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I was trolling the dark corners of the net yesterday and came across the following post on a "game" (no, lvl100 Warlock, not that kind of game) forum. Aside from the language and rather psychopathic mentality , this is so full of win and so perfectly describes some brutal truths that I had to share it here, lol. This also more or less convinced me full-stop to do EM 
Hi guys, long time lurker here. I’ve seen a lot of discussions lately centered around the concept of young dudes wanting to travel the world after putting in a good 10 or so years of work in the West. With that in mind, I thought I’d pitch in and write a not-so-brief synopsis on how a medical career-that is, becoming a physician-could fit that bill. How to become a doctor is no secret: get into medical school. This thread will focus on the "why," because I feel that many people have a fixed idea of what being a doctor entails that doesn't have to necessarily hold true. Brief disclaimer: this thread is directed more so at dudes still in college, and furthermore only that subset of them that has at least some interest in science and-most importantly-is good at test taking. Also, you best be American or Canadian. I’m sure medicine (read: $$$) is not far too different in the UK and Australia but your mileage may vary. If you’re not in the Anglosphere at all, forget about it from a monetary perspective.
Another disclaimer: I’m not a physician nor am I even a med student. In fact I hope to never attend med school as I’ll be the first to admit that there are better ways to spend one’s twenties than memorizing every ******ed little bone and blood vessel in the body. My plan A is to get an expat position and/or start a business in Asia; however that is a high risk proposition so med school is my backup plan. To that end, I’ve done the whole premed thing, shadowed physicians, done medical volunteering, taken the MCAT, and applied to medical schools. In fact I have a couple of med school interviews scheduled for later this year. More importantly, I’ve spent literally hundreds of hours doing due diligence on what one can expect from a career in medicine and how one can contort the idea of “medicine as a calling” to “medicine as an enabler of the global player lifestyle," which is ultimately what I want.
That last sentence is basically the crux of the matter. You’re probably thinking, “yes, doctors make $$$ but it comes at the price of having no life. “ This is true for many but doesn't have to be true for you. Medicine can definitely be a slog. I’m not trying to argue in this thread that it's the ultimate or even “good” life strategy for aspiring international players. Frankly, if you want to escape the West just do it asap. As a young guy you have time to figure **** out. However, if you're dead set on taking the "work now play later" approach of staying in the West initially, there are worse ways to go than becoming a physician. One of those worse ways is thinking you're gonna get an accounting or engineering degree and slave away for 10 to 15 years so that you can save what…300k? 500k? and live and travel off that puny sum.
With that out of the way, I'll get to some basics. The way medicine (in USA) works is that after college you enroll in medical school, which lasts 4 years. So ideally, you finish your official schooling at a fresh and spry 26. Bad news? You’re not done yet. For all intents and purposes, graduating medical school does not mean you can practice medicine. After your second year of med school, you take the USMLE, which is a test of the basic sciences you learned in those first 2 years. Based on your score on that test as well as grades, research, and networking skills, you then choose a specialty and apply for residencies in that specialty. This process can get dicey: if you’re dead set on becoming a plastic surgeon for example you better be the smartest person you’ve ever met, because you’ll have to be in the top 5% or so of your class(in practice, this means you’ll have to score in the top 5% on the USMLE). Now in general whenever someone says “top 5%” this doesn’t mean very much because when you look at a random group of people chances are you’ve got to go past 80-85th percentile just to get to those who are merely “somewhat competent.” Do remember though that medical students are already highly selected so that top 5% is really “top 5% of the top 5%.” You get the point. In any case, the good news is, as you’ll see in a bit you probably don’t want to be a plastic surgeon anyway.
Moving on. Let’s say you’ve done well enough on the USMLE to get your choice of specialties. Now you’ve got to decide what you want out of life. There is a huge difference between an orthopedic spine surgeon fusing the vertebrae in Payton Manning’s neck and a family doctor “prescribing” cough drops for an insufferable brat with a mild cold or telling a 300lb land whale that one step they could take to improve their health is lose a few pounds. If you really like the surgical specialties for the “coolness” factor (and the ridiculous salaries: no reason you can’t eventually be making $1m a year as a spine surgeon although $700k is more usual) then be prepared to treat medicine as a calling. But let’s assume that even at this point, we’re still treating a medical career same as before we started the process: as a means towards an end (the lifestyle we want) rather than an end in itself.
