How much does salary matter to you?

[Stagg737]

Uhh, this is slightly old, but it says all you need to know

and this one for the last generation of doctors. Money has always mattered. Even before student loans

This doesn't account for hours worked though. Many psychiatrists work less than 40 hour weeks with no/little call while many surgeons continue to work 60+ hour weeks after residency for years with terrible call hours. Your graphs fail to tell the full story and completely ignore the value of time off. Everyone here would agree that money matters, the question is how much does it matter and at what point do other factors gain priority over money?

---

Members don't see this ad.

 

[zero0]

This doesn't account for hours worked though. Many psychiatrists work less than 40 hour weeks with no/little call while many surgeons continue to work 60+ hour weeks after residency for years with terrible call hours. Your graphs fail to tell the full story and completely ignore the value of time off. Everyone here would agree that money matters, the question is how much does it matter and at what point do other factors gain priority over money?

I'd say that's still about right. Even when you look at the average hourly compensation, psych, FM, and friends are still pretty miserable.

 

[firstaidforever]

This doesn't account for hours worked though. Many psychiatrists work less than 40 hour weeks with no/little call while many surgeons continue to work 60+ hour weeks after residency for years with terrible call hours. Your graphs fail to tell the full story and completely ignore the value of time off. Everyone here would agree that money matters, the question is how much does it matter and at what point do other factors gain priority over money?

I agree. I personally use $/hour as measuring stick. That's why my personal hierarchy goes: psych/EM<anesthesiology<<<Derm

 

[vernhart]

You bean-counters amuse me. Money is only valuable because of our collective beliefs and values.

What matters is growth of value that underlies money. Starting with the lowest salaries in medicine are totally fine with me, if I grow at least 10% a year average in total value provided to humanity, because even a pediatrician can have more than enough to live comfortably. If that's ortho, I'd do it; if not, then no point - otherwise you should just become a high level banker as you'd make much more. The status quo only blinds people to the truth.

I.E. Priscilla Chan the Pediatrician value >>> random ortho guy value

Right now, I envision a top neurology, oncology/RadOnc or ID program to being the best value by induction, not deduction.

Why am I qualified? I made more than ortho surgeon in the first year of medical school.

huh?

 

[Stagg737]

I'd say that's still about right. Even when you look at the average hourly compensation, psych, FM, and friends are still pretty miserable.

I personally don't believe any of the hourly wage calculations I've seen. Many of them actually do a really poor job of calculating how many hours docs actually work. For example, go to the psych residency forums and you'll see attendings saying patient loads of X patients (which comes out to around 40 hours per week) should be asking for 250-300k for starting salary. 250k comes out to around 125/hr and 300k is 150/hr. Most surveys I've seen put psychiatrists around $100/hr or less, which isn't true at all. Now look at a gen surgeon pulling in 400k working 60hrs/wk. That's only 133/hr. Now look at a neurosurgeon working 80hrs/wk making 700k, it comes out to about $175/hr. So yes it's more, but is the extra $25/hr worth doubling their work hours? Not to mention that those numbers look even better for they psychiatrists when taxes are accounted for as Uncle Same will take less of that check.

I also know psychiatrists pulling in paychecks similar to that of orthos and neurosurgeons (via either a lot of hours or other means), so it's certainly attainable. DPC family med people can easily pull in 300k working 40 hour weeks as well, I talked to one that made 400k working 40 hour weeks (aka $200/hr) and spending 30 minutes with each patient. No, that's not the norm, but there are many other factors that play into this and make it much more complicated (private practice vs. employed, reimbursement models, time spent with patients, etc). The thing is that with most of the high paying fields there's a trade-off to the money. Surgery is length of training and hours (including call), EM is the odd schedule (night shifts) and burnout, derm is only spending 5 minutes with patients. It comes back to which trade-offs are acceptable to you.

 

[Mad Jack]

I personally don't believe any of the hourly wage calculations I've seen. Many of them actually do a really poor job of calculating how many hours docs actually work. For example, go to the psych residency forums and you'll see attendings saying patient loads of X patients (which comes out to around 40 hours per week) should be asking for 250-300k for starting salary. 250k comes out to around 125/hr and 300k is 150/hr. Most surveys I've seen put psychiatrists around $100/hr or less, which isn't true at all. Now look at a gen surgeon pulling in 400k working 60hrs/wk. That's only 133/hr. Now look at a neurosurgeon working 80hrs/wk making 700k, it comes out to about $175/hr. So yes it's more, but is the extra $25/hr worth doubling their work hours? Not to mention that those numbers look even better for they psychiatrists when taxes are accounted for as Uncle Same will take less of that check.

