I'm thinking about working as a rural nocturnist for 3 years after residency to maximize my income and invest heavily. Is this realistic?

[Nocturnist]

I had a financial adviser who works with physicians only tell me for every Hospitalist making $400k there is a cardiologist making $800k. Averages are averages for all specialties. You can’t take the 90% Hospitalist and compare to 25% cardiologist.

Is this the same financial advisor who's been making 6 figures since graduating with a bachelor's in econ at age 22?

That statement *might* be true, but it'd be a stupendous oversimplification from a financial perspective.

Would a financial advisor advise you to go into 1-2M of debt to pursue a higher paying career? Because that's the opportunity cost of another 3-5 years of training to become that cardiologist.

So now you're a 35 year old cardiologist out of training. Your hospitalist buddies already bought homes, had families, saved hundreds of thousands in retirement by now. Now at 35- are you that dude that's just as likely to make 800k as the hospitalist making 400k? or is it your 50, 60, or 70 year old partners who hustled for 20 years to establish their own practice? Are you making 800k on the coasts, or did you have to settle for a job in rural America to make more than your hospitalist colleagues? You'll keep telling yourself it's so nice and quiet out there, while the closest airport, professional sports team, theatre/museum/any upscale restaurant is hours away. Meanwhile any hospitalist anywhere in the country can make 400k right out of residency, not sure how many cardiologists in their 30s can say the same.

I can tell you my friend who graduated cards fellowship the same year I graduated residency and took a job at the same hospital as me was complaining his starting salary was 250k (community hospital in the northeast) and that was one of the only offers they got in the area. No idea what the market is like now, but it wasn't great if you wanted to be anywhere near civilization back then. Should we compare apples to apples even further? This cardiologist works 12-14 hours a day M-F with weekend call every 4-6 weeks. That's a minimum of 60 hours a week.
Do you know too many hospitalist working 60 hours? If they are, they're making at least 500-600k.

Look I do think over a 30 year career that cards and GI almost certainly come out on top. At the end of the day, we'll all be fine financially. One should go into whatever they can see themselves doing for 30 years. It's just not as simple as "for every one of this, there's that"

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[Osteoth]

Is this the same financial advisor who's been making 6 figures since graduating with a bachelor's in econ at age 22?

That statement *might* be true, but it'd be a stupendous oversimplification from a financial perspective.

Would a financial advisor advise you to go into 1-2M of debt to pursue a higher paying career? Because that's the opportunity cost of another 3-5 years of training to become that cardiologist.

So now you're a 35 year old cardiologist out of training. Your hospitalist buddies already bought homes, had families, saved hundreds of thousands in retirement by now. Now at 35- are you that dude that's just as likely to make 800k as the hospitalist making 400k? or is it your 50, 60, or 70 year old partners who hustled for 20 years to establish their own practice? Are you making 800k on the coasts, or did you have to settle for a job in rural America to make more than your hospitalist colleagues? You'll keep telling yourself it's so nice and quiet out there, while the closest airport, professional sports team, theatre/museum/any upscale restaurant is hours away. Meanwhile any hospitalist anywhere in the country can make 400k right out of residency, not sure how many cardiologists in their 30s can say the same.

I can tell you my friend who graduated cards fellowship the same year I graduated residency and took a job at the same hospital as me was complaining his starting salary was 250k (community hospital in the northeast) and that was one of the only offers they got in the area. No idea what the market is like now, but it wasn't great if you wanted to be anywhere near civilization back then. Should we compare apples to apples even further? This cardiologist works 12-14 hours a day M-F with weekend call every 4-6 weeks. That's a minimum of 60 hours a week.
Do you know too many hospitalist working 60 hours? If they are, they're making at least 500-600k.

Look I do think over a 30 year career that cards and GI almost certainly come out on top. At the end of the day, we'll all be fine financially. One should go into whatever they can see themselves doing for 30 years. It's just not as simple as "for every one of this, there's that"

The point is if you’re a proceduralist focused on making money you will make more than a Hospitalist all things being equal.

I can also tell you that I trained in socal and looked for jobs down there, their Hospitalist are definitely not making $400k. IF you can get a job, which is no guarantee, the hourlies I saw were $125-150 at best, so maybe you can make $400k working 20 shifts a month, which can be a hard pace to keep up.

 

[sloh]

The point is if you’re a proceduralist focused on making money you will make more than a Hospitalist all things being equal.

I can also tell you that I trained in socal and looked for jobs down there, their Hospitalist are definitely not making $400k. IF you can get a job, which is no guarantee, the hourlies I saw were $125-150 at best, so maybe you can make $400k working 20 shifts a month, which can be a hard pace to keep up.

Can confirm. Ain’t no hospitalists I know in SoCal making 400k haha. More like 300 with some bennies. Rough income in SoCal.

 

[Nocturnist]

The point is if you’re a proceduralist focused on making money you will make more than a Hospitalist all things being equal.

I can also tell you that I trained in socal and looked for jobs down there, their Hospitalist are definitely not making $400k. IF you can get a job, which is no guarantee, the hourlies I saw were $125-150 at best, so maybe you can make $400k working 20 shifts a month, which can be a hard pace to keep up.

Can confirm. Ain’t no hospitalists I know in SoCal making 400k haha. More like 300 with some bennies. Rough income in SoCal.

I don't know any day hospitalists in socal but I know 2 nocturnists. The one in SD proper makes 375k for 12 shifts, the one in LA works 40 minutes outside the city and makes 410k for 11 shifts a month. That's not including any bonuses. Even a rate of $150/hr puts you at 300k for a 40 hrs a week, and if your bonuses don't bring you up to at least 350k, your job is either too cush or too cheap. But ya, at 300k without a bonus, you'd have to work something like 4 extra shifts a month to get to 400k. Still significantly less hours than a cardiologist.

 

[voxveritatisetlucis]

Dating/Finding a wife like you mention is very unlikely in these small rural areas. From my observations, most get married young and it’s pretty difficult as an outsider. Maybe if it’s like <hour from a city then you could work that out.

 

[Osteoth]

Dating/Finding a wife like you mention is very unlikely in these small rural areas. From my observations, most get married young and it’s pretty difficult as an outsider. Maybe if it’s like QUOTE]

Or what I’ve seen people do is they have two places, one by the hospital the other in a big city.