Let’s backtrack. What is residency, anyway? It’s basically like an apprenticeship. After medical school you apply to a residency program-let’s say it’s a general surgery residency at New York Memorial Hospital, or whatever. Since in this example the specialty is general surgery, the residency lasts 5 years. During these 5 years you’re getting worked like a dog and are making 60-70k a year. The hours are brutal (especially if it’s surgery) and the pay sucks, so 5 years is a lot, isn’t it? Yep, especially since each year of residency is costing you the difference between resident pay (60k) and attending pay (varies but could be as much as 500k even just starting out.) So ideally your perfect “lifestyle” specialty has the shortest residency possible so you start raking in the big bucks as soon as you can, at the youngest you can.
So, you want to look at those specialties with the shortest residencies. Also, you want to be able to **** off to wherever for however long you want on a whim, right? So you want shift work- you don't want specialties where you have to “build a practice,” i.e. accumulate a patient base that is relying on you and to whom you must be available round the clock. So forget **** like dermatology, cardiology, (most) surgery, etc. Finally, you of course want to get $PAID$ for the shifts you put in. With all that said, there is one specialty that is basically a no-brainer:
Emergency Medicine.
That’s right, working in the E.R. Here’s why:
First, the residency is “short” at just 3 years. A couple other specialties are also 3 years but none is less than 3. So in an ideal scenario, you graduate med school at 26 and finish up your EM residency at 29. Yeah, that ain’t that young and you’re probably behind your peers who have been in the workforce for the past 7 years, but don’t worry. You’ve put in the work and are now a financial Usain Bolt, ready to leapfrog a whole bunch of fat sluggish mother****ers who happened to get a pathetically insufficient head start on you.
Anyway, it’s not even as bad as all that. We still haven't even mentioned moonlighting. Rules about this vary, but choose your residency program wisely and you can start moonlighting your second year of residency, i.e. at the age of 27. What is moonlighting? Well, hospitals and especially emergency rooms need to be open 24/7, for obvious reasons. You’d need to employ a lot of full time dudes to make sure that the round the clock coverage is always in effect, so inevitably there are gaps in coverage. Hospitals are often desperate to fill these gaps in their schedules when somebody takes vacation, goes on leave, etc. Desperate enough to pay YOU, a lowly resident, big bucks to fill those shifts. You can easily expect to make around $200/hr moonlighting. Shifts vary from 8-12 hours depending on the hospital. You’ll be dead tired from residency and the last thing you’ll want to do is MORE work, but just do the math. Force yourself to work even 2 or 3 12-hr moonlighting shifts a month and you’re looking at a yearly bonus of $80-90,000 on top of your measly resident salary. All in all, you can reasonably expect to make 160k a year starting your second year of residency so at 27 you're already making progress, buddy!
But enough about residency, let’s consider your life as a fully-fledged attending physician. I’m going to continue assuming we’re interested in leaving America behind, since we’re intimidated by strong, independent women and feel the need to slum it with young, naïve, easily- controlled foreign girls. Well, now you’ve got some more choices to make. Do you want to (immediately!) live a moderately affluent life in SEA or EE, or do you want to work hard for a few years and ball out? Let’s say the former for now. Good thing about EM (and physician shift work in general) is locum-tenens and moonlighting work. Locum-tenens is simply short term contract work: you go to bum**** nowhere, Texas, and since it’s a brief stint where they’re desperate for coverage and it’s in bum**** nowhere, you get that pleasant $300/hr rate. Nice. Your contract is for 4 weeks where you work 20 12hr shifts and make $72,000. Very nice! Now you can fuk off for a while if you so choose and you've only worked a month.
Now, are you always going to be able to find such contracts, back to back? Yep, you probably could, although getting $300hr consistently may be a stretch. Something like $250 is more the norm. It’s a moot point though, because you probably won’t want to work that much. The average EM physician works fewer than 14 shifts a month and it’s for a reason, namely that those shifts are exhausting physically and mentally. Those hypothetical 20 12hr shifts in one month are something you could probably do for a few months at a stretch as a young dude just out of residency but it’s not sustainable for the long run…so they say.
