"I want to be upper-middle class." Is this really so offensive?

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Being motivated by financial security is a clever euphemism for chasing money. Doctors have a tremendous responsibility to the well-being of their patients. Often, doing the job right does not come with commensurate remuneration. If you go to medical school solely motivated by earning potential, your practice of medicine will be likewise focused on earning potential. You will minimize contact time with patients, you will overbill or miscode, you will refuse to see certain patients due to their insurance plans or lack thereof, you will order unnecessary procedures, you will focus your talents on high paying elective procedures, you will do a million other things that have your bottom line as the cause. There are lots of doctors who are like this, and it is a big reason why there is so much waste and unnecessary billing in the profession. It is also a big reason that people don't trust doctors, so yes, it cheapens the profession when you care more about your "financial security" than appropriate treatment of your patients.

It is naive to believe that you will be most highly paid by by doing the most ethical and correct things for your patients. The most highly paid physicians are the ones who maximize the number of patients seen who undergo the most highly reimbursed procedures. The system is very screwed up and backwards.

There is more to being a good doctor than just getting the job done. To be a good doctor, you need to care about the work you are doing and how it affects peoples' lives. One of the biggest motivations I had to become a physician was all of the bad doctors who didn't care about me and treated me poorly, almost like I was just a broken piece of machinery.

You're confusing being motivated by money and being immoral.
 
I didn't come here to troll. Fact remains, law is oversaturated right now, and there are students at Harvard Law with no jobs. It's why I'm doing a post-bac.

As for the "ideals" fundamentalists below who blasted me for valuing consumption over production, I wonder how long your idealism will last in the vale of tears that is practice. I will concede that if you value your profession in and of itself, it is a great feeling and an excellent, self-sufficient incentive. But as with using love to sustain a marriage, it is unreliable and untenable.

Everyone finds his own way to get through. I plan to self-medicate with ADHD drugs. :laugh:

One of the worst things about the financial meltdown of 08 is the glut of unemployed lawyers and bankers who are going to be flooding AMCAS with applications next year. Luckily in the past, most of the i-wanna-get-rich, greed-is-good kids gravitated towards banking and law. Now they've got their eyes on medicine because suddenly the 8 year trek of medical education doesn't seem so bad compared with unemployment.

You have no business being a doctor. If you think that the practice of medicine is a "vale of tears," that it is untenable to value the profession of medicine, that you only want to do this to become "upper middle class" (whatever that is), and you will only be able to get through it by abusing drugs, then with no respect due whatsoever, **** you and the horse you rode in on.
 
You have no business being a doctor. If you think that the practice of medicine is a "vale of tears," that it is untenable to value the profession of medicine, that you only want to do this to become "upper middle class" (whatever that is), and you will only be able to get through it by abusing drugs, then with no respect due whatsoever, **** you and the horse you rode in on.

Your little self-righteous rant is the funniest thing I've read in a long time. Congratulations. 👍
 
Your little self-righteous rant is the funniest thing I've read in a long time. Congratulations. 👍

Glancing briefly at your past posts in order to find out why what I said struck a nerve and elicited a sarcastic response, it is clear that you are not just concerned, but obsessed with the statistically high earnings of specialists (esp. compared to other professionals), and this seems to be your only interest in the field of medicine. I was about to tell you where to go, but now I think I'll just smile.

I feel a little better that this attitude is less prevalent among med students than pre-meds, but it is definitely still there, and it is troubling.
 
Actually, I think you have it backwards. From what I can tell, far more pre-meds are out to save the world than med students. After grinding through a couple years of hell, it dawns on many of them that a little monetary compensation for all they sacrifice might be nice. That doesn't cheapen the profession. Why does someone's motivation matter, as long as he is good at what he does?
 
Actually, I think you have it backwards. From what I can tell, far more pre-meds are out to save the world than med students. After grinding through a couple years of hell, it dawns on many of them that a little monetary compensation for all they sacrifice might be nice. That doesn't cheapen the profession. Why does someone's motivation matter, as long as he is good at what he does?

This.

