If you are a premed, please read this!!!

[rabbott1971]

Yeah no.

Do you not believe in resident salary? Sometimes I have noticed that when other people are talking, and then you jump in, you sort of do not have a good feel for the discussion. Stagg737 and I were having a nice exchange, and then you bust in with aggressive smart-aleck comments. It is not appreciated, and it does not make a positive contribution to the discussion.

What are you talking about?? Docs made half of what they make now and the COL was a lot lower. Account for inflation and yeah doctors make more now based on raw numbers but the doctor dollar went a lot farther 25 years ago than it does today.

Thank you. This is not relevant, as inflation and cost of living affect all people, not just physicians. In fact it affects the UPS driver substantially more than the doctor, so your comment actually strengthens my position.

Wrong.

No, not wrong, right. Where did you get your law degree? Merely selling a debt instrument cannot serve to alter the terms of the underlying contract. This really is not a controversial issue, but its a free country, and you are free to have an inaccurate opinion.

You need to read your contracts better if you think this can't happen.

You're venturing outside your area of usefulness and doing it with a snarky, snotty tone that is not warranted given your total lack of a clue. Please stop.

The financial outlook is good for physicians, but not as good as it once was. This is also neglecting the time commitment, years of sacrificing any sort of income, and the debt load that are unique to medicine.

Why are you feeling compelled to insert yourself without even reading the discussion? All of these things were discussed in detail by myself and Stagg737. You need to eat a Snickers man. Seriously.

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[Stagg737]

This is a lot to address, so I'll try and keep it concise.

And residency should not be included in the period where debt accumulates. Average pay is over $50,000 now, so debt is not piling up for residents. I also don't think the bachelor's is fair to include. Your argument begins to take liberties in figuring its no big deal to skip all college education and simply start driving a truck right out of high school. We want to have a reasonable existence, not construct a hypothetical which is excessively spartan or consigned to privation. Not only this but you can't make a valid comparison to any other professions, because those are likely to require a bachelor's as well.

Residency should absolutely be included because interest continues to accumulate. I know many residents with 300k plus in debt who are are either using IBR or just trying to pay off interest. Additionally many residents have other life expenses like SO's or starting a family that eat into that. 50K is fine if you're not in debt, it's not given the financial situation of most residents.

Also, I think it's completely fair to include bachelor's into the calculation. I have many friends that made 50k easily without a bachelors and there are many careers available where you can accomplish this with a certificate or minimal vocational school (which you can start while in high school). The argument that you need a bachelor's degree to have a decent career is a complete myth if you're willing to actually work a full-time job. The question becomes are you satisfied making less than 60-70k for most of your career? If you are, then there are opportunities galore for those willing to work.

I don't really know what you're saying here. Physician pay increases over time, you admitted this when you said 25 years ago doctors made half what they make now. So, that incremental increase is going to apply to the docs out there doing work. On top of this, an employed doc may get actual raises, or a doc in a group will become partner and have a "business" component to his income like I suggested before.

Also I feel certain you are not running computations, because seriously, it would take me about eight minutes with a spreadsheet program and we would be done discussing the math part of this whole thing. And that's kind of the heart of this discussion, the math. You've got OB GYN making mid-$300,000, anesthetists, derm and rads around $400,000, and IM/FM at $220,000. Most of what I've discussed simply contemplates $200,000 a year with small increments reflecting the increasing value of physician services over time. The low numbers work just fine, let alone if you start talking about a specialty where you make half again as much or even double.

I really wish I could find the figure I'm referring to as it would clear a lot of things up. It basically showed that when you adjust for inflation and general trends, a physician's salary actually peaks sometime in their 50's. After that their relative earnings start to decline and I've seen the same thing echoed in the resident/attending forums when discussing job offers. Many of the new residents asking if their job off is fair are getting offers higher than what the long-time attendings in the same geographic areas make. Idk how to explain it economically, but what you're describing and the reality of the situation from what I've seen don't line up.

Also, doctors making more now that 25 years ago have more to do with general reimbursement trends and nature of the healthcare system than getting raises or anything that simple. Healthcare finance and salary is more complex than most other fields, as it's not just a fee-for-service model. Changes are better examined through trends in the system, which there is absolutely no guarantee of an increase and if we move to a universal or single-payer system, we may see some major slashes to physician salaries in the future. Something pre-meds should be made aware of.

