How was EM 10 years ago compared to now?

[scoopdaboop]

I'm trying to get a decent idea of what the last decade has been like for specialties I'm interested in and what implications that means the next decade will be like. I also posted a similar question on radiology.

basically, has your work flow gone up for the same salary? Do you think new docs tend to get burnt out more than 10 years ago? How has CMG's if you worked for one in 10 years; or multiple CMG's change their salary/pay structure? Do you dislike or don't mind it etc.

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[RustedFox]

If you want burnout, I am Mister Ashtray.

 

[gamerEMdoc]

My salary prospects have risen consistantly the last decade. I've been at my current hospital now for about 8 years and have seen a rise in salary within our area consistently. Our base salary is about 75K higher now than what it was 8 years ago.

If you believe the ACEP compensation report, there has been about a net 35% increase in EM salary over the past decade.

The issue is, some areas have leveled off or even regressed, and some areas that paid very low have seen an increase. Nationally, the average rises, but you are seeing less unicorn jobs I'd imagine.

It's very regional. The issue is, we pump out 2000 or so grads every year, but they all focus on the same markets, while some areas of the country continue to go underserved. So those markets continue to see salaries become stagnant, while others remain lucrative.

 

[GeneralVeers]

It's very regional. The issue is, we pump out 2000 or so grads every year, but they all focus on the same markets, while some areas of the country continue to go underserved. So those markets continue to see salaries become stagnant, while others remain lucrative.

Right. I'd expect big, popular metro areas like San Diego, LA, SF, Denver, and Austin to continue to stagnate or decline. Less desirable secondary cities may have some salary resiliency for awhile.

 

[fahimaz7]

The front range of Colorado is a dumpster fire. You can thank USACS and the democratic groups that sold for this fine change. They staff all the Centura-owned facilities in the state now. UC Health holds most of the other sites. There are a few independent hospitals/groups left, but boy it's thin these days.

 

[emergentmd]

I have worked about 140hrs for the past 20 yrs.

20 yrs ago - 350K
10 yrs ago - 400K
5 yrs ago - 450K
This yr - 700K
Next yr - Hope to go into the next level.

 

[BoardingDoc]

I have worked about 140hrs for the past 20 yrs.

20 yrs ago - 350K
10 yrs ago - 400K
5 yrs ago - 450K
This yr - 700K
Next yr - Hope to go into the next level.

You own a stake in a FSED. These numbers, while good for you, are not helpful.

 

[emergentmd]

Sure its not helpful

You own a stake in a FSED. These numbers, while good for you, are not helpful.

Sure not helpful but gives insight for young docs to know that there are other options than working for a CMG.

If I was working with my similar CMG this yr, I would be 300K given the covid reduction.

 

[GeneralVeers]

Also it's not really possible to get a stake in a FSED these days. The big hospital systems are flooding the market, and the existing doc-owned companies that didn't fail aren't taking new partners, or are a pyramid scheme.

 

[emergentmd]

There is alot of truth but you can still get in with connections. With the 60+ new residencies producing 5-600 residents a yr, market will get tight.

 

[Birdstrike]

I'm trying to get a decent idea of what the last decade has been like for specialties I'm interested in and what implications that means the next decade will be like. I also posted a similar question on radiology.

basically, has your work flow gone up for the same salary? Do you think new docs tend to get burnt out more than 10 years ago? How has CMG's if you worked for one in 10 years; or multiple CMG's change their salary/pay structure? Do you dislike or don't mind it etc.

How was EM 10 years ago? Bad enough for me that I decided I didn't want to do it anymore. So, I did an Interventional Pain fellowship and practice Pain Medicine full time now. I'm much happier. I can live a normal life now. I can sleep when I want to sleep, eat when I want to eat and ---- when I need to ----.

Has EM changed in the past 10 years? Is EM better now?

I have no idea. I haven't worked a shift in 9 years. Those on here that have been in the game 10+ years can give you more information. I suppose I could be wrong, but from what I've been reading on this site by them over the past 9 years, it doesn't sound like there's been much change for the better.

 

[Groove]

My salary prospects have risen consistantly the last decade. I've been at my current hospital now for about 8 years and have seen a rise in salary within our area consistently. Our base salary is about 75K higher now than what it was 8 years ago.

If you believe the ACEP compensation report, there has been about a net 35% increase in EM salary over the past decade.