Haven't you guys seen house? He doesn't give two ****s about his patients but he's the man saving lives left and right!

On a more serious note, I do agree that motivation really shouldn't matter to anyone else. What should matter is if your a competent doctor who can do his job and do it well.
 
You guys are so extreme. Life is rarely black and white. Just because someone wants to earn a heap of money and provide for a family doesn't mean he doesn't/won't give two *hits about his patients. Although, I do think someone with a passion for medicine will probably make a more considerate and dedicated physician.

When I first started working in healthcare, I was Ms. Save the World, gung-ho for the underserved, determined to better the health of the poor and indigent. Sorry, but every patient that comes in to the clinic with cigarettes stuffed into the diaper bag, Blackberrys and massive amounts of jewelry yet needs a script for Tylenol because they couldn't bother to spend $5 on their child's fever makes me care a little less. America used to be about opportunity, and it's slowly turning into a country of entitlement. I still intend to spend some time here and there caring for truly indigent people, but I'll be dam*ed if I'm going to put myself 300k in debt and work my ass off to keep other people sitting comfortably on theirs.

This kind of veered off topic, sorry. I just saw the posts about reimbursement cuts.
 
Motivation matters. If you are in it for the money, you will take shortcuts to get out of the hospital and onto the golf course, the lake, or just back to your sprawling suburban mansion or your family. I am not saying that is a bad thing because I know too many doctors who have no life outside of the hospital and they seem unhappy and unbalanced sometimes. Then again, there are other doctors who disappear into the labs as a medical student and never see the light of the sun until the day they die, working to cure cancer or discover something that will immortalize them in medical textbooks for the next hundred years.

Motivations are different, it does matter, and it is a good thing. It helps keep medicine diverse. Some patients need a relaxed doctor who can shoot the breeze about March Madness while telling him that he has cancer. Other people need a lab robot who can spout facts at them until they feel comfortable about their medical condition.

Doctors can find satisfaction with their careers even when they are coming from very different places. Live and let live. As long as your motivations are strong enough to get you through school and training and as long as you wake up happy with your career, then why would it matter if your reasons are the same as your colleagues'? Some people are motivated by money, other people aren't, and it is important to recognize what makes you tick.
 
If you are in it for the money, you will take shortcuts to get out of the hospital and onto the golf course, the lake, or just back to your sprawling suburban mansion or your family.
I'm with you on the rest of it, but for the billionth time, why does everyone assume "in it for financial security"="half-assed doctor?" That assertion simply makes no sense at all.
 
I'm with you on the rest of it, but for the billionth time, why does everyone assume "in it for financial security"="half-assed doctor?" That assertion simply makes no sense at all.

I completely agree with you Milk, if I was a half-assed doctor that pissed of patients, well, I bet I start losing patients, stop getting referrals, and open up myslef to lawsuits (ie. pay more malpractice). Thus, in the end, I probably LOSE more money by being half-assed.

If I am friendly to my patients, hard working, looking out for their best interest and I'm done everyday by 4 PM so I can hit the golf course or go to my kids baseball game, while making a **** TON OF MONEY; well, I think I'm a winner as I'm doing what I love and have time for myself and my family.

So, in the end, I think I would like to make a ton of money and live in a upper upper class since I sacrificed my life until the age of 35 to make some money.
 
This.

Haven't you guys seen house? He doesn't give two ****s about his patients but he's the man saving lives left and right!

On a more serious note, I do agree that motivation really shouldn't matter to anyone else. What should matter is if your a competent doctor who can do his job and do it well.

It really shouldn't matter to anyone else, and it doesn't matter to me, but I'm still gonna laugh when they come back years down the road complaining about: how crappy medicine is, how doctors get no respect, how they can't pay their loans, how they aren't getting reimbursed, how no one with a brain should choose medicine.

It's the people who went into medicine specifically for those things who can't deal with it.
 
You have no business being a doctor. If you think that the practice of medicine is a "vale of tears," that it is untenable to value the profession of medicine, that you only want to do this to become "upper middle class" (whatever that is), and you will only be able to get through it by abusing drugs, then with no respect due whatsoever, **** you and the horse you rode in on.

