PM&R Salary?

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medfiend12

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Im currently an M4 trying to decide between going into PM&R or EM. I know the salary should not be one of the top considerations, but as a student with pretty extensive student debt, I believe it’s is justified to have this be a factor in my decision. I love aspects of both specialties, but I am more draw to the procedures and patient relationships that PM&R allows.

Can anyone give me some realistic salaries that I could expect to make in PM&R private practice? Both starting out and let’s say 5-10 years into practice? I’m considering doing a spine or a pain fellowship, so any input on either of those?

Ideally I would like to open a practice (in the Midwest) but I obviously know there are a lot of challenges related to opening a practice. Does anyone have any input on what the compensation would look like in this scenario?

I really appreciate any input!

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I have a relative in pain/sports via PM&R in the midwest. They were making $200-$250k employed in a practice after training, but then made more like $350k when they partnered with a few other PM&Rs in their own practice and were doing primarily procedures (injections, RFA, etc.). Last few years have been rougher though, with decreasing reimbursement and health systems expanding and absorbing other practices and edging out the doc led ones. This year will be the worst with getting <25% of typical revenue for 3 mos or so due to the pandemic. They haven't been able to break $300k in the last 5 years or so, and this year might barely break $200k. To give you an idea though, they work 4.5 days a week on an 8-5 schedule. They also live adjacent to a medium-sized city, so not in the middle of nowhere.
 
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I have a relative in pain/sports via PM&R in the midwest. They were making $200-$250k employed in a practice after training, but then made more like $350k when they partnered with a few other PM&Rs in their own practice and were doing primarily procedures (injections, RFA, etc.). Last few years have been rougher though, with decreasing reimbursement and health systems expanding and absorbing other practices and edging out the doc led ones. This year will be the worst with getting <25% of typical revenue for 3 mos or so due to the pandemic. They haven't been able to break $300k in the last 5 years or so, and this year might barely break $200k. To give you an idea though, they work 4.5 days a week on an 8-5 schedule. They also live adjacent to a medium-sized city, so not in the middle of nowhere.
Can confirm this after looking at MGMA data from 2015-2019. Looks like PMR salaries have taken a nosedive, averages in all regions are below 300k now. I honestly had no idea the specialty was in such a state of decline. They had a 100% fill rate this past match. Maybe med students are still applying to it based off outdated data. I've noticed it takes a few years for people to catch on to specialty trends.
 
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They had a 100% fill rate this past match. Maybe med students are still applying to it based off outdated data.

They may be anticipating a rebound. Oscillations in compensation and employment isn’t without precedent (rads comes to mind - or so I’ve heard).
 
Can confirm this after looking at MGMA data from 2015-2019. Looks like PMR salaries have taken a nosedive, averages in all regions are below 300k now. I honestly had no idea the specialty was in such a state of decline. They had a 100% fill rate this past match. Maybe med students are still applying to it based off outdated data. I've noticed it takes a few years for people to catch on to specialty trends.

Or maybe people are fine with working an 8-5 job and scratching together a pathetic 280k... Mediocracy is a thing I guess. I know, I’m also equally disgusted by their 96th percentile take home salary! Poor ass sea urchins!
 
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Or maybe people are fine with working an 8-5 job and scratching together a pathetic 280k... Mediocracy is a thing I guess. I know, I’m also equally disgusted by their 96th percentile take home salary! Poor ass sea urchins!
I know right? Must be hard... My single mother makes less than I’ll make in my first year of residency, supported 6 kids on that teacher income. People looking down their nose at $250k, I don’t care how much debt you have - that’s a **** ton of money, are completely missing the big picture.

I think job security or prospects is appropriate though, I know people who can’t find jobs where they want to live and I suspect PM&R is more of a niche market. I could be wrong, but it’s gotta be much easier to find ER jobs.
 
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Or maybe people are fine with working an 8-5 job and scratching together a pathetic 280k... Mediocracy is a thing I guess. I know, I’m also equally disgusted by their 96th percentile take home salary! Poor ass sea urchins!
People getting butthurt over random stated facts is my favorite part of SDN. Love the inflamed anal sphincter avatar btw very fitting XD
 
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Every time someone says “salary shouldn’t be a concern” it makes my blood boil. Unfortunately SDN is filled with people like this.

