Inflation, Interest Rates and the Economy for 2025

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I guess the point is that it’s not only about ROI. What’s the ROI of putting our parents in a nice nursing home vs a basic one?
RoI would be negative.

So then the question is, why don't my parents have money (poor financial decisions or because they invested in me?). I won't fund a nicer lifestyle for someone because they blew all their money on the slot machines.

If they gave up their lives to make mine significantly better, then I would return the favor

But I see plenty of parents invest 100s of thousands in an education for their kids that more often than not, has little effects on their ultimate career aspirations.

Versus investing that money (and then you can give them 1-3 million). They can then get an easy job and retire early if you wanted them to
 
RoI would be negative.

So then the question is, why don't my parents have money (poor financial decisions or because they invested in me?). I won't fund a nicer lifestyle for someone because they blew all their money on the slot machines.

If they gave up their lives to make mine significantly better, then I would return the favor

But I see plenty of parents invest 100s of thousands in an education for their kids that more often than not, has little effects on their ultimate career aspirations.

Versus investing that money (and then you can give them 1-3 million). They can then get an easy job and retire early if you wanted them to
It’s true, the reasons for giving are dependent on the context of the relationship.

If you know your parents always have your back, cared most about your success, and have a reasonably good rapport with you no shame in going all in on their comfort if they sacrificed for you.

Same for a kid. No problem with helping out my kids if they end up being really great at something that doesn’t pay super well on the high end. Lots of things that are productive do but some don’t. If they’re a world renowned psychology researcher who doesn’t care to write books then I’d fund a wedding, say.
 
Well.

My perspective is always what's the risk vs ROI.

Should I spend 100k on pre college education, another 200k on college, another 300k on graduate school for my kid. What job are they guaranteed to get vs what would they have had otherwise.

Low chance that I get a reasonable ROI vs investing that for them

With the rise of ai/robotics medicine is probably still the most protected financially stable field and esp if u get an md in usa ur pretty set.

Law/business i think ivy and top schools correlate enormously to income. Tech will shrinks massively in jobs and again the top grads will get the limited spots.

Yeah, im worried the future kids of many current posters are going to be limited in jobs and income and we will be working longer as a result of it and not because the kids arent doing the hard work or getting the scores/grades but a circumstance of the ai boom.
 
It’s so hard to predict the market. I was so gun show from Sept 2008-‘March 2011. I barely put any “new” money into the market and kept of it in cash position. And that cost me a lot. And money didn’t even matter to met at that time. Because I wasn’t hurting for money. But I lost much on housing plus the stock market.

Made me gun shy when to re enter the market. And obviously missed a ton of gains from that time period.

These days I pace myself and dollar cost average in despite the volatility.

Tempted to pull out money during March/april 2020 covid but stuck to my guns. Same with peak early 2022 and even the March/april 2025 trump volatility
It's not about timing the market. I'm saying I'm very hesitant to go overloaded on stocks when valuations are near all time highs. It's simply a matter of not wanting to overpay for companies no different than not wanting to overpay for a piece of property or a small business investment such as a sandwich or ice cream shop.
 
RoI would be negative.

So then the question is, why don't my parents have money (poor financial decisions or because they invested in me?). I won't fund a nicer lifestyle for someone because they blew all their money on the slot machines.

If they gave up their lives to make mine significantly better, then I would return the favor

But I see plenty of parents invest 100s of thousands in an education for their kids that more often than not, has little effects on their ultimate career aspirations.

Versus investing that money (and then you can give them 1-3 million). They can then get an easy job and retire early if you wanted them to
Most parents who pay 30-40k a year on private k-12 school per kid already have net worth well
Above 1 million or more. As the parents get older and the kids enter college.

Spending 90k a year for Duke or similar institution full price means their net-worth is nearing 3-5 million (the median income is around 200k of the average Duke parent). So these kids are gonna to get an inheritance anyways despite the parents blowing 400k on undergrad on them.
 
Most parents who pay 30-40k a year on private k-12 school per kid already have net worth well
Above 1 million or more. As the parents get older and the kids enter college.

Spending 90k a year for Duke or similar institution full price means their net-worth is nearing 3-5 million (the median income is around 200k of the average Duke parent). So these kids are gonna to get an inheritance anyways despite the parents blowing 400k on undergrad on them.

Mind boggling duke tuition in 2015 or 10 years ago was 60k. So in 10 years from now it will be 140-150k !!

2015 pcp avg 191k vs 281k in 2025
2015 specialist 284k vs 398k in 2025

Per medscape.
 
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Most parents who pay 30-40k a year on private k-12 school per kid already have net worth well
Above 1 million or more. As the parents get older and the kids enter college.

Spending 90k a year for Duke or similar institution full price means their net-worth is nearing 3-5 million (the median income is around 200k of the average Duke parent). So these kids are gonna to get an inheritance anyways despite the parents blowing 400k on undergrad on them.
Just because they CAN afford it. Doesn't mean it makes much financial sense for the majority.

