How the competitiveness of medical specialties should be...

[Leo Aquarius]

I'm posting this for fun mostly. But if med students pulled their heads out of their rear ends and woke up to things that will really matter to them as they get older, the ranking of competitiveness of medical specialties should look something like this:

The Revised Medical Specialty Competitiveness Ranking:


Most competitive (least manual labor, least stressful, lowest malpractice rates, high hourly wage, ease of starting a private practice, great prospects most locations):

Reproductive Endocrinology & Infertility, Allergy & Immunology, Psychiatry


Very Competitive (some manual labor, some stress on the job, low malpractice rates, high hourly wage, good markets in big cities and good prospects beyond):

Dermatology, Pain Medicine


Competitive (some manual labor, some stress on the job, average malpractice rates, medium to high physician hourly wage, semi-saturated markets in big cities with good prospects beyond):

Neurology, PM&R, Pediatrics, Family Medicine, Radiology, Gastroenterology, Rad Onc


Not Very Competitive (lots of manual labor, high stress, average to high malpractice rates, medium to high hourly wage OR saturated markets in big cities with questionable prospects beyond):

Ophthalmology, ENT, Internal Medicine, Cardiology, Anesthesiology, Pathology, Emergency Medicine


Not Competitive At All (very labor-intense, stress big time, long hours, high malpractice rates, extremely long training, high hourly wage, AND saturated markets in big cities):

Urology, Neurological Surgery, Orthopedic Surgery, Ob-Gyn, Colon & Rectal Surgery, Thoracic Surgery, Vascular Surgery


Least Competitive (very labor-intense, very stressful, draining hours, above average malpractice rates, decent hourly wage, AND saturated markets in big cities):

General Surgery

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[OldPsychDoc]

You left OB/Gyn off the list...

Maybe it should have its own list.

 

[Shikima]

You left OB/Gyn off the list...

Maybe it should have its own list.

Ectomy of hysteria?

 

[Tyrone Slothrop]

This is basically what I realized in medical school. There were a few departments where everyone was happy to be at work, and psychiatry was one of them. My classmates seemed oblivious though and felt those fields were too boring. I'm pretty sure when I'm 60 I'll want "boring".

Personally I wouldn't care if surgery made a million dollars a year and every third patient was a puppy that just wanted to cuddle. I still wouldn't do it.

 

[Nasrudin]

Bravo. Excellently put. If I would've gone to med school in my 20's I might well have lacked the wisdom to choose psych. I would've liked it still. But just like I liked things like Mardi gras then, my tastes have matured. At some point, I'm not sure when I started liking scotch on the rocks or fine beers. I used to wonder how people could drink it. My roommate and I thought we were in hog heaven with a case of keystone light and southern comfort in coke (vomit).

But yeah. There is a youthful, dumb bliss in wide circulation in med school not unlike the Mardis gras. Whooooo! Show me your tits! Surgery is awesome!

I agree with you all completely. In fact I look forward to not wearing a white coat at all--with it being more the uniform of The Help.

 

[Yoyomama88]

How is optho stressful? I hear they work like 40 hours a week. Does psych really have a high hourly pay rate > Neurology or general surgery?

 

[Journey Gestalt]

Personally I wouldn't care if surgery made a million dollars a year and every third patient was a puppy that just wanted to cuddle. I still wouldn't do it.

Every third patient was a puppy that just wanted to cuddle? Sounds like a career change for me!

 

[Bartelby]

How is optho stressful? I hear they work like 40 hours a week. Does psych really have a high hourly pay rate > Neurology or general surgery?

Agree, I have heard good things about ophtho's lifestyle and it should probably get a bump up the list. Overall though great list, I really agree that med students may misestimate the importance of the factors you mentioned and often tent to flock to the wrong places. The SDN homepage article right now is actually about how 2/3 of ER physicians are burnt out, with more than half of IM burnt out. Psych doesn't come close to those numbers, and I doubt some of the other lower-stress specialties you mentioned do either.

 

[MacDonaldTriad]

I remember wondering about neurosurgery. During a neurosurgery rotation, I was released to go home late one night because the case was going to go on and on. I came back 8 hours later and they were still doing surgery on the same case. I couldn’t see any evidence of much progress. Hello psychiatry!

 

[Doctor Bagel]

How is optho stressful? I hear they work like 40 hours a week. Does psych really have a high hourly pay rate > Neurology or general surgery?

