Residency is done, Some thoughts

[snorgtguy]

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Sitting here studying for some board exams, I thought I might take a break to give back to the community. This doesnt apply to all of you, but some of you may use this information to empower yourself. I just finished residency in a competitive specialty, I have a pretty good job locked in with a small amount of upside. One thing that is very clear however, is that the world passed by during training. There is alot more money and power and respect being earned out there and none of it is in being a clinician. Clinicians are increasingly entering the overworked middle class.

By becoming a clinician you are relegating yourself to a life of work, and depending on your specialty very hard work. For many of you, this is no big deal, you saw your parents do it and thats what you want to do. To you I say great, you understand the sacrifice and signed up for it with this understanding. For those that do not, you need to understand that you are committing your life to this, and your overall compensation will not be great. Clinical medicine is no longer a way to build a very good lifestyle. You can not scale this job any longer and private practice is becoming a thing of the past as we move to a centralized system. Just like many other fields outside of medicine, the older doctors understand this and are waiting to prey on young doctors. Again, this does not apply to everyone but I believe your generation is in for hard times in medicine bc the old guard has no concept of the younger generation.

I believe this is important for a few reasons. If you have to take a large debt to be a physician (there are ways to avoid this), dont do it. You can do great things for the world without being a doctor. Next, learn to live within your means. Dont go promising yourself or anyone that the payout is around the corner, it's not. If you want to live in a big city on the coasts, especially with a family, consider something that is not medicine (do the math; do you know the mortgage on a 2 million dollar home). Next, medicine is a loner path, you do not really work with your peers (nurses, techs, secretaries are not your peers). If you are a very social person, consider something else.

Many of you will have the capacity to be in different careers and do amazing things. If you have this capacity you need to question if clinical medicine is really the right thing given the way to world is moving. Otherwise stay realistic, understand the new world of medicine, and take the best care of patients you can and you will rock it. Good luck!

 

[bashwell]

Sitting here studying for some board exams, I thought I might take a break to give back to the community. This doesnt apply to all of you, but some of you may use this information to empower yourself. I just finished residency in a competitive specialty, I have a pretty good job locked in with a small amount of upside. One thing that is very clear however, is that the world passed by during training. There is alot more money and power and respect being earned out there and none of it is in being a clinician. Clinicians are increasingly entering the overworked middle class.

By becoming a clinician you are relegating yourself to a life of work, and depending on your specialty very hard work. For many of you, this is no big deal, you saw your parents do it and thats what you want to do. To you I say great, you understand the sacrifice and signed up for it with this understanding. For those that do not, you need to understand that you are committing your life to this, and your overall compensation will not be great. Clinical medicine is no longer a way to build a very good lifestyle. You can not scale this job any longer and private practice is becoming a thing of the past as we move to a centralized system. Just like many other fields outside of medicine, the older doctors understand this and are waiting to prey on young doctors. Again, this does not apply to everyone but I believe your generation is in for hard times in medicine bc the old guard has no concept of the younger generation.

I believe this is important for a few reasons. If you have to take a large debt to be a physician (there are ways to avoid this), dont do it. You can do great things for the world without being a doctor. Next, learn to live within your means. Dont go promising yourself or anyone that the payout is around the corner, it's not. If you want to live in a big city on the coasts, especially with a family, consider something that is not medicine (do the math; do you know the mortgage on a 2 million dollar home). Next, medicine is a loner path, you do not really work with your peers (nurses, techs, secretaries are not your peers). If you are a very social person, consider something else.

Many of you will have the capacity to be in different careers and do amazing things. If you have this capacity you need to question if clinical medicine is really the right thing given the way to world is moving. Otherwise stay realistic, understand the new world of medicine, and take the best care of patients you can and you will rock it. Good luck!

Thanks, there's a lot of truth to what you say. Things are getting harder almost across the board for most doctors. But there's also a lot that depends on other factors. Such as which specific specialty you're in. Not that most medical specialties are easy, but some specialties are more flexible in terms of "lifestyle" than others. Mind saying what "competitive specialty" you're in? It'd be helpful so people can at least better see where you're coming from. Like if you're trauma surgery or interventional cardiology that might be a lot more understandable.

 

[deleted480308]

>$200k is not middle class, OP

 

[Psai]

if you're wearing a name tag at work and handed a check every 2 weeks, you're probably not upper class

 

[sholamd]

Thanks snorgtguy, for your thoughts. Your outlook sounds pretty gloomy. I wonder if you have any suggestions for those of us who are in too deep to turn back now. Are there ways we can control our working lives better?

