Is it possible?

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mkim27

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Hello, longtime lurker here. Currently in the middle of residency training and doing some financial and career planning for when I finish training to be an attending.

I've been looking at inpatient gigs in the midwest, mostly suburbs of Chicagoland area. My question is this:

Is it possible... if I'm willing to work 60+ hours, to gross $500k right out of the gate after residency by stacking a full-time inpt gig (~$250k) + locums in the late afternoon/evening for a geriatric psych unit (~$250k) and make it work, have enough energy to do a good job at both? Or would it be more advisable to do a FT inpt gig + a number of side gigs (moonlight at a ED, telepsych, nursing home, methadone clinics, take weekend call)?

The reason I'm trying so hard to hit that 500k/yr number is because when I did the math on monthly income after taxes + monthly expenses, the $25,181/mo net income I'd make would really fast forward the timeline in terms of reaching my goals (afford the house I want, pay off student loans at a good pace, have some leftover to start passive investments, etc). I know I can take it easy with 1 FT job and knock out the loans... then the mortgage... then feel less burdened/stressed but I'm sure you guys can relate after going through undergrad, postbacc, med school, residency the amount of delaying gratification has reached its limit. Don't want to keep waiting to feel financially free. Hope some of you guys can relate.

Anyway, my question is: is this possible? Is there a better way to do it? Is it a dumb goal/approach altogether? Would LOVE to hear everyone's opinion because a lot of my advisors have only been in academia and can't answer this question from personal experience, just anecdotal. While I welcome anecdotal responses, I would love to hear from people who know firsthand or who have at least attempted firsthand.

Thanks! I've honestly always learned a lot and had a lot of good folks help me on here in SDN throughout my career and hoping to continue my luck.
 
You could get close to that with one prison job, but it's all about how miserable you are okay with your life being. There should also be a little consideration for the (likely large number of) patients who have to deal with you doing this...
 
I couldn't do it. I'd burn out quick trying to do more than one clinical full time job well.

I know psychiatrists who are doing this. Workaholics who worship the dollar, in my opinion. Their patients inevitably come to me and tell me their last psychiatrist who has 4 jobs didn't listen very well. The patients see a lot of improvement once they have a real treatment plan to follow, which takes time that Dr. Makealottamoney wasn't willing or able to spend on the patients.
 
It might be possible, but I would strongly recommend against committing to this "right out of the gate." Get the first job and see how things are running, then sign on to additional commitments that seem tolerable. I think that is much better than overwhelming yourself right up front and potentially making unnecessary errors because you just can't keep up.
 
Thanks for all of the feedback. I should probably just learn how to live comfortably on 250k as it is more than majority of people and just be patient while knocking off each financial goal.

Got about 400k in loans but maybe I’ll just take it slow and pay it off over 10 years. And then pay off the mortgage over 30 years. Hopefully by 60, I’ll have some gas left in the tank to work a few more years before retiring so I can travel and live it up a little.

i think I’ll honestly just be grateful to have had a long and fulfilling career that the other stuff won’t matter as much
 
Taking on two full time jobs is not only a fool's errand, it may not even be allowed by the terms of your employment. In addition, it increases your liability, decreases your quality of life, and would lead to diminishing returns. You have several options to maximize your earnings however:
1. Do high paying locum jobs for a few years. You will be able to find jobs paying $200-300/hr (higher paying gigs will not pay for travel or housing most likely so take into account total compensation to compare jobs). It would be reasonable to work 50hrs per week (e.g. 5 10-hour days). I would discourage routinely working more than that.
OR
2. Find a good, stable, and decent paying employed position. remember the median salary for psychiatrists is now about $275000 so in general you should be able to find jobs paying this or greater (outside of academics etc.) You don't have to do it full time, but enough to qualify for benefits etc. Then with the remainder of the time find one or more independent contractor positions. Often the highest paying positions may only be for one day per week (or less) and so cobbling together multiple different jobs prioritizing those that pay well. If you earn at least $137,700 i you won't have to pay self-employment taxes above that so it's not so much of an issue. There are other advantages to doing 1099 work as well (e.g. tax deductions, being able to put more money into retirement, e.g. SEP-IRA).

