Is it really that bad???

[dutchman]

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

Hence the need for a resident's union. Their own gonads are hanging out, you just need to reach out and grab it.

---

Members don't see this ad.

 

[OncoCaP]

Hence the need for a resident's union. Their own gonads are hanging out, you just need to reach out and grab it.

Anyone know anything about this ....

http://www.cirseiu.org/ourlocal/

In a landmark achievement in 1975, CIR won contractual limits for on-call schedules of one night in three. In the late 1980s and early 1990s, CIR successfully negotiated innovative maternity leave clauses, won provisions for pay for housestaff covering for absent colleagues, and in 1989 helped shape New York State's regulations that set maximum work hour limits for housestaff. Since then, CIR members have negotiated hours limitations and program security clauses in Miami, Los Angeles and Boston. These important advances have become models for improving residency programs across the country

 

[da8s0859q]

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.

I'm really hoping that something changes at least a little bit - even just a little - in the next five years or so that it'll take me to be a resident.

 

[i61164]

I was a computer programmer before med school and so I also did the opportunity cost calculation. Even though I wasn't a professional in the sense that a lawyer or engineer is, I was pulling in 70K per year. And here's the shocker: I did almost no work. I got to work late (because I would stay up late), took 2 hours for lunch, left for hours during the day to take pre med classes at a local college, and slept at my desk on a regular basis. When I was not sleeping at my desk, I was on SDN.

If doing almost nothing is worth 70K, I hope I get 200K as a hard working doctor. When you guys think about how much a doctor should get paid, you have to consider how much you would get paid in another field. Not flipping burgers at McDonalds either, because if you are smart enough to make it through med school, you are definitely smart enough to make it into middle management at a fortune 500 company where you will make 100K+, play lots of golf, and get drunk on the company dime.

 

[dutchman]

Anyone know anything about this ....

http://www.cirseiu.org/ourlocal/

In a landmark achievement in 1975, CIR won contractual limits for on-call schedules of one night in three. In the late 1980s and early 1990s, CIR successfully negotiated innovative maternity leave clauses, won provisions for pay for housestaff covering for absent colleagues, and in 1989 helped shape New York State’s regulations that set maximum work hour limits for housestaff. Since then, CIR members have negotiated hours limitations and program security clauses in Miami, Los Angeles and Boston. These important advances have become models for improving residency programs across the country

They are a great association, but membership is small and they are still in the business of "soft" negotiation. The ideal residents union should have the balls to use word "strike" without fear. I know there are a lot of scared cats out there that don't want to stick their heads out for fear of violoting the 'hypnotic' oath but times have changed and doctors need to start adapting to the new times.

A strong residents union is not only advantageous to resident doctors, but to all doctors, for example:

-If the residents union were to fight for tort reform, all doctors will benefit. Same thing with all the other government policies that affect both attendings and residents.

-The idea of residents forming a union will help doctors start learning the art of fighting, which is a skill that they lack on a grand scale.

There is an opportunity here with a residents union(which for the most part is not handicapped by antitrust laws as a general physicians union is), and physicians need to seize that opportunity.

 

[OncoCaP]

They are a great association, but membership is small and they are still in the business of "soft" negotiation. The ideal residents union should have the balls to use word "strike" without fear. I know there are a lot of scared cats out there that don't want to stick their heads out for fear of violoting the 'hypnotic' oath but times have changed and doctors need to start adapting to the new times.

A strong residents union is not only advantageous to resident doctors, but to all doctors, for example:

-If the residents union were to fight for tort reform, all doctors will benefit. Same thing with all the other government policies that affect both attendings and residents.

-The idea of residents forming a union will help doctors start learning the art of fighting, which is a skill that they lack on a grand scale.

There is an opportunity here with a residents union(which for the most part is not handicapped by antitrust laws as a general physicians union is), and physicians need to seize that opportunity.

Is anyone doing this? It just seems to me that this idea would have been thought of and tried in the past. I like to learn from past mistakes and successes when I can.

 

[Chulito]

There is an opportunity here with a residents union(which for the most part is not handicapped by antitrust laws as a general physicians union is), and physicians need to seize that opportunity.

Oh, that's interesting. I'm perfectly ignorant in these matters. Why would a residents' union not be handicapped in the same ways that a physicians' union would be? It wouldn't really be a students' union, since residents are paid. Educate me.

 

[OncoCaP]

Oh, that's interesting. I'm perfectly ignorant on these matters. Why would a residents' union not be hanidcapped in the same ways that a physicians' union would be? It wouldn't really be a students' union, since residents are paid. Educate me.

The reasons Residents and Interns can organize, whereas physicians generally cannot (at least not easily) are ...

1. Residents and Interns are employees. Most physicians are contractors (to the hospital). Contractors cannot organize easily as such, as that would be an anti-trust violation.

2. Residents and Interns are generally "worker bees" whereas physicians are generally management or supervisory. Workers can organize, whereas management and supervisors generally cannot.

However, from what I can tell, Residents and Interns generally are cautious about doing anything that will hurt their career (by angering attendings and PDs who can write them a bad evaluation or otherwise make their life even less fun than it already is).