Ah, Pre-Allo, home of Burnett's Law.

Some things never change.
 
Dental School. Generally more money than medicine, and no residency. Fun fact for the day: dentists have the highest suicide rate in the country. My old dentist was actually one of them.😱
 
Lol my mother doesn't have much respect for doctors because she doesn't feel more are doing their job right. She especially despises emergency room docs.

What does your mother do?

You will never achieve satisfaction in your lives. No, you didn't sell your dreams out because you never had any dreams to begin with. Being a doctor is not a means to and end.

Well, I think there's some truth to both sides. Personally, I went into medicine for a variety of reasons, most of which being what SDN, in its collective wisdom, considers "good reasons". But the means to an end aspect as regards financial security, etc., is nice. I've actually heard that line from a practicing doc or two, no less; treating a job as solely a means to an end is not fulfilling, but in my world, neither is being entirely absorbed by it.

You are very naive. If you think that you can "develop a moderate interest in the subject," medical school and residency will chew you up and spit you out.

This. Although in all fairness, I will say that I've come to find a few things a little more interesting than I thought they might be.

You have no business being a doctor. If you think that the practice of medicine is a "vale of tears," that it is untenable to value the profession of medicine, that you only want to do this to become "upper middle class" (whatever that is), and you will only be able to get through it by abusing drugs, then with no respect due whatsoever, **** you and the horse you rode in on.

Your little self-righteous rant is the funniest thing I've read in a long time. Congratulations. 👍

Ah, Pre-Allo, home of Burnett's Law.

Some things never change.

Raryn beat me to it. :laugh:
 
I originally sent this to illegallysmooth as a reply, but I decided to post it.

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The median income of business is much lower than medicine. Sure there's the chance to make quite a bit, but it's between working in a small company (maybe starting your own), which is high risk, and working in large companies, which is typically starting in sales and hoping that you climb adequate through the corporate ladder.

Either way, it's no where near as stable as medicine.

In the end, there are tons of ways to make MORE money than medicine, but the risk associated with these are typically higher too.

On another note, I think engineering may actually be better than medicine. Most EEs start around 60-80k and have the potential to get to around 120k. That's pretty decent money for someone that start working at age 22 with minimal debt. People in medicine will earn much more over their life time, but when the EE's are driving their BMWs in their 30s, we'll be driving ours in our 50's when we're too old to enjoy it and our wife and kids keeps bitching at us in the backseat.

Being upper middle class is a good goal, but the truth is that while medicine makes money, the sacrifices for it are real and the income is declining somewhat. If you feel that the sacrifices are worth the return, by all means do it. I'm doing it and I enjoy it. There are days that I hate it and there are times that I want to stab my patient in the eye, but overall? It feels good to be needed. You see people at their most vulnerable hour and that is a privilege.

When people say there are better ways to make money, they typically think of partnered lawyers or business owners. What they should be thinking about is the guy that only works 40 hours a week, takes home a 70k a year check, and have plenty of time to spend with the wife/husband and kids. They're there for the soccer games and they get plenty of sleep every night. We may not.

We all have to trade parts of our lives to obtain resources to survive, but how much is enough?
 
I originally sent this to illegallysmooth as a reply, but I decided to post it.

--
The median income of business is much lower than medicine. Sure there's the chance to make quite a bit, but it's between working in a small company (maybe starting your own), which is high risk, and working in large companies, which is typically starting in sales and hoping that you climb adequate through the corporate ladder.

Either way, it's no where near as stable as medicine.

In the end, there are tons of ways to make MORE money than medicine, but the risk associated with these are typically higher too.

On another note, I think engineering may actually be better than medicine. Most EEs start around 60-80k and have the potential to get to around 120k. That's pretty decent money for someone that start working at age 22 with minimal debt. People in medicine will earn much more over their life time, but when the EE's are driving their BMWs in their 30s, we'll be driving ours in our 50's when we're too old to enjoy it and our wife and kids keeps bitching at us in the backseat.

