Salaries and pesky altruists

[GeddyLee]

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I'm just wondering why so many medical students get bent
out of shape when someone asks how much money they will
make when they finish their training? Every time someone
mentions salaries, we get the token comments about not going
into medicine for the money, and how ashamed we should be
for ever considering that we would like to someday make any
salary at all. I think this is absurd. Where did we learn that
we don't have a right to a salary commensurate with all our
years of education, training, and sacrifice? This is where
doctors have failed themselves. Physician's unwillingness to
proclaim their right to a salary is the root cause of decreasing
reimbursements and increasing malpractice. How low are we
willing to go?
For all you who get worked up whenever a question about
money is raised, I'd like to know if you're planning to work
strictly on a voluntary basis? Are you going to cut the amount
you charge as a doctor so that you make an average salary?
If not, why? I think it's a great idea to consider salary when
you choose a career, especially given that you'll all be over
$100,000 in debt.
Geddy

 

[Laura JC]

I DIDN'T go into medicine for the money. I've had enough career and life experience to know that there are a HECK of a lot easier ways to make money, and I've done it. That being said--I will have no problem whatsoever cashing any paycheck I ever get--and I definitely believe that my time and skill will be deserving of a large salary.

 

[medicine2006]

Just because you work hard in school does not entitle you to a high salary. Just ask any History PhD who has spent 5,6,7+ years to get their doctorate only to find out they can teach at a junior college for 40K.

Granted doctors are always gonna be in demand but to assume lots of time spent in training = high salary is anti-capitalism. People pay for what they need. That's why PhD's in art history are usually poor.

 

[Iron Horse]

Originally posted by GeddyLee
Physician's unwillingness to
proclaim their right to a salary is the root cause of decreasing
reimbursements and increasing malpractice.
Geddy

Actually one could argue that the period of time pre-managed care when many MDs made money by doing unnecessary procedures and overcharging for services helped pave the way for managed care and various other attempts to control sky-rocketing health care costs. Please explain your assertion that "physician's unwillingness to proclaim their right to salary is the root cause of decreasing reimbursements and increasing malpractice."

I have no argument against being paid fairly and well for doing important work after many sacrifices, financial and otherwise, I just fail to see any logic in your statement.

 

[powermd]

Originally posted by GeddyLee
I'm just wondering why so many medical students get bent
out of shape when someone asks how much money they will
make when they finish their training? Every time someone
mentions salaries, we get the token comments about not going
into medicine for the money, and how ashamed we should be
for ever considering that we would like to someday make any
salary at all. I think this is absurd. Where did we learn that
we don't have a right to a salary commensurate with all our
years of education, training, and sacrifice? This is where
doctors have failed themselves. Physician's unwillingness to
proclaim their right to a salary is the root cause of decreasing
reimbursements and increasing malpractice. How low are we
willing to go?
For all you who get worked up whenever a question about
money is raised, I'd like to know if you're planning to work
strictly on a voluntary basis? Are you going to cut the amount
you charge as a doctor so that you make an average salary?
If not, why? I think it's a great idea to consider salary when
you choose a career, especially given that you'll all be over
$100,000 in debt.
Geddy

I think part of the problem lies in the self-sacrificing posture people adopt in trying to impress those who will have an impact on their admission to medical school. Many, mostly pre-meds, and year 1-2 med students, feel very lucky to have been selected for this career, and experience a good deal of guilt whenever compensation is brought up. That all changes in the third year when they discover medicine is actually hard work. Those that don't change their minds by the end of medical school will almost certainly have changed by the end of residency.

Doctors have the power to determine what society will pay for medical services, although weilding that power is often difficult and may involve other sacrifices. No one puts a gun to a doctor's head when he signs a burdensom contract with an HMO, or chooses to see Medicare patients. There's an article at http://www.medicaleconomics.com this week that discusses opting out of Medicare. Something like 90% of internists and FPs bill Medicare, but those who are opting out are finding it highly beneficial. Read the article for more.

The fundamental issue the altruists reach for is the natural conflict of interest inherent in medicine. You have a duty to your patient to make choices that serve their best interests. The conflict arises from your financial interest in offering more, and more invasive care. Even if you are not consciously swayed by this fact, it still acts like a magnet on your decisionmaking. At some point you may accidentally end up choosing an option that is not the best one for the patient because it makes you more money. This is why the altruists (Mother Theresa types aside, who would prefer that we all work for free) see a big red flag go up when a physician indicates desire for more substantial compensation. They see this as an indication that you are a bad doctor, caring more for your bank balance than your patient.

