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Hi all,
I'm in my last year of fellowship in an outpatient-focused consultant specialty of IM, and should be starting the first attending job search right now about. Trying to figure out my next moves and figured I'd throw it out to the masses aka you lovely people. Apologize in advance for stream of conscious writing
I enjoy the outpatient setting much more than inpatient, and quite honestly don't really want to have to step foot into a hospital ever again (although I will miss my cafeteria meal allowance, but I digress). Also like the idea of autonomy, being able to set my clinic hours and see as many or little patients as I'd like depending on my stage of life. Want to hustle to pay off those loans? No need to moonlight elsewhere, I can just double down on my practice and work some extended hours (assuming the patients come)! That flexibility is very appealing, not to mention running the practice according to vision. Of course, realistically speaking, would likely need to look at multiple provider practices d/t start up costs, etc etc etc, but that's fine, especially w ability to bounce tough cases off each other built in to having partners.
In any case, one thing that's holding me back is the whole PSLF thing. Student loan-wise, I have more than most of ya'll. Chunk of both private from expensive full-sticker price undergrad, and with federal from med school in an expensive city, with the latter being over double the former.
PSLF-wise, to be employed seems to make a lot of sense financially. Only 5 more years of being employed and a the large monkey of federal student loans is off my back. Doing this, would also be incentivized to shelter as many clams away as possible (max 403b, 457, traditional roth). Also have a wife who could qualify as a real estate professional from tax perspective, which as long as we had documentation in order, would allow for the deduction of rental losses from joint tax returns (one could theoretically perform a cost-segregation analysis, and take advantage of bonus depreciation which is set to phase out over the next few years), and theoretically have even more money that could be forgiven at the end of the extra 5 years of PSLF. And then once you leave the 5-year employed position, 457 money can be taken out (albeit taxed as income), but allows for a nice influx of capital that is not age-penalized that was essentially sheltered from PSLF income calculations.
Howeverrr, I then think about the fact that, at the end of those 5 years at an employed position, living on hospital chicken nuggets, will I really want to leave? There's momentum, or lack-thereof which I fear may make me stagnate in an employed position, not practicing how I feel in my gut I truly want to practice. Also, if I was to transition, I'd be out 5 years of having my patient panel, or practice buy-in. Meanwhile, starting private practice now may bring home less in the short term (after accounting for paying full tax-bill, and less incentive to max retirement strategies as opposed to just paying the loans sooner), I do wonder if mid-late stage career if I'd overcome this initial loss due to the general yearly increased productivity in private, ie keeping what I earn as opposed to feeding the hospital admins off my labor, incentivizing me to bust my butt and work longer.
Then I can't help but think, is there some way to get the best of both worlds? Get a low-key employed position (PSLF requires 30 hrs per week), with the rest of the week (including weekends) somehow being spent in a private practice clinic that I'm working to buy partnership in? While hours in private practice would be less, at least the panel's being created, and I can start the buy-in process. Of course, not sure realistically how feasible any of that is. Finding two jobs that would be cool with that would be tough.
Any thoughts? Thinking too much? Prob
Any other last year fellows or last year residents trying to figure this -ish out? What are all of you guys doing?
Am I the only crazy person that hasn't spoken to any recruiters? Have the idea that I may have more bargaining chips on the table if whoever I'm negotiating with doesn't need to pay the recruiter fees too. Good idea / best idea / worst idea ever?
Only spoke to one employed job btw so far, and they said all bonuses are canceled d/t COVID. Is that the trend everywhere? Was that recruiter yanking my chain? What are all of you guys hearing??
Tldr; a last year fellow regurgitating scattered thoughts re job search. Nothing that interesting, recommend an alternative thread
I'm in my last year of fellowship in an outpatient-focused consultant specialty of IM, and should be starting the first attending job search right now about. Trying to figure out my next moves and figured I'd throw it out to the masses aka you lovely people. Apologize in advance for stream of conscious writing
I enjoy the outpatient setting much more than inpatient, and quite honestly don't really want to have to step foot into a hospital ever again (although I will miss my cafeteria meal allowance, but I digress). Also like the idea of autonomy, being able to set my clinic hours and see as many or little patients as I'd like depending on my stage of life. Want to hustle to pay off those loans? No need to moonlight elsewhere, I can just double down on my practice and work some extended hours (assuming the patients come)! That flexibility is very appealing, not to mention running the practice according to vision. Of course, realistically speaking, would likely need to look at multiple provider practices d/t start up costs, etc etc etc, but that's fine, especially w ability to bounce tough cases off each other built in to having partners.
In any case, one thing that's holding me back is the whole PSLF thing. Student loan-wise, I have more than most of ya'll. Chunk of both private from expensive full-sticker price undergrad, and with federal from med school in an expensive city, with the latter being over double the former.
PSLF-wise, to be employed seems to make a lot of sense financially. Only 5 more years of being employed and a the large monkey of federal student loans is off my back. Doing this, would also be incentivized to shelter as many clams away as possible (max 403b, 457, traditional roth). Also have a wife who could qualify as a real estate professional from tax perspective, which as long as we had documentation in order, would allow for the deduction of rental losses from joint tax returns (one could theoretically perform a cost-segregation analysis, and take advantage of bonus depreciation which is set to phase out over the next few years), and theoretically have even more money that could be forgiven at the end of the extra 5 years of PSLF. And then once you leave the 5-year employed position, 457 money can be taken out (albeit taxed as income), but allows for a nice influx of capital that is not age-penalized that was essentially sheltered from PSLF income calculations.
Howeverrr, I then think about the fact that, at the end of those 5 years at an employed position, living on hospital chicken nuggets, will I really want to leave? There's momentum, or lack-thereof which I fear may make me stagnate in an employed position, not practicing how I feel in my gut I truly want to practice. Also, if I was to transition, I'd be out 5 years of having my patient panel, or practice buy-in. Meanwhile, starting private practice now may bring home less in the short term (after accounting for paying full tax-bill, and less incentive to max retirement strategies as opposed to just paying the loans sooner), I do wonder if mid-late stage career if I'd overcome this initial loss due to the general yearly increased productivity in private, ie keeping what I earn as opposed to feeding the hospital admins off my labor, incentivizing me to bust my butt and work longer.
Then I can't help but think, is there some way to get the best of both worlds? Get a low-key employed position (PSLF requires 30 hrs per week), with the rest of the week (including weekends) somehow being spent in a private practice clinic that I'm working to buy partnership in? While hours in private practice would be less, at least the panel's being created, and I can start the buy-in process. Of course, not sure realistically how feasible any of that is. Finding two jobs that would be cool with that would be tough.
Any thoughts? Thinking too much? Prob
Any other last year fellows or last year residents trying to figure this -ish out? What are all of you guys doing?
Am I the only crazy person that hasn't spoken to any recruiters? Have the idea that I may have more bargaining chips on the table if whoever I'm negotiating with doesn't need to pay the recruiter fees too. Good idea / best idea / worst idea ever?
Only spoke to one employed job btw so far, and they said all bonuses are canceled d/t COVID. Is that the trend everywhere? Was that recruiter yanking my chain? What are all of you guys hearing??
Tldr; a last year fellow regurgitating scattered thoughts re job search. Nothing that interesting, recommend an alternative thread