How to keep options open in residency with minimum effort

[Modstopizdy]

To make it short, I'll be starting intern year soon at a mid tier university program. My plan right now is to forego fellowship and go straight into hospitalist medicine. The only way I see that plan changing is if hospitalist job market crashes while the lucrative sub specialties remain lucrative. In that case, I may have no choice but to stick around for 3 more years and do either cards or GI.

So the thing I am trying to figure out right now is how hard would I have to hustle to have a decent chance at matching cards or GI? If the answer is "really really hard" then I'm not sure I should even consider them as an option at all, since there is no way in hell I'm going to put in tons of effort into what would in effect be an insurance policy I'd be hoping to never have to use. I've never seriously considered or looked into the process of qualifying for competitive fellowships so I'd appreciate any thoughts on the matter. Would this be possible with a reasonable investment of time and effort, or would I have to spend much of the bandwidth remaining after general residency duties to accomplish this?

---

Members don't see this ad.

 

[InternistDO]

Research in something like pulmonary hypertension would be usable for both pulm/cc and cards as a backup plan, though I don't know if it would be worth the effort to get on a project like that.

I think your problem is going to be that medical specialties--especially super general ones like hospitalist medicine--don't crash or peak in two years, so you're not going to be any more well informed on the long term future of hospitalists by the time you have to decide to apply to fellowship.

 

[Modstopizdy]

Research in something like pulmonary hypertension would be usable for both pulm/cc and cards as a backup plan, though I don't know if it would be worth the effort to get on a project like that.

I think your problem is going to be that medical specialties--especially super general ones like hospitalist medicine--don't crash or peak in two years, so you're not going to be any more well informed on the long term future of hospitalists by the time you have to decide to apply to fellowship.

That's a good point, but that's somewhat ameliorated by the fact that my career goals could be summarized as a single minded pursuit of achieving financial independence as soon as humanly possible, and not relying on clinical medicine for the bulk of my income even sooner.

My plan post residency is to work myself right up to but short of the point at which it would start impacting my actual physical health, and to keep at it for as long as I possibly can while aggressively investing all the while. I'm hoping this mad dash wouldn't have to last for more than 3-5 years before I had enough money cooking in various pots to start devoting more and more energy to ventures outside of medicine than to clinical work within. In other words, if I'm seeing good hourly rates at the time I graduate residency in 2023 I'll have some confidence the income potential will be there hopefully at least as long as I'll need it to.

 

[shouldigomd]

The answer is not "really really hard" but that depends on your circumstances. If you are AMG without red flags at a mid tier program you will match cards / gi with a little effort. A "little" effort meaning some active research (doesn't even have to be published or completed) and some poster presentations (very easy). Plenty of people match without any research but there is some luck involved so I wouldn't take that chance.

That being said you haven't even started residency. It isn't that bad.

 

[chessknt]

Should find something you enjoy doing, you already picked the wrong specialty in terms of hourly income return on years of residency (winner of that is 3 year EM). If you got paid $350/hour cleaning garbage cans with your fingernails in 100 degree weather for 90 hours a week would you take that job?

 

[Modstopizdy]

The answer is not "really really hard" but that depends on your circumstances. If you are AMG without red flags at a mid tier program you will match cards / gi with a little effort. A "little" effort meaning some active research (doesn't even have to be published or completed) and some poster presentations (very easy). Plenty of people match without any research but there is some luck involved so I wouldn't take that chance.

That being said you haven't even started residency. It isn't that bad.

That's good to hear. I'm an AMG and my program is a very solid mid tier.

Should find something you enjoy doing, you already picked the wrong specialty in terms of hourly income return on years of residency (winner of that is 3 year EM). If you got paid $350/hour cleaning garbage cans with your fingernails in 100 degree weather for 90 hours a week would you take that job?

