How well off can you be if you go into family medicine and graduate without debt? Financially speaking.
Life style, money, family medicine
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deleted87716
You'll be in the top 5% of all wage-earners in the country. If you're not well off, it's your fault.
Any chance for income growth? Or are doctors just stuck at 200K?
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+1... You could literally buy a helicopter twice a year and still live well...
Now that's a little farfetched hahaha
Family Medicine is versatile specialty. It depends on how hard you want to work and what opportunities you seek out. You can pick up shifts in urgent care and ED, you could consult for nursing homes, you could work in hospice. Thats just some examples. The more patients you see, they more you will make if you just stick to ouptpatient clinic. But even if you made 200,000 and never had any growth you will have amazing financial success especially if you have no debt as you said. If that's true, you are unnecessarily worrying about it. Unless you screw it up.
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deleted87716
I don't think anyone has ever been "stuck" at any given income. Physician incomes, like incomes in general, have typically increased over time. Mine certainly has.
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My mentor loves to remind me constantly of her resident salary way back when
My mentor loves to remind me constantly of her resident salary way back when
Yah, but every doctor's income increases dramatically after residencies haha, I am asking more for during the career as an attending. I don't like the idea having a fixed income ceiling.
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If you run your own office, you can hire people to work under you and grow your income. That requires solid business skills though. If you take on group or hospital leadership positions, you can get a little bit of an income boost. Ancillary services, medical directorships, etc can also boost your income. And of course, investing in things can earn you passive returns, which is the best way to live better a few years down the line indefinitely.
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deleted87716
Where are you getting this idea of a "fixed income ceiling" from...? Seriously, post links.
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Yeah I agree with Blue.
You're only fixed and limited by how many hours you want to work or how hard you want to work. Theoretically I could work 5 days of outpatient clinic per week, take every weekend urgent care shift, and never take time off for vacation and I'd probably make $400-500k a year. But then I'd probably burn out and hate life within a year.
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I might be extrapolating a little here but you seem very fixated on money. Like it was mentioned before you will be in the top 5% of earners and will make a lot of money throughout your career. You will have various options available to you to add to your income if you are smart. I see you were "pre-health (field undecided)" at least back in July 2014 which I assume to mean that in the past 3 years you have not yet started medical school. If that is correct stop.....find something else. If you are going into medicine so that you can make a ton of money and not have a "fixed income ceiling" don't do it. There are plenty of other ways and careers that will make you more money with less headache than medicine.
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As with any career or specialty, it is going to depend entirely on you, on what you are willing / able to do in order to shape the conditions in which you practice.
If you are asking, "How much can I make if I do what everyone else is doing?" Then the answer is probably "What everyone else is making."
If you are willing to explore practice / compensation models and run your own practice the range runs from "Loose your shirt" to "Make out like a bandit" depending upon your business acumen.
If you are willing to be a nomad and go where the compensation is best, doing locums, you can probably earn 50-200% more for the year than you would in a regular salaried position, depending upon how many hours you are willing to put in, and under what conditions.
Over all, if you are looking for outlier incomes, you have to do outlier things to make that happen. You are likely to find that there are reasons that those are outlier behaviors, or else everyone would be doing them.
If you are asking, "How much can I make if I do what everyone else is doing?" Then the answer is probably "What everyone else is making."
If you are willing to explore practice / compensation models and run your own practice the range runs from "Loose your shirt" to "Make out like a bandit" depending upon your business acumen.
If you are willing to be a nomad and go where the compensation is best, doing locums, you can probably earn 50-200% more for the year than you would in a regular salaried position, depending upon how many hours you are willing to put in, and under what conditions.
Over all, if you are looking for outlier incomes, you have to do outlier things to make that happen. You are likely to find that there are reasons that those are outlier behaviors, or else everyone would be doing them.