 

[ArrogantSurgeon]

GeddyLee,

The great thing about medicine is that it gives you many options on how to tailor your life after your training is finished. If you want to make lots of money, there are specialites and practice settings that will allow you to do that (private practice cosmetic surgery, dermatology, etc). If you want to forgo the big bucks then you can also find practice settings that will let you achieve just that.

But the underlying point should be: Who cares what others think about why you're in medicine. Why should you even take on the need to justify your reasons for doing what you want to do? Whether that means making $1 million+ each year doing cosmetic surgery and selling wrinkle cream to rich housewives or making $50,000 living out in the middle of nowhere serving a rural community....it doesn't matter a single bit what others think as long as you enjoy what you are doing and it is fulfilling what you want to do with your career. The people complaining are usually not the ones who have to pay off your loans and family expenses. As with other things in life, just turn a deaf ear to what they say and do what you want with your career.

 

[LuckyMD2b]

😱 THis is what I'm talking about:

http://story.news.yahoo.com/news?tmpl=story&cid=573&ncid=757&e=1&u=/nm/20030711/od_nm/brain_dc

This doctor makes $430/month, but still goes out of his way to do everything he can for his patients.

Just curious, Did you mention that you want a large financial compensation when you were interviewing??

Didn't think so.

I am, by the way, going to reduce the amount I charge my patients so that I make no more than the average American citizen. In addition to that I'm going to give 10% of my income to the Church and another 10% to the Jimmy Fund😉

 

[ArrogantSurgeon]

Originally posted by LuckyMD2b
I am, by the way, going to reduce the amount I charge my patients so that I make no more than the average American citizen. In addition to that I'm going to give 10% of my income to the Church and another 10% to the Jimmy Fund😉

Good for you little Miss Muffin. But realize that most people did not become doctors to just make the same amout of money as the average American citizen. But to each his own...

 

[SunnyS81]

The median income is between $40-45k/year. You're seriously going to do that? I just graduated from undergrad and I'm making more with my bachelor's degree. I would have immense respect for you if you actually follow through, but I have a feeling that you won't be living off of ~ $33-38k (before taxes and after charity). I hope you aren't paying to go to medical school and are going to live in a rural area, in which case that is actually a pretty decent amount of money for small town life. You do realize that your nurses will make more than you. Especially since they are in such short supply.

By the way, the doctor is in Peru (cost of living is different) and probably doesn't have to worry about insurance. I guarantee you he wouldn't be a doctor in the US if he only got paid $450/month.....he wouldn't even be insured.

 

[ArrogantSurgeon]

It just her youthful idealism talking. It will be crushed somewhere in the third year of medical school and leave her running for the nearest dermatology residency in a upper-class part of town.

 

[LuckyMD2b]

I so totally am going to do that(make no more than the average American worker), obviously.

Why wouldn't I? It's not only feasible, but extremely practical.

--And I'm a man, dumas.

 

[ArrogantSurgeon]

Originally posted by LuckyMD2b
And I'm a man, dumas.

It's not easy to tell when you're acting like a little idealistic girl.

 

[LuckyMD2b]

I'm quite comfortable with my masculinity, thank you very much. Maybe it's you who is over compensating for something...

I thought my sarcasm would have been readily recognized.

Guess not.

😕

 

[Skip Intro]

Originally posted by GeddyLee
I'm just wondering why so many medical students get bent
out of shape when someone asks how much money they will
make when they finish their training? Every time someone
mentions salaries, we get the token comments about not going
into medicine for the money, and how ashamed we should be
for ever considering that we would like to someday make any
salary at all. I think this is absurd. Where did we learn that
we don't have a right to a salary commensurate with all our
years of education, training, and sacrifice? This is where
doctors have failed themselves. Physician's unwillingness to
proclaim their right to a salary is the root cause of decreasing
reimbursements and increasing malpractice. How low are we
willing to go?
For all you who get worked up whenever a question about
money is raised, I'd like to know if you're planning to work
strictly on a voluntary basis? Are you going to cut the amount
you charge as a doctor so that you make an average salary?
If not, why? I think it's a great idea to consider salary when
you choose a career, especially given that you'll all be over
$100,000 in debt.
Geddy

Because, as you should know, Geddy...

And the men who hold high places,
Must be the ones who start
To mold a new reality
Closer to the heart.