Word of advice: if anyone says that salary shouldn’t be a concern, stop listening to them. Anyone who is so privileged as to have that little perspective of hard realities should be taken with an entire shaker of salt.
 
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Every time someone says “salary shouldn’t be a concern” it makes my blood boil. Unfortunately SDN is filled with people like this.

Word of advice: if anyone says that salary shouldn’t be a concern, stop listening to them. Anyone who is so privileged as to have that little perspective of hard realities should be taken with an entire shaker of salt.
Not trying to argue or anything, but it’s funny that you say privilege is why someone would think that way. I have met many students who say “my parents are paying for med school so I’m not worried about income.” So I totally get that, to some degree. For me it’s the opposite effect where I grew up so poor that any kind of 6 figure income feels like winning the proverbial lottery. I’m also someone who worked in tech before med school and I laugh when people say medicine isn’t worth it because there are many easier ways to earn 100k and be comfortable. I have seen many people work themselves to death trying to hit that number only to have one market flub completely wreck their life. I’m not a doctor yet, but my family has lived better with me in med school than we ever did in my past jobs. And that’s on just crappy loans to get by.

Anyway, again, not trying to argue. I just think it’s funny how we have opposing opinions, and both attribute the other mindset to (for the most part) an entitled mindset.
 
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Not trying to argue or anything, but it’s funny that you say privilege is why someone would think that way. I have met many students who say “my parents are paying for med school so I’m not worried about income.” So I totally get that, to some degree. For me it’s the opposite effect where I grew up so poor that any kind of 6 figure income feels like winning the proverbial lottery. I’m also someone who worked in tech before med school and I laugh when people say medicine isn’t worth it because there are many easier ways to earn 100k and be comfortable. I have seen many people work themselves to death trying to hit that number only to have one market flub completely wreck their life. I’m not a doctor yet, but my family has lived better with me in med school than we ever did in my past jobs. And that’s on just crappy loans to get by.

Anyway, again, not trying to argue. I just think it’s funny how we have opposing opinions, and both attribute the other mindset to (for the most part) an entitled mindset.

It’s fine if salary isn’t important to you. That’s your own personal business my dude. Hell, I myself chose a specialty with lower pay because I loved it, despite my high debt.

my problem is when people ***tell*** medical students/applicants that salary shouldn’t be a concern of theirs.
 
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I know right? Must be hard... My single mother makes less than I’ll make in my first year of residency, supported 6 kids on that teacher income. People looking down their nose at $250k, I don’t care how much debt you have - that’s a **** ton of money, are completely missing the big picture.

I think job security or prospects is appropriate though, I know people who can’t find jobs where they want to live and I suspect PM&R is more of a niche market. I could be wrong, but it’s gotta be much easier to find ER jobs.

Its easy to look at 250k in a vacuum and say "wow thats a lot who needs more than that!" But keep in mind a lot of people who go into medicine are very driven, talented, and motivated by success/money/prestige etc. Those making 500k in rads or ortho would be successful in other fields as well if they decided to go that path, but given they chose medicine and gave up their 20's I wouldn't say they should be happy with 250k.

I grew up poor as well, but if you told me I was going to go through what it takes to become a doctor for 250k I'd be ready to throw hands with someone.
 
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Its easy to look at 250k in a vacuum and say "wow thats a lot who needs more than that!" But keep in mind a lot of people who go into medicine are very driven, talented, and motivated by success/money/prestige etc. Those making 500k in rads or ortho would be successful in other fields as well if they decided to go that path, but given they chose medicine and gave up their 20's I wouldn't say they should be happy with 250k.

I grew up poor as well, but if you told me I was going to go through what it takes to become a doctor for 250k I'd be ready to throw hands with someone.
I’d love to see studies on what the average person going to medical school would actually make if they forgo a medical education, like accepted students saying nope. I’d be willingn to say this argument you are making wouldn’t really pan out. I know plenty of harder working very smart people in finance and comp sci who are happy breaking 100k.
 
