How to balance finances and interests when choosing specialty?

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Unshuretain

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Hi all. I'm having an existential crisis right now, and my future choice of specialty has been on my mind.

For context, I'm currently an MD-PhD student. I do a lot of clinical/scientific work on diabetes. So for the longest time, I truly wanted to go into endocrinology because it was the natural decision if I wanted to study/work with diabetes. Lately, a lot of family developments have made me reconsider if endocrinology is financially feasible, especially as a physician-scientist. I don't want to sound like "woe is me," because the reality is that being an endocrinologist is very financially attractive compared to most jobs out there.

However, the longer I'm in medical school, the more I've realized that it'll very much be a labor of love. Three reasons I can think of immediately: 1) physician-scientists get paid less, 2) cost-of-living where I hope to train is going to burn through any salary I earn, and 3) as I mentioned before, family matters have made me reconsider everything. I honestly don't know how much longer I can keep up with this much training for what is near minimum wage salary—only to graduate with physician-scientist salary. I've read many previous threads with this same exact discussion. Often, posters reason that, "But 150k is plenty fine to be middle class, even in high cost-of-living areas." To be quite frank, that's not enough for my family—because now, I have multiple to take care of (sorry, I don't think I should go into any further detail).

I've considered other options which I find very exciting/interesting, though not the job I've always had in mind. For example, I hear cardiologists these days see even more diabetes patients than endocrinologists. As a scientist, I may even find a niche studying the intersection between diabetes/cardiology. Heme/onc is also very attractive given how friendly the field is to physician-scientist (at least, relatively speaking). I think I might actually prefer the clinical work oncologists do. Both of those two options are much more fairly compensated in my opinion.

Do I still have any chance to do the clinical/scientific work I am passionate about? When I'm out interviewing for residencies, is it going to be a red flag if I'm applying with such a strong diabetes focus? The latter has been a worry of mine.

Thanks all for helping.

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Realize that beyond maybe 300k there is diminishing returns. Yes, maybe the cardiologist can afford an Aston Martin compared to the endocrinologist’s AMG. Or maybe the cardiologist stays at the Plaza in NYC whereas the endo stays at the Stewart. Cardio buys Brunello Cucinelli suits whereas endocrinologist buys Hickey Freeman.

The point is diminishing returns and you should choose something you love because it would get very boring to do something you don’t like.
 
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Realize that beyond maybe 300k there is diminishing returns. Yes, maybe the cardiologist can afford an Aston Martin compared to the endocrinologist’s AMG. Or maybe the cardiologist stays at the Plaza in NYC whereas the endo stays at the Stewart. Cardio buys Brunello Cucinelli suits whereas endocrinologist buys Hickey Freeman.

The point is diminishing returns and you should choose something you love because it would get very boring to do something you don’t like.
I agree wholeheartedly. There were parts of my life where I lived around the poverty line, so my current situation is in some ways already an upgrade (as a student with a stable stipend). Past 300k per year is not necessary.

Unfortunately, I don’t even know if I can make that, especially as an academic. Academia seems to select for people who come from well-off backgrounds, who have a huge support network should they fall off. I knew this coming in, but after some years with my classmates, the reality is starting to really set in (e.g. people in the program who paid 4 years of med school, only to do a 6 year PhD and not worry about debt).

The reverse is true for me. Quite frankly, I don’t want my immediate+ family to have to go through poverty again. One could say that being in America makes it better than poverty in other countries—America’s apparently so wealthy after all—but I really don’t have fond memories of those times.

I really wish academia were a more viable path for people in my situation. Every day, the allure of private practice, consulting industry, and even finance grows…
 
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Academia isn’t for everybody and there’s no shame in going the PP route after getting a PhD. My dermatologist (PP owner) has an MD-PhD from Hopkins. Seems pretty happy and believe that he still does some meded type stuff (though no serious research).

Fortunately, it’s much easier to go academic path to private path so I doubt you would get any trouble come residency interview time
 
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Perhaps reconsider where you hope to train, and choose a low COL area? Ditto for where you settle as an attending. If you love endocrinology, go for it!
 
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Realize that beyond maybe 300k there is diminishing returns. Yes, maybe the cardiologist can afford an Aston Martin compared to the endocrinologist’s AMG. Or maybe the cardiologist stays at the Plaza in NYC whereas the endo stays at the Stewart. Cardio buys Brunello Cucinelli suits whereas endocrinologist buys Hickey Freeman.

The point is diminishing returns and you should choose something you love because it would get very boring to do something you don’t like.
I think this was true 5-10 years ago. For a family with a household income of 300k, they can live a very comfortable middle class life. However, if you’re buying an “AMG” and other luxury things it’ll run out quickly. Prices have skyrocketed recently, but physician incomes lag behind inflation.

Nonetheless, if you have appropriate expectations, it’s better to make 300k doing what you love instead of making twice that and being miserable.
 
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Realize that beyond maybe 300k there is diminishing returns. Yes, maybe the cardiologist can afford an Aston Martin compared to the endocrinologist’s AMG. Or maybe the cardiologist stays at the Plaza in NYC whereas the endo stays at the Stewart. Cardio buys Brunello Cucinelli suits whereas endocrinologist buys Hickey Freeman.

The point is diminishing returns and you should choose something you love because it would get very boring to do something you don’t like.
Agreed in spirit, but you're optimistic about an academic, R01-funded endocrinologist's earning potential. MD/PhDs not only start their career half a decade later, but also tend to train more afterwards, get paid less, and have less geographic flexibility. All of these factors compound.

I would expect something more like finish MD/PhD at 32, finish academic, extended endo fellowship or PSTP at 38, start academic position at $150K (instructor in research, 1-2 years) or $175K (Assistant Professor with substantial research time). Slowly rise up from $175K to $270K over 15-20 years from Assistant to Full Prof, all while needing to live close to the city where the prestigious academic center is.

So we're not just talking $300K vs. $500K. It's more like $225K on top of opportunity cost from all those years training, securing the position, and then taking a pay cut to buy more research time. When comparing to non-medicine earning potential, we're really looking at a career that affords you the life and financial earnings of someone who consistently makes ~$150K. That's nothing to sneeze at, but it's not AMG money either.