 

[anonperson]

So now you're a 35 year old cardiologist out of training. Your hospitalist buddies already bought homes, had families, saved hundreds of thousands in retirement by now. Now at 35- are you that dude that's just as likely to make 800k as the hospitalist making 400k? or is it your 50, 60, or 70 year old partners who hustled for 20 years to establish their own practice? Are you making 800k on the coasts, or did you have to settle for a job in rural America to make more than your hospitalist colleagues? You'll keep telling yourself it's so nice and quiet out there, while the closest airport, professional sports team, theatre/museum/any upscale restaurant is hours away. Meanwhile any hospitalist anywhere in the country can make 400k right out of residency, not sure how many cardiologists in their 30s can say the same.

Not to pile on because hospitalists do important work but you're comparing best case scenario for hospitalist work versus worst case scenario for cards.

At least one point. Plenty of people start families in residency and fellowship. I know numerous people in various specialties, myself included. Life doesn't just pause because you're in training.

At least in Southern California, there is no shortage for cardiology jobs in the various regions ( LA county, Orange county, etc). Same for GI.

Hospital will bend over backwards for specialists like cards and GI for various things to keep them happy. Equipment, staffing etc.

 

[Nocturnist]

Not to pile on because hospitalists do important work but you're comparing best case scenario for hospitalist work versus worst case scenario for cards.

At least one point. Plenty of people start families in residency and fellowship. I know numerous people in various specialties, myself included. Life doesn't just pause because you're in training.

At least in Southern California, there is no shortage for cardiology jobs in the various regions ( LA county, Orange county, etc). Same for GI.

Hospital will bend over backwards for specialists like cards and GI for various things to keep them happy. Equipment, staffing etc.

35 year old cardiologist isnt the worst case scenario, its pretty much best case scenario without a break in training. I was giving an example of myself vs a cardiologist who began working at the same hospital on the same exact day as myself. I think that's pretty fair?

Kudus to you for starting a family in training.
don't know how people do it. More than just having to have a stay at home spouse or full time childcare that would eat up half your salary, did you ever see your kids in residency? I left my house at 630am and walked back in the door at 7pm on a good day, 6 days a week. That was on ward months, icu months were tougher. Those hours would encompass my kids' entire awake time, i'd be lucky to get to tuck them in at night. Seeing my kids one day a week for 3 years especially through their attachment forming years is not something I personally think is fair to them. Certainly I wouldn't want to extend that to 6, 7, or even 8 years. You've now spent half their childhood in training. Just cuz you can do something, don't mean you should. But to each their own.

No shortage is one thing- But I'm asking a pretty simple question: what is the demographic of those specialists making 800K? Are they old and crusty, having spent 20 years at 60 hour weeks working their way up there from 400k, or is that a starting salary straight our of fellowship? Or are they practice owners, department heads, pulling crazy procedural volumes, workaholics, and/or living in the middle of nowhere?

400k is no where near best case scenario for a hospitalist, just look at myself and multiple members of this forum (no day time provider in my large group makes less than 300k and no nocturnist makes less than 400k)..and we've been making that much starting July 2nd the day we finished training. I'm just saying there's no differential for experience in hospital medicine (if there is a seniority bonus, it's symbolic and generally meant for retention). No climbing ladders, no promotions, partnership tracks...the only thing limiting your bottom line from day 1 is how much you want to work, and never a shortage of extra shifts.

And I can tell you this- compound interest and time in the market aside... it's been an absolute blast making what I've made throughout my entire 30s. I wouldn't trade it for 800k or a million in 10, 20, or 30 years because I'll never get those years back of being young, healthy, and having all the time and money in the world to enjoy it. To enjoy my family. Tomorrow isn't guaranteed. I'm still pretty young and have already had the misfortune of burying several classmates from medical school and residency (it really is always the good ones).

So once again to reiterate: go into what you can see yourself doing for 30 years. Be happy with your choice. Stop comparing yourself to others. We'll all be fine financially in the end.

 

[Splenda88]

General cardiologists make 500-550k/yr but they work ~55 hrs/wk.

I work ~45 hrs/wk on average this year and I make 401k.

If I work 55 hrs/wk on average, I'll earn 460k.

General cardiology is a bad deal in term of opportunity cost.

 

[Meerkatology]

400k is no where near best case scenario for a hospitalist, just look at myself and multiple members of this forum (no day time provider in my large group makes less than 300k and no nocturnist makes less than 400k)..and we've been making that much starting July 2nd the day we finished training. I'm just saying there's no differential for experience in hospital medicine (if there is a seniority bonus, it's symbolic and generally meant for retention). No climbing ladders, no promotions, partnership tracks...the only thing limiting your bottom line from day 1 is how much you want to work, and never a shortage of extra shifts.

And I can tell you this- compound interest and time in the market aside... it's been an absolute blast making what I've made throughout my entire 30s. I wouldn't trade it for 800k or a million in 10, 20, or 30 years because I'll never get those years back of being young, healthy, and having all the time and money in the world to enjoy it. To enjoy my family. Tomorrow isn't guaranteed. I'm still pretty young and have already had the misfortune of burying several classmates from medical school and residency (it really is always the good ones).

where do u guys work at lol? im in socal and even nocturnist jobs arent that easy to get.
the competition is so fierce here.
our salaries are also noticeably lower than those numbers u state.

for reference im a full time nocturnist making about 290k/yr doing 36 hrs per week.
relatively light shifts maybe avg 4 admits per 12 hour shift+xcover but do have to commute between 2 hospitals

 

[Nocturnist]

where do u guys work at lol? im in socal and even nocturnist jobs arent that easy to get.
the competition is so fierce here.
our salaries are also noticeably lower than those numbers u state.

for reference im a full time nocturnist making about 290k/yr doing 36 hrs per week.
relatively light shifts maybe avg 4 admits per 12 hour shift+xcover but do have to commute between 2 hospitals

I'm in the northeast suburban metro area.
Here's the breakdown:

Last year I made 550k.
I was contracted for 30 hours a week (10 shifts a month) for a base salary of 250k. If I were contracted for 36 hours a week, my base would be 310k so not that much higher than you. My bonuses brought me up to 325k. I worked 3-4 shifts a month at my side gig and made 125k there. The remaining 100k I made with a combination of home cross coverage and short daytime/evening admitting shifts.