The issue is, some areas have leveled off or even regressed, and some areas that paid very low have seen an increase. Nationally, the average rises, but you are seeing less unicorn jobs I'd imagine.

It's very regional. The issue is, we pump out 2000 or so grads every year, but they all focus on the same markets, while some areas of the country continue to go underserved. So those markets continue to see salaries become stagnant, while others remain lucrative.

I think they are staring to wisen up. I'm in a SE less desirable city and the past 2-3 years we've seen a big influx of ABEM grads from completely different areas of the U.S. with absolutely no connections here at all. My current hospital hired one that graduated this year and couldn't find a job in a NE state and I have no idea how he heard of us but he's moving down here in 1-2 months. What may buy us some time is if more hospitals continue to change bylaws to require ABEM physicians staffing their EDs. As our city has received more BCEM physicians in the past few years, we're having more and more hospitals require boards to work in the ED. We now have 3 hospitals in the city doing this whereas in years past it was never a requirement. Obviously, this will push out the IM/FM guys to less desirable locations but it may buy us a few more years...

 

[Vandalia]

I just realized that 10 years ago was 2010. I guess that is why I am now retired.

To be honest, there hasn't been a lot of difference in the last ten years, or ten minus one if I want to be technical. The real difference is that the last holdout for paper "t-sheets" gave in and went EMR. That was probably the biggest difference. The other difference is that the crackdown on opioids and the near universal use of pharmacy databases has made it slightly easier to identify and deal with drug seekers. The use of ultrasound has percolated more into the community facilities, but other than that not a whole lot has changed. There were midlevels and locums back then as well as today. You will still have to work nights/weekends/holidays. Pay has been relatively consistent with respect to inflation, but with many of the hills and valleys filled in.

 

[bravotwozero]

I just realized that 10 years ago was 2010. I guess that is why I am now retired.

Retired, as in, you left medicine for good?

 

[EctopicFetus]

How was EM 10 years ago? Bad enough for me that I decided I didn't want to do it anymore. So, I did an Interventional Pain fellowship and practice Pain Medicine full time now. I'm much happier. I can live a normal life now. I can sleep when I want to sleep, eat when I want to eat and ---- when I need to ----.

Has EM changed in the past 10 years? Is EM better now?

I have no idea. I haven't worked a shift in 9 years. Those on here that have been in the game 10+ years can give you more information. I suppose I could be wrong, but from what I've been reading on this site by them over the past 9 years, it doesn't sound like there's been much change for the better.

Agreed. I am 11 years out of residency. When I graduated I was able to interview with 4 different local SDGs and it wasn't hard to find them. Pay on a per patient basis was better and things seemed to have a positive outlook.

Now you hear about pay cuts (even pre covid), less control, more burnout etc.

Some people have nice setups. Own your own FSED thats great, do consulting thats sweet too, own a nice side business/hustle/real estate thats good.

but as far as coming into a shift and what your experience at work is and how much you get paid for it there is no doubt it is worse than 10 years ago.

 

[Birdstrike]

I just realized that 10 years ago was 2010. I guess that is why I am now retired.

To be honest, there hasn't been a lot of difference in the last ten years, or ten minus one if I want to be technical. The real difference is that the last holdout for paper "t-sheets" gave in and went EMR. That was probably the biggest difference. The other difference is that the crackdown on opioids and the near universal use of pharmacy databases has made it slightly easier to identify and deal with drug seekers. The use of ultrasound has percolated more into the community facilities, but other than that not a whole lot has changed. There were midlevels and locums back then as well as today. You will still have to work nights/weekends/holidays. Pay has been relatively consistent with respect to inflation, but with many of the hills and valleys filled in.

You and I have been on this forum for a lot of years together. I wasn't aware you had recently retired. Congrats!

 

[Kuratz]

I have worked about 140hrs for the past 20 yrs.

20 yrs ago - 350K
10 yrs ago - 400K
5 yrs ago - 450K
This yr - 700K
Next yr - Hope to go into the next level.

Lol. Boomer who had better opportunities than now and who is an owner chimes in to humblebrag about a top salary. Classic.

Just “use some elbow grease” young ones. Boomers extracted what they could from the profession and handed us a steaming pile of garbage. Glad your generation continues to “go into the next level”.

 

[Birdstrike]

Lol. Boomer who had better opportunities than now and who is an owner chimes in to humblebrag about a top salary. Classic.