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I’d love to see studies on what the average person going to medical school would actually make if they forgo a medical education, like accepted students saying nope. I’d be willingn to say this argument you are making wouldn’t really pan out. I know plenty of harder working very smart people in finance and comp sci who are happy breaking 100k.
As much as we bitch and moan about medicine's rapid erosion of some semblance of meritocracy, business and finance is exponentially worse. Most people don't have previous experience like you or me to this though so they think they are just going to job land after CS school and dropping 200k on their desk over all the other people who are equally good at CS or fake productive middle management jobs or fake value adding consulting PowerPoint expert gigs lol.
 
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As much as we bitch and moan about medicine's rapid erosion of some semblance of meritocracy, business and finance is exponentially worse. Most people don't have previous experience like you or me to this though so they think they are just going to job land after CS school and dropping 200k on their desk over all the other people who are equally good at CS or fake productive middle management jobs or fake value adding consulting PowerPoint expert gigs lol.
Dude yes, so many people go into those industries and just land in these weird fluff jobs barely cracking 70k and not doing anything remotely similar to their training. These are bright, motivated people that just can’t sell their souls for the sales world or don’t fit the good ‘ol boys model well enough to climb into upper management. Medicine is a long and hard road, but I still see it as such a blessed career. One of the few with such strong job security and solid income when training is over. Gonna come back in 10 years when I’m a good 5-6 years removed from residency and see if I still feel that way
 
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I’d love to see studies on what the average person going to medical school would actually make if they forgo a medical education, like accepted students saying nope. I’d be willingn to say this argument you are making wouldn’t really pan out. I know plenty of harder working very smart people in finance and comp sci who are happy breaking 100k.

I can only speak for myself and a couple people I know with prior careers. The people at their powerpoint jobs making 70k probably aren't putting in as many hours and making as many sacrifices as a medical student and resident does. If you're a talented individual working 80 hours a week it shouldn't be difficult to clear a decent amount of coin. But also I'm not saying people are going to go out and make 500k. I'm just saying you've gotta subtract the opportunity cost of all of those years of training and forgone income/investments etc. At 250k a year, it isnt worth it.
 
I can only speak for myself and a couple people I know with prior careers. The people at their powerpoint jobs making 70k probably aren't putting in as many hours and making as many sacrifices as a medical student and resident does. If you're a talented individual working 80 hours a week it shouldn't be difficult to clear a decent amount of coin. But also I'm not saying people are going to go out and make 500k. I'm just saying you've gotta subtract the opportunity cost of all of those years of training and forgone income/investments etc. At 250k a year, it isnt worth it.
if it isnt worth it, yet there are hoards of people lining up to go into FM and IM. The market would say it is to those people.
I had a career before and i absolutely busted my behind and barely cleared 100. I know many people in my social circle as well who worked hard and were very smart to not even get close to that.
The real world doesnt care how smart you are or how hard you work, otherwise no one would be dropping out of IB or finance , or even places like kinsey where it up or out. A large chunk of those people put in the hours and have the smarts yet never reach even PCP level of compensation.
IMO its delusional to say that entire med school classes would be raking it in if they went to alternative careers, most likely they would not and have middling professional careers.
 
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if it isnt worth it, yet there are hoards of people lining up to go into FM and IM. The market would say it is to those people.
I had a career before and i absolutely busted my behind and barely cleared 100. I know many people in my social circle as well who worked hard and were very smart to not even get close to that.
The real world doesnt care how smart you are or how hard you work, otherwise no one would be dropping out of IB or finance , or even places like kinsey where it up or out. A large chunk of those people put in the hours and have the smarts yet never reach even PCP level of compensation.
IMO its delusional to say that entire med school classes would be raking it in if they went to alternative careers, most likely they would not and have middling professional careers.
Getting passed up for 1 promotion or making the wrong lateral move can place you firmly on the 75k for life team no matter how hard you work in business. I cannot emphasize enough how much luck goes into who gets a 400k sales job versus a 90k sales job. It's a total crapshoot. Most med students didn't spend any time in business school or have huge groups of friends and mentors in business so I can see why they see their one high achieving friend make it into real tech jobs or IB and equate that to even a small majority doing so as well.
 