So a total of 13-14 nights a month, bonuses, and some work from home/couple hours of admitting on a few days off.

 

[Splenda88]

where do u guys work at lol? im in socal and even nocturnist jobs arent that easy to get.
the competition is so fierce here.
our salaries are also noticeably lower than those numbers u state.

for reference im a full time nocturnist making about 290k/yr doing 36 hrs per week.
relatively light shifts maybe avg 4 admits per 12 hour shift+xcover but do have to commute between 2 hospitals

It seems like the further away you are from a big metro, the better the salary and work conditions are.

I am in a small city in the southeast of population of 60k but major metro is ~1h:45 mins away.

Made 401k last year as a hospitalist working ~17 days/month (most importantly an average of ~45 hrs/wk)

Shooting for 450k this year because I need to buy an expensive (~70k) vehicle. Lol

 

[Meerkatology]

there are jobs where u strictly do home crosscover? lol

 

[Cyclogon]

I'm in the northeast suburban metro area.
Here's the breakdown:

Last year I made 550k.
I was contracted for 30 hours a week (10 shifts a month) for a base salary of 250k. If I were contracted for 36 hours a week, my base would be 310k so not that much higher than you. My bonuses brought me up to 325k. I worked 3-4 shifts a month at my side gig and made 125k there. The remaining 100k I made with a combination of home cross coverage and short daytime/evening admitting shifts.

So a total of 13-14 nights a month, bonuses, and some work from home/couple hours of admitting on a few days off.

Would you agree with Splenda88 that general cardiology is a bad deal from a purely financial perspective?

 

[Nocturnist]

Would you agree with Splenda88 that general cardiology is a bad deal from a purely financial perspective?

No

 

[Nocturnist]

there are jobs where u strictly do home crosscover? lol

I'm not aware of a full time home cross coverage job, but there are already several remote home hospitalist jobs so I think it's coming. The trend in hospital medicine has been increased flexibility. 10 yrs ago there used to be exactly 2 jobs- you were either 7a-7p rounder or 7p-7a nocturnist (often the only one on).

The explosion in volumes have forced hospitals to introduce multiple nocturnists, then swing shifts, then flexible admitting shifts where I just come in at any time bang out admissions and leave, and finally more and more remote work.

 

[bronx43]

It seems like the further away you are from a big metro, the better the salary and work conditions are.

I am in a small city in the southeast of population of 60k but major metro is ~1h:45 mins away.

Made 401k last year as a hospitalist working ~17 days/month (most importantly an average of ~45 hrs/wk)

Shooting for 450k this year because I need to buy an expensive (~70k) vehicle. Lol

Agreed. Ideal location is 45-90 minutes away from a major metro. Incomes there are easily 50% higher if not more. I'm working in a 40k pop city in the Midwest that is about 60 min from a major metro, and my income is almost 3x that of my previous big city gig.
There are dudes here that work 3 long days a week for full time and just commute from the metro area.

 

[bronx43]

I'm in the northeast suburban metro area.
Here's the breakdown:

Last year I made 550k.
I was contracted for 30 hours a week (10 shifts a month) for a base salary of 250k. If I were contracted for 36 hours a week, my base would be 310k so not that much higher than you. My bonuses brought me up to 325k. I worked 3-4 shifts a month at my side gig and made 125k there. The remaining 100k I made with a combination of home cross coverage and short daytime/evening admitting shifts.

So a total of 13-14 nights a month, bonuses, and some work from home/couple hours of admitting on a few days off.

That's a ton of nights. Unless you're one of the rare specimen that can thrive with erratic sleep patterns, this isn't sustainable longterm.

For longterm career, I think most people rather be the cardiologist in a big group taking occasional call - even with the 3 extra years of training and income loss.

 

[Nocturnist]

That's a ton of nights. Unless you're one of the rare specimen that can thrive with erratic sleep patterns, this isn't sustainable longterm.

For longterm career, I think most people rather be the cardiologist in a big group taking occasional call - even with the 3 extra years of training and income loss.

I can see where you're coming from. I've always said it's definitely not for everyone.

That said, couple points though:

-for all this talk about how unsustainable it is, all the nocturnists in my group have been at it for 8 to as long as almost 25 years. Our turnover rate is almost non existent.

-3 years of extra training is the absolute best case scenario. About half the resident in my class that went into cards or GI had to do at least a year before of chief year or echo fellowship or GI/cards hospitalist to be competitive enough to get in. Many them go on to do 1-2 years of subfellowships (EP, interventional, heart failure, advanced endoscopy). You can quickly get into 5-6 extra years.

-You seem to be looking at my career as the glass half empty, which is fine if it isnt for you. But I preferred to think of it as half full. Instead of thinking about it as "a ton of nights", I prefered to look at it as a ridiculous number of days off. Having 10-15 days off a month allowed me to travel extensively every single month. I've been able to see half the world. I had plenty of time to date, then plenty of time to spend with my spouse, and now it allows me plenty of time to spend with my kids.

-instead of spending as much as 5-6 extra years of training, just to then have to continue to work my way up to partner and wait til my 40s or 50s to make good money- I preferred to flip the script. You don't have to make 500-600k for too long in 20s and 30s before you can cut back. I'll have a net worth of 5M in the next 3-4 yrs. In 6 years my home is paid off. I'll be financially independent by then. After that I just have to make enough to coast and not tap into my savings. I could work 5-6 nights a month, which qualifies me for all benefits, and still make 200-250k. Try to do the math of what 5M untouched for another 20-30 years compounds to, and you'll see I'm looking at tens of millions at retirement age (some not too far fetched scenarios even put it at 100M). You're talking about some true generational wealth now.

Not for everyone. Worked well for me so far. Good option for some.

 

[Splenda88]

Would you agree with Splenda88 that general cardiology is a bad deal from a purely financial perspective?

I should have said it's not worth it IMO from a purely financial standpoint. If your are doing because you genuinely enjoy it, fine.

These people are putting in 70-80 hrs/wk. The hospitalists/noctunists I know who are working these type of hours are making 600k-700k/yr. I know a couple of them. One of them who graduated with me (same residency program) in 2021 told me I should not be financing a house that only cost 500k when I was complaining about interest rate being too high 3-4 months ago. Last week that same hospitalist told me she will be out of the rat race by the end of 2026.