Funny you should mention that, I was going to apply to EM and actually got the requisite SLOEs before deciding to do IM instead at the 11th hour. The thing is I've been tracking physician job markets since before I matriculated medical school and EM has been on a noticeable decline over the last couple years. The rates are still great don't get me wrong, but the trends that have pushed them down from recent peaks are only gathering steam so there is no reason to think the decline will stop anytime soon. EM is also a one trick pony whereas IM gives you many more "outs" if a certain segment of the field bites it. I'll probably lose money by going IM over EM but I just couldn't take the downside risk, and I didn't like the EM pace very much anyway.

Would I clean garbage cans for $350/hr? Absolutely, I've been working since I was 15 and the jobs weren't much better than that but only paid minimum wage. I'm still that same person, my mentality and capacity to get my hands dirty hasn't changed one bit. The math on your hypothetical job offer comes out as over 1.5 mil per year, I think the vast, vast majority of people would snap up that job with a quickness.

 

[Drrrrrr. Celty]

The answer is not "really really hard" but that depends on your circumstances. If you are AMG without red flags at a mid tier program you will match cards / gi with a little effort. A "little" effort meaning some active research (doesn't even have to be published or completed) and some poster presentations (very easy). Plenty of people match without any research but there is some luck involved so I wouldn't take that chance.

That being said you haven't even started residency. It isn't that bad.

I'm not entirely sure this is true. I think GI is a battle to grab for even committed AMGs in university programs.

 

[Drrrrrr. Celty]

OP should really consider nocturnist at a busy center. Can hit 400k easily 7 on 7 off. Then do his investing thing.

Cardiology and GI is a 3 year investment and then afterward you're going to be expected to work a lot of hours if you want to be part of most groups and or inpatient services. Doesn't sound like a great fit.

 

[medstud56]

You sound like me lol. I'm terrified of not being able to pay off my loans in a reasonable amount of time . Because of all the doom/gloom of physician salaries going down . I don't even want to be rich I just want to be comfortable and debt free .

 

[GastriqueGraffin]

The biggest risk to you struggling with loans or whatever, is that you seem like someone who is not really passionate about what you’re doing. Many but not all fellows really do have a strong interest in those fields. Lacking that before you even start is probably one of the biggest risk factors to burn out and burn out will make any specialty or job in medicine very hard to be successful in. I might be wrong but the tone of your post sounds more appropriate to someone who has years of works behind them and is now feeling cynical.

 

[tantacles]

If you really want to go the work your butt off early until you have enough money that you can scale back route, I would strongly suggest nocturnist. More bang for your buck. Well, actually it's really more buck for your bang.

 

[ramses99]

just a med student, but I'm pretty sure if you started on a research project this fall in either cards/GI that produced even a couple abstracts or something, the door would effectively still be open.

I am curious though. How much would you need to be making as a hospitalist in order for it to be a better route than specialist? my understanding is hospitalist pay is ~300k vs >600k for cards/GI assuming you're not in SF/boston etc. is the idea that since you want such a short career, the three years of fellowship become disproportionately costly?

 

[chessknt]

Funny you should mention that, I was going to apply to EM and actually got the requisite SLOEs before deciding to do IM instead at the 11th hour. The thing is I've been tracking physician job markets since before I matriculated medical school and EM has been on a noticeable decline over the last couple years. The rates are still great don't get me wrong, but the trends that have pushed them down from recent peaks are only gathering steam so there is no reason to think the decline will stop anytime soon. EM is also a one trick pony whereas IM gives you many more "outs" if a certain segment of the field bites it. I'll probably lose money by going IM over EM but I just couldn't take the downside risk, and I didn't like the EM pace very much anyway.

Would I clean garbage cans for $350/hr? Absolutely, I've been working since I was 15 and the jobs weren't much better than that but only paid minimum wage. I'm still that same person, my mentality and capacity to get my hands dirty hasn't changed one bit. The math on your hypothetical job offer comes out as over 1.5 mil per year, I think the vast, vast majority of people would snap up that job with a quickness.

I would recommend vitamin supplementation and/or tv personality then. You could lend medical credibility to GOOP perhaps. That would obviate the need for further training completely. Not sure why you even did medicine in the first place--finance and legal jobs pay more if you have the motivation to go get them.