In addition, the typical advice about living like a resident for a few years, not spending more that you can afford, refinancing student loans (this is a great time for this) also holds true. In this climate, you also want to make sure you've saved enough for at least 6 months' expenses.
 
I don't know anything about your personal situation (kids, other debts, a spouse who either works or does not, etc) but even with 400k in loans you can attain financial independence in way less than 30-40 years. Keep the spending end of the equation low, especially up front, and keep in mind income does not have to be all or nothing (either working 90 hour weeks or working one mid-range pay job with no moonlighting or other revenue streams). Even earning $250,000 per year with no additional income, it is likely you could save $100,000 per year. That could mean paying off your loan in well under 10 years, and then reaching your first million less than a decade after that. At that point, the million is probably earning about $70,000 per year in interest in relatively low risk investments. As you can imagine, a 25-year timeline or less remains entirely possible.
 
mkim27 said:
Thanks for all of the feedback. I should probably just learn how to live comfortably on 250k as it is more than majority of people and just be patient while knocking off each financial goal.

Got about 400k in loans but maybe I’ll just take it slow and pay it off over 10 years. And then pay off the mortgage over 30 years. Hopefully by 60, I’ll have some gas left in the tank to work a few more years before retiring so I can travel and live it up a little.

i think I’ll honestly just be grateful to have had a long and fulfilling career that the other stuff won’t matter as much
Click to expand...

I did inhouse moonlighting my first year out of residency. I cleared maybe 80k doing 10-12 extra hours a week. The money helped my debt, but the added shifts did not help my personal life. It was doable, just be very careful about what you select. The more patients, the more physical and legal liability. I stopped after my primary income increased 30k and I was clocked in the head, which coincidentally occurred about the same time. Transferred to telepsych, took a break for over a year, and found some good moonlighting gigs right when the pandemic started, so still not working extra.

I'm not saying don't work extra. Just make sure you find a really good, healthy primary job that values you and compensates you well. If you find something like that, then you'll be more selective with your side gigs and less likely to feel like you need to make a million dollars really fast to get out of dodge.
 
If you haven't already check out White Coat Investor's site. Getting an appropriate financial plan in place will assist in working smarter not harder.
 
mkim27 said:
Thanks for all of the feedback. I should probably just learn how to live comfortably on 250k as it is more than majority of people
Click to expand...

It is actually more per year than 97% of Americans. If you cannot make a go of things on 250k addressing however you are setting your money on fire is probably the first priority before a side gig.


splik said:
. Find a good, stable, and decent paying employed position. remember the median salary for psychiatrists is now about $275000 so in general you should be able to find jobs paying this or greater (outside of academics etc.) You don't have to do it full time, but enough to qualify for benefits etc. Then with the remainder of the time find one or more independent contractor positions. Often the highest paying positions may only be for one day per week (or less) and so cobbling together multiple different jobs prioritizing those that pay well. If you earn at least $137,700 i you won't have to pay self-employment taxes above that so it's not so much of an issue. There are other advantages to doing 1099 work as well (e.g. tax deductions, being able to put more money into retirement, e.g. SEP-IRA).
Click to expand...

Depending on your state and the relative expense of marketplace insurance plans, you can in fact come out ahead money wise just doing 1099 work even without benefits. In my current situation I figured out I could make appreciably more doing 24 hours a week of contract work (cobbling together different gigs as you advise) than at one of the better paying full-time gigs in town, AND with better health insurance to boot. Run some numbers, you can figure out what is best for you.

TexasPhysician said:
Could you? Yes
Should you? No

Many psychiatrists choose to practice medicine into their 70’s and 80’s. The hours may be reduced, but this is a gig that can easily be 8-20 hrs/week. Enjoy it.
Click to expand...

Yeah, I share your weird idea that maybe just don't work a bunch of jobs you hate in order to not have to work any more, but instead try and find jobs you don't hate so you can keep doing them for the long haul if you want.
 
