Job Cobbler after Residency - Advice?

[mistafab]

Hey Yall,

I'm at a time now where I'm fielding multiple offers. The issue I'm running into is my hunger for cash is high and it's influencing my decision-making too much. I'm in no pressure to sign at this time (to their dismay).

I enjoy teaching. I enjoy most psychiatry gigs (inpatient, outpatient, C/L, ED, outpatient). I am satisfied with life in general and I like to work. The thing is, I'm feeling like it might be better to put my so called "career" on hold after graduating, and just going out there and making money by working my face off. I'm considering just cobbling together many different jobs to sate the hunger, and then just decide after a year or two what I really want.

At the same time, it feels a little unsettling to consider doing the Job Cobbler gig, when nothing is as set in stone. I have my kids and family to consider so I don't want to take large risks. However, age-wise for the kids, this would be a good time to put my head down and work, leaning on my wife if I step back a bit from household stuff.

Any advice or pitfalls going the Job Cobbler route? Or advice in general? My student debt is hissing at me from the shadows (300k) - and I want to kill it ASAP so I can be free from the clutches of peonage. I am in an ivory tower kind of place so most people here would advise me differently than I think you all would. Thanks in advance.

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[TexasPhysician]

There are few jobs that are “safe”. You are not going to get fired from your own private practice and highly unlikely to be terminated from most VA jobs. Academic positions are also low on being terminated but it happens.

After that, everything is a risk. Jobs will come and go. On the flip side, there will be plenty of other jobs out there.

If you cobble jobs together, you will eventually be terminated from some. They will want to cut costs (you), or maybe they aren’t profitable enough and will go bankrupt. Either way, this path involves you periodically dropping some jobs and adding others.

 

[Sushirolls]

Kids/Wife first. Unless she explicitly states I will support you being a work-a-holic.
Kids need you at all stages.
If wife isn't can't supper support this - Don't.
Take the slower route, and accept loans will persist for while longer.

 

[bashir]

I think this is a discussion you need to have with your wife more than anyone else. I was composing a much less direct post in my head but then I read sushirolls post and sushirolls nailed it. Ignoring the wife and kids for a few years to indulge your desire to be out from under your debt strikes me as a really bad idea.

 

[bashir]

From the tenor of your post I'm concerned you won't ever "sate the hunger" and will become one of those workaholics with a poor quality of life if you aren't careful about prioritizing work-life balance at the outset of your career.

 

[dl2dp2]

There are few jobs that are “safe”. You are not going to get fired from your own private practice and highly unlikely to be terminated from most VA jobs. Academic positions are also low on being terminated but it happens.

After that, everything is a risk. Jobs will come and go. On the flip side, there will be plenty of other jobs out there.

If you cobble jobs together, you will eventually be terminated from some. They will want to cut costs (you), or maybe they aren’t profitable enough and will go bankrupt. Either way, this path involves you periodically dropping some jobs and adding others.

Agree 100%

Do one job. Then use the rest of your energy on starting a practice. Your future self will thank you.

It may be better to start with 1099 because it teaches you how to run a practice, even if it’s a by the hour inpatient job.

It took me maybe 3-6 months to realize that there’s a 50% haircut admins are taking off me. This haircut gets larger the older you get because as your PP goes filled you’ll be charging higher fees.

 

[comp1]

These are good questions! There are ways to get rid of your loans and have a regular not overworked job. I see the VA mentioned above (and it didn't even start with me). Remember that the VA offers $200k EDRP loan repayment prorated over 5 years on top of all other benefits and PSLF might wipe out the remainder if you stuck around another 5 years. Cobbling sounds, quite frankly, terrifying to me. And if you really MUST spend more time away from your wife and kids working, the VA doesn't stop you outside your tour of duty.

 

[Sushirolls]

Cobbling for some can be a money boon, and great way to work.

But if your wife is resentful - divorce - or kids have issues because your limited presence, then those feral kids and divorcing wife will cost far more money than you just earned, and now your digging out of 2 holes. Student loans and divorce (alimony + child support).

 

[Merovinge]

Job cobbler is not really a risk in psychiatry, you can always pick something up if something else falls through. That said, I agree with above. Does wife want to be out of debt as badly and want you to grind? I think it's okay to abdicate some childcare IF you both agree and want to get out of debt. I also think just working a basic 9-5 for 300kish a year will likely be just fine and have plenty of time with family. Not a right answer here, personal finance is personal, career aspirations are personal as well.

 

[annoyedpsychiatrist]

Just remember the more you make, the more you pay in taxes. At a certain point the quality of life tradeoff isnt worth it. Im making around 315k a year 8:30-4:30 and have a good quality of life.