Being upper middle class is a good goal, but the truth is that while medicine makes money, the sacrifices for it are real and the income is declining somewhat. If you feel that the sacrifices are worth the return, by all means do it. I'm doing it and I enjoy it. There are days that I hate it and there are times that I want to stab my patient in the eye, but overall? It feels good to be needed. You see people at their most vulnerable hour and that is a privilege.

When people say there are better ways to make money, they typically think of partnered lawyers or business owners. What they should be thinking about is the guy that only works 40 hours a week, takes home a 70k a year check, and have plenty of time to spend with the wife/husband and kids. They're there for the soccer games and they get plenty of sleep every night. We may not.

We all have to trade parts of our lives to obtain resources to survive, but how much is enough?
Engineers start out better, but they top out their salary quick. They'll be earning that 100k at 26, and at 46, and at 66 unless they go into managing a big engineering firm, which the vast majority of them won't. Its a stable field if you can get a good job, but you won't be "rich." Physicians, especially in some of the more competitive specialties, have a much higher lifetime earning potential.

Oh, and to whoever said dentists have the highest suicide rate, that is an urban legend. The real tabulated numbers say that of all medical professionals, psychiatrists are the ones with the highest suicide rate. (Its not *that* much higher, but its a statistically significant difference)

Finally, to everyone disparaging law as an option, do understand the difference between the different law schools. Law graduates have a distinctly bimodal salary graph, with a good number earning ~50k on average and a smaller number earning ~150k. But the people who could also get into medical school aren't the ones earning $50k. Law school as a general rule is not nearly as competitive as medical school. To look at the same quality of student, you should look at the top 50 law schools. Graduates of *those* schools are the ones who are starting out with $150k+ jobs. Those are the jobs that the people who are smart enough get into medicine would be vying for.

The market isn't the best right now, but I can tell you right now that a lawyer educated in one of the top tier law schools will not be unemployed for long.
 
Upper middle class (according to obama) is defined as having a household income of between 100,000-250,000, I would say 99.9% of doctors make it to at least upper middle class. So if that is your sole goal in life than I guess medicine will accomplish it.
 
Is there such thing as "lower-high-class"?
 
Is there such thing as "lower-high-class"?

I don't think so but you can break it up however you want to. In my opinion

Lower class= 0-30,000
Middle Class= 30,000- 80,000
Upper middle class- 80,000- 250,000
Lower high class- 250,000- 500,000
High class- 500,000+
 
Drives me nuts when people preach on here about not going into it for the money. EVERYONE is motivated by the money in medicine. In all truthfulness, I'm not motivated to go into medicine because helping people is my passion in life. I'm (hoping to) do it because I have a huge interest in medicine and all that it encompasses, and I can earn a nice living while I'm doing that. Helping people along the way will be a nice feeling, but I'd be lying if I said that was my driving force.



In the future, regardless of where Health Reform goes, this will change A LOT. Those that predominately have such motivation will feel jaded. Cut-backs in reimbursement will continue regardless. The cost of healthcare is overwhelming, and many times the pay-off as far as pts with many disease and disorders are concerned is not all that great, as their insurance premiums and contributions increase considerably.

If you don't have a firm love for medicine and being there for people in this capacity, you will will likely end up feeling locked in. It's not the prettiest fairytale--what some want to hear--but it's a lot closer to the truth.

I predict cuts will be rather broad, but, by and large I think that surgeons will be among the few that won't feel the cuts as hard--b/c there will always be a demand for good surgeons. I'd say the realistic difference is with those surgeons that are mediocre or less compared with those that are really good and then those that are greatly talented in this area. Although there's a lot of learning--a learning curve, not everyone has the talent to be an excellent surgeon. It is a very tough area in which to enter. It's a very tough residency, fellowship, the whole nine yards--and it can stay pretty busy thereafter. Many surgeons I know bust hump big time--many years post fellowship.



Many people with MBAs do a lot better than a lot of physicians with considerably less and debt and commitment.
 
