Is it really that bad???

[Doctor Bagel]

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I wonder how the other 90-95% manage to survive when they are in the same situation.

Don't you know that people who make less than $80k/year qualify for food stamps.

 

[Law2Doc]

I wonder how the other 90-95% manage to survive when they are in the same situation.

They live outside of the city and commute further. They have dual incomes. They drive a much more used car. They don't eat out as often. They drive to Florida on vacation instead of fly. And most importantly, they don't have big loans. I'm not saying you cannot live on less than six figures, as obviously most do. I'm just saying that people are throwing around the percentages like it means you are going to be rolling in it. It's simply not the case, particularly in big cities on either coast. Once you have actually earned a decent living, you will have a very different notion of what it takes to be comfortable. And you will be surprised at how little such an income actually stretches, in terms of things like savings and luxury items.

 

[Chulito]

👍
Thank god I'm not the only one who still thinks 125k is alot of money for one person to make!

I definitely agree with you, but there was a recent poll in pre-allo that asked how much money your parents make; and the mode response was 250K and up. If that is actually true, I can see how people might feel unsuccessful at that salary level.

I think that people definitely feel "punished" while going through medical training and want some recompense. If the majority of med grads really do have white collar roots, it's possible that their peers from college made more lucrative choices with easier training routes. That's about the only explanation I can come up with as to why someone would think 125K was low.

Agreed. My folks combine for about $60k/year right now, and when I was growing up we were a family of five living in a good (but not fancy) neighborhood of a fairly expensive west-coast part of the country. We were very happy and never wanted for anything. There was no vacation at the Ritz in Rio, or even in Florida for that matter, but we took vacations, went to the movies, ate out occasionally (nothing fancy) got new clothes each year, had gifts on Christmas, etc. The lifestyle to which L2D and CFDAVID have alluded may indeed be beyond most doctors, but am I to believe that only the financial wherewithal of Bill Gates is enough for true happiness? What's wrong with the Holiday Inn in Florida? It's more than most can afford.

Once you have actually earned a decent living, you will have a very different notion of what it takes to be comfortable.

I sure hope that I don't. That sounds to me like being spoiled in the purest sense of the word.

 

[Law2Doc]

What's wrong with the Holiday Inn in Florida? It's more than most can afford.

Totally agree with this. But when folks on here start getting excited about being in the top 5% of wage earners in the US, I suspect they have a more lavish lifestyle in mind. I'm just saying it usually aint so.

 

[Chulito]

Totally agree with this. But when folks on here start getting excited about being in the top 5% of wage earners in the US, I suspect they have a more lavish lifestyle in mind. I'm just saying it usually aint so.

You may be right about that. People should realize that most doctors are not at the level of LIFESTYLES OF THE RICH AND FAMOUS. My impression is usually that they feel they will be just scraping by, however, which also just ain't so.

 

[cfdavid]

I wonder how the other 90-95% manage to survive when they are in the same situation.

The other 90-95% lives with an outrageous debt load, and with an absolute lack of sufficient savings for their future. They refinance their homes during good times, and then find themselves up in sh..ts creek when the housing market turns against them. They also live with excessive financial stressors, that lead to any number of problems.

 

[cfdavid]

They live outside of the city and commute further. They have dual incomes. They drive a much more used car. They don't eat out as often. They drive to Florida on vacation instead of fly. And most importantly, they don't have big loans. I'm not saying you cannot live on less than six figures, as obviously most do. I'm just saying that people are throwing around the percentages like it means you are going to be rolling in it. It's simply not the case, particularly in big cities on either coast. Once you have actually earned a decent living, you will have a very different notion of what it takes to be comfortable. And you will be surprised at how little such an income actually stretches, in terms of things like savings and luxury items.

This too.

 

[cfdavid]

Agreed. My folks combine for about $60k/year right now, and when I was growing up we were a family of five living in a good (but not fancy) neighborhood of a fairly expensive west-coast part of the country. We were very happy and never wanted for anything. There was no vacation at the Ritz in Rio, or even in Florida for that matter, but we took vacations, went to the movies, ate out occasionally (nothing fancy) got new clothes each year, had plenty on Christmas, etc. The lifestyle to which L2D and CFDAVID have alluded may indeed be beyond most doctors, but am I to believe that only the financial wherewithal of Bill Gates is enough for true happiness? What's wrong with the Holiday Inn in Florida? It's more than most can afford.



I sure hope that I don't. That sounds like being spoiled in the purest sense of the word, to me.

I agree, and I'm playing the devil's advocate to some extent. Money does not dictate happiness, but it can make things easier PROVIDED you live within or under your means. That's key. But, most people don't do this.

 

[lilnoelle]

Totally agree with this. But when folks on here start getting excited about being in the top 5% of wage earners in the US, I suspect they have a more lavish lifestyle in mind. I'm just saying it usually aint so.

