights the pay would look like what you posted (135k) at first, but go a bit further out and take call, and it will go up to like 160-170 to start.

The numbers you posted on debt are kind of SDN doom and gloom also. Even at my midcost school (just less than 80k a year in tuition and COL), where we pull over 300k in principle, it only goes upto 360ish by the end of school since we are in deferment and the interest is not allow to capitalize. You can apply for a hardship deferral for all of residency if you only do three years, or you could do REPAYE which will effectively nearly half your interest rate during residency. And even when you are a peds making 160k, your payment on repaye would be 1k a month, you don't pay down much, but you will still be alright. Peds is the one specialty (due to low pay) that its pretty much always better to go with loan forgiveness programs rather than consolidate at lower rate thru a lender like SOFI.
 
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Ibn Alnafis MD

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Only reason you'd make pennies in primary care is if you choose not to have common sense. I also suspect most women take jobs that allow them greater family freedom and deal with less bs. This is why Kaiser is the best place in the world if you're a mommy.
Fixed it for you
 

AnatomyGrey12

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and primary care salaries well under $170k (most of them).
You're way low. Those include part time workers and those who really sacrifice salary for location. As Albino said, if you aren't dumb with no common sense then you should be at least pulling 225k no sweat. It's not even crazy difficult to break 300, it's just a matter of how much you want to work.

says Pediatricians in NYC
This is your problem, yeah you might make that much if you are trying to live in Manhattan
 
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Peach Newport

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You're way low. Those include part time workers and those who really sacrifice salary for location. As Albino said, if you aren't dumb with no common sense then you should be at least pulling 225k no sweat. It's not even crazy difficult to break 300, it's just a matter of how much you want to work.



This is your problem, yeah you might make that much if you are trying to live in Manhattan
There are many specialties that seem to make more in manhattan than other places. Neuro and Rheum come to mind
 
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AnatomyGrey12

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There are many specialties that seem to make more in manhattan than other places. Neuro and Rheum come to mind
Sometimes in those types of places there is a very niche clientele, and if you can tap into that then yeah I can see those types of fields making more.
 

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A related but different question. How well could you live in LA, NYC, on 200k (any specialty that makes that much) without debt?
 
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I'm talking about the DOs with student loans above 300k (most of them) and primary care salaries well under $170k (most of them).

At my school, my total student loans will be $400,000, which by the end of residency, has compounded to $650,000.

This means that, with a $150k salary (realistically), ill owe $60k/year in taxes and 65k in student loans, leaving $25k, which doesn't take into account malpractice insurance (which often exceeds $25k). These numbers aren't adding up. It seems to me that not only can you not pay off student loans as an attending, but being a doctor will actually cost you money every year.

What am I missing?
And MDs in primary care don't have the potential for this exact same issue?
 
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Peach Newport

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And MDs in primary care don't have the potential for this exact same issue?
Potential? Sure. But statistically there are (a) more DOs are in primary care, and (b) MDs as a whole have substantially less debt.
 
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Peach Newport

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A related but different question. How well could you live in LA, NYC, on 200k (any specialty that makes that much) without debt?
Eh, at least in NYC, you could do *okay*. With $140k post-tax income, you could get a $3000/month 2 bedroom apartment, especially uptown, queens, or Brooklyn, which is pretty okay. You can't really ball out but I live in manhattan with 3 roommates on about $40k/year.
 

kubyx

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I'm talking about the DOs with student loans above 300k (most of them) and primary care salaries well under $170k (most of them).

At my school, my total student loans will be $400,000, which by the end of residency, has compounded to $650,000.

This means that, with a $150k salary (realistically), ill owe $60k/year in taxes and 65k in student loans, leaving $25k, which doesn't take into account malpractice insurance (which often exceeds $25k). These numbers aren't adding up. It seems to me that not only can you not pay off student loans as an attending, but being a doctor will actually cost you money every year.

What am I missing?
All of your assumptions are terrible (sorry).

Your 170k estimate as a general salary was low. Then you lower it to 150k for inexplicable reasons.