One, I think ophthal has had significant declines in compensation -- it went from being one of the highest pay fields to closer to average. Two, they're busy. The guy I worked with in my ophthal rotation in medical school saw like 60 patients a day and then would do like 20 back to back cataract surgeries one morning a week. One, it was boring as hell, and two, a total mill.

 

[Doctor Bagel]

I do want to add a caveat to this thread, though, and say that while I'm glad I picked psychiatry, psychiatry is hard in its own way. It's emotionally challenging, and when you go deeper, the knowledge can be pretty complex. I can see lots of people being miserable in psychiatry, and those of us here self selected for it.

 

[hamstergang]

How is optho stressful?

To begin with, they have to learn how to spell ophthalmology.

 

[IamPsychiatrist]

To begin with, they have to learn how to spell ophthalmology.

Burn!

 

[IamPsychiatrist]

I'm posting this for fun mostly. But if med students pulled their heads out of their rear ends and woke up to things that will really matter to them as they get older, the ranking of competitiveness of medical specialties should look something like this:

The Revised Medical Specialty Competitiveness Ranking:


Most competitive (least manual labor, least stressful, lowest malpractice rates, high hourly wage):

Medical Genetics, Allergy & Immunology, Psychiatry


Very Competitive (some manual labor, some stress on the job, low malpractice rates, high hourly wage, saturated markets in big cities):

Dermatology, Pain Medicine, Pathology


Competitive (some manual labor, some stress on the job, average malpractice rates, average physician hourly wage, saturated markets in big cities):

Neurology, PM&R, Pediatrics, Family Medicine, Radiology


Not Very Competitive (lots of manual labor, average to high stress, average malpractice rates, high hourly wage, saturated markets beyond big cities):

Ophthalmology, ENT, Internal Medicine, Gastroenterology, Cardiology, Anesthesiology


Not Competitive At All (very labor-intense, stress big time, long hours, high malpractice rates, extremely long training, high hourly wage, saturated markets beyond big cities):

Urology, Neurological Surgery, Orthopedic Surgery, Emergency Medicine, Colon & Rectal Surgery, Thoracic Surgery, Vascular Surgery


Least Competitive (very labor-intense, very stressful, draining hours, above average malpractice rates, decent hourly wage, saturated markets beyond big cities):

General Surgery

This is a good list because it eliminates "what do others think of what you do?"

Which is a huge driving factor for many.

 

[DermViser]

You left OB/Gyn off the list...

Maybe it should have its own list.

I would say it would fit into the category, "You've got to be kidding me".

 

[DermViser]

I do want to add a caveat to this thread, though, and say that while I'm glad I picked psychiatry, psychiatry is hard in its own way. It's emotionally challenging, and when you go deeper, the knowledge can be pretty complex. I can see lots of people being miserable in psychiatry, and those of us here self selected for it.

I would also say unlike the NBME shelf exam and board review books - Psychiatry is not a checklist of symptoms --> diagnosis --> drug, as it is made out to be. There is so much nuance in the field it's not even funny. Also, besides psychiatrists having to be calm, they also have to be very much able to sniff out the malingerers. A good psychiatrist is worth his/her weight in gold.

 

[punkedoutriffs]

A good psychiatrist is worth his/her weight in gold.

I've always wondered where this expression came from. Like did it have a literal origin? It's hard to imagine it did, b/c the price of gold is around $1300/ounce. I'm around 150 lbs, so around 2400 ounces. That means that if I were a good psychiatrist, I would be worth a little over $3 Million. That seems kinda high, but I dunno............

 

[DermViser]

I've always wondered where this expression came from. Like did it have a literal origin? It's hard to imagine it did, b/c the price of gold is around $1300/ounce. I'm around 150 lbs, so around 2400 ounces. That means that if I were a good psychiatrist, I would be worth a little over $3 Million. That seems kinda high, but I dunno............

Well, you could also be worth your weight in salt or black pepper, but seeing as those things are relatively available : http://www.amnh.org/exhibitions/past-exhibitions/gold/eureka

 

[punkedoutriffs]

Well, you could also be worth your weight in salt or black pepper, but seeing as those things are relatively available : http://www.amnh.org/exhibitions/past-exhibitions/gold/eureka

PD: "punkedoutriffs, you're really good."
Me: "Am I so good that I'm worth my weight in gold?"
PD: "Well... maybe if you lost like 15 lbs."