And by all means, if people want to, absolutely go for it.

But the majority of the time, an expensive private education doesn't make a good investment compared to investing that money somewhere else.

The successful folks will, more often than not, be hurt as successful with a good public education (UC equivalent)
 
It's not about timing the market. I'm saying I'm very hesitant to go overloaded on stocks when valuations are near all time highs. It's simply a matter of not wanting to overpay for companies no different than not wanting to overpay for a piece of property or a small business investment such as a sandwich or ice cream shop.

The market will always be at an all time high. The overall trajectory is up.
 
Only if I have the money.

Let say I retire in 2035 and my net worth is 3.5M. If one of my daughters is getting married, she won't get a penny from me. If my networth is 5M, I might help.
Well arent you cheerful
 
In my opinion spending money on school for K-12 has a much bigger ROI than sending your kids to college for 300k+.
 
Just got together with 5 med school classmates yesterday in LA. We graduated >30 years ago. We all supported our kids through college and grad school in VHCOL east and west coast cities. Some of us still are. Another topic of discussion was how expensive it is to get our parents into a nice assisted living and skilled nursing facilities. We all attended expensive private undergrads and an expensive private medical school in Manhattan mostly financed by our parents. One of our friends is pouring a ton of money into his daughter who is an elite fencer with Olympic aspirations. We all happen to be of Asian descent. I wonder if there are cultural differences about how much money we are willing to pour into our kids. It wasn’t a controversial topic among this friend group as it is on SDN.

How old are the kids still being financed by parents?
 
I’d have figured shooting to be an Olympic fencer is even more pointless tbh
The kind of people who take any difficult task or "hobby" to a high level, over an extended period of time, are developing personal traits that will serve them well no matter what they do.

I paid many many many thousands of dollars for my daughter to do competitive gymnastics from age 5 to 18. We kept doing it even after it was clear she wasn't going to get to the Olympics. ROI? A responsible, reliable, disciplined, physcilaly fit person who grew up managing her time well and applying similar dedication to academics and other tasks. Oh and also she had a great time and made many close friends.

Laser focus on financial ROI is an exceptionally vacant approach to life.
 
With this discussion on financing kids, it’s worth mentioning that a lot of successful adults would have been successful either way due to innate personality qualities and innate intelligence. It makes little sense to overly invest in kids who don’t have potential.

70% of wealthy families lose their wealth by the second generation, and a stunning 90% lose it by the third generation Aug 22, 2024. Many times, it’s just hard for adults to acknowledge that their kids just aren’t wired for immense “success.”
 
With this discussion on financing kids, it’s worth mentioning that a lot of successful adults would have been successful either way due to innate personality qualities and innate intelligence. It makes little sense to overly invest in kids who don’t have potential.

70% of wealthy families lose their wealth by the second generation, and a stunning 90% lose it by the third generation Aug 22, 2024. Many times, it’s just hard for adults to acknowledge that their kids just aren’t wired for immense “success.”
Sounds like you're focused on outcomes and not process. 😉

One could argue that from a cold ROI perspective, those odds are all the more reason to invest heavily in the kids to tilt the odds in favor of them carrying on the family wealth for another generation.
 
Sounds like you're focused on outcomes and not process. 😉

One could argue that from a cold ROI perspective, those odds are all the more reason to invest heavily in the kids to tilt the odds in favor of them carrying on the family wealth for another generation.

Enjoying the process is fine but at some point you tip into a territory where what you’re sacrificing makes less and less sense.

Also, twin and adoption studies show direct parenting has much less of an impact than parents think. The irony is you’ll enjoy parenting more if you don’t feel like you have to financially give them the world to tilt the odds in their favor.
 
The market will always be at an all time high. The overall trajectory is up.
So you've thrown in the towel that the dollar will be endlessly devaluated into the dirt and inflation is the permanent future?

I basically agree, why I own 75% gold, but even still, buying the NASDAQ in 1999 was insane. I was there. It didn't take much insight to realize it was a massive time bomb.
 
Sounds like you're focused on outcomes and not process. 😉

One could argue that from a cold ROI perspective, those odds are all the more reason to invest heavily in the kids to tilt the odds in favor of them carrying on the family wealth for another generation.
Could just put the money in a trust and pay out only the earnings.

A higher education often does not result in financial savvy. Just look at how many docs are struggling financially.

Lifestyle creep is pretty common
 
So you've thrown in the towel that the dollar will be endlessly devaluated into the dirt and inflation is the permanent future?

I basically agree, why I own 75% gold, but even still, buying the NASDAQ in 1999 was insane. I was there. It didn't take much insight to realize it was a massive time bomb.

My investment plan has me going heavily on equities and just investing in the total market. Will it work, who knows? I know that going all in on more conservatives investments won't allow me to retire with enough money.

And I say this as someone who also believes in gold and have a stash of physical gold.