25k for malpractice? I just looked at a number of random fm jobs and every single one of them provided that. Especially any job under a major clinic that is bending you over on the salary you suggested.

You have negotiated quite possibly the worst deal ever if someone is paying you 150k for a FT fm position, and you're covering malpractice to boot.
 
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My starting salary in FM is a good bit higher than your first estimate; I get 70k/year in loan repayment, ~$45k per year in health and other benefits, and a very nice pension plan.

Thats all just the base offer too; I get a production bonus on top of it. It won't be that hard to clear 300k based on the RVU's I'm generating in residency right now.
 

HueySmith

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Eh, at least in NYC, you could do *okay*. With $140k post-tax income, you could get a $3000/month 2 bedroom apartment, especially uptown, queens, or Brooklyn, which is pretty okay. You can't really ball out but I live in manhattan with 3 roommates on about $40k/year.
3000*12 = 36k

140k - 36k = 104k

104k is ONLY okay in NYC? Is it that expensive to live there?
 
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Mad Jack

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Kaiser is offering pretty hefty loan repayment as well, on the order of an up-front 200k if you're in a less desirable area of Cali and put in for a few year commitment. That's on top of a decent salary and potential housing allowance with longer commitments. Their packages are incredibly good.
 
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Peach Newport

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3000*12 = 36k

140k - 36k = 104k

104k is ONLY okay in NYC? Is it that expensive to live there?
Like I said, I'm living in manhattan on about $40k a year, paying about $1000/month for rent (not a great neighborhood), meaning that I'm living on about $20k a year after other major expenses. I'm doing okay. I can go out to eat 1-2 times a week, buy lunch at a deli, do other things. A single guy (or a guy with a low-cost girlfriend) could have a pretty good life in manhattan on the budget you suggest. It's when you introduce kids that you might have a problem.

NYC isn't as expensive as people say, but there are a few things that come to mind that will destroy your budget:
1) housing (hence 3000k for a midrange 2-bedroom)
2) food (everything is at least 2-4x the price as it is in, say, Connecticut)
3) Schools. A decent private school in NYC might not be doable on this budget, many cost as much as a private college, with many in the 40-50k range).
4) entertainment. If you do something cool once every 1-2 weeks, you should be okay.

In general, on $100k of spending money a year, you'll be perfectly happy in NYC. But if you have kids you may want to consider making more money or moving to the suburbs.
 

Mehd School

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FM is the best kept secret right now in terms of compensation. I know one pulling in 340k (ten years out, but still only working 55 hrs/wk).
Everyone knows someone making stupid money somewhere, but you shouldn't plan on making close to double of the reported average salary in any specialty. Anesthesiologists in my area make $625k to schedule nurses lunches and put out fires. I'll probably make half of that doing my own cases in 5 years.

But the notion of primary care making $170k is laughable. The acgme family med residents at my hospital that graduated last year landed jobs starting around $220-290k, with very complex pay schemes (work load, loan repayment, hospital call, performance bonuses). Two of these residents got jobs paying that well in very desirable cities.
 
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Potential? Sure. But statistically there are (a) more DOs are in primary care, and (b) MDs as a whole have substantially less debt.
Fair point. DO schools on average scam students out of more money, it is their holistic approach. There are private MD schools engaging in the same type of behavior, although far less, at least by percentage.
 
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FM is the best kept secret right now in terms of compensation. I know one pulling in 340k (ten years out, but still only working 55 hrs/wk).
I have thought this many times. If you want to work 40 hours in FM, 300k isn't easily possible. Work 60 hours and 300k is easily possible. A good FM doctor that works efficiently can rack up serious RVUs
 

hallowmann

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Too high?

SDN and google tells me that's about right. Indeed.com says Pediatricians in NYC make, on average, $135k.
Yeah, if you want to be a pediatrician (pretty much one of the lowest paid medical fields) in a super saturated environment that attracts tons of people (NYC), and you're most likely working at a state/city hospital (most available physician jobs in NYC), then sure you're not going to get paid well. That's far from most people though.