I have a question to senior psychiatrists here. Why do teaching hospitals pay much less compared to for profit hospitals or hospitals without any student, residents etc? I always find it bland to work for somewhere there is no student of any kind. Just to work in an intellectually stimulating environment why should I give up on at least 50k annually ?
 
Marasmus1 said:
I have a question to senior psychiatrists here. Why do teaching hospitals pay much less compared to for profit hospitals or hospitals without any student, residents etc? I always find it bland to work for somewhere there is no student of any kind. Just to work in an intellectually stimulating environment why should I give up on at least 50k annually ?
Click to expand...

The academic jobs that I see are typically more relaxed. You may be supervising a 4 resident clinic in which you just walk in and briefly say hi to 2-4 patients every 30 minutes. You may get some admin time or research time. Grand rounds and other academic events may block your clinic. You may get teaching time. Your clinics are usually not double booked, so there is more down time. This non-working time adds up. Additionally you need to support the other docs with your revenue as they may be doing more teaching.
 
splik said:
Taking on two full time jobs is not only a fool's errand, it may not even be allowed by the terms of your employment. In addition, it increases your liability, decreases your quality of life, and would lead to diminishing returns. You have several options to maximize your earnings however:
1. Do high paying locum jobs for a few years. You will be able to find jobs paying $200-300/hr (higher paying gigs will not pay for travel or housing most likely so take into account total compensation to compare jobs). It would be reasonable to work 50hrs per week (e.g. 5 10-hour days). I would discourage routinely working more than that.
OR
2. Find a good, stable, and decent paying employed position. remember the median salary for psychiatrists is now about $275000 so in general you should be able to find jobs paying this or greater (outside of academics etc.) You don't have to do it full time, but enough to qualify for benefits etc. Then with the remainder of the time find one or more independent contractor positions. Often the highest paying positions may only be for one day per week (or less) and so cobbling together multiple different jobs prioritizing those that pay well. If you earn at least $137,700 i you won't have to pay self-employment taxes above that so it's not so much of an issue. There are other advantages to doing 1099 work as well (e.g. tax deductions, being able to put more money into retirement, e.g. SEP-IRA).

In addition, the typical advice about living like a resident for a few years, not spending more that you can afford, refinancing student loans (this is a great time for this) also holds true. In this climate, you also want to make sure you've saved enough for at least 6 months' expenses.
Click to expand...

Would you recommend independent contractor positions we find on our own or locums jobs? I see a ton of locums emails/ads, but it always feels so wrong to go through a locums company. Then again, I don't know how to go about locating/getting these independent contractor gigs outside of locums.
 
Mass Effect said:
Would you recommend independent contractor positions we find on our own or locums jobs? I see a ton of locums emails/ads, but it always feels so wrong to go through a locums company. Then again, I don't know how to go about locating/getting these independent contractor gigs outside of locums.
Click to expand...

I got one interesting offer by monitoring listings on Indeed but mostly cold-emailing agencies and practices in the area got very fast responses, like "called back in half an hour asking if they can buy me coffee in person to talk about opportunities" fast.
 
clausewitz2 said:
I got one interesting offer by monitoring listings on Indeed but mostly cold-emailing agencies and practices in the area got very fast responses, like "called back in half an hour asking if they can buy me coffee in person to talk about opportunities" fast.
Click to expand...

Would these places be independent private practices (outpatient), hospital jobs, nursing homes, or other? Feel free to message me if you're open to discussing and don't want to reveal too much on here.
 
As someone who has been living like a resident going on year 4 and managing multiple jobs. My biggest issue would be make sure you have your personal life set as in engaged or married before going into all this. Its very difficult to do that when your working many gigs as is maintaining a relationship that hasn't quite reached that point or hell even if your newly married enjoy that part of your life. If i could do it all over again i would have taken a more relaxed approach then pushing myself. A great partner who you have time to spend and truly enjoy is priceless. Jobs will come and go and will always be plentiful. Enjoy youth this is time you won't ever get back.
 
Mass Effect said:
Would these places be independent private practices (outpatient), hospital jobs, nursing homes, or other? Feel free to message me if you're open to discussing and don't want to reveal too much on here.
Click to expand...