If specialty is irrelevant you should have done nsg or derm for maximum income potential. Downward pressure on EM doesnt exist if youre willing to go anywhere so that was absolutely a blunder on your part. You can also build your own freestanding ED and make bank in some areas.

To answer your original point you can do a research project in basically any field (preferable a competitive one) and still get a position in a competitive fellowship if your program is decent. You will need to maintain contacts and have genuine interest. A lot of fellowship placement is about people coming to bat for you more than research itself so it pays dividends to be somewhere where people know other people who can help you. If you matched somewhere academic you are going to have to conceal your sole driving motivation for pursuing a specialty from the majority of academic attendings because it is basically a complete denunciation of their career choice and might not go over well.

 

[TwistedTea]

Totally in same boat. High boards+Mid tier IM with all the fellowships, except I’m a DO incoming PGY1. Want to practice semi rural as either hospitalist, cardio, or pulm crit. No research yet but they make us publish in residency. I like everything internal med so just doing whatever has the biggest sacks of cash to pay off these fat loans.

 

[Drrrrrr. Celty]

just a med student, but I'm pretty sure if you started on a research project this fall in either cards/GI that produced even a couple abstracts or something, the door would effectively still be open.

I am curious though. How much would you need to be making as a hospitalist in order for it to be a better route than specialist? my understanding is hospitalist pay is ~300k vs >600k for cards/GI assuming you're not in SF/boston etc. is the idea that since you want such a short career, the three years of fellowship become disproportionately costly?

Most Cardios aren't making 600k. 600k is top dog interventional cardiology pay. Most are making solid 300s. Hospitalists can make 250 to 400k. But again, 7 on 7 off.

Either way in the long run you'll be well off.

 

[lessismore123]

Most Cardios aren't making 600k. 600k is top dog interventional cardiology pay. Most are making solid 300s. Hospitalists can make 250 to 400k. But again, 7 on 7 off.

Either way in the long run you'll be well off.

600k is MGMA 75th for noninvasive cards and less than the median for interventional cards. You are underestimating specialist pay.

 

[Modstopizdy]

The biggest risk to you struggling with loans or whatever, is that you seem like someone who is not really passionate about what you’re doing. Many but not all fellows really do have a strong interest in those fields. Lacking that before you even start is probably one of the biggest risk factors to burn out and burn out will make any specialty or job in medicine very hard to be successful in. I might be wrong but the tone of your post sounds more appropriate to someone who has years of works behind them and is now feeling cynical.

You're right, I've been working since I was 15 and have had numerous jobs in the decade between then and medical school. I have a fair bit of interest in any field of medicine save things like OB, psych and peds but to me jobs are about earning money and any "self actualization" as yuppies call it is a nice but purely optional side bonus. So long as I feel the money I make puts me on track to achieve my financial goals I'm not worried about burnout. I'll self actualize via the lifestyle I am working to achieve for myself.

If you really want to go the work your butt off early until you have enough money that you can scale back route, I would strongly suggest nocturnist. More bang for your buck. Well, actually it's really more buck for your bang.

Absolutely, I am seriously considering going the nocturnist route. It's probably the best return on an hourly basis, the only question is how my body will react to night work. One thing I'm not willing to sacrifice in pursuit of $$ is my health so if doing nights makes me feel like I'm getting crushed, I'd have to abandon it. The other thing too is that I'm less concerned about pure hourly rate and more concerned about "how much money can I make in a month." If nocturnist rates are 20% higher than day rates, but I can work 50% more day hours in a month while maintaining the same quality of life as if I was doing fewer hours but at night, then to me it makes more sense (and more money) to go high volume days over lower volume nights.

Just curious, are you applying for nocturnist jobs right now?

I am curious though. How much would you need to be making as a hospitalist in order for it to be a better route than specialist? my understanding is hospitalist pay is ~300k vs >600k for cards/GI assuming you're not in SF/boston etc. is the idea that since you want such a short career, the three years of fellowship become disproportionately costly?

