Salary EM

[Taxguy]

Two old sayings deserve mention:

To each his (or her) own. Make the trade-offs which are right for you. Find the balance which is right for you.

Make hay while the sun shines. Only one thing is certain in health care today, things will change. No one knows what the future is for EM docs. There is no assurance that today's compensation levels will be available in the future. The relative shortage of EM docs may be declining. The high "profitability" of the ED may be a target in the future. Just sayin.... Also doing an extra shift or two may be easier when you are young or without family attachments.

---

Members don't see this ad.

 

[emergentmd]

I agree that you have to have a balance but some people would be better off sucking it up for 5 yrs and be financially set.

I know alot of doctors who are working into their 60's who wishes they could have sucked it up for 5 yrs and semi retire at 35.

Doing 20+, 12 hr shifts would be extremely hard. When I was in residency, we had all 12 hr shifts. I did 22 intern, 20 2nd yr, and 17 3rd yr.

I can tell you that I would rather do 20, 12 hr shifts rather than doing Q2 and Q3 calls for 5 yrs that my fellow NSG residents were doing 8 months out of the year.

 

[Silent Cool]

I agree that you have to have a balance but some people would be better off sucking it up for 5 yrs and be financially set.

I know alot of doctors who are working into their 60's who wishes they could have sucked it up for 5 yrs and semi retire at 35.

Doing 20+, 12 hr shifts would be extremely hard. When I was in residency, we had all 12 hr shifts. I did 22 intern, 20 2nd yr, and 17 3rd yr.

I can tell you that I would rather do 20, 12 hr shifts rather than doing Q2 and Q3 calls for 5 yrs that my fellow NSG residents were doing 8 months out of the year.

Not to mention actually doing....neurosurgery?

 

[southerndoc]

Yes and no. That's neurosurgery residency summed up. I can't say I'm familiar enough with the schedules of neurosurgery attendings to comment (but I can't say I see them around nearly as much as I see the residents).

Our neurosurgeons and neurointerventionalists are probably logging 80+ hours per week.

 

[Arcan57]

I agree that you have to have a balance but some people would be better off sucking it up for 5 yrs and be financially set.

I know alot of doctors who are working into their 60's who wishes they could have sucked it up for 5 yrs and semi retire at 35.

Of course they do. But it's not their failure to do so that leads to working more then they want into their 60's. It's either a continuing breakdown in fiscal discipline or they had some major life event that they were completely unprepared for (divorce without an enforceable pre-nup being the most common).

 

[Groove]

Of course they do. But it's not their failure to do so that leads to working more then they want into their 60's. It's either a continuing breakdown in fiscal discipline or they had some major life event that they were completely unprepared for (divorce without an enforceable pre-nup being the most common).

This is the most common that I've noticed. I moonlighted with a guy in his late 60s and he worked 18 12's a month. I asked him why he worked so much one night. "Well Groove...let's just say I got 3 ex-wives... Kind of cut into my retirement plans if you know what i mean." Nuff said.

My financial advisor calls the three biggest losses of money to a physician the "Dangerous D's" - "Death, drugs, divorce." lol

 

[SoulinNeed]

I've noticed that many salaried EM positions are only guaranteed for the first or second year. Does income typically fall off after this, or does it stay consistent? I'm just asking for opinions from those who might know.

 

[TooMuchResearch]

I've noticed that many salaried EM positions are only guaranteed for the first or second year. Does income typically fall off after this, or does it stay consistent? I'm just asking for opinions from those who might know.

Are those RVU-based jobs?

 

[Groove]

I've noticed that many salaried EM positions are only guaranteed for the first or second year. Does income typically fall off after this, or does it stay consistent? I'm just asking for opinions from those who might know.

I'm not quite sure what you mean. Are you referring to a fixed income/yr? That doesn't really apply to our specialty, or most medical specialties for that matter.

The concept is that you get paid for the work/time that you invest. The primary dichotomous variable affecting your salary is influenced by: the amount of work (RVU) or the amount of time ($$$/hr). The latter applies to both. Most private practice jobs are a combination of RVU incentive (the harder you work, the more you make...) with a base salary as a buffer that is generally much less than the RVU component.

