Plan B if things go down the drain?

[Fox800]

It's harder as a W2 without the option of a solo 401k. Just can't get to 100k pretax, no matter what.
-30k including match for 401k
-15k or so that employer puts in pension plan
-4k in HSA (can't do family as they are on another plan due to network)

Especially with the new tax laws, 1099 is the way to go.

K1/1099 is the way to go. If your group doesn't keep up, you're failing. This is exactly the reason why I'm leaving my under-paid employed W2 position.

$19,500 employee contributions to 401(k)
$37,500 employer contributions to 401(k)
$3,500 HSA
=$60,500

You can easily add $31,000+ from a personal defined benefit plan to get over $100,000, tax-deferred.

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[RustedFox]

K1/1099 is the way to go. If your group doesn't keep up, you're failing. This is exactly the reason why I'm leaving my under-paid employed W2 position.

$19,500 employee contributions to 401(k)
$37,500 employer contributions to 401(k)
$3,500 HSA
$6,000 health insurance (for me - single, no dependents)
$2,500 student loan interest
=$69,000

You can easily add $31,000+ from a personal defined benefit plan to get over $100,000, tax-deferred.

I'm sorry; "K1"?
Not an abbreviation I immediately recognize.

 

[Fox800]

I'm sorry; "K1"?
Not an abbreviation I immediately recognize.

K1 is the tax form you get paid on if you're in a partnership.

 

[RustedFox]

K1 is the tax form you get paid on if you're in a partnership.

Aye. Sorry.

 

[thegenius]

K1/1099 is the way to go. If your group doesn't keep up, you're failing. This is exactly the reason why I'm leaving my under-paid employed W2 position.

$19,500 employee contributions to 401(k)
$37,500 employer contributions to 401(k)
$3,500 HSA
$6,000 health insurance (for me - single, no dependents)
$2,500 student loan interest
=$69,000

You can easily add $31,000+ from a personal defined benefit plan to get over $100,000, tax-deferred.

How can you deduct your health insurance? That is legal as a 1099?
And student loan interest has an income ceiling. If I recall. And most if not all doctors are over that ceiling

 

[Fox800]

How can you deduct your health insurance? That is legal as a 1099?
And student loan interest has an income ceiling. If I recall. And most if not all doctors are over that ceiling

You might be right. OK, so nix $8,500.

Regardless, you can make up a personal defined benefit plan that allows you to put in way, WAY more money away tax-deferred. It trumps this paltry $8,500. Like...add up everything and it's close to, or over, $100,000.

 

[TheSingularity]

How can you deduct your health insurance? That is legal as a 1099?
And student loan interest has an income ceiling. If I recall. And most if not all doctors are over that ceiling

You cannot deduct this at this income level, 1099 or not

 

[TheSingularity]

Been 1099 for awhile while being a slave for a CMG. The solo-k is nice both in terms of amount of money you can sock away and ability to self direct your investment choices.

The ideal would be to continue as a 1099 or a K1, but the CMG environment is untenable, and where I live there are no SDGs that are structured with K1s. I figure I'll just front load a 529 for the little one and dump money into a taxable account.

 

[Fox800]

You cannot deduct this at this income level, 1099 or not

Good to know.

 

[TooMuchResearch]

I'm pretty sure if I lose enough hand in a table saw accident, I can cash in on my disability policies, then do urgent care or telehealth if I'm bored. Good plan?

 

[RustedFox]

I'm pretty sure if I lose enough hand in a table saw accident, I can cash in on my disability policies, then do urgent care or telehealth if I'm bored. Good plan?

Good plan.
Mine would pay me around 15k post-tax a month. I would then simply do telehealth nonsense.
Find us a good table saw and a really good anesthesiologist.

 

[miacomet]

Good plan.
Mine would pay me around 15k post-tax a month. I would then simply do telehealth nonsense.
Find us a good table saw and a really good anesthesiologist.

Can you take disability AND work? Mine you can't

 

[BoardingDoc]

Can you take disability AND work? Mine you can't

Mine does. I have own-occ specific disability which states if I can't work as an EP, I get paid. Whether I start working doing telemed or whatever else is immaterial.

 

[TooMuchResearch]

On a good/well-written policy, yes. Mine are specialty specific, own occupation until age 65-67. They also cover partial disability if you can do your specialty but earning ability is limited.

Can you take disability AND work? Mine you can't

 

[deuist]

Can you take disability AND work? Mine you can't

If you are going to pay a lot of money for a disability policy, it had better be own-occupation. Otherwise, you should not be spending more than a few dollars a month for total disability coverage. The beauty of these own-occupation policies is that even if you can do other jobs such as teaching or a non procedure based medical specialty, you still get to collect disability payments.