Don't underestimate compound interest, and purchasing power today vs. 4-5 years later.

Salary gap between hospitalists and a lot of subspecialties are getting closer when you calculate it $$$/hr (that is how it should be after all); that is why it's getting more popular. It's not because med students wake up one day and become enamored with hospitalist medicine.

When it comes to lifestyle/flexibility, hospital medicine is a GREAT deal.

 

[Nocturnist]

I should have said it's not worth it IMO from a purely financial standpoint. If your are doing because you genuinely enjoy it, fine.

These people are putting in 70-80 hrs/wk. The hospitalists/noctunists I know who are working these type of hours are making 600k-700k/yr. I know a couple of them. One of them who graduated with me (same residency program) in 2021 told me I should not be financing a house that only cost 500k when I was complaining about interest rate being too high 3-4 months ago. Last week that same hospitalist told me she will be out of the rat race by the end of 2026.

Don't underestimate compound interest, and purchasing power today vs. 4-5 years later.

How many years out of residency are you and your friend? If memory serves me I thought you were a couple years out?

If that's the case, "out of the rat race" in under 5 years just≈high earning spouse, not financial independence.

I think we have to be realistic with folks about what we can attain financially and how long it might take. In 10-12 years, you could make more money than most people ever dream of, attain a a higher networth than most MDs by their retirement (surveys show the vast majority of MDs retire with NW<5m), and to coast or cut back significantly from there. To imply it can be done in 5 or less years is just false advertisement tho. I'm sure plenty of cardiologist's wife are "out of the rat race" in less than 5 years, too.

Anyway, I do think cards and GI are financially worth it. Nephro/rheum/endo/ID are not. PCCM/Onc may or may not be depending on one's set up. That said, completely different lifestyle with those office based 9-5 specialties. You can't put a price on never working a weekend or a holiday. Like I've said, go into whatever makes you happy, as I have. I'm not here to beg people to be hospitalists or blow smoke nor to put down others' perfectly reasonable life choices- just to give people a realistic idea of what's possible as a hospitalist. If it resonates with them, I'm happy to tell them more. If not, I wish them best of luck in their pursuit of happiness.

 

[Splenda88]

How many years out of residency are you and your friend? If memory serves me I thought you were a couple years out?

If that's the case, "out of the rat race" in under 5 years just≈high earning spouse, not financial independence.

I think we have to be realistic with folks about what we can attain financially and how long it might take. In 10-12 years, you could make more money than most people ever dream of, attain a a higher networth than most MDs by their retirement (surveys show the vast majority of MDs retire with NW<5m), and to coast or cut back significantly from there. To imply it can be done in 5 or less years is just false advertisement tho. I'm sure plenty of cardiologist's wife are "out of the rat race" in less than 5 years, too.

Anyway, I do think cards and GI are financially worth it. Nephro/rheum/endo/ID are not. PCCM/Onc may or may not be depending on one's set up. That said, completely different lifestyle with those office based 9-5 specialties. You can't put a price on never working a weekend or a holiday. Like I've said, go into whatever makes you happy, as I have. I'm not here to beg people to be hospitalists or blow smoke nor to put down others' perfectly reasonable life choices- just to give people a realistic idea of what's possible as a hospitalist. If it resonates with them, I'm happy to tell them more. If not, I wish them best of luck in their pursuit of happiness.

Her spouse does not even work. I assume she will work part time. She is very conscious on how she spend her money. For instance, she paid cash for a 132k home and her husband who is a handyman renovated it.

Well, some people (you for example) might need 5+ mil to get out of the rat race. Others, like myself need 2.5 plus a paid off home to call it a day.

I could retire today in Mexico.

It's a matter of perspective man. < 3% of US household has a net worth > 3 mil

I am not here either to tell people to do HM, but I am here to provide a balanced viewpoint because I almost fell for SDN echo chamber "hospital medicine is not sustainable" when I was an IM resident.

At the end of the day, we all will be fine financially if we are not stupid with money.

 

[Splenda88]

Agreed. Ideal location is 45-90 minutes away from a major metro. Incomes there are easily 50% higher if not more. I'm working in a 40k pop city in the Midwest that is about 60 min from a major metro, and my income is almost 3x that of my previous big city gig.
There are dudes here that work 3 long days a week for full time and just commute from the metro area.

Interesting. Are you making > 600k/yr?

I have seen 20-35% difference in pay, not 2x let alone 3x.

 

[Nocturnist]

Her spouse does not even work. I assume she will work part time. She is very conscious on how she spend her money. For instance, she paid cash for a 132k home and her husband who is a handyman renovated it.

Well, some people (you for example) might need 5+ mil to get out of the rat race. Others, like myself need 2.5 plus a paid off home to call it a day.

I could retire today in Mexico.

It's a matter of perspective man. < 3% of US household has a net worth > 3 mil

I am not here either to tell people to do HM, but I am here to provide a balanced viewpoint because I almost fell for SDN echo chamber "hospital medicine is not sustainable" when I was an IM resident.

At the end of the day, we all will fine financially if we are not stupid with money.

That's a fair point, but that degree of lean FIRE is pretty extreme. I guess in my part of the country, I wouldn't be comfortable with less than 200-250k a year in retirement hence the 5M nest egg. The cheapest un-updated 1920s 1200 sqft 2-3 bedroom cape starts at 750k. A parking spot in town literally goes for 250k.
I wouldn't advise MDs to aim for lower than a 5M nestegg, and frankly if one simply maxes out one retirement account for 30 years there's no reason anyone should retire with less.

Btw, not to get into that whole pronoun BS but i've never said or implied that I'm a man 😉

 

[finalpsychyear]

That's a fair point, but that degree of lean FIRE is pretty extreme. I guess in my part of the country, I wouldn't be comfortable with less than 200-250k a year in retirement hence the 5M nest egg. The cheapest un-updated 1920s 1200 sqft 2-3 bedroom cape starts at 750k. A parking spot in town literally goes for 250k.
I wouldn't advise MDs to aim for lower than a 5M nestegg, and frankly if one simply maxes out one retirement account for 30 years there's no reason anyone should retire with less.