 

[ortho11111]

I don't know. Writing detailed in-patient psych notes (essays) is its own world of hell.

 

[Shikima]

I don't know. Writing detailed in-patient psych notes (essays) is its own world of hell.

Allows you to become a literary genious.
.... Or the infinite monkey theorem.

 

[IamPsychiatrist]

I don't know. Writing detailed in-patient psych notes (essays) is its own world of hell.

That's the great thing about private practice. You are your own boss and your notes can be as short as you'd like them to be. Oh, and it's 40 hrs a week, limited call.

 

[DermViser]

I don't know. Writing detailed in-patient psych notes (essays) is its own world of hell.

I could be wrong, but aren't most psychiatrists who graduate now do outpatient?

 

[notdeadyet]

I don't know. Writing detailed in-patient psych notes (essays) is its own world of hell.

It gets MUCH quicker with time. And if you go outpatient? Ask to look at someone's chart note for a therapy visit....

 

[shan564]

The list assumes that you place a great deal of value on "less manual labor" - most people in psych (myself included) will agree with you, of course, but most medical students seem to place higher value on a good mix of manual and cognitive work. I actually kind of like working with my hands, but I'm bad at it - I'm much more comfortable working with my head.

The list also assumes that there's only a single category of "high hourly wage" and that this is a mild-moderate concern for most people. For some people, this might be the only relevant factor, and they might want to subdivide "high" into "a bit high," "moderately high," and "super-high." If hourly wage is the most important factor to you, then you should probably choose radiology or pathology or derm or a procedural specialty.

I guess, in short, this list is accurate if you have the same preferences as an average psychiatrist.

 

[Leo Aquarius]

The list assumes that you place a great deal of value on "less manual labor" - most people in psych (myself included) will agree with you, of course, but most medical students seem to place higher value on a good mix of manual and cognitive work. I actually kind of like working with my hands, but I'm bad at it - I'm much more comfortable working with my head.

The list also assumes that there's only a single category of "high hourly wage" and that this is a mild-moderate concern for most people. For some people, this might be the only relevant factor, and they might want to subdivide "high" into "a bit high," "moderately high," and "super-high." If hourly wage is the most important factor to you, then you should probably choose radiology or pathology or derm or a procedural specialty.

I guess, in short, this list is accurate if you have the same preferences as an average psychiatrist.

No, this list is for everyone, not just psychiatrists. You miss my point. As you get older, and much older, you and the vast majority of people prefer less manual labor (ie. ER docs taking admin roles, etc), high hourly wage, low malpractice rates, more job secutiry, and less stress. My point is that med students are blind to these things, and prefer superficial things like PRESTIGE and ANNUAL INCOME. (Wow, brain surgery, so prestigious and so lucrative! Sign me up. And then you look at the divorce rates and it's sad...)

So I don't know what you're talking about there. My list will bear out the true raking preference in the backs of doctors' minds as they age. That's my point. Sure, every rank list has assumptions.

 

[Tyrone Slothrop]

I just realized you missed a metric. Potential for private practice.

 

[DermViser]

The list assumes that you place a great deal of value on "less manual labor" - most people in psych (myself included) will agree with you, of course, but most medical students seem to place higher value on a good mix of manual and cognitive work. I actually kind of like working with my hands, but I'm bad at it - I'm much more comfortable working with my head.

The list also assumes that there's only a single category of "high hourly wage" and that this is a mild-moderate concern for most people. For some people, this might be the only relevant factor, and they might want to subdivide "high" into "a bit high," "moderately high," and "super-high." If hourly wage is the most important factor to you, then you should probably choose radiology or pathology or derm or a procedural specialty.

I guess, in short, this list is accurate if you have the same preferences as an average psychiatrist.

Ask doctors when they're 50 years old if they still place higher value on having a mix of manual labor with cognitive work. I remember when it was the last year of being "Palliative Care and Hospice" medicine certified just by taking an exam, before the official fellowship was to start. So many people from different specialties took the exam including Surgeons.

 

[DermViser]

No, this list is for everyone, not just psychiatrists. You miss my point. As you get older, and much older, you and the vast majority of people prefer less manual labor (ie. ER docs taking admin roles, etc), high hourly wage, low malpractice rates, more job secutiry, and less stress. My point is that med students are blind to these things, and prefer superficial things like PRESTIGE and ANNUAL INCOME. (Wow, brain surgery, so prestigious and so lucrative! Sign me up. And then you look at the divorce rates and it's sad...)