As a hospitalist I need to make at the very minimum $400k a year and ideally >500k in order to feel like I'm on track to achieve financial independence in a timely manner. A little north of 300k is doable in undesirable locations for purely 7 on 7 off, so I figure if I throw in a whole bunch of extra shifts during "off" weeks $500k is doable with a little bit of suffering. As to the the second part of your question there are many reasons for this but the two biggest is that I'm concerned for the long term earning potential of non-surgical medicine and secondly I simply want to have money while I'm still young.

There is inherent risk in continually putting off actually making money by being forever in training. Imagine spending 7 years post medical school to be an interventional cardiologist only to graduate in a 2027 where salaries are decimated by universal healthcare and what you do manage to earn is taxed in a way that "helps us attain social justice" or whatever the zeitgeist will be in 2027. Not saying it would happen that way but the longer you wait to cash in on your investment the more time passes and time=change.

 

[Modstopizdy]

If specialty is irrelevant you should have done nsg or derm for maximum income potential. Downward pressure on EM doesnt exist if youre willing to go anywhere so that was absolutely a blunder on your part. You can also build your own freestanding ED and make bank in some areas.

I have you say you're pretty mistaken in terms of what you wrote for EM above. In actuality, it is exactly the high paying locums in the middle of nowhere that have experienced the most dramatic declines in recent years. The average rate in EM has actually been holding pretty steady, but the >90th percentile is a lot lower than it was just a few years ago. But as I said before, I decided not to go with EM as a risk management move. Most likely it will remain more lucrative than general IM for the foreseeable future, but there are several trends working against the specialty that concern me and that I don't want to bet against by choosing EM. Check out the EM forum for some of the discussions of threats if you're interested, I don't want to sidetrack by writing a novel on it in this thread.

To answer your original point you can do a research project in basically any field (preferable a competitive one) and still get a position in a competitive fellowship if your program is decent. You will need to maintain contacts and have genuine interest. A lot of fellowship placement is about people coming to bat for you more than research itself so it pays dividends to be somewhere where people know other people who can help you. If you matched somewhere academic you are going to have to conceal your sole driving motivation for pursuing a specialty from the majority of academic attendings because it is basically a complete denunciation of their career choice and might not go over well.

Thanks

 

[medstud56]

You're right, I've been working since I was 15 and have had numerous jobs in the decade between then and medical school. I have a fair bit of interest in any field of medicine save things like OB, psych and peds but to me jobs are about earning money and any "self actualization" as yuppies call it is a nice but purely optional side bonus. So long as I feel the money I make puts me on track to achieve my financial goals I'm not worried about burnout. I'll self actualize via the lifestyle I am working to achieve for myself.



Absolutely, I am seriously considering going the nocturnist route. It's probably the best return on an hourly basis, the only question is how my body will react to night work. One thing I'm not willing to sacrifice in pursuit of $$ is my health so if doing nights makes me feel like I'm getting crushed, I'd have to abandon it. The other thing too is that I'm less concerned about pure hourly rate and more concerned about "how much money can I make in a month." If nocturnist rates are 20% higher than day rates, but I can work 50% more day hours in a month while maintaining the same quality of life as if I was doing fewer hours but at night, then to me it makes more sense (and more money) to go high volume days over lower volume nights.

Just curious, are you applying for nocturnist jobs right now?



As a hospitalist I need to make at the very minimum $400k a year and ideally >500k in order to feel like I'm on track to achieve financial independence in a timely manner. A little north of 300k is doable in undesirable locations for purely 7 on 7 off, so I figure if I throw in a whole bunch of extra shifts during "off" weeks $500k is doable with a little bit of suffering. As to the the second part of your question there are many reasons for this but the two biggest is that I'm concerned for the long term earning potential of non-surgical medicine and secondly I simply want to have money while I'm still young.