The second most common that I've run across is a straight hourly rate.

Third... 100% RVU.

There are pros and cons to each. I don't have any insight into how people are paid in academics.

It can get more complicated but that's generally how it works. I work in a primarily RVU driven practice with a smaller base salary that makes up probably 1/3 of my salary. I work in a busy ED, so I prefer to get paid in this manner because it allows me to make more money...much more than I would with a pure hourly rate. If I worked in a slow ED then I would want more preferential pay in the hourly rate portion, or even 100% hourly.

 

[SoulinNeed]

I'm not sure. I'm just specifically talking about job openings that will say (and this is just an example), $300K guaranteed salary for first year, but it doesn't go into detail for afterwards.

 

[ShanFan]

In the EM world, is it expected that you will receive raises throughout your career? Or are you basically making the same $$/hour or $$/patient during your 20th year working as you did during your 4th year working (assuming you make partner by this point)?

 

[Grey Wind]

I've noticed that many salaried EM positions are only guaranteed for the first or second year. Does income typically fall off after this, or does it stay consistent? I'm just asking for opinions from those who might know.

is this due to the learning curve associated with being a new attending or is it more of a recruitment thing?

 

[SoulinNeed]

is this due to the learning curve associated with being a new attending or is it more of a recruitment thing?

From what I understand, many groups provide a guaranteed salary for the first few years to give you time to build up a patient base, but in EM, I don't really understand how it works. You don't really build up a patient base, right? Instead, you cover shifts in a EM that the group is contracted with or is owned by. Does this mean that afterwards, groups will give you a base salary based upon a minimum number of hours or shifts worked, and whatever you work after that, you get RVU bonus?

 

[WilcoWorld]

Soulineed - You obviously need to check on the specifics for each job, but I suspect that you're seeing ads for jobs with a partnership track. They'll guarantee a salary for the time it takes for you to get to partnership. At that point, if you make partner, your income will no longer be guaranteed, and it'll become based on your productivity and how much the group is making (usually, this means your pay will increase). Keep in mind that you are not guaranteed to make partner.

As for raises. My pay has increased every year that I've been in practice, but it is not guaranteed to continue to do so.

 

[SoulinNeed]

There seems to be a great deal of flexibility in EM salary, which is typical for medicine. Medscape says the average is $277K for 2013. How accurate would you guys think this is? I'm becoming interested in EM, but with huge loans on my back, I'm wondering how viable it is for me.

 

[YA7ES]

There seems to be a great deal of flexibility in EM salary, which is typical for medicine. Medscape says the average is $277K for 2013. How accurate would you guys think this is? I'm becoming interested in EM, but with huge loans on my back, I'm wondering how viable it is for me.

If 277k a year isn't enough to start chipping away at your debt then you might as well start buying lottery tickets.

 

[iish]

There seems to be a great deal of flexibility in EM salary, which is typical for medicine. Medscape says the average is $277K for 2013. How accurate would you guys think this is? I'm becoming interested in EM, but with huge loans on my back, I'm wondering how viable it is for me.

This seems to be average starting in a big city. You will make less in academics and can make alot more working in more lucrative places.

 

[happygilmore]

There seems to be a great deal of flexibility in EM salary, which is typical for medicine. Medscape says the average is $277K for 2013. How accurate would you guys think this is? I'm becoming interested in EM, but with huge loans on my back, I'm wondering how viable it is for me.

Lol. 277k mean isn't good enough for large loans?

Hate to say it but that's pretty damn good. Anything higher than that will probably be cut significantly by the govt any way except some surgical subs.

 

[deleted547339]

There seems to be a great deal of flexibility in EM salary, which is typical for medicine. Medscape says the average is $277K for 2013. How accurate would you guys think this is? I'm becoming interested in EM, but with huge loans on my back, I'm wondering how viable it is for me.

Dude, if 277k/y isn't enough to pay off your loans quickly and live a cushy lifestyle, you went to the wrong med school. Either that, or you shouldn't have put that Maserati on the credit card.