 

[Chulito]

The reasons Residents and Interns can organize, whereas physicians generally cannot (at least not easily) are ...

1. Residents and Interns are employees. Most physicians are contractors (to the hospital). Contractors cannot organize easily as such, as that would be an anti-trust violation.

2. Residents and Interns are generally "worker bees" whereas physicians are generally management or supervisory. Workers can organize, whereas management and supervisors generally cannot.

Ahhh, interesting. Makes sense.

However, from what I can tell, Residents and Interns generally are cautious about doing anything that will hurt their career (by angering attendings and PDs who can write them a bad evaluation or otherwise make their life even less fun than it already is).

As does this. Hmmm...

 

[Law2Doc]

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?

Many of the older docs are still hostile or annoyed at the fact that the current group of residents have this 80 hour limitation. Some programs are not exactly compliant as a result. You also hear the periodic use of the phrase "air of entitlement" when negatively describing the recent crops of young doctors. All these old timers did their tour of duty and certainly don't want to pick up the slack of any hour reallocations. I doubt that any additional requested revisions by residents are going to be met with receptive ears. So you'd have to actually be willing to strike. Which would likely mean a delay in completing your residency, any stigma of a "troublemaker" that might carry, and you always run the risk that the powers that be might just say "screw it" and replace you with scabs from all those offshore schools that want in on the American dream at any price, or all those quasi-professionals (PAs, NPs, CRNAs) looking to get more autonomy. I'm not sure you are negotiating from a power position here. You have no real leverage.

 

[OncoCaP]

Many of the older docs are still hostile or annoyed at the fact that the current group of residents have this 80 hour limitation. Some programs are not exactly compliant as a result. You also hear the periodic use of the phrase "air of entitlement" when negatively describing the recent crops of young doctors. All these old timers did their tour of duty and certainly don't want to pick up the slack of any hour reallocations. I doubt that any additional requested revisions by residents are going to be met with receptive ears. So you'd have to actually be willing to strike. Which would likely mean a delay in completing your residency, any stigma of a "troublemaker" that might carry, and you always run the risk that the powers that be might just say "screw it" and replace you with scabs from all those offshore schools that want in on the American dream at any price, or all those quasi-professionals (PAs, NPs, CRNAs) looking to get more autonomy. I'm not sure you are negotiating from a power position here. You have no real leverage.

Yes, it would take someone truly courageous and with some nice alternatives to practicing as a physician to challenge long hours and lack of training during internship and residency. I couldn't see more than a small minority taking such an approach except in cities that already have a strong labor culture.

"[People] make history and not the other way around. In periods where there is no leadership, society stands still. Progress occurs when courageous, skillful leaders seize the opportunity to change things for the better.
Harry S. Truman

 

[45408]

Yeah, well, med school is hard, but where else would I rather be? I can't think of anything, so I push forward. I just hate how my brain feels like facts are about ready to fall out of my brain if I shake it too hard right before an exam.

 

[dutchman]

The reasons Residents and Interns can organize, whereas physicians generally cannot (at least not easily) are ...

1. Residents and Interns are employees. Most physicians are contractors (to the hospital). Contractors cannot organize easily as such, as that would be an anti-trust violation.

2. Residents and Interns are generally "worker bees" whereas physicians are generally management or supervisory. Workers can organize, whereas management and supervisors generally cannot.

However, from what I can tell, Residents and Interns generally are cautious about doing anything that will hurt their career (by angering attendings and PDs who can write them a bad evaluation or otherwise make their life even less fun than it already is).

Not if everyone is on the same page. The union should also be ready to stand up against any Program that witch-hunts it's members for being active union participants(there are many ways to do this). Not to mention that if the entire physician community understands the value of fighting back, they will align with a residents union.

 

[dutchman]

Yes, it would take someone truly courageous and with some nice alternatives to practicing as a physician to challenge long hours and lack of training during internship and residency. I couldn't see more than a small minority taking such an approach except in cities that already have a strong labor culture.

"[People] make history and not the other way around. In periods where there is no leadership, society stands still. Progress occurs when courageous, skillful leaders seize the opportunity to change things for the better.
Harry S. Truman

You make a very good point. It is very easy to accept status-quo, and if I have a penny for every stinking excuse I have heard on why physicians are powerless and need to accept every last piece of crap laid on them, I will be a millionaire. Note that all these excuses are comming from physicians themselves. Courage is hard to find in medicine for the simple fact that doctors recieve ~1 decade of training where they are told "comply or we will screw you". There needs to be a change in attitude IMO.

and replace you with scabs from all those offshore schools that want in on the American dream at any price, or all those quasi-professionals (PAs, NPs, CRNAs) looking to get more autonomy

A residents union will be exactly what it is: a union of all residents in the U.S regardless of where they come from(foreign or American). Plus I will like to see them replace a $7/hr surgery resident with the $60/hr NP. There is power in unionizing, the question is; do residents have the courage?