At this point, I'll stay the course and see what happens. My net worth has steadily increased year over year so it may give me a false sense of security but work/family keeps me busy enough that I don't have enough time or energy to micromanage my investments or worry about drops in the market.
 
I hope all you doomsday silly ass mofos are watching real close rn. Sp closed above 6k 2 days in a row... there's gonna be a breakout soon. A wild ride to 7k or 5k... it doesn't matter. Win either way...


This is the market talking. Listen... trump or whoever can only barely influence it for a hot minute
 
I hope all you doomsday silly ass mofos are watching real close rn. Sp closed above 6k 2 days in a row... there's gonna be a breakout soon. A wild ride to 7k or 5k... it doesn't matter. Win either way...


This is the market talking. Listen... trump or whoever can only barely influence it for a hot minute

would love getting close to the 7k range but i can't be that greedy. I'd take something in the 6400-6500 by eoy.
 
So you've thrown in the towel that the dollar will be endlessly devaluated into the dirt and inflation is the permanent future?

I basically agree, why I own 75% gold, but even still, buying the NASDAQ in 1999 was insane. I was there. It didn't take much insight to realize it was a massive time bomb.

It really boils down to two broad possibilities:

1) Despite political turmoil, Trump-o-nomics, and other stressors, the USA will remain, in very broad terms, one of the top 3 economies in the world, competing with the EU, China, and the other also-ran regions. US corporations will continue to produce goods and services and sell them for profit. Whether that profit is denominated in dollars, bitcoin, gold doubloons, or lunar real estate vouchers isn't really relevant to the big picture.

2) Economic collapse of the USA along with its social structure and government.


If you believe the latter, you should invest in rural land (and move there), good neighbors, guns, and other supplies to endure a prolonged loss of security, food/fuel supplies, and social/public services.

If you believe the former, one would expect that partial ownership of said corporations (ie equities) will track along with inflation to a large degree. Perhaps in the worst case lagging it somewhat as inflation impacts those corporations' supply chains and customers' ability to buy.

We can talk about an equity bubble, but at least some of the current valuations reflect inflation and the expectation of inflation. Equities are already hedging inflation.

As for assets that hedge inflation - gold, TIPS ... and equities for the reasons listed above. Cryptocurrency, maybe - though there are other risks there.


Unless you believe total economic collapse of the USA and western civilization is in the cards, or a prolonged economic Greater Depression is coming that will extend beyond your investment horizon, there's not a great argument to get out of equities. Bet against the USA at your peril.

I personally remain invested in equities, physical gold. My main hedge beyond that is the aforementioned rural domicile and associated relationships and items.

I expect my career to continue to be profitable, and for it to be followed by a long, stable, economically boring retirement.
 
return on investment with competitive team sports for so so athletes is horrible these days.

The ncaa portal has completely ruin some sports like college baseball for even Division 3 aspiring baseball players to keep playing.

An 18 yo can’t compete with 24/25 yo in college division 3 baseball due to the portal transfers.
The discipline you think you give these kids early on unravels quickly when they can’t compete even on the lowest division 3 level because they are competing against men 6 years older than them.
 
The discipline you think you give these kids early on unravels quickly when they can’t compete even on the lowest division 3 level
That you think the discipline kids and teenagers learn in team sports "unravels" or is irrelevant because they don't/can't compete at the collegiate level just illustrates how you are, as usual, completely missing the point.
 
That you think the discipline kids and teenagers learn in team sports "unravels" or is irrelevant because they don't/can't compete at the collegiate level just illustrates how you are, as usual, completely missing the point.
no, you completely miss the point.

Kids quit real competitive sports for various reasons, injuries, lack of enjoyment. But reality sets in for many as they try to advance to higher and higher level. Their psyche is very fragile. Coaches hell at them for not performing. Team sports becomes less and less inclusive the higher they go (IE, your kid isn't good enough to compete, he rides the bench and doesn't get to play).

Your daughter quit gymnastics for whatever reason, I'm not gonna to speculative.

But the quitting of sports in the teen years after being elite happens for reasons and most of the time especially in teams sports, it's due to knowing you can't compete. The college portal makes it even worst for those on the fringes of competitive team sports like division 3 baseball. The college portal allows 24 year men to transfer to division 3 baseball easy and just destroy the psyche of young 18 year fresh out of high school who's trying to compete. Much older 24 yo will damage the 18 yo men in competitive sports. Because it's an unlevel playing field. They shouldn't even be in college sports to be honest.

You don't see that. And yes, it's breaks them. That's why many kids quit when the going gets rough. They are completely broken.

You can break kids mental state, especially teens this way.
 
I hope all you doomsday silly ass mofos are watching real close rn. Sp closed above 6k 2 days in a row... there's gonna be a breakout soon. A wild ride to 7k or 5k... it doesn't matter. Win either way...