I also know psychiatrists pulling in paychecks similar to that of orthos and neurosurgeons (via either a lot of hours or other means), so it's certainly attainable. DPC family med people can easily pull in 300k working 40 hour weeks as well, I talked to one that made 400k working 40 hour weeks (aka $200/hr) and spending 30 minutes with each patient. No, that's not the norm, but there are many other factors that play into this and make it much more complicated (private practice vs. employed, reimbursement models, time spent with patients, etc). The thing is that with most of the high paying fields there's a trade-off to the money. Surgery is length of training and hours (including call), EM is the odd schedule (night shifts) and burnout, derm is only spending 5 minutes with patients. It comes back to which trade-offs are acceptable to you.

The psychiatrists who can pull big numbers are the exception, not the rule. The national average for psych compensation is 226k in salary, or 215k in my area in the northeast. For every psychiatrist I know pulling more than 300k, I know literally ten pulling less than 220k. I believe the last compensation report I read put the 90th percentile of psychiatrist compensation in the 280s, which is lower than the 10th percentile for many higher paying specialties. Don't bank on being the exception, basically.

 

[Giovanotto]

This thread doesn't surprise me in the least bit, a good number of my classmates appear to not know what to do with themselves outside of school/medicine. I have more interests and expensive/time consuming hobbies than I can count with two hands, and my entry into medicine is directly correlated with my desire to work the least amount of time while making the most amount of money. Having said that, I truly hope to make a difference in people's lives and be a PCP above the rest. If that's impossible, I'll have to re-calibrate my priorities and make more time for work. I wouldn't be going into medicine if I thought the work wasn't fulfilling.

 

[Stagg737]

The psychiatrists who can pull big numbers are the exception, not the rule. The national average for psych compensation is 226k in salary, or 215k in my area in the northeast. For every psychiatrist I know pulling more than 300k, I know literally ten pulling less than 220k. I believe the last compensation report I read put the 90th percentile of psychiatrist compensation in the 280s, which is lower than the 10th percentile for many higher paying specialties. Don't bank on being the exception, basically.

That's fair, but at the same time what are the 10th and 90th percentile in terms of hours worked? I feel like almost every psychiatrist I've met other than 0ne or two work under 50 hrs/wk, which is basically unheard of in some other fields. I'm not trying to say that psych is going to be pulling in derm or ortho money, just saying that the discrepancy and reports don't seem to accurately capture the actual situation.

 

[IslandStyle808]

The psychiatrists who can pull big numbers are the exception, not the rule. The national average for psych compensation is 226k in salary, or 215k in my area in the northeast. For every psychiatrist I know pulling more than 300k, I know literally ten pulling less than 220k. I believe the last compensation report I read put the 90th percentile of psychiatrist compensation in the 280s, which is lower than the 10th percentile for many higher paying specialties. Don't bank on being the exception, basically.

Careers in medicine had the mean at $255k with the average psychiatrist working 45 hours. The ones that are working in the 90th percentile are most likely not working the same hours as a surgeon in the 90th percentile. At the same time, yes surgeons do make more per hours than psychiatrist. But those averages yearly salaries make it seem like the difference is that large when it isn't.

 

[Mad Jack]

Careers in medicine had the mean at $255k with the average psychiatrist working 45 hours. The ones that are working in the 90th percentile are most likely not working the same hours as a surgeon in the 90th percentile. At the same time, yes surgeons do make more per hours than psychiatrist. But those averages yearly salaries make it seem like the difference is that large when it isn't.

Does CiM use compensation or salary as the measure? Because that number fits with the total comp numbers I've seen, but not with any salary number I've ever come across. Very often people see compensation numbers like 255 and forget that only 225 or so of that is salary, the rest is health insurance, malpractice, and retirement benefits.

 

[IslandStyle808]

Does CiM use compensation or salary as the measure? Because that number fits with the total comp numbers I've seen, but not with any salary number I've ever come across. Very often people see compensation numbers like 255 and forget that only 225 or so of that is salary, the rest is health insurance, malpractice, and retirement benefits.