😉

-Skip

 

[funkless]

DR. FUNKLESS'S "AVERAGE AMERICAN" MEDICAL COMPENSATION PLAN:

1. Go into $150K+ debt for four years' med school.
2. Work for another four years as a resident ($30K a year)
3. Live off twigs, berries, and pine needle tea
4. Complete residency. Open private practice.
5. Realize that you're paying $80K yearly in malp. ins. premiums
6. Note that your nurses make $25/hr
7. Pay off student loans by age 36. By now you have three kids and a spouse, none of which you really have time for.
8. Move into Funkland Trailer Park.
9. Realize you make less than your nurses.
10. Take the GRE. Or maybe it's time to write that screenplay...


You're right! Feasible AND practical.

--Funkless

 

[zbarnes]

Originally posted by LuckyMD2b
I so totally am going to do that(make no more than the average American worker), obviously.

Why wouldn't I? It's not only feasible, but extremely practical.

--And I'm a man, dumas.

You wont because after trying it as a resident and then graduating, just the realization that you can make more will be too much. Youll figure you can buy 10 ramen noodles/wk instead of five and it will snowball from there.

How far along in school are you? I've noticed that so many people because of the competiveness of acceptance and the desire to be accepted to a school actually take all that bs about altruism/well roundedness/etc.. at 100% face value. Really you just need to be able to adapt to any situation and come off as competent, taking away from it whats important. I have a feeling that many will lose this naive view of medicine after they realize they are already in and they dont have to try to kiss arse all the damn time, how lame.

I have a question, have you ever lived at average american income levels, which are probably more on the range of 35-40K a year? Thats a level of income where one is stuck just above poor and below middle class. It wouldnt be fair to do this if you have family as a safety net or someone is paying off your debts, etc.. It would also be easier for you b/c if you felt you were to ever have a hard time you know you could immediately up your income 150K, a very valuable piece of mind the average american does not have.

 

[Skip Intro]

Originally posted by zbarnes
I have a question, have you ever lived at average american income levels, which are probably more on the range of 35-40K a year?

Well, that really depends on where you live. Ever spent any time in Oklahoma City? That goes pretty far in that town.

(Not disagreeing here, just making a side point.)

-Skip

 

[FMLizard]

Everyone says how it is far easier to make big money doing other things besides medicine. A reality check would show you that most people graduate undergrad and go work a worthless job that they could have had without college at all for about $10-12 per hour.

Most grad students don't do much better. MBA, JD, MS...all are very tenuous at best for finding work. Most MBAs and lawyers struggle to make 50-60 grand, if they have a job at all.

Also, rural practice will guarantee you a greater income, not a ridiculously low one. It is a simple law of supply and demand. Add in a lower cost of living, and it is financially advantageous to practice in rural areas.

 

[j_sde]

as a reply to FMLizard.. i'd just like to point out that many people who got accepted to medical school could've been competitive enough to have gotten accepted to a top 25 law/business school as well. the road to medicine is prob more competitive than that to get into any other graduate programs. to put it in numbers, the average medica accepted applicant prob has a gpa somewhere in 3.7 range.... and if you look at mba/jd programs, only the top 25 schools have average gpas in that range. further, if you ever took any history/poli sci/business classes in undergrad, i'd go so far to argue that the biochem/pchem classes were much more demandin and difficult to get As in.

and yea, there are mba/jds who are strugglin w/a 50k job... but if you look at average salaries of top 25 mba/jd students they are doin well above 50k.

anywyas, ... of course no one knows how performance of these students would be if they decided to go to the mba/jd route... nor what kinda jobs they would get. my argument tho is that anyone with decent smarts to get into a medical school could have prob used their energy to have gotten into a top 25 law/mba school as well. and given that... the average income to debt ratio of a law/mba student graduatin from top 25 is far greater than that of an average joe med student

 

[Firebird]

Originally posted by medicine2006
Just because you work hard in school does not entitle you to a high salary. Just ask any History PhD who has spent 5,6,7+ years to get their doctorate only to find out they can teach at a junior college for 40K.

Granted doctors are always gonna be in demand but to assume lots of time spent in training = high salary is anti-capitalism. People pay for what they need. That's why PhD's in art history are usually poor.

But when the History Ph.D. makes a mistake and tells his class that Julius Caesar was Greek and not Roman, his class doesn't all fall over and die from internal bleeding.

LAURA JC--question--what are these easier ways to make $300,000+ a year? Everyone is always saying, MBA's make a lot more than doctors and stuff like that. Perhaps the TOP 10% make more than doctors, but I bet the others are chipping away with a 120K a year...if that much.