Thanks for the insight, but I have heard that one too many times. Medicine DOES guarantee solid steady income compared to any other careers out there that doesn't require luck. Plus, I have already started med school and I like the subjects that I am studying, I just care a little bit more about money than any other medical students out there who claim that they "would work for free and wouldn't even think about earning more money as a physician because that's bad". Why do I care about money? Because I want to be able to live comfortably on top of being able to do the same thing my parents did for me: paying for my tuition so I can get out into the job field without a massive education debt.
Average FM salary is around 190 to 200 in most areas. After taxes (depending on where you live) that's about 10500 to 11 k per month if you don't contribute to retirements. If you put 20% into retirement that would lower your effective tax rate and therefore you would have around 8500 to 9000 left over. Something in that range.
That seems like a bunch of money but not really. You have lost out on about 10+ years of earning power and in the investment world time and compounding are what matter most along with low fees. So in my opinion you would be fine but you should live on about 4000 grand a month and put half of what's left over into more retirement and investment accounts and the rest into saving for a home down payment.
And I don't think you are fixated on money. Money is important. Very important. That doesn't mean you shouldn't be a good doctor but if the money is ignored you get taken advantage off by the man.
But if you have the grades go into something that pays more.
I know of very very few FM docs that make anywhere near 400 to 500k. And yes if you are a businessman and do well in the business of medicine you can make that. But to think that the average FM doc is going to do that is not reality. Not even close.
So be realistic. Remember that if you are in a specialty that makes 400 to 500k on a regular schedule you can make 600 to 700K working extra hard. So that argument can be used for anything.
If you make 100K and work extra hard, get no sleep and don't spend money on anything you may make 200k.
Also, the business of medicine is getting tougher. Private offices are getting harder to open and maintain. Most DPC practice docs make anywhere from 200 to 300 once they build up the clients. That's another 3 to 5 years where you will be making 150k working extra hours until your DPC practice takes off.
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Most, like 80% are stuck at around 200k. Those are facts. FM does not pay much compared to some other specialties.
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That's not even close to true. Go take a look at MGMA data and report back to the class.
The following the most recent Merritt Hawkins report on salaries. They are considered by most to be the most realistic research into salaries and job. Time for you to go back to school. You will notice the average salary is 210 for fp. There are FP's making 150 and a few making 250 or more. It's by region. Also look at the end. See how much the NP's are making or 1/3 of the time in education and risk and much less hours worked. So there you go. Np makes 119k. There are FP's making 150 full time in some regions. What the hell are you talking about. I said "stuck around 200k". Based on the fact below, which class did I miss?
Average Salaries for Top Five Most Requested Specialties by Region
Northeast
Midwest/Great Plains
Southeast
Southwest
West
Family Medicine
$210,000
$224,000
$222,000
$239,000
$231,000
Psychiatry
$237,000
$248,000
$237,000
$268,000
$257,000
Internal Medicine
$212,000
$238,000
$240,000
$271,000
$242,000
Hospitalist
$205,000
$247,000
$281,000
$282,000
$256,000
Nurse Practitioner
$119,000
$119,000
$97,000
$120,000
$117,000
Here is another for you from North Carolina.
Physician - Family Practice's Annual Base Salary
Job Title Salary Location Date Updated
Physician - Family Practice $179,845 Asheville,NC January 30, 2017
Physician - Family Practice $170,285 Burlington,NC January 30, 2017
Physician - Family Practice $183,802 Cary,NC January 30, 2017
Physician - Family Practice $172,389 Chapel Hill,NC January 30, 2017
Physician - Family Practice $186,453 Charlotte,NC January 30, 2017
Physician - Family Practice $179,814 Concord,NC January 30, 2017
Physician - Family Practice $175,353 Durham,NC January 30, 2017
Physician - Family Practice $174,897 Fayetteville,NC January 30, 2017
Physician - Family Practice $190,310 Gastonia,NC January 30, 2017
Physician - Family Practice $176,816 Greensboro,NC January 30, 2017
Physician - Family Practice $172,359 Greenville,NC January 30, 2017
Physician - Family Practice $175,357 Hickory,NC January 30, 2017
Physician - Family Practice $184,989 High Point,NC January 30, 2017
Physician - Family Practice $151,897 Jacksonville,NC January 30, 2017
Physician - Family Practice $180,173 Kannapolis,NC January 30, 2017
Physician - Family Practice $183,802 Raleigh,NC January 30, 2017
Physician - Family Practice $172,359 Rocky Mount,NC January 30, 2017
Physician - Family Practice $183,635 Salisbury,NC January 30, 2017
Physician - Family Practice $163,341 Wilmington,NC January 30, 2017
Physician - Family Practice $172,359 Wilson,NC January 30, 2017
Physician - Family Practice $184,989 Winston Salem,NC January 30, 2017
Not even 200k.