Your anecdote is highly suspect, with all due respect. The interest rate of a loan cannot be increased merely because the loan is sold. This is black letter law of contracts. If you re-financed to avoid default, you may have simply made a bad bargain. But the terms can't change, period, simply due to the debt instrument being conveyed to a third party. Whether a co-signer is at risk is irrelevant, of course they are, that's what co-signing means. But bottom line, student loan debt is statutorily outfitted with measures which make repayment easier and less burdensome. Is it just as good as not owing in the first place? No, of course not. But it is way better than owing a credit card company, or owing a bank mortgage where your home can be sold as security.

They absolutely can. It happened to my wife when Sallie May bought out the loan from the feds (rate went from 6.something to 10%). This also almost happened to me when my UG loans were bought out by Great Lakes lenders (loan rate increased from 6.7% to 8%), but I paid off my loan immediately. Idk when you took out loans or if you're still in the process, but fed loans have become more predatory as the years have gone on. They're not longer just a vehicle to allow more people to go to school, they're a way for the federal government to make money. It's gotten so bad that there have been several successful lawsuits against federal lenders for dubious collection practices and lending issues.

Fine, but you are engaging in a false equivalency when you portray as equal the career of one who enlists in manual labor at age 18 with one who obtains a bachelor's degree and then gets involved in further education and training. These two lifestyles are not equal. I appreciate you admitting here that "in the long term" the physician earnings will justify the investment. I never argued there was not an investment period, and if you like the term "sacrifice" then fine, it is an investment of time and resources, in which some lean years are endured in order to achieve high earning potential.

But consider a quick example. In 22 years, a primary care doctor will likely earn over $5 million. In 35 years, the UPS driver will do well to earn $2.3 million. Yes, the doctor has to pay back his loan, OK, his earnings are back down to a mere $4.6 million. So the doc doubles up the driver in 13 fewer years. And this is without any interest being earned, in which case the doctor further outstrips the driver. There just is no comparison.

I agree that there are differences between those engaging in manual labor vs. many doctors (arguably the physical demands of surgery combined with the hours). I also agree with what you're saying with the overall comparison to the 60k/year jobs. The total career earnings aren't close, but when things are calculated out the hourly earnings are. Another somewhat oversimplified figure (which doesn't take into account other investments), but a decent little mental exercise: The Deceptive Salary of Doctors – BestMedicalDegrees.com

You also didn't refute other points I made, such as the unavailability of unlimited hours for the UPS driver, wear and tear on the UPS driver's body, potential of a doctor to buy into a practice or side business such as lab or imaging, and others. Many of these directly impact the financial discussion, and are not just trimmings or lifestyle considerations.

I didn't address other points because I was trying to stick purely to the financial aspects associated with the jobs. Granted, the wear and tear stuff is valid but not exclusive to a single field. Also, I was trying to use the general aspect of careers earning around 50-60k/yr, not just a UPS driver. They do impact the financial discussion, but are not part of the general career path of being a physician and are side choices made. By your logic I could give the example of my friend who started his own landscaping company one summer, made around 40k for 2-3 summers working 3 months, then sold the company off for major money. Plus your situation doesn't take into account that the non-physician can start investing at least 11 years in advance, and will have to worry about whether to funnel their money into investing or debt repayment.

All of which is to say, the gloom and doom about how much it costs to be a physician is overblown. Costs have gone up for all education, but physician earnings have consistently increased year over year. Medical student loans can be handled, and non-income-producing years can be made up for, when you start earning average income of $200,000 a year. The sky is not falling.

I don't think anyone is really trying to project a sense of doom or gloom about the financial aspect of medicine, and it's certainly a very financially stable field to enter (given job security and salary). The point being made was that going into medicine purely for the money is a bad idea.

Edit: Failed at keeping it concise

 

[AnatomyGrey12]

Do you not believe in resident salary? Sometimes I have noticed that when other people are talking, and then you jump in, you sort of do not have a good feel for the discussion. Stagg737 and I were having a nice exchange, and then you bust in with aggressive smart-aleck comments. It is not appreciated, and it does not make a positive contribution to the discussion.
Thank you. This is not relevant, as inflation and cost of living affect all people, not just physicians. In fact it affects the UPS driver substantially more than the doctor, so your comment actually strengthens my position.
No, not wrong, right. Where did you get your law degree? Merely selling a debt instrument cannot serve to alter the terms of the underlying contract. This really is not a controversial issue, but its a free country, and you are free to have an inaccurate opinion.You're venturing outside your area of usefulness and doing it with a snarky, snotty tone that is not warranted given your total lack of a clue. Please stop.
Why are you feeling compelled to insert yourself without even reading the discussion? All of these things were discussed in detail by myself and Stagg737. You need to eat a Snickers man. Seriously.

Touch a nerve? Lol, I read the whole discussion. You are wrong in many of your points, and I just don't have the patience of Stagg to type out a lengthy response detailing why, and I see that Stagg has now done an excellent job of that.