So I don't know what you're talking about there. My list will bear out the true raking preference in the backs of doctors' minds as they age. That's my point. Sure, every rank list has assumptions.

I think this even applies to young people as well. Young people see where medicine is heading in this country.

 

[PrideNeverDie]

i thought geneticists make very little. is the wage/hr comparable to psychiatry?

 

[Tza]

i thought geneticists make very little. is the wage/hr comparable to psychiatry?

I didn't even know genetics was a medical residency in the US!

 

[Leo Aquarius]

i thought geneticists make very little. is the wage/hr comparable to psychiatry?

What I meant by medical geneticist is actually reproductive endocrinology and infertility. You run your own infertility clinic and you write your own checks.

I updated my original post to reflect this change, and added Ob Gyn (high stress, completely onerous malpractice insurance rates, and very high malpractice risk makes it not competitive at all).

 

[PrideNeverDie]

What I meant by medical geneticist is actually reproductive endocrinology and infertility. You run your own infertility clinic and you write your own checks.

I updated my original post to reflect this change, and added Ob Gyn (high stress, completely onerous malpractice insurance rates, and very high malpractice risk makes it not competitive at all).

thanks for the clarification

IVF is definitely top tier

 

[jno]

I think Anesthesiology should go one more notch down what with the massive increase in CNRIs driving down their overall salaries even though the hourly rate remains reasonably high.

 

[vistaril]

One, I think ophthal has had significant declines in compensation -- it went from being one of the highest pay fields to closer to average. Two, they're busy. The guy I worked with in my ophthal rotation in medical school saw like 60 patients a day and then would do like 20 back to back cataract surgeries one morning a week. One, it was boring as hell, and two, a total mill.

well run the numbers on those 20 cataract surgeries in a morning though......even if you only look at professional fees(which is silly because most optho groups own the ACS so they share all those facility fees and all the other revenue) at a lowball rate, you're still talking about an insane amount of $ for one morning's work.

 

[SteinUmStein]

It'll be interesting to see in 5 years what that insane amount will look like. And in 10. Things are changing quickly, I don't know that money should be a motivating factor for any of us in medicine at this point (or ever). The tables could be completely turned in just a few years, and turned again in another few years after that.

 

[vistaril]

It'll be interesting to see in 5 years what that insane amount will look like. And in 10.

Even if they continue to reduce it(they already have a ton as efficiency grew so much) and even if they find a way to take away all the ancillary revenue, the sheer volume of quick procedures stacked up like that dictates that it is going to be incredibly lucrative.

My understanding is that most opthos just can't get that many cataracts in the doors. Lots of competition for those, and that's why you have arrangements with the optos with basically kickbacks and stuff. But if you do line up those volumes.....wow, the math(even assuming bottom end reimbursement that continues to fall) is unreal, even without the facility fees.

 

[MacDonaldTriad]

In the early 80s, the mantra was that managed care was coming to ruin life as we knew it. I guess the 50s was some kind of high water mark for our mentors back then. I was told that if you weren’t a millionaire (a million was a lot of money then) and you practiced medicine in the 50s, you were an idiot. Thirty years later, I still don’t see any doctors selling pencils on the street. My guess is that things will not change too much.

 

[SteinUmStein]

In the early 80s, the mantra was that managed care was coming to ruin life as we knew it. I guess the 50s was some kind of high water mark for our mentors back then. I was told that if you weren’t a millionaire (a million was a lot of money then) and you practiced medicine in the 50s, you were an idiot. Thirty years later, I still don’t see any doctors selling pencils on the street. My guess is that things will not change too much.

I disagree, but my opinion on the rapidly changing face of healthcare isn't all that relevant to this thread. I'll settle for the example of the past 5 years, in which our healthcare system has undergone more fundamental change than perhaps any other 5 year period in the last century.

Quick edit: I'm not saying docs are going hungry any time soon, just that our reimbursement structures and income tiers are going to be turned upside down whether we like it or not. As a future psychiatrist, this doesn't particularly bother me since I think we'll have plenty of great dermatologists and orthopods at half their current average income.