I think a big, untouched factor here is spousal income. Is OP starting a family with another physician, another working professional, a low earner, or a stay-at-home spouse? If you are making $200K and your spouse is bringing in another $100K, I think it's less important. You'll afford what you need, and if you're still not happy it won't be the money.
I think this was true 5-10 years ago. For a family with a household income of 300k, they can live a very comfortable middle class life. However, if you’re buying an “AMG” and other luxury things it’ll run out quickly. Prices have skyrocketed recently, but physician incomes lag behind inflation.

Nonetheless, if you have appropriate expectations, it’s better to make 300k doing what you love instead of making twice that and being miserable.
HH income of $300K is a little better than middle class, depending on the number of kids and assuming not Bay Area or Manhattan. Median HH income for a family of 4 in the US is ~$100-110K. Making nearly 3x that with a single earner will afford you a very nice life, even when you factor in opportunity cost of medicine. Agreed on the AMG though. The picture @voxveritatisetlucis paints with AMG vs. Aston Martin is very misleading. If you are an endocrinologist living your entire life at an "AMG" and "Hickey Freeman suit" level of luxury, you'll burn through it quickly and work until you're 70+ just to catch up.
 
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Agreed in spirit, but you're optimistic about an academic, R01-funded endocrinologist's earning potential. MD/PhDs not only start their career half a decade later, but also tend to train more afterwards, get paid less, and have less geographic flexibility. All of these factors compound.

I would expect something more like finish MD/PhD at 32, finish academic, extended endo fellowship or PSTP at 38, start academic position at $150K (instructor in research, 1-2 years) or $175K (Assistant Professor with substantial research time). Slowly rise up from $175K to $270K over 15-20 years from Assistant to Full Prof, all while needing to live close to the city where the prestigious academic center is.

So we're not just talking $300K vs. $500K. It's more like $225K on top of opportunity cost from all those years training, securing the position, and then taking a pay cut to buy more research time. When comparing to non-medicine earning potential, we're really looking at a career that affords you the life and financial earnings of someone who consistently makes ~$150K. That's nothing to sneeze at, but it's not AMG money either.

I think a big, untouched factor here is spousal income. Is OP starting a family with another physician, another working professional, a low earner, or a stay-at-home spouse? If you are making $200K and your spouse is bringing in another $100K, I think it's less important. You'll afford what you need, and if you're still not happy it won't be the money.

HH income of $300K is a little better than middle class, depending on the number of kids and assuming not Bay Area or Manhattan. Median HH income for a family of 4 in the US is ~$100-110K. Making nearly 3x that with a single earner will afford you a very nice life, even when you factor in opportunity cost of medicine. Agreed on the AMG though. The picture @voxveritatisetlucis paints with AMG vs. Aston Martin is very misleading. If you are an endocrinologist living your entire life at an "AMG" and "Hickey Freeman suit" level of luxury, you'll burn through it quickly and work until you're 70+ just to catch up.
The average American family can’t afford an unexpected $500 bill. I don’t consider that middle class, even if it’s average. If your point is terminology I’ll concede. However, the average physician puts enough money for retirement and kids college funds and emergency funds etc that 300k/year you’re left with as much spending money as the “median household” that blows through the entire 100-110k. I’m not complaining, just saying 300k isn’t enough money to say anything above that isn’t going to impact your quality of life (in terms of disposable income).
 
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I think this was true 5-10 years ago. For a family with a household income of 300k, they can live a very comfortable middle class life. However, if you’re buying an “AMG” and other luxury things it’ll run out quickly. Prices have skyrocketed recently, but physician incomes lag behind inflation.

Nonetheless, if you have appropriate expectations, it’s better to make 300k doing what you love instead of making twice that and being miserable.
I think this depends upon where you live. In Massachusetts, California, New York, New Jersey etc., 300k really doesn’t go too far between exorbitant state taxes and high COL. But most other states (especially without IT) it goes pretty far. I guess AMG GT or G wagon would be pretty tough but most of the other models would be feasible if purchased used
 
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I agree wholeheartedly. There were parts of my life where I lived around the poverty line, so my current situation is in some ways already an upgrade (as a student with a stable stipend). Past 300k per year is not necessary.

Unfortunately, I don’t even know if I can make that, especially as an academic. Academia seems to select for people who come from well-off backgrounds, who have a huge support network should they fall off. I knew this coming in, but after some years with my classmates, the reality is starting to really set in (e.g. people in the program who paid 4 years of med school, only to do a 6 year PhD and not worry about debt).

The reverse is true for me. Quite frankly, I don’t want my immediate+ family to have to go through poverty again. One could say that being in America makes it better than poverty in other countries—America’s apparently so wealthy after all—but I really don’t have fond memories of those times.

I really wish academia were a more viable path for people in my situation. Every day, the allure of private practice, consulting industry, and even finance grows…
Are we the same person? Academics today are so insanely out of touch with what they ask of trainees. Literally no one wins. It's become a war of attrition. I'm now 30 and making $40K in a HCOL city and sharing a pest-infested apartment with a bunch of slobs despite a gold-plated resume and a laundry list of accomplishments and contributions to the world. I just got drinks yesterday with a bunch of friends from college, and the temptation to just ditch all of this is growing.

Friend of mine who didn't get into med school wound up attending an elite MBA and then joining a VC firm. Literally said to me, "VCs would salivate over your resume. If you ever want to get into VC let me know." His wife, who works in consulting (MBB), then said, "Seriously if you want to get into consulting I can connect you with tons of people, especially people who made the jump from medicine." Top consulting firms would start a fresh MD/PhD out at $250K TC and, assuming you aren't a total dolt who can't talk to people, you'd rise to $400K+ within 5 years. Unlike in medicine, 5 years is actually considered a lot of time in these fields. VC is the same, but higher risk (more like $150K, and continued success is based on the fund). Even if you failed in consulting/VC and couldn't/didn't want to make partner, there are tons of exit opportunities in industry that pay extremely well. I also have plenty of connections in pharma, and while they do want you to finish residency/fellowship, they still pay far better than academic tenure-track pathways.

When I talked to a big academic PI about my prospects in academia recently, his big takeaway was "well, you really will need to publish more and publish more high impact. So you'll have to do a residency with dedicated research time and make sure you publish a very high impact paper." For the record, I have 6 basic science pubs, including 2 first author in journals with IF > 15, and none of those are even my thesis work, which will very likely go to a top journal, and I will have ~12 basic science papers when the dust settles from this PhD.

