If you could go back in time knowing what you know now, what specialty would you choose?

[HoosierdaddyO]

Is this money for life and can I do other work outside an emergency department...

Ok the game I’m playing is let’s hypothetically say an insurance company is willing to pay you 50 percent of your current salary to not be a doctor anymore. You can pursue other avenues of income or revenue but your identity as a practicing clinical physician is over. Would you take the money and run and leave the medicine world behind?

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[thegenius]

Alright than mister master of observing people making obvious statements lol. What percentage of your current pay wound you accept to be a stay at home never to work in the ER ever again number?? 50 percent, 60, 40?

Well apparently 99.9% of people would accept their current monthly pay to stay at home. So I'll take 45K/month please. That's a nice round number.

In all honestly I would accept less, but I wouldn't go down to 20K/month. I don't know..it's kind of an interesting and dumb question because it will never actually happen.

 

[HoosierdaddyO]

Well apparently 99.9% of people would accept their current monthly pay to stay at home. So I'll take 45K/month please. That's a nice round number.

In all honestly I would accept less, but I wouldn't go down to 20K/month. I don't know..it's kind of an interesting and dumb question because it will never actually happen.

For example say someone has the option to collect on disability… let’s just say the dx of fibromyalgia. They own an own occupation policy that pays 50 percent of their current salary. Could they work sure, but the insurance company is giving them approval should they desire to retire on disability. Would you take the ability to leave medicine and work in an entirely different career for 50 percent. Agreed it is an entirely dumb but interesting question nonetheless lol!!

It’s a two fold thinking game. For what money could you dissociate yourself from being a doctor, and for what price and at what cost to your identity.

 

[Apollyon]

Well apparently 99.9% of people would accept their current monthly pay to stay at home. So I'll take 45K/month please. That's a nice round number.

In all honestly I would accept less, but I wouldn't go down to 20K/month. I don't know..it's kind of an interesting and dumb question because it will never actually happen.

You wouldn't take $20k/month to sit on your ass? Huh? Gimme that in a MINUTE!

 

[skougess]

I would take $150k/yearly to burn my medical license and never think about medicine again.

 

[Janders]

yeah for 50% of my current income i'll stay home and not work and not even get another job! :-D

 

[thegenius]

You wouldn't take $20k/month to sit on your ass? Huh? Gimme that in a MINUTE!

I read the question as - "you name the price, and i'll pay it" LMAO

 

[EctopicFetus]

what you are willing to take as a % of income depends on where you are in your career. Near the end it is likely small. At the beginning it is a lot. If you make 400k (Em avg), taking 200k to sit at home is not gonna work for many in the first 5 years. 1) generally burnout is less and 2) need for money is higher.

I also think the question of can i do something else or in the example above am I working FT to earn that 200k vs sitting at home retired making the 200k and i can find something else to make some money. Big difference and important variables..

 

[Sushirolls]

I'm Psych in Private Practice.
Not rolling in money.
This thread details my practice for the past few years, including income:

Private Practice in Progress

Building a private practice, N of 1. Enjoy. Month zero: Grand plan was to use money from inpatient gig where independent contractor doing own billings to expedite insurance paneling, so all I had to do was switch over the practice address once opened. Long story short, not a quality place I...

forums.studentdoctor.net

I'd have done NSx, Radiology, Cash IM DPC model, Colorectal surgery.

Currently looking to get out of medicine once financially possible, to be a farmer/rancher.

 

[watermanMD]

I'm Psych in Private Practice.
Not rolling in money.
This thread details my practice for the past few years, including income:

Private Practice in Progress

Building a private practice, N of 1. Enjoy. Month zero: Grand plan was to use money from inpatient gig where independent contractor doing own billings to expedite insurance paneling, so all I had to do was switch over the practice address once opened. Long story short, not a quality place I...

forums.studentdoctor.net

I'd have done NSx, Radiology, Cash IM DPC model, Colorectal surgery.

Currently looking to get out of medicine once financially possible, to be a farmer/rancher.

🧑‍🌾 is the way

 

[emergentmd]

For example say someone has the option to collect on disability… let’s just say the dx of fibromyalgia. They own an own occupation policy that pays 50 percent of their current salary. Could they work sure, but the insurance company is giving them approval should they desire to retire on disability. Would you take the ability to leave medicine and work in an entirely different career for 50 percent. Agreed it is an entirely dumb but interesting question nonetheless lol!!

It’s a two fold thinking game. For what money could you dissociate yourself from being a doctor, and for what price and at what cost to your identity.

So if I made 250/hr now. Its like someone saying they will pay me 125/hr to work in the ER. I doubt most docs would say no.