 

[Sporadicus]

I've always wondered where this expression came from. Like did it have a literal origin? It's hard to imagine it did, b/c the price of gold is around $1300/ounce. I'm around 150 lbs, so around 2400 ounces. That means that if I were a good psychiatrist, I would be worth a little over $3 Million. That seems kinda high, but I dunno............

Do the numbers, you will undoubtedly earn much more than that over your lifetime. So in fact, you are worth more than your weight in gold. Closer to $6 mil

 

[TexasPhysician]

Why is pathology high on this list? The pathologists I've met are struggling to find any jobs despite 2 completed fellowships. It is maybe the most saturated field from what I've heard. No disrespect for the field at all, but they appear to have it rough.

 

[Silent Cool]

I'm posting this for fun mostly. But if med students pulled their heads out of their rear ends and woke up to things that will really matter to them as they get older, the ranking of competitiveness of medical specialties should look something like this:

The Revised Medical Specialty Competitiveness Ranking:


Most competitive (least manual labor, least stressful, lowest malpractice rates, high hourly wage, ease of starting a private practice):

Reproductive Endocrinology & Infertility, Allergy & Immunology, Psychiatry


Very Competitive (some manual labor, some stress on the job, low malpractice rates, high hourly wage, saturated markets in big cities):

Dermatology, Pain Medicine, Pathology


Competitive (some manual labor, some stress on the job, average malpractice rates, average physician hourly wage, saturated markets in big cities):

Neurology, PM&R, Pediatrics, Family Medicine, Radiology


Not Very Competitive (lots of manual labor, average to high stress, average malpractice rates, high hourly wage, saturated markets beyond big cities):

Ophthalmology, ENT, Internal Medicine, Gastroenterology, Cardiology, Anesthesiology


Not Competitive At All (very labor-intense, stress big time, long hours, high malpractice rates, extremely long training, high hourly wage, saturated markets beyond big cities):

Urology, Neurological Surgery, Orthopedic Surgery, Emergency Medicine, Ob-Gyn, Colon & Rectal Surgery, Thoracic Surgery, Vascular Surgery


Least Competitive (very labor-intense, very stressful, draining hours, above average malpractice rates, decent hourly wage, saturated markets beyond big cities):

General Surgery

Cool list, but a couple of changes:

1) The hourly rate and job market for Path sucks.
2) The hourly rate for Radiology is way above average:http://www.fastgas.com/gov/FSS_contract.htm
3) Internal medicine and GI are not saturated. There is huge demand for both of these fields.
4) ER is in HUGE demand right now, practically everywhere.

Aside from that, I agree. Nice list!

 

[Leo Aquarius]

I bumped EM and GI up one and Path down one given the strong market for EM and GI, and the awful market for Path. I also revised some of the criteria. We're fine-tuning this master list as we go folks...

 

[Baller MD]

I bumped EM and GI up one and Path down one given the strong market for EM and GI, and the awful market for Path. I also revised some of the criteria. We're fine-tuning this master list as we go folks...

You forgot Rad Onc. Also, if you can, it would be nice to have a $/hr info. Much more concrete. I don't mind doing it - just not sure where to look.

 

[SMC123]

Psych has got to be up there with derm for money per hr

 

[greenlion]

I don't blame med students who shun psychiatry - this week "prescribing psychologists" (some of them actually call themselves "medical psychologists") got the thumbs up in Illinois to prescribe (with heavy restrictions though). Now it's LA, NM and IL. That's the first step. Second step is they'll erroneously claim their performance is equal to BC psychiatrists. Last step? What the CRNAs now do to Anesthesiologists- demand equal scope of practice. Why go through medical hoops if your online PhD in Psychology and some crappy part-time medical training makes you equal under the law? I wouldn't be surprised if psychiatry eventually goes down to 150k again after they plug the demand.

So factor in mid-levels. For example Derm got too greedy- they restrained supply too much and I'm positive Derm NPs will be big within 10 years. Ditto Pain-
states with independent NPs have plenty of shoddy pain clinics where they'll hire a schmuck Anesthesiologist looking for a 2nd job part-time to read charts for a 2-3 hours a week while they do their dangerous quackery.

