how to make the most money right after residency?

[phillyfornia]

i'm going to be starting my residency soon and i'm already trying to figure a plan for the future. one possible plan involves me going straight into private practice after residency and busting my a$$ off for a few years in order to make a bunch of money (5 years max). i'm thinking about moving to an "undesirable" location and working crazy hrs in order to make some money. afterwards, i'll just try to find a cush gig with a better lifestyle that pays less.

i had some questions about my plan that i hope some of the more experienced posters could help with:

1. if i'm trying to make as much money in 5 years, is it better to do locums or try to obtain a partnership track? my understanding is that with locums you start making good money right away but with partnership the money you make down the line (i.e. after making partner) is better.

2. how undesirable is an undesirable location? are we talking about something in the middle of alaska? or would a small town 1 hrs away from los angeles be considered undesirable too?

3. how difficult is it to find a cush job that requires NO call? i'm actually on call tonight as an intern and i've come to the decision that i HATE call and that i'm not going to do it when i'm older.

4. if i opt for the partnership route, am i allowed to determine how much vacation (LOTS) and call (NONE) i take once i make partner? i'm sure that every partership is different but does this sound like something that could easily be done?

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[jetproppilot]

I respect your desire to maximize your earning potential.

Yes, mosta the big cash jobs out there are in undesirable locations....but alotta them are livable.

Thats where I made my cash before moving here....in an undesirable location.

Problem though, Dude, is nothing comes for free.

You're gonna work and take equal call after you hit partner. But you'll also get alotta time off if you pick your gig right.

Your post brings out some cautious feelings in me....you wanna make da C notes but you're already trying to figure out how not to take call.

We ALL deplore call, dude.

Makes me feel a little uneasy.

Don't reveal that desire in any interview you go on.

Anyway, sounds like Zippy makes a great living in a surgery center gig.

Maybe thats the route you should take.

If you're truly trying to maximize your income, there are still some 600-700K partnerships out there...butcha gotta be the right dude at the right time.

And you've gotta take call.


Taking the call aspect from another viewpoint, at least at my current gig, there are some advantages of taking call:

1)The day before call you're out by noon most days.

2)The day after call you come in to start cases and are out by 0800-0830.

So it affords you a cuppla early days....one before and one after.

Gotta look at the bright side, huh?

But middla the nite stuff.....I never got used to it.

Have a cuppla colleagues that ask, when they're on late call and I'm on call, if I wanna switch. Late call is...you come in at normal time and leave whenever the call dude (who comes in at 3pm) can handle the scene. Late call usually leaves between 6-8 PM.

I take that bet. Every time.

I'd rather work a 14 hour late call than come in at 3pm and most likely be up in the middla nite.

Late call gets off early the next day too....just not as early as the on-call doc.

BTW....if Mil reads your post he's gonna tear you a new terd-cutter.

 

[elee20]

BTW....if Mil reads your post he's gonna tear you a new terd-cutter.[/QUOTE]

Thats the first thing i said to myself after reading this thread!

 

[urge]

Your expectations are quite high. I'm not saying they are wrong. But, finding your dream job will be hard.

You want: Lots of money, lots of vacation, no call
You are giving up: Location

Good luck with that!

LT will pay better than any partnertship track. But, if you plan is to do a partnertship track anyway, why not do the time early on? You will have to do it anyway.



I think your problem is you were born 1000 years too late. You should have been a king back then.

 

[phillyfornia]

i think i may have been a little unclear.

my plan is to make as much money as i can in the few years following residency. during these 5 or so years i would bust my a$$, take a bunch of call, live in a crappy area, etc. to accomplish this goal, would locums be the best way to go? or would it be better to do the partnership route (i.e. sacrifice some income the first year or two in order to make more as a partner). also, how crappy are the crappy areas? are any of them within an hour from a major city like los angeles?

after these years, i would like to settle into a gig where i didn't have to take call. i was wondering if these type of gigs would be hard to find. during these years, i'd be more than willing to take the pay cut. my hope is that by this time i would have enough do in my bank account saved up from my prior, lucrative gig that it wouldn't be a big deal to take the pay cut. is it tough to find a job that doesn't require call? also, is it possible to reduce the amount of call you take once you make partner (for a pay cut of course)? or are most partnerships not set up like that?

thanks for the responses.