I also have 320k in debt. However, i have roughly 6.5/10 years of pslf completed. I would guess you have 4 years of residency. If you can work for a not for profit system that has a good quality of life, you can still make good money and go the loan forgiveness route. I will let you know how this works out for me in 3.5 years. The money i would have paid in loans i just dump into index fund account and high yield savings at 5% (which heck thats only 1 percent differnece than my student loan rate anyways, not counting taxes).

You may be able to work 80 hours a week for a year or two and make good money but i promise you, eventually youll pay for it. No one can sustain an unhealthy work environment indefinitely, sooner or later it comes back to haunt them.

This is the weakness of my generation and people like us with loans, is that desire/ambition/hunger. The OP is playing the short game, but play the long game. My current trajectory, my net worth is going up at least 120-140k a year in savings, not counting return on investments/growth from my portfolio. If i can keep this path going for 15-20 years, ill be in a fairly good spot. Ultimately money does help with happiness but not past a certain point. I go on vacations every month, i door dash frequently/go out to eat, drive a nice car, have a nice place to live, etc. I dont fly first class or wear $300 dollar shirts though. Will 5 million dollar retirement make you that much happier than 4 million? Sure sometimes i really want to get there faster and i get obssessed with numbers in my head/financial possibilities but the best investment is always myself and my own happiness.

trust me it feels great being an attending and making money but it feels even better spending time with people you care about at a nice hotel laying by the pool drinking a strawberry dacquiri.

 

[clozareal]

Hey Yall,

I'm at a time now where I'm fielding multiple offers. The issue I'm running into is my hunger for cash is high and it's influencing my decision-making too much. I'm in no pressure to sign at this time (to their dismay).

I enjoy teaching. I enjoy most psychiatry gigs (inpatient, outpatient, C/L, ED, outpatient). I am satisfied with life in general and I like to work. The thing is, I'm feeling like it might be better to put my so called "career" on hold after graduating, and just going out there and making money by working my face off. I'm considering just cobbling together many different jobs to sate the hunger, and then just decide after a year or two what I really want.

At the same time, it feels a little unsettling to consider doing the Job Cobbler gig, when nothing is as set in stone. I have my kids and family to consider so I don't want to take large risks. However, age-wise for the kids, this would be a good time to put my head down and work, leaning on my wife if I step back a bit from household stuff.

Any advice or pitfalls going the Job Cobbler route? Or advice in general? My student debt is hissing at me from the shadows (300k) - and I want to kill it ASAP so I can be free from the clutches of peonage. I am in an ivory tower kind of place so most people here would advise me differently than I think you all would. Thanks in advance.

I'm in the same boat. I too have a similar amount of student loans. I'm about 1 year into my private practice and anticipate I'll be able to pay off my student loans before I hit 3 years. This is faster than if I took a PSLF job where I would need 5 years. I am also not working 40 hours a week. I do maybe 20 clinical hours a week and I'm probably making 50-75% more than most of the 40 hour a week jobs I was offered. The rest of the time I spend with my family and golfing. I'm actually ignoring my family less in this job than in fellowship and than any other employed gig. The hourly rate at the employed gig I was considering would be equivalent to 13% of what I am getting paid in private practice.

The best thing about private practice is that I get to take whatever time I want off flexibly and work more hours when my spouse's job is less demanding those days/weeks. I'm working 3-4 days a week and get to spend the rest of my time with my kid which is one of the main reasons why I'm working in the first place.

Live like a resident and pay off your student loans. It's not forever. It'll be 2-5 years and you can reach a few of your top big goals, whatever they may be. Don't teach for a few years since that won't make you money. If you enjoy all those kinds of gigs, pick the one that will pay you the highest for the least amount of hours worked. Your personality is that you probably won't be unhappy doing anything. Unfortunately, that may also mean that you want to do a bit of everything. Your first step after graduating is to stay focused so that you can be financially independent and really do what you want to do in your 40s and 50's and beyond (assuming you are in your 30s when graduating).

I will hard disagree with job cobbling. Doing two jobs is not 20 hours each. There will inevitably be spillover from each job that will feel like you're actually working 1.5 jobs rather than 1 full time job. If there's not extra spillover administratively or clinically, there will be psychologically as there are two different settings to keep track of, pay attention to, and even set shifting your thought process between two different jobs is a cognitive load. This will also take your time away from your family if not physically then mentally. Stay focused and stick to one EWYK job to reach your financial goals first.

 

[Stagg737]

Would echo the above and just add that you can always make more money, but you can't get back lost time. I hate that idea for most people as I see people who have financially screwed themselves by "living in the now" all the time, but for our field it's fortunately true that a stable income that builds a strong nest egg should generally not be a concern if you're financially responsible. It's also relatively easy to work PT past retirement and still bring in 6 figures to maintain a retirement fund for a couple of extra years.

