dmblue

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First, let me address the math...

Lets go with your 120-200K range for 4 years of Med school. We can't just ignore living expenses. Lets estimate 25K/year for living expenses. That puts the med school debt at 220-300K.

The rest of the grad school stipend should not be incorporated, because it goes straight to living expenses during those years. You don't just accumulate this money in savings.

So now we have 220-300k in debt, assuming no scholarships and living in a more expensive city.

I don't think it's safe to assume 7 years for md phd. 8 is more realistic at most schools. Therefore you would have 4 years of income, making an MD have to earn 55,000 to 75,000 in excess of cost of living expenses to break even. (I think this is completely doable for most physician's incomes)

On top of this, you are assuming that an MD/PhD will earn as much as an MD, while in reality they make less. (I think)

It doesn't make financial sense do go the MD/PhD route.


Although, I guess you could take into account that if you have college loans there are programs to get your loans massively reduced for going into academics.
 

littlelovefry

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say the average MD student has to borrow 70k per year for tuition, and say they add on 30 k per year living expense. so after 4 years, 400 k of debt. say they will add 100k of interest to that debt, so they are at -500 k when entering residency.

say the average MDPHD gets a stipend of 25 k. at the end of 7-8 years they enter residency at +175 to +200k.

say they both go into equally lucerative careers (which is not usually the case but whatever). say it takes each of them 20 years to get to the top of their earning potential. say at the top of their career they are making 300k. Now, realize that the MDPHD will have started the career 3-4 years later so assuming equal start and retirement age for MD vs MDPhD, you will subtract subtract 3 or 4 times top earning years (here 300k per year) from the MDPHD. so in the end of the day we have

MD: -500 K + lifetime earnings
MDPHD: +175 to 200 K - 900 or 1200 k + lifetime earnings

(lifetime earnings here same for both) so clearly MD comes out ahead, and i think i overestimated amount borrowed by MD, and also an MD interested in earning high can go over 300 k, and so to them the lost 3-4 years of PhD would have been better spent as years at the top earnings point of their career - where 3 to 4 years could earn a few million.
 

RxnMan

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say the average MD student has to borrow 70k per year for tuition, and say they add on 30 k per year living expense. so after 4 years, 400 k of debt. say they will add 100k of interest to that debt, so they are at -500 k when entering residency...
Those tuition and living expense numbers are ridiculously high (unless you go to Tufts). And you can do the compound interest calculation.

The other numbers - 250k total - are closer to the truth, and that includes living expense, though that is on the high end too.
 

Shifty B

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say the average MD student has to borrow 70k per year for tuition, and say they add on 30 k per year living expense. so after 4 years, 400 k of debt. say they will add 100k of interest to that debt, so they are at -500 k when entering residency.

say the average MDPHD gets a stipend of 25 k. at the end of 7-8 years they enter residency at +175 to +200k.
So, let's clear one thing up. Your conclusion is right but your numbers are off in both directions. No school has 70k tuition. Including living expenses, most people borrow <70k per year. Total loan amounts at the end of 4 years can reach the 200-300s but I've never heard of 500k in loans. So, at the end of your MD you have 200-300k in loans.

But you can't DOUBLE count those living expenses by acting like MD/PhDs deposit their stipend in the bank and have 200k in the bank at the end of 8 years. Most MD/PhDs finish with approximately ZERO dollars in the bank. Depending on their location, funding situation, and family situation, some even finish with loans.

So, the real difference is that MDs finish with a -300k balance at the bank and MD/PhDs with a 0 balance. MDs have 4 additional years during which they can offset that difference at their peak salary. Anything that they make over the 25k that we were making as PhD students goes toward that difference. If they make $100k/yr those 4 years (very modest income in most specialties, even in academics), the 300k balance is evened out. Most people can make more, even much more.

Intellectually, it may FEEL much worse to have -300k in loans but the time more than offsets any pure financial benefits of the MD/PhD program. If any fool out there isn't truly interested in MD/PhD probrams but thinks that it would be worth it to get your med school paid for, let me clear that one up for you: IT'S NOT WORTH IT.

The real financial benfit of an MD/PhD program is that you can do something that you love for 8 years while making a modest salary without having to worry about accumulating debt that will affect your choice of future career.
 

sluox

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So, the real difference is that MDs finish with a -300k balance at the bank and MD/PhDs with a 0 balance. MDs have 4 additional years during which they can offset that difference at their peak salary. Anything that they make over the 25k that we were making as PhD students goes toward that difference

Intellectually, it may FEEL much worse to have -300k in loans but the time more than offsets any pure financial benefits of the MD/PhD program. If any fool out there isn't truly interested in MD/PhD probrams but thinks that it would be worth it to get your med school paid for, let me clear that one up for you: IT'S NOT WORTH IT.