 

[Baller MD]

This guy gets it.

 

[Doctor Bob]

if you're wearing a name tag at work and handed a check every 2 weeks, you're probably not upper class

🙁

The department gave us all nametags... and we're paid every two weeks.

 

[deleted480308]

🙁

The department gave us all nametags... and we're paid every two weeks.

If it's a 5 digit check, not so middle class

 

[Doctor Bob]

If it's a 5 digit check, not so middle class

Do the numbers after the decimal point count?

 

[postbacpremed87]

I think a dose of realism is warranted. The world is changing around us, albeit at a snail's pace. It's kind of like boiling a lobster. Things are good for many now, but 10 years from now? 200k for what we go through is not a lot, especially when midlevels make 100-150k easily, more if you are that 4 letter word that they hate on that one thread.

 

[deleted480308]

I think a dose of realism is warranted. The world is changing around us, albeit at a snail's pace. It's kind of like boiling a lobster. Things are good for many now, but 10 years from now? 200k for what we go through is not a lot, especially when midlevels make 100-150k easily, more if you are that 4 letter word that they hate on that one thread.

At the rate their schools keep popping up, that will decrease

 

[Roxas]

Sitting here studying for some board exams, I thought I might take a break to give back to the community. This doesnt apply to all of you, but some of you may use this information to empower yourself. I just finished residency in a competitive specialty, I have a pretty good job locked in with a small amount of upside. One thing that is very clear however, is that the world passed by during training. There is alot more money and power and respect being earned out there and none of it is in being a clinician. Clinicians are increasingly entering the overworked middle class.

By becoming a clinician you are relegating yourself to a life of work, and depending on your specialty very hard work. For many of you, this is no big deal, you saw your parents do it and thats what you want to do. To you I say great, you understand the sacrifice and signed up for it with this understanding. For those that do not, you need to understand that you are committing your life to this, and your overall compensation will not be great. Clinical medicine is no longer a way to build a very good lifestyle. You can not scale this job any longer and private practice is becoming a thing of the past as we move to a centralized system. Just like many other fields outside of medicine, the older doctors understand this and are waiting to prey on young doctors. Again, this does not apply to everyone but I believe your generation is in for hard times in medicine bc the old guard has no concept of the younger generation.

I believe this is important for a few reasons. If you have to take a large debt to be a physician (there are ways to avoid this), dont do it. You can do great things for the world without being a doctor. Next, learn to live within your means. Dont go promising yourself or anyone that the payout is around the corner, it's not. If you want to live in a big city on the coasts, especially with a family, consider something that is not medicine (do the math; do you know the mortgage on a 2 million dollar home). Next, medicine is a loner path, you do not really work with your peers (nurses, techs, secretaries are not your peers). If you are a very social person, consider something else.

Many of you will have the capacity to be in different careers and do amazing things. If you have this capacity you need to question if clinical medicine is really the right thing given the way to world is moving. Otherwise stay realistic, understand the new world of medicine, and take the best care of patients you can and you will rock it. Good luck!

This is fairly disconcerting. I chose to enter medical school knowing that I would work hard for the rest of my life, but with no one in my family in medicine it's hard not to enter with a sizable amount of naivete. Not many docs you shadow as a pre-med are willing to open up their heart and souls to you about the doom and gloom of their profession. There were one or two who did appear to legitimately enjoy what they did (in FM no less) and I just hope to end up like them.

 

[RustBeltOnc]

>$200k is not middle class, OP

He alludes to the arbitrary rules, HR BS, ACO BS, politics etc that goes with being an employed physician.
These are things the real upper class does not experience.

 

[deleted480308]

He alludes to the arbitrary rules, HR BS, ACO BS, politics etc that goes with being an employed physician.
These are things the real upper class does not experience.

Ahhh, you think upper class means people who have no rules or politics to navigate? Haha

 

[RustBeltOnc]

Ahhh, you think upper class means people who have no rules or politics to navigate? Haha

Not like the employed physician; the real upper class sits on the boards that control the hospital system and make the rules.

 

[baxt1412]

so then don't buy a 2 million dollar house............

 

[Psai]

if the government is taking half of what you make, you're not rich
real money and real upper class people don't make cash from working hard, long hours and taking a salary. they're the ones signing the checks

 

[deleted480308]

if the government is taking half of what you make, you're not rich
real money and real upper class people don't make cash from working hard, long hours and taking a salary. they're the ones signing the checks

Then live like a resident for 20 years and invest

 

[VA Hopeful Dr]

If it's a 5 digit check, not so middle class

It takes a fairly impressive salary to get a net 5 digit check every 2 weeks. At my prior urgent care job, I was salaried at 212k. After taxes, my bi-weekly take home was about 4k. So to get to 5 digit bi-weekly net, you'd need a salary of closer to 450k - not many physicians actually pull that off.