 

[iish]

Dude, if 277k/y isn't enough to pay off your loans quickly and live a cushy lifestyle, you went to the wrong med school. Either that, or you shouldn't have put that Maserati on the credit card.

277k being enough money really depends on where you live. 277k with a family of 5 in NYC is actually not that much money. 277k in nebraska as a single person is like swimming in cash.

 

[happygilmore]

Dude, if 277k/y isn't enough to pay off your loans quickly and live a cushy lifestyle, you went to the wrong med school. Either that, or you shouldn't have put that Maserati on the credit card.

+1

277k being enough money really depends on where you live. 277k with a family of 5 in NYC is actually not that much money. 277k in nebraska as a single person is like swimming in cash.

Yeah, and 20 million per year sucks if your Bill Gates or Warren Buffet.

Let's be real for a sec. Earning 280k a year as a physician is very good... especially if you consider that some of the high paying specialties have reimbursement targets on their backs. I.e. all of medicine could face hits and 280k could be excellent for ANY field in medicine in 5-10 years, who knows. Which is to say, if that isn't enough for someone's lifestyle, then medicine was probably a bad choice. I mean, it's almost like saying, "I don't feel comfortable earning less than half a million." Really?

280k earned in NYC by one person is also extremely good. I'd be surprised if that isn't top 10% even in NYC.

 

[iish]

+1



Yeah, and 20 million per year sucks if your Bill Gates or Warren Buffet.

Let's be real for a sec. Earning 280k a year as a physician is very good... especially if you consider that some of the high paying specialties have reimbursement targets on their backs. I.e. all of medicine could face hits and 280k could be excellent for ANY field in medicine in 5-10 years, who knows. Which is to say, if that isn't enough for someone's lifestyle, then medicine was probably a bad choice. I mean, it's almost like saying, "I don't feel comfortable earning less than half a million." Really?

280k earned in NYC by one person is also extremely good. I'd be surprised if that isn't top 10% even in NYC.

280k by one person in NYC is plenty but for a family of 5 its not that much. I would also argue that 280k by physicians is pretty average. Also 280k in NYC is probably not top 10%

 

[Insulinshock]

Is that 277k going to hold up under the new healthcare? What's the thought on how the bill is going to affect EM?

 

[YA7ES]

280k by one person in NYC is plenty but for a family of 5 its not that much. I would also argue that 280k by physicians is pretty average. Also 280k in NYC is probably not top 10%

You've gotta be kidding me. I bet 280k is top 1-2% of NYC residents... are you nutts? Not everyone is NYC is a business professional pulling in bank.

 

[TooMuchResearch]

280k by one person in NYC is plenty but for a family of 5 its not that much. I would also argue that 280k by physicians is pretty average. Also 280k in NYC is probably not top 10%

Smells trollish in here.

 

[happygilmore]

Agreed.

He has no idea about incomes. 280k is a high income in America, period. Here's some real data:

http://www.decisionsonevidence.com/2012/02/want-to-know-your-household-income-percentile-ranking/

Anyway, here is a calculator based on location, $280,000 is top 4% in NY and Los Angeles:
http://www.nytimes.com/interactive/2012/01/15/business/one-percent-map.html?_r=0

Source: NYT

It's shocking how top income earners think they don't make enough. When the top 1-4% of income earners in America feel like they are barely making it...

Is that 277k going to hold up under the new healthcare? What's the thought on how the bill is going to affect EM?

No one knows. Everyone is guessing.

The best guess I've heard so far is to expect ALL physician incomes to decrease, maybe not family medicine.

 

[nyr77]

Dude, if 277k/y isn't enough to pay off your loans quickly and live a cushy lifestyle, you went to the wrong med school. Either that, or you shouldn't have put that Maserati on the credit card.

But the miles were totally worth it. Especially when I have alec baldwin double miles!!!!!

 

[deleted547339]

Smells trollish in here.

Dang. I think you're right and I just got trolled hard.

But the miles were totally worth it. Especially when I have alec baldwin double miles!!!!!

lol. I freakin hate alec baldwin.