The real financial benfit of an MD/PhD program is that you can do something that you love for 8 years while making a modest salary without having to worry about accumulating debt that will affect your choice of future career.
but isn't that exactly the financial benefits of mdphd? Counting how much money you'll make when u retire seems rather silly when your living standards post mdphd is often better than post mdonly. And u might be able to afford a family. This program is designed such that u don't need to worry too much about money.
 

alacast

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The real financial benfit of an MD/PhD program is that you can do something that you love for 8 years while making a modest salary without having to worry about accumulating debt that will affect your choice of future career.
This. Getting paid for 8 years of learning cool stuff, after which you have a plethora of options available to you and the complete financial freedom to choose between them, is the bee's knees. With a debt-funded MD, you have significantly restricted career options after graduation, including the fact that you need to get a well paying job to pay off that debt. But if you were specifically planning on doing that anyway, as most MDs are, then it's not a big deal. If you don't want options or possibilities, then they aren't valuable.
 

echod

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Total loan amounts at the end of 4 years can reach the 200-300s but I've never heard of 500k in loans. So, at the end of your MD you have 200-300k in loans.
Don't forget the 6.8% interest rate! Also remember that only $85,00/year is interest free while you are in school. 4 years (med school)+(4-6 years residency) along with that 6.8% interest can almost double a student loan-->think $500K--$600K total expenses instead of $200-$300K.
 

alacast

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$85,000 != $8,500. If you can get $85k subsidized per year you have no need to worry about interest, as it doesn't accrue during medical school and residency. You'd also be making nice money off of throwing most of that into a CD and not touching it until after you finish your training.
 

Shifty B

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Don't forget the 6.8% interest rate! Also remember that only $85,00/year is interest free while you are in school. 4 years (med school)+(4-6 years residency) along with that 6.8% interest can almost double a student loan-->think $500K--$600K total expenses instead of $200-$300K.
$85,000 != $8,500. If you can get $85k subsidized per year you have no need to worry about interest, as it doesn't accrue during medical school and residency. You'd also be making nice money off of throwing most of that into a CD and not touching it until after you finish your training.
Some of the rules are changing about subsidizing interest during residency. I don't have loans, so I'm not intimately familiar with the exact way this works out. Interest is real, but even if it contributes an extra $100k to the cost the argument is the same. The extra 4 years of peak salary more than makes up for it. There is no long-term financial benefit to pursuing the MD/PhD.

Getting paid for 8 years of learning cool stuff, after which you have a plethora of options available to you and the complete financial freedom to choose between them, is the bee's knees.
Exactly what I meant!

but isn't that exactly the financial benefits of mdphd? Counting how much money you'll make when u retire seems rather silly when your living standards post mdphd is often better than post mdonly. And u might be able to afford a family. This program is designed such that u don't need to worry too much about money.
I don't really think that md-only graduates have significantly different living standards than MD/PhD graduates. And I'm not talking about how much money you have when you retire. I'm talking about how much money you'll have at say, age 45. This is when you'll want a nice house, nice car, and send your kids to a nice school. By this time, most MDs could have paid off their loans with their 13 years of attending/PP salaries. MD/PhDs will likely have had 9 years or so of attending level salary.
 

echod

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I don't really think that md-only graduates have significantly different living standards than MD/PhD graduates. And I'm not talking about how much money you have when you retire. I'm talking about how much money you'll have at say, age 45. This is when you'll want a nice house, nice car, and send your kids to a nice school. By this time, most MDs could have paid off their loans with their 13 years of attending/PP salaries. MD/PhDs will likely have had 9 years or so of attending level salary.

Does 125K-175K feel very different than 225K-450K when it comes to standard of living? How different are they?
 

RxnMan

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...Intellectually, it may FEEL much worse to have -300k in loans but the time more than offsets any pure financial benefits of the MD/PhD program. If any fool out there isn't truly interested in MD/PhD probrams but thinks that it would be worth it to get your med school paid for, let me clear that one up for you: IT'S NOT WORTH IT.

The real financial benfit of an MD/PhD program is that you can do something that you love for 8 years while making a modest salary without having to worry about accumulating debt that will affect your choice of future career.
What a rational post. I completely agree.

but isn't that exactly the financial benefits of mdphd? Counting how much money you'll make when u retire seems rather silly when your living standards post mdphd is often better than post mdonly. And u might be able to afford a family. This program is designed such that u don't need to worry too much about money.
No - you're going to get 40k-60k/yr as a resident. The MD/PhD will still be in school at that time (i.e. MD will be on resident salary when the MD/PhD is still on 25k-30k student stipend). Even when a MD/PhD becomes a resident, they'll still be on the same resident salary as their MD colleagues of the same PGY.
 

