Physician>NP in gen peds?

[wavecrasher111]

3rd year med student here. I've been thinking a lot about gen peds recently and how much my personality fits with it. Always found kids easy to talk to and more enjoyable to work with, long term care, preventative medicine, counseling/education, being the first to see whatever the complaint is etc...
But given comparable salaries between docs and NP's (150k for peds NP vs 200k for peds md/do in sf bay area for example), all I can think about is, why didn't I just do NP/PA school and skip the extra 6 years of education and additional 200k of loans.

Not sure what I'm looking for from this post, whether its reassurance that as a physician I'll add value that other providers wouldn't or that I'll be able to live comfortably on those salaries with 450k of debt.

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[deleted407021]

Wonder about this myself. I want to go into a higher acuity area of peds and hoping physicians still hold their position in the sub specialties.

 

[SurfingDoctor]

1. Generally speaking, if you can’t live a reasonable life as a top 2% earner, even having to pay off a 30 year loan, you got big issues.

2. Outside of that, you will always have a wider breathe of knowledge when it comes to NP and will be able to practice independently where NP/PAs can not. Is that worth only a $50K/year difference in salaries... well that market forces for you. Also if that $50K/year is what is really driving your happiness and satisfaction, see 1.

 

[oldbearprofessor]

I don't like trying to compare physicians with PA/NPs, that's always a dead end on SDN that spirals into oblivion. But, I want you to think about something else. As a pediatrician you are being trained to be an advocate for children. Pediatricians (largely but not entirely via the AAP) have become a powerful voice regarding the rights of children to be free of violence, hunger and captivity in all its forms as well as the right to be vaccinated properly and fed healthy diets in schools and elsewhere. If you haven't, spend some time on the AAP website (or twitter for that matter) and see what is there from the pediatricians and what we do. This isn't part of the money equation, but is a big part of my job satisfaction, and I believe, the satisfaction of many others in pediatrics

 

[GonnaBeADoc2222]

3 mistakes here:

1) Gen Peds. If the midlevels are coming for adult EM, Derm, etc, you can bet they're coming for you. I'm not trying to make the case that gen peds isn't important. It's very important. But the government, etc want to cut costs and they will for sure either let a midlevel order the vaccines or let you do it and pay you like a midlevel. Go PEM or NICU...Pretty nice demand for these fields. Cards, heme/onc avoid unless you like not having a job.

2) Bay Area. I mean come on. 200k in SF is nothing.

3) 450k debt. Do you have a plan for this? And don't just say PSLF.

Sent from my Pixel 3 using SDN mobile

 

[deleted941485]

You make marginally more than an NP and when you factor in training, time, and money its probably one of the few specialties that might just about have a breakeven return on investment. But you arent alone, CRNAs are making about the same as IM hospitalists at around 180K with a union set breaks and controlled hours along with an MD to soak up the risk.

I mean we can talk all day about the knowledge gap and experience and all that but at the end of the day its what they are willing to pay you for that additional experience that speaks infinitely more about how your services are valued compared to the endless BS spouted.

 

[NecFasc92]

1. Generally speaking, if you can’t live a reasonable life as a top 2% earner, even having to pay off a 30 year loan, you got big issues.

2. Outside of that, you will always have a wider breathe of knowledge when it comes to NP and will be able to practice independently where NP/PAs can not. Is that worth only a $50K/year difference in salaries... well that market forces for you. Also if that $50K/year is what is really driving your happiness and satisfaction, see 1.

In almost half the states they can practice “advanced nursing” (aka medicine without a license) independently and that number is only growing.

 

[wavecrasher111]

3 mistakes here:

1) Gen Peds. If the midlevels are coming for adult EM, Derm, etc, you can bet they're coming for you. I'm not trying to make the case that gen peds isn't important. It's very important. But the government, etc want to cut costs and they will for sure either let a midlevel order the vaccines or let you do it and pay you like a midlevel. Go PEM or NICU...Pretty nice demand for these fields. Cards, heme/onc avoid unless you like not having a job.

2) Bay Area. I mean come on. 200k in SF is nothing.

3) 450k debt. Do you have a plan for this? And don't just say PSLF.

Sent from my Pixel 3 using SDN mobile

I just did a rough estimation of having 460k in loans after finishing residency w/ 7.3% interest. I'm from CA so it'd be nice to settle back there but just using 180k for low ballpark gen peds salary it just doesn't seem feasible. With taxes my take home per month would be around 5k. With 2k monthly payments I would never pay off that loan and with 3k it would take 37 years. I feel like I have to pick a specialty where I can expect a salary of at least 250k to make a dent. Unless you have other suggestions?