 

[SoulinNeed]

I would think that EM would benefit under the new bill. So many people that go to the ER have no coverage and never pay. Even if their coverage now is medicaid, at least it's better than nothing.

 

[EctopicFetus]

Keep in mind. Your belief of being "rich" is relative. I term doctors as a whole and EM docs in general as the working rich.

You dont worry about putting food on the table, can take some nice vacations and unless you are terrible with money have some extra. You can enjoy some luxuries. The issue is that the top 1% of people in terms of assets is 6.8M. No ED doc can get there by simply pulling shifts unless you are a goo disciplined saver and investor. You def wont get there by 50.

Top 5% is 1.9M.

http://online.wsj.com/article/SB10001424127887323300404578205502185873348.html

Hard to feel rich. Ultra rich is defined as 10M. Thats an impossibility for any EM doc IMO.

 

[happygilmore]

Keep in mind. Your belief of being "rich" is relative. I term doctors as a whole and EM docs in general as the working rich.

You dont worry about putting food on the table, can take some nice vacations and unless you are terrible with money have some extra. You can enjoy some luxuries. The issue is that the top 1% of people in terms of assets is 6.8M. No ED doc can get there by simply pulling shifts unless you are a goo disciplined saver and investor. You def wont get there by 50.

Top 5% is 1.9M.

http://online.wsj.com/article/SB10001424127887323300404578205502185873348.html

Hard to feel rich. Ultra rich is defined as 10M. Thats an impossibility for any EM doc IMO.

Well, anyone earning 300k per year for a long time can build wealth.

Investing $6,250 per month ($75,000 annually) for 31 years @ 8% return ---> 10 million dollars. To hit near the top 1%, that would be 25 years ---> 6 million.

8% is a fair return for anyone investing long term, heck a basic index fund could pull that off for you in the next 30 years. I don't even think anyone would call 8% a great return, probably average.

I understand probably no one would want to invest $75,000 annually to retirement, but if they did and worked from age 30-61... they are ultra rich. So impossibility is probably not the best description.

 

[Hercules]

Well, anyone earning 300k per year for a long time can build wealth.

Investing $6,250 per month ($75,000 annually) for 31 years @ 8% return ---> 10 million dollars. To hit near the top 1%, that would be 25 years ---> 6 million.

8% is a fair return for anyone investing long term, heck a basic index fund could pull that off for you in the next 30 years. I don't even think anyone would call 8% a great return, probably average.

I understand probably no one would want to invest $75,000 annually to retirement, but if they did and worked from age 30-61... they are ultra rich. So impossibility is probably not the best description.

$75k/yr is not unreasonable in EM. Several of us are putting aside $100k+/yr investments.

 

[RustedFox]

$75k/yr is not unreasonable in EM. Several of us are putting aside $100k+/yr investments.

Sure, after the debts are paid off.

Oh, debt, debt, debt. Hate you.

 

[skontroller]

Sure, after the debts are paid off.

Oh, debt, debt, debt. Hate you.

Depending on the interest rate of your debt you should not forgo saving/investment to pay it off too quickly. Folks who have school debt with rates of 2-4% can afford to pay them off more slowly and put their excess cash into investing and paying off higher rate liabilities.

SK

 

[JediZero]

280k by one person in NYC is plenty but for a family of 5 its not that much. I would also argue that 280k by physicians is pretty average. Also 280k in NYC is probably not top 10%

As everyone else has already discussed your thoughts on relative incomes of NYC residents, I'll instead focus on those of physicians: are you nuts? FM/Peds salaries have been dwindling down to the $100-150k range, and that's a plurality of the physician workforce (okay, maybe along with IM, but it's not much better there). OB is struggling, Gas is losing turf to CRNAs, Gen Surg is getting squeezed... Unless you're in a ROAD specialty, NuSu or Cards, you're going to have a very tough time clearing $300k. I'd put the median around $180k, and I have a feeling that will continue to drop. Though I don't think it's entirely wishful thinking to say that EM will probably hold relatively steady amid all this...

 

[TooMuchResearch]

Well, anyone earning 300k per year for a long time can build wealth.

