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Scraping by on $7K per month...

Started by drusso
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drusso

drusso

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I recently returned from a physician wellness seminar. Had an illuminating conversation with a hospital-employed primary care doctor who graduated from residency 5 years ago:

His post-tax, post-retirement deferral, post-health insurance take-home pay is $7K per month.

Minus $1800 student loan (private US DO school)
Minus $2000 mortgage (modest 1900 sq ft home)
Minus $750 per month car payments (wife and his own)

Married, stay at home wife, with 3 children. He feels profound buyer's remorse having sacrificed his twenties only to have a "very middle class" existence.

As his employer, what advice would you give him to "cultivate his personal resiliency" and "re-kindle his passion" for patient care.
 
drusso said:
I recently returned from a physician wellness seminar. Had an illuminating conversation with a hospital-employed primary care doctor who graduated from residency 5 years ago:

His post-tax, post-retirement deferral, post-health insurance take-home pay is $7K per month.

Minus $1800 student loan (private US DO school)
Minus $2000 mortgage (modest 1900 sq ft home)
Minus $750 per month car payments (wife and his own)

Married, stay at home wife, with 3 children. He feels profound buyer's remorse having sacrificed his twenties only to have a "very middle class" existence.

As his employer, what advice would you give him to "cultivate his personal resiliency" and "re-kindle his passion" for patient care.
Click to expand...


...tell his wife to find her way to a job...
 
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I'm not even a physician but $7k - expenses leaves him $2500 disposable?

Middle class has less than $1k disposable and don't live in 1900 sq ft homes... maybe encourage him to volunteer in a homeless shelter to remind himself of how well he, and his family, have it?

Am wondering if $$ is not the issue but family life is?
 
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Aren't we all somewhere in the middle class range? What was he expecting as a PCP? To be rolling around in a S class and living in a mansion in SF?

If money was really an issue, he has options such as practicing in a less urban area and/or taking a risk and starting his own practice. But it sounds like he wants his cake and eat it too.
 
The gist of this topic is a point well taken by the way. Dude puts a lot of skin in the game and here he is 5 yrs out and still underwater. Sucks...

I would have to ask that guy if he deferred his loans as a resident or not (terrible idea), what lifestyle did he have as a resident and new attending, how much retirement is he putting away (maybe pay off that loan and put less into retirement), etc.

Can he get a new job?

Eat what you kill though...If you don't kill much you don't get fat...
 
SommeRiver said:
The gist of this topic is a point well taken by the way. Dude puts a lot of skin in the game and here he is 5 yrs out and still underwater. Sucks...

I would have to ask that guy if he deferred his loans as a resident or not (terrible idea), what lifestyle did he have as a resident and new attending, how much retirement is he putting away (maybe pay off that loan and put less into retirement), etc.

Can he get a new job?

Eat what you kill though...If you don't kill much you don't get fat...
Click to expand...
This.

I know PCPs that do VERY well in a physician owned group setting. It sounds like this dude is getting taken advantage of as an employee in an expensive metropolitan area.
 
Postictal Raiden said:
So let’s do the math:

7k/month = 84k/year = 125k of taxable income (assuming one third of his salary goes to taxes) = 180k gross income before deducting retirement and health insurance.

He better be working part time, or seeing less than 15 pts a day.
Click to expand...
Employed position may also include retirement benefits- matching 401k for example...

$250k salary is average salary for internists. Remember that few primary care doctors make what specialists like us make.
 
Ducttape said:
Employed position may also include retirement benefits- matching 401k for example...

$250k salary is average salary for internists. Remember that few primary care doctors make what specialists like us make.
Click to expand...

Probably why he's likely maxing out his 401k
 
I was in this spot just a few years ago. Picked up a side gig to pay off student loans. Once his 1800/month student loan is gone he'll feel like a big roller.

It's probably cheaper for his wife to stay at home than to arrange child care for 3. Unless she has a large income generating profession.
 
I know what it's like to have 3 kids. Not buying new cars would save some cash. Not sure where the doctor lives but that mortgage for 1900 square feet is on the higher side if a 30 year mortgage. Not sure how long off the student loan will be paid off but life will be better after that.

In the end, going into primary care you have to get some fulfillment from the job to make it worth it. It can't be about the money because to sacrifice 7 years after college for an upper middle class existence where one doesn't enjoy what they do is sad. There might be some grass is greener mentality for this doctor as well.
 