 

[cyanide12345678]

All Docs young and old need to have an exit plan with passive income.

Pay off deb, have passive income so you don't have to work another day. Do something to get passive income so you don't have to touch your retirement without working.

You have alot of disposable income, put some of that towards passive income.

I currently have about 100K in passive income. Once my debt is paid off, and I hit 200K/yr passive, I am going to watch paint dry until I get too bored.

Is it mostly all in real estate since i remember you owned a few properties?

 

[emergentmd]

Real estate
apartment syndication
FSER ownership
Stocks

All I need is one to do well and i can retire.

 

[Old_Mil]

Avoid debt. Avoid debt. Avoid debt. Live modestly.

 

[hundreddaysoff]

Avoid debt. Avoid debt. Avoid debt. Live modestly.

Unfortunately, avoiding debt is sometimes not consistent with starting a side gig. May I ask whether your own side gig involved a significant amount of debt and whether it now generates passive income?

Personally, I'm always torn between buying acreage and learning how to grow food (much easier said than done I know) and having the ability to live on $10k/y if SHTF (not bloody likely I know, but ~everyone said that in the 1920s too) vs going into debt to start my own side gig vs something in between. With a new kid and a neurotypical wife, I don't think I have time to start a side gig for a cost of even $0 at this very minute anyway, but maybe I'm just lazy.

Not carrying a mortgage on my personal residence is a no-brainer for me even though I'm sacrificing ~2y of 401(k)/CBP savings to get there. I'm still doing better than 99% of the country here.

 

[Fox800]

Currently my plans are to pay down my loans ASAP. If EM takes a crap, I'd try to stay in my current full-time internal locums gig (might be more sheltered with multiple sites that are hard to staff), look into Australia, or think about a CCM fellowship. Long-term: investing in real estate.

 

[TheSingularity]

Internal locums / "firefighting" is garbage.

I know because I used to do it.

The amount of "holy **** wtf did I get myself into" moments I experienced were staggering. maybe for 1000/hr would I continue that job

Currently my plans are to pay down my loans ASAP. If EM takes a crap, I'd try to stay in my current full-time internal locums gig (might be more sheltered with multiple sites that are hard to staff), look into Australia, or think about a CCM fellowship. Long-term: investing in real estate.

Sent from my Pixel 3 using SDN mobile

 

[Fox800]

Internal locums / "firefighting" is garbage.

I know because I used to do it.

The amount of "holy **** wtf did I get myself into" moments I experienced were staggering. maybe for 1000/hr would I continue that job

Sent from my Pixel 3 using SDN mobile

I get you. However, unfortunately, I live in one of those hip/cool cities that all the cool hip kids are trying to move to, so there are either no jobs, or jobs that pay 10-20% below what I feel is a decent acceptable average hourly pay for EM ($225/hr). And my whole family is here. So it's do this kind of job and make some good coin, or move away to the Midwest or the southeast, potentially in more expensive COL areas with higher taxes.

Here's what I got offered the other day: $170/hr FSED, that's "busy" (per the recruiter - not sure what that means but it's ominous that they don't sugar coat it). Extra $10 per disposition per hour. Oh, and it's a good 90 minutes away from my place, more if there's traffic.

USACS - no openings, plus I hate them (re: Austin/Denver job markets, Summa residency program)

TH - no openings

Prior job - below national average pay, no plan for raises, no opportunities for overtime, can't work anywhere else. Lazy specialist backup, improperly stocked EDs (medications, equipment) despite being a massive hospital system.

No thanks. I'll go with the $277/hr locums gig with guaranteed annual raises, and see how that goes.

 

[TheSingularity]

I hear you brother (or sister). Family was reason I ate the **** sandwich for a few years too.

I get you. However, unfortunately, I live in one of those hip/cool cities that all the cool hip kids are trying to move to, so there are either no jobs, or jobs that pay 10-20% below what I feel is a decent acceptable average hourly pay for EM ($225/hr). And my whole family is here. So it's do this kind of job and make some good coin, or move away to the Midwest or the southeast, potentially in more expensive COL areas with higher taxes.

Here's what I got offered the other day: $170/hr FSED, that's "busy" (per the recruiter - not sure what that means but it's ominous that they don't sugar coat it). Extra $10 per disposition per hour. Oh, and it's a good 90 minutes away from my place, more if there's traffic.

USACS - no openings, plus I hate them (re: Austin/Denver job markets, Summa residency program)

TH - no openings

Prior job - no plan for advancement, below national average pay, no plan for raises, no opportunities for overtime, can't work anywhere else. Sub-par specialty backup, improperly stocked EDs (medications, equipment) despite being a massive hospital system.