 

[baylormed]

Well, the FP's I know also work 5 days a week from about 8am to 5pm (sometimes 6pm, but never much later). They pull ~130K/year, give or take a few thousands. It doesn't sound too bad to me, because the hours are nice and the job isn't stressfull at all.

Come to rural West Texas... our FPs are the rich folk in the sticks! Some make 300K+...

Actually, I live in West Texas, which is where I know these people. It's not the "rural" part of it, but I didn't know they could make so much in those areas!

Not only that, but costs of living in this part of the country aren't that high, and you could practically buy a big, nice, luxurious house for ~200K, something you can't do in other places.

 

[Kashala]

It seems like in business fields and law fields people get layed off all the time if you get hired. Sure it is one thing to be law and be at Harvard and get recruited, in medicine the playing field is way more even atleast I hope Bottom line in medicine if you are competent you will have a job and a good one is that not right? I don't see many unemployed docs that have licences(spelling). Some people can do very well with 100kwhile to some people 100k is peanuts when you have four kids that wanna go to ivy league schools cost like 40k a year with no financial aid!!! because you make more than most Americans. If you are really interested in making money invest open a restaurant being a physician will make you be able to live comfortably period if your want more than that study your ass off and get good residency, if you look around the richest people aren't always the brighest. Don't worry about what your friends are making so much people will always make more money than other people.

 

[TRAMD]

I am a numbers, no BS kind-of-guy. Here is my impression as an intern with many physician relatives and friends.

Hours: Not bad at all during medical school. I only threatened the 80-hour work week once on my third year OB/GYN rotation. Expect 40-50 hours per week years 1-2 with 10-15 being self-directed study. Expect 30-80 hours years 3-4 with 2-10 self-directed study depending on rotation.
It is the rare few who don't have a normal life outside medicine and that is due to personality, not how busy they are. Internship will probably suck anywhere you go, but can be highly variable. Expect 50-80 hours per week, rotation dependent, and variable degrees of intrusion into your personal life. The constant fear of studying for tests is decreased, however. Residency after that is HIGHLY variable between specialties
and locations. Hours during practice vary a lot as well. You must look both at hours worked and WHEN they work. ER doctors work some of the fewest hours of all physicians, but work shifts at all times: nights, weekends, holidays . . .

Money: Try not to get careless with your loans. Realize that the average debt after medical school hovers around 100k-150k. It will be easier to keep your loans low if you are single or have a spouse that works and if you have no kids. Keep very good track of your loans, interest rates and options. Many residents defer their loans, but it is a good idea to pay what you can. For most of us it is true that you will be able to pay back your loans with little difficulty once in practice, but not for all. The best advice I heard was to live as you did in residency. Your loans should easily be paid off in less than 5 years if you can do this.

As far as salaries go, I have heard of salaries in my area ranging from 80k for a first year out of residency family doc to over $2 million for a spine specialist neurosurgeon (whom works fewer hours than the aforementioned FP). I would say, however, that it is the rare for a doctor to be outside the range of 120k-750k and that a large majority would fall into the 150k-350k range with the average being about 200k.

 

[TRAMD]

As far as the issue of easier jobs making more money . . . Yes, this is true, but . . . If you want a GUARANTEE of making good money for the rest of your life, nothing is better than being a physician. If you want to make big big bucks, go into something else, but remember . . . for every lawyer and business owner making $100 million per year there are 100+ of them making $40k. And I would bet if you talked to them, no matter what level of income, very few would describe their job as "easy". If you really want a gamble, get your real estate license. I know more people with that than a high school diploma. I swear the next person that tells me they are now a real estate agent and gives me their card . . .

I could also make an argument that someone with the intelligence and work ethic that it requires to complete medical training would almost surely be successful in anything they put that much effort into.

 

[OncoCaP]

TRAMD:
What is your impression of the future with respect to physician compensation and hours worked. Many physicians complain (55% in Texas -- TMA) about decreasing reimbursements and having to work harder / longer to maintain their pay. If this continues, it could be a challenge, don't you think?

P.S. I'm going into medicine expecting it to be a challenge. If it turns out easier than I expected, well, that's not necessarily a problem.

 

[Critical Mass]

...If you want a GUARANTEE of making good money for the rest of your life, nothing is better than being a physician...

Not buying this. If being a doc guaranteed a good salary the rest of your life, people wouldn't be running away from certain specialties kicking and screaming.

My story--mediocre feelings with my job despite a 70K salary and little hard work. Medicine? Likely less passion for the career than nearly all of my classmates, but my previous work was not going to get me ahead of my previous school loans for about 20 years. So I did this. Even if I hit a total of 200K in loans, I still realize that it is a gamble as to whether or not I will ever break even.

I've heard different responses, but I'll throw this out here. Let's say that after residency, I was able to get a job offer of say 140K or whatever. Would it at all be realistic to work out a deal in which the practice can pay 100K of my school debt plus 40K to me for two years? I know that the government does loan repayment for its low-paying jobs, but I was just curious if it was ever possible to work an agreement like this under the table in the private sector. If I just took the 140K salary, Uncle Sam would wipe half of it out before I could start paying my loans.