I'm one of those who thinks that doubling our income (from $60K prior to me going to med school) to $120K is a big deal. I'm used to living on less and think of the fun things I can do with more. I think people can live a "lavish" lifestyle with the above income(my definitions of lavish are much less than I'm guessing yours is) but they have to be smart about it. I plan to live the same lifestyle that I'm currently comfortable with until my loans are paid off (hopefully in 5-10 years). Then we will probably move up, but will buy things when we have the cash to buy them (other than the mortgage of course) rather than putting everything on a payment plan and trying to add everything at once. I think most people overextend themselves by doing too much at once and when they get in trouble with unforeseen expenses, they have nothing nothing to fall back on and out come the credit cards. Rather than spending the absolute minimum during those times, they maintain they're previous lifestyles and get into a world of trouble.

Obviously previous divorces/child support also could cause financial difficulty.

 

[dutchman]

Let me just jump in real fast and say: It is a rasonable expectation that physicians be in the top 5% income bracket because they also happen to be in the top 5% when it comes to debt in America. Who else starts a career with 200K debt. Add a mortgage and Car to that and you have you a hefty financial mountain only climbable with high income.

 

[Law2Doc]

Who else starts a career with 200K debt.

And add on to this, who else basically starts their (first) career 7+ years after graduating college.

 

[Chulito]

Let me just jump in real fast and say: It is a rasonable expectation that physicians be in the top 5% income bracket because they also happen to be in the top 5% when it comes to debt in America. Who else starts a career with 200K debt. Add a mortgage and Car to that and you have you a hefty financial mountain only climbable with high income.

I fully agree with this, and I believe that declining physician income is a problem that needs addressing. The years of training, the grueling hours of residency, the average debt incured, and the importance of being at the top of your game when you are working all combine to make it utterly reasonable that physicians be in the top 5% of wage earners on average. But once we're there, let's recognize it and be happy about it. Let's also band together to advocate our case when strategies for reducing health-care costs are discussed by politicians, because as it stands we are an easy and fairly defenseless target.

I think we can agree that perspective is important. It's not appropriate to be in the top 5% of wage earners in the wealthiest country on the planet, and talk of not having enough money to live comfortably. It is also foolish to imagine the life and income of a doctor as akin to the life and income of actors and athletes, princes and Kennedys, CEOs and mafia godfathers. They are a rarefied economic elite. We will be amongst the best off in the world, but we will have to budget our money, save and invest judiciously, and live within our very generous but still limited means. And we will have to work very hard for it. Understanding this is an important part of deciding that medicine is the right field for you.

 

[mjl1717]

mann I have not started medical school but everyone here sure makes it seem very gloomy...

pays gonna "suck" according to our expectations
sucks the life out of students for 4 years
then residency stinks and takes away more time depending on specialty
then loans stink to repay after medical school....

then you get out and still have to work a lot...

Idk...im begining to question at this stage if its even worth it (of course I am going to pursue it since I have been accepted and cant imagine doing anything else)....

Is it just that people are more apt to speak out about the negatives of medicine or is this just how it is??????!!!

The only happy physicians I have seen are derms and some ortho...

there are a lot of ways to answer this: Ill just add what about power mongul insurance companies and L2D will tell you what about unscrupulous lawyers. Also having a good rapport with patients may protect you, but if they can get a few bucks from you they will gladly take it! [good topic]

 

[mjl1717]

I love medical school. Yeah, it has it's rough spots (like Ob/Gyn), but even as a medical student, you get some highs you just don't get watching TV and working in banking raking in the big bucks. Here are a few:
1. The first time a patient tells you their whole life story, because you're doctor enough for them;
2. The first time you suture skin and then see the person back in the office a couple of weeks later to see a well-healed scar;
3. The first time you're doing an H&P, and as you go the differential appears in your mind, and you know what the plan is;
4. The first time you make a pick up that makes a real difference in someone's life;
5. Sitting with a patient who has just been given a life-changing diagnosis, and staying with them while they grieve;
6. The first time a patient refuses to see anyone but "my doctor", and that 'doctor' is you... and they don't care you're a student, because you're the one they want to talk to.
7. Hanging out with the very close friends you'll make over the course of your years at med school
8. Looking up at the end of a long, busy night on call, and realizing you're proud to be part of this team
9. Meeting some of the incredible, giving people who are competent and smart, for whom the patient's interest is the only interest... and working with them day after day.
10. Teaching someone a year younger than you something you know (wow! I actually know something!)
11. Having someone come up to you in the street and say "Hey, Doc! You remember me!" And you remember how a year or so ago, they were intubated in the ICU with an open abdomen and sepsis, and everyone thought they weren't going to make it.
12. During a heart transplant: looking into a patient's chest and seeing it empty, then watching while a new heart is being sewn in. And then it starts beating; and the person is awake and alert the next day.

The list could go on forever. Yeah, we all have our rough spots, but it is wonderous what we get to see and do all day.

Anka

Nice!!!!!! {many dont realize that there is more to it then $$ and the obvious}

 

[Law2Doc]

I think we can agree that perspective is important. It's not appropriate to be in the top 5% of wage earners in the wealthiest country on the planet, and talk of not having enough money to live comfortably. It is also foolish to imagine the life and income of a doctor as akin to the life and income of actors and athletes, princes and Kennedys, CEOs and mafia godfathers. We will be amongst the best off in the world, but we will have to budget our money, save and invest judiciously, and live within our very generous but still limited means. And we will have to work very hard for it. Understanding this is an important part of deciding that medicine is the right field for you.