So let’s step back and take a look at the broader picture. You’re now 29. You’ve done moonlighting for the last 2 years of residency and hopefully paid off your med school debt with the proceeds. Your income potential is around $3000 a day (assuming a middle of the road $250/hr but gruesome 12 hr shifts). You can work as much or as little as you wish, wherever you wish, so long as you apply for the requisite state medical licenses. If you choose to get a steady job in Texas (generally best state for physician compensation) you will make $400k a year on roughly 13-15 8hr shifts a month. Do some moonlighting above and beyond that and you can make $500-600k without stretching yourself too much, or up to $700k if you go full-on kamikaze mode. Let’s say that first year out of residency you put in the time and make $600k. Congrats, you’ve almost caught up to your accountant and engineer friends (let’s be generous and say that their first 8 years income out of college looked like this: 60+70+80+90+100+110+120+130=$760,000). Of course, you added( 600k-tax-1 year living expense) to your bank account, whereas they added (760k-tax-8 years living expenses) to their accounts. Chances are you’re ahead, even taking compounding investment returns into account.
I can easily live on less than 20k a year in USA especially when working like a madman, and so can you when you keep your goals in mind. After that first year of full time work you put away roughly 350k after tax and living expenses into the bank and you’ve just turned 30. Now you’re ready to **** off to wherever you want for 3 months before coming back for another 1 month locum-tenens contract. You’ve got decent capital already and you know you can always get more so you’re not risk averse. Invest that money in your ***** paradise and become a somebody. Hell, you’re an American trained doctor for chrissakes, the business opportunities are endless both home and abroad. You’re ****ing set, more or less, because you’re always just a week of 12hr ER shifts away from another $15,000.
Now compare your situation to that of an average working stiff 8 years into his career. Moral of this story: if you’re a college kid and you’re thinking that the path you want to take is to invest your 20s and early 30’s into a career here in the West rather than jetting off to your ***** paradise right off the bat, seriously consider medicine. Unless, of course, you go to HYPS and have an inside track for a Wall Street job, in which case you already know to disregard this without me having to tell you.
Some concluding disclaimers: the situation I’ve described is very uncommon in medicine. Most doctors are blue pill as hell, have families, and care deeply for the patients. Moreover, they’ve grown fat and happy and hustling is not their forte. They’d rather work within the same 20 mile radius to stay close to the wife and kids than jet around the country in pursuit of those 300/hr contracts. The jobs I described are like the “Canadian Oil Fields” of medicine. You’re not going to be paid $300/hr to work a 9-5 shift in NYC or LA.
Finally, and most importantly: all I wrote above is true for today and today only, and may not and almost certainly will not describe the situation 10 years from now. The US healthcare system is under intense financial pressure. Moreover, the corporate leeches and parasites have started to descend upon the medical profession. Consider this: When a dentist pulls a tooth, the dentist gets the money. When a plumber fixes the sink, the plumber gets the money. When the factory worker builds the car, the CEO and shareholders get the money and the worker gets crumbs. Why? Because the worker is part of a large organization and in large organizations the money is always sucked to the top. Medicine is undergoing a profound transformation. It is changing from a system where medical care is provided by physician owned practices. In such practices, physicians are both the providers of medical care and the owners of the business, so the money flows to them. Increasingly, gigantic “Healthcare Systems” have been assimilating these independent practices and turning doctors into hospital employees, cogs in a machine. In the eyes of the parasitic elite, for too long have doctors escaped relatively unscathed from the despoiling of the American economy by the vampire class. If 100 Orthopedic surgeons earn $200,000 a year instead of $500,000, then that means 30 million dollars was just freed up to go to the Healthcare System CEOs and the private equity firms behind them! There are other potential pitfalls that I won’t go into, but the takeaway is just be aware that today’s reality may be tomorrow’s wistful reminiscence. But that is true of the future period, not just medicine.
Anyway, I hope some of you found this interesting/useful. Hit me up if you have any questions.
That whole thing was so thoroughly gross. He was being sarcastic when he said he's looking for "young, naïve, easily-controlled foreign girls," right? Please tell me that was sarcastic.