Panda, I am familiar with your scramble story (and the program which I will not mention out of courtesy), and I have read your blog. What I am not sure of is why you didn't pick up a simple prelim year in medicine or the like rather than going to family med. Most people I have known to scramble have done this and picked up an advanced spot later or stuck with IM for the other 2 years to specialize later. What was the advantage in doing family med if you didn't want to be a family doc? (Feel free to point me to a specific blog if you don't wanna answer here.) Other opinions on the matter are welcome too.

 

[MattD]

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.

If you plan on reaching retirement age and only having 100K saved, you are either starting work at a SIGNIFICANTLY older age than most, or you're just plain spending too much damn money.

For the record, I'm an ME, and I think it was obvious that the payroll numbers I was expressing for engineers was that of employed engineers, not private contractors. As far as money goes, let me put it this way. While I was in college, I made less than $30K per year. I lived alone in a nice apartment (no one sharing the rent), I ate out often, I purchased a new car (VW Jetta, I'll grant you it's not a Bentley ), I had health and comprehensive auto insurance, and I purchased books for school. I had cable, broadband net access, and plenty of the other little niceties of life. I was also able to save enough money to purchase an engagement ring with a diamond you can actually see. By the end of college, I had about $10K saved up in the bank (10% of L2D's hopes and dreams for retirement, apparently.) You just have to spend money on what matters to you, and not waste money on what doesn't.

As far as the earlier comments about why 100K doesn't stretch much further than the 'other people's' 50K, it's a load. The argument was basically, "100K doesn't stretch as far as 50K because if you make 100K you have the money to move into a bigger house closer to the city, upgrade your car, eat out more, save more, buy nicer things, let your spouse quit his/her job, and hire a maid." Ok, the maid was my own addition. But really, you can't tell me 100K doesn't stretch much farther than 50K for the sole reason of YOU SPEND ALL THE EXTRA ON NICER STUFF! That's plain rediculous. The fact is, if you suddenly get a raise from 50K to 100K per year, that's in the ballpark of an extra 25K per year of spendable money. Why in the world would you assume that you have to immediately go out and buy a newer, more expensive car, and a bigger house closer to the city? What's wrong with your old house? What's wrong with the car you're driving now? The problem here is the assumption that by saying "docs make good money" I'm really saying "docs are exorbitantly wealthy and can live a life of absolute luxury." That's not correct. You can't have it all (at that price anyway). I know plenty of people who make 50-75K per year, who drive nice cars but don't upgrade every year or two years, who live in nice houses but not mansions, who go on nice vacations to nice places but not 2 week cruise tours of the mediterranean every year, and who have families and kids who are not wanting for anything. These people also do not live in NYC, or Chicago, or L.A. You don't HAVE to live in the big city, ya know. But if you want to, well, you have to trade off something. If 95% of the population is living on less money, either we're living in a land of poverty or those people aren't wasting their money like some of the complainers here are. And yes, I know someone implied earlier that they ARE living in poverty, but that person was full of crap.

I think that if you're a career changer who was making 6 figures before, you have to be willing to downgrade your lifestyle considerably to go to med school. That doesn't mean you're not gonna come out making nothing in the end, it just means you accepted an opportunity cost to do something more interesting. If you were making 100K+ before school and you plan on intering primary care, obviously you're not going to get much of a raise. But if you were making 100K+ before school, you also did not stop your prior education at a B.S. in Bio Let's look at those opportunity cost calcs for an engineer again, and I'll use myself as an example. In the particular engineering job I could have accepted, I'd have netted 35-40K per year after taxes in years 1-4. I'm assuming a total tax burden of 30%, not going to bother looking up the real rates. Years 5-7 I'll give myself 55K per year, I'm assuming I was really aggressive and made it into some of the upper positions. So now I'm $315K in the hole. Add in 150K in loans I'm taking out for school, and I'm 465K in the hole. Subtract my approximately 90K I'll net in 3 years of residency and that comes out to an opportunity cost of 375K by the first day post residency. This is significantly higher than the cost to someone who did not leave undergrad with a professional degree, which is the situation for the majority of med students. Now, my hypothetical engineering job is pretty much capped at this point, so I'd still be netting 55K per year after that. But now I'm working as an FP grossing 140K (I'm using the average so I don't have to scale as the years go by), which after tax should be around 80K. So, I'm now on top of the situation by 25K per year. At that rate, I break even (excluding debt repayment) in 15 years. Am I really only planning to work for 15 years? That's 43 years old for the typical 4 year-4year-3 year education plan. If you work till you're 50, that's 175K ahead of not going to med school. If you work till you're 60, that's 425K ahead. Not too shabby, especially considering you've probably been taking 3-4 weeks per year vacation MORE than you would have as the employed engineer, who works a similar # of hours per week. So in this hypothetical, if the doc maintains the same lifestyle as the engineer, by retirement he's got half a million dollars MORE saved, assuming a 0% return on investment. if the doc decides to live a nicer lifestyle (remember the engineer is quite comfortable, so maybe this equates to having some "extravagances"?), he winds up with less saved, but probably still ahead in savings. And keep in mind this is pretty much the low end for physicians. If you go into anything other than peds, FP, or a low paying area of IM, you're going to do better than this. Also, most people will not do as well as the hypothetical engineer outside of medicine.