 

[GoodMonkey]

Originally posted by j_sde
and yea, there are mba/jds who are strugglin w/a 50k job...

wow, i guess i never thought as 50K as struggling. you may need a little perspective as to what constitutes "struggling." i make less than 35K/yr and granted, i'm single and i don't have children, but i own my own home and a car, there is food on my table and i have pretty nice clothes, a computer and some other techy gadgets. i'm a FAR cry from struggling. and i'm 15K under your 50K mark.

i also agree with skip - a lot of the whole "how far your money goes" debate rests on where you choose to live. that "chipping away on 120K" business someone posted - people in my small hometown in mid-michigan live quite comfortably on that - and live in v.v.nice houses, with a couple of cars, and a family of four and all sorts of nice posessions on top of basic creature comforts.

conversely, there are people who, the more money they make, manage to toss all that much more money away. and wind up in the same spot as your 50K joe-shmoe anyway. (that was grammatically horrific, i think, but you get my point i hope. 🙂 )

 

[carrigallen]

I agree. I know people who the more money they've made, it seems the less happy they've become. Life's not really a monopoly game.

where i come from, a single person making 35k/yr is living high off the hog. For a family to make more than 50-60k, those are the rich kids.

 

[Laura JC]

Originally posted by Firebird
LAURA JC--question--what are these easier ways to make $300,000+ a year? .

Ummm..........stripping?

But seriously, 300,000+ ? Most doctors don't make anywhere near that amount. What I said was that there are easier ways to make money than being a doctor. But if you want an example, here's one. My husband is an estate planner, makes good money and would be the first to tell you the job isn't all that difficult compared to, say, ditchdigging. He sets his own hours and takes vacations whenever he wants them. In medicine, you pay a LOT of money just to be trained, then you undergo several years of grueling challenges, are worked like a dog and are given very little compensation for a very long time. Not many people would put up with that unless it was something they really loved, even if there was a promise of big $ way down the road.

 

[Firebird]

Yes, most doctors make near to $300k a year. At least specialists do.

Are you saying that the typical estate planner makes approx. $300k a year?

What are some other jobs where it's easy to make that much moo-lah? Cuz I can't think of any, other than stuff like lawyers (not much easier than medicine...if at all), CEO's (harder than medicine), Entertainment (harder than medicine), or professional sports (harder than medicine).

The more I think about it, the more I believe that medicine is the easiest way to make the big bucks.

 

[8744]

Folks, there is absolutely nothing wrong with wanting to make a good income at your chosen profession or with trying to get the best salary you possibly can on the basis of your skills.

And I don't really care if the door greeter at Wal-Mart thinks it's unfair that a physician makes twenty times his salary. Your typical Wal mart employee didn't just spend the whole day changing dressings on the rotting feet of diabetic vascular surgery patients, nor does he get up at zero-dark thirty to write notes on patients to have ready for rounds at a time in the morning when most working people are hitting the snooze button.

The correct phrase is "investment in human capital." By the time we finish medical school we will have been training for little or no pay for between seven and twelve 12 years depending on specialty. If you don't think there should be some salary distinction between that kind of commitment and and a fast-food worker then, with respect, you place very little value on your time.

And I don't mean to bust down on regular working folks. But my neighbor comes home at five and generally sits out in his back yard drinking beer and listening to the radio except when he goes hunting or fishing. I sometimes say hello to him early in the morning as he backs his bass-boat into the street. God loves him, I have no doubt, but hunting, fishing, and a few "irregular pleasures" are the extent of his ambition and I'm not going to cry "crocadile tears" when, with luck, I make more in a month then he will make in a year.

On the same note, I don't envy those people who either make or have more money then I could earn in fifty lifetimes. Their wealth has no effect on me in the same way that my salary has no effect on my neighbor.

I also enjoy hunting and fishing, by the way, but these are pleasures that I have had to pretty much defer because of the time commitments of medical school and family.

I'm not saying that money was the primary reason I got into medicine, but it is definently in the top three.

 

[funkless]

Panda Bear, that was an insightful and logical post. I'm not sure you belong on SDN. You're making too much sense...


And, by the way, I've met plenty of lawers who just scrape by with horrible little town-square practices. And many of those with MBAs end up working at an EdJones branch after one of H&R Block's infamous Easter Parades. At the same time, very few doctors make less than $100k. They just have to sacrifice much of their youth and vigor for the spot. All in all, I'd say the issue boils down to whether or not you get a real buzz from helping others. It's corny, but it's true.

--Funkless

 

[Hero]

From the thread: http://www.studentdoctor.net/forums/showthread.php?s=&threadid=8069 (If salaries of MDs were below 50G, Ed..tuition- free, Only 10% of us will be applying )

I think rxfudd said very well on this topic. Allow me to bold the key point in which i totally agree with him:

"Going into this for the money" and "not wanting to be $150,000 in debt making less than most people who started working when they were 21" are two COMPLETELY different things and should be treated as such.