If I were single or even didn't have kids with an low-maintenance spouse on board, I'd probably have just fed my OCPD and hustled for a few years to build a 7-figure nest egg and then move to a more laid back/academic career. My kid is still under 10 though, and other than the first 6ish months where you're mostly keeping them alive there's too much to miss out on to not prioritize them imo.

 

[clozareal]

Would echo the above and just add that you can always make more money, but you can't get back lost time. I hate that idea for most people as I see people who have financially screwed themselves by "living in the now" all the time, but for our field it's fortunately true that a stable income that builds a strong nest egg should generally not be a concern if you're financially responsible. It's also relatively easy to work PT past retirement and still bring in 6 figures to maintain a retirement fund for a couple of extra years.

I just came back from AACAP and went to a financial talk that revealed to me that psychiatrists can be woefully financially incompetent.

Yes if you have a good sized emergency fund, pay off your moderate to high interest debt, plan for/insure against financial catastrophe, and save 20% of your income over 30 years, you will likely be fine.

 

[whopper]

I've met Mistafab in person, and I can tell you if you stay in the St. Louis area the two teaching institutions aren't going to pay much. I generally tell new graduates it's not a bad idea to go into academia, but I don't know if I'd give this advice to someone in the St. Louis area especially if understandably (especially with debt) that you want to make money.

Adding to the problem I don't feel the two universities allow you to grow and the develop in the way you want to unless you're going to heavily make your focus research.

Feel free to give me call if you want me to run some ideas by me.

 

[jbomba]

Hey Yall,

I'm at a time now where I'm fielding multiple offers. The issue I'm running into is my hunger for cash is high and it's influencing my decision-making too much. I'm in no pressure to sign at this time (to their dismay).

I enjoy teaching. I enjoy most psychiatry gigs (inpatient, outpatient, C/L, ED, outpatient). I am satisfied with life in general and I like to work. The thing is, I'm feeling like it might be better to put my so called "career" on hold after graduating, and just going out there and making money by working my face off. I'm considering just cobbling together many different jobs to sate the hunger, and then just decide after a year or two what I really want.

At the same time, it feels a little unsettling to consider doing the Job Cobbler gig, when nothing is as set in stone. I have my kids and family to consider so I don't want to take large risks. However, age-wise for the kids, this would be a good time to put my head down and work, leaning on my wife if I step back a bit from household stuff.

Any advice or pitfalls going the Job Cobbler route? Or advice in general? My student debt is hissing at me from the shadows (300k) - and I want to kill it ASAP so I can be free from the clutches of peonage. I am in an ivory tower kind of place so most people here would advise me differently than I think you all would. Thanks in advance.

So I did/do this. I have like 4.5 jobs and I'm not killing myself doing them all. I am on pace to make 800k this year. If you want more details I'm happy to share via PM as not to dox myself.

 

[psychemdoc]

So I did/do this. I have like 4.5 jobs and I'm not killing myself doing them all. I am on pace to make 800k this year. If you want more details I'm happy to share via PM as not to dox myself.

I appreciate people like you [mention]jbomba [/mention] and others that share the ways it can be reasonable to pull off these numbers. There are people scared off from psych thinking the pay is low even though they like everything else. Those students, residents, and even a lot of psychiatrists need to learn these options.

 

[annoyedpsychiatrist]

So I did/do this. I have like 4.5 jobs and I'm not killing myself doing them all. I am on pace to make 800k this year. If you want more details I'm happy to share via PM as not to dox myself.

800k? Lol wow that is insane. How many hours are you working? I can only imagine the taxes youre paying on that. If youre in cali your effective tax rate would be like 45% lol. However if youre in a state with no income tax then that would be pretty awesome. Still even being taxed at 45% gives you a sizeable net pay..You could live frugally for a year and pay off student loans in a year..lol

 

[PsyDr]

One of the things I have noticed with workaholics, is that they get very good at their job, because they are there. They also lose the comfort of home, friends, and family. So they choose to return to where they feel comfortable...at work. It takes an unusual friend/spouse to remain close to someone who is never around.

 

[Stagg737]

I just came back from AACAP and went to a financial talk that revealed to me that psychiatrists can be woefully financially incompetent.

Yes if you have a good sized emergency fund, pay off your moderate to high interest debt, plan for/insure against financial catastrophe, and save 20% of your income over 30 years, you will likely be fine.

I mean, this is true of many physicians, but psychiatrists seem to be especially clueless in multiple areas of common sense for some reason. Where I'm at my colleagues all seem to have their heads on straight, but some of the docs I've met...yikes.