I would quit and never do anything medicine again for 50% pay. Making 200K/yr and having an abundance of time leads to many other businesses that you can be successful in. Its a no brainer.

 

[Sushirolls]

For example say someone has the option to collect on disability… let’s just say the dx of fibromyalgia. They own an own occupation policy that pays 50 percent of their current salary. Could they work sure, but the insurance company is giving them approval should they desire to retire on disability. Would you take the ability to leave medicine and work in an entirely different career for 50 percent. Agreed it is an entirely dumb but interesting question nonetheless lol!!

It’s a two fold thinking game. For what money could you dissociate yourself from being a doctor, and for what price and at what cost to your identity.

I'm trying to do it for a target of 50k post tax income from farming.
However, to make a million dollars in farming you start with 2 million. <-- that's a tongue/cheek joke of losing money, not making money
Need lot of infrastructure buildings, equipment, livestock, etc before I can tap out and say I have my income stream.

 

[MD46]

I'm trying to do it for a target of 50k post tax income from farming.
However, to make a million dollars in farming you start with 2 million.
Need lot of infrastructure buildings, equipment, livestock, etc before I can tap out and say I have my income stream.

Heard you can get farm land and rent it out to a farmer, but investing 2 mil and getting 1mili in return quickly, is that possible?

 

[Sushirolls]

Rarely.
1) need to know the local going rate per acre
2) need to know the relative profit per acre
3) need to know the local rents per acre
4) need to know those 3 numbers compute to lead to profit. There can be gains from inflation and relative land value increasing, too; which is part of why Bill Gates and others are looking into farm land.

My local area, farmland is going anywhere from 5k to 30K per acre depending upon size of land, location, and other numerous variables.
Local crops at best can conservatively count on grossing $400 per acre. $500 per good year. But definitely less in bad year. Simply doing a hay crop, count on normal overhead of 50% - (not including major break downs of equipment).

Seeds, fertilizer, diesel, storage of crops, twine/wrap, transport of crop to market/destination, machine breakage, tractor breakage, maintenance, etc

Rents per acre in my area go for $30-100 per acre, but really $50-60 is most common.

So you have 100 acres here locally, renting for $60 = $6000/year. Now minus your land monthly payments, property taxes.... Not really left with much, unless you paid cash up front for whole land, no bank loan. Then you need to think, is farm land, $800k for that 100 acres? the best investment or, was a VOO, SPY etc better for that 800K? If you did the haying yourself, grossed $400/ac, but Net is $200/ac; that's 20K before taxes.

A dividend yield stock like PTY, NLY, FDUS, etc could get ~10% per year, so that 800K gets 80K in dividends.

Pretaxes: 80K is > 20K > 6K

 

[solitarius]

Employed full time psych is more like 280-330, less in places like NYC, can be slightly better in rural places. Exceptions exist, but you can't bank on them. Psych is pretty much a 300K/year job

Wild. I saw this on the interwebz: "As of June 2024, the average salary for a psychiatrist in New York City is $256,539 per year, or about $123.34 per hour. "

• I made more per hour in my moonlighting gig as a resident.
• One of the attendings at our program moved to NYC and is probably making less.
• I guess there is a reason why APA always rotates between NYC and SF.

 

[TooMuchResearch]

Ok the game I’m playing is let’s hypothetically say an insurance company is willing to pay you 50 percent of your current salary to not be a doctor anymore. You can pursue other avenues of income or revenue but your identity as a practicing clinical physician is over. Would you take the money and run and leave the medicine world behind?

Where do I sign up?
I already sent in my resignation letter and told all medical licensing boards to eat glass.

 

[MD46]

Rarely.
1) need to know the local going rate per acre
2) need to know the relative profit per acre
3) need to know the local rents per acre
4) need to know those 3 numbers compute to lead to profit. There can be gains from inflation and relative land value increasing, too; which is part of why Bill Gates and others are looking into farm land.

My local area, farmland is going anywhere from 5k to 30K per acre depending upon size of land, location, and other numerous variables.
Local crops at best can conservatively count on grossing $400 per acre. $500 per good year. But definitely less in bad year. Simply doing a hay crop, count on normal overhead of 50% - (not including major break downs of equipment).

Seeds, fertilizer, diesel, storage of crops, twine/wrap, transport of crop to market/destination, machine breakage, tractor breakage, maintenance, etc

Rents per acre in my area go for $30-100 per acre, but really $50-60 is most common.

So you have 100 acres here locally, renting for $60 = $6000/year. Now minus your land monthly payments, property taxes.... Not really left with much, unless you paid cash up front for whole land, no bank loan. Then you need to think, is farm land, $800k for that 100 acres? the best investment or, was a VOO, SPY etc better for that 800K? If you did the haying yourself, grossed $400/ac, but Net is $200/ac; that's 20K before taxes.