RxnMan

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Does 125K-175K feel very different than 225K-450K when it comes to standard of living? How different are they?
Again, 450k is way out in the high end of debt.

Your standard of living and how fast you pay off your debt is basically about controlling your spending and what plan you enact to pay it off (10-yr vs 30-yr, etc.).
 

gbwillner

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No, it doesn't all all work. You should NEVER do the MD/PhD for the money.
1. Ultimately it doesn't really pay out. Assuming four additional years of training means you will be 4 years older before making a real paycheck. Even if you have to pay for med school and have loans, you pay them off slowly over time. You won't care as much about paying them off while earning 6 figures. That means you will have a comfortable, non-student lifestyle at least 4 years earlier. That is the most tangible financial difference. You can play with the numbers all you want, but this is probably the bottom line.
2. With the PhD you will have to do a LOT OF HARD WORK. If your heart is not in it, you will suffer A LOT trying to complete it.
3. Career outcomes are typically different in the two pathways. While you have a lot of options as an MD/PhD, your standard, physician-scientist outcome is not on the same payscale as a private practice DOC. It's really apples and oranges. Let me give you a personal example- albeit anecdotal. I am doing s short-track residency after my 8 yr MD/PhD. I am finishing my second year of residency, with no debt. I was even able to save a little money, but I have at least 2 more years before I start earning asst. Prof. money. I may have to be an instructor first. 2 weekends ago I went to a med school friend's wedding. He's finished residency and working in rad onc PP earning 400K/yr. Another friend is working his butt off in derm, earning 1.2 mil/yr 2 years out of residency. Now you tell me, if it was only about the money, how would I have come out ahead in this deal? My rad onc friend just bought a mercedes C55 because he felt like it, and my derm friend- he could have a Ferrari if he wanted. My car is 8 yrs. old!
4. The MD/PhD is not as helpful landing a competitive specialty as getting AOA and good step I scores. Why spend 4 years on a PhD when you can just study harder for a damned test? Furthermore, as Neruonix frequently points out, if may not even help at all in some cases or be detrimental (i.e., Rads at Penn). And none of this helps AT ALL in the end when you are trying to land a job. You want a job in a pseudo-rural derm practice where you can earn 1.2 MIL working 70 hrs/wk? You think the partners care how many JBC papers you published? They don't- they'll think your an idiot for wasting your time, and instead hire your cocky colleague who's more fun at parties. THem's the breaks.
Bottom line is don't do the PhD unless you love science, and think the idea of biopsying rashes and handing out topical steroids to countless individuals sounds like hell.
 

solitude

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No, it doesn't all all work. You should NEVER do the MD/PhD for the money.
1. Ultimately it doesn't really pay out. Assuming four additional years of training means you will be 4 years older before making a real paycheck. Even if you have to pay for med school and have loans, you pay them off slowly over time. You won't care as much about paying them off while earning 6 figures. That means you will have a comfortable, non-student lifestyle at least 4 years earlier. That is the most tangible financial difference. You can play with the numbers all you want, but this is probably the bottom line.
2. With the PhD you will have to do a LOT OF HARD WORK. If your heart is not in it, you will suffer A LOT trying to complete it.
3. Career outcomes are typically different in the two pathways. While you have a lot of options as an MD/PhD, your standard, physician-scientist outcome is not on the same payscale as a private practice DOC. It's really apples and oranges. Let me give you a personal example- albeit anecdotal. I am doing s short-track residency after my 8 yr MD/PhD. I am finishing my second year of residency, with no debt. I was even able to save a little money, but I have at least 2 more years before I start earning asst. Prof. money. I may have to be an instructor first. 2 weekends ago I went to a med school friend's wedding. He's finished residency and working in rad onc PP earning 400K/yr. Another friend is working his butt off in derm, earning 1.2 mil/yr 2 years out of residency. Now you tell me, if it was only about the money, how would I have come out ahead in this deal? My rad onc friend just bought a mercedes C55 because he felt like it, and my derm friend- he could have a Ferrari if he wanted. My car is 8 yrs. old!
4. The MD/PhD is not as helpful landing a competitive specialty as getting AOA and good step I scores. Why spend 4 years on a PhD when you can just study harder for a damned test? Furthermore, as Neruonix frequently points out, if may not even help at all in some cases or be detrimental (i.e., Rads at Penn). And none of this helps AT ALL in the end when you are trying to land a job. You want a job in a pseudo-rural derm practice where you can earn 1.2 MIL working 70 hrs/wk? You think the partners care how many JBC papers you published? They don't- they'll think your an idiot for wasting your time, and instead hire your cocky colleague who's more fun at parties. THem's the breaks.
Bottom line is don't do the PhD unless you love science, and think the idea of biopsying rashes and handing out topical steroids to countless individuals sounds like hell.