Just “use some elbow grease” young ones. Boomers extracted what they could from the profession and handed us a steaming pile of garbage. Glad your generation continues to “go into the next level”.

Jealousy will get you nowhere, my friend. But it will supply you with an endless supply of bitterness for as long as you choose to choke it down.

 

[Rekt]

Jealousy will get you nowhere, my friend. But it will supply you with an endless supply of bitterness for as long as you choose to choke it down.

Yeah agree, but let's be real. He was being purposely misleading which helps no one and falsely shows "EM is fine!"

 

[Birdstrike]

...but as far as coming into a shift and what your experience at work is and how much you get paid for it there is no doubt it is worse than 10 years ago.

Do you remember how much **** I got on this forum 10 years ago, when I came on here and started talking about getting out of EM? Back then, like now, less people are interested in the truth, than are interested in hearing only what confirms what the want to believe is true.

 

[Kuratz]

Jealousy will get you nowhere, my friend. But it will supply you with an endless supply of bitterness for as long as you choose to choke it down.

It’s a completely unhelpful post. Great the guy took advantage of favorable practice conditions to make >$400/hr as an owner and with a lust for more. Not applicable one bit to a new grad getting less than half that and with heavy loan burden.

The older docs are seemingly ignorant And tone deaf towards the challenges facing new grads. I’m in a different field but it’s always fun to hear a doc complain about how they used to make more money in real dollars for less work 20 years ago. This post doesn’t do that but it gaslights that $700k+ is a reasonable expectation.

 

[Birdstrike]

Yeah agree, but let's be real. He was being purposely misleading which helps no one and falsely shows "EM is fine!"

EmergentMD has been very clear about how he's diversified over the years. The person who responded even alluded to that ("'owner' chimes in") in his response. It's classic loser-think.

Loser-Think: Listen to someone's story of success and feel bitter, angry, resentful that it's not you.

Winner-Think: Listen to someone's story of success and use the information as a springboard to improving your own situation.

Both are free. Choose one.

 

[Birdstrike]

It’s a completely unhelpful post. Great the guy took advantage of favorable practice conditions to make >$400/hr as an owner and with a lust for more. Not applicable one bit to a new grad getting less than half that and with heavy loan burden.

The older docs are seemingly ignorant And tone deaf towards the challenges facing new grads. I’m in a different field but it’s always fun to hear a doc complain about how they used to make more money in real dollars for less work 20 years ago. This post doesn’t do that but it gaslights that $700k+ is a reasonable expectation.

Winner-Think: Asking EmergentMD, "What you claim to have achieved seems like an unreasonable expectation. How did you achieve it and how can I apply that to improving my future?"

Loser-Think: "You achieved something I'd like to achieve. But being bitter, angry and blaming you for doing so, is easier than taking action to improve my situation and changing my thinking, which takes effort and energy I don't want to expend."

Both are free. Choose one.

 

[Kuratz]

EmergentMD has been very clear about how he's diversified over the years. The person who responded even alluded to that ("'owner' chimes in") in his response. It's classic loser-think.

Loser-Think: Listen to someone's story of success and feel bitter, angry, resentful that it's not you.

Winner-Think: Listen to someone's story of success and use the information as a springboard to improving your own situation.

Both are free. Choose one.

There is interesting psychology literature out there highlighting that successful people tend to attribute their success to who they are and what they have done instead of good fortune. In most fields of medicine the practice environment no longer exists to out and start a new practice. Additionally there is considerably more competition for employed positions, oh and don’t mention the ridiculous cost of med school. Striving to achieve based on someone else is admirable, but if you neglect the circumstances that allowed that type of success then you are striving towards something that can no longer be achieved. That’s why it’s a useless post.

 

[Spikebd]

I think there is some truth to this. We’re mostly going to be employees instead of owners like our parents and grandparents generations.
I don’t know how much of a choice the boomers had to stop things, though.

 

[Apollyon]

There is interesting psychology literature out there highlighting that successful people tend to attribute their success to who they are and what they have done instead of good fortune.

So, hard work doesn't count? Nobody has earned what they have? It's all random luck? "Interesting psychology literature" does not imply reality or truth. What is true is that, for most people, they have to work at getting through med school. Are you saying that it is "good fortune", and not intentional? If you mean something else besides just random combination, you have to REALLY expand on that.

What field is yours?