Agree- but on SDN I have frequently struck a nerve by indicating that doctors these days can expect to be only "comfortable but not rich". There are more than a few folks on SDN (mostly in pre-allo, but a few on here as well) who actually expect to get that same kind of sports car and summer home that some rich uncle who was a physician back in the "golden age" managed to earn. And when you hear percentages like top 5%, it probably sounds possible. But it isn't for most.

All I was saying is that when you actually earn six digits, you will be living comfortably, but really quite modestly compared to most of the notions on here. No mansions, no bentleys, no summering in Ibiza, no bathing in Dom Perignon with the Doublemint twins. A fairly normal non-wealthy lifestyle.

 

[Chulito]

Agree- but on SDN I have frequently struck a nerve by indicating that doctors these days can expect to be only "comfortable but not rich". There are more than a few folks on SDN (mostly in pre-allo, but a few on here as well) who actually expect to get that same kind of sports car and summer home that some rich uncle who was a physician back in the "golden age" managed to earn. And when you hear percentages like top 5%, it probably sounds possible. But it isn't for most.

All I was saying is that when you actually earn six digits, you will be living comfortably, but really quite modestly compared to most of the notions on here. No mansions, no bentleys, no summering in Ibiza, no bathing in Dom Perignon with the Doublemint twins. A fairly normal non-wealthy lifestyle.

 

[lilnoelle]

Agree- but on SDN I have frequently struck a nerve by indicating that doctors these days can expect to be only "comfortable but not rich". There are more than a few folks on SDN (mostly in pre-allo, but a few on here as well) who actually expect to get that same kind of sports car and summer home that some rich uncle who was a physician back in the "golden age" managed to earn. And when you hear percentages like top 5%, it probably sounds possible. But it isn't for most.

All I was saying is that when you actually earn six digits, you will be living comfortably, but really quite modestly compared to most of the notions on here. No mansions, no bentleys, no summering in Ibiza, no bathing in Dom Perignon with the Doublemint twins. A fairly normal non-wealthy lifestyle.

And those of us on the other end of the spectrum hear "you'll be comfortable but not rich" and object because we're comfortable now with half or less of the income (I actually feel more than comfortable, I feel blessed). No doubt it is easy to acclamate to an increase in income, but someone who can adjust from a $60K income to $120K income and not really notice the difference is not spending their money wisely.

 

[Critical Mass]

All I was saying is that when you actually earn six digits, you will be living comfortably, but really quite modestly compared to most of the notions on here. No mansions, no bentleys, no summering in Ibiza, no bathing in Dom Perignon with the Doublemint twins. A fairly normal non-wealthy lifestyle.

Who needs the Doublemint twins when we have lilnoelle and psipsina? (Though I think we may need to explain the term Doublemint twins to the young 'uns.)

Sad to hear that I won't be bathing in Dom. The bubbles give me good vibrations.

 

[lilnoelle]

Who needs the Doublemint twins when we have lilnoelle and psipsina? (Though I think we may need to explain the term Doublemint twins to the young 'uns.)

Sad to hear that I won't be bathing in Dom. The bubbles give me good vibrations.

haha, I'm afraid I'll have to meet psipsina before I agree to such a tryst 😉

 

[TMP-SMX]

Perspective is everything...

The mind is its own place, and can make a heaven of hell, a hell of heaven

 

[Law2Doc]

but someone who can adjust from a $60K income to $120K income and not really notice the difference is not spending their money wisely.

The money goes further but not nearly as far as you think till you get there. After loans, you maybe get a place with a few more square feet or a shorter commute, a more reliable car, do a few more meals out, a few more channels on cable, get that cool PDA you've been eyeing, maybe drop a few $ into your 401k/IRA for the tax benefits, and suddenly the paycheck's pretty much gone. Moreso if you have a family and start entertaining ideas of things like private schools, nanny/daycare, a minivan, braces, college savings accounts. And you will quickly forget how you managed to do so much more with much less. Happens to almost everyone no matter how careful they plan to be. You live up to your means.

 

[Law2Doc]

(Though I think we may need to explain the term Doublemint twins to the young 'uns.)

Coors light twins sounded too wordy. And Doublemint was better alliteration with Dom Perignon. Guess I could have gone with Coors twins and Crystale...

 

[psipsina]

And those of us on the other end of the spectrum hear "you'll be comfortable but not rich" and object because we're comfortable now with half or less of the income (I actually feel more than comfortable, I feel blessed). No doubt it is easy to acclamate to an increase in income, but someone who can adjust from a $60K income to $120K income and not really notice the difference is not spending their money wisely.