 

[me454555]

i think i may have been a little unclear.

my plan is to make as much money as i can in the few years following residency. during these 5 or so years i would bust my a$$, take a bunch of call, live in a crappy area, etc. to accomplish this goal, would locums be the best way to go? or would it be better to do the partnership route (i.e. sacrifice some income the first year or two in order to make more as a partner). also, how crappy are the crappy areas? are any of them within an hour from a major city like los angeles?

after these years, i would like to settle into a gig where i didn't have to take call. i was wondering if these type of gigs would be hard to find. during these years, i'd be more than willing to take the pay cut. my hope is that by this time i would have enough do in my bank account saved up from my prior, lucrative gig that it wouldn't be a big deal to take the pay cut. is it tough to find a job that doesn't require call? also, is it possible to reduce the amount of call you take once you make partner (for a pay cut of course)? or are most partnerships not set up like that?

thanks for the responses.

Almost every post I've ever read by you is about money and lifestyle. I really hope this isn't a trend that follows you into your professional life

 

[IN2B8R]

Almost every post I've ever read by you is about money and lifestyle. I really hope this isn't a trend that follows you into your professional life

Not to defend the fella, but I think this intern may actually have a head on his shoulders. The guy is trying to plan out his future. There is nothing wrong with making money the fastest way you can--it is called business. Take a look at how much CEO's make and then grill this guy about his day dreams. The cash he is talking about is chump change compared to what those guys make. By the time he finishes his training, he will have invested 12-13 years of his life to get to the point of being an attending. Add several more years as a junior attending/partner, that is right around 15 years to reach around 400-500K. Now tell me where in business, with equivalent training, work hours, certifications and degrees (and all the other BS), will you make less than what this fella is asking for.... PERSPECTIVE--that is a word that many in medicine have not come to comprehend yet.

p.s.: I fully agree with everything that Jet said.

 

[Coastie]

VERY VERY few places will you make this money outside of entrepreneurship, and even then, most business owners make nowhere near this, and especially not in their late 20's/early 30's.

Let's keep perspective on just how well this job pays.

Not to defend the fella, but I think this intern may actually have a head on his shoulders. The guy is trying to plan out his future. There is nothing wrong with making money the fastest way you can--it is called business. Take a look at how much CEO's make and then grill this guy about his day dreams. The cash he is talking about is chump change compared to what those guys make. By the time he finishes his training, he will have invested 12-13 years of his life to get to the point of being an attending. Add several more years as a junior attending/partner, that is right around 15 years to reach around 400-500K. Now tell me where in business, with equivalent training, work hours, certifications and degrees (and all the other BS), will you make less than what this fella is asking for.... PERSPECTIVE--that is a word that many in medicine have not come to comprehend yet.

p.s.: I fully agree with everything that Jet said.

 

[swpm]

In your pursuit of cash, remember that it's generally easier to get rich by spending 1/3 less than by earning 1/3 more. A lot of doctors seem to have a problem with this concept.

 

[Bougie]

Wow.

This is the future of our profession, ladies and gentlemen. All talk about tons of money, no call, cush lifestyles, a mansion in the hills, and the gift of 50 playmate virgins upon graduation. No mention whatsoever of wanting to be a good doctor.

We will all be replaced by the Binford 5100 Gasinator in 10 years...

To the OP: My advice is to focus on learning about anesthesiology and medicine as a whole right now. Hit the books, learn from your upper level residents, learn from your attendings (the good and the bad). Develop good professional and interpersonal skills. Know that being a good physician is more than just getting the tube in as fast as possible. I could train my pet monkey to do that in a month. If you develop excellent technical skills, a sound knowledge base, and good interpersonal skills you will be able to go anywhere and those dollars you crave will roll in. First things first....