There is inherent risk in continually putting off actually making money by being forever in training. Imagine spending 7 years post medical school to be an interventional cardiologist only to graduate in a 2027 where salaries are decimated by universal healthcare and what you do manage to earn is taxed in a way that "helps us attain social justice" or whatever the zeitgeist will be in 2027. Not saying it would happen that way but the longer you wait to cash in on your investment the more time passes and time=change.

Wow, why do you "need" 400k-500k to achieve "financial independence" ?

 

[tantacles]

Wow, why do you "need" 400k-500k to achieve "financial independence" ?

Financial independence is highly dependent on the cost of living in the city you want to live in, and the goal, ultimately, is often not just to achieve financial independence but to achieve it early. A salary of $250,000/year, particularly in high cost of living cities, might cut it if you want to retire at 65, but won't if you want to retire at 45 or 50.

That being said, the idea of financial independence isn't that you necessarily will retire, but rather that you have the option. When you have that option, you're working only for yourself and your goals and not because you're chained to the money you receive from your job, so if things get bad, you actually have the option to leave, regardless of whether you have another job waiting.

 

[medstud56]

Financial independence is highly dependent on the cost of living in the city you want to live in, and the goal, ultimately, is often not just to achieve financial independence but to achieve it early. A salary of $250,000/year, particularly in high cost of living cities, might cut it if you want to retire at 65, but won't if you want to retire at 45 or 50.

That being said, the idea of financial independence isn't that you necessarily will retire, but rather that you have the option. When you have that option, you're working only for yourself and your goals and not because you're chained to the money you receive from your job, so if things get bad, you actually have the option to leave, regardless of whether you have another job waiting.

That makes sense! I would say go for it and if it happens great , but it's a bit entitled/un-realistic to expect to achieve it by age 45 if most of us don't start earning real money till 30-35...

 

[NITRAS]

That's a good point, but that's somewhat ameliorated by the fact that my career goals could be summarized as a single minded pursuit of achieving financial independence as soon as humanly possible, and not relying on clinical medicine for the bulk of my income even sooner.

My plan post residency is to work myself right up to but short of the point at which it would start impacting my actual physical health, and to keep at it for as long as I possibly can while aggressively investing all the while. I'm hoping this mad dash wouldn't have to last for more than 3-5 years before I had enough money cooking in various pots to start devoting more and more energy to ventures outside of medicine than to clinical work within. In other words, if I'm seeing good hourly rates at the time I graduate residency in 2023 I'll have some confidence the income potential will be there hopefully at least as long as I'll need it to.

I’m happy for people to fine rewarding careers outside of clinical medicine, but it seems silly to haven’t even started residency and only planning on 5 years of clinical medicine. I’d think it be easier to fine a sustainable career that would net your more income and be more enjoyable. . . But that is just my opinion.

I expect we will have a drop in average income for Hospitalist in the next couple of years as I’m finding out in the next 30 days what my new income will be. I expect them to come back, but it will take a while. I expect this will likely make fellowship opportunities more competitive for the time, too.

 

[TwistedTea]

I’m happy for people to fine rewarding careers outside of clinical medicine, but it seems silly to haven’t even started residency and only planning on 5 years of clinical medicine. I’d think it be easier to fine a sustainable career that would net your more income and be more enjoyable. . . But that is just my opinion.

I expect we will have a drop in average income for Hospitalist in the next couple of years as I’m finding out in the next 30 days what my new income will be. I expect them to come back, but it will take a while. I expect this will likely make fellowship opportunities more competitive for the time, too.

Bummer

 

[medstud56]

I’m happy for people to fine rewarding careers outside of clinical medicine, but it seems silly to haven’t even started residency and only planning on 5 years of clinical medicine. I’d think it be easier to fine a sustainable career that would net your more income and be more enjoyable. . . But that is just my opinion.

I expect we will have a drop in average income for Hospitalist in the next couple of years as I’m finding out in the next 30 days what my new income will be. I expect them to come back, but it will take a while. I expect this will likely make fellowship opportunities more competitive for the time, too.

Won't all the incomes (regardless of specialty) go down?