I totally agree with this. My hubby and I are currently living on about 45K/year and are very very comfortable. We don't own a home because we're hoping to relocate for residency and buying a home in NOLA doesn't seem like its the strongest investment right now, and we don't really get to vacation, but we eat out multiple times a week, wear really nice clothing, have cable tv and internet, have cell phones, own a new car, have a gorgeous apartment with comfy furnishings, make groceries at whole foods etc. The idea that we could triple this income (not including any contribution from my hubby) and not be considered wealthy is ridiculous, even with the debtload. [an aside, I think there does need to be some reform for how much debt doctors incur and how long it takes to even be able to make decent payments on that debt but thats a different conversation]

I hope to always remember what not being comfortable felt like so I don't ever acclamate to my 6 figure income and think that its just no enough. I hope I remember when my tooth broke in half because I'd had a cavity forever but didn't have dental insurance, and then how I had to borrow money from a friend to be able to afford the root canal. I hope I remember when my hubby worked as a pizza maker and we lived entirely on the one pizza he could bring home for free every day for months. I hope I remember how shameful it felt when debt collectors called and there was no money to appease them. To not have to deal with these struggles is comfort. A yatch is indulgence.

I remember a physican I saw who alternated between a Hummer and a spankin new mazda sports car and yet b*tched and moaned about how he was barely making it with these puny reimbursments. I'm not saying we don't deserve to make a great living, but to equate barely making with with the state of owning a sports car and a hummer is asanine. I think attitudes like these are what make our patients feel so disconnected and misunderstood by their physicians. Many of your patients will work long hard hours their whole life and never escape a paycheck to paycheck lifestyle constantly on the brink of poverty if something goes wrong. Imagine how it looks to them when they hear about physician complaining about their 6 figure salaries not being enough for their hard work?

 

[Law2Doc]

I'm not saying we don't deserve to make a great living, but to equate barely making with with the state of owning a sports car and a hummer is asanine.

I don't beleive anyone on this thread said anything like this. Just that comfortable does not mean rich. You can get your tooth fixed with comfortable. You can eat foods other than pizza with comfortable. You can service a mortgage in a less expensive part of the country with comfortable. You cannot likely own two luxury cars such as you describe with just comfortable unless you plan to live in one.

 

[i61164]

The money goes further but not nearly as far as you think till you get there. After loans, you maybe get a place with a few more square feet or a shorter commute, a more reliable car, do a few more meals out, a few more channels on cable, get that cool PDA you've been eyeing, maybe drop a few $ into your 401k/IRA for the tax benefits, and suddenly the paycheck's pretty much gone. Moreso if you have a family and start entertaining ideas of things like private schools, nanny/daycare, a minivan, braces, college savings accounts. And you will quickly forget how you managed to do so much more with much less. Happens to almost everyone no matter how careful they plan to be. You live up to your means.

L2D is right on. Let also not forget that the more you make, the higher your tax bracket, so it's not like when your salary jumps from 60 to 120 that you actually have 60K in extra ca$h money. Your school loan will be like paying an extra mortgage (unless mommy and daddy paid your tuition). If you think that it easy to delay the "spending spree" until your loans are paid off (age 35+ if you're lucky), then why don't most doctors do it?

 

[lilnoelle]

The money goes further but not nearly as far as you think till you get there. After loans, you maybe get a place with a few more square feet or a shorter commute, a more reliable car, do a few more meals out, a few more channels on cable, get that cool PDA you've been eyeing, maybe drop a few $ into your 401k/IRA for the tax benefits, and suddenly the paycheck's pretty much gone. Moreso if you have a family and start entertaining ideas of things like private schools, nanny/daycare, a minivan, braces, college savings accounts. And you will quickly forget how you managed to do so much more with much less. Happens to almost everyone no matter how careful they plan to be. You live up to your means.

The problem still seems to boil down to a lack of gratitude for what we have. Obviously everything we spend money on will wittle down our paychecks. Its certainly that way for me now, I don't expect that to change. But I do expect myself to realize my spending limits and stay under them (as I do now) and to be grateful for everything I have (trying to remember what I didn't have before).

 

[Law2Doc]

But I do expect myself to realize my spending limits and stay under them (as I do now) and to be grateful for everything I have (trying to remember what I didn't have before).

Everybody tries this, many fail. You won't know how realistic this is until you get there - perspectives change, expenses change. I expect that years from now you will be marvelling on how you ever got by on what you used to.

 

[lilnoelle]

If you think that it easy to delay the "spending spree" until your loans are paid off (age 35+ if you're lucky), then why don't most doctors do it?

I doubt it will be easy, and I'm guessing most don't do it because of a lack of self control or because they don't feel it is important to get rid of the debt right away. Some of the need to improve lifestyle right away probably has to do with the fact that a high percentage of physicians came from wealthy families and are therefore used to the better lifestyle.
I'm sure there is also the feeling that one deserves it and should reward themself for all of the hard work. I'm sure that I will experience this too.
I don't plan on depriving myself to pay off my loans, but why would I need to be deprived, I'm comfortable now. If I can just concentrate on maintaining my current level of living, instead of adding to it, I should be able to pay off loans expediently.

 

[lilnoelle]

Everybody tries this, many fail. You won't know how realistic this is until you get there - perspectives change, expenses change. I expect that years from now you will be marvelling on how you ever got by on what you used to.

Its possible. We'll see.