I saw a couple of nursing home jobs and a ton of hospital postings but not my thing. The interesting offer I explored but didn't take was a combo outpatient/residential treatment set up with a specialized population. The ones I found via just cold contacting are outpatient with private practice groups or CMHCs (albeit doing something fairly specialized).

If I was willing to go work for The Other Health System in town there are all kinds of postings at the moment but for various reasons that is not an option.
 
After doing a search, I realize there was a thread similar to this back in July and sparked a whole conversation about good standard of care so I apologize for duplicating that subject.

Amt of income aside, does anybody have really diverse/unique clinical settings they work in? Does anyone do non-clinical hobbies he/she gets paid for (blogging, writing, e-commerce, yoga instructor lol etc)? Thx!
 
mkim27 said:
After doing a search, I realize there was a thread similar to this back in July and sparked a whole conversation about good standard of care so I apologize for duplicating that subject.

Amt of income aside, does anybody have really diverse/unique clinical settings they work in? Does anyone do non-clinical hobbies he/she gets paid for (blogging, writing, e-commerce, yoga instructor lol etc)? Thx!
Click to expand...

I'm really off the whole side-gig thing for physicians. I get that bloggers are actively doing it, it's fun to talk about, but let's be real. After lawyers, we bill around the second most for per/hour, sweat equity work of any profession. The likelihood you find something that ends up being a more effective use of your time if you are trying to maximize $ is very low. If you really are financially focused, spent your time learning personal fiance and interviewing aggressively.

As for your original question, many chicagoland suburb jobs can easily hit $300k on a regular schedule. CoL is pretty reasonable in the suburbs in general, if you take home $180k after tax, you should have no difficultly living well on 80k and paying off the loans in 4 years. From there the path to FI could certainly be achieved in 20 years and you can use your experience/connections to find additional work (e.g. medical directorships).

If you have geographic flexibility and are okay with more rural locations, pay will go up, CoL down and the time to FI will dramatically shorten. If you do not, I would start as above then look to add work in the future once you know the area/people and are use to being an attending (Chicagoland is definitley a doable place to build wealth, it's no Bay area, NYC, or SoCal). Definitely would not start with 2 FTE out of the gate.
 
mkim27 said:
Is there a better way to do it? Is it a dumb goal/approach altogether? Would LOVE to hear everyone's opinion because a lot of my advisors have only been in academia and can't answer this question from personal experience, just anecdotal. While I welcome anecdotal responses, I would love to hear from people who know firsthand or who have at least attempted firsthand.
Click to expand...

If finances are your main concern, expand your geographical search. Chicago as a whole is high CoL and not the most spectacular pay. Could easily improve your financial situation drastically by looking at other cities if you’re open to it.

Merovinge said:
I'm really off the whole side-gig thing for physicians. I get that bloggers are actively doing it, it's fun to talk about, but let's be real. After lawyers, we bill around the second most for per/hour, sweat equity work of any profession. The likelihood you find something that ends up being a more effective use of your time if you are trying to maximize $ is very low. If you really are financially focused, spent your time learning personal fiance and interviewing aggressively.

As for your original question, many chicagoland suburb jobs can easily hit $300k on a regular schedule. CoL is pretty reasonable in the suburbs in general, if you take home $180k after tax, you should have no difficultly living well on 80k and paying off the loans in 4 years. From there the path to FI could certainly be achieved in 20 years and you can use your experience/connections to find additional work (e.g. medical directorships).

If you have geographic flexibility and are okay with more rural locations, pay will go up, CoL down and the time to FI will dramatically shorten. If you do not, I would start as above then look to add work in the future once you know the area/people and are use to being an attending (Chicagoland is definitley a doable place to build wealth, it's no Bay area, NYC, or SoCal). Definitely would not start with 2 FTE out of the gate.
Click to expand...

Im going to disagree with IL being a good place to build wealth. IL is one of the worst states to live in financially, and that goes triple for the Chicago area. Most of the suburbs are not much better and some are much worse for building wealth (especially if you want to live in a town with a solid school district). After other taxes and utilities OP would be extremely lucky to take home $180 on $300k gross. I wouldn’t recommend that anyone trying to fast-track their wealth building move to Chicagoland unless they’ve got some ridiculous benefits or perks being offered.
 