Most pediatricians I know won't settle for less than $150-$180k even in a decent sized (>500k) city.

Potential? Sure. But statistically there are (a) more DOs are in primary care, and (b) MDs as a whole have substantially less debt.
Median debt level for US MDs is $190k according to AAMC. According to AACOM average debt for DOs is $240k. Its definitely higher, but its not astronomically more. The difference constitutes less than 6 months of salary in even a low paying field.

You also need to take into account the vast array of debt incentives in primary care. Most places, even if they can't afford to give you a high salary, will give you a nice hefty loan repayment incentive (I've seen anywhere from $40k-$120k either per year or just as part of sign-on).

Like I said, I'm living in manhattan on about $40k a year, paying about $1000/month for rent (not a great neighborhood), meaning that I'm living on about $20k a year after other major expenses. I'm doing okay. I can go out to eat 1-2 times a week, buy lunch at a deli, do other things. A single guy (or a guy with a low-cost girlfriend) could have a pretty good life in manhattan on the budget you suggest. It's when you introduce kids that you might have a problem.

NYC isn't as expensive as people say, but there are a few things that come to mind that will destroy your budget:
1) housing (hence 3000k for a midrange 2-bedroom)
2) food (everything is at least 2-4x the price as it is in, say, Connecticut)
3) Schools. A decent private school in NYC might not be doable on this budget, many cost as much as a private college, with many in the 40-50k range).
4) entertainment. If you do something cool once every 1-2 weeks, you should be okay.

In general, on $100k of spending money a year, you'll be perfectly happy in NYC. But if you have kids you may want to consider making more money or moving to the suburbs.
So basically you're describing the life of someone well into the top 1%. Someone who in NYC is paying at least 2-4x as much for food (let me guess they're going out to a nice restaurant 2-3 times a week), someone who sends their kids to a $40k/yr private middle/high school, and someone that goes to a Broadway show or does something that requires spending a lot for "entertainment" every week.

Housing, sure that's really expensive there for everyone, there's no way around it, unless of course if you commute from a more reasonably priced area outside the city like half the people working in the city do to begin with.

You're really talking about a very specific lifestyle. Spending $40-$50k/year per kid through their secondary (and maybe even primary) education is not something most people could afford. That's why most docs I know spend the money to buy a house in a place with a good school system. Either that or they make sure the school they pick for their kid is offering some incentives or a nice hefty scholarship.

Sure, if you're living like you make $500k/yr when you're actually making $200k/yr with $300k in debt then life is pretty hard as a primary care doc. Most people don't live like that though.
 

AnatomyGrey12

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There are private MD schools engaging in the same type of behavior, although far less
The percentage is only lower because there are dramatically more MD schools than DO schools. There are lots of private MD schools that do the same thing. The only difference is these MD schools also have to have monetary flow from other revenues like research, this is one area DO schools are seriously lacking
 
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Fair point. DO schools on average scam students out of more money, it is their holistic approach. There are private MD schools engaging in the same type of behavior, although far less, at least by percentage.
Every public school is"scamming" OOS students as well, by that logic.

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Igor4sugry

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I'm talking about the DOs with student loans above 300k (most of them) and primary care salaries well under $170k (most of them).

At my school, my total student loans will be $400,000, which by the end of residency, has compounded to $650,000.

This means that, with a $150k salary (realistically), ill owe $60k/year in taxes and 65k in student loans, leaving $25k, which doesn't take into account malpractice insurance (which often exceeds $25k). These numbers aren't adding up. It seems to me that not only can you not pay off student loans as an attending, but being a doctor will actually cost you money every year.

What am I missing?
This is unfortunately more and more common today. Single doc with $400k+ in loans. For you likely $500k by end of residency.
I highly recommend reading www.whitecoatinvestor.com as there are articles on this specific situation of heavy loans in low paying field.