This is the market talking. Listen... trump or whoever can only barely influence it for a hot minute
It's been talking since Breakout Monday on May 12. Gapped over a cluster of significant long term trendlines including the 100 year and imo only complete craziness from Psycho Prez or something else can stop it. I see huge drops in stocks like Tesla last week as strong trading opportunities now. If you flight it the train will mow you over.
 
no, you completely miss the point.

Kids quit real competitive sports for various reasons, injuries, lack of enjoyment. But reality sets in for many as they try to advance to higher and higher level. Their psyche is very fragile. Coaches hell at them for not performing. Team sports becomes less and less inclusive the higher they go (IE, your kid isn't good enough to compete, he rides the bench and doesn't get to play).

Your daughter quit gymnastics for whatever reason, I'm not gonna to speculative.

But the quitting of sports in the teen years after being elite happens for reasons and most of the time especially in teams sports, it's due to knowing you can't compete. The college portal makes it even worst for those on the fringes of competitive team sports like division 3 baseball. The college portal allows 24 year men to transfer to division 3 baseball easy and just destroy the psyche of young 18 year fresh out of high school who's trying to compete. Much older 24 yo will damage the 18 yo men in competitive sports. Because it's an unlevel playing field. They shouldn't even be in college sports to be honest.

You don't see that. And yes, it's breaks them. That's why many kids quit when the going gets rough. They are completely broken.

You can break kids mental state, especially teens this way.
What is this? Take it elsewhere pls. This thread is about the economy pls...
 
Lol Since I have some people on block I don't know what that person was referring to, but I had your same reaction, What the heck is this hahaha

musings of someone who got picked last in dodgeball.? I kid I kid.

So elon and trump are together again and some possibility of trade war with china calming down. New records for the markets incoming?
 
musings of someone who got picked last in dodgeball.? I kid I kid.

So elon and trump are together again and some possibility of trade war with china calming down. New records for the markets incoming?
Let's hope so but also near my time to buy so im ok with a discount too. Abb. Always be buying
 
A lot of people here talking about how we make too much. VHCOL areas had their houses virtually double during covid. The people moving in aren’t anesthesiologists, they’re people working for Facebook. They’re partners at big law. They’re in PE. IB. OMFS. entrepreneurs. A lot of fields had their pay match inflation and then some.

Not every anesthesiologist could succeed in IB, but not every IB could succeed as an anesthesiologist either.

By hours spent/sacrifice physicians deserve to be in the top 1%. Maybe you don’t feel comfortable making 600k+ because your job is “easy” but remember people making 600k+ are all over the place. Literally >1 million. They’re doing mundane crap like franchising car washes. Owning a chain of nail salons. Most of these people never have significant legal liability, have to sleep at work, deal with blood/dying people, work after 9pm. Not everyone is a giga-genius at openAI with an IQ of 212. Life is good for a lot of “regular” people, working “easy” jobs. Might as well be good for physicians too imo.
 
A lot of people here talking about how we make too much. VHCOL areas had their houses virtually double during covid. The people moving in aren’t anesthesiologists, they’re people working for Facebook. They’re partners at big law. They’re in PE. IB. OMFS. entrepreneurs. A lot of fields had their pay match inflation and then some.

Not every anesthesiologist could succeed in IB, but not every IB could succeed as an anesthesiologist either.

By hours spent/sacrifice physicians deserve to be in the top 1%. Maybe you don’t feel comfortable making 600k+ because your job is “easy” but remember people making 600k+ are all over the place. Literally >1 million. They’re doing mundane crap like franchising car washes. Owning a chain of nail salons. Most of these people never have significant legal liability, have to sleep at work, deal with blood/dying people, work after 9pm. Not everyone is a giga-genius at openAI with an IQ of 212. Life is good for a lot of “regular” people, working “easy” jobs. Might as well be good for physicians too imo.
Physicians are not swimming in a sea of $$$, but making 400k+/yr or 600k+ (in the case of anesthesiologists) is something to be content about. As someone who, at one time, making $10/hr in early 2000s, I can't even begin to tell you the difference in lifestyle that I have.

True story.... I remember I bought a very old Nissan Sentra (I think it was a 1985) from my cousin for $1000 in 2001/2002 to go to work. I gave him $500 and then had to pay him $100/month for the remaining balance.

2+ months later, my cousin was involved in a car accident and his car was total loss. You know what he did: He gave me my $700 and took his car back since the title was still in his name. 1 month later, I lost my job because I was late to work a couple of times. I was late because I was relying on friends to take me to work.

Of course, we are not making millions. Who are? Just a few-- in fact < 0.5% make 1M).

Lets be honest here: Most of us are in the top 3% in term of salary. I think physicians are intelligent, but I do not think our average IQ is in the 95th percentile.
 
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Physicians are not swimming in a sea of $$$, but making 400k+/yr or 600k+ (in the case of anesthesiologists) is something to be happy about. As someone who, at one time, making $10/hr in early 2000s, I can't even begin to tell you the difference in lifestyle that I have.