I say again, the money's there, maybe not in buckets, but you're gonna have plenty to buy toys with. The biggest financial drawback to medicine really is the delayed gratification aspect. I think if we could bring med school tuition costs down to the level of undergrad tuition, and maybe implement a 6 year BS/MD type program as the standard (do you REALLY need a B.S. first to be a doc, other than as a backup in case you fail?), then all the whining will have to dry up pretty quickly, as people will have lost their last excuse as to why they 'need' 300K to survive in this tough world.

 

[MattD]

I've heard different responses, but I'll throw this out here. Let's say that after residency, I was able to get a job offer of say 140K or whatever. Would it at all be realistic to work out a deal in which the practice can pay 100K of my school debt plus 40K to me for two years? I know that the government does loan repayment for its low-paying jobs, but I was just curious if it was ever possible to work an agreement like this under the table in the private sector. If I just took the 140K salary, Uncle Sam would wipe half of it out before I could start paying my loans.

I'm not sure if a tax lawyer could find you a loophole, but I'm pretty sure the loan repayment would still be considered income, and thus taxable. If you're in primary care and willing to work rurally for a few years though, there are a number of programs that will repay some or all of your loans IN ADDITION to your normal income. While that would also be taxable, you'd still come out way ahead by doing that. I'm not really sure how that would work though, as you'd be hit with a pretty enormous tax bill that year. Someone else may know more details about those programs. As far as your stated plans goes though, if there's no tax benefit, you may just want to pay down your loans over the term specified by the contract. If you have decent rates on those loans, you may do better paying your normal payment and investing the rest of your income.

 

[Law2Doc]

As far as the earlier comments about why 100K doesn't stretch much further than the 'other people's' 50K, it's a load.

You will see when you get there. It sounds better on paper than it works out in reality. As your income rises, your expenses will rise to keep pace. No way to convey this in text but it is the rare individual who doesn't wonder how s/he ever got by on less once they get there. (And no, we aren't talking luxury things like maids; mostly upgraded versions of standard boring things - that's what I mean by modest lifestyle). Of course in very inexpensive parts of the country (You are in Alabama?) I'll concede it could be a bit different, but even there I expect you will be impressed at how fairly mundane and nonextravagant expenses seem to eat up your higher income.

 

[Law2Doc]

Not buying this. If being a doc guaranteed a good salary the rest of your life, people wouldn't be running away from certain specialties kicking and screaming.

Agree. As I said on the first page, "Guaranteed is a bad word choice, and the older you get, the less you will use it. In my prior career I've worked with plenty of physicians whose practices became bankrupt (not from medmal), and their salaries literally dropped to zero. Most physicians earn over six digits, but there are really no guarantees in life".

You have very good odds of doing well, good enough for many people to risk investing 7+ years of their potential earning years in schooling and training, good enough for lenders to loan such people a couple hundred grand in student loans, but definitely not a guarantee of it. Never underestimate the ability of someone (or even a whole profession) to screw up a good thing.

 

[TRAMD]

TRAMD:
What is your impression of the future with respect to physician compensation and hours worked. Many physicians complain (55% in Texas -- TMA) about decreasing reimbursements and having to work harder / longer to maintain their pay. If this continues, it could be a challenge, don't you think?

P.S. I'm going into medicine expecting it to be a challenge. If it turns out easier than I expected, well, that's not necessarily a problem.

I can't speak for everywhere in the country as managed care is practically non-existent where I live. My true belief is not that future docs should worry so much about what specialties are going to be bad and take huge pay cuts in the future, but try to have the insight into what specialities are going to be good (such as going into radiology 10-15 years ago). I kept hearing from people that I should go into something I love and it wouldn't matter how many hours I worked or how much I made. My response is this: "No matter what I do for a career, I will enjoy the rest of my life more." I realized that lifestyle was the most important part of my decision for specialty. I didn't have the grades for derm, so I chose PM&R.

I do think there is reason for concern in general, however. Physician salaries, while still very high in general, are not keeping up with salaries in other professions. The problem is that everyone (most importantly politicians and the general public) think we make way too much, but still expect perfection in their healthcare. The money is still there, but it is being taken by HMOs, insurance companies, lawyers and drug companies. I am always annoyed to hear someone complain about "doctor" bills when that money goes into so many other pockets as well.

I am afraid the days of healthcare being about the doctor and the patient are gone. Along with this goes the days of physicians being tops in respect and in salary. This all makes me very sad. Now, with all the whining and crying out of the way, let me say this. Being a doctor is still a good job and will continue to be a good job. As evidence, I present the high number of second (like myself), third, etc generation docs in training.

I will admit that thoughts of prestidge and money have been all there was to keep me going at times (and fear of how in the heck else will I pay back these loans). These things, however, will not be sufficient motivation all the time. I am at this point rambling and will now end this post.