No thanks. I'll go with the $277/hr locums gig with annual raises, and see how that goes.

Sent from my Pixel 3 using SDN mobile

 

[Porfirio]

Be mobile and willing to move anywhere, rake in those high sign on bonuses and $$/hr in low cost of living areas of the country for 1-5 years starting out, live like a normal middle class American, refi the student loan debt to the lowest interest rate for a 5 year loan, save the max for retirement, if you are W2 then get a 1099 side gig ASAP.

You only really need to do this a good 5 years then you are set for life. You can go anywhere, work for the **** pay, pay the Cali-fuc*me-fornia taxes, and buy the decent money pit house.

For me, I have planned for 10 years instead of 5. So far, so good.

Plan B - just stop

 

[deleted109597]

Never working full time for anyone still ranks up there for me. Yeah, it makes me have to maintain more credentials, but it also protects me from having to work 18 shifts a month or getting cut to 0.

 

[OccptlMed]

How does one transition from EM to occupational medicine?

start practicing - should not be too difficult from EM. Or do a fellowship - See UW.

 

[cyanide12345678]

I'm pretty sure if I lose enough hand in a table saw accident, I can cash in on my disability policies, then do urgent care or telehealth if I'm bored. Good plan?

So how many fingers do you need to lose to not be able to intubate

 

[Splenda88]

The EM market is fine.

What we are seeing is a reduction of locums rates as of about 2 or 3 years ago. This may signal a general reduction of rates but so far to my knowledge it hasn't happened.

If you're not dumb you can easily get a job paying 200/hr or more. At 1500/hrs/yr that's 300k. If you are single, you are fine at this income. Sure you won't be buying a yacht but you are verrrrry comfortable.

Even if married with kids, if your spouse works for even a third of 300k and you have to pay for child care you are still doing great.

Things may change in the future but who knows.

Contrast this to some other fields (esp in academia) where even getting a job is a problem.

The days of 500/hr locums are probably done for good but we are still doing well.

But I need a a 4000+ sqft home in a nice suburb and a maserati

 

[Old_Mil]

So anyone here have a plan B for their lives if our field went down the sh** hole? Let's say the following happens over the next 5 years:

1) The law passes where out of network billing is at 125% of median in network and reimbursement starts to decline

2) 100+ new hca and cmg sponsored new residencies open and the market is flooded with new grads

3) CMGs continue taking over SDG contacts and replacing doctors with MLPs, leading to decreased physician demand.

Let's say our worst possible scenario happens and compensation drops to around 150/hour in most places.

What's next? Anyone with an exit strategy or plan B here? Or would you just suck it up and keep grinding?

What you’re describing is a scenario in which physicians would no longer practice Emergency Medicine. I’d either (B) Look for a crtical care fellowship, (C) Find a nurse half my age who looked good in a bikini, take off on my boat, and start a YouTube channel, or (D) Move to a mountaintop in Tibet and chant until death or a Yeti came for me. The Great Depression of Coronavirus basically has torpedoed plan A.

 

[TooMuchResearch]

I'll have to read through my policies...honestly just one thumb might do it. Unfortunately my group is really supportive and would probably just let me do double/triple coverage and low acuity section shifts.

So how many fingers do you need to lose to not be able to intubate

 

[deleted109597]

So, things going down the drain.

My email has blown up from every locums agency I have talked to, ever.
They're all desperate for doctors. All of them. HHS has allowed us to cross state lines with impunity.


Let's do this.

 

[Fox800]

So, things going down the drain.

My email has blown up from every locums agency I have talked to, ever.
They're all desperate for doctors. All of them. HHS has allowed us to cross state lines with impunity.


Let's do this.

I'm backing out of tentative locums shifts because the rates...yeah they can do better. Like way better. I don't need this.

 

[deleted109597]

I'm backing out of tentative locums shifts because the rates...yeah they can do better. Like way better. I don't need this.

Correct. I'm not working for free. If you need me, you need to pay me. I'm not working for lower than market rates.

 

[GeneralVeers]

Yeah they talk about how desperate they are, but then offer sub $250 rates. For me to travel it starts at $400 for a decent city and goes up depending on crappiness of the area.

 

[thegenius]

Is it unethical to charge double the going locums rate in this state of emergency?

What is the incentive for anyone to take these locums jobs at the current rate? If there is going to be a near 100% chance you'll get this virus in the next year, with anywhere from a 0.5-2% chance you die from it, WTF why work for the same old going rate of $250/hr?

We need to have hazard pay built into this pandemic.