 

[Modstopizdy]

I expect we will have a drop in average income for Hospitalist in the next couple of years as I’m finding out in the next 30 days what my new income will be. I expect them to come back, but it will take a while. I expect this will likely make fellowship opportunities more competitive for the time, too.

Actually, something I've been wondering about is whether it's even possible for salaries to recover if they were to go down significantly. As far as I understand, a lot of salary negotiations revolve around MGMA and other aggregate salary data. In fact, there is apparently some component in the Stark laws that in certain (most?) cases makes it difficult for employers to offer physicians salaries much beyond the median or else risk Federal lawsuits. I would imagine this is particularly relevant to hospitalist positions as it's hard for a hospitalist to make a decent salary on what they bill, so there is often a hospital stipend involved and it's those stipends that are often the subject of Stark law investigations.

So basically, if contracts over the next year or two are revised downwards due to Covid, it seems pretty unlikely salaries will recover even if Covid goes away and the economy magically bounces back. The lower salaries in the near term will just become the new MGMA median baseline for negotiations going forward, and that will act as an anchor holding them down even in the medium to long term. I think we've kind of seen that hospitalist salaries have been utterly stagnant in recent years, 5 years ago they were hovering in the low to mid 200s and that's exactly where they still are today, and this kind of reinforces the idea that the focus on "median" salary during job negotiations acts as an anchor preventing upward movement over time.

 

[shouldigomd]

I'm not entirely sure this is true. I think GI is a battle to grab for even committed AMGs in university programs.

It can be and luck / # programs applied plays a role. I know several people from my program without any research and did GI. I also know others with some research who didn't match. Similar situation with cards. Typically those without any research were ok doing hospital medicine so if you want something you should invest a decent amount of effort...

 

[shouldigomd]

There is inherent risk in continually putting off actually making money by being forever in training. Imagine spending 7 years post medical school to be an interventional cardiologist only to graduate in a 2027 where salaries are decimated by universal healthcare and what you do manage to earn is taxed in a way that "helps us attain social justice" or whatever the zeitgeist will be in 2027. Not saying it would happen that way but the longer you wait to cash in on your investment the more time passes and time=change.
[/QUOTE]

Long gone is the "golden era" of medicine. It is no longer a field for making money.... that's business and administration. I think the way we are trained is outdated and needs to change but currently you have to enjoy what you do to make it worth it.

 

[TwistedTea]

There is inherent risk in continually putting off actually making money by being forever in training. Imagine spending 7 years post medical school to be an interventional cardiologist only to graduate in a 2027 where salaries are decimated by universal healthcare and what you do manage to earn is taxed in a way that "helps us attain social justice" or whatever the zeitgeist will be in 2027. Not saying it would happen that way but the longer you wait to cash in on your investment the more time passes and time=change.

Long gone is the "golden era" of medicine. It is no longer a field for making money.... that's business and administration. I think the way we are trained is outdated and needs to change but currently you have to enjoy what you do to make it worth it.
[/QUOTE]
Take from those who do according to ability and give to others in accordance to what government determines is need. I think most people would quit medicine. I would if it was like that. I enjoy it but not going to provide an “expert service” At less compensation and more risk than many other expert services with much less education, And debt. This is a legit fear.

 

[Eyeronic]

This thread is worth the read.

I, for one, do not expect to still be working in clinical medicine (or even anything medicine-related) when I am 60 years-old. I am finding this is not such an unusual opinion anymore.

That said, I might recommend to the OP to consider a cognitive restructuring. Pronto. You should be at the somewhat bright-eyed bushy-tailed phase. Unless you become the darling pet of the residency program, things go south quickly during intern year and you do not want a jaded "head start" on that.

 

[Splenda88]

As people have said, consider noctunist. One person I know is on track to make ~500k in his 1st year working 18 shifts/month.

 

[Splenda88]

That makes sense! I would say go for it and if it happens great , but it's a bit entitled/un-realistic to expect to achieve it by age 45 if most of us don't start earning real money till 30-35...

Really!