 

[da8s0859q]

I will admit that thoughts of prestidge and money have been all there was to keep me going at times (and fear of how in the heck else will I pay back these loans). These things, however, will not be sufficient motivation all the time. I am at this point rambling and will now end this post.

No sir, you're not rambling. Or if you are rambling, please continue your rambling! I'm one of the gazillion premedders here that worries about some of what you've said - money and the usual concerns - but I've also already decided to make lifestyle a priority concern when the match rolls around. EM, with call and hours (total more so than what shift, anyway) being what they are, has this benefit from what I understand.

Even in my comparatively inexperienced opinion, I've always been of the "there's no such thing as a poor doctor" variety, relatively speaking. It's good to see an intern supporting this.

 

[cfdavid]

I wouldn't get discouraged (and have not been myself) from entering medicine just because there are challenges to the profession. Every field has areas of concern, and with the proper organization (i.e. a strong lobby) these challenges can be overcome. As others have said, the sky never really ends up falling. And, often when these discussions take place, the many benefits of being a physician are often not part of it. So, keep it in perspective, cause there's always a lot of doom and gloom talk, which isn't bad necessarily. But, it can give the wrong impression perhaps.

 

[deleted77919]

I'm pretty sure the loan repayment would still be considered income, and thus taxable.

This is indeed correct.

 

[i61164]

I think one way to get the most bang for your buck in medicine is to go into EM or Gas. They are competitive specialties, but not to the level of derm, so I think it is possible to get into them if you want it bad enough. EM is only a three year residency and where I live there are guys clearing 250K and taking 2 weeks off per month. Granted, they are working hard on those two week on per month, but still, it can be a pretty good deal. Gas is a 4 year residency and the private practice guys here are making 400K. The chief of the dept. at this hospital told us that he has to pay his staff around 325K to work here at an academic institution. Academia likes to pay lower, but he said that any lower than 325K around here for an anesthesiologist and he would not have any employees. Basically, my point is that some specialties are a better financial investment than others. The way things are going with falling reimbursements (especially for procedures), some of these 7 year surgical residencies and 6 year internal medicine specialties aren't such a good deal when you could make just as much or more with only 3-4 years of residency in the right field.

I just wish I had any interest at all in EM or Gas. Oh well.

 

[45408]

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

ah, but most people familiar with one wouldn't be too familiar with the other

 

[Critical Mass]

This is indeed correct.

Surely there is a creative accountant around here somewhere who can help me out.

 

[45408]

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.

Just a guess, but I'm going to go ahead and say that you're probably not planning for the future the way most people in your situation (sans the part about going to be a doctor) have to plan. Meaning that you're probably not putting aside as much (or any) money for a bigger house, college funds for the kids, retirement funds, etc. Plus, you're probably not old enough to be getting hit with the really heavy insurance premiums like my parents have - $2000 a month with an annual $5000 deductible. $29,000 later, their health insurance is taken care of, for a single year. Gee, that's a nice car!

 

[45408]

I think one way to get the most bang for your buck in medicine is to go into EM or Gas. They are competitive specialties, but not to the level of derm, so I think it is possible to get into them if you want it bad enough. EM is only a three year residency and where I live there are guys clearing 250K and taking 2 weeks off per month. Granted, they are working hard on those two week on per month, but still, it can be a pretty good deal. Gas is a 4 year residency and the private practice guys here are making 400K. The chief of the dept. at this hospital told us that he has to pay his staff around 325K to work here at an academic institution. Academia likes to pay lower, but he said that any lower than 325K around here for an anesthesiologist and he would not have any employees. Basically, my point is that some specialties are a better financial investment than others. The way things are going with falling reimbursements (especially for procedures), some of these 7 year surgical residencies and 6 year internal medicine specialties aren't such a good deal when you could make just as much or more with only 3-4 years of residency in the right field.

I just wish I had any interest at all in EM or Gas. Oh well.

Hmmm, I think I'll love EM, and gas could potentially keep me interested (I've shadowed both).

 

[deleted77919]

Surely there is a creative accountant around here somewhere who can help me out.

Unfortunately the tax law is very well established on this point. I know because I had considered the same possibility.

 

[Biscuit799]

Define good money. 70K? 100K? 200K?
Guarantee? don't think so. maybe for 70K, but that's it. Pediatricians and FP's (esp in cities) quite often take home <100K/yr (less than 50% of the time, but it's still quite a chunk of the pie considering the debt and time costs). 100K? Okay, but only if a) you structure your practice right, which most doctors DON'T do bc they suck at business and don't want to get better (b) you choose a great location or (c) you go into the right specialty.
200K? don't even think about that being guaranteed at all. Even derm has a low end of the distribution curve.

 

[Biscuit799]

OP: http://www.medschoolhell.com/ www.medschoolhell.com

 

[Brown429]

so...if my salary gets cut in half...even though I would rather not, I will start doing some sort of cosmetic procedures in my field to attempt to boost up my salary. If medical insurance becomes universal...we currently are the ones that will be "suffering" because we still incurr the debt of medical school 100-200k and have salaries that are less than ideal for the future.