Investing $6,250 per month ($75,000 annually) for 31 years @ 8% return ---> 10 million dollars. To hit near the top 1%, that would be 25 years ---> 6 million.

8% is a fair return for anyone investing long term, heck a basic index fund could pull that off for you in the next 30 years. I don't even think anyone would call 8% a great return, probably average.

I understand probably no one would want to invest $75,000 annually to retirement, but if they did and worked from age 30-61... they are ultra rich. So impossibility is probably not the best description.

Is that 8% after inflation?

 

[grt398]

Is that 8% after inflation?

No it's not. A quick calculation of long term inflation adjusted returns (including average dividend yield of S&P500) if you just wanted to put money into the S&P500 index are ~5.5% for 1973-2013, 6.5% for 1993-2013 and 6% for 2003-2013. For anyone interested, you can find the raw data for this and many other interesting things here:

http://research.stlouisfed.org/fred2/

 

[Perrotfish]

FM/Peds salaries have been dwindling down to the $100-150k range, and that's a plurality of the physician workforce (okay, maybe along with IM, but it's not much better there)...

Not quite that bad. Medscape still puts the average pediatrician at 175K, and the average FP at around 200K.

 

[JediZero]

Not quite that bad. Medscape still puts the average pediatrician at 175K, and the average FP at around 200K.

Seriously? Huh. Not at all what I'd been hearing. Maybe that's just California...

 

[SoulinNeed]

As everyone else has already discussed your thoughts on relative incomes of NYC residents, I'll instead focus on those of physicians: are you nuts? FM/Peds salaries have been dwindling down to the $100-150k range, and that's a plurality of the physician workforce (okay, maybe along with IM, but it's not much better there). OB is struggling, Gas is losing turf to CRNAs, Gen Surg is getting squeezed... Unless you're in a ROAD specialty, NuSu or Cards, you're going to have a very tough time clearing $300k. I'd put the median around $180k, and I have a feeling that will continue to drop. Though I don't think it's entirely wishful thinking to say that EM will probably hold relatively steady amid all this...

Who told you that Fm and Ped salaries are going down to $100-$150? Their salaries have either stayed the same or gone up from what I've seen. Gas may be losing turf, but many Anes do fellowships now, and Gen surg can clear $300K pretty well depending on the location (rural vs city).

 

[happygilmore]

Who told you that Fm and Ped salaries are going down to $100-$150? Their salaries have either stayed the same or gone up from what I've seen. Gas may be losing turf, but many Anes do fellowships now, and Gen surg can clear $300K pretty well depending on the location (rural vs city).

Yeah, PC has moved up the last few years.

 

[happygilmore]

$75k/yr is not unreasonable in EM. Several of us are putting aside $100k+/yr investments.

Exactly, so a decent investor could easily have 5 million on a long term strategy (25 years)

Is that 8% after inflation?

What would make you think I adjusted for inflation.

Unless stated, no financial #'s are adjusted for inflation.

No it's not. A quick calculation of long term inflation adjusted returns (including average dividend yield of S&P500) if you just wanted to put money into the S&P500 index are ~5.5% for 1973-2013, 6.5% for 1993-2013 and 6% for 2003-2013. For anyone interested, you can find the raw data for this and many other interesting things here:

http://research.stlouisfed.org/fred2/

Good data. Even adjusting for inflation, index funds have performed rather well. 6.5 and 6% returns over the past 30 years is very close to 8% - and that's with inflation.

 

[EctopicFetus]

$75k/yr is not unreasonable in EM. Several of us are putting aside $100k+/yr investments.

I am in that group... but to the poster before you.. 6M in retirement isnt 10 million in the bank. To be the one thing worse than debt is taxes. I can deal with 2-4%.. not 45-50%.

Just some food for thought.

Also, if you believe 75k /yr in post tax money is easy to save give it a shot for 10 years and let me know how it goes esp if your wife doesnt work and if you have kids.

Not saying its impossible, heck I do it but its not easy.

 

[EctopicFetus]

Exactly, so a decent investor could easily have 5 million on a long term strategy (25 years)



What would make you think I adjusted for inflation.