 

[baxt1412]

Then live like a resident for 20 years and invest

this, you're making 200k+ more than likely. even in high cost of living you should be able to live rather comfortably off of 50-75% of your income. obviously it's all speculation until you look at specific numbers, but i've never seen any docs in the line at the soup kitchen

 

[Merely]

Some of you are confusing "upper class" with "elite." Many physicians that I know are certainly upper class, earninig 300k+ but they are certainly not the elites. The elites are the CEOs of the hospitals and insurance companies earning millions, not a few hundred thousand.

 

[deleted480308]

It takes a fairly impressive salary to get a net 5 digit check every 2 weeks. At my prior urgent care job, I was salaried at 212k. After taxes, my bi-weekly take home was about 4k. So to get to 5 digit bi-weekly net, you'd need a salary of closer to 450k - not many physicians actually pull that off.

I think like an employer...checks are gross, not net. How much an employee deducts for various things and what the government seized from them don't really change how much their labor cost me. $260 puts a gross check biweekly at 5 digits

 

[Moose A Moose]

OP... Stop rustling my jimmies with your talk, and get this two-million dollar house nonsense out of here.

 

[Psai]

if you're living like a resident, you're not upper class lmao

 

[deleted480308]

if you're living like a resident, you're not upper class lmao

If you want your income to be more from investment than labor, you must cut spending and invest. It's a basic concept

 

[VA Hopeful Dr]

I think like an employer...checks are gross, not net. How much an employee deducts for various things and what the government seized from them don't really change how much their labor cost me. $260 puts a gross check biweekly at 5 digits

What the employer thinks decide middle class versus upper class, the amount of money the employee gets does. I'm happy to ignore retirement, insurance, deductions and all that but you can't ignore taxes.

 

[deleted480308]

What the employer thinks decide middle class versus upper class, the amount of money the employee gets does. I'm happy to ignore retirement, insurance, deductions and all that but you can't ignore taxes.

Pretax is how we actually define middle class in america...

 

[Psai]

If you want your income to be more from investment than labor, you must cut spending and invest. It's a basic concept

if you need to cut spending to invest, you're not upper class

 

[deleted480308]

if you need to cut spending to invest, you're not upper class

Stop moving the goal post, you tried to define upper class as those with the majority of their income not coming from labor. I just described how to make it happen

 

[VA Hopeful Dr]

Pretax is how we actually define middle class in america...

I just spent the last 15 minutes on Google trying to figure out what qualifies as middle class. No one actually seems to know. Its infuriating. I've seen as low as 88k and as high as 300k. I give up.

 

[deleted480308]

I just spent the last 15 minutes on Google trying to figure out what qualifies as middle class. No one actually seems to know. Its infuriating. I've seen as low as 88k and as high as 300k. I give up.

It kind of depends on who is using it to grab votes, a lot like "wealthy"

 

[Mad Jack]

If you want your income to be more from investment than labor, you must cut spending and invest. It's a basic concept

Most people seem to think you are either born with wealth or you'll never have it- rare is the person actually willing to make the sacrifice to obtain it.

 

[Psai]

Stop moving the goal post, you tried to define upper class as those with the majority of their income not coming from labor. I just described how to make it happen

haha how am i moving a goal post?
if you're earning a salary, you're probably not making a majority of your income from something other than your labor. not that this is even remotely relevant to the op
so many social justice keyboard warriors here

 

[Mad Jack]

haha how am i moving a goal post?
if you're earning a salary, you're probably not making a majority of your income from something other than your labor. not that this is even remotely relevant to the op
so many social justice keyboard warriors here

All of this is relevant to the discussion at hand- one of the reasons OP cited for not being a physician was income. Many of us have voiced the opinion that it isn't as big of a concern as it seems, as even at 200k we'll be earning plenty. It's more than enough to invest with and make a good life for yourself. No idea how that concept got convoluted into some push for social justice lol.

Couple other things about the OP that bugged me- there are plenty of fields where you can work directly with colleagues, particularly in inpatient medicine. But even if you are working with non-physicians- why does that matter? We hung out together in the ED- physicians, nurses, techs, etc. Plenty of opportunity to socialize if you don't view non-physicians as somehow being beneath you.