I've met Mistafab in person, and I can tell you if you stay in the St. Louis area the two teaching institutions aren't going to pay much. I generally tell new graduates it's not a bad idea to go into academia, but I don't know if I'd give this advice to someone in the St. Louis area especially if understandably (especially with debt) that you want to make money.

Adding to the problem I don't feel the two universities allow you to grow and the develop in the way you want to unless you're going to heavily make your focus research.

Feel free to give me call if you want me to run some ideas by me.

Out of curiosity, do you know what base pay for attendings at those programs is? I looked at several academic positions when I was applying, but surprisingly I've never seen job postings for either that I can recall. Even if it's terrible you could just live across the river in ESL, although if you do that your life expectancy may drop by a few decades...

 

[Merovinge]

800k? Lol wow that is insane. How many hours are you working? I can only imagine the taxes youre paying on that. If youre in cali your effective tax rate would be like 45% lol. However if youre in a state with no income tax then that would be pretty awesome. Still even being taxed at 45% gives you a sizeable net pay..You could live frugally for a year and pay off student loans in a year..lol

The US tax rates, even at the absolute highest tiers, are really not that bad (I know because my combined household income is similar to that person's individual earnings). Paying an extra 10-15% does not suddenly invalidate the work, this is not like living in past when the top bracket was 90%. You are still keeping well north of 50% of the income and the rest of that money is actually being put to real use, it's not as though it disintegrates. I really wish they gamified taxes and made a scoreboard for lifetime contributions a person makes to their society (that has given them so much).

 

[TheRightMedication]

One divorce, one wayward child, one stress / lifestyle related illness, and all the money you stored away is gone.

You can get rich slow and still enjoy your spouse and children. Everyone says you don't get that time back with your kids. Obvious, but it's also obvious that time flies, and if you're not very dileberate the world will eat your time and that's it - your growing child is never really going to be the same kid on that lost day as they are the next. And no amount of money you make is going to be quite like that day either.

If you can get rich fast and maintain that balance more power to you, but I know for myself, I had to choose - and even having chosen, it's still a struggle to live it out.

 

[calvnandhobbs68]

800k? Lol wow that is insane. How many hours are you working? I can only imagine the taxes youre paying on that. If youre in cali your effective tax rate would be like 45% lol. However if youre in a state with no income tax then that would be pretty awesome. Still even being taxed at 45% gives you a sizeable net pay..You could live frugally for a year and pay off student loans in a year..lol

Not to take away from whatever jobs he's found, but jbomba just graduated from residency in July, so I'm sure this is being extrapolated into entire calendar year of doing what he/she is doing right now and this isn't really an accurate assessment of how sustainable this is over the course of years, depending on how some of these contracts eb and flow. There was another thread about this but he basically does stuff like seeing tele outpatient clinic patients while being "on call" for tele ER shifts and doing corrections coverage as well. So essentially "double dipping" across multiple jobs.

I'm gonna be honest and also question how high quality some of these ER assessments are when you're trying to get to your next clinic patient you have scheduled. We used to have a similar thing in residency where we had contracted outside telepsych to see some of the patients when volume was up and it was...underwhelming. I know they made a lot of money though cause I learned how much they were charging the hospital.

I will echo everyone else that if you have younger kids, nobody ever said to themselves they wish they worked more and saw their kids less when they were little. It's actually the opposite, your kids will barely even want to see you when they're 14+ lol, go work more then.

 

[Stagg737]

The US tax rates, even at the absolute highest tiers, are really not that bad (I know because my combined household income is similar to that person's individual earnings). Paying an extra 10-15% does not suddenly invalidate the work, this is not like living in past when the top bracket was 90%. You are still keeping well north of 50% of the income and the rest of that money is actually being put to real use, it's not as though it disintegrates. I really wish they gamified taxes and made a scoreboard for lifetime contributions a person makes to their society (that has given them so much).

Eh, I'm actually more with AP on this one. If you've got two high earners making $400k each with a decent schedule, great for you. If one person is pulling in 5 figures and the other is making the rest of that $800k, then at some point you're going to question if it's really worth it to work those extra 10-20 hours to keep half (or even 65%) of what you're making. I would much rather work 40ish hours to gross $300k (probably net $190-240k) than work 60-70 hours to gross $600k (net $300-360k).

In some states (NJ, CA, HI, OR, DC) or specific locales (NYC) $800k/yr puts you just below 50% total income tax for those extra earnings. Where I'm at our total tax rate will be around 30% and effective will be around 23%. Kind of a major difference. Unless you're entire goal is to go for a high score and accumulate as much wealth as possible, at some point it's just not worth it at all and graduated tax brackets just further devalue that work.