Their defining it as salary. However, the numbers they are citing are from the MGMA reports so it maybe a misinterpretation of compensation, as you have stated.

 

[TypeADissection]

For some reason, it has unfortunately become somewhat taboo for physicians to talk about money and wanting more of it. Of course money matters to an extent and for each person it will vary. I came into this with a certain target number in mind of how much I wanted to make. As I go through my training there's been a definite change in how I view my initial monetary goals. At this point, it's really more about the job and the opportunity rather than just a pure number. Once I finish my vascular surgery fellowship, I will be far more interested in the opportunity to have good senior mentorship, diversity of cases and hopefully the opportunity to be involved in teaching. Money matters for sure, but at this phase of my life, it's not the main focal point of any job that I pursue. Things could change so check in again with me a few years down the road.

 

[Tenk]

What about the cost to get there though? How do you reconcile this statement with the opportunity cost of GME? They just mentioned that neurosurg is probably the highest-paid specialty, but isn't it 7 YEARS of 80+ weeks before you're actually making the big attending salary? That doesn't sound like more money = more time off with my wife. I don't really know the lifestyle of NS attendings, but do they really have as much time off as direct-primary care doc?

If you're already in a long-term relationship, does the end justify the means? Is making $700k+/yr worth it if your wife is the only one that can spend it because you're constantly working? Or if your spouse leaves you because they couldn't handle 5+ years of you basically living at the hospital?

I'm not a neurosurgeon so I don't really care what kind of home life most of them have. Same concept applies though. That surgeon could work part time or do locums work and have a lot more time off for a slight dip in pay. YOU determine how much you work and what kind of life you want to live. I would never work more than 40 hours a week on average as an attending. Just not what I want in life.

 

[VolibearMain]

I'm not a neurosurgeon so I don't really care what kind of home life most of them have. Same concept applies though. That surgeon could work part time or do locums work and have a lot more time off for a slight dip in pay. YOU determine how much you work and what kind of life you want to live. I would never work more than 40 hours a week on average as an attending. Just not what I want in life.

I think what atom is indicating is before you get to the point where you set up your own part time practice you still have to go thru 11 years of hell and back. The best case scenario being you finish by the time youre about 31-32 in the united states having watched your entire 20's disappear infront of you. If neutosurgeons are pulling 700 / year theres nothing stopping them from living on 100 k a year and working 1 day a week, besides going thru that "right of passage".
Personally, I believe if someone took the amount of effort, resilience, and brain power it takes to get thru medical school and residency, and put it in another career such as investment banking or engineering -patent based, they could make way more money. Because frankly after taxes, even a million a year is still not gonna buy you much more than a large house and an upper class vehicle (no private yachts, hotel clubs, personal shopping malls or A380 jets)

 

[Raryn]

I think what atom is indicating is before you get to the point where you set up your own part time practice you still have to go thru 11 years of hell and back. The best case scenario being you finish by the time youre about 31-32 in the united states having watched your entire 20's disappear infront of you. If neutosurgeons are pulling 700 / year theres nothing stopping them from living on 100 k a year and working 1 day a week, besides going thru that "right of passage".
Personally, I believe if someone took the amount of effort, resilience, and brain power it takes to get thru medical school and residency, and put it in another career such as investment banking or engineering -patent based, they could make way more money. Because frankly after taxes, even a million a year is still not gonna buy you much more than a large house and an upper class vehicle (no private yachts, hotel clubs, personal shopping malls or A380 jets)

Ain't nobody hiring a neurosurgeon to work 1 day a week. His revenue wouldn't even cover his malpractice expenses. Much less talking about skill atrophy.

 

[VolibearMain]

Ain't nobody hiring a neurosurgeon to work 1 day a week. His revenue wouldn't even cover his malpractice expenses. Much less talking about skill atrophy.

Our family friend is a neurosurgeon and works two days a week... at Geisinger Hospital

 

[Mad Jack]

Their defining it as salary. However, the numbers they are citing are from the MGMA reports so it maybe a misinterpretation of compensation, as you have stated.

MGMA provides total comp. If you can get access to the numbers, they're not that high for salary alone alone (I can't repost them here because MGMA is highly protective of the their IP).