Who needs a two million dollar home? I mean, seriously- I know tons of people that live in big coastal cities, zero of which have cracked 100k in income, so surely a physician can do it.

I do agree with the general sentiment though- medicine is certainly not what it once was. If you're in it for the lifestyle, be prepared for disappointment.

 

[Low Flow]

I'm reluctant to classify someone who earns, or whose net worth is more than 90% of Americans as "middle class". That's not even close to the middle. While it's certainly not rolling in the green like many elite investors, the majority of physicians will live comfortably above the masses (save for those who blow it all on a million dollar home).

 

[bc65]

OP, I completely sympathize with your point of view. I have experienced similar feelings after realizing how much of my life was spent on call in the hospital.
I think it's a great post, and should be read by anyone contemplating medicine. However, I disagree about the money. It's true that the debt can be formidable, and if you will have a large debt total and will be going into a lower paid specialty, the math may not work out in your favor.

That said, many of us have lost perspective on salaries. The average US income is about 52k. Most Americans would consider an income of 100k to be rich. 200k , unimaginable. If you were a computer programmer AND you founded Facebook or Twitter, you would have more money, but you didn't do that. Neither did 99% of programmers, who work very long hours for a lot less money than you will earn.

They highest " guaranteed " income that I'm aware of is being a physician. I'm not saying it's worth all the misery you went through, but the money is actually pretty good. Investment banking jobs and highly compensated corporate positions do pay more, but those jobs are few and far between, they often work longer hours than doctors, and most who try for those jobs don't get them.

If you are in a highly compensated specialty, as I believe you are, and you're careful with your money, then you can easily achieve a net worth in the low to middle 8 figures in your lifetime. That's rich. You are probably comparing yourself to billionaires. You will not become a billionaire as a physician. If you want that kind of money, become a physician entrerpreneur.

Note: You can either accumulate a high net worth, OR have a lot of toys: Lamborghini, a plane, a big boat, a vacation home. As a physician, you won't be able to have both. Decide which one you want, and proceed from there. If you want both, you need to get lucky or do what the really rich people did: start a successful company, or marry someone who did.

 

[Mad Jack]

I'm reluctant to classify someone who earns, or whose net worth is more than 90% of Americans as "middle class". That's not even close to the middle. While it's certainly not rolling in the green like many elite investors, the majority of physicians will live comfortably above the masses (save for those who blow it all on a million dollar home).

A million dollar home is surprisingly affordable for many specialists, for the record. Two million is a stretch though.

 

[studentdoct69]

OP is absolutely correct. One major thing he is saying here is that medicine is not a great financial investment. Many people have tried to warn the country (and doctors specifically b/c they are impacted most) what the ramifications are regarding where medicine is heading (and has already gone). One of my friends is living in Hawaii right now...is on Medicaid, gets food stamps and other gov't benefits....AND she comes from an upper-class family that had a $1 mill.+ house growing up. She's literally partying and having a great time "travelling" while we work and study for a career. I get that it's two different lifestyles and there are pros and cons to both the ambitious student doctor and beach bum...but keep in mind that a lot of these gov't programs (food stamps, obamacare etc) are taking from the "rich" AKA working class doctors like us and giving to people in "need" like my friend in hawaii...lol. This is an extreme example, but it happens way way way more than you think. Just something to think about.

"real money and real upper class people don't make cash from working hard, long hours and taking a salary. they're the ones signing the checks"
There really isn't a short-cut to success and wealth--you gotta put in the work. Most of the "elites" and the people "signing checks" built big businesses from the ground up or stayed in the same gruelling big-four accounting firm for 30 years. Which takes getting lucky and an incredible amount of work.

Doctors are upper-middle class. They get paid around the most for the middle/working class. The unfortunate thing is that private practice is delcining, thus incentives to be more creative and lucrative fly out the window. Unless drastic changes are made, it will only get worse. And, with the increasing tuition at schools going to college will be veryyyyyyyyy unwise (in say 10 years). I would love to counsel and advise high school students about their decision to go to college lol.

One message that can be taken from OP is that wealth redestribution disincentivizes people from working hard and getting rich through hard work. Hence why he's telling you it's too much work and possibly not worth it in the end with the future of medicine.

I do think "the grass is greener on the other side" applies HARD to our medical profession though.