It's fantastic that you're a nurse making that much money, that you have no student loans, and that you love your job. But you fail to recognize that you are a rare situation in your profession. My girlfriend is a nursing student - she has been told more times than I can count (by nurses with whom she works) to get out of nursing because the pay is just not there, especially when you consider the hours and energy you must put in. From our experiences (from multiple Chicago hospitals) this mentality seems to be the rule rather than the exception.

Physicians do not begin making actual money until post-residency. At this point, he or she is $150,000+ in debt, almost 30 years old, working long hours, and paying insane malpractice insurance premiums. The average salary for a doctor in the united states is currently about $150,000. Can anyone here really imagine doing all of that with less than $50K a year?

And even if tuition were free - I still don't understand the problem with wanting to make money. I don't care how humanistic and compassionate your are - medicine is still a career. When will people be willing to admit that you can go into medicine because you love it AND because it pays well? I see nothing wrong with being able to love your job and make good money at it at the same time. There are a hell of a lot of people in the world who are musicians and who love making music - they don't do it (even though they truly love it) because the average salary for a musician is shameful. I don't think it makes them any less of a person that they let financial considerations factor into a career decision. There seem to be purists who feel that you must suffer from low wages in order to be a worthy doctor. I just don't get it...

 

[thackl]

I graduated from RIT in 97' with an engineering degree and started with Motorola. I started out with a whopping $43k/yr and let me tell you, it was A LOT. Within 6 months (in Austin, TX- not the cheapest place to live), I had a new Maxima, a new motorcycle, two jet-ski's and a house. 2 yrs later, I was with 3M making $60k, married, one kid, one more on the way, a new minivan, Lincoln LS, quarter million dollar house (wife made $20-25K part time) and not strugling.

Now, I'm a pre-med, living in an apt, driving a Ford Focus, van is 3 yrs old/50k miles and getting ready to be a student for the next 8 yrs. I'm happier now than I was a year ago. What's the moral of the story here? Most of you have never worked a real job and don't understand what a lot of money is. I could have stayed where I was, kept hitting the 401k @ 15% and ritired a millionaire by 55. You have to like what you are doing. Money is not enough. Don't whine about only making $150k in FP. THAT'S A SH1T LOAD OF MONEY BY MOST STANDARDS! If you like FP, then do it. You may be "poor" by doctor standards, but get real.

Plus, for whoever posted it: average MBA's make MUCH, MUCH less than $120k.

 

[powermd]

Originally posted by Hero
From the thread: http://www.studentdoctor.net/forums/showthread.php?s=&threadid=8069 (If salaries of MDs were below 50G, Ed..tuition- free, Only 10% of us will be applying )

I think rxfudd said very well on this topic. Allow me to bold the key point in which i totally agree with him:

SORRY TO SHOUT BUT THE FUNDAMENTAL PROBLEM IS CONFLICT OF INTEREST. There. I think I said this earlier, but apparantly no one read it.
When a doctor talks about wanting to make a lot of money, some people have trouble believing that doctor's first priority is beneficience toward his patients. In essence, they see that person as a BAD DOCTOR. Of course, those of us who think a little deeper realize this is inevitable as long as doctors are NOT working for free. Most of us know there has to be a careful balance not to sell the patient health care he/she doesn't need, just because it makes us more money. Unfortunately, that point is difficult for people to see when future radiologists are talking about "rollin' a 360 Modena" in the SDN forum. (of course, this is a forum of future DOCTORS who should see that point, but I digress..) The best policy is probably to continue to downplay (publicly) the importance of making a lot of money, and only bring it up in critical situations where it actually impacts physician salaries. In case it is unclear to some reading this, I fully support physicians continuing to earn very, very well. Many people will still have trouble understanding how this is compatible with serving the patient's best interests.

 

[Red514LX]

Originally posted by GeddyLee
I think it's a great idea to consider salary when
you choose a career, especially given that you'll all be over
$100,000 in debt.
Geddy

I've never been ashamed to say that "for the money" is ONE of the reasons I find a career in medicine appealing. Of course, if that was the ONLY reason, then I would have chosen a different career path. 😉

Based on the people I have spoken with, take-home pay vs. take-home pay, most doctors make a GREAT salary (and have a super interesting, fun, challenging, and exciting job to boot) compared to your average college graduate.

The one caveat I do have is that residents (at least 1st year residents) are severely underpaid considering their avg. financial and life situation (kids, house, $100K debt).