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I agree that he should be making more money, assuming he works hard. I just object to the idea that this is scraping by.

To me, scraping by means you are barely feeding yourself/family. You are taking the bus to your 3rd minimum wage job, renting a studio, eating ramen.

But I do think it's fair for him to feel frustrated, after so much time investment.
 
drusso said:
I recently returned from a physician wellness seminar. Had an illuminating conversation with a hospital-employed primary care doctor who graduated from residency 5 years ago:

His post-tax, post-retirement deferral, post-health insurance take-home pay is $7K per month.

Minus $1800 student loan (private US DO school)
Minus $2000 mortgage (modest 1900 sq ft home)
Minus $750 per month car payments (wife and his own)

Married, stay at home wife, with 3 children. He feels profound buyer's remorse having sacrificed his twenties only to have a "very middle class" existence.

As his employer, what advice would you give him to "cultivate his personal resiliency" and "re-kindle his passion" for patient care.
Click to expand...
Well, can't put a price on family.

I'm single with 3 jobs and make 3x
 
hyperalgesia said:
I agree that he should be making more money, assuming he works hard. I just object to the idea that this is scraping by.

To me, scraping by means you are barely feeding yourself/family. You are taking the bus to your 3rd minimum wage job, renting a studio, eating ramen.

But I do think it's fair for him to feel frustrated, after so much time investment.
Click to expand...

kids and a wife are expensive. so are trips to singapore, but i digress.

his payments are not outlandish.

this is the way the cookie crumbles. you pay an arm and a leg for med school and then become a PCP with 3 kids and a wife who isnt working, you cannot expect to be living the high life. another reason to NOT go into primary care -- especially when you may be paying 300K or more for medical school
 
I did internal medicine as an intern...Hard year but best decision ever. Anyways, if I just did a full IM residency I would have definitely become a hospitalist. Great gig.
 
hyperalgesia said:
You are taking the bus to your 3rd minimum wage job, renting a studio, eating ramen.
Click to expand...
have you had a good bowl of ramen?


6e9c6155f8e128d7b35da0e257a92e92.jpg
 
drusso said:
I recently returned from a physician wellness seminar. Had an illuminating conversation with a hospital-employed primary care doctor who graduated from residency 5 years ago:

His post-tax, post-retirement deferral, post-health insurance take-home pay is $7K per month.

Minus $1800 student loan (private US DO school)
Minus $2000 mortgage (modest 1900 sq ft home)
Minus $750 per month car payments (wife and his own)

Married, stay at home wife, with 3 children. He feels profound buyer's remorse having sacrificed his twenties only to have a "very middle class" existence.

As his employer, what advice would you give him to "cultivate his personal resiliency" and "re-kindle his passion" for patient care.
Click to expand...

He needs a sense of purpose. Give him one. That will solve #1 and #2. As medical students we worked hard and tirelessly and nobody burned out because we had a clear purpose. Once the purpose is gone, you can expect burnout and complaints.
 
Hospital employed clearing $7k/m after taxes and insurance and retirement is scraping by? He eats for free too.
 
Postictal Raiden said:
So let’s do the math:

7k/month = 84k/year = 125k of taxable income (assuming one third of his salary goes to taxes) = 180k gross income before deducting retirement and health insurance.

He better be working part time, or seeing less than 15 pts a day.
Click to expand...

this. Doesn't make sense. Where is he working? 180k is low even for primary care, especially 5 years out. That may be a starting salary in some high saturation areas. But 5 years out? Something doesn't add up.
 
I’d like to hear more about what you learned at this Physician wellness seminar and how we can apply it to our practices/lives.
 
DOctorJay said:
I’d like to hear more about what you learned at this Physician wellness seminar and how we can apply it to our practices/lives.
Click to expand...

"Servent-Leadership..."