 

[Raryn]

Our family friend is a neurosurgeon and works two days a week... at Geisinger Hospital

Only operates 2 days a week? Possible. Even probable.

Only works 2 days a week? No way I'll believe it. People have to have clinic. And rounds. If you only work 2 days a week total, that means at best you're operating a day a week and letting your other work suffer... and no one sane should let you operate on them.

Perhaps he works 2 days a week there and works multiple days elsewhere, which is also possible.

Edit: typo

 

[787593]

Going from 40k to 75k or so does make a big difference. At 40k you need to budget and bargain hunt. At 75k you probably don't need to watch money that tightly, unless in an expensive city, and can afford luxuries that are valuable to you.

Going from 75k to 125k or so does provide a little happiness, but most of the jobs that pay 125k or more...you'll earn it.

Going from 125k to 250k did absolutely nothing for my personal happiness.

What if I'm trying to have like 10 kids...

 

[cluelessmedstudent411]

Your hierarchy is off. EM makes way more than psych and anesthesiology per hour.

Not sure how accurate the information in this link is and its a few years old but interesting data.

72 Statistics on Hourly Physician Compensation

 

[VolibearMain]

What if I'm trying to have like 10 kids...

For the good of humanity invest in a pack of condoms

 

[InvestingDoc]

You don't have to choose a specialty based on income level but OP let me ask you a question focused on malpractice?

Lets say you make $20 vs $400 off of every patient. Or $100k vs $500k per year. Would that effect how you look at your job after taking into account malpractice? How would you feel knowing that you're making maybe $20 a patient visit if you "don't care about money" but can potentially get sued for millions. Would you still put your neck out there?

Financial compensation isn't always important to everyone. However, at a certain point the liability of keeping the lights on and practicing medicine are not worth the pay out.

What you and I define as good compensation will vary. I can easily live off of $100k per year. One of my older brothers friends makes millions per year but recently filed bankruptcy. No matter how much money you make, you can always find a way to blow it.

 

[GypsyHummus]

Geeze, why would anyone want to live in San Fran? Legitimate question.

a 700k home in San Francisco is just a hovel...

 

[VolibearMain]

Geeze, why would anyone want to live in San Fran? Legitimate question.

Well if youre an engineer, or government employee then the stats I posted earlier about salaries is the answer. (Which is why everyone lives there)
Aside from that, its a clean area, lots of good schools, tons of stuff to do. California in general has what ever culture, climate, activity, food, etc that you want.

 

[GypsyHummus]

People can get all that stuff in the midwest and south too.

800K as a house in the South and Midwest gets you a palace.

Heck, as someone who worked 60hours/week last year barely taking home 24K, 100K after taxes sounds like a dream. That wasn't even minimum wage either! I lived off of about 1.5K/month.

Well if youre an engineer, or government employee then the stats I posted earlier about salaries is the answer. (Which is why everyone lives there)
Aside from that, its a clean area, lots of good schools, tons of stuff to do. California in general has what ever culture, climate, activity, food, etc that you want.

 

[bananafish94]

It's an interesting question that I've thought a bit about. I find myself far more drawn to the specialties on the lower end of the salary spectrum in terms of personal fulfillment, practice setup, hours, etc. but sometimes wonder if I would regret not doing something that pays more. I also have to consider the fact that I'm in a healthy amount of debt from college loans and go to a private medical school. That being said, I feel like salary reaches a point of diminishing returns at some point.

 

[VolibearMain]

People can get all that stuff in the midwest and south too.

800K as a house in the South and Midwest gets you a palace.

Heck, as someone who worked 60hours/week last year barely taking home 24K, 100K after taxes sounds like a dream. That wasn't even minimum wage either! I lived off of about 1.5K/month.

That's not what I meant, and no it isnt available anywhere else besides florida. If youre talking about having kids, having a wife, the standard "American Dream" (assuming you have money) it's california.
You have disney, universal, seaworld- for the kids (amongst 100's of other amusement parks in each city/town)
Mountains, rivers, valleys, even a huge national park (Yosemite, tahoe)
If youre into snow, you can go to tahoe and live a "northern climate"
Then you have all the various beaches which are unparalleled anywhere besides maybe florida.
I can go on and on and on for days, but the basic concept is, most people who live in california dont spend much time at their house. My family is always going on hiking, camping, beach trips, and during the milder winters still outside and going to malls etc.
Forgot to add its one of the biggest melting pots of cultures, what ever performance, cuisine, etc you want, theyve got it, and its close by your house.