True story.... I remember I bought a very old Nissan Sentra (I think it was a 1985) from my cousin for $1000 in 2001/2002 to go to work. I gave him $500 and then had to pay him $100/month for the remaining balance.

2+ months later, my cousin was involved in a car accident and his car was total loss. You know what he did: He gave me my $700 and took his car back since the title was still in his name. 1 month later, I lost my job because I was late to work a couple of times. I was late because I was relying on friends to take me to work.

Of course, we are not making millions. Who are? Just a few-- in fact < 0.5% make 1M).

Let’s be honest here: Most of us are in the top 3% in term of salary. I think physicians are intelligent, but I do not think our average IQ is in the 95th percentile.
On the whole physicians actually are around the 95th percentile, but intelligence is specifically NOT required to enter the top 1% which is why I said not everyone is a rain man style giga-genius at openAI. Plenty of smart people are poor because they lack ambition/don’t want to work to provide value to others.

On an hours worked/deferred gratification basis (which correlates better to income in general) I would place physicians solidly in the top 1%. In most other fields where you’re working your butt off in your 20s (law/banking) you’re at least paid well while you do it. You can have kids while trying to make partner at a law firm if your spouse is stay at home. As a resident? Good luck affording that! Biglaw Salary Scale This is what workaholic lawyers make BEFORE they make partner.

It is possible you don’t run in these sorts of circles but I assure you there are an insane amount of people making >500k doing jobs that often don’t even require a master’s. For starters, that ortho spine rep? Odds are they are making as much as the anesthesiologist. Yes, I’m serious. Do you think they feel guilty making so much without going to medical school? No, they sleep like a baby.

As a final note. One of my older partners said they were barely making 200k in the 1990s and new grads don’t know how good they have it. I pointed out that normalized to median price of home in this area new grads would have to be making around 1.5 million to have the same quality of life. That’s reality. Physician salaries are lagging behind other industries.

Someone is going to be in the top 1%, why not have a good chunk of them be physicians? Should they instead exclusively be composed of successful realtors, cosmetic dentists, NPs running successful med spas etc?
 
It is possible you don’t run in these sorts of circles but I assure you there are an insane amount of people making >500k doing jobs that often don’t even require a master’s. For starters, that ortho spine rep? Odds are they are making as much as the anesthesiologist. Yes, I’m serious. Do you think they feel guilty making so much without going to medical school? No, they sleep like a baby.
Your circle is not representative of the population. I think that is the reason you think a LOT people out there make > 500k/yr.

About 1% of the US make 500k+/yr. It goes without saying that is a remarkable income. Just imagine you were on the top 1% of your med school class of 200 students. The two people would be you and some other guy/gal who is intelligent and studies 12+ hrs/day.


 
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Your circle is not representative of the population. I think that is your issue.

About 1% of the US make 500k+/yr. It goes without saying that is a remarkable income. Just imagine you were on the top 1% of your med school class of 200 students. The two people would be you and some other guy/gal who is intelligent and studies 12+ hrs/day.


You are thinking I’m saying something I’m not. I am not saying 500k is the norm. What I am saying is of the top 1% (well, really top 2% since anesthesiologists are generally no longer part of the 1%) it is filled with completely average intelligence people, as evidenced by your article. The largest member of the 1%? Managers.

There is a subgroup of physicians that feels guilty for making good money even though they have doctorates, worked like dogs throughout their 20s and provide exceptional value to society. Meanwhile a son/daughter of a successful realtor that gets the contacts served to them on a silver platter doesn’t feel guilty at all about making 1M despite not even going to college.

If we are not careful we will end up like the UK where the only people that actually have money are the landed gentry and the finance sector which never feels guilty about getting their portion of the pie.

PS I don’t know if the DQYDJ site uses surveys but this infographic uses actual IRS returns and has a much higher threshold to join the 1%: Mapped: The Income Needed to Join the Top 1% in Every U.S. State
 
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You are thinking I’m saying something I’m not. I am not saying 500k is the norm. What I am saying is of the top 1% (well, really top 2% since anesthesiologists are generally no longer part of the 1%) it is filled with completely average intelligence people, as evidenced by your article. The largest member of the 1%? Managers.

There is a subgroup of physicians that feels guilty for making good money even though they have doctorates, worked like dogs throughout their 20s and provide exceptional value to society. Meanwhile a son/daughter of a successful realtor that gets the contacts served to them on a silver platter doesn’t feel guilty at all about making 1M despite not even going to college.

If we are not careful we will end up like the UK where the only people that actually have money are the landed gentry and the finance sector which never feels guilty about getting their portion of the pie.

PS I don’t know if the DQYDJ site uses surveys but this infographic uses actual IRS returns and has a much higher threshold to join the 1%: Mapped: The Income Needed to Join the Top 1% in Every U.S. State
I would look at percentage instead of raw numbers.