Well, in a nutshell, large structural forces beyond our control are radically disrupting the essence of what it means to be a doctor. You went into this because you wanted to be a hero or have some kind of sub-conscious God complex. Get over it. Some of us won't make it. Look to your left and look to your right. One of those people will 1) burn out, 2) retire early, 3) develop a self-destructive habit, or 4) kill themselves. There's a looming doctor shortage and more baby-boomers heading into the system with high expectations. These people are entering the peak health care consuming times of their lives...they will likely not accept the status quo...they're kind of a pain in the ass. Not like their parents (the greatest generation). So, there is no escaping change. You must accept that. Accept that or die. Doctors got to be doctors by being very disciplined and focused and good a doing a few things really well. So, what. What have you done for me lately? That is not the Golden Key to Prosperity in the Future. Medicine is a Team Sport now. There is no "I" in team. Though you are not the Captain of the Ship, you are a Doctor and still have tremendous Moral Authority. That's about the only thing left you've got going for you. Don't squander your Moral Authority by being mean, creepy, obnoxious, or greedy. At the same time recognize that medicine socializes the rewards and privatizes the accountability. At the end of the day, someone's got to be accountable. Guess what? That's you. You're accountable. Don't whine about the ****ty tools, bad systems, and unrealistic expectations dumped on you by people who couldn't "solve for x" in high school let alone count electrons in Organic Chemistry. They are your boss now. Maybe you want to be the boss too? Great. But, you've got to get your card punched first because you squandered your 20's going to medical school dummy. Go get a MPH, MBA, MHA, MS, MMM, or some other degree to get you through the front door of the C-suites because with just your medical degree you're not qualified to sweep the floors. By the way, if you become a "Physician-Leader" your peers will hate you. Want a friend in Physician-Leadership? Get a dog. Oh, and don't think of Physician-Leadership as your one-way ticket out of the salt mines. Because the farther away you get from the grunts actually doing the work the more "abstract" becomes their pain and suffering to you. It's easy to intellectualize how crappy it is to be on the front lines dealing with all the poo-poo coming through the door. If you want credibility as a Physician-Leader, then you've got to FEEL that pain. So, cultivate your sense of empathy for your peers (who are soon about to hate you). Exercise your mirror neurons. Learn to eat last...

Servent-Leadership...
 
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What I’m more curious about is how 5 people are living in a 1900 square ft place. Maybe they are just all a little claustrophobic.

There are fellowship trained pmr docs making 200k at NYU. Some of you guys have a skewed perception of what people make outside of wherever it is you might be..
 
Last edited:
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drusso said:
"Servent-Leadership..."

Well, in a nutshell, large structural forces beyond our control are radically disrupting the essence of what it means to be a doctor. You went into this because you wanted to be a hero or have some kind of sub-conscious God complex. Get over it. Some of us won't make it. Look to your left and look to your right. One of those people will 1) burn out, 2) retire early, 3) develop a self-destructive habit, or 4) kill themselves. There's a looming doctor shortage and more baby-boomers heading into the system with high expectations. These people are entering the peak health care consuming times of their lives...they will likely not accept the status quo...they're kind of a pain in the ass. Not like their parents (the greatest generation). So, there is no escaping change. You must accept that. Accept that or die. Doctors got to be doctors by being very disciplined and focused and good a doing a few things really well. So, what. What have you done for me lately? That is not the Golden Key to Prosperity in the Future. Medicine is a Team Sport now. There is no "I" in team. Though you are not the Captain of the Ship, you are a Doctor and still have tremendous Moral Authority. That's about the only thing left you've got going for you. Don't squander your Moral Authority by being mean, creepy, obnoxious, or greedy. At the same time recognize that medicine socializes the rewards and privatizes the accountability. At the end of the day, someone's got to be accountable. Guess what? That's you. You're accountable. Don't whine about the ****ty tools, bad systems, and unrealistic expectations dumped on you by people who couldn't "solve for x" in high school let alone count electrons in Organic Chemistry. They are your boss now. Maybe you want to be the boss too? Great. But, you've got to get your card punched first because you squandered your 20's going to medical school dummy. Go get a MPH, MBA, MHA, MS, MMM, or some other degree to get you through the front door of the C-suites because with just your medical degree you're not qualified to sweep the floors. By the way, if you become a "Physician-Leader" your peers will hate you. Want a friend in Physician-Leadership? Get a dog. Oh, and don't think of Physician-Leadership as your one-way ticket out of the salt mines. Because the farther away you get from the grunts actually doing the work the more "abstract" becomes their pain and suffering to you. It's easy to intellectualize how crappy it is to be on the front lines dealing with all the poo-poo coming through the door. If you want credibility as a Physician-Leader, then you've got to FEEL that pain. So, cultivate your sense of empathy for your peers (who are soon about to hate you). Exercise your mirror neurons. Learn to eat last...