 

[IN2B8R]

There are plenty of jobs outside of entrepreneurship that will easily earn you over 400K after 15 years of education (not to mention after your avg 200K debt). Consider banking, a CEO position (quite achievable at age 30+), and the many consulting positions that one can have with pharmaceuticals, etc. Perhaps you have missed the point of my post: medicine is not the place where one gets filthy rich.

VERY VERY few places will you make this money outside of entrepreneurship, and even then, most business owners make nowhere near this, and especially not in their late 20's/early 30's.

Let's keep perspective on just how well this job pays.

 

[Pilot Doc]

a mansion in the hills, and the gift of 50 playmate virgins upon graduation. No mention whatsoever of wanting to be a good doctor.

To the OP: My advice is to focus on learning about anesthesiology and medicine as a whole right now. Hit the books, learn from your upper level residents, learn from your attendings (the good and the bad). Develop good professional and interpersonal skills. Know that being a good physician is more than just getting the tube in as fast as possible. I could train my pet monkey to do that in a month. If you develop excellent technical skills, a sound knowledge base, and good interpersonal skills you will be able to go anywhere and those dollars you crave will roll in. First things first....

Not sure I really agree with your post.

Your general idea that being a good doc is important, I agree with.

You exaggerate the OP's desires.

Your inference that because he asks about money here that he has no other interests is a major leap in logic. Who says he's not interested in those things? Perhaps he is, he understands how to pursue those goals and has ready resources to work toward them in his program. The resources to educate yourself about the business side of medicine are much harder to find in most programs.

As for the idea that money seeks out the best doctors like a magnet. Kinda hard to support that argument. Lots of factors go into compensation and, at least directly, physician skill isn't one of them. I'll grant you that more desireable opportunities come to better docs, but if your goal is quickly building financial independence post-graduation, you'll need a lot more than good clinical skills.

 

[Coastie]

Sure, I do in fact know plenty of people who are very wealthy at a young age, but this is such a very, very, very small fraction of the population, and composed of talented, yet self-admitted LUCKY people, that to expand this to a general statement as you have done below shows that your perspective of the real world job market is delusional.

Before you throw out the "law school chewbacca defense", know that only the top dog lawyers (top 10% from YLS, HLS, Stanford, or a similar T14 school) have the chance at landing a BigLaw job which will START @ 180k in NYC/DC/Chicago, with a CHANCE to get partner after 7 years.

You do gas, making the average amount, in a city with nowhere near the COL, and you'll do far better than the vast majority of this tiny, tiny, tiny fraction of the lawyer world.

Let's keep some perspective, guys. BTW, did I mention the vast amounts of vacation many physicians enjoy?

There are plenty of jobs outside of entrepreneurship that will easily earn you over 400K after 15 years of education (not to mention after your avg 200K debt). Consider banking, a CEO position (quite achievable at age 30+), and the many consulting positions that one can have with pharmaceuticals, etc. Perhaps you have missed the point of my post: medicine is not the place where one gets filthy rich.

 

[Pilot Doc]

You're making the wrong comparison. The question is not what the average lawyer makes but what would happen to the average med student if he had gone to law school or MBA school. We're a pretty smart and hardworking bunch.

I agree, medicine is in many ways a great guaranteed deal, but those with slightly more risk tolerance for their intellectual capital frequently make much more money. (Which is notably different than a generation ago)

 

[Bougie]

Agreed Pilot Doc. It was probably unfair to make assumptions.

However, having been very involved with resident recruitment and education of junior residents, I feel that several come into this field with the mentality that they will make tons of money for very little work.

We know that's not true. These residents (of course I'm generalizing; my n=10) that realize that anesthesia is actually difficult and can be demanding both mentally and physically are the ones that get burned out, complain often, are sloppy, and don't enjoy their job.

It's concerning that a certain percentage of new anesthesiologists have this mentality considering that our field is beset on all sides by poachers.

That's all I'm sayin...

Maybe this isn't a new problem or one that's unique to our field???

 

[Bertelman]

We know that's not true. The residents (of course I'm generalizing; my n=10) that realize that anesthesia is actually difficult and can be demanding both mentally and physically are the ones that get burned out, complain often, are sloppy, and don't enjoy their job.

Am I reading that correctly?