 

[rabbott1971]

Residency should absolutely be included because interest continues to accumulate. I know many residents with 300k plus in debt who are are either using IBR or just trying to pay off interest. Additionally many residents have other life expenses like SO's or starting a family that eat into that. 50K is fine if you're not in debt, it's not given the financial situation of most residents.

Well, all I know is, residents are making money not borrowing it, so I wouldn't include it in the period of no earnings. What expenses they have, etc., is not relevant as the UPS driver has the same issues.

Also, I think it's completely fair to include bachelor's into the calculation. I have many friends that made 50k easily without a bachelors and there are many careers available where you can accomplish this with a certificate or minimal vocational school (which you can start while in high school). The argument that you need a bachelor's degree to have a decent career is a complete myth if you're willing to actually work a full-time job. The question becomes are you satisfied making less than 60-70k for most of your career? If you are, then there are opportunities galore for those willing to work.

I think you are grossly over-estimating the job opportunities for the bare high school graduate. There are undoubtedly some jobs, but to say there are generally available jobs for greenhorn high school grads making $5,000 a month is, in my experience, not very common. And if we're talking about vocational training, or something else, it needs to be factored into the calculations, which has not been the case so far in our discussion.

I really wish I could find the figure I'm referring to as it would clear a lot of things up. It basically showed that when you adjust for inflation and general trends, a physician's salary actually peaks sometime in their 50's. After that their relative earnings start to decline and I've seen the same thing echoed in the resident/attending forums when discussing job offers. Many of the new residents asking if their job off is fair are getting offers higher than what the long-time attendings in the same geographic areas make. Idk how to explain it economically, but what you're describing and the reality of the situation from what I've seen don't line up.

In general, when the pay goes up for an industry, the people in that industry realize an increase in their earnings. Doctors are no different. I do understand older guys settling into a salary, versus new guys going out and getting the best highest offer. There is some of both, but generally, the pay is higher for doctors who have experience; you can easily google this. In addition, I mentioned partnership income, and ownership interests in labs, clinics, imaging facilities, etc.

Also, doctors making more now that 25 years ago have more to do with general reimbursement trends and nature of the healthcare system than getting raises or anything that simple. Healthcare finance and salary is more complex than most other fields, as it's not just a fee-for-service model. Changes are better examined through trends in the system, which there is absolutely no guarantee of an increase and if we move to a universal or single-payer system, we may see some major slashes to physician salaries in the future. Something pre-meds should be made aware of.

Yes there are many business models in healthcare. But honestly, the discussion of the means of remuneration really doesn't seem to have any relevance; the income is what matters, not how it is meted out. And speculating about the future of health care is fraught with its own obvious perils. Doctors' incomes have increased steadily, consistently, and there isn't any good reason to predict the trend won't continue.

They absolutely can. It happened to my wife when Sallie May bought out the loan from the feds (rate went from 6.something to 10%). This also almost happened to me when my UG loans were bought out by Great Lakes lenders (loan rate increased from 6.7% to 8%), but I paid off my loan immediately. Idk when you took out loans or if you're still in the process, but fed loans have become more predatory as the years have gone on. They're not longer just a vehicle to allow more people to go to school, they're a way for the federal government to make money. It's gotten so bad that there have been several successful lawsuits against federal lenders for dubious collection practices and lending issues.

I think you made the point in your last sentence, where you characterize the attempts to raise rates as dubious practices that have been curtailed by lawsuits. These websites confirm that student loan interest rates cannot increase merely because of a change in the loan servicer (conveyance of the debt instrument is how I referred to this before).

How Student Loan Interest Works – Navient
https://studentloanhero.com/featured/pay-off-medical-school-debt/

This is not meant to be exhaustive, but merely evidence that the general legal principle does apply to the specific instance of student loans. It is axiomatic that the assignee of a debt instrument stands in the shoes of the assignor. The assignee cannot receive greater rights than what was already in the contract. Federal student loans tend to have fixed interest rates. Therefore, a third party who buys the right to collect student loans simply cannot alter the terms of the original loan contract. I'm sorry if someone tried to rooky-doo you or your wife with some illegal rate increase, but that's exactly what it was. Saying that you were the victim of an attempted scam does not equate with the scam being a lawful action. This is really a rather unimportant tangent in this discussion, so I don't wish to continue belaboring it.