Btw, not to get into that whole pronoun BS but i've never said or implied that I'm a man 😉

Pre covid i thought the 25x number was game over. Now that everything costs so much 50x with part time at least 5 years to negate sequence of returns seems a lot safer to me.

Its funny how in 3-4 years both our views may change again but u will have almost a paid off house.

I think reaching the number is step 1 then working 5 to 10 years part time after so u can ensure it grows and maybe doubles negates the risks of some 50 percent correction.

 

[Splenda88]

Pre covid i thought the 25x number was game over. Now that everything costs so much 50x with part time at least 5 years to negate sequence of returns seems a lot safer to me.

Its funny how in 3-4 years both our views may change again but u will have almost a paid off house.

I think reaching the number is step 1 then working 5 to 10 years part time after so u can ensure it grows and maybe doubles negates the risks of some 50 percent correction.

The beauty of being a physician is that we make a lot of money. We all can work 7-8 days/month and make ~200k/yr.

We all can semi retire after home is paid off and have 1 mil in the bank/investment.

"Just imagine telling the average Joe you make 200k+/yr working 7-8 days/month." These were the words of a female ED physician when she was telling me how good being a physician is when I was rotating in the ED as a PGY2.

 

[Nocturnist]

Pre covid i thought the 25x number was game over. Now that everything costs so much 50x with part time at least 5 years to negate sequence of returns seems a lot safer to me.

Its funny how in 3-4 years both our views may change again but u will have almost a paid off house.

I think reaching the number is step 1 then working 5 to 10 years part time after so u can ensure it grows and maybe doubles negates the risks of some 50 percent correction.

The trinity study where the 4% rule came from studied the success rates of portfolios retroactively from 1925 through 1995 (later expanded to include up until 2009). A 4% withdrawal rate had a success rate of 96% (defined by having unspent money at the end of a 30 year period). For some, a 4% failure rate is simply unacceptable.

My dude- that period literally included the great depression, a dozen recessions, and an entire decade with 8% inflation rates. Covid was the first time anyone under 40 ever experienced an inflation rate over 5% and it only lasted a couple years.

A 3.3% withdrawal rate was virtually 100% foolproof. If you're looking to 50x it, you're guaranteed to be dying with a portfolio that is multiple times what you started with. Your kids, grandkids, and great-grandkids sure will appreciate you, though you'll miss out on alot of fun you could have had by not spending more.

Anyway, the trinity study only looked at steady, unchanging withdrawal rates regardless of what was going on in the real world. You better believe in retirement if the market is booming I'm spending more than 4%, but in a recession I'm tightening my belt. You better believe I'm working at Starbucks part time before touching my savings.

Despite all the noise- I'm a firm believer the world neatly divides into two polarized categories in retirement: the wildly underprepared that have no chance of their nestegg outlasting them, those well prepared for which that 4% failure rate keeps them up at night...and very, very few people in the middle who thread the needle and die with exactly zero. You and I will probably be the latter.

 

[Nocturnist]

The beauty of being a physician is that we make a lot of money. We all can work 7-8 days/month and make ~200k/yr.

We all can semi retire after home is paid off and have 1 mil in the bank/investment.

"Just imagine telling the average Joe you make 200k+/yr working 7-8 days/month." These were the words of a female ED physician when she was telling me how good being a physician is when I was rotating in the ED as a PGY2.

I always despised those useless average Joe comparisons because the "Average Joe" has a median of just 5k in savings and less than 500k in retirement. The average Joe is just one car breakdown or a late paycheck away from financial catastrophe. The average Joe makes up the bulk of the group i consider to have a snowball's chance of their portfolio outlasting them. Average Joe also didn't accrue tens or hundreds of thousands in debt nor deferred gratification to make a slave's wage through their entire youth like we did. The average Joe hears "200k a year" and assumes you've been making that since you were 18 or 22, like they have. He has not idea what it took to get there. He hears 200k a year and doesn't have the financial literacy to understand it's actually 120k after uncle sam takes his cut, 90k after you've maxed your retirement and Roth, and 50k after you've paid off your student loans. Six figures just ain't what it used to be.

Neither is a paid off house with 1M in investments. 40k a year might be enough for you in the rural south. It's practically poverty rate up here. The property tax on my primary home alone is half of that already. Add insurance, utilities, landscaping and basic maintenance and I'm at 40k already just to not lose my paid off home.

My hot take is that No MD should retire with less than 5M net worth. The first million was toughest to make and it wasn't even that difficult..the second and third were inevitable. If you can get to 2.5M, you can get to 5M and it's not going to be anywhere near twice the effort. If you want to cut down and coast til you get there, go for it. But I would not stop at 2.5M and certainly not at 1M. Just my humble opinion.

 

[Meerkatology]

I can see where you're coming from. I've always said it's definitely not for everyone.

That said, couple points though:

-for all this talk about how unsustainable it is, all the nocturnists in my group have been at it for 8 to as long as almost 25 years. Our turnover rate is almost non existent.

-3 years of extra training is the absolute best case scenario. About half the resident in my class that went into cards or GI had to do at least a year before of chief year or echo fellowship or GI/cards hospitalist to be competitive enough to get in. Many them go on to do 1-2 years of subfellowships (EP, interventional, heart failure, advanced endoscopy). You can quickly get into 5-6 extra years.

-You seem to be looking at my career as the glass half empty, which is fine if it isnt for you. But I preferred to think of it as half full. Instead of thinking about it as "a ton of nights", I prefered to look at it as a ridiculous number of days off. Having 10-15 days off a month allowed me to travel extensively every single month. I've been able to see half the world. I had plenty of time to date, then plenty of time to spend with my spouse, and now it allows me plenty of time to spend with my kids.

-instead of spending as much as 5-6 extra years of training, just to then have to continue to work my way up to partner and wait til my 40s or 50s to make good money- I preferred to flip the script. You don't have to make 500-600k for too long in 20s and 30s before you can cut back. I'll have a net worth of 5M in the next 3-4 yrs. In 6 years my home is paid off. I'll be financially independent by then. After that I just have to make enough to coast and not tap into my savings. I could work 5-6 nights a month, which qualifies me for all benefits, and still make 200-250k. Try to do the math of what 5M untouched for another 20-30 years compounds to, and you'll see I'm looking at tens of millions at retirement age (some not too far fetched scenarios even put it at 100M). You're talking about some true generational wealth now.