What classroom are you in?
I see this data, but from personal experience those seeing patients 4.5-5 days/week are making 250-300k. Family medicine also has a significant number part time physicians. In my office, only the 8/16e physicians are even full time. Some work 3-4 days (patient care + admin) week where this data makes more sense.
And what do you recommend people do instead? I wholeheartedly concur that derm, GI, Cards are insanely better compensated, they are also hard to get into.
I couldnt do psych, nor deal with what ER is (ER IS NOT LIFESTYLE). and go hear the griping on the Anesthesia form. Surgery and surgical subspecialities are callings (ENT, ORTHO, Plastics are also insanely hard to do). doing radiology involves giving up patient care which is a HUGE decision.
I guess something like neuro, PM&R ?
I know endo, nephro, ID, rheum doctors compensated less than straight primary care with a job landscape that is vastly inferior.
What exactly is this promised land that people should go to?
And what do you recommend people do instead? I wholeheartedly concur that derm, GI, Cards are insanely better compensated, they are also hard to get into.
I couldnt do psych, nor deal with what ER is (ER IS NOT LIFESTYLE). and go hear the griping on the Anesthesia form. Surgery and surgical subspecialities are callings (ENT, ORTHO, Plastics are also insanely hard to do). doing radiology involves giving up patient care which is a HUGE decision.
I guess something like neuro, PM&R ?
I know endo, nephro, ID, rheum doctors compensated less than straight primary care with a job landscape that is vastly inferior.
What exactly is this promised land that people should go to?
The original post asked if he could live a good life on an FP salary. So I showed his potential life with real numbers. 250 is possible and 300 less likely in most FM practices. If you are going to see 35pts per day it fine but how long do you think you can keep that up and what quality do you think your patients will have on 35 patients per day. In fact most patient are complaining about that and that's why some docs are opening DPC practices.
So I simply replied to the original post with some facts. And I said if he has the grades he should consider something else.
The solution to the low salary is to get paid more. But FM's would rather argue how wonderful it is to be an FM and look down on anyone who brings up salaries. It's like they live in another universe.
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So the fact that averages are above $220k for everywhere except the Northeast means salaries are "stuck around 200k" to you?
Oh, and had you looked harder at that Merritt Hawkins paper, you'd have seen that salaries as a whole for FM went up 13% from 2015.
Going back further, from 2010 through 2014 there has been a steady rise in average income for FPs - 175k in 2010 to 199k in 2014.
If you look at MGMA data (the most recent I have is 2014), you'll see a marked increase in median salary for years practicing. It makes sense: the longer you practice the more patients you see so the more money you make.
Look, I'm not trying to sell medical students on family medicine by saying we make bunches and bunches of money. Compared to many other specialties, we don't. But in today's climate, it is very easy to start over 200k and have that increase over time.
Let's run some numbers. Let's say you work 4.5 days/week and work 44 weeks per year (that's 8 weeks off including holidays). If you see 22 patients/day, that's 4356 patient encounters/year. Let's further say that between procedures and proper coding, you average 1.25 wRVU per patient (it should be higher, but that's a safe number). So you now have 5445 wRVU/year. The going rate in my area is still between 40-45 depending on location, so let's go with 40. That's 218k/year. If 3 years later you negotiate your contract to pay $42/wRVU, that jumps to 229k/year. If you're really good and convince them to pay you $45/wRVU now you're pulling in $245k/year. That doesn't include any quality bonuses, moonlighting, or any other income sources. Lots of doctors I know will do a shift in a system-wide weekend clinic or urgent care. Typically at $100/hr for 8 hours. Do that once/month and you're getting another $9600/year. So now your 218k/year becomes 227k/year.