Are you saying that if I realize Anesthesia is difficult, I will burn out?

 

[Dr Serenity]

Am I reading that correctly?

Are you saying that if I realize Anesthesia is difficult, I will burn out?

I actually had to read Bougie's post twice before I got what he was saying...he's referring to residents who have "the mentality that they will make tons of money for very little work".

I just hope I don't burn out over the next few years when I'll be making very little money for lots of work...

 

[powermd]

You're making the wrong comparison. The question is not what the average lawyer makes but what would happen to the average med student if he had gone to law school or MBA school. We're a pretty smart and hardworking bunch.

I agree, medicine is in many ways a great guaranteed deal, but those with slightly more risk tolerance for their intellectual capital frequently make much more money. (Which is notably different than a generation ago)

I'm calling BS on this one.

There's a reason why the average med student is, in fact, a med student, and not a business, or law school student. Med students are fundamentally idealistic people who, when pressed, say they wouldn't want to be in business because they're not schmoozers, liars, and salespeople. It's not enough to be a hard worker in the business world. You have to be fairly creative, and also somewhat cutthroat to rise to the top. You have to be ready to step on other people. Thankfully, I haven't met many med students who get excited about doing that. Med students as a group, just aren't the kind of people who do well in business.

Maybe that's why doctors have historically been awful business people. Doctors don't want to deal with the BS of business. They want real work that has real results, not just financial gain.

To say that "you could just be a CEO, industrialist, entrepreneur, BigLaw guy, or consultant" ignores the fact that med students for the most part aren't cut out for these jobs. If they were, that's what they'd do instead, because ultimately, we all follow the money that's easiest for us.

 

[amyl]

well...as a broken arrow coming to medicine after a stint in the business/investments world I can say powermd hit the nail on the head. i was doing very well financially but i wasn't happy. the schmoozing, the selling, the speculation...i don't know i didn't feel like i earned any of the money i made. i never pushed the envelope of ethics in business... although the temptation was there many times and it is a very slippery slope... but i still didn't feel right. i don't think i ever stepped on anyone else, certainly not consciously, but I was in business for myself...I think if you are rising the corporate ladder in an existing company you will step on many. I don't really like schmoozing, it seems so dishonest and eventually it wore on me. like bryan brown said in cocktail --there are only two types of people in this world...the workers and the hustlers. medicine is not the place for hustlers and business, law, etc. is not the place for workers. i would rather work than hustle.
i don't know why but that first meager check i will receive of my interns salary means more to me than the millions i dealt with in the past...because i feel i have earned it and have sacrificed for it and thus it means more. guess that sounds pretty stupid...

 

[Pilot Doc]

I'm calling BS on this one.
[/B]

I didn't say med students would rule the world if they went to business school.

I said that comparing the average lawyer to the average doctor was a bad comparison. It's a lot easier to get into law school than medical school, mostly because it's a lot easier to start a law school and there are more of them. Same for MBA school.

As for med students being laid back, lovey types ... maybe the med students and pre-meds where you went to school were different from the one's at mine. Sure, there were the save the world stereotypes, but there were also the I wanna be an orthpod and a team doc and start a chain of surgery center types.

A large number of med students could have made more money in other careers. Clearly, they chose medicine for a reason. Not to say that they couldn't have done something else.

 

[powermd]

A large number of med students could have made more money in other careers. Clearly, they chose medicine for a reason. Not to say that they couldn't have done something else.

That's what I'm calling BS on.

I think you're greatly overestimating the number of med students who could have done something else that would have led to a $300K+ salary.

I've met a few students/residents who talk big about wanting to do something entrepreneurial in medicine (me included). So what. We know that the vast majority become "workers" to use Amyl's term from Cocktail.

They would be "workers" no matter what career you plunked them in. They wouldn't suddenly become very successful "hustlers" just because they're smart and do well on standardized tests.

 

[powermd]

.

 

[Gardner]

Since our res programs won't give us the information we need to make smart business/career moves, we should also avoid seeking out advice elsewhere? By virtue of simply asking for advice on how to reach a financial goal it is assumed that one is disinterested in being an excellent physician and becoming a master at their trade?