 

[deleted480308]

A million dollar home is surprisingly affordable for many specialists, for the record. Two million is a stretch though.

exactly.....that's in the range of $5k/month, a lot of docs could swing that if they controlled other expenses

 

[VA Hopeful Dr]

I'm reluctant to classify someone who earns, or whose net worth is more than 90% of Americans as "middle class". That's not even close to the middle. While it's certainly not rolling in the green like many elite investors, the majority of physicians will live comfortably above the masses (save for those who blow it all on a million dollar home).

Generally speaking, I completely agree. The one exception is our loan burden. Even if you're making good money, most loans are now essentially a second mortgage. That's tough, at least for many primary care folks.

 

[bc65]

the majority of physicians will live comfortably above the masses (save for those who blow it all on a million dollar home).

If you live in Manhattan or Silicon Valley, one to two million is a starter home. No exaggeration.

 

[baxt1412]

If you live in Manhattan or Silicon Valley, one to two million is a starter home. No exaggeration.

co-ops could be a good idea in a situation like that until you can build up a big down payment

 

[mw18]

I'm in my upper 20s and I'm starting school this fall and residency money will be about twice as much as I've ever made in a year (save for a tax-free year in Iraq). It's really all about perspective. OP is trying to give some, and I think probably does a fair job at doing so on many topics. I'm not even a student yet, let alone a resident or an attending, but the idea that a profession that easily makes 200k is just getting by financially ("compensation not all that great" and "no longer a way to build a very good lifestyle") lacks perspective. But living within your means has to be the reason why so many physicians struggle with their loans. But I've gotten by for a long time like this, so it is all about expectation management I would imagine.

And I guess I've been in situations where life has truly passed me by, so I'm not all that worried about residency.

 

[baxt1412]

perspective is truly important. income doesn't make you rich. evident by lots of professionals still declaring bankruptcy, etc

 

[bc65]

co-ops could be a good idea in a situation like that until you can build up a big down payment

For those who are not familiar with co-ops, they are the same as condo's. but they have a different ownership structure, in which you own a share in the building, which gives you the rights to your apartment, instead of owning the apartment outright. That means that you are subject to the co-op board approval before you can buy an apartment, and the buyers must be approved before you sell it. You also have limits on borrowing against the co-op or mortgaging it. So, in fact, co-ops are the least liquid and require the larger amount of cash up front. I have only encountered co-ops in NY, I don't know if they exist elsewhere.

If by co-op you might mean buy an apartment instead of a house, I'm talking about apartments, which are currently way above a million per bedroom for anything decent. There are very few free-standing homes in Manhattan. Usually, those are townhouses ("brownstones"). The nicer ones are foreign embassies and consulates for United Nations delegations. There are a very few real houses in Manhattan. The ones that still exist were all once the mansions of the very wealthy at one time, and are mostly museums now, but a few are in the hand of billionaires. Doctors usually can't afford brownstones or houses in Manhattan.

 

[Mad Jack]

If you live in Manhattan or Silicon Valley, one to two million is a starter home. No exaggeration.

Dear god, you might have to *gasp* get a condo or not live in Silicon Valley!

 

[deleted480308]

Dear god, you might have to *gasp* get a condo or not live in Silicon Valley!

it's like saying I can't afford transportation and then posting a pic of veyron

 

[Mad Jack]

it's like saying I can't afford transportation and then posting a pic of veyron

Exactly. Judging how well off physicians are by determining whether they can afford homes in some of the most expensive real estate markets in the world is a bit of a false measurement to go by.

 

[studentdoct69]

Dear god, you might have to *gasp* get a condo or not live in Silicon Valley!

The point is student doctors feel disincentivized to work hard to get what they want in life. bc65 might want to live in Silicon valley which is incredibly reasonable seeing as to how he is a doctor and has worked his ass off all these years.

 

[tymont12]

Most people seem to think you are either born with wealth or you'll never have it- rare is the person actually willing to make the sacrifice to obtain it.

Yes, the wet dream of inheriting billions of old money sounds great, but most people achieve financial success through what you're saying. The average person who works hard, has a well paying job and has a very high net worth, does it by saving and investing. There aren't really any 'jobs' now that allow you to become financially independent...you have to start a (highly successful and probably not feasible) company with a software-like markup, or win the lottery for that to happen. Or be given a large inheritance. All are very unlikely.

I had a work acquaintance who made himself thru selling modular helicopter storage containers. He had a $3 million house with a private runway to his garage but he had these bizarre idiosyncracies about money, which allowed him to be so wealthy. For example, he never bought alcohol because it was 'too expensive' so once a week he'd drive to this hotel where they served free glasses of $5 bottles of wine. He also never bought a new car. Everyone I've met who has had a decent net worth has been singularly fixated on growing that number.