Heck, run those same numbers at 40/wRVU but work 5 days per week instead of 4.5. If you change nothing else, that's now 242k/year.
Is this ortho or derm money? Of course its not, but I'll gladly take $220,000/year for 4.5 days per week with 5 weeks of vacation, benefits, CME money, bankers hours, low malpractice risk, evenings/weekends off, never setting foot in the hospital again, never working on another holiday, easy patient volume.
But what about student loans, you say. Well, most places nowadays offer quite a bit of loan repayment. In fact, according to that Merritt Hawkins survey you mentioned average loan forgiveness (usually with a 3 year contract) was 88k. Even with the 300k loans many students have, that knocks out right around 30% of that loan.
So no, family medicine won't likely have you making the 500k that ortho or neurosurgery make or even the 400k that a busy general surgeon or OB can make. But our call is by phone, we have a pretty sweet lifestyle, and we have regular hours.
Oh, and had you looked harder at that Merritt Hawkins paper, you'd have seen that salaries as a whole for FM went up 13% from 2015.
Going back further, from 2010 through 2014 there has been a steady rise in average income for FPs - 175k in 2010 to 199k in 2014.
If you look at MGMA data (the most recent I have is 2014), you'll see a marked increase in median salary for years practicing. It makes sense: the longer you practice the more patients you see so the more money you make.
Look, I'm not trying to sell medical students on family medicine by saying we make bunches and bunches of money. Compared to many other specialties, we don't. But in today's climate, it is very easy to start over 200k and have that increase over time.
Let's run some numbers. Let's say you work 4.5 days/week and work 44 weeks per year (that's 8 weeks off including holidays). If you see 22 patients/day, that's 4356 patient encounters/year. Let's further say that between procedures and proper coding, you average 1.25 wRVU per patient (it should be higher, but that's a safe number). So you now have 5445 wRVU/year. The going rate in my area is still between 40-45 depending on location, so let's go with 40. That's 218k/year. If 3 years later you negotiate your contract to pay $42/wRVU, that jumps to 229k/year. If you're really good and convince them to pay you $45/wRVU now you're pulling in $245k/year. That doesn't include any quality bonuses, moonlighting, or any other income sources. Lots of doctors I know will do a shift in a system-wide weekend clinic or urgent care. Typically at $100/hr for 8 hours. Do that once/month and you're getting another $9600/year. So now your 218k/year becomes 227k/year.
Heck, run those same numbers at 40/wRVU but work 5 days per week instead of 4.5. If you change nothing else, that's now 242k/year.
Is this ortho or derm money? Of course its not, but I'll gladly take $220,000/year for 4.5 days per week with 5 weeks of vacation, benefits, CME money, bankers hours, low malpractice risk, evenings/weekends off, never setting foot in the hospital again, never working on another holiday, easy patient volume.
But what about student loans, you say. Well, most places nowadays offer quite a bit of loan repayment. In fact, according to that Merritt Hawkins survey you mentioned average loan forgiveness (usually with a 3 year contract) was 88k. Even with the 300k loans many students have, that knocks out right around 30% of that loan.
So no, family medicine won't likely have you making the 500k that ortho or neurosurgery make or even the 400k that a busy general surgeon or OB can make. But our call is by phone, we have a pretty sweet lifestyle, and we have regular hours.
Money is damn important. And its in our best interest that every FM doctor out there values him/herself as they should, and doesnt accept the first lowball offer they're given by some hospital system. I had a friend refuse to negotiate for a job I had gotten an extra 20k base salary out of (SAME EXACT JOB). He still works there. I can only shrug. Your criticism that some look at this profession as only a calling and not in anyway as a financial endeavor is true. It is also true that some also could not see themselves matching into anything else.
