Ignore ALL posts attempting to link specialty to future income

[LADoc00]

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Im clearing out my inbox on this site because I rarely have time to post here and need to post up rather than send out tons of individual messages to folks....so bear with me if this is all stuff you get.

Folks, there is no magic medical specialty that will guarantee you mad amounts of $$.

Stop deciding altogether on which field to go into based solely on what people historically have made. Government CAN and WILL change the winners and the losers from time to time. (making this no different than a nerf and buff cycle in WOW)

Bullet points:
1.) Reimbursement in medicine is incredibly VOLATILE. For a decade or more, some fields have rolled in cash only to see their incomes destroyed by relatively minor changes by CMS because they are so invested in a very small number of CPT codes.
2.) The business models in some specialties do not lend themselves to people who suck at the actual art of business. Pathology is one of them. If suck at business and are unwilling to learn, you will be miserable IMO in Pathology. If you are at least willing to learn and develop skills, it is not bad. Not great but not bad.
3.) Because specialty X like subspec surgery makes on average 300K per year has zero bearing on what you will make. ZERO.

1. I know subspec surgeons who barely make 90K.
2. I know subspec surgeon who is literally living in "van down by the river".
3. I also know surgeons who are living in crazy baller mansions with girlfriends who are basically models.
4. I know Pediatricians making 80K a year as academic faculty.
5. I know a Pediatrician who (confirmed, yes confirmed) makes 2.1mil a year.
6. I know an internist who sleeps on her mom's couch.
7. I know an internist who drives an $200,000 Audi and then pulls into a work in a beater BMW when I call him out on it (not to be a player hater, just thought it was funny as he pretends to be all poor).
8. I know a Psychiatrist who sleeps in his office.
9. I know a Psychiatrist who owns $20 mil bucks in property but wont sell me a mere 40 acres of it...wth
10. I know a Pathologist who walks to work because he is both broke AND has no driver's license
11. I know Pathologists who essentially own and run most of the town they live in...

The point is SDN: YMMV on everything.

 

[nr-xxx]

agree with post. on www.sermo.com there is a neurologist just starting that had to do without a salary for several months. so there are many factors in the equation . as I get older ( I am age 67 years) the old adage about the graduating medical school class seems to be true : the upper third of the class go into academics and teach, the middle third make the best doctors, and the lowest third make the most money
it is all relative, remember the story of the man who perfected carpal tunnel syndrome surgery: he made $39 million dollars, but he has been married and divorced 5 times, the last wife got him arrested for assaulting her, , he tested positive for cocaine and lost his medical license . so I ask you what good did the $39 million dollars do him?

 

[darknecrosforte]

It's nice to know that my idea of going into business after specializing in something I think I'll enjoy (pathology) isn't as "out there" as my classmates make it seem.

 

[LADoc00]

remember the story of the man who perfected carpal tunnel syndrome surgery: he made $39 million dollars, but he has been married and divorced 5 times, the last wife got him arrested for assaulting her, , he tested positive for cocaine and lost his medical license . so I ask you what good did the $39 million dollars do him?

There is a very famous orthopod I know of who after making tens of millions of dollars creating joint devices had some sort of mental breakdown, left his family and married a Thai hooker. He was then EVICTED by the local sheriff from his trailer park after losing his entire fortune because the Thai hooker was only 20 and it was a 55+ trailer park community. That is an actual true tale of sorrow.

Even when you win and WIN BIG, you can end up a total bleeping loser.

And then there are the countless throngs who never even win to begin with...Life is a mess. A total mess. Have fun though. Focus on fun.

 

[yaah]

Denton Cooley went bankrupt. Denton Cooley conducted 100,000 surgeries and founded a massively successful heart institute, then made some bad real estate decisions and lost it all.

Some others I know make lots of money but are perpetually strapped for cash and essentially living paycheck to paycheck. Others in the same group have millions in the bank and stress over paying an extra $20 on an airline ticket. So many variables. DO NOT pick a career based on what income you think it will provide you, especially if you either don't really like it or don't really understand it.

The best advice I can give you is to keep your own house and affairs in order. Don't lend money to every relative you have (you won't get it back, and you might end up on the hook for more), don't marry the wrong person. If you do get married, don't treat your spouse like an afterthought. Don't get into drugs. Don't invest too much in one thing, especially if it's risky and involves real estate or someone's business. Don't do unethical or corrupt things, it may make you some money but it may also boomerang back on you and bite you.

Common sense is one of the most predictive traits for doing well in life. That and enjoying being bored.

 

[hurtem&healem]

Not one of the horror stories in this thread have anything to do with the "predictive power of current salaries." A more apt title would be "Successful physicians can still make terrible financial/life choices, and good businessmen can make buckets regardless of what field they're in."

I understand the sentiment, but the examples are completely removed from your point. SDN is littered with threads about how salaries/lifestyles in gas and rads have fallen off. Are there any examples of specialties which have seen a similar respective increase in compensation?