1.2 million in derm two years out of residency, are you for real? I admire the guy for working hard but it is absolutely insane that our system facilitates people making that much money in derm. Unless he is treating Stevens-Johnson reactions all day long or something.
 

gbwillner

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1.2 million in derm two years out of residency, are you for real? I admire the guy for working hard but it is absolutely insane that our system facilitates people making that much money in derm. Unless he is treating Stevens-Johnson reactions all day long or something.
Yes, I'm serious, and it's probably more like pimple-popper MD.
 

Neuronix

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1.2 million in derm two years out of residency, are you for real? I admire the guy for working hard but it is absolutely insane that our system facilitates people making that much money in derm. Unless he is treating Stevens-Johnson reactions all day long or something.
It's not so much our system supporting that. It's probably mostly out-of-pocket cosmetic stuff. This is why Derm and Plastics are so popular--it's widely viewed they're untouchable by perceived future lower salaries due to healthcare reform.
 

gonogo

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No, it doesn't all all work. You should NEVER do the MD/PhD for the money.
1. Ultimately it doesn't really pay out. Assuming four additional years of training means you will be 4 years older before making a real paycheck. Even if you have to pay for med school and have loans, you pay them off slowly over time. You won't care as much about paying them off while earning 6 figures. That means you will have a comfortable, non-student lifestyle at least 4 years earlier. That is the most tangible financial difference. You can play with the numbers all you want, but this is probably the bottom line.
2. With the PhD you will have to do a LOT OF HARD WORK. If your heart is not in it, you will suffer A LOT trying to complete it.
3. Career outcomes are typically different in the two pathways. While you have a lot of options as an MD/PhD, your standard, physician-scientist outcome is not on the same payscale as a private practice DOC. It's really apples and oranges. Let me give you a personal example- albeit anecdotal. I am doing s short-track residency after my 8 yr MD/PhD. I am finishing my second year of residency, with no debt. I was even able to save a little money, but I have at least 2 more years before I start earning asst. Prof. money. I may have to be an instructor first. 2 weekends ago I went to a med school friend's wedding. He's finished residency and working in rad onc PP earning 400K/yr. Another friend is working his butt off in derm, earning 1.2 mil/yr 2 years out of residency. Now you tell me, if it was only about the money, how would I have come out ahead in this deal? My rad onc friend just bought a mercedes C55 because he felt like it, and my derm friend- he could have a Ferrari if he wanted. My car is 8 yrs. old!
4. The MD/PhD is not as helpful landing a competitive specialty as getting AOA and good step I scores. Why spend 4 years on a PhD when you can just study harder for a damned test? Furthermore, as Neruonix frequently points out, if may not even help at all in some cases or be detrimental (i.e., Rads at Penn). And none of this helps AT ALL in the end when you are trying to land a job. You want a job in a pseudo-rural derm practice where you can earn 1.2 MIL working 70 hrs/wk? You think the partners care how many JBC papers you published? They don't- they'll think your an idiot for wasting your time, and instead hire your cocky colleague who's more fun at parties. THem's the breaks.
Bottom line is don't do the PhD unless you love science, and think the idea of biopsying rashes and handing out topical steroids to countless individuals sounds like hell.
Very good post. Just wanted to add a couple of things that could be helpful to those considering md/phd vs md. While you can say that md/phd will take about 8 years, there's no accurate way of predicting duration. It may as well take 9 years (as was my case), in fact, longer depending on the field you decide to do your phd on. I have a friend who spent 7 years on the phd part. This may be unusual, but can happen. So you have to keep it in mind.
I also wanted to underscore one thing that was said in the post above. Most straight MDs in PP will regard md/phds as weird. So it's totally correct to assume that those lucrative PP jobs will be easier to get for straight MDs. If one thing is clear to me is that an md/phd is not financially rewarding. You'll be well in your mid 30s and will still be living on a resident's salary.
 
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It's the early money that matters most. MDs come out ahead financially because they can earn real salaries sooner, invest money earlier, and rake in compounding interest from those early investments.

For example:

If you invest $10,000 per year at a 6% interest rate for 40 years, you'll end up with $1.64 million in your retirement account.

If you have the same investment plan, but start investing 4 years later (thanks, PhD!), you end up with $1.26 million in your account.