Not feeling guilty at all. In fact, I want them to pay me more $$$ despite making the top 2-3% last year as a hospitalist. But I also understand I am fortunate to make that kind of money. More $$$ is always good.

There are plenty people with PhD that are working hard for <100k year. For instance, one of the best clinicians in my hospitalist group is also a PhD guy who was teaching biology at a community college. I asked him one time why did he leave teaching. His answer was "I was barely able to pay my bills."
 
On the whole physicians actually are around the 95th percentile, but intelligence is specifically NOT required to enter the top 1% which is why I said not everyone is a rain man style giga-genius at openAI. Plenty of smart people are poor because they lack ambition/don’t want to work to provide value to others.

On an hours worked/deferred gratification basis (which correlates better to income in general) I would place physicians solidly in the top 1%. In most other fields where you’re working your butt off in your 20s (law/banking) you’re at least paid well while you do it. You can have kids while trying to make partner at a law firm if your spouse is stay at home. As a resident? Good luck affording that! Biglaw Salary Scale This is what workaholic lawyers make BEFORE they make partner.

It is possible you don’t run in these sorts of circles but I assure you there are an insane amount of people making >500k doing jobs that often don’t even require a master’s. For starters, that ortho spine rep? Odds are they are making as much as the anesthesiologist. Yes, I’m serious. Do you think they feel guilty making so much without going to medical school? No, they sleep like a baby.

As a final note. One of my older partners said they were barely making 200k in the 1990s and new grads don’t know how good they have it. I pointed out that normalized to median price of home in this area new grads would have to be making around 1.5 million to have the same quality of life. That’s reality. Physician salaries are lagging behind other industries.

Someone is going to be in the top 1%, why not have a good chunk of them be physicians? Should they instead exclusively be composed of successful realtors, cosmetic dentists, NPs running successful med spas etc?
Because we aren't in a free market... The entire medical market is completely contrived by government rules, not free market forces. Anesthesia and surgeons only make lots of money because hospitals get paid a lot of money in facility fees, not because there is a huge supply/demand mismatch.

Look at the many medical subspecialties that have been in massive shortage for a decade or more still getting paid under 200k. There is enormous demand for endocrinology with the rise of diabetes and they provide immense benefit and prevent expensive downstream chronic health problems yet they get paid crap because collectively as a society via our elected representatives we have deemed cognitive medicine the lowest value. From a free market force perspective, plenty of medicare recipients would love to pay extra to cut the massive lines they face in care and make up for the plummeting reimbursement associated with their government mandated insurance but they can't because it is illegal.

Our society just doesn't value physicians or healthcare in general despite what we spend on it.
 
Because we aren't in a free market... The entire medical market is completely contrived by government rules, not free market forces. Anesthesia and surgeons only make lots of money because hospitals get paid a lot of money in facility fees, not because there is a huge supply/demand mismatch.

Look at the many medical subspecialties that have been in massive shortage for a decade or more still getting paid under 200k. There is enormous demand for endocrinology with the rise of diabetes and they provide immense benefit and prevent expensive downstream chronic health problems yet they get paid crap because collectively as a society via our elected representatives we have deemed cognitive medicine the lowest value. From a free market force perspective, plenty of medicare recipients would love to pay extra to cut the massive lines they face in care and make up for the plummeting reimbursement associated with their government mandated insurance but they can't because it is illegal.

Our society just doesn't value physicians or healthcare in general despite what we spend on it.

And its only going to get worse. I have a few friends fp/im that work a few jobs and break the 500k level. Most docs if motivated can do this. I believe all docs shud be making 500+ and if u pick a field where thats harder to do peds/endo u shud be aware of that going into it.

The salary above then sets up the investment side of things where once u have put enuf into voo for example the annual return will get closer to ir base salary. Maybe 50% base in 10 years then matches ur doc salary at 15 years then double ur doc salary at year 20.

Its not easy but its a game changer if ur able to get to those milestones in this broken system.
 
Because we aren't in a free market... The entire medical market is completely contrived by government rules, not free market forces. Anesthesia and surgeons only make lots of money because hospitals get paid a lot of money in facility fees, not because there is a huge supply/demand mismatch.

Look at the many medical subspecialties that have been in massive shortage for a decade or more still getting paid under 200k. There is enormous demand for endocrinology with the rise of diabetes and they provide immense benefit and prevent expensive downstream chronic health problems yet they get paid crap because collectively as a society via our elected representatives we have deemed cognitive medicine the lowest value. From a free market force perspective, plenty of medicare recipients would love to pay extra to cut the massive lines they face in care and make up for the plummeting reimbursement associated with their government mandated insurance but they can't because it is illegal.

Our society just doesn't value physicians or healthcare in general despite what we spend on it.
people are cheap with healthcare. They don’t want to pay for concierge type of medicine.

Say u have $30-50 co pay and regular fully subsidized health insurance

Do you think you will pay $200 extra to see the doctor sooner?