 

[Stagg737]

Not sure how accurate the information in this link is and its a few years old but interesting data.

72 Statistics on Hourly Physician Compensation

Not accurate at all. They simply took average physician salaries and divided by 40 hrs per week, which makes the fields where people average 60+ hrs/wk have grossly inflated compensation in that report.

 

[W19]

It's an interesting question that I've thought a bit about. I find myself far more drawn to the specialties on the lower end of the salary spectrum in terms of personal fulfillment, practice setup, hours, etc. but sometimes wonder if I would regret not doing something that pays more. I also have to consider the fact that I'm in a healthy amount of debt from college loans and go to a private medical school. That being said, I feel like salary reaches a point of diminishing returns at some point.

At what point, there is a diminishing returns... No one can or should define that point for someone else.

 

[GypsyHummus]

I mean Ohio has six flags.

Tennessee has BBQ.

What more do you need? You can always visit Disney world.

That's not what I meant, and no it isnt available anywhere else besides florida. If youre talking about having kids, having a wife, the standard "American Dream" (assuming you have money) it's california.
You have disney, universal, seaworld- for the kids (amongst 100's of other amusement parks in each city/town)
Mountains, rivers, valleys, even a huge national park (Yosemite, tahoe)
If youre into snow, you can go to tahoe and live a "northern climate"
Then you have all the various beaches which are unparalleled anywhere besides maybe florida.
I can go on and on and on for days, but the basic concept is, most people who live in california dont spend much time at their house. My family is always going on hiking, camping, beach trips, and during the milder winters still outside and going to malls etc.
Forgot to add its one of the biggest melting pots of cultures, what ever performance, cuisine, etc you want, theyve got it, and its close by your house.

 

[787593]

Debt is getting crazy. My state school cost 170K about 10 years ago, now about 265K...think rule of thumb is that total student debt should be less than anticipated 1st year earnings after training

I guess I gotta make $340,000...

 

[Jabbed]

Not accurate at all. They simply took average physician salaries and divided by 40 hrs per week, which makes the fields where people average 60+ hrs/wk have grossly inflated compensation in that report.

I see mention of that in the comment section but do you have the source information?

 

[W19]

If you want to make money, do spine surgery. I worked with one who stated openly that he makes over $ 1 mil... He own a 4-sitter plane now... Not sure how expensive these toys are. Still a relative young guy though.

The thing I really liked about the guy is that he was a good advocate for the profession; he won't let nurse anesthetist work on his cases... it had to be a MD/DO. He did not care nurses were talking sh... I don't know if he still does that though, but it was amazing that the hospital accommodate his requests. One thing he always said was that, physicians have a lot of power and yet they are being run over because most of them are afraid to use it...

 

[mistafab]

I am not in medicine for the money.

With that stated clearly, I do have an expectation of myself to make three hundred thousand per year minimum. I am a hard worker and was never interested in primary care fields (not interesting to me). I am straddling the fence with gen surg and psychiatry wondering what I want to do. Considering that my ideal lifestyle is probably midwest in a suburb or rural-ish area - my expectations are not in the least bit impossible to meet. I expect to work 65+ hours a week since I am someone who enjoys work. 65-80 hrs/wk would be what I expect at my attending, mid-career stage.

 

[Stagg737]

I see mention of that in the comment section but do you have the source information?

It was actually brought up in an MBA class because the prof was big on Becker's Hospital Review as a source. I don't have access to the original Jackson and Coker analysis, but a classmate pulled it up and found that it wasn't the best tool (inconsistencies with surveys from different recruitment companies, not accounting for practice settings, etc). I can try and find the original analysis, but I'm pretty sure it's behind a paywall, and I don't feel like paying for that data.

 

[DrYoda]

Not accurate at all. They simply took average physician salaries and divided by 40 hrs per week, which makes the fields where people average 60+ hrs/wk have grossly inflated compensation in that report.

Hell i work barely over 40 hours a week and it's still horribly inaccurate.

 

[firstaidforever]

Your hierarchy is off. EM makes way more than psych and anesthesiology per hour.