Let say a 30 yr old doc start making ~300k/yr ( 175k after tax/401k/health insurance). Assuming your student loan payment is 3k/month (36k/year). You are left with 139k/yr... If you spend 60k/yr to live, you will have ~80k/yr to invest + the 18.5k/yr invested in 401k.

If your asset is not ~2 mil $$$ after 10 yrs, you are definitely doing something wrong.

 

[Splenda88]

I’m happy for people to fine rewarding careers outside of clinical medicine, but it seems silly to haven’t even started residency and only planning on 5 years of clinical medicine. I’d think it be easier to fine a sustainable career that would net your more income and be more enjoyable. . . But that is just my opinion.

I expect we will have a drop in average income for Hospitalist in the next couple of years as I’m finding out in the next 30 days what my new income will be. I expect them to come back, but it will take a while. I expect this will likely make fellowship opportunities more competitive for the time, too.

What % of US citizen make 400k+/yr? Not many

360k/yr put one's household (not individual) income in the 98 percentile. The idea that is not extremely difficult to make 200k+/yr is something I only see in SDN. I guess we (physicians) are out of touch with the life of the average American.

Household Income Percentile Calculator, US - DQYDJ

Check your household income percentile vs. 2023's United States income distribution in this calculator. How does it rank: top 1%, median, or other?

dqydj.com

As a PGY2, I kind of have the same goal with OP. My plan is to work hard for 10 yrs in order to have a ~2 mil $$$ asset, then work the way I want and not beholden to anyone. I probably will need ~350k/yr for 10 yrs to pull that off.

 

[Modstopizdy]

This thread is worth the read.

I, for one, do not expect to still be working in clinical medicine (or even anything medicine-related) when I am 60 years-old. I am finding this is not such an unusual opinion anymore.

That said, I might recommend to the OP to consider a cognitive restructuring. Pronto. You should be at the somewhat bright-eyed bushy-tailed phase. Unless you become the darling pet of the residency program, things go south quickly during intern year and you do not want a jaded "head start" on that.

Different folks different strokes bro. I'm happy for those who are able to have a "bright-eyed bushy-tailed" outlook well into adulthood but that's not what life has served up for me. On the positive side though, I don't have any unrealistic expectations that I should feel happy or fulfilled driving to work every morning. Having that expectation is what I think leads to burnout more so than not having it, as those bright eyed bushy tailed folks finish med school only to realize the work is not rainbows and unicorns.

 

[TwistedTea]

I wouldn’t consider not being bright and bushy a bad thing. Most of the people in my class who worked a lot of jobs in past are just plain not bright and bushy. Usually the bright and bushy ones were the doc kids who haven’t had any hardship yet besides which 60k car to buy next and which 4k mcat prep course to ask their parents to buy. Not totally true but this is the norm from personal experience.

 

[NITRAS]

What % of US citizen make 400k+/yr? Not many

360k/yr put one's household (not individual) income in the 98 percentile. The idea that is not extremely difficult to make 200k+/yr is something I only see in SDN. I guess we (physicians) are out of touch with the life of the average American.

Household Income Percentile Calculator, US - DQYDJ

Check your household income percentile vs. 2023's United States income distribution in this calculator. How does it rank: top 1%, median, or other?

dqydj.com

As a PGY2, I kind of have the same goal with OP. My plan is to work hard for 10 yrs in order to have a ~2 mil $$$ asset, then work the way I want and not beholden to anyone. I probably will need ~350k/yr for 10 yrs to pull that off.

My suggestion is to fine a physician job that you can work for longer. One you will be happy to work. The whole idea to work hard for a few years then semi-retire before you 40 I think is short sighted. . . But I’m not going to question your dreams. First off, you’ll get bored as hell. Second. You are putting a lot of risk in your life. That long of time and market volatility can force you into working down the line.

A little effort, and you can find jobs you can do for decades and make more money. I love working as a physician. I know it is hard work sometimes, but it seems such a wast to train/school for 7 years after college in a highly sought after career to end up retiring in less than a decade. There isn’t a medical school that would admit you if you told them that dream.