Are financial goals and being an excellent physician mutually exclusive? I know that since day one of med school I've watched most people around me recoil in horror from any expression of concern over income post-residency.

I thought JPP's response was great. I don't think he read anything into the OP's original question. Personally, I'd rather get advice from someone who has been there (hopefully from this forum) and can either slap me with a little reality or tell me about some of the pitfalls they had to navigate - instead of having to learn it the hard way.

Is the bottom line to this forum just to never ask about anything financial? Income posts always seemed to be followed by a smackdown. Maybe the topic has just been beaten to death? I don't know...

 

[huktonfonix]

I think it is absolutely reasonable and wise to look into the financial side of the profession. While it shouldnt be your driving motivation, it will affect the decisions you make as far as your future practice. Quite a few of us finish residency with a 6 figure education debt, kids, mortgage, etc.... Financial security is very important as mentioned in JPPs FU account posts. ITs all about what you choose. To me location close to family and friends was more important than the money so I chose location.

 

[Coastie]

Average med student going to law school would in fact have access to a better law school. I'd say guarenteed tier 1, but not guarenteed top 14. Regardless, the curve is fierce, and BigLaw jobs wouldn't be assumed, even for an average med student.

I'm just reminding the poster to remember that in Anesthesiology, we do really, really well, compared to medicine in general, and most any other job. He can use his time off and capital earned to really make money if he wants. This setup, as the market and reimbursement currently stands, won't last forever, though.....and it doesn't come easy. Gotta love what you do.

You're making the wrong comparison. The question is not what the average lawyer makes but what would happen to the average med student if he had gone to law school or MBA school. We're a pretty smart and hardworking bunch.

I agree, medicine is in many ways a great guaranteed deal, but those with slightly more risk tolerance for their intellectual capital frequently make much more money. (Which is notably different than a generation ago)

 

[Coastie]

Are financial goals and being an excellent physician mutually exclusive?

No. They are tied together, actually. Run your biz well, better for you and your patients.

 

[IN2B8R]

Since you are not clearly reading my posts and your tone is becoming insultive to someone who has a well established, thriving private practice, I will post this as my last reply to you: medicine is not the place to make tons of money--you will NOT become filthy rich doing anesthesiology on a daily basis. If you invest wisely, you can retire comfortably, send off the kids to private schools, and be debt free by about age 40-50 (this all equates to not being filthy rich in my book). As a practicing attending of chronic pain and anethesia, I can tell you that with similar sacrafice in other fields, you can make lots more money. Is this simple enough to you?

Sure, I do in fact know plenty of people who are very wealthy at a young age, but this is such a very, very, very small fraction of the population, and composed of talented, yet self-admitted LUCKY people, that to expand this to a general statement as you have done below shows that your perspective of the real world job market is delusional.

Before you throw out the "law school chewbacca defense", know that only the top dog lawyers (top 10% from YLS, HLS, Stanford, or a similar T14 school) have the chance at landing a BigLaw job which will START @ 180k in NYC/DC/Chicago, with a CHANCE to get partner after 7 years.

You do gas, making the average amount, in a city with nowhere near the COL, and you'll do far better than the vast majority of this tiny, tiny, tiny fraction of the lawyer world.

Let's keep some perspective, guys. BTW, did I mention the vast amounts of vacation many physicians enjoy?

 

[me454555]

like bryan brown said in cocktail --there are only two types of people in this world...the workers and the hustlers. medicine is not the place for hustlers and business, law, etc. is not the place for workers. i would rather work than hustle....

BS, the different between a good private practice office and bad one is the hustle. Talk to any FP doc making good money and they will tell you it's all about the hustle.

To be good in medicine you need to have both work and hustle, if you don't understand why now you will when you try looking for a job

 

[Coastie]

Uh. I wasn't insulting you. I said your statement that there are "plenty of jobs and fields" in which you can "make 400k after 15 years with equivalent education and worth ethic" was wrong. I can't believe an intern had so much gall as to call someone out on a anonymous internet board who is an attending on a non-medical issue! I think we can both agree that medicine is not the place to become "filthy rich".