I'm just flabbergasted at the iron grip academics have over this elite workforce. It seems they keep us here through shame ("Pharma is bad," "Don't be tempted by pharma") and ignorance. How much education have you gotten on any pathway outside of "produce more Nature papers for your PI"? If most MD/PhDs and PhDs knew how far their skills could take them (and how poor their chances of actually starting a successful lab were), the entire structure of biomedical research would fall apart.

Personally, I've got a year until my PhD is over and I'm now starting to explore pathways in VC, pharma, and non-lab academic sub-specialty surgery. I suggest you and all other MD/PhDs do the same. You might find you're perfectly happy running clinical trials or directing translational programs at a big pharma company, and there are definitely opportunities in endo.
 
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Correct me if I'm wrong but I think any specialty takes a significant pay cut for academics. I don't know what an academic cardiologist makes, but it's probably much, much less than someone churning through echos or spending tons of time in the cath lab.

If you really want to stick with academics, consider thinking outside the box and supplement your earnings, especially with passive income. Investments, rental properties, consulting etc. Having only one stream of income makes it highly difficult to be truly wealthy, yet many docs work themselves into the ground for only a slightly higher salary. A physician's salary will give you enough capital to start branching out. There's only so much time in the day. Otherwise consider more clinical work.
 
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Realize that beyond maybe 300k there is diminishing returns. Yes, maybe the cardiologist can afford an Aston Martin compared to the endocrinologist’s AMG. Or maybe the cardiologist stays at the Plaza in NYC whereas the endo stays at the Stewart. Cardio buys Brunello Cucinelli suits whereas endocrinologist buys Hickey Freeman.

The point is diminishing returns and you should choose something you love because it would get very boring to do something you don’t like.
There is no such thing as diminishing returns. If you earn more, you don't need to spend more- you can invest that money and have a comfortable life for yourself and your family should you decide to leave medicine, you want to pay for college for your children, you want to establish a charitable fund for something, etc. Personally, I am likely to put in a lot of extra time to push my income north of 400k so that I can have enough money to handle the blows of any potential changes in healthcare or payment models in the future, as well as have the ability to walk away if I no longer enjoy medicine.

Money is a means to influence your own life and the world around you. By having more of it, you have more ability to choose what you want to do, how you want to do it, and to limit the power of emergencies and external actors to negatively influence your life. Don't ever by into the nonsense that more money =/= better. It only isn't better if you don't know how to use the money you make to further enrich and protect your life and lifestyle.
 
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Correct me if I'm wrong but I think any specialty takes a significant pay cut for academics. I don't know what an academic cardiologist makes, but it's probably much, much less than someone churning through echos or spending tons of time in the cath lab.

If you really want to stick with academics, consider thinking outside the box and supplement your earnings, especially with passive income. Investments, rental properties, consulting etc. Having only one stream of income makes it highly difficult to be truly wealthy, yet many docs work themselves into the ground for only a slightly higher salary. A physician's salary will give you enough capital to start branching out. There's only so much time in the day. Otherwise consider more clinical work.
Base pay is much lower, but if you can get patents or devices under your belt you can earn far more than the average physician. If you bring in grant funding you can also get a big bump in pay. Many institutions give a percentage of patent income to the physician that develops them- if memory serves my contract would award me 50% of anything <100k, 25% 100k-1M, and 10% of any earnings >1M. What is given to you for large grants is highly variable. With a PhD as the OP has, both of these options are open more so than with just a medical degree. Getting to the point you are at the head of a department and actually patenting things and getting grants is a whole separate issue, the payoff just feels too long for me.
 
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Base pay is much lower, but if you can get patents or devices under your belt you can earn far more than the average physician. If you bring in grant funding you can also get a big bump in pay. Many institutions give a percentage of patent income to the physician that develops them- if memory serves my contract would award me 50% of anything <100k, 25% 100k-1M, and 10% of any earnings >1M. What is given to you for large grants is highly variable. With a PhD as the OP has, both of these options are open more so than with just a medical degree. Getting to the point you are at the head of a department and actually patenting things and getting grants is a whole separate issue, the payoff just feels too long for me.
Can you elaborate more on how grants translate into additional income? My impression was that grants go primarily to the university and the PI for research-related expenses only. Also by patents do you mean medical device/biotech companies seeking your services as a consultant/expert in the field?
 
Can you elaborate more on how grants translate into additional income? My impression was that grants go primarily to the university and the PI for research-related expenses only. Also by patents do you mean medical device/biotech companies seeking your services as a consultant/expert in the field?
You can get paid for running drug trials, and may be given a stipend for bringing in grants by your institution. By running multiple trials you can augment your salary considerably. I know one doctor in Pennsylvania that does a lot of trials for psychiatric medications and makes a fortune between that and the clinics he owns.
 
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Realize that beyond maybe 300k there is diminishing returns. Yes, maybe the cardiologist can afford an Aston Martin compared to the endocrinologist’s AMG. Or maybe the cardiologist stays at the Plaza in NYC whereas the endo stays at the Stewart. Cardio buys Brunello Cucinelli suits whereas endocrinologist buys Hickey Freeman.

The point is diminishing returns and you should choose something you love because it would get very boring to do something you don’t like.

Strongly disagree.

The average doctor doing the traditional pathway comes out way behind other professionals on retirement/cash savings. MD/PhD is worse and to subject themselves to lower career earning potential as well, that's a double whammy.

As Madjack said, there's no such thing as diminishing returns.
 
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Physicians, as a group, are terrible with money.

Get a solid foundation in financial literacy and you'll already be 4 steps ahead of most physicians.
 
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It's a very valid question. Everyone has to answer it at some point. You should think about what your priorities are. If your priority is to spend time with your family, then make that the key issue when deciding. If it's money, then do that. I don't pass judgment here - I know that money matters to some people more than it matters to others and that we are all a reflection of our social circumstances. But in response to some of your more general points:
- Yes, MD/PhDs make less money than clinicians if they choose to go into part-time lab work. Lab work just isn't reimbursed as handsomely as clinical work (just compare PhDs to MDs). When you're expected to generate part of your income from grants instead of taking care of patients, that time is necessarily going to be worth less (monetarily speaking).
- Proceduralists will make more than non-proceduralists. That's why interventional cardiologists make so much. But procedural specialties also make it very difficult to do the sort of basic science lab work that a lot of MD/PhDs do. Because you have to run a clinic to drum up business for your procedures and then do your procedures as well. That leaves less time for other stuff.
 