I agree that there are differences between those engaging in manual labor vs. many doctors (arguably the physical demands of surgery combined with the hours). I also agree with what you're saying with the overall comparison to the 60k/year jobs. The total career earnings aren't close, but when things are calculated out the hourly earnings are. Another somewhat oversimplified figure (which doesn't take into account other investments), but a decent little mental exercise: The Deceptive Salary of Doctors – BestMedicalDegrees.com

Critiquing those statistics would take a long time but they don't seem right to me. Two examples: (1) 2.5 times as many hours for medical school as bachelor's degree? and (2) only $5 million lifetime earnings (using their income of $203,000 a 35 year career earns $7 million; most docs go for at least this long and probably longer). But that's just going to put us down a rabbit hole, so suffice it to say, I just don't agree that the hourly rate goes down so low.

I didn't address other points because I was trying to stick purely to the financial aspects associated with the jobs. Granted, the wear and tear stuff is valid but not exclusive to a single field. Also, I was trying to use the general aspect of careers earning around 50-60k/yr, not just a UPS driver. They do impact the financial discussion, but are not part of the general career path of being a physician and are side choices made. By your logic I could give the example of my friend who started his own landscaping company one summer, made around 40k for 2-3 summers working 3 months, then sold the company off for major money.

That is extremely anecdotal so thanks for not bringing it up

Plus your situation doesn't take into account that the non-physician can start investing at least 11 years in advance, and will have to worry about whether to funnel their money into investing or debt repayment.

I left out interest income and side businesses paid for with investment of savings, because this would grossly favor the physician, even if you take your head start. I just really am skeptical of how much you can invest on the side on your $60k pre-tax income. But on year three, a physician could put $50,000 into an investment, no problem. So this really seems to favor my side of the argument if you want to get into using savings to make more money.

I don't think anyone is really trying to project a sense of doom or gloom about the financial aspect of medicine, and it's certainly a very financially stable field to enter (given job security and salary). The point being made was that going into medicine purely for the money is a bad idea.

I might never have responded if you hadn't used some dramatic language, which I bolded in my original response, about how things are worse now. If you're dialing it back to "don't go into medicine strictly for money" then I have no problem with your premise at all. But to say things have taken a dramatic turn for the worse, I think the numbers do not bear that out, and perhaps even the opposite is true.

Edit: Failed at keeping it concise

Glad that never happens to me!

 

[Stagg737]

Well, all I know is, residents are making money not borrowing it, so I wouldn't include it in the period of no earnings. What expenses they have, etc., is not relevant as the UPS driver has the same issues.

Partially fair, however the UPS driver also does not have interest accruing at the rate of 10's of thousands of dollars per year (which they may or may not be paying off), so I think it is fair to include it in that period.

I think you are grossly over-estimating the job opportunities for the bare high school graduate. There are undoubtedly some jobs, but to say there are generally available jobs for greenhorn high school grads making $5,000 a month is, in my experience, not very common. And if we're talking about vocational training, or something else, it needs to be factored into the calculations, which has not been the case so far in our discussion.

I really don't think I am, as I found numerous jobs (that I worked at while in college) that easily paid 40k/yr, some of which didn't even require an education at all. The more valid critique is that people with only a hs education may not have the drive or willingness to work those kinds of jobs or may not have the creativity/knowledge to find or create those positions (more than one of those jobs were in businesses that either I or a friend started ourselves).

In general, when the pay goes up for an industry, the people in that industry realize an increase in their earnings. Doctors are no different. I do understand older guys settling into a salary, versus new guys going out and getting the best highest offer. There is some of both, but generally, the pay is higher for doctors who have experience; you can easily google this. In addition, I mentioned partnership income, and ownership interests in labs, clinics, imaging facilities, etc.

The bolded is becoming less and less valid of an argument, as the number of self-employed physicians has continued declining every year, and will likely continue to do so based on my and the incoming generation's desire to do less work and lack of administrative understanding. If we move into a universal system (which seems more and more likely), we'll seen an even greater exodus from self-employment.

Critiquing those statistics would take a long time but they don't seem right to me. Two examples: (1) 2.5 times as many hours for medical school as bachelor's degree? and (2) only $5 million lifetime earnings (using their income of $203,000 a 35 year career earns $7 million; most docs go for at least this long and probably longer). But that's just going to put us down a rabbit hole, so suffice it to say, I just don't agree that the hourly rate goes down so low.

Like I said, just a mental exercise, but worth pointing out that if you take training and school into account, physicians make far, far less than the $120/hr that physicians easily make throughout their career.

That is extremely anecdotal so thanks for not bringing it up

I left out interest income and side businesses paid for with investment of savings, because this would grossly favor the physician, even if you take your head start. I just really am skeptical of how much you can invest on the side on your $60k pre-tax income. But on year three, a physician could put $50,000 into an investment, no problem. So this really seems to favor my side of the argument if you want to get into using savings to make more money.