Good luck in your well-established, thriving PP!

Since you are not clearly reading my posts and your tone is becoming insultive to someone who has a well established, thriving private practice, I will post this as my last reply to you: medicine is not the place to make tons of money--you will NOT become filthy rich doing anesthesiology on a daily basis. If you invest wisely, you can retire comfortably, send off the kids to private schools, and be debt free by about age 40-50 (this all equates to not being filthy rich in my book). As a practicing attending of chronic pain and anethesia, I can tell you that with similar sacrafice in other fields, you can make lots more money. Is this simple enough to you?

 

[DrN2O]

or would a small town 1 hrs away from los angeles be considered undesirable too?

Dude, an hour from L.A., you are still in L.A. I doubt any place in Cali can be called undesirable.

 

[powermd]

Is the bottom line to this forum just to never ask about anything financial? Income posts always seemed to be followed by a smackdown. Maybe the topic has just been beaten to death? I don't know...

No. Just recognize that if you want to avoid a smackdown, you need to be tactful in how you ask your questions. The reasons for smackdown on this topic are threefold:

1) Older, wiser colleagues know how bad it sucks to be in a job you hate but chose just for the money. They will try to prevent you from making a major mistake.

2) Self-righteous folks who love the field want to protect it (and patients) from a doctor who's a greedy pr*ck. Sorry, but you immediately lose credibility as a serious physician (among strangers in an anonymous forum) the moment you ask "how can I make the most money possible in this field?" That doesn't mean you can't be a serious physician, and have that question. People will doubt your credibility and motives regardless.

3) Reimbursement across the board in medicine is falling, and the future doesn't look very bright for medicine as a whole. If your goal in life is to make a lot of money, medicine is probably not the best place to invest your time and tuition dollars.

Everyone wants to maximize their income- so the interest, and the information is out there. But you're going to have to ask about it in a tactful way if you want people to give you serious answers.

 

[bobg504]

Almost every post I've ever read by you is about money and lifestyle. I really hope this isn't a trend that follows you into your professional life

While I understand your concern. PLEASE, step off your high horse. There is NOTHING wrong with wanting to have a decent lifestyle and money while providing patients with quality care. The sooner physicians understand that, the happier we will be!

 

[bobg504]

Not to defend the fella, but I think this intern may actually have a head on his shoulders. The guy is trying to plan out his future. There is nothing wrong with making money the fastest way you can--it is called business. Take a look at how much CEO's make and then grill this guy about his day dreams. The cash he is talking about is chump change compared to what those guys make. By the time he finishes his training, he will have invested 12-13 years of his life to get to the point of being an attending. Add several more years as a junior attending/partner, that is right around 15 years to reach around 400-500K. Now tell me where in business, with equivalent training, work hours, certifications and degrees (and all the other BS), will you make less than what this fella is asking for.... PERSPECTIVE--that is a word that many in medicine have not come to comprehend yet.

p.s.: I fully agree with everything that Jet said.

Well said!

 

[me454555]

While I understand your concern. PLEASE, step off your high horse. There is NOTHING wrong with wanting to have a decent lifestyle and money while providing patients with quality care. The sooner physicians understand that, the happier we will be!

I've been a member of this board for about 5 years now. I've read quite a few of phillyfornia's posts in the past and most of them seem to do w/money and lifestyle. Thats where the comment came from. This may be selective memory but it's an observation.

I understand that $$ are an important factor and I'm not preaching from a high horse. Like others have said, there is a tactful way to discuss this and a nontactful way. OP chose the nontactful way and got flamed for it.

 

[bobg504]

I've been a member of this board for about 5 years now. I've read quite a few of phillyfornia's posts in the past and most of them seem to do w/money and lifestyle. Thats where the comment came from. This may be selective memory but it's an observation.

I understand that $$ are an important factor and I'm not preaching from a high horse. Like others have said, there is a tactful way to discuss this and a nontactful way. OP chose the nontactful way and got flamed for it.

I guess you are right. I don't think I would have posed the question exactly the way the OP did. I've been around here for over 5 years too so I know how folks can be.