Unless stated, no financial #'s are adjusted for inflation.



Good data. Even adjusting for inflation, index funds have performed rather well. 6.5 and 6% returns over the past 30 years is very close to 8% - and that's with inflation.

But in 25 years the $6 million number wont be 6 anymore,

the difference over 25 years between 6% and 8% on 75k/yr is huge. If you look at 6% you end up at $4.361M at 8% its $5.921M. 1.6M is a ton of dough.

Like I said it would be hard to get into that top 1%. Not impossible but very very hard and very few EPs do it. We enjoy our lives too much.

 

[EctopicFetus]

FYI for anyone interested in a very flexible retirement calculator..

http://www.bankrate.com/calculators/retirement/retirement-plan-income-calculator.aspx

 

[happygilmore]

But in 25 years the $6 million number wont be 6 anymore,

the difference over 25 years between 6% and 8% on 75k/yr is huge. If you look at 6% you end up at $4.361M at 8% its $5.921M. 1.6M is a ton of dough.

Like I said it would be hard to get into that top 1%. Not impossible but very very hard and very few EPs do it. We enjoy our lives too much.

8% was arbitrary # chosen because it's usually near a basic index fund (i.e. an IQ of <70 could do that). With any decent investing skills and study, one could get 10-11% return, which would then qualify my calculations.

Not to mention that income can usually increase with inflation, hence adding to that fixed investment of $6,250 a month.

Anyhow, does it matter? The fact that we are talking about the mere possibility to be in the top 1% of the richest population know to man - that's a pretty amazing prospect.

 

[EctopicFetus]

8% was arbitrary # chosen because it's usually near a basic index fund (i.e. an IQ of <70 could do that). With any decent investing skills and study, one could get 10-11% return, which would then qualify my calculations.

Not to mention that income can usually increase with inflation, hence adding to that fixed investment of $6,250 a month.

Anyhow, does it matter? The fact that we are talking about the mere possibility to be in the top 1% of the richest population know to man - that's a pretty amazing prospect.

Regarding top "the top 1% of the richest population know to man" residents are there. on an income basis worldwide it about 33k.

My point is you wont get there barring some major change. Think of it a different way, that guy with $6m today will earn that same 11% you think is so easy to earn. You might get there on 500K. you will continue to fall behind.

BTW the belief that you can outperform the market is laughable. 70% of mutual funds cant do it. Those guys do this for a living. So by rule your chances of outperforming the market are tiny. Outperforming it long term by 3-4% means you have chosen the wrong field.

Table 1: Income, net worth, and financial worth in the U.S. by percentile, in 2010 dollars
Wealth or income class Mean household income Mean household net worth Mean household financial (non-home) wealth
Top 1 percent $1,318,200 $16,439,400 $15,171,600
Top 20 percent $226,200 $2,061,600 $1,719,800
60th-80th percentile $72,000 $216,900 $100,700
40th-60th percentile $41,700 $61,000 $12,200
Bottom 40 percent $17,300 -$10,600 -$14,800
From Wolff (2012); only mean figures are available, not medians. Note that income and wealth are separate measures; so, for example, the top 1% of income-earners is not exactly the same group of people as the top 1% of wealth-holders, although there is considerable overlap.

There it says it is 16.4M which is closer to the number I heard. Nonethless 6M is a serious effort for an EM doc.

ER docs and docs in general are the working rich. The ultra rich by rule is impossible without inheritance.

 

[happygilmore]

Regarding top "the top 1% of the richest population know to man" residents are there. on an income basis worldwide it about 33k.

My point is you wont get there barring some major change. Think of it a different way, that guy with $6m today will earn that same 11% you think is so easy to earn. You might get there on 500K. you will continue to fall behind.

BTW the belief that you can outperform the market is laughable. 70% of mutual funds cant do it. Those guys do this for a living. So by rule your chances of outperforming the market are tiny. Outperforming it long term by 3-4% means you have chosen the wrong field.



There it says it is 16.4M which is closer to the number I heard. Nonethless 6M is a serious effort for an EM doc.