Not for everyone. Worked well for me so far. Good option for some.

ive been a pure nocturnist straight out of residency for the last 10 years, i can't imagine doing days now and having to do deal with all the bs
i think theres a misunderstanding in someway that people who work pure nights must have erratic sleep schedules.

in a 7p-7a schedule, we can sleep from 8a to 3p or whatever and keep that schedule until u need a large block to travel or something. normal people are at work and not availalbe during that time anyway.

im not sure if this has long term effect on my health, if so its not too obvious yet. on the contrary, nightshift has actually kept me safe from covid so far (at least one ER doctor at my hospital died to covid). when u can do most of the work on the computer and then duck in and out to see the patient, it was easy to stay well geared up and protected during patient contact. compared to being in the hospital the entire shift.

i work alot less than you do and make alot less. i wanted more free time and nights was the best way to get it since nights are often an oncall basis. if u purposely live close and take a lighter job u can have alot of the time for free.

on most shifts i end up spending at least half of the time at home playing computers games and stuff.

if i ever get put in a financial pinch, i can easily take extra shifts without sacrificing my sanity in this structure. since the actual work volume is relatively low to begin with. but if i did 7on7off 12 hour days, taking extra shifts would suck

5-6 night/month wouldn't make full time, how would u be able to get full benefits? just a specific job offering it im guessing?

 

[Nocturnist]

ive been a pure nocturnist straight out of residency for the last 10 years, i can't imagine doing days now and having to do deal with all the bs
i think theres a misunderstanding in someway that people who work pure nights must have erratic sleep schedules.

in a 7p-7a schedule, we can sleep from 8a to 3p or whatever and keep that schedule until u need a large block to travel or something. normal people are at work and not availalbe during that time anyway.

im not sure if this has long term effect on my health, if so its not too obvious yet. on the contrary, nightshift has actually kept me safe from covid so far (at least one ER doctor at my hospital died to covid). when u can do most of the work on the computer and then duck in and out to see the patient, it was easy to stay well geared up and protected during patient contact. compared to being in the hospital the entire shift.

i work alot less than you do and make alot less. i wanted more free time and nights was the best way to get it since nights are often an oncall basis. if u purposely live close and take a lighter job u can have alot of the time for free.

on most shifts i end up spending at least half of the time at home playing computers games and stuff.

if i ever get put in a financial pinch, i can easily take extra shifts without sacrificing my sanity in this structure. since the actual work volume is relatively low to begin with. but if i did 7on7off 12 hour days, taking extra shifts would suck

5-6 night/month wouldn't make full time, how would u be able to get full benefits? just a specific job offering it im guessing?

My jobs both offer full benefits to anyone who is 0.5 FTE or above. That would be 5 nights a month at my main job, or 6 nights at my side job.

 

[bronx43]

Interesting. Are you making > 600k/yr?

I have seen 20-35% difference in pay, not 2x let alone 3x.

Close to that, but I was also making very little in the big city.

I do technically see more pts now, but I have so much more clinical support that double the number of patients actually feels like 1/2 the work.

 

[Nocturnist]

Close to that, but I was also making very little in the big city.

I do technically see more pts now, but I have so much more clinical support that double the number of patients actually feels like 1/2 the work.

You're working the same number of shifts in both jobs?

I knew jobs in town (generally in academia) pay in prestige, but I've never heard of a hospitalist making >500k or<200k for 1 fte anywhere in the country.

 

[sloh]

Close to that, but I was also making very little in the big city.

I do technically see more pts now, but I have so much more clinical support that double the number of patients actually feels like 1/2 the work.

Man congrats on the gig. What a turnaround from when we last discussed. Very happy for you

 

[bronx43]

Man congrats on the gig. What a turnaround from when we last discussed. Very happy for you

Thanks man. There are drawbacks to not working/living in a major metro, but overall QOL is significantly better.

You're working the same number of shifts in both jobs?

I knew jobs in town (generally in academia) pay in prestige, but I've never heard of a hospitalist making >500k or<200k for 1 fte anywhere in the country.

Sorry, I should have been more clear. I'm a rheumatologist, so I see more pts in clinic now than I did before in the big city. I was a hospitalist before fellowship, but didn't do nocturnist.

 

[finalpsychyear]

The trinity study where the 4% rule came from studied the success rates of portfolios retroactively from 1925 through 1995 (later expanded to include up until 2009). A 4% withdrawal rate had a success rate of 96% (defined by having unspent money at the end of a 30 year period). For some, a 4% failure rate is simply unacceptable.

My dude- that period literally included the great depression, a dozen recessions, and an entire decade with 8% inflation rates. Covid was the first time anyone under 40 ever experienced an inflation rate over 5% and it only lasted a couple years.

A 3.3% withdrawal rate was virtually 100% foolproof. If you're looking to 50x it, you're guaranteed to be dying with a portfolio that is multiple times what you started with. Your kids, grandkids, and great-grandkids sure will appreciate you, though you'll miss out on alot of fun you could have had by not spending more.

Anyway, the trinity study only looked at steady, unchanging withdrawal rates regardless of what was going on in the real world. You better believe in retirement if the market is booming I'm spending more than 4%, but in a recession I'm tightening my belt. You better believe I'm working at Starbucks part time before touching my savings.

Despite all the noise- I'm a firm believer the world neatly divides into two polarized categories in retirement: the wildly underprepared that have no chance of their nestegg outlasting them, those well prepared for which that 4% failure rate keeps them up at night...and very, very few people in the middle who thread the needle and die with exactly zero. You and I will probably be the latter.

Questions for you. I largely agree with what you have said and i understand the variable withdrawal approach is more realistic i.e. higher in bull years and adjusted in bear ones. I currently am married and renting with no kids but that will all change in the next 12-24 mo.

1. Let's assume you were renting rather than 6 years from being mortgage fee in this environment of higher interest rates. Also, you would be walking into a 5000-6000 mortgage in the next 12-24 mo inclusive of mortgage, taxes, insurance but not utilities.