How much do associate deans make at medical school? Maybe I can do that part-time.

 

[Critical Mass]

How much do associate deans make at medical school? Maybe I can do that part-time.

About $120K where I go to school. The head honcho is over $300K I'm sure.

 

[Gametime]

Law2Doc & Panda Bear,

You've both gave some strong arguments on how "doctorhood" doesn't automatically equal a bucket of gold. Agreed. You also mentioned that only a tiny fraction of doctors make what I call crazy money(500k + a year). Agreed.

Besides opening up your own practice and running it like a hard-nosed business, is there any other venue to increase one's income as a physician ? Or are you totally swamped for time ? I guess what I'm asking in a roundabout fashion is, what is it that those 'filthy rich' docs do that makes them bring in those big bucks. Besides enlarging breasts(insert any Orange County plastic doc) or plying family connections-money(Senator Bill Frist).

 

[Anka]

You could always come up with something useful and patentable.

 

[dutchman]

Law2Doc & Panda Bear,

You've both gave some strong arguments on how "doctorhood" doesn't automatically equal a bucket of gold. Agreed. You also mentioned that only a tiny fraction of doctors make what I call crazy money(500k + a year). Agreed.

Besides opening up your own practice and running it like a hard-nosed business, is there any other venue to increase one's income as a physician ? Or are you totally swamped for time ? I guess what I'm asking in a roundabout fashion is, what is it that those 'filthy rich' docs do that makes them bring in those big bucks. Besides enlarging breasts(insert any Orange County plastic doc) or plying family connections-money(Senator Bill Frist).

Like any other profession, they are simply better businessmen/women. At the end of the day, a doctor has a skill that is in high demand, and a good businessman(sometimes not even the doctor) could maximize the profits from those skills. Unfortunately, most doctors never acquire business skills or instincts.

 

[Law2Doc]

Law2Doc & Panda Bear,

You've both gave some strong arguments on how "doctorhood" doesn't automatically equal a bucket of gold. Agreed. You also mentioned that only a tiny fraction of doctors make what I call crazy money(500k + a year). Agreed.

Besides opening up your own practice and running it like a hard-nosed business, is there any other venue to increase one's income as a physician ? Or are you totally swamped for time ? I guess what I'm asking in a roundabout fashion is, what is it that those 'filthy rich' docs do that makes them bring in those big bucks. Besides enlarging breasts(insert any Orange County plastic doc) or plying family connections-money(Senator Bill Frist).

A lot of those filthy rich docs got into the profession at a time when money was better and there were fewer hurdles to opening a large practice (leveraging employees makes those at the top of the pyramid rich). These days, you will generally have to work longer hours for less money. The traditional ways of making large money on the side are investment, inheritance and marriage. Few physicans have the investment acumen and spare time to earn a whole lot through investment -- you probably put money into some mutual funds and get the index. Getting on TV seems to work for some (Dr 90210), inventing the next new medical apparatus works for others. But if there were easy ways to make big bucks everybody would do it.

 

[dutchman]

OP: http://www.medschoolhell.com/ www.medschoolhell.com

So who here does disimpactions regularly?

 

[Gametime]

A lot of those filthy rich docs got into the profession at a time when money was better and there were fewer hurdles to opening a large practice (leveraging employees makes those at the top of the pyramid rich). These days, you will generally have to work longer hours for less money. The traditional ways of making large money on the side are investment, inheritance and marriage. Few physicans have the investment acumen and spare time to earn a whole lot through investment -- you probably put money into some mutual funds and get the index. Getting on TV seems to work for some (Dr 90210), inventing the next new medical apparatus works for others. But if there were easy ways to make big bucks everybody would do it.

I see. What about plain ol' hard work ? Some people work 2 or 3 jobs to save up for a house/car/retirement. Can that be duplicated in the medical field and is it a effective money-making vehicle ? I'm thinking something like working at a hospital(no need to worry about insurance etc), consulting on various medical issues for various organisations/groups, teaching on the side. Basically utilising your training and body knowledge to the maximum. Provided that you're willing to work your butt off, how high is the ceiling for average(no ivy league, no competitive speciality, etc) doctors.

Good point, dutchman. But as Law2Doc and others have mentioned, it's kind of hard to 'blossom' financially in today's difficult enviroment when running a practice. Malpractice, lawsuits, crazy insurance costs all eat in your profit margin. At the end of the day, you might find yourself with a lower income than a regular doc working for a hospital. Right ?

All speculation from my end, just a lowly premed tryna weigh the financial side of doctorhood.

 

[sirus_virus]

I see. What about plain ol' hard work ? Some people work 2 or 3 jobs to save up for a house/car/retirement. Can that be duplicated in the medical field and is it a effective money-making vehicle ? I'm thinking something like working at a hospital(no need to worry about insurance etc), consulting on various medical issues for various organisations/groups, teaching on the side. Basically utilising your training and body knowledge to the maximum. Provided that you're willing to work your butt off, how high is the ceiling for average(no ivy league, no competitive speciality, etc) doctors.