Servent-Leadership...
Click to expand...
Any downside mentioned?
 
Pain docs are uniquely protected from the forces mentioned by drusso. U can hang up ur shingle and avoid most of the above.

One of my residency classmates is in NYC solo practice. Pmr pain doc year ahead of me in fellowship has solo practice in NYC.
 
drusso said:
"Servent-Leadership..."

Well, in a nutshell, large structural forces beyond our control are radically disrupting the essence of what it means to be a doctor. You went into this because you wanted to be a hero or have some kind of sub-conscious God complex. Get over it. Some of us won't make it. Look to your left and look to your right. One of those people will 1) burn out, 2) retire early, 3) develop a self-destructive habit, or 4) kill themselves. There's a looming doctor shortage and more baby-boomers heading into the system with high expectations. These people are entering the peak health care consuming times of their lives...they will likely not accept the status quo...they're kind of a pain in the ass. Not like their parents (the greatest generation). So, there is no escaping change. You must accept that. Accept that or die. Doctors got to be doctors by being very disciplined and focused and good a doing a few things really well. So, what. What have you done for me lately? That is not the Golden Key to Prosperity in the Future. Medicine is a Team Sport now. There is no "I" in team. Though you are not the Captain of the Ship, you are a Doctor and still have tremendous Moral Authority. That's about the only thing left you've got going for you. Don't squander your Moral Authority by being mean, creepy, obnoxious, or greedy. At the same time recognize that medicine socializes the rewards and privatizes the accountability. At the end of the day, someone's got to be accountable. Guess what? That's you. You're accountable. Don't whine about the ****ty tools, bad systems, and unrealistic expectations dumped on you by people who couldn't "solve for x" in high school let alone count electrons in Organic Chemistry. They are your boss now. Maybe you want to be the boss too? Great. But, you've got to get your card punched first because you squandered your 20's going to medical school dummy. Go get a MPH, MBA, MHA, MS, MMM, or some other degree to get you through the front door of the C-suites because with just your medical degree you're not qualified to sweep the floors. By the way, if you become a "Physician-Leader" your peers will hate you. Want a friend in Physician-Leadership? Get a dog. Oh, and don't think of Physician-Leadership as your one-way ticket out of the salt mines. Because the farther away you get from the grunts actually doing the work the more "abstract" becomes their pain and suffering to you. It's easy to intellectualize how crappy it is to be on the front lines dealing with all the poo-poo coming through the door. If you want credibility as a Physician-Leader, then you've got to FEEL that pain. So, cultivate your sense of empathy for your peers (who are soon about to hate you). Exercise your mirror neurons. Learn to eat last...

Servent-Leadership...
Click to expand...

FIRE it is

seems like that was the only glimmer of hope to take away
 
nvrsumr said:
Pain docs are uniquely protected from the forces mentioned by drusso. U can hang up ur shingle and avoid most of the above.

One of my residency classmates is in NYC solo practice. Pmr pain doc year ahead of me in fellowship has solo practice in NYC.
Click to expand...

and how are they doing? I give them credit for going solo in the big apple. But am curious as to how they are doing financially
 
You need about 500k to live decently in nyc. I don’t know a lot of pain docs making that. There are def some making it doing lots of cash based stuff and possible “aesthetics” on the side. Maybe if they are married and their spouse works they can make it.
 
Dr. Ice said:
You need about 500k to live decently in nyc. I don’t know a lot of pain docs making that. There are def some making it doing lots of cash based stuff and possible “aesthetics” on the side. Maybe if they are married and their spouse works they can make it.
Click to expand...
Why so much? It must be kids. I live in a very expensive area and have a great life and spend about 70k/year. Kids/wives scare me financially.
 
Ad2b said:
I'm not even a physician but $7k - expenses leaves him $2500 disposable?

Middle class has less than $1k disposable and don't live in 1900 sq ft homes... maybe encourage him to volunteer in a homeless shelter to remind himself of how well he, and his family, have it?

Am wondering if $$ is not the issue but family life is?
Click to expand...

Don't tune up your violin just yet. Just because he is a high earner doesn't mean he is living the good life.