 

[Groove]

Give it time. Like all of you, the locums people have come out of the woodwork. Once they are desperate enough, the rates will follow. The next year should be very good for the locums peeps.

 

[VA Hopeful Dr]

Is it unethical to charge double the going locums rate in this state of emergency?

What is the incentive for anyone to take these locums jobs at the current rate? If there is going to be a near 100% chance you'll get this virus in the next year, with anywhere from a 0.5-2% chance you die from it, WTF why work for the same old going rate of $250/hr?

We need to have hazard pay built into this pandemic.

I wouldn't think it is.

It would be one thing to try and use this to get more money out of your current job (I haven't heard of anyone doing that thankfully). But expecting to be paid more for a fill in job during times like this is not unreasonable.

 

[cyanide12345678]

Is it unethical to charge double the going locums rate in this state of emergency?

What is the incentive for anyone to take these locums jobs at the current rate? If there is going to be a near 100% chance you'll get this virus in the next year, with anywhere from a 0.5-2% chance you die from it, WTF why work for the same old going rate of $250/hr?

We need to have hazard pay built into this pandemic.

Yeah i have no plans on increasing my exposure at the rate that they are emailing at right now.

 

[namethatsmell]

Yeah i have no plans on increasing my exposure at the rate that they are emailing at right now.

Spot on, I've been laughing at them.

The only place I'd go back to at their normal rate is the one shop that all along paid fairly for the market and treated their docs extremely well. Every promise they ever made they actually delivered on, and then some. They have my loyalty.

For all the places that have treated us like crap all along, they'll need to prove they will have our backs during the pandemic. For me the two most objective measures of this right now are:

1) PPE they will provide

and

2) demonstrating they understand the sacrifice and risk we're taking and offer appropriate pay and financial coverage should we get sick/have to go on quarantine.

 

[cyanide12345678]

Spot on, I've been laughing at them.

The only place I'd go back to at their normal rate is the one shop that all along paid fairly for the market and treated their docs extremely well. Every promise they ever made they actually delivered on, and then some. They have my loyalty.

For all the places that have treated us like crap all along, they'll need to prove they will have our backs during the pandemic. For me the two most objective measures of this right now are:

1) PPE they will provide

and

2) demonstrating they understand the sacrifice and risk we're taking and offer appropriate pay and financial coverage should we get sick/have to go on quarantine.

And the fact that 40 percent of those hospitalized in the US were fairly young isn't helping either.

 

[Birdstrike]

How does one transition from EM to occupational medicine?

You just do it. I did some moonlighting in this in residency and it wasn't hard. I actually kind of liked it. Think urgent care, only way easier.

 

[Piebaldi]

For $150/hr there are lots of other things that oculd be done. Working for pharma, or hospital admin pays $200-$300K with much less stress and exposure to liability.

hospital admin jobs are also not that easy to land.

 

[Piebaldi]

1. Locums for the highest bidder in states with decent med-mal.
2a. Work in Australia, where they still pay ED docs a good living wage. Or Canada. Less likely the Middle East.
2b. Fellowship: critical care, ?pain
3. Marry a sugar mama.

Sugar mamas also have bills to pay.

 

[deleted109597]

I wouldn't think it is.

It would be one thing to try and use this to get more money out of your current job (I haven't heard of anyone doing that thankfully). But expecting to be paid more for a fill in job during times like this is not unreasonable.

Consider it hazard pay.

 

[deleted941485]

This is so silly.

As soon as this shows even the slightest hint of letting up the rates will go right back down.

Hazard pay?! Your a healthcare provider in he middle of a national disaster which means they’ll put you in harms way and pay you whatever they feel like it when they feel like it.

 

[thegenius]

This is so silly.

As soon as this shows even the slightest hint of letting up the rates will go right back down.

Hazard pay?! Your a healthcare provider in he middle of a national disaster which means they’ll put you in harms way and pay you whatever they feel like it when they feel like it.

Not if you have a choice.

 

[miacomet]

Not if you have a choice.

Exactly. Everyone else is out of work, I can join their ranks no problem. Also, telehealth. In my germ-free bunker.

 

[miacomet]

Yeah i have no plans on increasing my exposure at the rate that they are emailing at right now.

Agreed. I just got an email for the very generous sum of $200 an hour in...NYC. ROFL. Better time to watch Netflix and go for runs in the woods.

 

[bravotwozero]

Agreed. I just got an email for the very generous sum of $200 an hour in...NYC. ROFL. Better time to watch Netflix and go for runs in the woods.

I think you should share this person's name and contact info so we can all send him sarcastic emails...

 

[miacomet]

It's Northwell, if I recall correctly.