The high debt will affect all major decisions going forward (where to live, maybe even family size, ability to save for retirement, etc).
Some ideas
Live LIKE a RESIDENT for next 5years.
1. Move to low cost of living area.
At this point forget about east or west coast.
2. Get a job with loan repayment.
3. Consolidate loans with private lenders (to bring interest down to 3% or less)
4. Maximize your income (moonlight, locums to Alaska, north dakota, you get the picture)
5. Dont buy a house or lease a car or fancy vacations or private schools for kids.

Say you have $500k debt, on 10yr repayment plan at 6.8% its $5,754/mo payment.
Say you get a salary of $225k/yr with benefits. Use paycheckcity.com. Say you live in NY, single filing take home pay will be $11,414/mo.
That leaves you with $5,560/mo for all other expenses.
Let me tell you that is not much if you have a young family. This is crappy middle-class income for which many good years were spent in training.

--it can be done. But after spending your 20s in school/training you will continue to have to be frugal. You will have mid-levels outearning you and laughing all the way to the bank as they have relatively good pay and the docs cary liability for supervising their work.

--in post-residency world there are docs that are doing great (i.e. Little student loans, high paying fields, or physician couple). Then there are docs who are stuck with lots of debt, living a very much middle class lifestyle for which they spent many years in training.
 
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Ibn Alnafis MD

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A very close friend is doing FM at community program in SoCal. He said his upper classmates have signed contracts for 240k working 4 days a week at Kaiser or a similar pay at other nearby community hospitals plus the opportunity to work more days for extra money.

The residents at one of the sites I rotated at were signing contracts during the beginning of their PGY2 in exchange for a 2k a month stipend for the remaining of their training.

My point is, for all of you future doctors, know your worth. Don't let the suits pay you the pennies while they make 7 figures. Govt is desperate to provide sufficient coverage for the population. The ball is in your court.
 

vm26

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A very close friend is doing FM at community program in SoCal. He said his upper classmates have signed contracts for 240k working 4 days a week at Kaiser or a similar pay at other nearby community hospitals plus the opportunity to work more days for extra money.
That's good cash to start out with. In general what's the pay progression with Kaiser? Do they have their equivalent of "partnership"?
 

Ibn Alnafis MD

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That's good cash to start out with. In general what's the pay progression with Kaiser? Do they have their equivalent of "partnership"?
I have no idea.

By the way I forgot to mention that Kaiser also gives 50k sign on bonus. In SoCal.
 

vm26

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I have no idea.

By the way I forgot to mention that Kaiser also gives 50k sign on bonus. In SoCal.
I am surprised that primary care is that open in SoCal...pay progression/autonomy/decisions regarding the practice is something to keep in mind though. Traditional PP may start out with lower compensation but more potential upside. Some organizations (not sure if KP falls into this category), start out with a sweet upfront deal with less potential upside.
 
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Ibn Alnafis MD

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I am surprised that primary care is that open in SoCal...pay progression/autonomy/decisions regarding the practice is something to keep in mind though. Traditional PP may start out with lower compensation but more potential upside. Some organizations (not sure if KP falls into this category), start out with a sweet upfront deal with less potential upside.
Good point. I'll keep that in mind when I enter the job market in the near future.
 

IslandStyle808

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I am surprised that primary care is that open in SoCal...pay progression/autonomy/decisions regarding the practice is something to keep in mind though. Traditional PP may start out with lower compensation but more potential upside. Some organizations (not sure if KP falls into this category), start out with a sweet upfront deal with less potential upside.
What do the upsides entail? I just want to have an understanding of what to expect when negotiating a contract.
 

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Mad Jack

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That's good cash to start out with. In general what's the pay progression with Kaiser? Do they have their equivalent of "partnership"?
You get vesting shares based on how many years you've been there from what I've heard. It's basically a form of partnership once you reach a certain point, though I don't know how good of benefits reaching the higher levels of Kaiser actually entails compared to PP partnership tracks.
 

vm26

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What do the upsides entail? I just want to have an understanding of what to expect when negotiating a contract.
Income and time off are the biggies. Having a say in how the practice runs such as scheduling, call shifts, policies regarding day to day issues and problems, purchasing equipment, how large CME funds should be, decisions regarding retirement benefits and health insurance benefits, and hiring decisions (for other physicians and support staff) are also important...Income and vacation jump from associate to partner can be substantial. My 1st job which was a 3 year track, partners made over twice as much as associates and vacation also went up by about 25-30% (this was a high volume, high stress practice). My current and better PP job, partners make about 25-30% more and also have about 20% more vacation time. Be sure to inquire about buy-ins for partnerships which are highly variable (and can be substantial if a practice owns equipment, office-space etc). Btw I am in a different specialty but I would think that the above also applies to primary care
 

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You guys make it seem like I'm going to have a chance to have a good life after medical school. good job!
 