 

[Celexa]

I don't think anyone's mentioned yet that the first year as an attending is super exhausting. I stayed where I did fellowship and it's still exhausting. Learning a new system is exhausting. Yes as a resident you know the clinical work but there's an adjustment there. If you go to a new system add in learning that places quirks. Even if both places have epic, it can be just different enough to be aggravating. You've spent four years in residency and that means four years of accumulating all the institutional knowledge that makes the day to day run smoother. You're going to have to start from scratch at each new job figuring that stuff out. The amount of time and evergy you will need in a new job to do say, one hour of patient facing, will NOT start out at the same amount of time and energy it costs you now as a pgy4 in residency. It will be more, until you settle in.

There is almost no downside to going slow initially. The jobs will be there later if you want to add stuff.

 

[comp1]

Definitely concur that first year as an attending is a lot even if you rotated at a site as a resident. You spent a lot of time learning what's important and now you're going to be spending almost as much time learning what is not.

 

[Sushirolls]

My first attending year was less exhausting than residency. I was moonlighting substantially then, and just doing one job, and not changing rotations monthly, was more relaxing. Moonlighting already took care of much of the new attending angst. That was minimal. Hence, my SDN recommendation for students to choose programs that allow moonlighting and even embrace. Programs that say nay, or put restrictions, should rank lower.

 

[Merovinge]

Eh, I'm actually more with AP on this one. If you've got two high earners making $400k each with a decent schedule, great for you. If one person is pulling in 5 figures and the other is making the rest of that $800k, then at some point you're going to question if it's really worth it to work those extra 10-20 hours to keep half (or even 65%) of what you're making. I would much rather work 40ish hours to gross $300k (probably net $190-240k) than work 60-70 hours to gross $600k (net $300-360k).

In some states (NJ, CA, HI, OR, DC) or specific locales (NYC) $800k/yr puts you just below 50% total income tax for those extra earnings. Where I'm at our total tax rate will be around 30% and effective will be around 23%. Kind of a major difference. Unless you're entire goal is to go for a high score and accumulate as much wealth as possible, at some point it's just not worth it at all and graduated tax brackets just further devalue that work.

I think it's more a frame of reference than anything else. For much of US history and for much of the developed world, having a 50% marginal rate for top 1% earning income would be considered very standard to even low, certainly not a reason to dissuade doing more work. If you are basing it solely on recent US tax brackets I can see feeling that way. Having progressive tax structure is a glue to keep society held together and we are seeing that fray away with what the ultrarich are able to do nowadays and how long term cap gains are taxed. Docs take the absolute blunt of our current tax system and if the .01% paid their fair share it would be a different picture. Alas I have 0 expectation for that to happen but do not see the tax system as a reason to work less. Work less if you want to spend more time with friends/family and/or take care of yourself.

 

[clausewitz2]

I think it's more a frame of reference than anything else. For much of US history and for much of the developed world, having a 50% marginal rate for top 1% earning income would be considered very standard to even low, certainly not a reason to dissuade doing more work. If you are basing it solely on recent US tax brackets I can see feeling that way. Having progressive tax structure is a glue to keep society held together and we are seeing that fray away with what the ultrarich are able to do nowadays and how long term cap gains are taxed. Docs take the absolute blunt of our current tax system and if the .01% paid their fair share it would be a different picture. Alas I have 0 expectation for that to happen but do not see the tax system as a reason to work less. Work less if you want to spend more time with friends/family and/or take care of yourself.

50% marginal tax rate for the top bracket is actually in the middle of the pack of developed countries, cf this chart breaking it down for the EU:

Top Personal Income Tax Rates in Europe

Denmark (55.9 percent), France (55.4 percent), and Austria (55 percent) have the highest top statutory personal income tax rates among European OECD countries.

taxfoundation.org

 

[Celexa]

My first attending year was less exhausting than residency. I was moonlighting substantially then, and just doing one job, and not changing rotations monthly, was more relaxing. Moonlighting already took care of much of the new attending angst. That was minimal. Hence, my SDN recommendation for students to choose programs that allow moonlighting and even embrace. Programs that say nay, or put restrictions, should rank lower.

I haven't had any new attending clinical angst/anxiety. I'd moonlit a ton in residency (internal, but with a great deal of autonomy). Also, we had stopped rotating after second year (schedule was the same week to week for the year, divided up by half days). I'm talking things like--how do I print? Why isn't my printer configured and I don't have access to x random thing I need. Wheres the bathroom? What meds are on this hospitals formulary? Who am I supposed to ask questions of about local mental health laws? Is that the person who actually knows the answers? Oops I was left off a relecant listerv surprise here's some extra credentialing things we forgot to tell you about. How do I see ekgs and why aren't they where they were in epic at my last place? Which local psychiatrists have good judgment and which are hacks? Which admin staff can be trusted to do what they say they will and which are less reliable than a epileptic rabbit? Where can I reliably get a good lunch? My computer setup is giving me carpal tunnel, how do I get that changed? How do I page people around here? How do I order labs outside our system? (something that recently took me, I kid you not, asking four people and at least an hour of time spread over two days...and I'm still not sure I know how. Bloody order screen looks totally different in epic with different options than at any other place I've worked). How do I forward my pager to my phone (been working on this one for longer than I care to contemplate, something apparently got screwed in the transition from trainee to attending).