(Interest compounded annually, total earnings calculated here)

Note that apart from the $10,000/year investments, this comparison doesn't take into account the extra four years of salary at your top earning potential.

It's true that your student loans are also accruing interest, no doubt about it, but even making those payments you should still be ahead financially as an MD-only.

Just my $0.02.... Sorry, couldn't resist. I'm weak. :laugh:
 

bd4727

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Does 125K-175K feel very different than 225K-450K when it comes to standard of living? How different are they?
This is basically the difference (in a major US city) between renting a small average apartment in an okay area versus owning a nice medium sized apartment in a nice area and having a car. Its a huge difference.
 

echod

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This is basically the difference (in a major US city) between renting a small average apartment in an okay area versus owning a nice medium sized apartment in a nice area and having a car. Its a huge difference.
One would need 150K to rent a small average apartment in an okay area of a major US city like Boston, New York, Seattle, San Fran, LA, etc? Things are that expensive?
 

CielloStelatto

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that was my exact reaction! I have a decent 2br (granted not 100% downtown chicago) on a 31k salary. I don't feel the need for a $5000 fancy shmancy apartment.
 

Neuronix

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I have a sizable 1BR with 200sq ft deck growing all my little plants in the best part of Philly for $1050/mo including most utilities. My post-tax stipend is about $2000/mo. I think cost of living is being exaggerated by some posters.
 
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Shifty B

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I have a sizable 1BR with 200sq ft deck growing all my little plants in the best part of Philly for $1050/mo including most utilities. My post-tax stipend is about $2000/mo. I think cost of living is being exaggerated by some posters.
I think there are two separate questions here which are extending across multiple threads. One is the cost of living issue in the thread of Baylor vs. Northwestern, where I simply pointed out that cost of living can be high in major cities and can significantly eat into your stipend. I didn't mean to imply that it's impossible to live in a big city or anything, as it certainly is and people do it. It also is heavily dependent on what area you live in and how close you want to live to the medical center.

For instance, it doesn't seem like Charlottesville, VA should be so expensive but places near the hospital are quite costly. A 20 minute drive away and things drop off substantially.

Does 125K-175K feel very different than 225K-450K when it comes to standard of living? How different are
they?
I think this question is referring to post-residency, attending level salaries, which is a different issue. I think that most of the benefits of having a salary of $300k are obtained by the first $150k. I don't think you're going to have double the lifestyle because you make twice as much money. However, in a lot of places it could determine where you are able to buy the type of accommodations you might want. That is, if you want a 3-bed 2-bath house with a yard and decent schools for your kids, it could be the difference in the upscale inner ring suburb (with a 10 minute commute) versus the outer ring suburb (with a 45 minute commute).

However, all these things really are dependent on the city, what kind of expectations you have, what size family you have, etc. It might make more difference in a very expensive city than it would in a less expensive city.

In general, though, a comfortable lifestyle is very achievable with $150k in pretty much any place in the US.
 

dmblue

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I have a sizable 1BR with 200sq ft deck growing all my little plants in the best part of Philly for $1050/mo including most utilities. My post-tax stipend is about $2000/mo. I think cost of living is being exaggerated by some posters.
basically cost of living is nearly all of your stipend for most programs
 

Instant Noodles

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Do the MD/PhD's working as full-time medical practitioners experience more or less salary growth/employment opportunity compared to regular MD's?
 

Shifty B

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Do the MD/PhD's working as full-time medical practitioners experience more or less salary growth/employment opportunity compared to regular MD's?
So, the simple answer to this question is that the salary growth and employment opportunities will be roughly the same for an MD/PhD and an MD-only pursuing 100% clinical practice (assuming both were in PP or both were in academics). It may be slightly harder to get these types of positions as an MD/PhD because you would have to convince the practice/hospital that you are no longer interested in research.

The more complex answer is that on average MD/PhDs make less money than their MD counterparts. For the same job, the salaries are roughly the same. That is, an MD and an MD/PhD with a job that is 20% clinical and 80% research would have the same salary (within reason). Same for MDs and MD/PhDs in 100% clinical. However, the 100% clinical salary may be considerably higher than the person doing research 80% of the time. Typically, getting research time is going to be a compromise and that will likely result in salary concessions.

Because MD/PhDs are more likely to incorporate research time (and thus more likely to be in 80/20 research positions that pay less than 100% clinical jobs), the average MD/PhD will make less money. More than enough to have a comfortable lifestyle, but perhaps less than their clinical counterparts. Also, even for 100% clinical jobs, MD/PhDs are probably more likely to take them in academics vs private practice. The PP person also will make more money than in academics, although that gap has been narrowing.
 

bubbachuck

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not relevant to the thread, but after not having been on SDN for a while, I was impressed that a fairly controversial thread has not degenerated into an insult sling-fest by the tenth post. this is the antithesis to every other forum i frequent on the internets.

hats off to the future Doctor's of America.
 