 

[Doctor Bagel]

They live outside of the city and commute further. They have dual incomes. They drive a much more used car. They don't eat out as often. They drive to Florida on vacation instead of fly. And most importantly, they don't have big loans. I'm not saying you cannot live on less than six figures, as obviously most do. I'm just saying that people are throwing around the percentages like it means you are going to be rolling in it. It's simply not the case, particularly in big cities on either coast. Once you have actually earned a decent living, you will have a very different notion of what it takes to be comfortable. And you will be surprised at how little such an income actually stretches, in terms of things like savings and luxury items.

You write about them like they're mysterious people that you've heard about in fables. I don't think anybody is really asking how they survive because lots of us have first experience at not making six figures and getting by.

 

[8744]

...So even that FP making 90K is beating the 10 year engineering veteran. If you think docs don't make good money, you're crazy...

Physicians do make good money but the only engineers who work in the 50K range are the ones who never improve themselves (PE license) and never work for themselves. The money in engineering is in consulting and if you work as hard at your engineering business as you will for medical school and residency, you can do very well. I billed between 40 and 60 bucks an hour as self-employed structural and foundation engineer and I generally had enough work to keep me busy.

Seriously, if you think that residency, not to mention medical school and hundreds of thousands in debt, is worth it for $90,000 a year you need to rethink your opinion. I was probably netting $70,000 per year my last year in engineering (after expenses) and if all I could look forward to was $90,000...well...I'd be kicking myself in the ass right about now.

As some of you know, before I matched into Emergency Medicine I had to scramble and ended up in Family Medicine. My wife cried. She knew instinctively that all of the poverty, the hard work, the time away from the family which might be worth it for what an EM attending makes is so not worth it for the typical starting salary of an FP. Eight years of sliding back to make just a fraction more, if that, what I could have done as an engineer without the aggravation, the humilation, the sleep deprivation, and the general chicken-**** of medical training.

(I matched into EM last year after bailing from a certain flaming wreck which, in the interests of civility we will not mention here but which I understand is being raised from the bottom of the lake into which it crashed and is going to be refurbished.)

You folks are crazy. If medicine didn't pay so well (most specialties) it would be a dog because the training blows. I have had Q3 call, for example, for the last three weeks and I am physically ill when I go home, haven't seen the sun in a month except from my car window, and I get treated like a slave and worse by most of services on which I rotate. I have not had a day off in two week either except if you want to call a lying, cheating "post call" day as a day off (which your service often will).

It is almost impossible to eat right, exercise, or have a normal life as a resident. The schedule is so varied that you can't plan anything except in the broadest sense (i.e., I will get my car fixed when I have vacation next month).

And a prememptive "**** you" to anybody who says, "Well, it's only four years. After that it will be different."

No kidding. But you are much too casual about time and wave that four (or five, six, or seven) year around like it's four weeks or four months. Four years is a long time to be somebody's prison bitch.

And yes, to answer the OP's question, it is really that bad and don't let anybody tell you otherwise.

 

[Law2Doc]

I don't think anybody is really asking how they survive because lots of us have first experience at not making six figures and getting by.

I was responding to someone who said he "wondered" how they survive. I probably took him too literally, but wasn't the only one who answered his query.

I too have experienced multiple ends of the income spectrum, and so I am someone who can confidently say that your day to day life and appreciable level of wealth doesn't change as much as you'd think just by moving above the six digit line.

 

[Chulito]

Physicians do make good money but the only engineers who work in the 50K range are the ones who never improve themselves (PE license) and never work for themselves. The money in engineering is in consulting and if you work as hard at your engineering business as you will for medical school and residency, you can do very well. I billed between 40 and 60 bucks an hour as self-employed structural and foundation engineer and I generally had enough work to keep me busy.

Seriously, if you think that residency, not to mention medical school and hundreds of thousands in debt, is worth it for $90,000 a year you need to rethink your opinion. I was probably netting $70,000 per year my last year in engineering (after expenses) and if all I could look forward to was $90,000...well...I'd be kicking myself in the ass right about now.

As some of you know, before I matched into Emergency Medicine I had to scramble and ended up in Family Medicine. My wife cried. She knew instinctively that all of the poverty, the hard work, the time away from the family which might be worth it for what an EM attending makes is so not worth it for the typical starting salary of an FP. Eight years of sliding back to make jsut a fraction more, if that, what I could have done as an engieer without the aggravation, the humilation, the sleep deprivation, and the general chicken-**** of medical training.

You folks are crazy. If medicine didn't pay so well (most specialties) it would be a dog because the training blows. I have had Q3 call, for example, for the last three weeks and I am physically ill when I go home, haven't seen the sun in a month except from my car window, and I get treated like a slave and worse by most of services on which I rotate. I have not had a day off in two week either except if you want to call a lying, cheating "post call" day as a day off (which your service often will).

It is almost impossible to eat right, exercise, or have a normal life as a resident. The schedule is so varied that you can't plan anything except in the broadest sense (i.e., I will get my car fixed when I have vacation next month).

And a prememptive "**** you" to anybody who says, "Well, it's only four years. After that it will be different."