Granted I do CL so there's more of this stuff than for, say, a straightforward outpatient position bc we are running all over the hosp and working with many different teams. But it's not absent in those roles either.

OP also mentions enjoying teaching, and if you take a teaching role, even if you've done a lot of supervising of juniors as a senior resident, that's it's own skill set too that has to get reworked.

All these things are meta work and logistics that are largely independent of clinical skill and either only have to be learned/done once (per instition) or ever (as an attending). But they've been pervasive and exhausting these last few months, to me at least.

 

[clozareal]

Eh, I'm actually more with AP on this one. If you've got two high earners making $400k each with a decent schedule, great for you. If one person is pulling in 5 figures and the other is making the rest of that $800k, then at some point you're going to question if it's really worth it to work those extra 10-20 hours to keep half (or even 65%) of what you're making. I would much rather work 40ish hours to gross $300k (probably net $190-240k) than work 60-70 hours to gross $600k (net $300-360k).

In some states (NJ, CA, HI, OR, DC) or specific locales (NYC) $800k/yr puts you just below 50% total income tax for those extra earnings. Where I'm at our total tax rate will be around 30% and effective will be around 23%. Kind of a major difference. Unless you're entire goal is to go for a high score and accumulate as much wealth as possible, at some point it's just not worth it at all and graduated tax brackets just further devalue that work.

Making that much money is only one piece of accumulating wealth. Someone who makes $800k could theoretically not save as much as someone who makes $400k depending on their tax strategy, savings rate, and investment portfolio.

 

[clozareal]

My first attending year was less exhausting than residency. I was moonlighting substantially then, and just doing one job, and not changing rotations monthly, was more relaxing. Moonlighting already took care of much of the new attending angst. That was minimal. Hence, my SDN recommendation for students to choose programs that allow moonlighting and even embrace. Programs that say nay, or put restrictions, should rank lower.

I moonlighted several places with several systems and learned different outpatient and inpatient practice policies during residency and fellowship. This caused me much less angst as a new attending and was highly beneficial monetarily and with confidence. Starting a private practice full time right out of fellowship provided me with enough angst, I can't imagine doing it and never having practiced independently before.

 

[Merovinge]

50% marginal tax rate for the top bracket is actually in the middle of the pack of developed countries, cf this chart breaking it down for the EU:

Top Personal Income Tax Rates in Europe

Denmark (55.9 percent), France (55.4 percent), and Austria (55 percent) have the highest top statutory personal income tax rates among European OECD countries.

taxfoundation.org

Relatively few people would face 50% rates outside of NYC/Cali. The average across the US is certainly lower.

 

[whopper]

The few people I've seen who make mondo money do so the following ways.
1-See several patients, charge a lot of money but only spend a few minutes with each patient. I don't recommend this. This will be highly frustrating, unsatisfying, will burn you out, and you're setting yourself up for a lot of patients not doing well some of whom may seek action against you for such quick and likely poor treatment.

2-Working your ass off, like 80+ hours a week. Same problems as above.

3-Build a system where you're the head. This is a great idea and if implemented well and you make such a great system more power to you if you make good money. I'm all for financial success if done honestly that will benefit society. The problem is with the nationwide shortage of psychiatrists it's going to be hard to hire anyone in most areas and you will have to settle with a lot of bad psychiatrists under your wing. While some places are the best of the best such as Meninger or Lindner, it's unrealistic to expect you'll make the next place that's so good you can get any good provider you want, but if you can do this go for it. Also your medical training will not be enough for you to get a system going. You will need expertise in more areas such as business and management.

Okay so you're not willing to make the best, in fact you're willing to be BS and just make the money. Okay, I don't approve, but I've seen people do this. IMHO not worth it still unless you know what you're doing. Also most people I've seen who do some type of unethical pay structure often times get unhappy employees who are going to leave them ASAP giving the employer the headache of having to find new people.

4-There's some gig out there that is willing to pay way more money than the usual. E.g. a prison. Fine go for it, but I've been in several prisons and jails during my forensic gigs and I do not think I would ever enjoy working at such a place every single day for years. Also I've seen several people work in such places and something happens that's utterly terrible that's directly related to the prison/jail culture. Like the doctor's tires get slashed, or patients die that were completely avoidable, but no one in the prison gives a damned about these people so despite your protests for better care no one listens to you.