The OP can do as he pleases, but I think he will be a whole lot happier and wealthier if he found a career that he could work and serve others for a few decades rather than rushing to the finish line while holding his nose.

 

[Splenda88]

My suggestion is to fine a physician job that you can work for longer. One you will be happy to work. The whole idea to work hard for a few years then semi-retire before you 40 I think is short sighted. . . But I’m not going to question your dreams. First off, you’ll get bored as hell. Second. You are putting a lot of risk in your life. That long of time and market volatility can force you into working down the line.

A little effort, and you can find jobs you can do for decades and make more money. I love working as a physician. I know it is hard work sometimes, but it seems such a wast to train/school for 7 years after college in a highly sought after career to end up retiring in less than a decade. There isn’t a medical school that would admit you if you told them that dream.

The OP can do as he pleases, but I think he will be a whole lot happier and wealthier if he found a career that he could work and serve others for a few decades rather than rushing to the finish line while holding his nose.

It would be ideal...

I actually like (not love) medicine. I would like to work until I am ~75, but I also want to be financially independent early into my career. These are not mutually exclusive.

Being semi retired does not mean you sit around and watch TV everyday. $$$ might not make one happy, but it gives you options. At the end of the day, I would like to have options.

 

[Eyeronic]

Different folks different strokes bro. I'm happy for those who are able to have a "bright-eyed bushy-tailed" outlook well into adulthood but that's not what life has served up for me. On the positive side though, I don't have any unrealistic expectations that I should feel happy or fulfilled driving to work every morning. Having that expectation is what I think leads to burnout more so than not having it, as those bright eyed bushy tailed folks finish med school only to realize the work is not rainbows and unicorns.

I could have worded it better. What I was getting at is I feel very badly for you that you already feel this way NOW as a MS4. Because the odds of feeling that way intermittently or even chronically go up exponentially in residency, in fellowship, in actual practice etc. Hopefully you'll find some services / rotations in residency that you find more enjoyable than you expected, or a research opportunity elective with cush hours, or tasty donuts at inpatient morning report, etc. Anything to make this process more bearable, because it isn't summer camp and the attending level compensation doesn't feel so awesome on your more painful days.

I wouldn’t consider not being bright and bushy a bad thing. Most of the people in my class who worked a lot of jobs in past are just plain not bright and bushy. Usually the bright and bushy ones were the doc kids who haven’t had any hardship yet besides which 60k car to buy next and which 4k mcat prep course to ask their parents to buy. Not totally true but this is the norm from personal experience.

LAWL. You are so far off.

 

[TwistedTea]

I could have worded it better. What I was getting at is I feel very badly for you that you already feel this way NOW as a MS4. Because the odds of feeling that way intermittently or even chronically go up exponentially in residency, in fellowship, in actual practice etc. Hopefully you'll find some services / rotations in residency that you find more enjoyable than you expected, or a research opportunity elective with cush hours, or tasty donuts at inpatient morning report, etc. Anything to make this process more bearable, because it isn't summer camp and the attending level compensation doesn't feel so awesome on your more painful days.



LAWL. You are so far off.

Maybe you had a different experience but that was mine. We don’t have to be bright and bushy to be a good resident. It’s a job just like anything else. Also, not being bright and bushy doesn’t make somewhat automatically jaded. Just real brah. If you have low expectations it’s harder to get jaded

 

[tantacles]

That makes sense! I would say go for it and if it happens great , but it's a bit entitled/un-realistic to expect to achieve it by age 45 if most of us don't start earning real money till 30-35...

It really depends what field you're in and what opportunities are open to you. As a hospitalist, with per diem contracts with other hospitals and my main job working nights, I should be able to get my income up to $400,000 working about 15 shifts per month. Depending on how much I save, could totally mean financial independence at 45. But I agree that it's unlikely. I can work more and save more or work the same and work for a longer period of time. Those are your options! Sounds like OP is hoping to frontload the work of life. Many people have tried and failed to do that, but many have succeeded. It's all individual.