But their hours are really ****ty. Psych never works nights.

My hospital has home-call built in to the deal with the psych group as standard part of contract, but if one actually has to come in, the automatically get $300 base + $200 for every hour they are in for.

EM is just expected to be there day and night @$200/hr

 

[WingedOx]

SFs culture up to about 2011 was remarkably open, and the weather is good. It does merit a premium of 30-50 percent over other cities.

Restrictions on development and the tech bubble have created a kind of tulip mania that probably won't last. I say it's a bube because it's about 10x per square foot of Austin or Chicago and about 5x as much as Boston

The tulip mania - old money hipster millenials with no unique voice - moved in en masse around 2011, and pushed the diversity out. It's culturally indistinguishable from New York at this point.

Seriously. Living in San Francisco about 10-15 years ago would be awesome. Today the place just seems expensive and stale aside from the geography.

 

[VA Hopeful Dr]

But their hours are really ****ty. Psych never works nights.

My hospital has home-call built in to the deal with the psych group as standard part of contract, but if one actually has to come in, the automatically get $300 base + $200 for every hour they are in for.

EM is just expected to be there day and night @$200/hr

That's the trick of it all. If you're in a well paying specialty, there's a reason for that.

EM has to provide coverage 24/7/365. That means you WILL miss major events - Christmas, kid's soccer game, and you work a good many nights.

Neurosurgery - Lots of hours, grueling residency, lots of call.

Derm - Have to be top of the class in med school, see lots of patients/day.

Cardiology - 6 years of training, lots of call since STEMI's happen at all hours.

You get the idea.

Conversely, stuff like FM, peds, psych don't pay as much but we essentially work banker's hours, home call at worst, and our clinics don't have to run at breakneck speed. Its all about what's important since none of us in medicine are badly all that badly.

 

[WingedOx]

That's the trick of it all. If you're in a well paying specialty, there's a reason for that.

EM has to provide coverage 24/7/365. That means you WILL miss major events - Christmas, kid's soccer game, and you work a good many nights.

Neurosurgery - Lots of hours, grueling residency, lots of call.

Derm - Have to be top of the class in med school, see lots of patients/day.

Cardiology - 6 years of training, lots of call since STEMI's happen at all hours.

You get the idea.

Conversely, stuff like FM, peds, psych don't pay as much but we essentially work banker's hours, home call at worst, and our clinics don't have to run at breakneck speed. Its all about what's important since none of us in medicine are badly all that badly.

This is why I both get and don't get @Tenk 's statement. I'm making right around the median salary for psych. There are gigs with some of the major hospital systems that would pay quite a bit more, but they work you like a dog for that cash. I could move out of the city and probably be able to demand a significant amount more, but again, lifestyle is important for both me and the wife. There certainly are tradeoffs in lifestyle for increased salary.

 

[VA Hopeful Dr]

This is why I both get and don't get @Tenk 's statement. I'm making right around the median salary for psych. There are gigs with some of the major hospital systems that would pay quite a bit more, but they work you like a dog for that cash. I could move out of the city and probably be able to demand a significant amount more, but again, lifestyle is important for both me and the wife. There certainly are tradeoffs in lifestyle for increased salary.

I mean I get what he's saying and why so many people choose EM - their total monthly hours at work are less than pretty much every other full-time physician out there and they still usually do quite well in terms of salary. But they have to work less because their hours are usually more stressful than the majority of the rest of us AND their irregular hours screw with circadian rhythm and require a day or so to recover. So working 13 days/month for them is way harder on the body than us 8-5 people working 20 days/month.

Beyond that, I do know quite a few people in EM who actually work more like 10 shifts/month and still earn a good bit of money. I think this is what he was getting at. In EM the money is good enough that they can work significantly fewer hours per week than the rest of us typically do and still do well.

In FM its possible to break 200k working 30 hours/week (3.5 days), but it takes some doing. In EM, its pretty darned easy - let's say you work 3 shifts per week at 10 hours each. Assuming $200/hour that's 24k/month or 288k/year working 30 hours/week.

 

[Peach Newport]

Seriously. Living in San Francisco about 10-15 years ago would be awesome. Today the place just seems expensive and stale aside from the geography.

"SF is a utopia gone wrong, LA is a dystopia gone right."