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Base pay is much lower, but if you can get patents or devices under your belt you can earn far more than the average physician. If you bring in grant funding you can also get a big bump in pay. Many institutions give a percentage of patent income to the physician that develops them- if memory serves my contract would award me 50% of anything <100k, 25% 100k-1M, and 10% of any earnings >1M. What is given to you for large grants is highly variable. With a PhD as the OP has, both of these options are open more so than with just a medical degree. Getting to the point you are at the head of a department and actually patenting things and getting grants is a whole separate issue, the payoff just feels too long for me.
In my experience "patent income" is something institutions offer to look like they're providing a benefit without actually providing a benefit. Most professors I've talked to are insanely naïve about patents, so it works as a fake carrot. There are very, very few recent examples of direct sale of IP from a university to an established company.

The only way your patent means anything is if you license it yourself from the university, start a company, obtain funding, and then bulldoze your previous IP with better IP (on an improved product) drafted by non-academic counsel. Unless you just ported CRISPR into mammalian cells and are about to fight a massive IP battle worth billions, your university is going to hire low quality lawyers to create pseudo-IP for the cheapest price. Then if Roche really likes your product, and you haven't spun out a company they can buy that will come with acquisition of expert employees and expert scientific counsel (you, supposedly), they look for the inevitable weaknesses in your academic IP and bulldoze it.

Any actual money in academics comes from

1) Entrepreneurship. Basically every professor in the BME department at my university has at least 1 startup. I've seen 3 go to successful exits since I started my degree. I think that's considered wildly successful in a department with > 100 faculty members.

2) Chief/chair/top admin roles or heads of fancy services (e.g., director of a major cancer center). Transparent California is a good resource to see this in action. Typical comp for a tenure-track oncologist at UCLA is ~$200-500K. $200K for the assistant profs and $500K once they've really established themselves (lots of grey hair on the high earners). Their chief makes over $1M. Director of the cancer center makes over $600K.

3) Expert side hustles. You can consult for companies (if the politics of your department allows it, which most do these days). You can write books. You can collect speaking fees (but only if you're a rock star).

Almost always, you earn more simply being a community doctor. Startups almost always fail. I've done the math on pathway #2. Even if by some miracle you make it, the years spent at ~$200K can't be made up by earning $800K+ in your twilight years. Not to mention, it is absurdly difficult to obtain the roles I listed above. There are fewer people like that than there are literal rock stars. People in these roles have massive H-indexes and major scientific discoveries tied to them. For the masses, academia is about surviving. To obtain these roles your success needs to be the rolling snowball that somehow transforms into an avalanche. It's the career equivalent of uploading a viral video. Number 3 is viable, but usually you'd make much more just doing locums anyway.
 
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You can get paid for running drug trials, and may be given a stipend for bringing in grants by your institution. By running multiple trials you can augment your salary considerably. I know one doctor in Pennsylvania that does a lot of trials for psychiatric medications and makes a fortune between that and the clinics he owns.
Could you please elaborate on this doctor’s job? This is pretty close to my dream job actually. Does he manage these trials? Is he involved in the science side of the drug design? How involved is he academically? Thanks.
 
Could you please elaborate on this doctor’s job? This is pretty close to my dream job actually. Does he manage these trials? Is he involved in the science side of the drug design? How involved is he academically? Thanks.
He owns several practices. He does not design the trials, merely enrolls patients from his clinics that meet the study criteria and runs the treatment trials per protocols provided by pharmaceutical companies. He's not an academic, and has the opposite of what one might consider fancy credentials, but he has garnered a reputation for reliability within his field in the pharmaceutical industry so he gets high priority when trials are conducted.
 
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Strongly disagree.

The average doctor doing the traditional pathway comes out way behind other professionals on retirement/cash savings. MD/PhD is worse and to subject themselves to lower career earning potential as well, that's a double whammy.

As Madjack said, there's no such thing as diminishing returns.
This always comes up, and it's always fiercely debated. In my experience, whether or not you agree with this statement completely depends on your socioeconomic circle.

People who attended Ivies/prestige schools (or were born in the 1%) immediately recognize several defined, achievable pathways that out earn medicine several times over. People who don't have access to that crowd will think it's lunacy. I grew up in a rural area and attended a public high school. My five best friends from home work in engineering/bar backing/film production/sales at Best Buy/middle management. However, I went to an Ivy, and my best friends from college went to med/law school or did elite PhDs or MBAs and then hopped to consulting/PE/IB/HF/VC. People act like medicine is the only surefire route to a $300K+ income. Every mediocre consultant that followed a cookie-cutter path to Deloitte disagrees with you.

So I agree with @guytakingboards. Doctors are pretty far behind most other professionals (with similar academic chops AND who choose the classic prestige paths). The MD/PhD compounds that further. Doctors are way ahead of pretty much any decently humanitarian profession. I'd personally rather retire with $5M in the bank having been a physician and leader in my community than a faceless management consultant or corporate strategy professional with $10M. That's my preference.

While I complain plenty, the difference is that I do truly love my work and they (mostly) hate theirs, or at least they feel no passion for it. I agree there are no diminishing returns on the wealth, but the choices you make to earn that wealth still have consequences. I will never find the tradeoff between the extra wealth of consulting/IB/HF vs. medicine worthwhile, and I'd rather die than go PE. VC is actually pretty cool, but that's a single, very exclusive pathway.
Could you please elaborate on this doctor’s job? This is pretty close to my dream job actually. Does he manage these trials? Is he involved in the science side of the drug design? How involved is he academically? Thanks.
Remember that behind every clinical trial (for a novel drug/therapy) there is a company and a large panel of investors. That means neither community nor academic physicians are being paid to design trials. You might consult, but someone with a high stake in the company is designing the trial and working with the FDA to figure out endpoints. Something so important to company success isn't being ported out to some physician who isn't explicitly employed by the company (and whose financial future isn't hinging on the success of the trial).

If you want to design clinical trials, you can do that academically with repurposed drugs, new techniques, etc... You can get grants to pay for these sorts of studies. Otherwise you're looking at a pharma career. Some of these pathways let you practice occasionally (a few clinic days a month), but I don't think that's the norm.

Overall, it's very hard to have your cake and eat it too in medicine (or life). Basically pick 2 between high pay, low risk, and a fascinating/satisfying career.
 