 

[Kuratz]

So, hard work doesn't count? Nobody has earned what they have? It's all random luck? "Interesting psychology literature" does not imply reality or truth. What is true is that, for most people, they have to work at getting through med school. Are you saying that it is "good fortune", and not intentional? If you mean something else besides just random combination, you have to REALLY expand on that.

What field is yours?

Sorry to clarify: there is a tendency to downplay one‘s good fortune or extrinsic factors in favor of their “hard work” or intelligence. I didnt intend to imply that success is 100% luck but rather that luck plays a much larger role in success than we are willing to admit to ourselves. For most things work is still required, though smart work being the key (not hard work)

In terms of success as it relates to your med school example: it’s largely good fortune to live in a country which compensates physicians overall still well. It’s also basically totally extrinsic factors controlling whether this remains the case over the next 30 years, or potentially increases. Two med students could both put in equal hours and choose conventionally lucrative fields but have one field get their bread and butter slashed (by reimbursement, socialized medicine or decreased need) while the other sees a huge bump (better compensation, new lucrative procedure etc). One could live a healthy life into their 80s while the other succumbs to an unfortunate cancer before they can even pay debts off. These scenarios are very real and why pure chance accounts for a lot. Plenty of people work just as hard as physicians but aren’t nearly as fortunate.

Where do you disagree?

Edit: and an interesting article

The Role of Luck in Life Success Is Far Greater Than We Realized

Are the most successful people in society just the luckiest people?

blogs.scientificamerican.com

 

[Apollyon]

Where do you disagree?

First, again - what is your field?

Second, saying it's random chance sounds like magical thinking.

If a firefighter puts water on a fire, it goes out. If that doesn't work, use foam. There's no random chance there that may or may not work. You put your foot on the gas, the vehicle moves. Not luck.

 

[RustedFox]

I think there is some truth to this. We’re mostly going to be employees instead of owners like our parents and grandparents generations.
I don’t know how much of a choice the boomers had to stop things, though.

It was the BOOMERS that ruined it though their insatiable greed and "manifest destiny".

 

[Kuratz]

First, again - what is your field?

Second, saying it's random chance sounds like magical thinking.

If a firefighter puts water on a fire, it goes out. If that doesn't work, use foam. There's no random chance there that may or may not work. You put your foot on the gas, the vehicle moves. Not luck.

Strawman. This has nothing to do with physics. My point is extrinsic factors play an enormous role in life success, more than we admit to ourselves and probably more than the work we put in or the talent we have.

 

[Apollyon]

Strawman. This has nothing to do with physics. My point is extrinsic factors play an enormous role in life success, more than we admit to ourselves and probably more than the work we put in or the talent we have.

So, you have used "boomer" and "strawman", and have not said what is your field. You are straying close to "agenda", and that clouds your argument.

By your thesis, therefore, anyone could be replaced in the same situation, and get the same result. Your thesis precludes any talent. This is not borne out by fact. But, you say that it is. I just find it rather, well, outrageously unlikely that Ross Perot would become a billionaire - twice. Not $2 billion, but, two separate businesses/episodes that earned him $1 billion.

And, you call it "luck". I call it random chance. Regardless, you seem to state that it is only "luck". However, think a little more deeply. "Luck" is what happens. However, that is, then, worked on by human performance. "Luck" is that it is raining. I see that, and I use an umbrella. That is not "lucky" of me.

 

[Kuratz]

So, you have used "boomer" and "strawman", and have not said what is your field. You are straying close to "agenda", and that clouds your argument.

By your thesis, therefore, anyone could be replaced in the same situation, and get the same result. Your thesis precludes any talent. This is not borne out by fact. But, you say that it is. I just find it rather, well, outrageously unlikely that Ross Perot would become a billionaire - twice. Not $2 billion, but, two separate businesses/episodes that earned him $1 billion.

And, you call it "luck". I call it random chance. Regardless, you seem to state that it is only "luck". However, think a little more deeply. "Luck" is what happens. However, that is, then, worked on by human performance. "Luck" is that it is raining. I see that, and I use an umbrella. That is not "lucky" of me.

Again, its not 100% chance or extrinsic factors that account for success and thus not reproducible given the exact same circumstances for two people. But I think it’s naive to suggest that luck is not a massive player in success. Firstly to be born in the US or other favorable nation is lucky, then it’s lucky to have parents that care about you, then it’s lucky to have a medically healthy mind and body until at least late middle age, then it’s lucky to choose a path that might yield success and actually does, and then it’s lucky to happen to know the right people or be in the right place at the right time to get a stellar opportunity.... and on and on.