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I know right? Must be hard... My single mother makes less than I’ll make in my first year of residency, supported 6 kids on that teacher income. People looking down their nose at $250k, I don’t care how much debt you have - that’s a **** ton of money, are completely missing the big picture.

Einstein's theory of relativity. I guess I could be happy about my miniscule July 1st pay raise by telling myseIf at least I work way less than those poor incoming interns who are getting pounded. But I'd rather bitch about the lazy attendings who make multiples more than me by signing my notes on patients whom they know nothing about.

In any event, there are easier ways to hit $250k in healthcare: NP, PA, CRNA. Firefighters and police without college degrees can still hit $200k-$300k with OT and retire by early 40s with full pension and healthcare.
 
Einstein's theory of relativity. I guess I could be happy about my miniscule July 1st pay raise by telling myseIf at least I work way less than those poor incoming interns who are getting pounded. But I'd rather bitch about the lazy attendings who make multiples more than me by signing my notes on patients whom they know nothing about.

In any event, there are easier ways to hit $250k in healthcare: NP, PA, CRNA. Firefighters and police without college degrees can still hit $200k-$300k with OT and retire by early 40s with full pension and healthcare.

Just because it’s possible doesn’t mean it’s easier...

Id say you have a higher chance of getting shot as a cop than making 300k.
 
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I’d love to see studies on what the average person going to medical school would actually make if they forgo a medical education, like accepted students saying nope. I’d be willingn to say this argument you are making wouldn’t really pan out. I know plenty of harder working very smart people in finance and comp sci who are happy breaking 100k.
As much as we bitch and moan about medicine's rapid erosion of some semblance of meritocracy, business and finance is exponentially worse. Most people don't have previous experience like you or me to this though so they think they are just going to job land after CS school and dropping 200k on their desk over all the other people who are equally good at CS or fake productive middle management jobs or fake value adding consulting PowerPoint expert gigs lol.
Dude yes, so many people go into those industries and just land in these weird fluff jobs barely cracking 70k and not doing anything remotely similar to their training. These are bright, motivated people that just can’t sell their souls for the sales world or don’t fit the good ‘ol boys model well enough to climb into upper management. Medicine is a long and hard road, but I still see it as such a blessed career. One of the few with such strong job security and solid income when training is over. Gonna come back in 10 years when I’m a good 5-6 years removed from residency and see if I still feel that way
Getting passed up for 1 promotion or making the wrong lateral move can place you firmly on the 75k for life team no matter how hard you work in business. I cannot emphasize enough how much luck goes into who gets a 400k sales job versus a 90k sales job. It's a total crapshoot. Most med students didn't spend any time in business school or have huge groups of friends and mentors in business so I can see why they see their one high achieving friend make it into real tech jobs or IB and equate that to even a small majority doing so as well.

100% all this being said.

Whenever I hear an attending tell a student something that boils down to "Don't go into medicine. I'm 60yo, all set in life, and paid pocket change to graduate medical school and have done no research to back up my opinion, but since I'm jaded and have unrealistic expectations, I'm going to tell you to just go into business/computers/accounting/yodeling." ... I get very mad.

Same thing with when I heard classmates say, "My friend/family member does ___ and makes ____, it must be way easier than med school. Why did I do this?" I dunno, doofus, but you may wanna consider the years it took your friend or family member coding in Silicon Valley to get the education and experience they needed for the job they got and how many people with the exact same background as them DON'T have it nearly as good.
 
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Medicine is like a one way elevator to $200K (and higher) Everything else? It's like a never-ending game of politics, nepotism, and rolling the dice
 
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I know right? Must be hard... My single mother makes less than I’ll make in my first year of residency, supported 6 kids on that teacher income. People looking down their nose at $250k, I don’t care how much debt you have - that’s a **** ton of money, are completely missing the big picture.