Now if you are already paying full price $2000/month for health care plus a hefty $10k deductible. You may pay that’s $200 extra to see the concierge doctor that doesn’t get applied to the high deductible.
 
people are cheap with healthcare. They don’t want to pay for concierge type of medicine.

Say u have $30-50 co pay and regular fully subsidized health insurance

Do you think you will pay $200 extra to see the doctor sooner?

Now if you are already paying full price $2000/month for health care plus a hefty $10k deductible. You may pay that’s $200 extra to see the concierge doctor that doesn’t get applied to the high deductible.

Are kids today healthier than in the past. Not by a long shot. With uber eats and apps for everything its scary what will happen to healthcare costs in the future.

I know the disipline it takes to workout/eat healthy and maybe the most important SLEEP!!! I've maintained my high school weight for the last 20 years. It is no joke and requires a massive amount of effort and always trying to improve and learn new things. I can't believe people eat doritos or 500 cal starbucks lattes regularly in 2025.
 
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Because we aren't in a free market... The entire medical market is completely contrived by government rules, not free market forces. Anesthesia and surgeons only make lots of money because hospitals get paid a lot of money in facility fees, not because there is a huge supply/demand mismatch.

Look at the many medical subspecialties that have been in massive shortage for a decade or more still getting paid under 200k. There is enormous demand for endocrinology with the rise of diabetes and they provide immense benefit and prevent expensive downstream chronic health problems yet they get paid crap because collectively as a society via our elected representatives we have deemed cognitive medicine the lowest value. From a free market force perspective, plenty of medicare recipients would love to pay extra to cut the massive lines they face in care and make up for the plummeting reimbursement associated with their government mandated insurance but they can't because it is illegal.

Our society just doesn't value physicians or healthcare in general despite what we spend on it.
There absolutely is a huge supply/demand mismatch in anesthesia, and you can argue the reason for that but it absolutely exists. If there wasn’t hospitals wouldn’t have to offer insane locums rates to get extra people to show up.

By contrast fields like endocrinology do not have a huge supply/demand mismatch by definition. If there was, they’d be paid better. If half of endocrinologists died tomorrow you’d see them be paid more than what they collect (and you’d see insane locums rates to incentivize existing endocrinologists to work 60+ hours a week).

Note that despite anesthesia reimbursement being flat or even falling salaries have gone up because of the shortage.

I’ll also note that while salaries are lower for doctors in many other countries, that’s true for nurses, truck drivers, plumbers etc.


PS: any time someone claims there is a shortage in a field that pays poorly, they’re lying. During the pandemic ECMO nurses were making upwards of 10k a week. I’ve heard about a teacher shortage for >20 years and yet their salaries are still low because a lot of people want to be teachers (or at least think they do until they switch careers) despite the pay being low. Same for pediatrics. Should those careers be paid more? Maybe. But there isn’t a shortage unless wages are increasing significantly (regardless of “reimbursement rates”).

I would look at percentage instead of raw numbers.

Not feeling guilty at all. In fact, I want them to pay me more $$$ despite making the top 2-3% last year as a hospitalist. But I also understand I am fortunate to make that kind of money. More $$$ is always good.

There are plenty people with PhD that are working hard for <100k year. For instance, one of the best clinicians in my hospitalist group is also a PhD guy who was teaching biology at a community college. I asked him one time why did he leave teaching. His answer was "I was barely able to pay my bills."
Then I think we are in agreement. I don’t think we are horrendously underpaid, but until recently my group averaged a ~1% increase in compensation for a 20 year stretch meanwhile home prices tripled. There are going to be very well paid people in society and I will continue to advocate for physicians to be a substantial portion of that 1-3%.
 
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I believe all docs shud be making 500+
A low percentage of doctors fall in the excellent category and no field should get some set pay rate that feels good for all members. In a free market doctors would make far less. Be thankful there are barriers to entry and massive government subsidies that prop up your salary.
 
There absolutely is a huge supply/demand mismatch in anesthesia, and you can argue the reason for that but it absolutely exists. If there wasn’t hospitals wouldn’t have to offer insane locums rates to get extra people to show up.

By contrast fields like endocrinology do not have a huge supply/demand mismatch by definition. If there was, they’d be paid better. If half of endocrinologists died tomorrow you’d see them be paid more than what they collect (and you’d see insane locums rates to incentivize existing endocrinologists to work 60+ hours a week).

Note that despite anesthesia reimbursement being flat or even falling salaries have gone up because of the shortage.

I’ll also note that while salaries are lower for doctors in many other countries, that’s true for nurses, truck drivers, plumbers etc.


PS: any time someone claims there is a shortage in a field that pays poorly, they’re lying. During the pandemic ECMO nurses were making upwards of 10k a week. I’ve heard about a teacher shortage for >20 years and yet their salaries are still low because a lot of people want to be teachers (or at least think they do until they switch careers) despite the pay being low. Same for pediatrics. Should those careers be paid more? Maybe. But there isn’t a shortage unless wages are increasing significantly (regardless of “reimbursement rates”).