No kidding. But you are much to casual about time and wave that four (or five, six, or seven) year around like it's four weeks or four months. Four years is a long time to be somebody's prison bitch.

The bolded phrase is the key. The argument in this thread has not been whether a career in medicine is worth all the toil and tribulation of the training, nor whether doctors should grouse about declining reimbursement. Those issues have been periferally mentioned, but the meat of this discussion is whether the salary that you eventually will have is a damn good salary or just a comfortable living (or even less). You've mentioned a potential increase from $70k as an engineer to $90k as a beginning FP, but that is the very low end of the spectrum. FPs at the low-income community clinic where I work start at 145k (if they work full time), which is more than twice what you made as an engineer. (That is in Seattle, of course, and thus probably higher than it is in most places.) They also work good hours and uniformly love their job. As you've said, specialists and ER docs usually make considerably more than FPs, so the financial rewards, while not worthy of King Midas, are substantial.

Medical training is a terribly difficult row to hoe and often very inefficient. I will be the first to decry the unnecessary cruelty of residency, its paradoxical devaluing of the health of health-care providers, its disregard for their happiness and the well-being of their families, and the danger that it represents for patients. It is indefensible in its exaggeration, in my mind, but I'm willing to go through the system as it is because of the sort of work that I will be able to do afterwards (though it will still be very difficult work with its own drawbacks) and the satisfaction and financial rewards it will offer me. I think that doctors deserve those rewards, but they also ought to recognize where they stand in the economic hierarchy of society and not bemoan too loudly their inability to buy the Bentley when most people can't imagine being unhappy with a nice Honda.

 

[Chulito]

I was responding to someone who said he "wondered" how they survive. I probably took him too literally, but wasn't the only one who answered his query.

I too have experienced multiple ends of the income spectrum, and so I am someone who can confidently say that your day to day life and appreciable level of wealth doesn't change as much as you'd think just by moving above the six digit line.

Well, I was being both ironic and sardonic. I thought (based on the tone of your answer) that you had picked up on that. That's not to say that I meant to be insulting, mind you. But a good many of us in the 95% that I was referring to are not aware that we are having as much difficulty getting by as you've suggested. Again, it depends on your perspective, and thus quite likely on your starting point in life and the expectations you derive from that, though I suppose a person can cultivate such high standards later in life as well. I hope that I don't, because I see them as a liability in the search for happiness.

 

[Law2Doc]

FPs at the low-income community clinic where I work start at 145k (if they work full time), which is more than twice what you made as an engineer.

FWIW, $145k is way above the starting salary for FPs at most of the places I have heard of.
According to the JAMA list I posted earlier, assuming things have not changed much in the last couple of years for the better in FP (which anecdotally, and according to a NY Times article this past year they haven't), $132k is about the average salary (not starting) in FP, and one would assume "starting salary" is a bit lower than the ultimate average.

 

[Brown429]

I really like medicine and would love to become a cardiolgist but I do not want to live to work...I do not always want to be on call, I want a rich family life. I "like" dermatology because of the lifestyle and if I am fortuante enough to be able to chose that path in the future I will because of the lifestyle...you can have a normal life in residency (45-47hrs/wk) and afterwards the pay is awesome. You get patient interaction, same setup as a IM office, ect.

I like medicine and want meaning to my life, but I am selfish because I would rather have a nice lifestyle (9-5 workday, $280k+ sal, nice car, house, and time with family) than have the opposite of working 6-6, $350+ sal, and not as much time to relax. Just too much to give up.

 

[Chulito]

FWIW, $145k is way above the starting salary for FPs at most of the places I have heard of.
According to the JAMA list I posted earlier, assuming things have not changed much in the last couple of years for the better in FP (which anecdotally, and according to a NY Times article this past year they haven't), $132k is about the average salary (not starting) in FP, and one would assume "starting salary" is a bit lower than the ultimate average.

Very true. If we posit an average national starting salary of $120k, however, I think that the point still stands.

 

[Law2Doc]

I like medicine and want meaning to my life, but I am selfish because I would rather have a nice lifestyle (9-5 workday, $280k+ sal, nice car, house, and time with family) than have the opposite of working 6-6, $350+ sal, and not as much time to relax. Just too much to give up.

Just bear in mind that if a $280k salary and a 9 to 5 lifestyle are very important to you, you have a huge chance of being disappointed. Only a tiny fraction of physicians manage to get both of those. Probably the majority get neither. If those two things are nonnegotiable to you I would probably suggest a different career path, because the odds just aren't with you here, IMHO.

 

[8744]

The bolded phrase is the key. The argument in this thread has not been whether a career in medicine is worth all the toil and tribulation of the training, nor whether doctors should grouse about declining reimbursement. Those issues have been periferally mentioned, but the meat of this discussion is whether the salary that you eventually will have is a damn good salary or just a comfortable living (or even less). You've mentioned a potential increase from $70k as an engineer to $90k as a beginning FP, but that is the very low end of the spectrum. FPs at the low-income community clinic where I work start at 145k (if they work full time), which is more than twice what you made as an engineer. (That is in Seattle, of course, and thus probably higher than it is in most places.) They also work good hours and uniformly love their job. As you've said, specialists and ER docs usually make considerably more than FPs, so the financial rewards, while not worthy of King Midas, are substantial.