I think job security or prospects is appropriate though, I know people who can’t find jobs where they want to live and I suspect PM&R is more of a niche market. I could be wrong, but it’s gotta be much easier to find ER jobs.
I concur with you but complacency is a dangerous road provided doctors don't have a union. As nice as the salary may seem to the public even with a nosedive currently, healthcare is going through a transformation, tuitions are going the opposite way up. If I were you, I would keep an eye on policies being passed behind the veil. I always tell myself that pharm, law were affected by school expansion and oversaturation, but know that some of our fields in medicine are affected by more and more residency graduates needing further fellowship training. We have significant number of years in training ahead of colleagues in law and pharm already before fellowship so it makes it even more painful to go through more time sacrifice. Everyone in medicine is looking for a way to look unique but all the same they spend their productive years in trying to do so. It's happening slowly, faster in some fields, but if you don't notice this properly and raise the alarm early, the bigger reforms will definitely sweep you off your feet. Issue isn't that we need to compare ourselves with teacher salaries or any other hard working intellect who doesn't get paid enough. Personally, I wish teachers could earn 150k and that's their fight to fight. It's harder to fall down from grace and even harder to rise up.
 
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There must be a reason only ~10% of the US population makes over 100k. Maybe it's not that easy. However, I must admit close to 50% of the US population can not distinguish their right hand from the left.

The idea that people think that all medical students would be making bank (200k+/yr) had they chosen another career does not match reality. An income of 200K+ put one in the top 3%. It's just not easy to make that kind of money in other industries...

If we are talking about 100k+/yr, I think almost all US med students would probably make that if they were in other industries. However, that 100k+/year would not happen in day 1.


I like to post this chart so SDN users can compare our industry with others.

 
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Einstein's theory of relativity. I guess I could be happy about my miniscule July 1st pay raise by telling myseIf at least I work way less than those poor incoming interns who are getting pounded. But I'd rather bitch about the lazy attendings who make multiples more than me by signing my notes on patients whom they know nothing about.

In any event, there are easier ways to hit $250k in healthcare: NP, PA, CRNA. Firefighters and police without college degrees can still hit $200k-$300k with OT and retire by early 40s with full pension and healthcare.

My guess is that less than 3% of NP, PA, COPS make 200k/yr. On the other hand, >90% of US physicians make 200k+/year if they hold a FT job. About 25-30% CRNA make over 200k per year.

 
While I may have over-estimated these peoples' ability to hustle in the real world based on the posts in this thread, you guys are completely ignoring the opportunity cost. Thats the whole point. If I were to go through 4 years of med school with loans and another 4 of residency to earn 200k that would be a bad investment.
 
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While I may have over-estimated these peoples' ability to hustle in the real world based on the posts in this thread, you guys are completely ignoring the opportunity cost. Thats the whole point. If I were to go through 4 years of med school with loans and another 4 of residency to earn 200k that would be a bad investment.
Opportunity cost has been beaten to death on here over the years and generally the math still favors being a pediatrician in the long run from all the threads I remember. Compound interest on early career salary that is delayed by medicine is an important factor and I agree with you there. One thing that is not often mentioned though is cash flow. Even if one does well with their 401k in business, the ability of even an junior attending to take larger cashflow and turn it into business opportunities is essentially impossible for the slow and steady saving style of a regular career. You have to have money to make money and medicine represents an opportunity to buy real estate or other businesses to go from "rich" to potentially wealthy. Medicine is one career that allows for the opportunity for generational wealth even for shrewd academic physicians.

Edit: A good example are some junior attendings I know that have several relatively passive businesses on the side because they had the 100k at one time to jump in and do something like that. You will not see a mechanical engineer at your local office in on these deals.
 
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While I may have over-estimated these peoples' ability to hustle in the real world based on the posts in this thread, you guys are completely ignoring the opportunity cost. Thats the whole point. If I were to go through 4 years of med school with loans and another 4 of residency to earn 200k that would be a bad investment.
Look, if the oppotunity cost was soo high that people could make plenty of other money in other fields , there wouldnt be a large line to get into medical school.

300k loans, 600K total cost
70k x 4 lost income + interest
Lets round it to a million.
30 year career at 200 k -
~6 mill life time

Vs a 37 year career at 100k
3.7 million


The above calculations are simple , but you are more likely to be unemployed outside of medicine, less likely to break in the 200k + , and most kids out of college are not getting 100K jobs, so its a fair estimation.

And if you think that early career people are socking away larges sums of money in the 401ks you are mistaken, they are buying cars, houses, vacations and generally being terrible investors.
 