Then I think we are in agreement. I don’t think we are horrendously underpaid, but until recently my group averaged a ~1% increase in compensation for a 20 year stretch meanwhile home prices tripled. There are going to be very well paid people in society and I will continue to advocate for physicians to be a substantial portion of that 1-3%.
This is so wrong. Have you ever run an outpatient practice or have any idea how outpatient billing works? Even if you are literally the only outpatient provider in a specialty for an entire region with a monopoly you can't just set your own rates. Medicare/medicaid pays exactly the same and the insurance companies will either out of network you or in network you at **** tier rates barely above medicare because you have are solo provider and they have all the power and market share.

You are confusing hospital subsidies with free market forces. If the hospital loses access to the cash cow your subsidy is gone then you're back in the same playing field the unsubsidized outpatient providers are. I dare you to find a medium sized city in a Midwest state with enough endocrinologists or rheumatologists to support its population needs and claim that there isn't a shortage. If you've ever had to find a rheumatologist yourself you'd quickly realize how insanely hard they are to find almost anywhere. The ones near me are booking out over 2 years from now.
 
There absolutely is a huge supply/demand mismatch in anesthesia, and you can argue the reason for that but it absolutely exists. If there wasn’t hospitals wouldn’t have to offer insane locums rates to get extra people to show up.

By contrast fields like endocrinology do not have a huge supply/demand mismatch by definition. If there was, they’d be paid better. If half of endocrinologists died tomorrow you’d see them be paid more than what they collect (and you’d see insane locums rates to incentivize existing endocrinologists to work 60+ hours a week).

Note that despite anesthesia reimbursement being flat or even falling salaries have gone up because of the shortage.

I’ll also note that while salaries are lower for doctors in many other countries, that’s true for nurses, truck drivers, plumbers etc.


PS: any time someone claims there is a shortage in a field that pays poorly, they’re lying. During the pandemic ECMO nurses were making upwards of 10k a week. I’ve heard about a teacher shortage for >20 years and yet their salaries are still low because a lot of people want to be teachers (or at least think they do until they switch careers) despite the pay being low. Same for pediatrics. Should those careers be paid more? Maybe. But there isn’t a shortage unless wages are increasing significantly (regardless of “reimbursement rates”).


Then I think we are in agreement. I don’t think we are horrendously underpaid, but until recently my group averaged a ~1% increase in compensation for a 20 year stretch meanwhile home prices tripled. There are going to be very well paid people in society and I will continue to advocate for physicians to be a substantial portion of that 1-3%.
Yup, everywhere you look in the peds job market what’s the first thing you hear?

Saturated.

Pediatrics is 3:1 male to female match. Women tend to be less willing to relocate to rural areas and tend to be less likely to be primary earners so demand on high salary is way less and high earning isn’t as necessary to make the household whole financially. Therefore the demand to do that job in medicine in cities outstrips the demand for high compensation in it.
 
This is so wrong. Have you ever run an outpatient practice or have any idea how outpatient billing works? Even if you are literally the only outpatient provider in a specialty for an entire region with a monopoly you can't just set your own rates. Medicare/medicaid pays exactly the same and the insurance companies will either out of network you or in network you at **** tier rates barely above medicare because you have are solo provider and they have all the power and market share.

You are confusing hospital subsidies with free market forces. If the hospital loses access to the cash cow your subsidy is gone then you're back in the same playing field the unsubsidized outpatient providers are. I dare you to find a medium sized city in a Midwest state with enough endocrinologists or rheumatologists to support its population needs and claim that there isn't a shortage. If you've ever had to find a rheumatologist yourself you'd quickly realize how insanely hard they are to find almost anywhere. The ones near me are booking out over 2 years from now.
Then why can’t rheums do concierge practices with a little general practice mixed in? Charge a retainer fee up front and then take good insurances only. Seems like it would be easy enough if a certain percentage of people have good payors.
 
Yup, everywhere you look in the peds job market what’s the first thing you hear?

Saturated.

Pediatrics is 3:1 male to female match. Women tend to be less willing to relocate to rural areas and tend to be less likely to be primary earners so demand on high salary is way less and high earning isn’t as necessary to make the household whole financially. Therefore the demand to do that job in medicine in cities outstrips the demand for high compensation in it.
Why has psychiatrist salaries grown the last 15 years? Was in the mid 150s pre ACA. Now in the low 300s (I know it varies by outpatient vs inpatient) etc.

Psychiatry is one of those hot growing Residency trends I’ve discussed previously. And half the people going into psych tend to be in the spectrum themselves. ….not exactly frat boys. So weirdos demand more ? Or the ACA allowed more reimbursements for mental health?

We all know the answer it’s the ACA allowing more mental health.

But ACA didn’t help peds reimbursements? Especially since half the kids in the USA are on Medicaid? That’s something the ACA should have addressed but didn’t.
 
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