Shifty B

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not relevant to the thread, but after not having been on SDN for a while, I was impressed that a fairly controversial thread has not degenerated into an insult sling-fest by the tenth post. this is the antithesis to every other forum i frequent on the internets.

hats off to the future Doctor's of America.
While we do have the occasional flame, the fact that these forums are well-buried helps prevent them from degenerating. Thanks for the shout-out!

B
 

RxnMan

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Do the MD/PhD's working as full-time medical practitioners experience more or less salary growth/employment opportunity compared to regular MD's?
For the same job, I don't see how a MD or a MD/PhD would make different money. As stated above, two guys in the same clinical job with the same years of clinical experience are going to make the same money. One of those guys might have a PhD, but employers (to my admittedly sparse knowledge) aren't generally going to look on it as benefit. Dependent on the field, they may question why you're going into PP. Promotion and income in PP is going to depend more on whether you have your own practice or are employed, whether you are a junior or senior partner, and how long you've spent at that level, and so on. PP "promotion" more to do with business savvy than degrees.

On the flip side, I can imagine academia giving a bump (better lab start-up package, shorter time to promotion and tenure) to someone with greater academic achievement, but your income will depend more on specialty, amount of time allotted to clinical work (e.g. surgery), grant support, and so on.

In general, going academic will pay less than PP. This makes sense as you will likely split your time between teaching duties, committee appointments, clinic, and research as a academician. PP will do just patient care, which is where most of the money is made.
 

gonogo

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In general, though, a comfortable lifestyle is very achievable with $150k in pretty much any place in the US.
In a city like NY and San Francisco, 150k (before taxes) is really not much money. You need much more than that if you want to afford real state prices in these cities. Not to mention once you have a family with kids and factor in day care, nanny, education, etc. Keep in mind that at least 40% of your salary will go in taxes (highest bracket for federal, then state, city, fica, etc...).
 

sluox

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In a city like NY and San Francisco, 150k (before taxes) is really not much money. You need much more than that if you want to afford real state prices in these cities. Not to mention once you have a family with kids and factor in day care, nanny, education, etc. Keep in mind that at least 40% of your salary will go in taxes (highest bracket for federal, then state, city, fica, etc...).
Eh...I don't know if you ever lived in SF or NYC or if you are familiar with the real estate situation in either places. 150k is plenty is both places as long as you don't attempt to live in a huge space in the most expensive neighborhood. If you commute 30 min (less than the average American commute), you can get nice real estate no matter where you live. I lived in both of these cities (along with Boston and LA), and have many friends who are paid significantly less than 150k a year, and they seem to be thriving in these expensive places. A two bedroom apartment in a nice area of SF is about $2500 a month. if you are paid 150k a year with two kids, your after tax salary is 9k a month.

Furthermore, assuming your spouse also holds down a job, your combined salary is not 150k but close to 200k. And if that's still not enough for you, then I don't know what to tell you. You make more than the vast majority of people living in even the most expensive areas in the country, beating the averages of the most affluent counties in the US.

People from the midwest and the south often assume that the coasts are really expensive, but in reality the kind of concessions you need to make in urban areas (i.e. smaller space, no yard, no car, public transit) are not only good for you but also good for the environment. Unless you think all the firefighters, high school teachers, non-profit organization workers and college professors are all not living an acceptable lifestyle...And yes taxes are a lot higher, but how else can you get the cable car, the farmers market, the art scene, and the beautiful golden gate bridge?
 
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CielloStelatto

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I agree for the most part. BUT, I just feel the need to add that a having no yard isn't necessarily "good for you" by definition, and you can get farmers markers without being in a hugely populated area like SF.
 

Shifty B

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We can debate until the end of time about the advantages and disadvantages of big cities vs small towns, etc. To each their own, I guess.

It does cost much more money to live in some big cities, and $150k is going to go further in some places than others. However, I stand by my statement that $150k can provide you a comfortable lifestyle in any city in the US. You may not live in the neighborhood you want, you may have 3 bedrooms instead of 4, you may drive a Mazda instead of an Audi, but you should still be comfortable.

To say that living on $150k is a big city is not going to be comfortable is way out of touch with how most Americans are living. The vast majority of teachers, policemen, firefighters, salesmen, tech workers, small business owners (and the list could go on and on), all make less than $150k even in big cities.
 