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Look, if the oppotunity cost was soo high that people could make plenty of other money in other fields , there wouldnt be a large line to get into medical school.

300k loans, 600K total cost
70k x 4 lost income + interest
Lets round it to a million.
30 year career at 200 k -
~6 mill life time

Vs a 37 year career at 100k
3.7 million


The above calculations are simple , but you are more likely to be unemployed outside of medicine, less likely to break in the 200k + , and most kids out of college are not getting 100K jobs, so its a fair estimation.

And if you think that early career people are socking away larges sums of money in the 401ks you are mistaken, they are buying cars, houses, vacations and generally being terrible investors.

Not only that, most people who graduate with a baccalaureate degree start making 50k-60k/yr. You can only have a car, a decent place and invest < 10% of your salary in most US cities/suburb (I am being generous here in the investing part)... If you are getting 80k+ right out of college, you are definitely in the minority... For instance, I am friend with a nurse whose daughter graduated from MIT with an engineering degree. She is brilliant and her 1st job with Boeing was a meager 85k/yr. This is good money for a 23 yr old but she was not wallowing in cash.
 
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Not only that, most people who graduate with a baccalaureate degree start making 50k-60k/yr. You can only have a car, a decent place and invest < 10% of your salary in most US cities/suburb (I am being generous here in the investing part)... If you are getting 80k+ right out of college, you are definitely in the minority... For instance, I am friend with a nurse whose daughter graduated from MIT with an engineering degree. She is brilliant and her 1st job with Boeing was a meager 85k/yr. This is good money for a 23 yr old but she was not wallowing in cash.
SWE is quite an exception though. I know several CS majors from my low-tier newer UG making 100k+. Not all of them had internships either.

Also there's some people who drop from med to pursue SWE (like the guy who admitted to a coke addiction here earlier this year).
 
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SWE is quite an exception though. I know several CS majors from my low-tier newer UG making 100k+. Not all of them had internships either.

Also there's some people who drop from med to pursue SWE (like the guy who admitted to a coke addiction here earlier this year).
Some people will do well, but it is just a minority. Medicine is arguably the only profession in the US in which you can start out making 400k+/yr with little creativity. For instance, one graduate from my program started as a nocturnist with a salary of ~500k/yr working 18 12 hrs shift/month. No industry in the US you can start making 400k+/yr with little creativity. Hopefully things won't change for the worse with a Biden.
 
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SWE is quite an exception though. I know several CS majors from my low-tier newer UG making 100k+. Not all of them had internships either.

Also there's some people who drop from med to pursue SWE (like the guy who admitted to a coke addiction here earlier this year).
yes, but for every CS guy making 100+ there are 5 making 50k somewhere.
 
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My guess is that less than 3% of NP, PA, COPS make 200k/yr. On the other hand, >90% of US physicians make 200k+/year if they hold a FT job. About 25-30% CRNA make over 200k per year.


Police "officers" make an average salary (not counting OT than can double base pay) but police "sergeant/lieutenant/captains" do well. If you have some intelligence you will rank up every 5-10 years and retire as captain (~$150k + OT) by early-mid 40s, with lifetime pension based on last 2-5 years of income (base + OT).

The young-ish midlevels I see in the ED are probably making $90k-$110k for 40 hrs. But our inpt psych midlevels are making at least $200k with heavy call. My med school hospital's CRNAs probably cracked $250k if they worked some OT. They spent a lot of time in the lounge talking about their investments, toys, vacations, second homes, kids with college paid for etc, while the anesthesiologists ran around looking tired.

Anyway, there opportunities in blue collar-ish, hands on jobs (see also procedural vs nonprocedural physician income) where a motivated young person with average to slightly above average intelligence can make a decent income. But the college crowd tends to feel a random bachelor's followed by a desk job is the way to go.

Overall, medicine is a good job. I work less and have less stress in med school and residency than at any post-college job. I will only begrudge the attendings who work less and make multiples of my salary, as well as the admin who make multiples of my attendings' income.
 
I like to post this chart so SDN users can compare our industry with others.


If I recall, that article points to research that says American's income fluctuates a lot over a lifetime and a large % of American households will hit at least $100k-$200k a year sometime but not necessarily stay there.
 
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