I agree if you have interests that are satiated by something else and you can do them, go for them, however I think you need to take a clear view of what is actually "better".
works hours, calls, weekends responsibilities are real and I honestly think only a few specialties are clearly superior in this regard. others require you to do work fundamentally different that what I envisioned myself doing/being as a physician.
Just one common example which I keep throwing around:
You can see 20 patients/day 5 days a week with no call and weekends and make 240k (before 401k match, pension, bonus, loan repayment) at kaiser and they are desperate for PCPs
Im not trying to be adversarial, but would you have rather done than FM?
I think you make some excellent point. We do have to compare apples to apples as much as possible.
To those doctors who don't see themselves as doing something else, I say that is great. Just don't sell yourself short.
Kaiser does offer that. And, most kaiser docs are not very happy but most tend to refer quite a lot (and that's ok). I get the feeling they are waiting for the pension to kick in and then bye bye.
Fair enough. So tell me why it is that there are soooo many unhappy FM docs. I run into them everyday. That does not count the medical forums they are on. Several I know off just went DPC after 20 years in practice.
Many are quit to do non-clinical work. The latest survey for in medicine found that 57% of FM docs would go into medicine again but would not choose FM. If it's so great why so much dissatisfaction?
Some financials: lets say the FM puts away 40K per year for 30 years compounded at 8%. That would be about 4.9million at 30 years. Some have a pension and at 20 years they can go part time.
The specialist that can put away 200k for 18 years at 8% can walk away with 8 million. That 12 years less time. Should it really be like that? I don't believe so. Some have a pension and at 20 years they can live like kings.
Most FM's keep harping like you on how great it is to be one. Lifestyle etc. But you know what, when you turn 62 and still have to see 30 patients a day its not that great.
This is true, but for a guy to put away 200k year they have to make 450-500. This is common in surgical subspecialties, derm, GI and maybe interventional cards. If you can do one of these things, go for it.
The days of this being radiology, anes, ER money are declining with corporate medicine making inroads. In reality these people will make in the low 300s. If you love any of those things go for it. But from a purely financial standpoint radiology with fellowship (everyone has at least 1) takes 6 years, Anes takes 4-5 and ER takes 3-4. ER is the money play here if you like it. But you will work nights and weekends and the work will be more stressful than anything else.
Correct. The point of that exercise was that we need to keep corporate medicine out. We need to fight like hell to keep our salaries above 300K.
If I was a kaiser doc. I would take the easy cases and refer all the rest because I make nearly the same for a multidrug DM, HTN case as I would for a simple HTN case. In fact I could see two of those and make more in the time I see one of the latter. If that's how corporate wants to play it. So be it. I'll make my 250 or whatever and walk out with the least charting possible and the most pay for simple cases.
Exactly.
And it's costing you money. That NP can do at least 1/2 of your job for 1/2 the money.
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There is nothing wrong with going into medicine for career stability and a higher income and I did not mean to insinuate otherwise. I meant that as you transition out of medical school and into residency/fellowship and into attending-hood you will see that it is not what people think that it is. Like what was said earlier you will be a high income earner and will have the ability to do well for your self and your family. Physicians are notorious for being bad investors and engaging in questionable financial endeavors in an attempt to supplement earnings so you should be careful. Again as others have said there are several things that you can do to earn more than the average but it will come with harder work on your part. I would recommend meeting with a financial advisor or two to talk about what you can do with your money in order to be able to do the things that you want.
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Easy: increased bureaucratic burden and increasing patient volume. If, like many of us do, you keep volumes reasonable (20-25/day), have a decent EMR, and have someone helping with the paperwork (usually an MA), that satisfaction rate goes up markedly.
Plus, there is a large element of "grass is greener" to it.
The point I was attempting to make is that money isn't everything. FPs make decent money. Its rarely yacht or Lamborghini money, but its week at the beach, nice house, Disney World every few years money while still saving enough to have a decent retirement. And we do it working fewer hours with little/no weekends or holidays compared to our specialist colleagues.