$2500 isn't anywhere near his disposable. He still hasn't fed his family, kept the power/water/gas on, put gas in the cars, insurance, disability policy, paid phone bill etc. Vacation or savings account? Lol, that's funny. Better hope nothing expensive breaks in the house.

I'll bet his disposable is less than $500/month after covering cost of living. I'd say that's scraping by. No volunteer experience needed to remind him that there are ones who are worse off. Half the point of his journey through med school and residency was likely to be able to live more comfortably than most, and there's nothing wrong with that. To sacrifice what he has to be where he is for a few hundred bucks left at the end of each month... yeah, I'd be salty about it too.

Income is adequate if he wasn't drowning in debt. I know the pain as my loans are much worse and I'm primary care as well. His wife working may be a break even proposition unless she has skills that can land a high earning job. Child care for 3 kids is pretty rough.

There are definitely better paying primary care gigs out there but may require moving. He could moonlight at urgent care or do something to up his patient volume. If his payor mix is mostly 'caid, that's a problem as well. It's a tough spot for sure.
 
drusso said:
As his employer, what advice would you give him to "cultivate his personal resiliency" and "re-kindle his passion" for patient care.
Click to expand...

Tell him to get on his big boy pants, sell his cars he can't afford, and tell him the key to financial success is in himself and his ability to serve his patients and his family. There is dignity in work, but he reeks of self entitlement. He may feel like he is entitle to more, but he got the loans, he is living above his means, he chose the job, he chose the area. He can also dig himself out.
 
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jsaul said:
and how are they doing? I give them credit for going solo in the big apple. But am curious as to how they are doing financially
Click to expand...

My co-resident has 2 clinics but primary is in chinatown. He has a very specific patient population. I know he makes good money.

PMR doc from my fellowship is a cable news medical expert on TV weekly. I assume she is killing from FB posts it but not certain.
 
FrustratedFamDoc said:
Don't tune up your violin just yet. Just because he is a high earner doesn't mean he is living the good life.

$2500 isn't anywhere near his disposable.
Click to expand...
I was a high income earner, single mom (my choice and then father passed away). My net after taxes, insurance (health, dental) was similar to his. My mortgage was $3200, student loans $800, private school for my son (hoops player went to school focused on that + hockey); after all of that and food for the myriad of great danes, and paying for my parents' help (they nannied for me), I still had about $1000 to spend each month on whatever; I had 2 cars in the driveway (Escalade and FX45 when they first came out) took my son on vacations to foreign lands.

And I whined that I was "always broke" ... but the day my son (then 5) whined about having to sit in "coach" vs. 1st class, the following changes happened:

1. we never flew 1st again (this is back in the old days when upgrades to 1st class were automatic for those with certain miles on that certain airline)
2. HE and I started volunteering every 4th Saturday at our local church food provider/truck thing providing food to the needy
3. HE and I started going to the soup kitchens every month to feed the homeless (my son was 5 at the time going on 6)
4. That continues to this day (over 23 years now)

You know what that taught me?

Didn't really need $120,000+ worth of vehicles in my driveway that only I could drive; didn't need the big fancy house either; didn't need to take the big trips (though, those were for the Olympics and he did have to learn about the geopolitical, history, financial aspect of the countries we attended); didn't need to eat out all the time; and eventually, my then teenage son didn't need to attend private school anymore either

True, it was easier for me to cut fat and waste and live within a different budget because I did not have a spouse and 2 extra kids but I did make choices that made me ever so thankful for the life I'd been given and developed... now as a premed, I'm not worried about being middle class or having to live on less because I've already done so; though, truth be told, I'd rather not wake up with centipedes crawling on me again.

An ex bf of mine was a physician with 30 yrs behind him; 3 kids (all went to med school). He never had the fancy house either, or the big cars or the big debt. He lived frugally and thankfully, his wife had been on board with that (though she might have taken him to the cleaners when he left her). He worked as a teacher at the local med school during fam med stuff, did other stuff (taking call shifts) for a time to help pay off things initially (his student debt) so that eventually, the salt he might have tasted in his 30s was washed away in his 40s.

This guy is what, about 33 or 34? (22 + 7 + 5?) If he were older, say in his 40s, and still had issues like he does, then maybe I'd have some more sympathy but right now? Not so much... and I still have to wonder if his wife isn't part of the discontent.

But what do I know ... 🙂
 
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