I look at my cousin who is homeless after losing his parents in high school while I happened to shadow a friend‘s surgeon dad who ended up mentoring me well into med school and I realize the fortune I’ve had to get to this point, in many ways. Then I also look at an old high school friend who years ago happened to meet an Amazon person of influence on a plane, shared some interests, ended up with a job and now is incredibly wealthy and also realize the fortune that played into her path. Do choices play a role? Yes absolutely. But two equally talented, ambitious people are a string of tragedies or strokes of good luck away from vastly different lives.

We are diverting far from the thread and deeper into Philosophy. I won’t be responding on this thread so to not clutter it further but I am more than happy to continue this conversation via DM.

 

[Apollyon]

Edit: and an interesting article

The Role of Luck in Life Success Is Far Greater Than We Realized

Are the most successful people in society just the luckiest people?

blogs.scientificamerican.com

I read that blog post. I'm just saying that I'm not persuaded. I still call it "random chance", not "luck", but that might just be semantic. I'm not a PhD psychologist or statistician, so I can't get "into the weeds" about chaos theory with any expert skill. I get the basic, gestalt idea, but I don't ascribe it to "luck". I guess I think of "luck" as something metaphysical, like someone can be a "bad luck charm", which is with what I disagree. I still believe that how one person succeeds and another fails is not random chance (beyond just that - randomly distributed chance), but all the granular, very specific, right down to the second choices that are made. One person makes the most efficient, complete chain, another is less efficient, but completes it, and another doesn't complete it.

 

[southerndoc]

I think you two need to carry this into a private message thread.

 

[GeneralVeers]

I think you two need to carry this into a private message thread.

"You didn't build that!"

 

[emergentmd]

Glad to see that some can always derail a thread for their own self worthlessness.

The question was how EM was 10 yrs ago vs now. Everyone has their own experience, I shared mine. It is not impossible or really that difficult to get into the FSER gig. Its not all rainbows but its worth it if this model Fits you. Some just like to work for a CMG, collect their 200/hr and go home. Some are willing to risk their financial neck opening up a business and when it works out well, reaps some rewards.

The successful EM docs throughout the years tend to keep it to themselves b/c they don't want their turf to be crowded. I am one to share my experiences b/c I know I can compete even if the secret is out.

I shared where to get $4-500/hr rates 5 yrs ago. I shared that you need passive income to retire. I am now sharing that the FSER market is out there as an option.

Most EM docs just sit back, whine that CMGs are ruining everything then just show up to continue to punch the clock. Kuratz and the like just like to complain, protest, and hope that someone will make their life better. Life is not that way, you make your own luck 99% of the time.

I could have taken the easy road, Kept punching my 225/hr gig for Mr CMG but I took a huge financial risk. Anyone can join the FSER world if you are willing to risk 7-8 figure debt. Its not for everyone but don't complain that its not available to you. You just choose to not take the risk, which is OK.

 

[EctopicFetus]

Most EM docs just sit back, whine that CMGs are ruining everything then just show up to continue to punch the clock. Kuratz and the like just like to complain, protest, and hope that someone will make their life better. Life is not that way, you make your own luck 99% of the time.

I’m just a lowly em doc. The question is 2 fold. What are you willing to sacrifice to do better. Many people come with the “I can’t move” etc. That’s fine. You can but you choose not to.
Luck surely plays a part. I think it’s not as big as people say. I think grit and hard work can overcome bad luck.
The problem with the young folks and I think I’m fairly young still is that there is no interest to understand the economics of em and even less interest in trying to own your practice. I mean from scratch.
You can take a contract from a cmg. But it’s hard and few if any have any interest or desire.
You can call the older guys boomers but the young folks want $hit handed to them on a silver platter. Earn it.
I came from literally being on government assistance. I ate government cheese and remember my family using food stamps. I was “lucky” I had great parents but “unlucky” that they didn’t understand the education game in the us. I was “unlucky” my parents missed a lot of time with me on the weekends as they were peddling dresses at the flea market.
No one has all good or bad luck. That’s what the research doesn’t show.
The young em docs are conditioned to be sheep. The cmgs have won. I’ll keep getting mine.
As said want to be happy? Get money outside of em. Invest wisely and aggressively. Find a non clinical way to make money. Consult, real estate, side business etc.
Many aren’t gifted with handling of money or business. You are all smart enough to earn it.
The sdg owners don’t / didn’t owe squat to medical students or high school kids aspiring to be docs.
I would say the issue is how those sdgs screwed patients. Some had a choice in selling. Others simply got a pay day before the inevitable happened. (See summa) see sdg in arlington who got 0 and became cmgs anyhow.