2. Also, factor in 1-2 kids on top of that. How much did your spending increase since you've had kids?

3. Current yearly spending 120-130k with 4k rent and 2300/mo in vehicles that will drop to 1500 in 2 years then by 2028 all will be paid off except an ongoing mortgage at that time.

When i think of a future 5m nest egg it sounds great if you have a paid off home. I am generously estimating that 1-2 kids will take my yearly spending from 120 to 180 if you have part time nanny, babysitting etc. Also add in potential 6k all inclusive mortgage which adds 24k to the 180 numbers so roughly 205k with 2 kids and a future mortgage to come. I know eventually the 27k in yearly car payments falls off but i'd rather keep it for planning purposes as there are always things that will come up unexpectedly.. i.e new house needing repairs etc.

Would you be as comfortable with the 5m number if the above applied to you as well?
Im guessing you started working in july 2016 as a nocturnist.

 

[Nocturnist]

Questions for you. I largely agree with what you have said and i understand the variable withdrawal approach is more realistic i.e. higher in bull years and adjusted in bear ones. I currently am married and renting with no kids but that will all change in the next 12-24 mo.

1. Let's assume you were renting rather than 6 years from being mortgage fee in this environment of higher interest rates. Also, you would be walking into a 5000-6000 mortgage in the next 12-24 mo inclusive of mortgage, taxes, insurance but not utilities.

2. Also, factor in 1-2 kids on top of that. How much did your spending increase since you've had kids?

3. Current yearly spending 120-130k with 4k rent and 2300/mo in vehicles that will drop to 1500 in 2 years then by 2028 all will be paid off except an ongoing mortgage at that time.

When i think of a future 5m nest egg it sounds great if you have a paid off home. I am generously estimating that 1-2 kids will take my yearly spending from 120 to 180 if you have part time nanny, babysitting etc. Also add in potential 6k all inclusive mortgage which adds 24k to the 180 numbers so roughly 205k with 2 kids and a future mortgage to come. I know eventually the 27k in yearly car payments falls off but i'd rather keep it for planning purposes as there are always things that will come up unexpectedly.. i.e new house needing repairs etc.

Would you be as comfortable with the 5m number if the above applied to you as well?
Im guessing you started working in july 2016 as a nocturnist.

Yup, I've been a nocturnist since 2016.
I'd need much more information than you've told me, but hard to say if I would or wouldn't be comfortable with 5M in your situation.

Alot to unpack here, but broadly- 5M invested allows you to withdraw 200k fairly safely and have a 96% chance of not running out in 30 years time.

If your projected yearly spending is 232k, you'd need 5.8M invested.

That said, you're assuming here that your spending now will be the same at the time of your retirement, and for its duration. You're *probably* not going to be paying for a nanny or babysitter a)when you retire b)definitely not for the duration of your retirement. Same probably goes for your mortgage. I only have 15 year mortgages which helps with planning because I'll be done with them way before retirement, but even a 30 year would likely be paid off before or shortly into yours.

Day care or nanny are big expenses but generally pretty temporary ones. We haven't had those "expenses" yet because we've stayed home with ours, but we pay for it in decreased income from my spouse going per diem around my schedule. But the way we see it, once they're school aged and in a structure, we'll be able to make up for it by working more.

More importantly than child care, everyone with kids has to make the decision of whether they're going to finance their children's college education and if so to what degree. There's no right or wrong answer. You should prioritize your own retirement over their tuition. They can take out loans for school, you cant take out loans for a failed retirement. We're personally putting $800 a month towards each kid's 529. Over 18 years it should conservatively grow to 250-300k each. It definitely won't be enough for private school, maybe not even enough for public school..but the way I see it it's both ok for them to have some skin in the game and/or for me to moonlight another shift or two a month when they're in college if I really need to course correct. Either way, it's a much bigger expense than childcare.

Most people find they spend less in retirement, which is why advisors advise you to aim for 80% of your pre retirement spending. Youll probably be driving way less. Also dont forget your tax rate on your 200k withdrawl will be lower than the rate on my 550k income it took to get there. But that's very individual. If you're going to be replacing work with traveling each month, you might be spending more. Very variable, you should probably sit down with an hourly fee advisor at some point to chat.

 

[finalpsychyear]

Yup, I've been a nocturnist since 2016.
I'd need much more information than you've told me, but hard to say if I would or wouldn't be comfortable with 5M in your situation.

Alot to unpack here, but broadly- 5M invested allows you to withdraw 200k fairly safely and have a 96% chance of not running out in 30 years time.

If your projected yearly spending is 232k, you'd need 5.8M invested.

That said, you're assuming here that your spending now will be the same at the time of your retirement, and for its duration. You're *probably* not going to be paying for a nanny or babysitter a)when you retire b)definitely not for the duration of your retirement. Same probably goes for your mortgage. I only have 15 year mortgages which helps with planning because I'll be done with them way before retirement, but even a 30 year would likely be paid off before or shortly into yours.

Day care or nanny are big expenses but generally pretty temporary ones. We haven't had those "expenses" yet because we've stayed home with ours, but we pay for it in decreased income from my spouse going per diem around my schedule. But the way we see it, once they're school aged and in a structure, we'll be able to make up for it by working more.

More importantly than child care, everyone with kids has to make the decision of whether they're going to finance their children's college education and if so to what degree. There's no right or wrong answer. You should prioritize your own retirement over their tuition. They can take out loans for school, you cant take out loans for a failed retirement. We're personally putting $800 a month towards each kid's 529. Over 18 years it should conservatively grow to 250-300k each. It definitely won't be enough for private school, maybe not even enough for public school..but the way I see it it's both ok for them to have some skin in the game and/or for me to moonlight another shift or two a month when they're in college if I really need to course correct. Either way, it's a much bigger expense than childcare.

Most people find they spend less in retirement, which is why advisors advise you to aim for 80% of your pre retirement spending. Youll probably be driving way less. Also dont forget your tax rate on your 200k withdrawl will be lower than the rate on my 550k income it took to get there. But that's very individual. If you're going to be replacing work with traveling each month, you might be spending more. Very variable, you should probably sit down with an hourly fee advisor at some point to chat.

For simplicity, just assume we have similar stats.