Stagg737 said:
If finances are your main concern, expand your geographical search. Chicago as a whole is high CoL and not the most spectacular pay. Could easily improve your financial situation drastically by looking at other cities if you’re open to it.


Im going to disagree with IL being a good place to build wealth. IL is one of the worst states to live in financially, and that goes triple for the Chicago area. Most of the suburbs are not much better and some are much worse for building wealth (especially if you want to live in a town with a solid school district). After other taxes and utilities OP would be extremely lucky to take home $180 on $300k gross. I wouldn’t recommend that anyone trying to fast-track their wealth building move to Chicagoland unless they’ve got some ridiculous benefits or perks being offered.
Click to expand...

Agree on both counts. IL's pension bomb will be a major problem. Many of the houses in the good suburbs are materially depreciating as property tax is increasing in an unsustainable way to prop up the pension bubble.

If you are single I would also advise moving out of Chicago -- for example to Indiana or Wisconsin/Minnesota, if you need to be in proximity to Chicago. Jobs typically pay more slightly out of Chicago. The only advantage of Chicago would be if you decide to build a high-end cash practice on the north side--which is perfectly feasible.
 
Illinois has serious issues with corruption and pension no doubt, credit rating is struggling as well, but it also has Chicago which is the third biggest hub of economic activity in America (per wikipedia 2018 data). I'm just as offended as everyone else at the Forbes article showing people without college degrees making my salary but that was clearly intended to be sensational. The sky is not falling for my friends who live there, Cost of Living index remains around 107 which is dramatically lower than most of the top 10 GDP areas of the country, there are very real CoL benefits to being in a colder climate.

Of course you will make more money in Indiana, Wisconsin, Minnesota but none of those areas have cities that hold a candle to Chicago in terms of culture, restaurants, or diversity, so this is continual trade-off nearly everyone considers (Twin Cities are great but dramatically colder than Chicago and much less diverse).
 
For those familiar w Chicagoland, what do you guys think of living in a suburb like Glenview or Schaumburg? Often voted one of the best places to raise your kids, 10/10 schools, safe/friendly/diverse (I’m a minority) community and about an hour from Chicago. Reason I’m so set on Illinois is because my parents live there and I want them to be able to see my son everyday. I’m really close w my parents.

Thanks for your guys’ advice! You guys are awesome.
 
Convince the parents to move.

Incorporate them in on the decision making and do a joint effort family targeting of some place else. Plus, their moving gives the benefit of them down sizing the presumed life time of stuff they accumulated.
 
Marasmus1 said:
I have a question to senior psychiatrists here. Why do teaching hospitals pay much less compared to for profit hospitals or hospitals without any student, residents etc? I always find it bland to work for somewhere there is no student of any kind. Just to work in an intellectually stimulating environment why should I give up on at least 50k annually ?
Click to expand...

haaaa 50k... one of my friends this year turned down a 400k corporate job with kaiser to work a 200k in academia... I was a supportive friend but secretly smh on the inside :')
 
mkim27 said:
Hello, longtime lurker here. Currently in the middle of residency training and doing some financial and career planning for when I finish training to be an attending.

I've been looking at inpatient gigs in the midwest, mostly suburbs of Chicagoland area. My question is this:

Is it possible... if I'm willing to work 60+ hours, to gross $500k right out of the gate after residency by stacking a full-time inpt gig (~$250k) + locums in the late afternoon/evening for a geriatric psych unit (~$250k) and make it work, have enough energy to do a good job at both? Or would it be more advisable to do a FT inpt gig + a number of side gigs (moonlight at a ED, telepsych, nursing home, methadone clinics, take weekend call)?

The reason I'm trying so hard to hit that 500k/yr number is because when I did the math on monthly income after taxes + monthly expenses, the $25,181/mo net income I'd make would really fast forward the timeline in terms of reaching my goals (afford the house I want, pay off student loans at a good pace, have some leftover to start passive investments, etc). I know I can take it easy with 1 FT job and knock out the loans... then the mortgage... then feel less burdened/stressed but I'm sure you guys can relate after going through undergrad, postbacc, med school, residency the amount of delaying gratification has reached its limit. Don't want to keep waiting to feel financially free. Hope some of you guys can relate.