 

[qwerty89]

You can see salaries for yourself at the University of California system here: Compensation at the University of California: Annual Wage

When you look up Faculty | Department of Pediatrics it seems as though some assistant professors make around 260k. Some make less.

Meanwhile an ENT PA makes 190k. Laura Kirk | UCSF Medical Center

At UCLA the program director makes only 180k Faculty Profiles | UCLA Health
Additional searches revealed an assistant professor making 169k.
Meanwhile type in "nurse pract" into the title section and you will get a giant list of NP salaries going up to 250k with overtime. Some are at 190k base salary.
Type in "physcn ast" into the title section to see PA salaries at UCLA and the highest is 224k with the highest base salary around 161k.

 

[Hatfield0429]

3rd year med student here. I've been thinking a lot about gen peds recently and how much my personality fits with it. Always found kids easy to talk to and more enjoyable to work with, long term care, preventative medicine, counseling/education, being the first to see whatever the complaint is etc...
But given comparable salaries between docs and NP's (150k for peds NP vs 200k for peds md/do in sf bay area for example), all I can think about is, why didn't I just do NP/PA school and skip the extra 6 years of education and additional 200k of loans.

Not sure what I'm looking for from this post, whether its reassurance that as a physician I'll add value that other providers wouldn't or that I'll be able to live comfortably on those salaries with 450k of debt.

You can always take a risk and start your own practice with another MD plus a few PAs/NPs. With a bit of a hustle, some MDs in private practice take home at least $300-400k.

 

[SurfingDoctor]

In almost half the states they can practice “advanced nursing” (aka medicine without a license) independently and that number is only growing.

Yes, in some states NPs can, but I’m unaware any place PAs can.

 

[VA Hopeful Dr]

I just did a rough estimation of having 460k in loans after finishing residency w/ 7.3% interest. I'm from CA so it'd be nice to settle back there but just using 180k for low ballpark gen peds salary it just doesn't seem feasible. With taxes my take home per month would be around 5k. With 2k monthly payments I would never pay off that loan and with 3k it would take 37 years. I feel like I have to pick a specialty where I can expect a salary of at least 250k to make a dent. Unless you have other suggestions?

First thing you do when you finish residency is refinance. My wife's loan was at 6.8 percent, refinanced down to 3.25. With your loan that cuts the monthly payment using a 10 year schedule from 5.4k/month to 4.5k/month.

Second, lots of places offer loan repayment. Find one.

Third, moonlight. I'm an FP and if I moonlight in an urgent care I'll gross around 1k/day.

 

[calvnandhobbs68]

You just have to accept that you won’t make too too much more in outpatient gen peds M-F office hours than an NP in a similar setting. You should be comparing outpatient peds NP salaries though, not like CRNA or ENT NP salaries, so the NP salary is probably going to be a little less overall (although not too too much less).

People end up doing outpatient peds because they love the work and love watching their patients grow up (and sometimes send their kids to their old pediatrician) not for any big bucks. Outpatient peds has never been a big money maker unless you’re the owner of a big group. Unlike FP there isn’t a lot of room for supplemental income because most kids are healthy and there aren’t a lot of procedures to be done (FPs that are into it will do small excisions, suturing, splinting, etc) and not as much imaging/labs/sub specialty referrals that make you more valuable to a hospital system that can drive all those referrals internally. Moonlighting is an option as noted above but again peds moonlighting pays quite a bit less than adult moonlighting because of the lack of lucrative interventions that can be billed for (bc tbh most of peds urgent care is fevers, URIs and rashes with a sprinkling of actual asthma and minor trauma which you may not actually even be equipped to handle at an urgent care depending on where you are).

 

[Perrotfish]

(150k for peds NP vs 200k for peds md/do in sf bay area for example),

Where are you getting these numbers?

 

[NecFasc92]

Yes, in some states NPs can, but I’m unaware any place PAs can.

I really wouldn’t call 23/50 states as “some.” Further, not like their independent practice of medicine illegally has been a slow trend, they bamboozle states every year. It would
be an easy bet to win to wager that within the next 10-15 years they’ll be able to practice “advanced nursing” independently in every state.

Also maybe you don’t know this but the pa profession is making a big push to make their degree a “doctorate” and to also be independent.

 

[VA Hopeful Dr]

I really wouldn’t call 23/50 states as “some.” Further, not like their independent practice of medicine illegally has been a slow trend, they bamboozle states every year. It would
be an easy bet to win to wager that within the next 10-15 years they’ll be able to practice “advanced nursing” independently in every state.