Medical training is a terribly difficult row to hoe and often very inefficient. I will be the first to decry the unnecessary cruelty of residency, its paradoxical devaluing of the health of health-care providers, its disregard for their happiness and the well-being of their families, and the danger that it represents for patients. It is indefensible in its exaggeration, in my mind, but I'm willing to go through the system as it is because of the sort of work that I will be able to do afterwards (though it will still be very difficult work with its own drawbacks) and the satisfaction and financial rewards it will offer me. I think that doctors deserve those rewards, but they also ought to recognize where they stand in the economic hierarchy of society and not bemoan too loudly their inability to buy the Bentley when most people can't imagine being unhappy with a nice Honda.

Medicine. 130K. So not worth it.

I mean considering the eight years of lost income from some other profession. My opportunity cost for going to medical school will be: Four years of lost salary at 70K, and four years of a 30K per year pay cut which is $400,000.

Add to that $250,000 in debt (and getting larger) for a total cost, and it is a real cost by the way, not notional because I would have made the money if I had stayed in engineering, of $650,000 or close to three-quarters of a million bucks.

considering the 60K difference in pay between engineering and FP, and not considering any fancy time-value calculations, it would be 11 years before the break-even point.

This does not take into account that while it is true I might have had a worse year as an engineer, I also could have made a lot more if I had pumped as much time into the business as I am doing now into residency where there is no financial incnetive at all to working hard.

 

[Law2Doc]

Medicine. 130K. So not worth it.

I mean considering the eight years of lost income from some other profession. My opportunity cost for going to medical school will be: Four years of lost salary at 70K, and four years of a 30K per year pay cut which is $400,000.

Add to that $250,000 in debt (and getting larger) for a total cost, and it is a real cost by the way, not notional because I would have made the money if I had stayed in engineering, of $650,000 or close to three-quarters of a million bucks.

considering the 60K difference in pay between engineering and FP, and not considering any fancy time-value calculations, it would be 11 years before the break-even point.

This does not take into account that while it is true I might have had a worse year as an engineer, I also could have made a lot more if I had pumped as much time into the business as I am doing now into residency where there is no financial incnetive at all to working hard.

I think this is actually a fairly common kind of calculation most nontrads do when deciding to go back to school. Maybe even adding in a postbac year or two to the "paycut" years. Which is why it is safe to say that very few nontrads are doing it for the money. And why you have to be genuinely interested in the practice aspect, because the financial aspects simply aren't much of a selling point.

 

[Chulito]

Medicine. 130K. So not worth it.

I mean considering the eight years of lost income from some other profession. My opportunity cost for going to medical school will be: Four years of lost salary at 70K, and four years of a 30K per year pay cut which is $400,000.

Add to that $250,000 in debt (and getting larger) for a total cost, and it is a real cost by the way, not notional because I would have made the money if I had stayed in engineering, of $650,000 or close to three-quarters of a million bucks.

considering the 60K difference in pay between engineering and FP, and not considering any fancy time-value calculations, it would be 11 years before the break-even point.

This does not take into account that while it is true I might have had a worse year as an engineer, I also could have made a lot more if I had pumped as much time into the business as I am doing now into residency where there is no financial incnetive at all to working hard.

This is all very true. But if both paths ultimately result in enough money for you to live happily, retire happily, and want for nothing, does it matter which of the two would have gotten you further beyond that point? As an extreme example, if you die with the same house, the same cars, the same toys, but $10 million in the bank instead of $15 million, does it matter? This assumes, of course, that you would have reached your minimum amount for happiness by taking either path, which may not be true.

I have found myself wishing that residents had an option B available to them, which would allow them to work 60-65 hours per week spread out evenly over 6 days (thus guaranteeing enough time to sleep and exercise properly, as well as spend a minimal amount of time with friends and family) for more years. Though I don't actually think it should be necessary, I personally would even be willing to take a proportional pay cut during residency to do so. This, of course, means more years in residency and fewer years earning the big bucks. (See Panda Bear's equation above for the consequences, then extend it to lost earning power of investments for those years.) Would other people find this preferable in spite of the lost total income over the course of a lifetime?

 

[Brown429]

280k and 9-5 is ideal and I am not going to chose a different career path... I just thought from reading derm boards and things...280k was average? I did not realize derms are open after 6PM generally? So 9-5 and 280k seem pretty good.

I mean ER docs dont always have 9-5 but they make 240k and up (varying on region) with about 40hrs a week?

so how is 9-5 280k not possible?

 

[Law2Doc]

If you die with the same house, the same cars, the same toys, but $10 million in the bank instead of $15 million, does it matter?

You need to introduce me to your broker. If I accumulate either of those amounts in my bank account I will be shocked. Lose two zeros on each of those figures, perhaps.

 

[Law2Doc]

280k and 9-5 is ideal and I am not going to chose a different career path... I just thought from reading derm boards and things...280k was average? I did not realize derms are open after 6PM generally? So 9-5 and 280k seem pretty good.