5-You're so good and so highly specialized people will seek you out as an advisor. I wouldn't expect this to happen to any of your fresh graduates. This is for the best of the best such as top researcher.

6-You made some type of gig where you're selling yourself and made some type of brand and you get to sell your name on something BS like vitamins that cost 4x the usual price. Aside that most of the people I see doing this are more or less BS, this is hard to do, niches are filled.

 

[jbomba]

800k? Lol wow that is insane. How many hours are you working? I can only imagine the taxes youre paying on that. If youre in cali your effective tax rate would be like 45% lol. However if youre in a state with no income tax then that would be pretty awesome. Still even being taxed at 45% gives you a sizeable net pay..You could live frugally for a year and pay off student loans in a year..lol

I'm California. Not even close to 45%. My taxable income isn't 800k. I contribute much more to a 401k than W2 can. I take a large chunk as distribution which avoids payroll tax. I have a company car which is a deduction. Home office deduction. Rent my house to my Corp for corporate meetings which is tax free income. There's a lot of things you can do. My rate is around 36%.

I do about 40-45 hours a week..one weekend month.

 

[psychemdoc]

I'm California. Not even close to 45%. My taxable income isn't 800k. I contribute much more to a 401k than W2 can. I take a large chunk as distribution which avoids payroll tax. I have a company car which is a deduction. Home office deduction. Rent my house to my Corp for corporate meetings which is tax free income. There's a lot of things you can do. My rate is around 36%.

I do about 40-45 hours a week..one weekend month.

You run all this by accountants and lawyers to make sure it’s kosher? I never know anymore and I always worry that something is setting me up for trouble with the IRS. And my mother always told me to get screwed by anyone but the IRS. And mother knows best.

 

[jbomba]

You run all this by accountants and lawyers to make sure it’s kosher? I never know anymore and I always worry that something is setting me up for trouble with the IRS. And my mother always told me to get screwed by anyone but the IRS. And mother knows best.

Yep I have a very good long time accountant. Everything is kosher. The odds of an audit are very low. It's like worrying about sending someone into TdP because you're giving them emergency haldol. Sure it could happen but most likely won't.

 

[Stagg737]

I think it's more a frame of reference than anything else. For much of US history and for much of the developed world, having a 50% marginal rate for top 1% earning income would be considered very standard to even low, certainly not a reason to dissuade doing more work. If you are basing it solely on recent US tax brackets I can see feeling that way. Having progressive tax structure is a glue to keep society held together and we are seeing that fray away with what the ultrarich are able to do nowadays and how long term cap gains are taxed. Docs take the absolute blunt of our current tax system and if the .01% paid their fair share it would be a different picture. Alas I have 0 expectation for that to happen but do not see the tax system as a reason to work less. Work less if you want to spend more time with friends/family and/or take care of yourself.

My point is just that at higher tax brackets you're taking home a lower portion of your gross. Regardless of what loopholes you can find find, those only allow for so much leverage. At some point the time invested for the extra money earned isn't worth it, and the higher the bracket you get into the lower that income-to-time ratio becomes for straight work hours. This is more relevant than some of the stuff jbomba is talking about as I believe part of it has been him starting his own company, which enters an entirely different arena than cobbling multiple employed positions.

Making that much money is only one piece of accumulating wealth. Someone who makes $800k could theoretically not save as much as someone who makes $400k depending on their tax strategy, savings rate, and investment portfolio.

Right, but being able to take home $400k instead of $200k has more potential using those strategies. Again, the point was just that at some point taking home less per hour becomes a disincentive to doing the extra work for the money. It's the same idea as "production bonuses" that decrease after a certain number of wRVUs.

 

[Merovinge]

I'm California. Not even close to 45%. My taxable income isn't 800k. I contribute much more to a 401k than W2 can. I take a large chunk as distribution which avoids payroll tax. I have a company car which is a deduction. Home office deduction. Rent my house to my Corp for corporate meetings which is tax free income. There's a lot of things you can do. My rate is around 36%.

I do about 40-45 hours a week..one weekend month.

Everything you mentioned there is actually legit tax stuff. Not buying into crazy land easements or shifting money in tax avoidance ways. Good for you.

 

[vespers]

So I did/do this. I have like 4.5 jobs and I'm not killing myself doing them all. I am on pace to make 800k this year. If you want more details I'm happy to share via PM as not to dox myself.

I'd be interested in hearing how you strung stuff together, but your profile is private, so I can't message you.