 

[WilcoWorld]

So, hard work doesn't count? Nobody has earned what they have? It's all random luck? "Interesting psychology literature" does not imply reality or truth. What is true is that, for most people, they have to work at getting through med school. Are you saying that it is "good fortune", and not intentional? If you mean something else besides just random combination, you have to REALLY expand on that.

What field is yours?

I think @Kuratz is referring to Fundamental Attribution Error, a very interesting and evidence-supported phenomena. It's worth reading about, as it's pretty humbling, which I think you & I agree(?) can be a good thing.

 

[WilcoWorld]

Not one to miss a chance for a music reference - Field Music (a band that should be WAY bigger than they are) has a pretty catchy song about it:

"Count It Up"

Check it out to get your fix of post-Genesis Peter Gabriel style pop.

 

[alpinism]

Personally I think all the current EM docs complaining about CMGs have no one to blame but themselves.

The problem is that nowadays many new docs have this entitlement that after 12+ years of school they deserve to have their ideal career and schedule. Basically the common theme is I'm done sacrificing and I'm going to live in this specific location and work these specific hours even if it means working for a corporate medical group that's screwing over patients while actively destroying the profession of emergency medicine.

 

[Birdstrike]

There is interesting psychology literature out there highlighting that successful people tend to attribute their success to who they are and what they have done instead of good fortune. In most fields of medicine the practice environment no longer exists to out and start a new practice. Additionally there is considerably more competition for employed positions, oh and don’t mention the ridiculous cost of med school. Striving to achieve based on someone else is admirable, but...

If you're trying to convince me that because there are obstacles in your way, you'll never succeed, you have me convinced. The conditions are perfect and your plan is foolproof!

 

[Birdstrike]

"Life is too hard. There are many obstacles against me. I'll never succeed."

With that action plan, I can guarantee that you're right!


"The solutions for make things better are too hard."

That's right, because making excuses is too easy!


A) Stay convinced that you'll fail, there's no chance of success and all things worth doing have already been done by others, then you're guaranteed to fail.

B) Turn you mindset around, 180 degrees, and you might, you just might, have a chance at something better. You still may fail, but you open the door to at least a chance of success, improvement, or something better.


Many people choose A and that's okay. There's plenty of company there, and you'll never be lonely in group A. Choice A is comfortable, risk-free and easy to accomplish. A few brave souls choose B. A few of those, succeed. An even smaller few, succeed beyond their wildest dreams.

 

[GeneralVeers]

Many people choose A and that's okay. There's plenty of company there, and you'll never be lonely in group A. Choice A is comfortable, risk-free and easy to accomplish. A few brave souls choose B. A few of those, succeed. An even smaller few, succeed beyond their wildest dreams.

Don't worry. With UBI and Stakeholder Capitalism everyone can be a winner regardless of effort or ability.

 

[Birdstrike]

Don't worry. With UBI and Stakeholder Capitalism everyone can be a winner regardless of effort or ability.

I can't think of a better way to multiply poor work ethic, lack of ingenuity and non-productive complaining, than to pay people for it. Brilliant!

 

[Kuratz]

Choice A is comfortable, risk-free and easy to accomplish. A few brave souls choose B. A few of those, succeed. An even smaller few, succeed beyond their wildest dreams.

Listen I’m pretty conservative and believe in the value of hard work and that with risk comes the possibility of reward. But that has to be a calculated risk, and I’m simply drawing attention to the fact that by attending medical school and paying inordinate tuition and spending nearly a decade training, there is already a major risk being taken with no guarantee of payoff. Certainly this is much more so than in generations previously. It’s also fair to point out that regulations and policies have shifted tremendously to the point that the odds of success have drastically shifted away from physicians and towards mega-conglomerate systems and insurance companies.

Thus it was fortuitous circumstances for physicians in the 90s with functionally a fraction of the tuition costs, in some cases a shorter training pathway, and a practice environment in which nearly any physician who wasn’t a total ignoramus could hang a shingle and have great success. That simply isn’t the case anymore and it’s flat out not helpful to suggest like the other poster did that an investment of “7-8 figures” may be necessary. That’s not having a loser mentality, that’s realizing the calculated risk grossly favors failure when failure could be catastrophic. That doesn’t mean us young physicians shouldn’t take risks and find a way to be successful elsewhere, it means that we shouldn’t be stupid with how we assess and implement that risk.