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However, I went to an Ivy, and my best friends from college went to med/law school or did elite PhDs or MBAs and then hopped to consulting/PE/IB/HF/VC. People act like medicine is the only surefire route to a $300K+ income.
Are you sure this isn’t survivorship bias? Many of my friends from Ivy’s who did two years of banking or consulting are no longer in finance/consulting whatsoever. A lot end up in corporate middle management type corporate roles. Now I’m not completely sure if this is on their own volition or whether they go lukewarm reviews/bonuses and thus we’re forced out. Only a handful got to mega fund PE roles while a bunch are either at boutique/MM PE shops where compensation is much more a function of deal flow and results. Of course Apollo, Bain, Carlyle, Tiger cubs have guaranteed salary that is multiples of physician salary but these aren’t easy to get. You have to be intelligent and charismatic/well liked to get these in my experience
 
Are you sure this isn’t survivorship bias? Many of my friends from Ivy’s who did two years of banking or consulting are no longer in finance/consulting whatsoever. A lot end up in corporate middle management type corporate roles. Now I’m not completely sure if this is on their own volition or whether they go lukewarm reviews/bonuses and thus we’re forced out. Only a handful got to mega fund PE roles while a bunch are either at boutique/MM PE shops where compensation is much more a function of deal flow and results. Of course Apollo, Bain, Carlyle, Tiger cubs have guaranteed salary that is multiples of physician salary but these aren’t easy to get. You have to be intelligent and charismatic/well liked to get these in my experience
Also, you know graduating from an Ivy League school.

Medicine is achievable from most schools. Ivies give you a huge leg up the day you graduate from one of them.
 
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Are you sure this isn’t survivorship bias? Many of my friends from Ivy’s who did two years of banking or consulting are no longer in finance/consulting whatsoever. A lot end up in corporate middle management type corporate roles. Now I’m not completely sure if this is on their own volition or whether they go lukewarm reviews/bonuses and thus we’re forced out. Only a handful got to mega fund PE roles while a bunch are either at boutique/MM PE shops where compensation is much more a function of deal flow and results. Of course Apollo, Bain, Carlyle, Tiger cubs have guaranteed salary that is multiples of physician salary but these aren’t easy to get. You have to be intelligent and charismatic/well liked to get these in my experience
Maybe, but I'm 30 now and have a good sense of where people landed.

The culture is definitely "up or out," and only a handful get the mega fund PE roles, but those pay multiples of a physician's salary. My point is that there are defined pathways that are less competitive (and less work) than med school, but still pay just as much reliably. A much more typical path is undergrad --> analyst job --> T20 MBA --> consulting/IB. From that consulting/IB job, which is extremely attainable for any T20 MBA grad (approximately as competitive as getting into med school, maybe less competitive even), you start at ~$220-250K. From there it's sink or swim, but salaries in the sink category are still good enough that you probably outperform a physician when you consider loans and opportunity cost.

For context, if you take that pathway, even if you take out $100K in loans for business school (most don't) and even if you "sink," land in a $150K/year corporate job and then never advance above $200K, you still retire with as much as a specialist physician making $370K (but who trained for 6 years). And those are the worst of the bunch, so comparing them to specialists might not even be appropriate.

Physicians reliably out earn most career pathways, but it's far from the only "guaranteed" pathway to high income/wealth. I think it's odd that people on this forum are so keen on making the MD seem like the only secure pathway to a high income. If you have the skills to get here and the skills to pass med school, steps, and survive residency, you definitely have the skills to make more elsewhere. People in medicine vastly overestimate the competence of people in other industries. You've all been around high performing people for far too long.
Also, you know graduating from an Ivy League school.

Medicine is achievable from most schools. Ivies give you a huge leg up the day you graduate from one of them.
These pathways are also available from any school. You don't need to be a genius from Harvard to go to UVA/Cornell/UCLA for an MBA, but those schools will definitely place you in a consulting firm or investment bank that gets you on the path outlined above. I mentioned this before, but my brother-in-law went to a random liberal arts school, got a 3.8 GPA, worked a hum-drum job in financial compliance for 5 years, and then went to one of the most elite MBA programs in the US. It's not at all like medicine where you have to save at least 50 African villages from tuberculosis, marry the Dean's daughter, and still manage a 3.9+ with a 99th percentile MCAT just to get an interview at Harvard.
 
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Maybe, but I'm 30 now and have a good sense of where people landed.

The culture is definitely "up or out," and only a handful get the mega fund PE roles, but those pay multiples of a physician's salary. My point is that there are defined pathways that are less competitive (and less work) than med school, but still pay just as much reliably. A much more typical path is undergrad --> analyst job --> T20 MBA --> consulting/IB. From that consulting/IB job, which is extremely attainable for any T20 MBA grad (approximately as competitive as getting into med school, maybe less competitive even), you start at ~$220-250K. From there it's sink or swim, but salaries in the sink category are still good enough that you probably outperform a physician when you consider loans and opportunity cost.

For context, if you take that pathway, even if you take out $100K in loans for business school (most don't) and even if you "sink," land in a $150K/year corporate job and then never advance above $200K, you still retire with as much as a specialist physician making $370K (but who trained for 6 years). And those are the worst of the bunch, so comparing them to specialists might not even be appropriate.

Physicians reliably out earn most career pathways, but it's far from the only "guaranteed" pathway to high income/wealth. I think it's odd that people on this forum are so keen on making the MD seem like the only secure pathway to a high income. If you have the skills to get here and the skills to pass med school, steps, and survive residency, you definitely have the skills to make more elsewhere. People in medicine vastly overestimate the competence of people in other industries. You've all been around high performing people for far too long.

These pathways are also available from any school. You don't need to be a genius from Harvard to go to UVA/Cornell/UCLA for an MBA, but those schools will definitely place you in a consulting firm or investment bank that gets you on the path outlined above. I mentioned this before, but my brother-in-law went to a random liberal arts school, got a 3.8 GPA, worked a hum-drum job in financial compliance for 5 years, and then went to one of the most elite MBA programs in the US. It's not at all like medicine where you have to save at least 50 African villages from tuberculosis, marry the Dean's daughter, and still manage a 3.9+ with a 99th percentile MCAT just to get an interview at Harvard.
Top 20 MBA school is easily obtainable?
 