Anyway, my question is: is this possible? Is there a better way to do it? Is it a dumb goal/approach altogether? Would LOVE to hear everyone's opinion because a lot of my advisors have only been in academia and can't answer this question from personal experience, just anecdotal. While I welcome anecdotal responses, I would love to hear from people who know firsthand or who have at least attempted firsthand.

Thanks! I've honestly always learned a lot and had a lot of good folks help me on here in SDN throughout my career and hoping to continue my luck.
Click to expand...
I think it depends on how hyperthymic you are. I'd also be careful about non-competes and clauses about how outside activities need to be approved.
 
Marasmus1 said:
I have a question to senior psychiatrists here. Why do teaching hospitals pay much less compared to for profit hospitals or hospitals without any student, residents etc?
Click to expand...
This is isn't entirely the case- but academic medical centers do pay substantially less for clinician educator faculty than one could make elsewhere. For the most part there are several factors that contribute to that: 1) there continues to, although weakening, a steady flow of people willing to take such positions; 2) you in general will be seeing far fewer patients and being less "productive" clinically than if you were working elsewhere (if this isn't true then I don't see the point of taking such a positions); 3) the bureaucracy of academic institutions means that your pay/productivity is subject to multiple taxes - the dean's tax, the department tax, and division taxes. What that means is that 10-50% of the money you are making is siphoned off to feather the nests of those in administrative positions who aren't generating review or other operating costs.; 4) if you happen to have "protected time" which at many places is about 0.1-0.2 FTE, this is usually uncompensated time which leads to an overall salary reduction.

You will however find huge variations in academic and pseudo-academic (i.e. community programs, community affiliates, medical schools without academic medical centers) salaries and productivity requirements.

That said, although I see fewer patients than my colleagues working for non-academic institutions, you will often work more hours. supervising students and residents, mentoring, preparing didactics, curriculum development, reviewing medical school and residency/fellowship applications, writing papers, books and grants, preparing conference presentations, serving on committees, administrative activities, and professional service (e.g. reviewing papers, serving on editorial boards, serving on national committees, writing exam questions etc) which is most all uncompensated for clinician-educators takes it toll and means most people are working a lot more than if you just took an 8-5 job somewhere else.

I currently feel fairly compensated and there is more job security and decent benefits compared to colleagues in private sector who are really hurting due to COVID-19. Things are only going to get worse.
 
Last edited:
mkim27 said:
Hello, longtime lurker here. Currently in the middle of residency training and doing some financial and career planning for when I finish training to be an attending.

I've been looking at inpatient gigs in the midwest, mostly suburbs of Chicagoland area. My question is this:

Is it possible... if I'm willing to work 60+ hours, to gross $500k right out of the gate after residency by stacking a full-time inpt gig (~$250k) + locums in the late afternoon/evening for a geriatric psych unit (~$250k) and make it work, have enough energy to do a good job at both?
Click to expand...

I mean yeah you can do it.....and plenty of people do. but lets cut the crap right now about doing good at both, especially the one that is going to allow you to pop in in the evening and basically just sign charts and do crappy work.

Obviously the second of the gigs hasnt been able to find someone to come in and do a good job for a fair salary, so they are just looking to sell it off to a 'chart-signer' is what I call them. There are plenty of units run like that, but whats surprising to me is that they want to do a hospital employment situation. Usually a place like that wants to pay you a stipend and let you do the billing yourself as well. Then whoever takes the contract is free to cover it however(likely with an np during the day for a bit that you could just go and chart sign for)....

I think your best bet is to contact the second place that is allowing you to come in and chart sign and see if they will give you the contract with a stipend and you keep billings. That way you could then hire a psych np for some hours so she could see the patients during the day, and then after work you could run over and sign those charts. Thats going to be a lot better situation for both you and the hospital than a more traditional employment contract when you already have a traditional employment contract with another hospital.....
 
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