Appreciate the insight. My other point is sometimes its very hard to calculate some of these theoretical things until they actually happen. That same 6k mortgage at rates now could be closer to 5k if rates fall and you refinance. Do we end up with 1-3 kids etc. You'd likely have to withdraw more than 200k on a 5m nest egg since you are paying some taxes. I don't know if i will send my kids to private school but i'd like to have it in the budget. You have the house and kids so it's much easier to calculate. The same house pre covid would have been a 3k vs a 6k mortgage now.

My napkin math right now since a few variables such as kids and house mortgage is to assume my spending of 120-130 ish becomes close to 250k at its peak levels. Not accounting for taxes this would require a liquid portfolio of somewhere in the 6-7 range assuming a 3-4% withdrawal. Maybe closer to 3.5% in bear years and 4% in bull years etc.

by 2030 and depending on how the market does i'll have a better idea i guess if I can get there.

 

[Nocturnist]

For simplicity, just assume we have similar stats.

Appreciate the insight. My other point is sometimes its very hard to calculate some of these theoretical things until they actually happen. That same 6k mortgage at rates now could be closer to 5k if rates fall and you refinance. Do we end up with 1-3 kids etc. You'd likely have to withdraw more than 200k on a 5m nest egg since you are paying some taxes. I don't know if i will send my kids to private school but i'd like to have it in the budget. You have the house and kids so it's much easier to calculate. The same house pre covid would have been a 3k vs a 6k mortgage now.

My napkin math right now since a few variables such as kids and house mortgage is to assume my spending of 120-130 ish becomes close to 250k at its peak levels. Not accounting for taxes this would require a liquid portfolio of somewhere in the 6-7 range assuming a 3-4% withdrawal. Maybe closer to 3.5% in bear years and 4% in bull years etc.

by 2030 and depending on how the market does i'll have a better idea i guess if I can get there.

For simplicity,

My mortgage payments are around 13k/month (8500 for my primary with 6 years left and 4500 for my vacation home with 12 years left)
Utilities lets say are another 1k.
College savings $800 per kid.
Credit card bills are 6-7k on average.
10k vacations 3 times a year for another 2.5k/month.
Cars are paid off, student debt long paid off.
No debt other than mortgages.

I max out 2 retirement accounts and spouse maxes out a 3rd. My job contributes another 20k a year, spouse's job stopped contributing since went per diem. This is a total of around 85k a year, plus 13k for each of our Roth's so call it 100k.

Whatever is left, generally around 8k a month goes to our brokerage account. My goal has been 100k a year towards the taxable account.
So I'm investing around 200k a year, plus the 100k a year or so that comes back to my net worth as equity.

So our spending is broadly around 25k/month on average. That's a gross oversimplification. For example, we put a 15k generator last year, and 10k in finish carpentry work to spruce up our vacation house.

But once my primary home is paid off, my monthly spending will go down by 6-7k a month, and another 3-4k a month when 2nd home is paid off. College saving contributions go away too when the kids turn 18. The wild card will be health spendings, which no one can predict.
Inflation and rise in property taxes is impossible to predict as well...

But broadly I'm assuming my spendings would be down to 10-15k a month with paid off homes and kids in college. 200k a year seem like a reasonable target to aim for. I dont hate working and 2 shifts a month can make me 60k, 4 shifts a month 120k etc...so I'm not too worried about my ability to course correct if I'm a little off.

 

[finalpsychyear]

For simplicity,

My mortgage payments are around 13k/month (8500 for my primary with 6 years left and 4500 for my vacation home with 12 years left)
Utilities lets say are another 1k.
College savings $800 per kid.
Credit card bills are 6-7k on average.
10k vacations 3 times a year for another 2.5k/month.
Cars are paid off, student debt long paid off.
No debt other than mortgages.

I max out 2 retirement accounts and spouse maxes out a 3rd. My job contributes another 20k a year, spouse's job stopped contributing since went per diem. This is a total of around 85k a year, plus 13k for each of our Roth's so call it 100k.

Whatever is left, generally around 8k a month goes to our brokerage account. My goal has been 100k a year towards the taxable account.
So I'm investing around 200k a year, plus the 100k a year or so that comes back to my net worth as equity.

So our spending is broadly around 25k/month on average. That's a gross oversimplification. For example, we put a 15k generator last year, and 10k in finish carpentry work to spruce up our vacation house.

But once my primary home is paid off, my monthly spending will go down by 6-7k a month, and another 3-4k a month when 2nd home is paid off. College saving contributions go away too when the kids turn 18. The wild card will be health spendings, which no one can predict.
Inflation and rise in property taxes is impossible to predict as well...

But broadly I'm assuming my spendings would be down to 10-15k a month with paid off homes and kids in college. 200k a year seem like a reasonable target to aim for. I dont hate working and 2 shifts a month can make me 60k, 4 shifts a month 120k etc...so I'm not too worried about my ability to course correct if I'm a little off.

Humor me. If you only had a 5-6k mo/ primary mortgage and no other real estate what about amount of investment portfolio would you need to consider work purely for enjoyment.... ?

 

[Nocturnist]

Humor me. If you only had a 5-6k mo/ primary mortgage and no other real estate what about amount of investment portfolio would you need to consider work purely for enjoyment.... ?

Pretty much the same amount, because I'd personally be getting a 15 year mortgage and working until I paid it off. The real estate I have only matters in regards to how much more I have to make during my working years compared to you all else being equal. I'll have to make more and work more years than you to afford a more expensive home as well as a second home- which I'm Ok with. If my mortgage was 5-6k, my monthly spendings would be 6-7k lower a month than they currently are. If we make the same, you'd be able to put 72-84k more than me a year in the market. You would get to that FU number much quicker, but the number wouldn't change. my other discretionary spendings would still be 10-15k a month so I'd still aim for 200k income in retirement. I could eat out less, I could choose not to drive a super car, or go on less vacations. I just don't want to. I'm Ok with retiring 15 instead of 25 years early. Different folks, different strokes.

 

[Meerkatology]

Thanks man. There are drawbacks to not working/living in a major metro, but overall QOL is significantly better.


Sorry, I should have been more clear. I'm a rheumatologist, so I see more pts in clinic now than I did before in the big city. I was a hospitalist before fellowship, but didn't do nocturnist.

how do u feel about having to maintain board certification for IM plus subspecialty? for me having to do one is pretty annoying and stress inducing already :\