Top 20 MBA school is easily obtainable?
As easy as med school, yes (if you'd call getting into med school easy). Class sizes are significantly larger and many successful/connected individuals are already weeded out (they don't need an MBA). I know some bona fide idiots who went to Dartmouth and Duke. I don't think stats adequately convey MBA admissions criteria, but GPAs are low across the board and GRE/GMAT scores don't really even touch med school competitiveness. Acceptance rates are probably a better gauge, and they are about an order of magnitude higher than med schools.
 
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As easy as med school, yes (if you'd call getting into med school easy). Class sizes are significantly larger and many successful/connected individuals are already weeded out (they don't need an MBA). I know some bona fide idiots who went to Dartmouth and Duke. I don't think stats adequately convey MBA admissions criteria, but GPAs are low across the board and GRE/GMAT scores don't really even touch med school competitiveness. Acceptance rates are probably a better gauge, and they are about an order of magnitude higher than med schools.
I think you might be overestimating the difficulty in getting accepted into a medical school. Average acceptance rate for medical school is around 41%. Top MBA program rate looks to average out at around 20-25% by my rough estimation. Lowest I saw was around 7% with the highest around 35% or so.

This topic comes up irritatingly often and its always the same. "Look at all the tech/business/banking/whatever people making great money at younger ages than physicians!!!!". And it always overlooks the same things over and over again.

- Graduating from a T20 MBA school doesn't guarantee you a great income.
- The skills needed to succeed at business/tech/whatever don't necessarily translate from those good at science. This is honestly the key point in all of those. To become a doctor you need to be really good at studying with just enough of a personality to not creep people out on interview day. That would not make you successful in much of the business world.
- Barring a massive shift in healthcare, our jobs are among the most stable in the country. If you look at most stable jobs, its like 90% healthcare jobs. This isn't just about job availability either which from my reading is also good in business, but people staying in their jobs long term.
- Most physicians make a good bit more than is widely appreciated. For example, most sources I have access to say that 90% of neurosurgeons earn less than 950k. I do not know a single neurosurgeon making less than 1 mil. Most are closer to 1.3/4. Average for FM is around 240k at the moment. Most of the FPs I know are almost doubling that.
 
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Barring a massive shift in healthcare, our jobs are among the most stable in the country. If you look at most stable jobs, its like 90% healthcare jobs. This isn't just about job availability either which from my reading is also good in business, but people staying in their jobs long term.
Exactly. As with any investment, risk adjusted returns are much more important than just nominal returns.

Medical school is probably akin to making a sizeable investment in the S&P 500. You probably won’t quintuple your money in the intermediate term but won’t lose it all either

Law/business are probably akin to making a sizeable investment in a volatile stock such as Tesla without diversification. Some make 1000x returns whereas similar investments in other companies go to 0

However, I do think that the risk associated with pursuing medicine has increased due to its increasingly corporate nature, declining reimbursement, etc.
 
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Exactly. As with any investment, risk adjusted returns are much more important than just nominal returns.

Medical school is probably akin to making a sizeable investment in the S&P 500. You probably won’t quintuple your money in the intermediate term but won’t lose it all either

Law/business are probably akin to making a sizeable investment in a volatile stock such as Tesla without diversification. Some make 1000x returns whereas similar investments in other companies go to 0

However, I do think that the risk associated with pursuing medicine has increased due to its increasingly corporate nature, declining reimbursement, etc.
Granted I've only been out about 10 years at this point, but income in my specialty has gone up every year since I finished residency.
 
I think you might be overestimating the difficulty in getting accepted into a medical school. Average acceptance rate for medical school is around 41%. Top MBA program rate looks to average out at around 20-25% by my rough estimation. Lowest I saw was around 7% with the highest around 35% or so.

This topic comes up irritatingly often and its always the same. "Look at all the tech/business/banking/whatever people making great money at younger ages than physicians!!!!". And it always overlooks the same things over and over again.

- Graduating from a T20 MBA school doesn't guarantee you a great income.
- The skills needed to succeed at business/tech/whatever don't necessarily translate from those good at science. This is honestly the key point in all of those. To become a doctor you need to be really good at studying with just enough of a personality to not creep people out on interview day. That would not make you successful in much of the business world.
- Barring a massive shift in healthcare, our jobs are among the most stable in the country. If you look at most stable jobs, its like 90% healthcare jobs. This isn't just about job availability either which from my reading is also good in business, but people staying in their jobs long term.
- Most physicians make a good bit more than is widely appreciated. For example, most sources I have access to say that 90% of neurosurgeons earn less than 950k. I do not know a single neurosurgeon making less than 1 mil. Most are closer to 1.3/4. Average for FM is around 240k at the moment. Most of the FPs I know are almost doubling that.
But that could follow the same trend of the "Pa school versus med school" argument. Sure as a whole Pa schools have "lower acceptance rates" than MD schools. But the overall applicant also isn't as "accomplished" in regards to gpa/stats/standardized exams/ research/ ec's/ etc. So you have "less qualified" applicants keeping for less spots which makes Pa school "sO MuCh MoRe CoMpEtItIvE tO GeT InTo ThAn MeDiCaL ScHoOl".

Comparing programs difficulty solely based on acceptance rates creates a very large fallacy.
 
But that could follow the same trend of the "Pa school versus med school" argument. Sure as a whole Pa schools have "lower acceptance rates" than MD schools. But the overall applicant also isn't as "accomplished" in regards to gpa/stats/standardized exams/ research/ ec's/ etc. So you have "less qualified" applicants keeping for less spots which makes Pa school "sO MuCh MoRe CoMpEtItIvE tO GeT InTo ThAn MeDiCaL ScHoOl".

Comparing programs difficulty solely based on acceptance rates creates a very large fallacy.
Naturally, but since you don't have to take the MCAT for business school the only other thing we can use is GPA which is fairly similar between med school and top MBA programs.
 
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Naturally, but since you don't have to take the MCAT for business school the only other thing we can use is GPA which is fairly similar between med school and top MBA programs.
True, I would say a degree in business is not comparable to a premed degree though.

n=1, A good friend of mine in undergrad managed to party and go to bars 5-6x per week and still pull a 4.0 in business.
 
True, I would say a degree in business is not comparable to a premed degree though.

n=1, A good friend of mine in undergrad managed to party and go to bars 5-6x per week and still pull a 4.0 in business.
Several of my fraternity brothers did that but with 3.7-7 in the various sciences.
 