Good point, dutchman. But as Law2Doc and others have mentioned, it's kind of hard to 'blossom' financially in today's difficult enviroment when running a practice. Malpractice, lawsuits, crazy insurance costs all eat in your profit margin. At the end of the day, you might find yourself with a lower income than a regular doc working for a hospital. Right ?

All speculation from my end, just a lowly premed tryna weigh the financial side of doctorhood.

If you already work 60 hrs a week, how are you going to double or triple that and maintain your sanity?

 

[sirus_virus]

So who here does disimpactions regularly?

Doing disimpactions is symbolic of how low people will go for a medical degree.

 

[i61164]

There are ways to increase your income as a doctor. The main way is to see more patients/work longer hours. If you are willing to work 70-80 hours per week after residency you will make more than if you work only 40 hours. You can tailor your practice to focus on the things that get reimbursed better by the insurance companies. You can have mid level providers working beneath you. That way you can be the top of a mini-pyramid. If you want the money bad enough, you can find ways to get it. If you want to work 40 hours and spend more time with your family, you will still have a comfortable lifestyle, but not what I consider rich. However, if like some of the people on here have claimed, you feel that having a nice house in the suburbs, driving a new honda, and being able to buy christmas presents is being rich, then maybe you will be rich.

Just for fun, I figured out would your loan payment would be if you graduate with 150K in debt (the current avg. for private schools, public schools aren't that far behind, and the number goes up every year) and you want to pay it back in 5 years by "living like a resident" for your first five years of practice.

So assuming 150K in debt and interest of 6% (arguable) for 60 months you pay: $2,900 per month. After tax money of course. Don't forget also that if you defer your loans during residency they can grow significantly from what they were when you graduated. To take this further, assume that you pay an average tax rate of 20%. The $2900 loan payment will be $3625 of your gross income, or $43,500 of your gross annual income.

If you are one of the middle-classers that takes all loans for undergrad and med school and end up with $300,000 in debt (this is starting to happen to some people), you can double those numbers. Your gross annual income that you would have to pay to pay off your loans in 5 years would be $87,000 (assuming 6% interest of course). For most people, especially if you have a family, this is not doable. So you pay off the loans over 15 year, or 25 even. You can refinance the loans just for this purpose. So whats worse, living like a pauper for 5 years of your 30's and pay them off quick or having to still make those payments in your 50's. Pick your poison.

 

[psipsina]

Just a guess, but I'm going to go ahead and say that you're probably not planning for the future the way most people in your situation (sans the part about going to be a doctor) have to plan. Meaning that you're probably not putting aside as much (or any) money for a bigger house, college funds for the kids, retirement funds, etc. Plus, you're probably not old enough to be getting hit with the really heavy insurance premiums like my parents have - $2000 a month with an annual $5000 deductible. $29,000 later, their health insurance is taken care of, for a single year. Gee, that's a nice car!

I think having the ability to have a big house, a college fund for your kids, a retirement fund, health care, go on a vacation every year etc is the definition of wealthy. I am arguing that it is possible to be comfortable (fine but without investments and a few luxuries) at 45K/year (for a couple) that if you triple that income for a single earner you become wealthy. I think alot of premeds picture themselves in the lifestyles of the rich and famous and am pointing out its preposterous to then have a tantrum or whine when you realize that you will in fact only be wealthy.

The majority of americans fall within the spectrum of living paycheck to paycheck for their needs (i.e. no investments, no luxuries, and many without even insurance which I consider to be a need) to having to choose between having the investments or having the luxuries. Wealth is being able to cover your needs, have investments and insurance, and still be able to have a few luxuries like vacations or a bigger house. This is achievable with a single earner pulling in 125K pretax.

 

[Law2Doc]

There are ways to increase your income as a doctor. The main way is to see more patients/work longer hours. If you are willing to work 70-80 hours per week after residency you will make more than if you work only 40 hours.

The catch is that a lot of physicians are already working in the 60-70 hr/wk range and not getting close to the point that the prior poster would have described as "filthy rich". Plus, unless you work for yourself, you don't generally get the choice to work whatever hours you want based on how much you want to earn anyhow. The reimbursemt system is leading to gradually increasing hours just for most physicians to more or less stay put. And upping your hours to make more money is not really an option when you are already working long hours.

 

[45408]

If you already work 60 hrs a week, how are you going to double or triple that and maintain your sanity?

There was an article about a cardiologist in my area who was working 100+ hours every week, and he somehow managed to clear $1.7 million in a single year. No lie. Of course, there's always the possibility he was scamming people, but still.....DEFINITELY the exception.

My wife works with a transplant surgeon (who happens to be the dad of one of my classmates, I found out last week ) who has worked 100+ hours for coming up on 15 years. He rounds on all of his patients 7 days a week, and he's now the only transplant surgeon at that hospital (which is a huge one). My classmate just about never saw him when she was growing up, and he's on his second marriage. I am SURE he is making mad bank, but for what?