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CCmetal94

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Correct me if I'm wrong but aren't DOs (particularly in primary care) a lot more likely to practice in rural or underserved areas than MDs? My school (DO) that is 100 years old told us like 60% of all alumni practice in underserved areas. Docs working in rural areas make waaayyy more money than the average for their given specialty typically.


I scribed in the rural Midwest for a few years and the FM docs were making 250k, IM docs makings 300-350k, and the ER docs making 500k. I worked with a ton of DOs and they all told me not to worry about the debt lol.
 
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PlutoBoy

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A related but different question. How well could you live in LA, NYC, on 200k (any specialty that makes that much) without debt?
The median household salary in NYC is around $50,000. Given that the average new yorker is not struggling for food, it is reasonable to assume that you could live pretty well.

I think that doctors, and student doctors in particular, have a really biased view of money, salary, and life in general. Since most of our friends tend to be other doctors, we assume that it is normal to make upwards of $100,000 a year. It is not. You will be fine.

Welcome to the 5%.

Income Percentile Calculator - Find Your Percent With WhatsMyPercent.com
 

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Here is the reality. A lot of new FM grads get an offer that seems to be awesome, but the fine print gives you a year or two years of a guaranteed salary, and then you make what you earn. You have to see 50 patients a day to keep up with your lifestyle and just can't do it. Academic jobs always pay less. Jobs at desirable locations always pay less. Jobs in the bid city always pay less. Also, it sucks to work for someone else and have no control over your staff or your situation. Work for a large corporation and that will be your reality. Your autonomy will be in question because your "boss", who has no medical degree, will be telling you how to practice medicine. If you ever have an interview and don't have the chance to discuss the job with several other physicians in the practice, not just the management, don't take it. Consider working in a state with low or no state taxes. When you are already in the 39.5% tax bracket and extra 6% can be a lot. $400,000.00 x .06 = $24,000.00.
 

AnatomyGrey12

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Here is the reality. A lot of new FM grads get an offer that seems to be awesome, but the fine print gives you a year or two years of a guaranteed salary, and then you make what you earn. You have to see 50 patients a day to keep up with your lifestyle and just can't do it. Academic jobs always pay less. Jobs at desirable locations always pay less. Jobs in the bid city always pay less. Also, it sucks to work for someone else and have no control over your staff or your situation. Work for a large corporation and that will be your reality. Your autonomy will be in question because your "boss", who has no medical degree, will be telling you how to practice medicine. If you ever have an interview and don't have the chance to discuss the job with several other physicians in the practice, not just the management, don't take it. Consider working in a state with low or no state taxes. When you are already in the 39.5% tax bracket and extra 6% can be a lot. $400,000.00 x .06 = $24,000.00.
You do realize that actual FM docs on this very site have refuted your statements.... there was a very good AMA in pre-allo a while ago that addressed all of these points.
 

scpod

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You do realize that actual FM docs on this very site have refuted your statements.... there was a very good AMA in pre-allo a while ago that addressed all of these points.
You do realize that I am an "actual" IM doc who works very closely with a lot of FM docs in the REAL world. I guarantee you that I know more of them personally than you will ever see posting here. I don't usually post much anymore here. I usually read and post in forums for "actual" docs. One of the reasons is because I can avoid posts from know-it-alls with no real life medicine experience, like yourself. I'm licensed in two states and generate about 12,000 working RVU's a year. My time is valuable.When I do spend time in these forums I like to offer my real life experience for those who haven't been there yet.
 
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