ER docs and docs in general are the working rich. The ultra rich by rule is impossible without inheritance.

Ok. Being the working rich is a quality problem to have. And where you land in the top 1% is also a quality problem.

Ultra rich isn't impossible - there are many investments that can gain more than 10%. My example was just your basic index fund - but there is real estate, business ventures, etc. I know plenty of people who earn more than 10% return on real estate. My family + many friends invest in rental properties for solid returns. You could even buy some smaller apartments with a few million capital + leverage (usually only need 25% down with proper debt to income ratio).

It's only impossible if you decide it to be. I know it's very possible, especially with capital - we've already outlined a path to having a few million in capital. Learning some investing skills, you can do some pretty amazing things - ask the WhiteCoatInvest guy if an investor pulling 10-12% is impossible. Hardly. It's ridiculous to say that an physician that can pull returns on investments greater than 8% is "in the wrong field" - it's far from impossible.

Also, we've been working off the average income - partner salaries can hit 400-450k, easily allowing the individual to invest double - i.e. $13,000 monthly - on an index fund (accounting for inflation too?!) = 12 million. with inflation? 9 million.

GOOD DAY SIR!!!!

 

[The White Coat Investor]

Ok. Being the working rich is a quality problem to have. And where you land in the top 1% is also a quality problem.

Ultra rich isn't impossible - there are many investments that can gain more than 10%. My example was just your basic index fund - but there is real estate, business ventures, etc. I know plenty of people who earn more than 10% return on real estate. My family + many friends invest in rental properties for solid returns. You could even buy some smaller apartments with a few million capital + leverage (usually only need 25% down with proper debt to income ratio).

It's only impossible if you decide it to be. I know it's very possible, especially with capital - we've already outlined a path to having a few million in capital. Learning some investing skills, you can do some pretty amazing things - ask the WhiteCoatInvest guy if an investor pulling 10-12% is impossible. Hardly. It's ridiculous to say that an physician that can pull returns on investments greater than 8% is "in the wrong field" - it's far from impossible.

Also, we've been working off the average income - partner salaries can hit 400-450k, easily allowing the individual to invest double - i.e. $13,000 monthly - on an index fund (accounting for inflation too?!) = 12 million. with inflation? 9 million.

GOOD DAY SIR!!!!

There are many investments that can gain more than 10%. Heck, there are investments that can gain 20000%. But I wouldn't count on your portfolio making much more than 8%, BEFORE expenses, taxes, and inflation over any kind of long-term. While I agree it doesn't take much brainpower to invest in an index fund, it turns out it takes an awful lot of discipline to stick with it for a few decades. And applying MORE brainpower and MORE discipline, doesn't necessarily get you higher returns. If you can minimize expenses and taxes, then you might get 5% after inflation. At 5% a year, your money will take 14 years or so to double in real terms. That fact combined with an understanding of a safe withdrawal rate will give you some real motivation to save a 6 figure amount each year, especially if an early retirement is your goal.

If you're making $400K, and can keep your taxes to just 25%, that leaves you with $300K. Saving $13K a month would be $156K, or 52% of what's left after taxes. Most folks I know have a very hard time saving that much. Sure, it still leaves you $144K to live on ($12K a month), so it isn't impossible. But when I look around I sure don't see anyone doing it, including me. Remember that $156K would be in addition to saving for college for the kids, a house downpayment, your next car etc. And even if you're willing to be that hyperfrugal and work that hard, remember that for many docs there is a significant other +/- kids involved in these decisions too.

 

[RustedFox]

- Someone please bump the 'EM doc's budget' thread.

- Saving so much after your loans/living expenses (LIVING expense, not LUXURY expenses) is a challenge.

I'll say it, straight up. It has been said by others here, but it bears repeating....

There's this 'mythical trap' of thinking - "I presently live on 900 dollars a month. LOLZ. When I make eleventeen thousand a month, life will be GRREEAT!"

I stepped into that trap.

Its not as easy as it seems. No waaaay. Maybe if you have zero loan-debt, sure... but otherwise. Be warned.