 

[bravotwozero]

Stakeholder Capitalism? As in, you are a stake holder in a business, property etc? Is this a bad thing?

 

[RustedFox]

Listen I’m pretty conservative and believe in the value of hard work and that with risk comes the possibility of reward. But that has to be a calculated risk, and I’m simply drawing attention to the fact that by attending medical school and paying inordinate tuition and spending nearly a decade training, there is already a major risk being taken with no guarantee of payoff. Certainly this is much more so than in generations previously. It’s also fiair to point out that regulations and policies have shifted tremendously to the point that the odds of success have drastically shifted away from physicians and towards mega-conglomerate systems and insurance companies.

Thus it was fortuitous circumstances for physicians in the 90s with functionally a fraction of the tuition costs, in some cases a shorter training pathway, and a practice environment in which nearly any physician who wasn’t a total ignoramus could hang a shingle and have great success. That simply isn’t the case anymore and it’s flat out not helpful to suggest like the other poster did that an investment of “7-8 figures” may be necessary. That’s not having a loser mentality, that’s realizing the calculated risk grossly favors failure when failure could be catastrophic. That doesn’t mean us young physicians shouldn’t take risks and find a way to be successful elsewhere, it means that we shouldn’t be stupid with how we assess and implement that risk.

I was just going to make a Grandpa Simpson joke, but you did way better.

The BOOMERS also practiced largely without corporate overreach, MLP encroachment, and a hyperlitigious climate.

Oranges to Cadillacs comparison.

 

[Birdstrike]

Stakeholder Capitalism? As in, you are a stake holder in a business, property etc? Is this a bad thing?

Not exactly. I'm not an expert on this concept. But what little I've read about it leads me to believe it's a philosophy that corporations should not only seek profit, pay shareholders and increase stock value, but should also work to "benefit the environment" and "community," i.e. oft forgotten 'stakeholders' in the company. It's one of those things that sounds good on paper and seems at face value impossible to be against. But it seems to me that buried in the concept is the implication that businesses necessarily, and by their nature, harm the environment and community. Some certainly do. Plenty do not.

 

[Birdstrike]

Listen I’m pretty conservative and believe in the value of hard work and that with risk comes the possibility of reward. But that has to be a calculated risk, and I’m simply drawing attention to the fact that by attending medical school and paying inordinate tuition and spending nearly a decade training, there is already a major risk being taken with no guarantee of payoff. Certainly this is much more so than in generations previously. It’s also fair to point out that regulations and policies have shifted tremendously to the point that the odds of success have drastically shifted away from physicians and towards mega-conglomerate systems and insurance companies.

Thus it was fortuitous circumstances for physicians in the 90s with functionally a fraction of the tuition costs, in some cases a shorter training pathway, and a practice environment in which nearly any physician who wasn’t a total ignoramus could hang a shingle and have great success. That simply isn’t the case anymore and it’s flat out not helpful to suggest like the other poster did that an investment of “7-8 figures” may be necessary. That’s not having a loser mentality, that’s realizing the calculated risk grossly favors failure when failure could be catastrophic. That doesn’t mean us young physicians shouldn’t take risks and find a way to be successful elsewhere, it means that we shouldn’t be stupid with how we assess and implement that risk.

Are you happy with your career?

 

[EctopicFetus]

There are some SDG docs on here who are fairly successful. People 10 years out. People who graduated HS not med school in the 90s.

Is it way harder now. NO doubt. See my posts.. But when people want to talk about risk and med school perhaps a reality check is needed. A semi ******ed HCA EM residency grad can earn 400k a year in EM working under 2k hours a year. If you are flexible on location you can get $225-250/hr now. Thats under 150 hours a month.

Simply a guaranteed $400k/yr is not all that risky. Do the WCI and live like a resident and you can truly be out of debt in 2-3 years. worst case scenario its 5 years.

So lets relax with the "risk" argument. FWIW I wouldnt take on massive debt do to a FSED. doesnt mean some wont work but I know people who invested who make crap pay, FSEDs closed etc. UNlike med school and an EM residency which guarantees you a boatload of money owning a FSED isnt a guarantee.