A dividend yield stock like PTY, NLY, FDUS, etc could get ~10% per year, so that 800K gets 80K in dividends.

Pretaxes: 80K is > 20K > 6K

Thanks for such a detailed reply! Makes a lot of sense.

 

[gruemd]

If someone paid me to sit at home for 200k a year or I was disabled, I could increase my lifestyle, still save 3k/mo toward retirement, and retire with 6 million at age 65 (when my disability would stop paying out). I'm definitely not a "I have to work to be happy" person but I'd still probably figure out some job out of boredom, so that income would be gravy. Sign me up.

 

[Franzd'Epinay]

I'm Psych in Private Practice.
Not rolling in money.
This thread details my practice for the past few years, including income:

Private Practice in Progress

Building a private practice, N of 1. Enjoy. Month zero: Grand plan was to use money from inpatient gig where independent contractor doing own billings to expedite insurance paneling, so all I had to do was switch over the practice address once opened. Long story short, not a quality place I...

forums.studentdoctor.net

I'd have done NSx, Radiology, Cash IM DPC model, Colorectal surgery.

Currently looking to get out of medicine once financially possible, to be a farmer/rancher.

I read through a lot of your thread. Very informative and interesting stuff. Thanks for sharing.

A few follow-up questions:

1) Are you still trying to do ECT?

2) You mention Cash IM DPC as a something you wish you had done. Is that so different from cash-only psych?

3) The move seemed kinda sudden from the post timeline, though that might just be a function of going from monthly to yearly updates. Can you elaborate on why you moved? It seems like a lot of work after going through the effort of establishing your practice.

 

[Sushirolls]

1) No
2) DPC (Direct Primary Care) is different from cash psych because cash psych is always fee for service, but DPC is "retainer" based and charge people usually a monthly fee, $80-200/month to be their doctor. Whether seen or not. "unlimited access"
3) Politics. The state I was in wants to teach kindergarteners transgender sexual topics. Hell no. When you have your own child and see their development its very obvious any sexual themes of that kind are too soon. Basic sex ed, sure, in 4th grade perhaps, but the agenda lib states are pushing to expand transgender issues are a usurpation of parental rights - and the state will never do better at parenting than a real parent. The state also defunded police, and many simply retired or left to other states. Passed laws that essentially give rights to criminals, and tied the hands of law enforcement. Lawlessness was expanding. Not some news talking point, but legitimate changes when you stop and talk with law enforcement officers. DAs not even pushing to prosecute child sexual abuse. Homelessness expanding and was visible from my office window, when wasn't when I started.

 

[HoosierdaddyO]

1) No
2) DPC (Direct Primary Care) is different from cash psych because cash psych is always fee for service, but DPC is "retainer" based and charge people usually a monthly fee, $80-200/month to be their doctor. Whether seen or not. "unlimited access"
3) Politics. The state I was in wants to teach kindergarteners transgender sexual topics. Hell no. When you have your own child and see their development its very obvious any sexual themes of that kind are too soon. Basic sex ed, sure, in 4th grade perhaps, but the agenda lib states are pushing to expand transgender issues are a usurpation of parental rights - and the state will never do better at parenting than a real parent. The state also defunded police, and many simply retired or left to other states. Passed laws that essentially give rights to criminals, and tied the hands of law enforcement. Lawlessness was expanding. Not some news talking point, but legitimate changes when you stop and talk with law enforcement officers. DAs not even pushing to prosecute child sexual abuse. Homelessness expanding and was visible from my office window, when wasn't when I started.

Sounds like you live in California lol🙄?!

 

[Sushirolls]

Any blue state fits the description.

 

[Prehealth1011]

2) You mention Cash IM DPC as a something you wish you had done. Is that so different from cash-only psych?

You might be on call 24/7 and be available all-day if you're doing DPC. Something to keep in mind.

They might not call you, yes, but you're still on-call.

 

[Sushirolls]

Going from a practice of 2000-4000 on a usual primary care panel, down to 200-800 patients, and having personal ownership of the practice, you'll be glad when your patients call. Even if it is to just educate and say, yes, go to the hospital, or I'll see you tomorrow.

 

[VA Hopeful Dr]

Going from a practice of 2000-4000 on a usual primary care panel, down to 200-800 patients, and having personal ownership of the practice, you'll be glad when your patients call. Even if it is to just educate and say, yes, go to the hospital, or I'll see you tomorrow.

As someone who has actually done DPC, I disagree with this.

 

[Prehealth1011]

Being available 24/7 is a no go for me, regardless of how often they may or may not call.