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Just to point out - I am an intern at a nationally known money management firm and I would say that the majority of the highest earners (lets say, 125-150k+) do not have MBAs. What they do go for, however, is certifications like the CMT or CFA, which require little to no money put forth (and in the finance world at least, bring forth the biggest bonuses). An MBA is sought after by a person for the connections gained through your classmates. There is relatively little information "learned" that the person has never seen before. I've been told multiple times that unless I am accepted into Wharton, an MBA is just a waste of money (and you pursue it, generally, after you have been employed for 5-7 years already, meaning that you must take a leave of absence to pursue this education). Business in no way requires the same money up front that Law and Medicine require. Not even close.
 
Glancing briefly at your past posts in order to find out why what I said struck a nerve and elicited a sarcastic response, it is clear that you are not just concerned, but obsessed with the statistically high earnings of specialists (esp. compared to other professionals), and this seems to be your only interest in the field of medicine. I was about to tell you where to go, but now I think I'll just smile.

I feel a little better that this attitude is less prevalent among med students than pre-meds, but it is definitely still there, and it is troubling.

You've never worked a day in your life, have you, medical student?
 
Just to point out - I am an intern at a nationally known money management firm and I would say that the majority of the highest earners (lets say, 125-150k+) do not have MBAs. What they do go for, however, is certifications like the CMT or CFA, which require little to no money put forth (and in the finance world at least, bring forth the biggest bonuses). An MBA is sought after by a person for the connections gained through your classmates. There is relatively little information "learned" that the person has never seen before. I've been told multiple times that unless I am accepted into Wharton, an MBA is just a waste of money (and you pursue it, generally, after you have been employed for 5-7 years already, meaning that you must take a leave of absence to pursue this education). Business in no way requires the same money up front that Law and Medicine require. Not even close.

Business in no way requires the same money up front that Law and Medicine require. Not even close

Yep, I agreed with that.

But what I will say about the MBA is this. If you have it you have a lot more security at maintaining a six figure income over a greater period of time and over a larger geographical spread than if you do not have one.

Plus, what I have seen in business is that those with such masters prep are somehow allowed more dumping off of things on to those that don't have the degree. It's nice for them, since when all goes well they get the credit and praise, and when all goes south, they get to blame in on the person/s they dumped it on in the first place--you know, the ones without the MBA or advanced degree.

It's amazing how industries and such want titles. The roles in my view should require proof of effectiveness, with or without all the formal educational credentials. Often enough what is really desired are figure heads with titles. It's more gameplaying; but since no one seems to give a fig where business and industry really goes in this country anymore, well, proof of effectiveness no longer seems like an essential qualification. The title is pretty much what matters. Everything is seen as superfluous--even though in reality, true insight, experience, and talent will eventually affect quality of overall performance much more than a degree and thus is far from superfluous. I know I read some studies that say otherwise; but they are weak IMO. I want someone running the show that knows what they are doing and that really kicks butt and is not afraid to be held acountable. This is becoming rare every day in the US business world.
 
I don't think so but you can break it up however you want to. In my opinion

Lower class= 0-30,000
Middle Class= 30,000- 80,000
Upper middle class- 80,000- 250,000
Lower high class- 250,000- 500,000
High class- 500,000+


It is very, very weird that making 80,000 puts you in the top 10% income for individuals, yet you're still considered middle to upper-middle class. The median income for an individual (not a household) in the United States is 30,000.

80,000 is not a lot of money to live on if you have any sort of family whatsoever. But it is a LOT more money than most people have. It's difficult to reconcile both those ideas.

The only worthwhile metric for calculating how much you should make is to compare yourself against other professionals with graduate degrees. Otherwise you're going to come up against the fact that you live in a country that has particularly high income inequality compared to other OECD nations. You might not feel rich and you might not be living like how you think a rich person should live...but congrats, you make more than 90% of your fellow countrymen.
 