I mean ER docs dont always have 9-5 but they make 240k and up (varying on region) with about 40hrs a week?

so how is 9-5 280k not possible?

It's probably possible in derm -- the average hours are about 46 hrs/wk in that field, so some people doing that probably are working 40. But what percentage of physicians get into derm? Pretty nominal. That field has the fewest residency slots of any specialty (by design). You don't go to med school banking solely on that. You can give it a stab, but most come up short. So you'd better resolve to be happy doing something else too, if you go the medicine route. And that something else will either have non 9-5 hours or it will have a salary reduction.

ED docs can work 40 hours/week or less and earn nicely (although the average hours are also 46), but not usually 9-5. More like several overnights a week and several off days. Or graveyard shifts. Talk to Panda on the schedules for this.

 

[Chulito]

I think this is actually a fairly common kind of calculation most nontrads do when deciding to go back to school. Maybe even adding in a postbac year or two to the "paycut" years. Which is why it is safe to say that very few nontrads are doing it for the money. And why you have to be genuinely interested in the practice aspect, because the financial aspects simply aren't much of a selling point.

This is definitely true for me, except that unlike you and Panda Bear, I'm not coming from a professional career and thus have not left behind a job that pays well. Still, I've made the decision to accrue debt for four years and earn modestly for 3-5 years before I get to the point that I can begin seriously investing to provide for retirement, so the calculation of postponed gain has been very significant for me. But I'm very happy with my choice.

 

[Chulito]

You need to introduce me to your broker. If I accumulate either of those amounts in my bank account I will be shocked. Lose two zeros on each of those figures, perhaps.

Yeah, that was just an outlandish example to make a point, i.e. that once you have made all the money that you could possibly want to spend and give away, anything beyond that serves only to enhance your bragging rights in the hot tub at the gym.

 

[8744]

This is all very true. But if both paths ultimately result in enough money for you to live happily, retire happily, and want for nothing, does it matter which of the two would have gotten you further beyond that point? As an extreme example, if you die with the same house, the same cars, the same toys, but $10 million in the bank instead of $15 million, does it matter? This assumes, of course, that you would have reached your minimum amount for happiness by taking either path, which may not be true.

I have found myself wishing that residents had an option B available to them, which would allow them to work 60-65 hours per week spread out evenly over 6 days (thus guaranteeing enough time to sleep and exercise properly, as well as spend a minimal amount of time with friends and family) for more years. Though I don't actually think it should be necessary, I personally would even be willing to take a proportional pay cut during residency to do so. This, of course, means more years in residency and fewer years earning the big bucks. (See Panda Bear's equation above for the consequences, then extend it to lost earning power of investments for those years.) Would other people find this preferable in spite of the lost total income over the course of a lifetime?

You're buying what "The Man" is selling, and you shouldn't. A lot of residency training is inefficient because, seeing that hospitals can make you work incredibly long hours for peanuts, there is no incentive whatsoever to make it otherwise. A big chunk of your training time now is totally without educational value. This is inevitable, of course, because patients are unpredictable but a lot of it has to do with the way things are done.

The answer is to improve pay, shorten hours, but cut out all of the bull****. There is, however, no incentive to do this either so long as so many people will "eat a poop hotdog" to get into medical school and put themselves in the pipeline to be abused in their turn.

They have got us by the gonads, no question about it.

 

[Chulito]

You're buying what "The Man" is selling, and you shouldn't. A lot of residency training is inefficient because, seeing that hospitals can make you work incredibly long hours for peanuts, there is no incentive whatsoever to make it otherwise. A big chunk of your training time now is totally without educational value. This is inevitable, of course, because patients are unpredictable but a lot of it has to do with the way things are done.

I most definitely am not. As I've said, I don't think that it should be necessary to reduce residents' annual pay in order to shorten their weekly hours and lengthen the total number of years in residency; it may not even be necessary to lengthen the total number of years in residency if more efficient training could be implemented instead. But given (or at least assuming for now) that the system is not going to adjust this radically, the lesser of two evils for me would be humane hours for more years with less annual pay. This too is just a pipe dream, of course...

The answer is to improve pay, shorten hours, but cut out all of the bull****. There is, however, no incentive to do this either so long as so many people will "eat a poop hotdog" to get into medical school and put themselves in the pipeline to be abused in their turn. They have got us by the gonads, no question about it.

You're certainly right. I'm ready to do my tour as a resident under the current rules of the system. But only because that's the way it's done, not because I think it's effective or just.

 

[OncoCaP]

...
The answer is to improve pay, shorten hours, but cut out all of the bull****. There is, however, no incentive to do this either so long as so many people will "eat a poop hotdog" to get into medical school and put themselves in the pipeline to be abused in their turn.
...

I wonder if a significant number of medical students & residents have the courage to push for such changes in a practical way (organizing residents and having them push for real reforms)? I wonder if this has been tried in the past?

 

[Chulito]

I wonder if a significant number of medical students & residents have the courage to push for such changes in a practical way (organizing residents and having them push for real reforms)? I wonder if this has been tried in the past?

I do too, OncoCaP, I do to. Is there no residents' union? Could there be one?