I'm going to be in my mid-40's by the time I'm an attending. Getting into the game a decade behind, compensation is absolutely a factor in my decision about what specialties I will be considering. It's neither the only nor the primary factor, but it is a major one.

My question in the second paragraph is a real question, btw. A few specialties have gained popularity due to lifestyle factors, but I'm unaware of any that have climbed the ladder in regards to compensation. With that in mind, historical pay is the only thing to look at other than trying to guess how much mid-levels and/or AI will push out physicians in a given field.

 

[LADoc00]

Oncology is a perfect example: If you looked at historical mean compensation, they did okay but CMS rules changed and they are currently in a tailspin.

Neurology had a few codes nuked and the field practically was obliterated.

Gas income dipped about 15 years ago coinciding with the rise of Nurse Anes. and people were claiming the sky was falling, but they came back and are doing well now.

The point being: all the data the public sees is skewed by alot of outliers. Guys in ortho doing spine, guys in Path seeing 10000 derm cases/yr, diagnostic rads guys reading a crazy number of scans, guys who own their surgical centers etc.

More to the point: there are many avenues to income generation in healthcare that historically have been present but simply wont be available to the folks coming up through the ranks now due to the massive changes the field is experiencing and will continue to experience for next few decades. To put it bluntly you are totally f-'d.

 

[SouthParkStudio]

There is a very famous orthopod I know of who after making tens of millions of dollars creating joint devices had some sort of mental breakdown, left his family and married a Thai hooker. He was then EVICTED by the local sheriff from his trailer park after losing his entire fortune because the Thai hooker was only 20 and it was a 55+ trailer park community. That is an actual true tale of sorrow.

Even when you win and WIN BIG, you can end up a total bleeping loser.

And then there are the countless throngs who never even win to begin with...Life is a mess. A total mess. Have fun though. Focus on fun.

agree with post. on www.sermo.com there is a neurologist just starting that had to do without a salary for several months. so there are many factors in the equation . as I get older ( I am age 67 years) the old adage about the graduating medical school class seems to be true : the upper third of the class go into academics and teach, the middle third make the best doctors, and the lowest third make the most money
it is all relative, remember the story of the man who perfected carpal tunnel syndrome surgery: he made $39 million dollars, but he has been married and divorced 5 times, the last wife got him arrested for assaulting her, , he tested positive for cocaine and lost his medical license . so I ask you what good did the $39 million dollars do him?

funny adage. Who are these doctors? Now that I think about it, all the doctors at my med school graduated top of their class. One pioneered something in a sub specialty and makes it rain though. So there are a few exceptions tho.

 

[gbwillner]

Im clearing out my inbox on this site because I rarely have time to post here and need to post up rather than send out tons of individual messages to folks....so bear with me if this is all stuff you get.

Folks, there is no magic medical specialty that will guarantee you mad amounts of $$.

Stop deciding altogether on which field to go into based solely on what people historically have made. Government CAN and WILL change the winners and the losers from time to time. (making this no different than a nerf and buff cycle in WOW)

Bullet points:
1.) Reimbursement in medicine is incredibly VOLATILE. For a decade or more, some fields have rolled in cash only to see their incomes destroyed by relatively minor changes by CMS because they are so invested in a very small number of CPT codes.
2.) The business models in some specialties do not lend themselves to people who suck at the actual art of business. Pathology is one of them. If suck at business and are unwilling to learn, you will be miserable IMO in Pathology. If you are at least willing to learn and develop skills, it is not bad. Not great but not bad.
3.) Because specialty X like subspec surgery makes on average 300K per year has zero bearing on what you will make. ZERO.

1. I know subspec surgeons who barely make 90K.
2. I know subspec surgeon who is literally living in "van down by the river".
3. I also know surgeons who are living in crazy baller mansions with girlfriends who are basically models.
4. I know Pediatricians making 80K a year as academic faculty.
5. I know a Pediatrician who (confirmed, yes confirmed) makes 2.1mil a year.
6. I know an internist who sleeps on her mom's couch.
7. I know an internist who drives an $200,000 Audi and then pulls into a work in a beater BMW when I call him out on it (not to be a player hater, just thought it was funny as he pretends to be all poor).
8. I know a Psychiatrist who sleeps in his office.
9. I know a Psychiatrist who owns $20 mil bucks in property but wont sell me a mere 40 acres of it...wth
10. I know a Pathologist who walks to work because he is both broke AND has no driver's license
11. I know Pathologists who essentially own and run most of the town they live in...

The point is SDN: YMMV on everything.

Great post- very true. It's amazing what kind of business you can create for yourself when you are willing to take charge and take risks. Most people in our field are risk adverse.

I remember when I first got into medicine and had this perverse idea that people in medicine got compensated based on how smart they were and how hard they worked. In reality, there is almost no correlation. Fortune really favors the bold.

 

[pathstudent]

This is totally dumb ass advice from ladoc. While there may be a rare pediatrician that earns more than a plastic surgeon, almost all plastics surgeons earn considerably more than pediatricians.

In general sub specialty surgery is the way to go.

Take a public data base where all salaries are open for all to see, like the University of California.