Also maybe you don’t know this but the pa profession is making a big push to make their degree a “doctorate” and to also be independent.

23/50 isn't most, it isn't a few, it's not the majority. Some seems like exactly the right word.

 

[Socrates25]

I dont agree that Peds NPs get to 150k, unless they are working in a factory seeing 50 patients a day or they live in San Francisco.

Average peds NP would be 100-110k, maybe 150k for somebody with 10+ years of experience at a high volume clinic.

Peds MD average 200k with an average caseload. If you want to bust your ass, you can make 300-400k but you're gonna put in at least 60 hours in the clinic averaging 40-50 per day to make that income.

Seeing 50 patients per day sucks. Correction, it REALLY sucks.

Much rather make 200k seeing 25 patients per day. The docs who run factories seeing 50 patients per day are either bad doctors who dont care about their patients or they are headed for burnout within 5 years.

 

[Socrates25]

You can always take a risk and start your own practice with another MD plus a few PAs/NPs. With a bit of a hustle, some MDs in private practice take home at least $300-400k.

Peds making 300-400k is going to require a LOT of hustle. We're talking minimum 40 patients per day, 6 days a week kind of hustle.

If you see any volume of Medicaid patients, it's even worse and you'll need to run a factory "supervising" 4-5 PAs/NPs with your own 50 patients per day to make that kind of money.

 

[y123]

Most NPs/PAs I know don’t make $150k.
Although they seem to work fewer hours than physicians.

 

[Obnoxious Dad]

I just did a rough estimation of having 460k in loans after finishing residency w/ 7.3% interest. I'm from CA so it'd be nice to settle back there but just using 180k for low ballpark gen peds salary it just doesn't seem feasible. With taxes my take home per month would be around 5k. With 2k monthly payments I would never pay off that loan and with 3k it would take 37 years. I feel like I have to pick a specialty where I can expect a salary of at least 250k to make a dent. Unless you have other suggestions?

Your problem is your need to settle in California. Because so many people want to live there your salary as a physician will be depressed and your cost of living will be obscenely high in the three largest metro areas. Furthermore, you will have no place on your federal or state income tax return to deduct the principal and interest payments on your loans. Finally, for every taxable dollar you earn in California over $56,083 you will pay 9.3% to the State of California in income taxes.

State taxes: California

Each state has its own taxation system, usually a combination of income, sales and property taxes.

www.bankrate.com

The median listing price of a home in California at $549,900 ranks third in the country.

Go ahead and be a general pediatrician Just don't do it in California.

 

[Perrotfish]

I just did a rough estimation of having 460k in loans after finishing residency w/ 7.3% interest. I'm from CA so it'd be nice to settle back there but just using 180k for low ballpark gen peds salary it just doesn't seem feasible. With taxes my take home per month would be around 5k. With 2k monthly payments I would never pay off that loan and with 3k it would take 37 years. I feel like I have to pick a specialty where I can expect a salary of at least 250k to make a dent. Unless you have other suggestions?

Dude, use a tax calculator. 180K with taxes in California gives you an after tax monthly take home of almost exactly 10K.

Also 250K is a pretty average salary at most places I interviewed for jobs with no call, no weekends, and 20-30 patients/day. 180K is a normal salary for a new grad but with reasonable productivity and 5 years experience 250K is very obtainable.

 

[Merely]

I dont agree that Peds NPs get to 150k, unless they are working in a factory seeing 50 patients a day or they live in San Francisco.

Average peds NP would be 100-110k, maybe 150k for somebody with 10+ years of experience at a high volume clinic.

Peds MD average 200k with an average caseload. If you want to bust your ass, you can make 300-400k but you're gonna put in at least 60 hours in the clinic averaging 40-50 per day to make that income.

Seeing 50 patients per day sucks. Correction, it REALLY sucks.

Much rather make 200k seeing 25 patients per day. The docs who run factories seeing 50 patients per day are either bad doctors who dont care about their patients or they are headed for burnout within 5 years.

I don’t understand, how much does a pediatrician make per patient? How do you see 50 patients and not make 600k+

 

[smq123]

Most NPs/PAs I know don’t make $150k.
Although they seem to work fewer hours than physicians.

Agreed. I've worked with many NPs and PAs; the only job offers for >$100K that they have seen were in ER, ICU, or anesthesia.

An NP that I worked with told me that, in a busy practice, where she generated a very high number of RVUs, in a rural state (so salaries are generally higher), she broke $110K once.