I have a cousin who is a hand surgeon. He easily makes 2.5-3X what I do. But he has overnight call 1:5, and since that's a level 1 trauma center he keeps busy on his call nights. His days run 6am-6pm, M-Th, Friday usually done by 3pm or so if no call. Works out to one weekend/month at the hospital. Usually 2 major holidays per year as well.
Would I like to make that much money? Sure, that would be very nice. Would I rather have that extra weekend/month, 15 hours/week, and every holiday with my children? No question.
Ok. My point is your not going to be able to keep volumes very reasonable in the near future. And, those basic cases won't be around much because someone with 7 to 8 years less training can treat them. The you will have to see 40 a day or 25 complicated cases. Many are already doing that.
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deleted87716
I'll take mine without butter. but with salt.
The argument first was that Fam Med people didnt make that much, then turned into corporate medicine sux and now sits at "MIDLEVELS ARE GONNA TAKE YER JOBS"
The argument is the same. It's just and extension of all the problems in primary care. They are not going to take your job. You just won't make as much because they can do 1/2 your job for much less.
NP's and PA's are loving it. They get to see maybe 15 -- 20 patients per day. Take care of basic HTN, DM, Acne etc. Nothing complicated. If there is something complicated they get to refer it out or run to daddy for help. No real board cert., moc or other BS. And, they get to make 120k doing it with 1/2 the time in school and no real residency. In the meantime they take 1/2 your basic cases from you and you get stuck with the complicated cases. Can you say burnout?
So the remedy is to stand up and say no. or play the game and refer out like the NPs/PA if your close to retirement or until you find something better in the non-clinical world.
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No one I know is doing that. In fact in my area the hospitals are taking midlevels out of primary care.
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Now that's just wrong, no butter indeed.
I know. It sucks. It's a lactose thing.
I hope you are right. Personally I don't ever want to work a hospital system but it seems they are buying practices left and right. But then that was the trend in the 90's until it wasn't. We will see how the new and improved healthcare system will work out in the next couple of years and see if this trend will continue.
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Worst case is we go all socialized medicine, but you'll notice all the countries that do that don't have the midlevel problem that we do.
The way things are now, hospitals are actively trying to attract patients by being better than their competition. They've realized that you don't do that with midlevels, especially in the era of high deductibles. If you're paying $120 to be seen, getting stuck with the NP is going to piss you off more than if you just have your $10 copay.
I think it's going to swing the other way. Hospital charge way more for one visit than independent docs. The new healthcare system (if it happens and stays the same for longer than 4 years) is going to recognize that.
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I certainly hope so as I would love to see a return of private practice.
But even then, if you charge less for midlevel visits then the profit margin you get from them shrinks quite a bit. Its like I said - the socialized countries that really pay attention to cost don't use midlevels. If we really focus on prices here, you'll see most doctors take a paycut and midlevels will start getting cut out all together.
In the region I work, they took away patient panels from midlevels. If there is one in a PCP office, they are maybe doing outreach via the phone. Most work in the specialties doing very narrow tasks ie joint injections, assisting in surgeries, helping with PFT, stress tests etc. Even in a controlled system like Kaiser, people have a say in who their PCP is and when they believe the person hasnt helped them and they want to see another doctor and/or a specialist, what may look like a lower cost initially can be very expensive.
Part of it scope of practice and training. Primary care use to do lots of things. I know most of us don't want to do surgery in the O.R or deliveries but many places frown upon us doing extensive management of disease. They want us to refer to specialist. Frankly I don't care at this point but if I was coming out of residency I would care because it devalues us.
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Who says there is a "fixed income ceiling"? That's your own mind holding you back. I have my permanent job with a base salary but then there are the bonus checks and RVU's plus I pick up extra shifts elsewhere since my perm job overhired and there are no longer extra extra shifts locally. I still have some side locums gigs and without working too hard I added 100K to my base pay this year so went over 300K gross.
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