 

[HemorrhagicShock]

As someone who has actually done DPC, I disagree with this.

Which parts?

 

[VA Hopeful Dr]

Which parts?

Most of it.

Being on call always. Running a business. Dealing with the sunset of patients (not all but some) who think DPC means concierge and you have to do what they want basically no matter what.

 

[bky3c]

Being available 24/7 is a no go for me, regardless of how often they may or may not call.

Exactly. Just knowing that it's possible that someone MIGHT call is an awful, trapped feeling, at least for me.

 

[HemorrhagicShock]

Most of it.

Being on call always. Running a business. Dealing with the sunset of patients (not all but some) who think DPC means concierge and you have to do what they want basically no matter what.

I hear so many EM and FM docs talk about how starting a DPC-type clinic/practice/urgent care/whatever is the "ideal way out."

It's funny though, when I talk to or ask questions of a DPC doc who is actually doing it I get one of two answers:

1. They tell me something similar to you, and how it's a different form of jail and doesn't have a lot of financial or career upside that you think it does, it's not a grass is greener situation

2. They "ABSOLUTELY LOVE IT, IT SAVED MY CAREER, BROUGHT TIME BACK FOR MY FAMILY, BROUGHT MEANING TO MY PRACTICE" and it also turns out part of their business/practice/approach is lecturing on or selling DPC-adjacent shovels that help other practitioners (MD/DO/NP/PA) "escape" into DPC

I'm slowly realizing that there's no easy escape beyond changing specialties (of which things like CCM and pain count)

 

[emergentmd]

Why do I feel that if you took every EM doc, had them throw a dart at every specialty available, the vast majority would want to go back to EM. Maybe I would be wrong, but I would put this number at 75%+. If you did the same for all other professions and take into account the amount of schooling EM has, that number would be 99%+.

Sometimes you have to see how bad the other sides are before you appreciate how lucky you have it.

Imagine if you switched with a public school teacher with little support, no family involvement, kids disrespectful, working 9 hrs a day brining work home then turning around wondering how you are going to pay for basic bills. Teachers would absolutely kill for the EM lifestyle.

 

[DarkHorizon]

Would do Ortho every time. Thank the good lord everyday I got in when I did, because there’s no way I’d get in now.

 

[WhatJobDoIPick]

Why do I feel that if you took every EM doc, had them throw a dart at every specialty available, the vast majority would want to go back to EM. Maybe I would be wrong, but I would put this number at 75%+. If you did the same for all other professions and take into account the amount of schooling EM has, that number would be 99%+.

Sometimes you have to see how bad the other sides are before you appreciate how lucky you have it.

Imagine if you switched with a public school teacher with little support, no family involvement, kids disrespectful, working 9 hrs a day brining work home then turning around wondering how you are going to pay for basic bills. Teachers would absolutely kill for the EM lifestyle.

Again, no one cares about the comparison of EM doc to pleb. We are comparing EM to derm / Ortho / rads etc. specialties that a lot of us could have gotten into with our scores, but were instead misled down the EM pipeline.

 

[VA Hopeful Dr]

Again, no one cares about the comparison of EM doc to pleb. We are comparing EM to derm / Ortho / rads etc. specialties that a lot of us could have gotten into with our scores, but were instead misled down the EM pipeline.

But would you actually like it?

Its easy to say that the lifestyle is better or the money is better, but you still have to do the job every day for decades.

My grades/scores weren't good enough for the super competitive specialties, but every so often I do wonder about what it would have been like:

Derm makes way more than I do, but they also work much harder in an average day than I do.

Psych requires you to listen to patients for way longer than my longest appointments.

Pretty much everything else either involves call or surgery, both of which are no-go for me.

 

[sloh]

But would you actually like it?

Its easy to say that the lifestyle is better or the money is better, but you still have to do the job every day for decades.

My grades/scores weren't good enough for the super competitive specialties, but every so often I do wonder about what it would have been like:

Derm makes way more than I do, but they also work much harder in an average day than I do.

Psych requires you to listen to patients for way longer than my longest appointments.

Pretty much everything else either involves call or surgery, both of which are no-go for me.

Do you think derm actually works harder though? Lots of patient visits but they are short and don’t need to listen any of the social issues or manage chronic comorbidities. They certainly get more steps in during the day haha.

 

[VA Hopeful Dr]

Do you think derm actually works harder though? Lots of patient visits but they are short and don’t need to listen any of the social issues or manage chronic comorbidities. They certainly get more steps in during the day haha.

Definitely since a huge percentage of patients with dermatology appointments end up getting stuff cut off. So it's an office visit and procedure.

 

[miacomet]

Derm, Plastics, and then anything where I don't have to work for other people or deal with admin