MEDUSA23

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Ran across this thread and thought "Does it really matter?" If you feel like you made less money than your MD-only counterpart, retire a couple years later. In a career that can span over 25 years, a few years pursuing a PhD won't matter much. The important thing is to do what makes you happy. There are examples of successful physicians quitting and going to law school. Life is a journey; you shouldn't wish your life away dreaming of the expensive mercedes you'll be driving 20 years from now.
 

tensoranalysis

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obviously this whole thread is bogus because money is the worst thing to ever happen to society... (ok I see how that is ridiculous but I like to think of myself as a minimalist).

anyway you guys are forgetting one crucially important detail. Everyone is calculating a NET change in financial status over the course of your entire lifetime or ~20-30 years.

But the best part about the MD/PhD versus the MD is that i'm not spending my 20s (and early 30s) in debt.... I'm going to do what I love during the best time of my life and not have to worry.. as much.. Could life be more awesome? I could care less about the details of my !salary! when i'm 40+.
 
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MEDUSA23

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Thank you tensoranalysis. Finally some true wisdom. I think people do too much complaining on these forums.

Don't lose sight of the fact that many people in this world work extremely hard and never reach a comfortable lifestyle. You are getting paid to be a student and conduct your own research. I have watched my mother work herself near-to-death in factory for the last 25 years, and I feel privileged to have the opportunity to pursue a respected, well-paid profession.
 

Shifty B

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People who don't think money is important uniformly share one characteristic: they have enough money. You may not have a tremendous income to have enough, but you aren't lacking, because people lacking money know how important it is.

But remember what Daniel Tosh says, "Money can't buy happiness but it can buy a waverunner."
http://www.youtube.com/watch?v=3l3z5EAykVE
 

muchomaas

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People who don't think money is important uniformly share one characteristic: they have enough money. You may not have a tremendous income to have enough, but you aren't lacking, because people lacking money know how important it is.
True story, Word of Honor:
Joseph Heller, an important and funny writer
now dead,
and I were at a party given by a billionaire
on Shelter Island.
I said, "Joe, how does it make you feel
to know that our host only yesterday
may have made more money
than your novel 'Catch-22'
has earned in its entire history?"
And Joe said, "I've got something he can never have."
And I said, "What on earth could that be, Joe?"
And Joe said, "The knowledge that I've got enough."
Not bad! Rest in peace!"

--Kurt Vonnegut
 

mercaptovizadeh

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People who don't think money is important uniformly share one characteristic: they have enough money. You may not have a tremendous income to have enough, but you aren't lacking, because people lacking money know how important it is.

But remember what Daniel Tosh says, "Money can't buy happiness but it can buy a waverunner."
http://www.youtube.com/watch?v=3l3z5EAykVE
I and my family do not come from money. We do not have money; we have debt. All of us. I actually have less debt (~25k) than my sibling (~160k) and parents (~90k). And their prospects of paying them off soon are very small (i.e. nonexistent).

I will openly admit that I'm doing the MD/PhD heavily out of financial reasons. I do not want a debt load when done with residency. I know what debt is, I fear it, I hate what it does to people, and I want nothing of it.

I do like the thinking of science, the "great ideas," and perhaps I deluded myself into thinking I would like the day-to-day aspects of science. I do not. Most journal articles nauseate me, those in biology and chemistry even more so than those in physics. Most of what's done is "not seeing the forest for the trees," it's an incredible amount of grunt work and troubleshooting and ordering 5 different antibodies that can specifically bind to the protein of interest because the previous three I tested failed to do anything (even though the Nature/JI/JEM/etc. papers said they would). Journal club is a particularly awful thing.

I am content with my graduate school stipend because I budget it well and make it go a long way (even repaying debts of other family members with it) and I do not have need for much beyond the basics - a warm house, food, books, internet, music CDs, public transportation. I would love to travel and see all the places I've read and dreamt about, but I simply lack the money. I don't care for expensive dinners, expensive sports events, cars, flatscreen TVs, or the many other things people pour their disposable income into.

Sorry, I can't say I look forward to MS3/4 or residency, as they appear to be awful experiences for many. So what's keeping me sane? Prayer for help in my work every day. Storing up ideas (rather unorthodox ones, I might add) for curing diseases many years from now, if, God-willing, I'm in a position to do the research that I want to do rather than what my boss or my circumstances or the taskmaster (NIH) demand. (I see that I am still deluding myself.) Planning on becoming an itinerant international medical missionary who spreads the Gospel in myriad languages while administering medical treatments. To that end, I've become obsessed with foreign languages and am approaching fluency in Spanish after 6 months of study during my spare time: next come Portuguese, Italian, French, Latin, German, ancient Greek, Hindi....you get the picture. Reading lots of fiction literature to escape the lassitude-inducing nature of graduate school.