 

[Frazier]

I don't blame med students who shun psychiatry - this week "prescribing psychologists" (some of them actually call themselves "medical psychologists") got the thumbs up in Illinois to prescribe (with heavy restrictions though). Now it's LA, NM and IL. That's the first step. Second step is they'll erroneously claim their performance is equal to BC psychiatrists. Last step? What the CRNAs now do to Anesthesiologists- demand equal scope of practice. Why go through medical hoops if your online PhD in Psychology and some crappy part-time medical training makes you equal under the law? I wouldn't be surprised if psychiatry eventually goes down to 150k again after they plug the demand.

So factor in mid-levels. For example Derm got too greedy- they restrained supply too much and I'm positive Derm NPs will be big within 10 years. Ditto Pain-
states with independent NPs have plenty of shoddy pain clinics where they'll hire a schmuck Anesthesiologist looking for a 2nd job part-time to read charts for a 2-3 hours a week while they do their dangerous quackery.

I would venture to say that the overwhelming (OVERWHELMING) majority of med students that shun psychiatry do so for reasons other than psychologist prescribing rights.

I agree with you that the increase in prescribing rights of nonphysicians is less than ideal for actual physicians.

That said, in regards to this recent Illinois bill, it looks like there are pretty tight reins on patient population (no one aged under 18, no one aged 65+, no one with a "serious mental condition") and also constraints on the meds which can be utilitzed. As always, things can quickly change from this point.

A compromise was reached this spring, and the resulting measure requires psychologists to undergo extensive training and work under the supervision of a physician. They’ll only be permitted to prescribe a limited class of drugs and will be prohibited from writing prescriptions for minors, seniors or any patient with a serious mental condition.

“We have to make sure people across Illinois can be properly cared for by a medical professional they know and trust,” Quinn said in a statement. “If someone needs help and lives on a budget, they shouldn’t have to make multiple appointments or travel far and wide to get a prescription.”

Illinois joins New Mexico and Louisiana in granting the right to prescribe to psychologists.

Under the new law, psychologists could earn prescription rights after they have completed 2-1/2 years of additional, postdoctoral training, with course work requirements including graduate-level instruction in numerous areas such as neuroscience and psychopharmacology. In addition, training would require that psychologists treat a minimum of 100 patients under the supervision of a qualified medical practitioner, according to the legislation. Psychologists would be able to prescribe antidepressants, such as Prozac, but not stimulants, such as Ritalin, commonly used for attention deficit disorder. http://www.chicagotribune.com/news/...ist-prescription-bill-20140624,0,953771.story

Encroachment is starting to take place at the specialty-level for many different areas of medicine (Psych, Gas, FM, Ophtho, EM, IM, Derm). Other specialties are more insulated against encroachment from midlevels (surgical specialties, RadOnc, Rads, Neuro, Path) -- but have their own problems ranging from hellish lifestyle, to poor job market, to high risk of low satisfaction.

The current solution for many of the specialties in the earlier group would be to pick a subspecialty and further differentiate yourself from the midlevels trying to claim equal SOP. For example, Ophtho can do VR surgery, IM can do Heme/Onc, Psych can do CA, etc. The solution for the specialties in the latter grouping is less clear cut.

In regards to salaries dropping to 150k... the risk likely largely revolves around your model of employment. If a employer can fill your shoes with a cheaper alternative, of course it will be done. That is just good business. If you are self-employed, with a reliable patient load that you harvested over time and a strong name/reputation in your community...not so sure income will plummet -- especially if you are aligned with cash payment.

There will undoubtedly be entrepreneurial psychiatrists that have a net increase in income from the bill by finding a psychologist that can be employed to do bread and butter prescribing for the practice. Granted, when it comes to the kind of psychologist that would go through the extra training and supervision, I bet they would likely prefer hanging their own shingle rather than work for a psychiatrist's practice -- but there will always be exceptions and employees to be found if the net is cast wide enough.

 

[Dharma]

@greenlion good points but the situation you describe seems to be the case across the board minus some of the subspecialties mentioned above. (But could these niches also reach a saturate point as many are driven into further specialization by the fear of mid level "encroachment?")

Point being (as mentioned earlier) choosing a field based on current market trends is a bad idea (unless you're one of those skilled speculators). Basing the selection on tendencies driven by fear is even worse. All in all, we'll still be able to afford that Friday night Delmonico with a nice glass of Cabernet... And do so with a smile.

 

[BestDoctorEver]

@greenlion ... Isn't average psych salary between 150-180k anyway?

 

[SMC123]

200 national..in midwest 225..thats working 35-40 hr weeks