It is anecdotal, but so is your assumption that many or even a significant number of physicians are going to make investments in side business ventures. I agree that docs can make larger investments in the long run, which is why I said that once docs catch up (sometime in the late 40's or 50's), their earning power increases exponentially. The bottom line is still that being a physician isn't as financially cushy as many people think, and you can do just as well in many other careers during the earlier years as you would in medicine.

I might never have responded if you hadn't used some dramatic language, which I bolded in my original response, about how things are worse now. If you're dialing it back to "don't go into medicine strictly for money" then I have no problem with your premise at all. But to say things have taken a dramatic turn for the worse, I think the numbers do not bear that out, and perhaps even the opposite is true.

Not sure where I said medicine was taking a dramatic turn for the worse, or where anyone else said that. The whole point of the thread is that going into medicine just for the money is a bad idea, and it's getting to be a worse idea (though not necessarily dramatically) due to the rising costs of education and debt, greater rates of employment by hospitals and larger groups, and greater dependency on government reimbursement.

 

[rabbott1971]

Not sure where I said medicine was taking a dramatic turn for the worse, or where anyone else said that.

I bolded it in an earlier post, but here it is again:

So yes, the financial outlook of future physicians is far worse than it was and is only getting worse.

It seems you have backed off from this, and so I feel like further debate is not needed. As a final point, I would just say, look around you. You will see doctors tending to live an affluent lifestyle, and high school graduates living perhaps comfortably but rarely achieving affluence, and many struggle.

So, with that said, I hope things work out for you, and have a nice day.

 

[Stagg737]

I bolded it in an earlier post, but here it is again:It seems you have backed off from this, and so I feel like further debate is not needed. As a final point, I would just say, look around you. You will see doctors tending to live an affluent lifestyle, and high school graduates living perhaps comfortably but rarely achieving affluence, and many struggle.

So, with that said, I hope things work out for you, and have a nice day.

Not trying to continue this unnecessarily, but just want to address the bolded. I see med students with 6 figures of debt living an affluent lifestyle as well. I have classmates taking yearly vacations around the world, renting apartments that someone with 6 figure debt has no business renting, or leasing cars that they have no business driving. You don't have to be rich to live a luxurious lifestyle, and plenty of people don't mind staying in debt until they're 60 so they can live in luxury. At the same time I know people who just rack up credit card debt and other debt so they can live in affluence when in reality they don't make much at all.

Yes, an affluent lifestyle is certainly more financially viable for docs later in their career, but a poor method of measuring the financial viability of different careers throughout their courses.

 

[rabbott1971]

Not trying to continue this unnecessarily, but just want to address the bolded. I see med students with 6 figures of debt living an affluent lifestyle as well. I have classmates taking yearly vacations around the world, renting apartments that someone with 6 figure debt has no business renting, or leasing cars that they have no business driving. You don't have to be rich to live a luxurious lifestyle, and plenty of people don't mind staying in debt until they're 60 so they can live in luxury. At the same time I know people who just rack up credit card debt and other debt so they can live in affluence when in reality they don't make much at all.

Yes, an affluent lifestyle is certainly more financially viable for docs later in their career, but a poor method of measuring the financial viability of different careers throughout their courses.

My last post on this thread: affluent lifestyle is a function of financial outlook. That is what you said (and retracted) was on the decline, "financial outlook" for physicians. I think you live someplace extraordinary where high school grads seamlessly step into $60k/yr jobs and debt-burdened students take around-the-world vacations. Anecdotes aside, I'm glad we agree that the financial outlook for physicians is actually NOT declining, and in fact is excellent, but that nonetheless income shouldn't be the sole factor in deciding to pursue a medical career. Unwatching thread.

 

[ctaim]

If ~200k debt is the cost for me to save at least one life, I'm all in.

 

[Stagg737]

My last post on this thread: affluent lifestyle is a function of financial outlook. That is what you said (and retracted) was on the decline, "financial outlook" for physicians. I think you live someplace extraordinary where high school grads seamlessly step into $60k/yr jobs and debt-burdened students take around-the-world vacations. Anecdotes aside, I'm glad we agree that the financial outlook for physicians is actually NOT declining, and in fact is excellent, but that nonetheless income shouldn't be the sole factor in deciding to pursue a medical career. Unwatching thread.

The bolded is not what I'm saying at all, and from your other statements in this response you seem to have a problem reading within context as you're once again making several false assumptions (which I've already addressed). You can take whatever you want out of this thread, hopefully others who read it can keep the statements within the context they're given.