The apocalypse being near and my career prospects not mattering very much anyway also helps me put grad school in perspective. However, I do NOT regret NOT taking on all that debt.
 

gbwillner

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Sorry, I can't say I look forward to MS3/4 or residency, as they appear to be awful experiences for many. So what's keeping me sane? Prayer for help in my work every day. ...The apocalypse being near and my career prospects not mattering very much anyway also helps me put grad school in perspective. However, I do NOT regret NOT taking on all that debt.

Good god that is depressing. You sound like you need help....
 

Shifty B

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The apocalypse being near and my career prospects not mattering very much anyway also helps me put grad school in perspective. However, I do NOT regret NOT taking on all that debt.
If we are factoring the apocalypse being near into this discussion, I think that tips the balance strongly in favor of MD-only. I mean, why waste your last few years on earth in an MD-PhD program? It's too long for those of us who expect 50 or so more years, let alone those preparing for the apocalypse. Plus, who cares about a few loans if the earth is going to end?

In that context, I think you're going about this debt thing all wrong, and your family actually has it right. Apocalypse will erase your debts, so there is no reason to worry about paying them back. What you need is a waverunner; it's all throttle. You'll love it.

Even if we dodge the big apocalypse (think fiery end of the world) and hit the jackpot on mini-apocalypse (think total collapse of the world financial markets), runaway inflation will quickly erase your debt. $250,000 in loans is nothing if a loaf of bread costs $100,000.
 

echod

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5 different antibodies that can specifically bind to the protein of interest because the previous three I tested failed to do anything (even though the Nature/JI/JEM/etc. papers said they would). Journal club is a particularly awful thing.
Next time, don't let your boss know that you're buying 3-5 antibodies for the same protein and try them all together on one blot. This will save you time.
 
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Ran across this thread and thought "Does it really matter?" If you feel like you made less money than your MD-only counterpart, retire a couple years later. In a career that can span over 25 years, a few years pursuing a PhD won't matter much. The important thing is to do what makes you happy. There are examples of successful physicians quitting and going to law school. Life is a journey; you shouldn't wish your life away dreaming of the expensive mercedes you'll be driving 20 years from now.
...Smartest thing said on this thread.
 

BlackBox

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No, it doesn't all all work. You should NEVER do the MD/PhD for the money.
1. Ultimately it doesn't really pay out. Assuming four additional years of training means you will be 4 years older before making a real paycheck. Even if you have to pay for med school and have loans, you pay them off slowly over time. You won't care as much about paying them off while earning 6 figures. That means you will have a comfortable, non-student lifestyle at least 4 years earlier. That is the most tangible financial difference. You can play with the numbers all you want, but this is probably the bottom line.
2. With the PhD you will have to do a LOT OF HARD WORK. If your heart is not in it, you will suffer A LOT trying to complete it.
3. Career outcomes are typically different in the two pathways. While you have a lot of options as an MD/PhD, your standard, physician-scientist outcome is not on the same payscale as a private practice DOC. It's really apples and oranges. Let me give you a personal example- albeit anecdotal. I am doing s short-track residency after my 8 yr MD/PhD. I am finishing my second year of residency, with no debt. I was even able to save a little money, but I have at least 2 more years before I start earning asst. Prof. money. I may have to be an instructor first. 2 weekends ago I went to a med school friend's wedding. He's finished residency and working in rad onc PP earning 400K/yr. Another friend is working his butt off in derm, earning 1.2 mil/yr 2 years out of residency. Now you tell me, if it was only about the money, how would I have come out ahead in this deal? My rad onc friend just bought a mercedes C55 because he felt like it, and my derm friend- he could have a Ferrari if he wanted. My car is 8 yrs. old!
4. The MD/PhD is not as helpful landing a competitive specialty as getting AOA and good step I scores. Why spend 4 years on a PhD when you can just study harder for a damned test? Furthermore, as Neruonix frequently points out, if may not even help at all in some cases or be detrimental (i.e., Rads at Penn). And none of this helps AT ALL in the end when you are trying to land a job. You want a job in a pseudo-rural derm practice where you can earn 1.2 MIL working 70 hrs/wk? You think the partners care how many JBC papers you published? They don't- they'll think your an idiot for wasting your time, and instead hire your cocky colleague who's more fun at parties. THem's the breaks.
Bottom line is don't do the PhD unless you love science, and think the idea of biopsying rashes and handing out topical steroids to countless individuals sounds like hell.
I'm doing everything to avoid studying right now, so I'm bumping this ancient thread...mostly b/c I think this is one of the best posts I've read on SDN.
 
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