 

[Lee Ik-jun MD]

Job cobbler is not really a risk in psychiatry, you can always pick something up if something else falls through. That said, I agree with above. Does wife want to be out of debt as badly and want you to grind? I think it's okay to abdicate some childcare IF you both agree and want to get out of debt. I also think just working a basic 9-5 for 300kish a year will likely be just fine and have plenty of time with family. Not a right answer here, personal finance is personal, career aspirations are personal as well.

family first!
enjoy the freedom from residency, where you can dictate hours.
earning $300,000 plus a year, but living a resident's life is the key to kill that student loan. Dont buy a house right away, , don't RENT a luxury apartment either and don't buy that Mercedes . Delayed gratification will get you out that hole.

 

[jbomba]

I'd be interested in hearing how you strung stuff together, but your profile is private, so I can't message you.

should be able to msg now

 

[whopper]

I've looked into the company car thing. Didn't think it was worth it, but maybe it will work out for others. I ran it by my accountant and a tax lawyer. I think what seemed a foul was you had to keep detailed logs on travel which was a pain in the butt. I to do the household office thing. While I have a separate office, my wife works in the home office, and I sometimes telemedicine out of it.

 

[clozareal]

I've looked into the company car thing. Didn't think it was worth it, but maybe it will work out for others. I ran it by my accountant and a tax lawyer. I think what seemed a foul was you had to keep detailed logs on travel which was a pain in the butt. I to do the household office thing. While I have a separate office, my wife works in the home office, and I sometimes telemedicine out of it.

Section 179 is great for tax benefits. Deducting the full cost of your car from your business income is great. There are lots of app to track your miles and starting and ending destination and will even generate an IRS-compliant reports of mileage and other deductions (e.g., Stride, Hurdlr, etc.). Going from your home office to your actual office counts.

If you talk business with your friends/other psychiatrists, you can theoretically claim that you are traveling for business meetings. Same if your spouse also travels with you if they are an employee of your business and you spend more than half the time talking about your business (who is keeping track).

 

[annoyedpsychiatrist]

family first!
enjoy the freedom from residency, where you can dictate hours.
earning $300,000 plus a year, but living a resident's life is the key to kill that student loan. Dont buy a house right away, , don't RENT a luxury apartment either and don't buy that Mercedes . Delayed gratification will get you out that hole.

honestly people always say this but mercedes are highly affordable cars when compared to other luxury brands or trucks/suvs

 

[Lee Ik-jun MD]

honestly people always say this but mercedes are highly affordable cars when compared to other luxury brands or trucks/suvs

True, but I was thinking more of an S class or a G Wagen AMG.

 

[calvnandhobbs68]

honestly people always say this but mercedes are highly affordable cars when compared to other luxury brands or trucks/suvs

I mean this is off topic but what? Dude a GLS starts at 87K and the absolute highest trim Suburban (which is one of the more expensive "non luxury" SUVs and is significantly bigger) is 83K.

When you're talking about "luxury brands" mercedes is nowhere near considered "highly affordable" unless you're looking at like Range Rovers or Porsche. What people are usually comparing them to unless you're at AMG level are Lexus, Acura, BMW, Audi, Volvo, Cadillac, etc.

 

[sloh]

honestly people always say this but mercedes are highly affordable cars when compared to other luxury brands or trucks/suvs

AMG g-wagon starting at 180k. Go big or go home!

 

[vespers]

I mean this is off topic but what? Dude a GLS starts at 87K and the absolute highest trim Suburban (which is one of the more expensive "non luxury" SUVs and is significantly bigger) is 83K.

When you're talking about "luxury brands" mercedes is nowhere near considered "highly affordable" unless you're looking at like Range Rovers or Porsche. What people are usually comparing them to unless you're at AMG level are Lexus, Acura, BMW, Audi, Volvo, Cadillac, etc.

When people make that claim, they aren't talking about comparing new top-model offerings. They're talking about used late model vehicles. Mercedes is indeed cheaper than most other luxury brands on this front.

 

[annoyedpsychiatrist]

I mean this is off topic but what? Dude a GLS starts at 87K and the absolute highest trim Suburban (which is one of the more expensive "non luxury" SUVs and is significantly bigger) is 83K.

When you're talking about "luxury brands" mercedes is nowhere near considered "highly affordable" unless you're looking at like Range Rovers or Porsche. What people are usually comparing them to unless you're at AMG level are Lexus, Acura, BMW, Audi, Volvo, Cadillac, etc.

Well it depends on what type of mercedes youre getting for one. I got a really good deal on a new mercedes a class. The a class brand new was only around $34,000. Just googling the average price of a new car it says "48,000"

If youre getting a suv sure itll run more expensive, but SUVs as a whole do.

 

[TheRightMedication]

Spending that much extra on a car is unimaginable to me. The emotional pain of putting $50k extra out on the street instead of in an investment would be unbearable. Or to just cobble one less job.