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Several of my fraternity brothers did that but with 3.7-7 in the various sciences.
I am sure it also varies school to school as well. Point is it is multifactorial and I don't think comparing gpa's and acceptance rates (excluding standardized comparison) give any indications on competitiveness when comparing anything
 
I am sure it also varies school to school as well. Point is it is multifactorial and I don't think comparing gpa's and acceptance rates (excluding standardized comparison) give any indications on competitiveness when comparing anything
It's not great, but it's literally all we have to go on.
 
Naturally, but since you don't have to take the MCAT for business school the only other thing we can use is GPA which is fairly similar between med school and top MBA programs.
Don't most business schools require a GMAT score? Tops schools would then likely demand strong GMATs scores... akin to MCAT then.
 
In my experience "patent income" is something institutions offer to look like they're providing a benefit without actually providing a benefit. Most professors I've talked to are insanely naïve about patents, so it works as a fake carrot. There are very, very few recent examples of direct sale of IP from a university to an established company.

The only way your patent means anything is if you license it yourself from the university, start a company, obtain funding, and then bulldoze your previous IP with better IP (on an improved product) drafted by non-academic counsel. Unless you just ported CRISPR into mammalian cells and are about to fight a massive IP battle worth billions, your university is going to hire low quality lawyers to create pseudo-IP for the cheapest price. Then if Roche really likes your product, and you haven't spun out a company they can buy that will come with acquisition of expert employees and expert scientific counsel (you, supposedly), they look for the inevitable weaknesses in your academic IP and bulldoze it.

Any actual money in academics comes from

1) Entrepreneurship. Basically every professor in the BME department at my university has at least 1 startup. I've seen 3 go to successful exits since I started my degree. I think that's considered wildly successful in a department with > 100 faculty members.

2) Chief/chair/top admin roles or heads of fancy services (e.g., director of a major cancer center). Transparent California is a good resource to see this in action. Typical comp for a tenure-track oncologist at UCLA is ~$200-500K. $200K for the assistant profs and $500K once they've really established themselves (lots of grey hair on the high earners). Their chief makes over $1M. Director of the cancer center makes over $600K.

3) Expert side hustles. You can consult for companies (if the politics of your department allows it, which most do these days). You can write books. You can collect speaking fees (but only if you're a rock star).

Almost always, you earn more simply being a community doctor. Startups almost always fail. I've done the math on pathway #2. Even if by some miracle you make it, the years spent at ~$200K can't be made up by earning $800K+ in your twilight years. Not to mention, it is absurdly difficult to obtain the roles I listed above. There are fewer people like that than there are literal rock stars. People in these roles have massive H-indexes and major scientific discoveries tied to them. For the masses, academia is about surviving. To obtain these roles your success needs to be the rolling snowball that somehow transforms into an avalanche. It's the career equivalent of uploading a viral video. Number 3 is viable, but usually you'd make much more just doing locums anyway.
Not saying your experience isn't valid, but I did my PhD in a laboratory that has produced a lot of patents (I'm co-inventor on one, myself) and I'm just here to say that it varies tremendously. You will absolutely make more money in the long-term if you go start your own company (assuming it works out), but you can also make really good money working through the institution.

They will take a ridiculous percentage of it (~50% from my experience, but this includes all of the legal work regarding patent filing, etc...and varies a lot depending on institution), but if you make a good product, you can make good money. Based on the IP that my lab produced (and the fact that, as a co-inventor, I could see how much different people got), I'm confident my PI was bringing in at least $100-200k from IP alone.

The lab (and frequent collaborating lab) basically produced the IP, got the university to handle all patent stuff, then partnered with a company to mass produce and distribute. Even several years later, I still receive payments every 3 or so months (ranging from $300-1k/payment) and I'm only a 5% creator. And keep in mind that I only have one patent. My former PI has probably 30 or so.
 
As an MD/PHD, hopefully this is a clear moment of personal growth for you. It is fun on paper to be a "physician scientist" - but only a handful of people have really thought out the implications of the training, the additional workload after residency (not likely to get a K grant out the gate...)...

Not that this necessarily helps you, however I would thank your gods now that you're thinking about it realistically now, rather than later. Half of the MD/PHD route provides is really just the question of "do you really want to do this?" Better to know as a med student than figure it out 3 years into academia, after completing a residency, failing to get a K grant, additional pressures of family... etc

If the answer is yes, then by all means go forth and prosper.
 
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Annually?
Yep, their lab produces a lot of IP that is widely used in research and to a lesser degree, clinically. On the patent I am co-inventor on, the initial payment they received was over a couple dozen grand (won't disclose exact amount). And this was just one. They get multiple every year, plus continued payments from subsequent sales of previous ones. And I know of several PIs who get paid well for IP produced in their lab, without having to start their own company.
 
- Most physicians make a good bit more than is widely appreciated. For example, most sources I have access to say that 90% of neurosurgeons earn less than 950k. I do not know a single neurosurgeon making less than 1 mil. Most are closer to 1.3/4. Average for FM is around 240k at the moment. Most of the FPs I know are almost doubling that.
Any thoughts on why this is the case regarding reported vs "actual" pay? People working part time included in the numbers?
 
Any thoughts on why this is the case regarding reported vs "actual" pay? People working part time included in the numbers?
Because the response rate on those surveys is pretty low.

I can't prove this, but I suspect those who are making way more than average don't advertise it by doing those surveys.
 
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Because the response rate on those surveys is pretty low.

I can't prove this, but I suspect those who are making way more than average don't advertise it by doing those surveys.
Does this apply to MGMA numbers as well or would you consider them to be more accurate? MGMA 2021 median total comp for FM without OB is listed at 265k but mean is 290k. Always heard/thought MGMA was the most accurate but maybe it is low too due to response rate?
 
Does this apply to MGMA numbers as well or would you consider them to be more accurate? MGMA 2021 median total comp for FM without OB is listed at 265k but mean is 290k. Always heard/thought MGMA was the most accurate but maybe it is low too due to response rate?
Why wouldn’t you expect the mean and the mode to be different?? For almost any income salary, there is positive skew due to outliers making millions
 
Why wouldn’t you expect the mean and the mode to be different?? For almost any income salary, there is positive skew due to outliers making millions
That wasn't my question? Of course the mean and median will be different due to skew. I'm asking about the difference of reported vs "actual" salaries and was just giving those numbers as reference.
 