It is very, very weird that making 80,000 puts you in the top 10% income for individuals, yet you're still considered middle to upper-middle class. The median income for an individual (not a household) in the United States is 30,000.
But what's the median income for an individual working full-time (40 hours/week at a minimum) at their primary profession? If you're including high schoolers at part-time jobs, retired seniors working as greeters at Wal-mart, mothers working 1-2 days a week and staying at home the rest of the time, etc., then this is not a fair comparison to a physician working 50-60 hours a week at their main job.
 
Sometimes I get depressed while reading these forums with all the bleak predictions for the future and the "lessons" on how life is. Then I look away from my computer for a moment and realize WHEW its just SDN.
 
Haven't you guys seen house? He doesn't give two ****s about his patients but he's the man saving lives left and right!

I aspire to do a residency in Diagnostic Medicine 🙂
 
As a motivation for entering medicine? If there are better ways to make money, what would they be? (DO NOT say law, which is a toilet profession in decline.)


It's not as offensive as it is naive. Imagine this statement: "I am going to become a physicist so that I can be wealthy." Can you guess what's wrong with it? The fallacy is that becoming a physicist has nothing to do with becoming wealthy. Now, what makes you think that a doctor is any different? Doctors, on average, earn more money, but many also lack the financial know-how to keep much of that money. In the end, the liabilities, loans, delayed employment, and the government take away most of what you earn. There have been studies where doctors making more than half a million a year did not have enough money to retire (700K salary). Just look around SDN. Why do you think everyone is complaining about low doctor salaries? They sure earn a lot of money, but they don't know how to keep it. Finally, specialties have large salary ranges from 120K to over a million. There is no guarantee that you will land in your specialty residency, or that you will finish it, or pass the boards, or avoid being sued, or that the specialty salary today won't be half of what it is in ten years.

The second negative reason for your statement is this: why state it? Obviously everyone is striving for financial security (though very few get there), but what's the point of mentioning it? The value of your statement really depends on the context in which it is used.

Don't forget the high probability of you divorcing your wife, losing 50% of your estate, and being almost destitute after you take care of the alimony of each of your children. Not to mention that there is always the possibility that you could lose your license after some of your colleagues assume that your seeing more patients somehow translates into poor patient care (which is unsubstantiated, but that's exactly how a medstudent already described you in this thread) and either due to ignorance or jealousy they will subject you to the medical review board - some true horror stories from the residency forum.

And if you were truly on the path of financial independence, you'd be likely reading some financial books and planning your portfolio strategy rather than posting on SDN about becoming wealthy. This is why being wealthy is the least of your worries now.
 
There have been studies where doctors making more than half a million a year did not have enough money to retire (700K salary)

What the ****.

I demand to see this.
 
What the ****.

I demand to see this.
The research team of Thomas J. Stanley. He mentioned this in one of his books (The Millionaire Next Door). I don't recall the page number as I read it a while ago. These guys have done extensive research on wealth via thousands of surveys since 1980s, including doctors, lawyers, and other professionals. Read a couple of his books. They are very unintuitive, yet revealing.
 
That sounds more like a money management issue than a med school debt issue. If you can't live like a king on $700k/year, you're screwing up badly somewhere along the way.
 
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That sounds more like a money management issue than a med school debt issue. If you can't like like a king on $700k/year, you're screwing up badly somewhere along the way.
That's exactly what it is. However, due to numerous reasons, doctors are very susceptible to this and if you surveyed most doctors, I think you'd find that a very small percentage of doctors is actually wealthy. Many residents receive a sum of money that is not all that little - congruent to the average American household. Yet many claim that they don't have enough money to do even IBR, which is only 15% of the salary. This sort of behavior remains with them, becomes inveterate, and when they do earn six figure salaries, their expenses keep up and get into six figures as well. The rat race doesn't end. Even consider the likely definition of "upper middle class." What does it mean? I bet the OP means about expenditures on large liabilities - large house, "nice" car, clothes, etc.
 
Sometimes I get depressed while reading these forums with all the bleak predictions for the future and the "lessons" on how life is. Then I look away from my computer for a moment and realize WHEW its just SDN.

Hahah, yep. I remember wondering if the sky was falling faster on SDN than elsewhere in the world.
 
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