That wasn't my question? Of course the mean and median will be different due to skew. I'm asking about the difference of reported vs "actual" salaries and was just giving those numbers as reference.
My bad based on the quoted thing I misread the question
 
I think you might be overestimating the difficulty in getting accepted into a medical school. Average acceptance rate for medical school is around 41%. Top MBA program rate looks to average out at around 20-25% by my rough estimation. Lowest I saw was around 7% with the highest around 35% or so.

This topic comes up irritatingly often and its always the same. "Look at all the tech/business/banking/whatever people making great money at younger ages than physicians!!!!". And it always overlooks the same things over and over again.
You can't compare individual school acceptance rates to overall success rates of a field, but I don't really want to belabor basic stats here. I agree with @Future_Bone_Docta that acceptance rates are a bad metrics, as are test scores, though both favor med school pretty heavily. I guess I'm left with the overwhelming subjective, anecdotal experience of watching my own cohort go to either med or business school. In my experience it takes a much more dedicated and intelligent person to go to med school than a T20 MBA program. It's econ with the bros vs. calc II curved to a C+. It's table service with the consulting cohort vs. late nights in the lab.
Graduating from a T20 MBA school doesn't guarantee you a great income
Going to a T20 MBA effectively guarantees you the same floor as physicians without ever having to work at med school/residency level. The floor for physicians is probably family med or peds, which make median $240-250K with 10th %ile at $180K/160K (MGMA 2021). Normalize this to the opportunity cost of 7 years of training and student loans with standard net present value calculations and you wind up with the equivalent of a consistent ~$150-160K for the median and $120K for the floor. Lost earning years matter a lot. Any T20 MBA will earn this on average throughout their career, likely much more. The exceptions are those who go into non-profit work and entrepreneurship, which is a choice and a gamble respectively.
The skills needed to succeed at business/tech/whatever don't necessarily translate from those good at science. This is honestly the key point in all of those. To become a doctor you need to be really good at studying with just enough of a personality to not creep people out on interview day. That would not make you successful in much of the business world.
These are different skills, but you're attributing your own bias to the difficulty. Obviously they are different, but each is ultimately X people vying for Y spots with A, B, and C criteria separating them.

Idk if this forum is just full of people who struggle socially, but plenty of business folks struggle with the basic competencies needed to become a doctor (and plenty struggle socially, too). So (obviously) there's a certain element of "pick what you're good at." If you're top specialty choices were rads and path, congrats you found the absolute best place to be. It doesn't really change the overarching conclusion that equal skill/effort will earn you more in business than medicine.
Most physicians make a good bit more than is widely appreciated. For example, most sources I have access to say that 90% of neurosurgeons earn less than 950k. I do not know a single neurosurgeon making less than 1 mil. Most are closer to 1.3/4. Average for FM is around 240k at the moment. Most of the FPs I know are almost doubling that.
You're probably just in a nicely reimbursed/unsaturated market, and you're getting reports from high earners looking to brag. I'm not really willing to trust anecdotal data on this. If comp was really 50-100% higher than MGMA, then no practice or hospital group would be able to hire using MGMA medians as a baseline, but that's the industry standard.

Either way, I think we're wildly off topic. Conventional wisdom says that if you want money, get a top MBA and not an MD. Conventional wisdom is correct. MDs pay a premium for emotionally and intellectually satisfying work (relative to other professions). Conventional wisdom also says that if you want money, get an MD and not an MD/PhD, and do community medicine instead of academics.
 
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You can't compare individual school acceptance rates to overall success rates of a field, but I don't really want to belabor basic stats here. I agree with @Future_Bone_Docta that acceptance rates are a bad metrics, as are test scores, though both favor med school pretty heavily. I guess I'm left with the overwhelming subjective, anecdotal experience of watching my own cohort go to either med or business school. In my experience it takes a much more dedicated and intelligent person to go to med school than a T20 MBA program. It's econ with the bros vs. calc II curved to a C+. It's table service with the consulting cohort vs. late nights in the lab.
Honestly, I have to hard-agree with this. I think more senior physicians of the forum (understandably) don't know the reality of this current generation's university-to-job pipeline. I am straight-up tutoring a distant family friend in basic math for her Econ homework. Weeks ago, she also received a job offer to a top private equity firm. If all goes well, she'll be making 7 figures before I even graduate. Sure, this is anecdotal. But my anecdotes are definitely more than n=1, and I have many university friends who concur: your sacrifices, intellect, and devotion to the medicine/science are severely undervalued if we're counting dollars.

Also attaching relevant screenshots from UCLA.

Now, we could talk about the issues in our medical system—for example, the shady practices PE uses in physician investments. But our senior colleagues seem perfectly content with where they are. After all, MGMA numbers don't look that bad, right? And yes, I've heard of this one physician making 7 figures... Right...? Right?


In any case, I appreciate the discussion on this thread. It's stirred a lot of thought. One day, I hope I can update this thread with "it all worked out," but we'll see.
 

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Honestly, I have to hard-agree with this. I think more senior physicians of the forum (understandably) don't know the reality of this current generation's university-to-job pipeline. I am straight-up tutoring a distant family friend in basic math for her Econ homework. Weeks ago, she also received a job offer to a top private equity firm. If all goes well, she'll be making 7 figures before I even graduate. Sure, this is anecdotal. But my anecdotes are definitely more than n=1, and I have many university friends who concur: your sacrifices, intellect, and devotion to the medicine/science are severely undervalued if we're counting dollars.

Also attaching relevant screenshots from UCLA.

Now, we could talk about the issues in our medical system—for example, the shady practices PE uses in physician investments. But our senior colleagues seem perfectly content with where they are. After all, MGMA numbers don't look that bad, right? And yes, I've heard of this one physician making 7 figures... Right...? Right?


In any case, I appreciate the discussion on this thread. It's stirred a lot of thought. One day, I hope I can update this thread with "it all worked out," but we'll see.
Yeah it’s the whole “if all goes well” part that typically throws a wrench in that 7 figure payday. Who knows, maybe she’ll be one of the lucky ones.

The ucla pics are somewhat comical seeing as ucla has some of the highest physician pay in the world. I’m guessing those are all residents in the pics. As for the faculty docs, a quick look at California public salary databases show plenty of docs making 7 figures there. And even more of them in the very high 6s.
 
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